April 8-12 is National Youth Violence Prevention Week. According to the U.S. Centers for Disease Control and Prevention, youth violence is a leading cause of death for young people and results in more than 500,000 nonfatal injuries each year.
Iris Wagman Borowsky, M.D., Ph.D., with the University of Minnesota Medical School, answers questions on the prevalence of youth violence in the United States and options for intervention to reduce and prevent violence among young people.
Q: What is the magnitude of the problem of youth violence?
Dr. Borowsky: Youth violence, firearm violence in particular, is a public health emergency. It is a familiar refrain when we hear the trinity of mortality sources for adolescents and young adults in America: unintentional injury, suicide and homicide. The most recent mortality data in 2017 from the Centers for Disease Control and Prevention's National Vital Statistics Report shows that each day in the U.S. an average of 16 children, ages 19 and younger, die from intentional injuries. This number represents eight homicides and eight suicides. That’s a whole classroom full of children lost every couple of days in this country to violence. Most of these deaths involve firearms.
We also know that the overall rates don’t tell the whole story, because — when we look at the data on violence-related injury — there are wide gender and racial/ethnic variations for youth. Rates of homicide, suicide and firearm-related deaths are many fold greater in male as compared to female adolescents. African American youth are most affected by homicides and firearm-related deaths, and rates of suicide are highest among American Indian youth.
Q: What increases the likelihood of youth involvement in violence?
Dr. Borowsky: There are many factors associated with youth violence involvement, including at the individual level and within the multiple contexts in which young people live — their families, peers, schools and communities. Some of the risk factors include previous violent behaviors, violence victimization, substance use, depression, school failure, family violence, overly harsh and inconsistent discipline, poverty, involvement in antisocial groups like gangs, exposure to neighborhood violence, availability and legal access to firearms, our societal culture and history of violence, and media violence. Bottom line — violence is a preventable problem, because injuries, including violent ones, do not occur randomly, but rather in predictable patterns determined by recognizable risk factors and buffered by protective factors that can be strengthened.
Q: What are some of the factors that protect youth from involvement in violence?
Dr. Borowsky: Fortunately, we have identified many factors that buffer and protect young people against adverse health outcomes, including violence. Some of those protective factors are high academic achievement and educational aspirations, emotional health, parent and family caring and connectedness, parental monitoring and supervision, positive discipline methods, and connectedness to school and to adults in the community.
Across cultures and economic circumstances, research shows that children and teens raised in homes characterized by authoritative parenting fare the best in terms of psychosocial development, mental health, social competence, academic performance and avoidance of problem behaviors. Authoritative parents are warm and involved, and also firm and consistent, in establishing and enforcing limits, guidelines and appropriate expectations. School connectedness means perceived closeness to people at school, perceived teacher caring, feeling part of your school, feeling happy at school, believing that teachers treat students fairly, and feeling safe at school. School connectedness, like family connectedness, has been found to be protective against almost every health-risk behavior among youth.
Q: What is effective in preventing youth violence?
Dr. Borowsky: Violent injuries result from a chain of circumstances and therefore present multiple opportunities for prevention along that chain. A combination of strategies used together, addressing both risk and protective factors, is likely to be most successful in preventing youth violence. I will highlight two key prevention strategies that we know are effective. First, family-level interventions are among the most promising youth violence prevention approaches known to date. Many randomized controlled studies have demonstrated the effectiveness of parenting education programs in improving parenting skills and family cohesion, and reducing behavioral problems, violent behavior, and substance use among children and adolescents.
Second, studies comparing rates of violence in cities with different firearm legislation have identified gun availability as a critical factor associated with firearm-related violence. Guns are more likely to kill than any other weapon used in an assault. When we prevent firearm injuries with stronger gun laws to keep children safe, violent events will still occur, but the severity of the injuries will be greatly reduced.
Q: How are you working to reduce and prevent youth violence?
Dr. Borowsky: Our research in the Division of General Pediatrics and Adolescent Health focuses on improving health outcomes and reducing health-risk behaviors, including violence and bullying, among youth, particularly those from underserved and vulnerable communities. My academic focus in the area of youth violence prevention stems from the public health significance of the problem as well as the patients and families for whom I care. Our work developing, implementing, and evaluating violence prevention strategies in the health care setting and disseminating youth violence prevention best practices includes what I call “Minnesota Best Bets.” It is a handful of practices that are both feasible in the clinical setting and worth health care professionals’ time because they are each supported by evidence that they can make a difference in reducing violence involvement among youth. The five recommendations with a locally inspired mnemonic, LAKES, are to:
Lower media exposure
Address behavior and mood (screening for, assessing, and managing mental health problems in children and youth that we know largely go un-noticed and un-heeded in primary health care settings)
Key adults (pay attention to key adults in children’s lives and refer families to mentoring programs for their child when appropriate)
Education and support for parenting (this means referring parents to parenting education programs and home visitation programs to extend what we are able to do in the office setting)
Safe firearm storage (counsel gun-owning families about four evidence-based practices to follow: store firearms locked and unloaded, store ammunition locked and separate from firearms).
Dr. Iris Wagman Borowsky is a professor of pediatrics and director of the Division of General Pediatrics and Adolescent Health at the University of Minnesota Medical School. As a clinician, educator, and researcher, she studies risk and protective factors for involvement in self-directed and interpersonal violence among youth and development of effective violence prevention strategies.
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