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Violence as a Public Health Problem

By Elaine Cassel

Almost 16 million adolescents --including 70% to 95% of children in inner cities -- have witnessed some form of violent assault, including robbery, stabbing, shooting, murder, or domestic abuse, according to a report released December 12, 2000 by the Commission for the Prevention of Youth Violence, a coalition of ten medical, nursing, and public health organizations, including the American Medical Association.

In 1933, 75% of deaths among youths 15 to 19 years old were from natural causes. Sixty years later, 80% of deaths in this age group were the result of homicide and unintentional injury, most of them committed by people younger than 18.

To help combat what the Commission sees as an increasingly alarming attack on public heath and safety, the Commission calls for the following initiatives:
  • support for the development of healthy families and the promotion of healthy communities
  • enhanced services for early identification and intervention for children, youth, and families at risk of violence or violent behavior
  • increased access to health care and mental health care services
  • reduced access to and risk from firearms for children and youth
  • national advocacy for necessary research, public policy, legislation, and funding
  • reduced exposure to violence in the media
The Commission calls on health care professionals--the people who repair the gunshot wounds, pronounce victims dead, bind the physical wounds of abused children and intimate partners, and treat the psychological and substance-related conditions of victims of violence--to make violence screening, prevention, and intervention an integral part of their professional practice.

The American Medical Association has urged its members to be attuned to warning signs of child abuse, intimate partner violence, and substance abuse, and to refer patients for counseling and other interventions. Some physicians are providing information packets on violence in their waiting and treatment rooms and are using electronic self-screening assessments. Doctors believe that patients more freely admit problems in an electronic survey than they do in a face-to-face screening.

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