Introduction

Youth violence has become one of the most serious public health problems in the United States. This chapter presents an overview of the public health approach to preventing violent behaviors and to reducing the death and injuries that result from violence. This chapter reviews the nature and scope of the problem, emphasizing why violence constitutes a public health problem and how the tools of public health can be effectively brought to bear on the design, implementation, and evaluation of meaningful school- and community-based interventions. Risk factors important in the incidence and severity of youth violence are considered, with special focus on those that emerge when the problems associated with youth violence are approached using the public health model. Finally, this chapter concludes with a discussion of the serious social, economic, and public policy challenges to the implementation of a public health approach to violence reduction, as well as a proposal for an agenda for the future of public health research in this important area.

Framing the Issue: What Is Violence?

In Chapter 1 of this volume, the editors offer a definition of violence as “the threat or use of physical force with the intention of causing physical injury, damage, or intimidation of another person.” This definition will serve as the foundation for this chapter. Intentionality is at the heart of this definition, and distinguishes injuries inflicted with intent to harm from injuries that are truly unintentional and result from accidents such as motor vehicle mishaps, falls, poisonings, drownings, fires, and burns. The distinction is an important one. While all injuries combined are the leading cause of death among children and adolescents in the United States, intention violence, alone, accounts for one-third of all injury deaths. It should be noted there is some overlap in the antecedents of intentional and nonintentional violence; impulsivity, for example, appears to be associated with both forms of violence, as are many aggressive and drug-related behaviors. The underlying configuration of causes of intentional violence, however, is quite different than that of unintentional violence. Thus intentional violence is reduced and prevented through different interventions.