The Public Health Model for Violence Prevention: A Partnership in Medicine and Education

Abstract

Child abuse, domestic violence, and interpersonal/community violence are leading causes of injury and death for specific gender and racial sectors of the U.S. population, especially young ethnic minority males. Responses to this public health issue have brought together leaders in medicine and education in the design of interventive curricula and programs for classrooms and communities. Health providers have played a nontraditional role in the design and implementation of some of these initiatives. This article reviews some of the interdisciplinary collaborative strategies that have been offered and presents evaluative commentary on the success and challenges of this new partnership. INTRODUCTION Historically, practitioners in the field of medicine have focused on disease-oriented prevention and treatment strategies, with an emphasis on infectious diseases and on the reduction of morbidity and mortality related to these diseases. Within the past 10 years, however, professionals involved in and concerned with the health of adolescents have responded to a burgeoning amount of data that demonstrates the overwhelming effect of behaviorally related health conditions on this population. Today, along with promoting healthful diet, physical activity, and oral health, health practitioners have begun to address substance abuse, the consequences of early unprotected sexual activity, and mental health, violence, and safety issues as the foci of health promotion and prevention activities. These activities range from community-based initiatives to individual approaches, and involve a diverse set of participants-from the traditional physicians, nurses, and social workers, to educational and school-based professionals, juvenile justice workers, and policymakers, to name just a few. The interaction of these participants has been promoted through funded research initiatives and advocacy forums. Though the results of such collaborations have yet to be fully analyzed, their cumulative effect has been to bring together professionals across disciplines in a heretofore uncharacteristic way, fueled by an urgency to secure the health and productivity of the future generation of adults. Causes of injury and death during adolescence vary considerably based on gender and race/ethnicity. The additional consideration of socioeconomic status as a factor in injury and death rates, although suggested as a variable of significance in smaller studies, is not supported by national data analysis. Violence and injuries related to violence are more prevalent in the African American adolescent population, and even more prevalent among African American males. For example, motor vehicle accidents (MVAs) are the prime cause of death in the total population of 10- to 19-year-olds. However, 15- to 19year-old African American males are almost five times more likely to die from homicide than MVAs, and Black females in this age group are about one-and-a-half times more likely to meet the former than the latter fate. Fifteen- to 19-year-old African American males are eight-and-a-half times more likely than their White male age-peers to die from homicide, and African American females aged 15 to 19 are almost four times more likely than White females of the same age to die in this manner (U.S. Department of Health and Human Services, 1996). The morbidity or nonfatal injuries sustained from violent acts is less accurately documented, but estimates suggest that for every fatality, there are at least 100 nonfatal assaults (Cohall & Cohall, 1995). Although adolescents are not characteristically the age group that comes to mind in consideration of child abuse, adolescents make up one-quarter of the reported child abuse and neglect cases in the United States. Children under five years of age and teenagers are the most likely victims of physical abuse that causes injury (Harrington & Dubowitz, 1995). As Table I shows, the National Health Objectives for the Year 2000 incorporate specific targeted objectives for children and adolescents related to violence and child abuse. …