Homicide and Interpersonal Violence

To prevent homicide, it is essential to look at the etiology of interpersonal violence. According to Bukoff, at least half of all homicides occur among family and persons acquainted with the victim.⁷ (#715) Risk factors for homicide among "intimates" (husband/wife, boyfriend/girlfriend) include prior wife abuse and dating violence; therefore, education programs for high school students aimed at relationships without violence could be especially beneficial, says Jacquelyn Campbell of Wayne State University.

It also is important to note that the majority of murders, regardless of the sex or race of the victim, are committed by men. (#402) Several testifiers underline the lack of self-esteem, sense of social uselessness, or feelings of alienation that may influence aggressive or violent tendencies in individuals, especially young males. The homicide toll is especially great in minority communities, according to Carl Bell, Executive Director of the Community Mental Health Center (CMHC) in Chicago. (#018)

Bell describes homicide and interpersonal violence intervention strategies that have been implemented in a poor, Black Chicago community. The overall plan is to provide primary, secondary, and tertiary prevention programs to the community. Key elements are (1) to publicize and provide education on the causes of homicide and violence and how to cope with stress and violence, and (2) to get the medical community involved in recognizing and stopping cycles of violence.

Myths, ethnic tensions, and ignorance of homicide dynamics must be overcome, according to Bell. In CMHC's community, the task of clarifying the reality of homicide dynamics was undertaken through several steps: developing a series of radio talk shows on the facts and fables of homicide, distributing several thousand T-shirts with a slogan to "Stop Black-on-Black Murder," and persuading the staff of a local hospital emergency room to wear these T-shirts to awaken their coworkers to the possibilities of intervention. Other primary prevention resources have been used to redirect activities of young men, such as a karate class that Bell teaches which, he feels, "has done more to constructively influence the lives of young Black males away from violent tendencies" than has his work as a psychotherapist. (#018)

The importance of drug traffic-related violence was brought up by the Public Health Education Section of the American Public Health Association. Using the recent Washington, D.C., experience of 100 drug-related murders in just four months as an illustration of the magnitude of the problem, the group suggests a year 2000 objective "that addresses a reduction in violent drug-related deaths and injuries." (#616)

Primary prevention of homicide must strive to establish positive value systems in community members, testifiers say. Youth gangs, for instance, give social cohesiveness to young men, but accept murder and violence as appropriate ways to resolve conflict. These gangs, says Nancy Allen of the UCLA Neuropsychiatric Hospital, should be targeted for homicide reduction activities. (#240) The Los Angeles Gang Violence Reduction Project, for example, employs gang member consultants who are respected members of youth gangs in their communities to intervene in potentially dangerous situations to prevent escalation. ⁸ (#240) Jeff Roth of the National Research Council suggests, however, that ideally interventions need to begin long before the ages of gang membership: with nutrition and parent training for expectant mothers during the prenatal period, and continuing through preschool with parental bonding; social learning about how to deal with frustrating situations nonaggressively; Head Start; etc. (#785)

In addition to the psychosocial strategies useful to communities, testifiers believe that handgun control legislation could significantly reduce homicide rates. "United States citizens are the most heavily armed in the world," says Allen. A great danger with private ownership, she warns, is that gun owners are often unfamiliar with their weapons and sometimes kill unintended victims, usually family members. (#240) Steven Macdonald of the University of Washington says that an enraged person with a gun is much more likely to kill someone than an enraged person who lacks ready access to a firearm. (#322) However, given the reality of current gun ownership, Bukoff calls the 1990 objective to reduce the number of privately owned handguns by 25 percent "naive" and Carl Bell calls it "idealistic." Instead Bell asks for a "major media effort to encourage handgun owners to unload their readily available deadly weapons," and Bukoff advocates outlawing plastic handguns in all 50 states. (#018; #715)

Suicide

Adolescent suicide rates have nearly tripled in three decades, says Martha Medrano of the University of Texas Health Science Center at San Antonio.⁹ (#500) Among Native American communities, adolescent suicide already has become a local health priority.

According to Tom Barrett of the Center for Psychological Growth in Denver, American youth are finding it difficult to cope with the pressures of growing up in a rapidly changing society. (#702) Stress and substance abuse are widely prevalent and are two of the leading factors in adolescent suicide. Donna Gaffney of Columbia University emphasizes that it is not one particular stress that emerges as a significant correlate of suicidal behavior but rather "an entire constellation of life stresses that differ in severity from non-suicidal children." (#731) Adults must 'create a less threatening and more supportive setting for youth, one with less social isolation, despair, and depression" in order to prevent suicide and other intentional injuries, says Michael Greenberg of Rutgers University. (#537)

Damien Martin of the Hetrick-Martin Institute in New York says that reducing communication barriers is especially vital in preventing suicide among adolescent homosexuals. Many of these adolescents have no cognitive, emotional, or social role models. Many are afraid to admit their homosexuality for fear of rejection. Educational interventions in the school, counseling for those who have attempted suicide, and research into the reasons for suicide, should all include "the possibility of social and psychological factors related to the stigmatization of homosexuality as contributing to teenage suicide." (#466)

Education against suicide must take place in the schools and in the community, argues Medrano. Stress-coping and communication skills need to be taught. Teacher strategies should include "breaking the taboo of keeping a suicide secret, especially for the students themselves." (#500) In the community, health professionals need to be informed of the signs of suicidal behavior, how to deal with them, and where to refer potential suicidal individuals. Because drug and alcohol abuse also are related to suicide among adolescents, intervention programs in these areas should include a component of suicide intervention, according to Barrett. (#702)

The media need to be made aware of what factors increase the "contagious" phenomenon of suicide and what factors decrease this effect. (#500) To do this, greater understanding of the role of the media in so-called copycat suicides is required, says Greenberg. For example, did the media coverage of recent widely publicized teen suicides increase the likelihood of similar incidents, or did it reduce them by conveying calming messages? (#537) Although Lou Large of Houston believes that television has the potential for "improving the physical, emotional, and intellectual health of this nation," she also says it can contribute to violent behavior, especially among young children. Large proposes objectives for the year 2000 to reduce violence in children's programming and during hours when children watch television, along with a campaign to educate parents and children about appropriate selective viewing for youngsters. (#304)

After a suicide has occurred, schools and communities must move quickly to prevent other suicides, according to Medrano. This involves "assisting students, staff, and parents to ventilate feelings of grief, guilt, rejection, and anger" produced by the suicide. (#500)

Meyer Moldeven of Del Mar, California, says that volunteer training is an important component of successful suicide interventions for all ages: "A community's suicide intervention and prevention resources—of which the suicide prevention center, crisis center, and 'hotline' are elements—depend to an enormous degree on local paraprofessionals and trained volunteers." In the workplace, employers already provide programs for stress management, as well as cardiopulmonary resuscitation and first-aid training. Thus, "why not a lay worker on the job site who is trained to function in an emergency suicide intervention?" asks Moldeven. The United States Army and Navy already have established formal suicide prevention programs, and the groundwork laid can be used to tailor programs for other employers. (#602)

Family Violence

Millions of people a year are affected by family violence, and the majority are women and children. A history of abuse, early parenthood, low socioeconomic status, and poor coping skills for stress—all can produce aggression and violent conflict resolution within households. Children of battered mothers also are at high risk for stress-related physical problems, as well as behavioral and developmental problems, and show a propensity for family violence in adulthood, especially if male, according to Jacquelyn Campbell. (#402) David Besaw, representing the Wisconsin Tribal Health Directors, says that most domestic violence in Native American populations occurs under the influence of alcohol or other drug abuse. (#514) The single biggest correlate of interpersonal violence, say witnesses, is poverty. (#420; #715) According to Bukoff, reductions in poverty would improve our ability to prevent violence. (#715)

The community, especially health professionals, can intervene in domestic violence by recognizing perpetrators and victims. Emergency rooms could screen for victims of abuse, and alcohol and drug abuse programs could screen for violence, as well as provide stress-coping techniques. One such model emergency room program has been established at Rush-Presbyterian-St. Luke's Medical Center in Chicago. (#402) Community programs involving health professionals, in tandem with criminal justice efforts, could effectively change the nature of conflict resolution and childrearing in many communities. (#293)

Implementation

One hindrance to the development of prevention programs, especially primary interventions, is inappropriate assessment of the level of injury and the cost to families and society. Klingbeil refers to confusion about definitions, terminologies, classifications, and psychologies: ''If we can't count it it doesn't exist.'' (#697) In addition, "we don't even know what the cost of these injuries are," says Bukoff. "We don't have good methods yet of estimating the health costs, economic costs, in terms of days of work lost, etc." (#715)

Clinical protocols for the prediction, assessment, and diagnosis of various forms of family violence, and better definitions of family violence nationwide will permit better reporting and provide better statistical evaluation, according to Klingbeil. (#697) Hwalek offers an example of a definition of abuse for one population, the elderly, that consists of six distinguishable categories: physical abuse, physical neglect, psychological abuse, psychological neglect, material abuse (exploitation), and violation of personal rights. "Each component of this comprehensive definition of elder abuse can be related to important health implications," she says. (#403)

Several testifiers encouraged the establishment of a national center for the study and prevention of homicide. It would, among other things, coordinate and fund research projects on homicide; promote the use of standardized reporting methods and records; establish a state and national homicide registry; coordinate homicide information and education; assist communities in establishing homicide prevention services; coordinate and develop restitution and victim-assistance programs; and develop hypotheses and theories regarding perpetrators and victims. (#240) Other suggestions for more and better data collection and surveillance included a comprehensive data capability to monitor and evaluate the status and impact of substance abuse on criminal behavior because of the "links known to exist" between the two (#093) ; more information about external causes and circumstances surrounding injuries, particularly internal injuries (#715); the establishment of trauma registries in all states (#108); and the use of E-codes (external cause of injury codes) in hospitals (#322; (#334).

References

1.

Centers for Disease Control: Homicide Surveillance, High-Risk Racial and Ethnic Minorities. Draft report. Atlanta: 1986. [PubMed: 3114613]

2.

National Center for Health Statistics: Health United States, 1987 (DHHS Publication No. [PHS] 88-1232), 1988.

3.

Amler RW, editor; , Dull HB, editor. (Eds.): Closing the Gap: The Burden of Unnecessary Illness. New York: Oxford University Press, 1987.

4.

Flanagan TJ, editor; , Jamieson KM, editor. (Eds.): Sourcebook of Criminal Justice Statistics, 1987. U.S. Department of Justice. Bureau of Justice Statistics; Publication No. NJC-111612, 1988.

5.

Barancik JI, Chatterjee BF, Greene YC, et al.: Northeastern Ohio trauma study: I. Magnitude of the problem. Am J Pub Health 73(7):746-751, 1983. [PMC free article: PMC1650900] [PubMed: 6859356]

6.

U.S. Department of Health and Human Services: Surgeon General's Workshop on Violence and Public Health: A Report (DHHS Publication No. [HRS-D-MC]86-1), 1986.

7.

Federal Bureau of Investigation: Uniform Crime Reports for the U.S., 1987.

8.

Allen NH: Homicide Perspectives on Prevention. New York: Human Sciences Press, 1980.

9.

National Center for Health Statistics: op. cit., reference 2.

10.

Straus MA, Gelles R J: Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. J Marriage Family 48(3):465-479, 1986.

11.

Hotaling G, Sugarman D: An analysis of risk markers in husband to wife violence: The current state of knowledge. Violence and Victims 1(2):101-124, 1986. [PubMed: 3154143]

12.

Straus MA, Gelles RJ: op. cit., reference 10.

13.

University of California at Los Angeles, Centers for Disease Control: The Epidemiology of Homicide in the City of Los Angeles, 1970-1979. U.S. Department of Health and Human Services, August 1985.

Testifiers Cited in Chapter 16

018 Bell, Carl; Community Mental Health Council (Chicago)

093 Heckmann, Glenn; Texas Board of Pardons and Paroles

094 Helton, Anne; Bellaire, Texas

108 Jarrett, Michael; South Carolina Department of Health and Environmental Control

240 Allen, Nancy; University of California, Los Angeles

293 Justice, Blair; University of Texas Health Science Center at Houston

304 Large, Lou; La Porte Independent School District (Texas)

310 McFarlane, Judith; Texas Woman's University

322 Macdonald, Steven; University of Washington

334 Rivara, Frederick; Harborview Injury Prevention and Research Center (Seattle)

402 Campbell, Jacquelyn; Wayne State University

403 Hwalek, Melanie; SPEC Associates (Detroit)

420 Drake, Patience; Michigan Department of Management and Budget, and Dolsen, Robert; Statewide Health Coordinating Council

466 Martin, A. Damien; Hetrick-Martin Institute (New York)

500 Medrano, Martha; University of Texas Health Science Center at San Antonio

514 Besaw, David; Wisconsin Tribal Health Directors

537 Greenberg, Michael; Rutgers University

602 Moldeven, Meyer; Del Mar, California

616 Windle, Anne; American Public Health Association, Public Health Education Section

697 Klingbeil, Karil; University of Washington

702 Barrett, Tom; Center for Psychological Growth (Denver)

715 Bukoff, Allen; Wayne State University

731 Gaffney, Donna; Columbia University

748 Russ, Blanche; Parent-Child, Inc. (San Antonio)

785 Roth, Jeff; National Research Council