Violent Behavior

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Chapter 107 Violent Behavior

The World Health Organization (WHO) recognizes violence as a leading worldwide public health problem and defines violence as “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychologic harm, maldevelopment or deprivation” (Chapter 36). Youths may be perpetrators of violence, victims of violence, or observers of violence with varying severity of impact on the individual, family, or larger community. A number of risk factors have been identified that may increase the risk of a youth to engage in violence such as poverty, substance abuse, mental health disorders, and poor family functioning.

Epidemiology

In 2006, homicide in the USA was the second leading cause of death for 10-24 yr olds totaling 5,958 deaths, which were largely males (87%) killed by a handgun (84%) in a gang-related incident (Table 107-1). The WHO reports that other than the USA, where the youth and young adult homicide rate was 11 per 100,000, most countries with homicide rates above 10 per 100,000 are developing nations or countries with rapid socioeconomic changes. However, while rates of violent deaths among adolescents are higher in the USA compared to other developed countries, rates are increasing; in Israel, France, and Norway, firearms are the second leading mechanism of death in 15-24 yr olds. Although the prevalence of behaviors that contribute to violence has decreased from 1991 to 2007, fighting and weapon carrying remain prevalent among U.S. youth (Table 107-2). In 2007, 668,000 youths were treated in U.S. emergency departments for violence-related injuries such as stab wounds, gunshot wounds, broken bones, and lacerations. The rate of homicide by handgun is considerably higher than homicide by other weapon type, suggesting that access to firearms may play a major role in youth injuries and deaths (Fig. 107-1). A cross-sectional, nationally representative survey of ~21,000 youth at ages 11.5, 13.5, and 15.5 yr in 5 countries (Ireland, Israel, Portugal, Sweden, and the USA) revealed that the rates of fighting, weapon carrying, and fighting injury were similar among the countries while bullying frequency varied widely, from 15% in Sweden to 43% in Israel (Table 107-3).

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Figure 107-1 Number of victims of homicides by weapon type, 1976-2005.

(From U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics: Homicide trends in the U.S. www.ojp.usdoj.gov/bjs/homicide/teens.htm. Accessed June 2009.)

Violence at schools in the USA and elsewhere remains a significant problem with 12.4% of students reported being in a fight on school property in the preceding 30 days. The 2007 Youth Risk Behavior Surveillance System reported 18% youths overall carried a weapon such as a gun, knife, or club in the last 30 days; 6% carried the weapon to school; and 8% reported being threatened or injured with a type of weapon on school property. Males are more likely than females to carry a gun or weapon and therefore may need increased monitoring at home and at school. Physical fighting remains prevalent at schools; 12.4% of students report having been in a physical fight on school property in the preceding 12 mo. These violence-related behaviors at school affect the students’ perception of safety. Five percent of students did not go to school on 1 or more days in the preceding 30 days because they felt it unsafe at school. Dating violence (having been hit, slapped, or physically hurt intentionally by a boyfriend or girlfriend) is reported by 9.9% of students, with highest prevalence rates seen in African-American students (14.2%) and older students (10.6%, 11th graders; 12.1%, 12th graders). School-based prevention programs initiated at the elementary school level have been found to decrease violent behaviors in students. Increased surveillance of students is warranted both on and around school property to improve student safety.

Advancements of technology are being used by youths as a vehicle to inflict aggression of a different nature. The Centers for Disease Control and Prevention (CDC) defines electronic aggression as any type of harassment or bullying (teasing, telling lies, making fun of someone, making rude or mean comments, spreading rumors, or making threatening or aggressive comments) that occurs through e-mail, chat rooms, instant messaging, blogs, test messaging or videos or photos posted on a website or sent via cell phone (Chapter 36.1). In 2005, 9% of youth surveyed reported being a victim of online harassment via instant messaging (67%), e-mail (24%), and text messages (15%). Of the youth surveyed, 7-14% reported being both a victim and a perpetrator, suggesting that there is a related behavioral link between the 2 roles.

Parents can provide the primary prevention with filters on the home computer, increased monitoring of their teen’s use of electronic interactions, and setting limits on texting and instant messaging. Many schools have established cyber-bullying policies and are increasingly involved with teaching youth about guidelines for appropriate online interactions, and monitoring for cyber-bullying problems. About 12 states have enacted legislation that allows schools to take action in response to electronic aggression or cyber-bullying against a student, whether it takes place on or off school grounds.