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Violence in the African-American Community
as a Public Health Issue
Annotated Bibliography

Kimberly Chipman, RN
2nd Year Law Student
The University of Dayton School of Law
Fall 1998


Violence is the number one killer of children between the ages of 15-24. In 1989, the FBI released statistics that 21,500 people died as the victims of homicides. That translates into a homicide rate of 8.7 per 100,000 population. The homicide rate for young males ages 15-24 is 21.9 per 100,000. The homicide rate for young black males in this age category is 85.6 per 100,000! The overall homicide rate for young males in the United States was between 4 and 73 times higher than the homicide rate for young males in any other industrialized nation. Firearms were used in three-quarters of the homicides in the United States. The top five "lethal" cities in the United States are Detroit, Washington, D.C., Dallas, Jacksonville, and Baltimore. William Julius Wilson at the University of Chicago established that homicide rates soar in neighborhoods where men have no jobs, children are raised without fathers, and social institutions are in disarray. The correlation between poverty and violence is a well-established factor in social science literature. Being poor in America means living in a devastated, crime-ridden neighborhood. It often means growing up in a family without a father and going to schools where most students fail.

The above statistics verify and demand that violence has become epidemic and a major public health issue. There is not one strategy alone that can combat the problem of violence. It is proven that violence is more prevalent in the African-American community, yet one national program alone can not combat the issues that provoke and entice aggressive behavior. The stimulus and factors that pre-dispose African-Americans to violence may not be the same factors that initiate violent behavior in whites. Social scientists have demonstrated that racial segregation, racism, social isolation, drug and alcohol consumption, and media violence all contribute to the likelihood of aggressive, violent behavior. Most social scientists and physical scientists agree that a program to attack violence must include strong, multi-disciplinary approaches. It is interesting to note that even though the above factors pre-dispose the incidence of violence, treatment of violence can not segregate these issues into paradigms of racial bias that only serve to further divide communities. A balanced mix of social science, physical science, and the law must come together and utilize this information to demand a unified, yet individuous approach. To change violent behaviors, the program must address inner-city poverty and the other social ills that accompany poverty. Poverty, like a disease, has been passed from generation to generation. Most sociologists agree that we have created a "socio-economic underclass" that often feels destined to fail before they attempt to succeed. Not until the legislative powers can unite with the above noted scientific groups will this strategy be effective. Not one discipline alone can attack the years of social demise that has left many Americans destitute with feelings of hopelessness and powerlessness. Our criminal justice system is built on a system of deterrence, but with our prisons overflowing, it seems obvious that the deterrent of imprisonment may only be safe shelter and regular meals to some. 

Many young men of color suffer from "Black self-hatred." This is not genetically induced, but results from years of conditioning in the social environment. Many of these young men are growing up without fathers or significant role models. They seek and learn behavior from television and movies. It only seems just that this teenager will consider carrying a gun when he has identified with Bruce Willis in any of the many "Die Hard" movie plots. This factor combined with constant confrontations with police only seems to solidify to this young black man that he is "bad." Police often react by treating all young black males "the same." The general assumption is that if they are on the streets, they are planning a crime or looking to "gang-bang." Everyone is aware that every teenager who is seeking independence feels a strong sense of adult ambivalence. Therefore, many of these teens see any intervention by the police as harassment and excessive. The reality is that these young men have been forced to "raise" themselves as many have no fathers and their mothers may be forced to work two minimum wage jobs just to feed and cloth them. Without appropriate role models, they seek the advice and support of friends. This may lead them to participate in risk taking behavior but often just places them in "the wrong place at the wrong time." Many of these young men also carry weapons because their inner-city neighborhoods are overridden with gangs and drug dealers. Owning a gun places them at higher risk to be shot with their own gun or to commit suicide when the feelings of destitution become overwhelming.

The program against violence has to originate from a multi-disciplinary approach. There must be community support financially, spiritually, and physically. This must include parental involvement, religious involvement, and strong support from educators. Community focus groups and forums will delineate the problem at the source it is arising. Not every issue of violence is the same from one neighborhood to the next. Once this objective has been met, an aggressive program focusing on conflict resolution and self-esteem building must be instituted. This program ideally needs to be initiated in the young, elementary student. Most scientists agree that cognitive and behavioral patterns become very well defined by the adolescent years. This is not disregarding the teenager, but an effective violence prevention strategy should work like the "public health model" and address the primary issue of prevention before the problem has been identified. More aggressive strategies of conflict resolution and self-esteem building should be instituted at the adolescent level. This approach must include mentoring programs so that fatherless young men can have role models that are supportive and exemplify African-American adult survivors. 

The school system, the physicianís office, the emergency rooms, the court system all must work together to identify these young people at risk. There must be strong interdisciplinary support and referral capability. Each discipline must work together for the common goal of eradicating violence. There must not be any issues of "control" or "power struggles" as each can identify the common denominator. These same groups should lobby together to direct the nation at effective legislation towards reducing violence. There is little possibility of reversing the Second Amendment "right to bear arms," however, there needs to be a coalition with the above named entities, the NRA, and gun manufacturers to guarantee every persons right to "safety in the presence of firearms!" Many gun manufacturers are working at gun grips that "learn" the palm pattern/finger imprints of the owner. This affords a higher probability that the owner is the only person that can fire that weapon. Mandating this type of standard along with continued free distribution of gun locks and education to prior gun owners may help to decrease the incidence of accidental or "heat of passion" type killings. 

The most aggressive approach to eradicating violence has to surround the eradication of racism and social inequity. Legislatures must continue to aggressively attack any "hate crimes" and fully prosecute any action that may be construed to be racial in nature. The general population must be educated regarding the existence of social inequality and racism that still exists in the United States. The beginning of this should include that even though statistics indicate that blacks are more prone to homicides and living with violent crime, that pattern is not based on genetically pioneered factors, but the mere condition that chronic poverty and powerlessness experienced by most African-Americans. The general public still believes that affirmative action is a plot to unjustly deprive white people of jobs!

There are many existing programs dealing with issues of violence. I do not feel that there is a need to eliminate these, as some are very effective. However, there needs to be an aggressive, national approach to this epidemic that sees no political barriers. Many of these programs are institute driven and in the competitive nature of todayís health care market, the chief objective seems to be lost. If these violence prevention programs are implemented by institutions for the purpose of "bragging rights," then the primary effect often gets lost in the wings. A more unified approach must be taken for the sake of our nation children. For example, in Dayton, Ohio, all the hospitals in the region formed the "Injury Prevention Center" several years ago. The purpose of this was to reduce injuries and their impact in the Miami Valley by coordinating activities, which were independently presented by different hospitals. The goals of the program included development and implementation of specific injury prevention initiatives and adoption of community wide goals for reduction of injury. A collaborative effort such as this could combine resources of many differing agencies. The financial incentives of reduced expenditures combined with the increased political affluence of multi-focused diversities is highly effective.

It is well documented that violence has become one of the nations most endemic and epidemic health care crises. It is also documented that African-Americans are at a significantly higher risk than any other racial or ethnic group. Just as the nation united several years ago to form the "war against drugs," it is time for the people to demand a collaborative effort between law and medicine to eradicate this problem before it significantly alters perspective racial and ethnic groups. True diversity exists when all ethnicities support each other.

The following articles are included in this bibliography:

Constitution and Statutes

United States Annotated Code, Title 20, Chapter 70, Subchapter IV, Part A, Subpart 2 (1998)


Adolescence: The Dangerous PassageDeadly Consequences, Chapter 4, p. 48

An American TragedyDeadly Consequences, Chapter 2, p. 11

An Endangered Species-Young Men of Color Living in PovertyDeadly Consequences, Chapter 5, p. 64

A Peer Education Program to Promote the use of Conflict Resolution Among At-Risk School Age MalesPublic Health Reports, Vol. 109, No.2.

A Profile of Homicides on the Streets and in the Homes of New York CityPublic Health Reports, Vol. 110, No. 1.

A School-Based, Primary Violence Prevention ProgramViolence Issues for Health Care Educators and Providers, p. 83

Assaultive Violence, Violence in America, Chapter 2, p. 14

Disposable Children in Black Faces: The Violence Initiative as Inner-City Containment Policy, 62 U.M.K.C. L. Rev. 423 (Spring 1994)

Free-Floating AngerDeadly Consequences, Chapter 1, p. 1

Interdisciplinary Interventions Applicable to Prevention of Interpersonal Violence and Homicide in Black Youth, Surgeon Generalís Workshop on Violence and Public Health Report, p. 35

Interpersonal Violence and Public Health Care: New Directions, New Challenges,  United States Department of Health and Human Services page 9-17, October 27-29, 1985.

On Ending the War on Drugs, 31 Val. U. L. Rev. XVII (Spring 1997)

Patterns of Violence in American Society, Understanding and Preventing Violence, Chapter 2, p. 42

Plenary Session I,  Surgeon Generalís Workshop on Violence and Public Health Report, Chapter 1, p. 3

Possession and Carrying of Firearms Among Suburban YouthPublic Health Reports, Vol. 110, No. 1

Preventing Firearm ViolenceViolence Issues for Health Care Educators and Providers, p. 99

Successful Approaches to Community Violence Intervention and Prevention  The Pediatric Clinics of North America, Volume 45 Number 2, page 454-467 (April 1998).

Teaching Our Kids to Kill," Deadly Consequences, Chapter 3, p. 29

Teaching Violence Prevention: A Critical Role for Medical Education," Violence Issues for Health Care Educators and Providers, p. 11

The Concept of Race and Health Status in America,  Public Health Reports, Vol. 109, No. 1

The Nations Within: Race, Class, Region, and American Lethal Violence, 69 U. Colo. L. Rev. 905 (Fall 1998)

Theoretical Frameworks: Development Psychopathology, the Public Health Approach to Violence and the Cycle of Violence, The Pediatric Clinics of North America, p. 281

The Prevention of Youth Violence-A Framework for Community Action, p. 1

The Public Health ApproachDeadly Consequences, Chapter 9, p. 130

Violence Against Women of Color, 43 Stan. L. Rev. 1301 (July 1991)

Violence and Public Health, Surgeon Generalís Workshop on Violence and Public Health Report, p. 19

What the Kids Say," Deadly Consequences, Chapter 6, p. 8



Deborah Prothrow-Stith, M.D., " Deadly Consequences "Adolescence: The Dangerous Passage Chapter 4, pages 48-63 (1991).

The author focuses on the extreme psychological pressures that adolescentís face during "normal" growth and development. There is often a strong degree of adult ambivalence, as most parents seem unable to cope with choices and the consequences their children make. This ambivalence has a strong effect on young males who perceive any adult intervention as "police power." The effect is felt further by poor non-whites that are confronted in retail stores as if they are a crime waiting to happen. Also, increased crime rates have caused police to believe they must randomly stop and search young people. Therefore, on a daily basis, young black men are confronted with the assumption that they are bad and dangerous. 

Adolescent development includes stages of, 1) separating from family, 2) forging a healthy sexual identity, 3) preparing for the future, and 4) forging a moral value system. All of these stages force teenagers to make decisions based on peer pressure. Unfortunately, the adolescents that live in the crime ridden inner-city this peer pressure often leads them to violent activities to survive the actions of their surroundings.

I agree with the author as teens are often confronted with multiple authority figures. Often, the reception is negative and condescending as with teachers and police. Since this is such a large developmental stage for fostering independence, more emphasis should be placed on mentoring and encouraging growth. The same authority figures could give positive encouragement and guidance while still maintaining a safe environment for the community. This would foster a healthy sense of support and safety for a class of individuals identified as being at risk. 

Deborah Prothrow-Stith, M.D., Deadly Consequences "An American Tragedy" Chapter 2, page 11-28 (1991).

The author illustrates a startling number of statistics regarding violence, injuries, and death.

In 1986, statistics from the FBI revealed for young males between the ages of 15-24, 4,223 died of homicide. This worked out to a homicide rate of 21.9 per 100,000. The homicide rate for young black males in this age bracket was a staggering 85.6 per 100,000-making homicide the number one cause of death for young men of color. This makes the homicide rate for young black men seven times more frequent than that for young white males. Also, the homicide rate for young males in the United States was between 4 and 73 times that of any other industrialized nation. It is noted that in the homicides in the United States, firearms were used in three-quarters of those homicides. Most homicide victims are poor. There is a strong social science correlation between poverty and violence. 

The community health approach to this epidemic of violence must include more than increased police control. This approach must include an approach to change violent behavior. To do this the author suggests strategies to deal with anger and aggressive feelings. She advocates mobilization of the media to carry the message. She also recommends utilizing the physician and the emergency room to network youths at risk into appropriate programs.

I agree that an approach to deal with violence must be comprehensive and include multi-disciplines. A mass campaign to combat violence seems idealistic without the support of major community and religious leaders. Therefore, I agree with the principles, but feel the first step must include community "buy-in" from those most able to lend political and financial assistance.

Deborah Prothrow-Stith, M.D., Deadly Consequences "An Endangered SpeciesóYoung Men of Color Living in Poverty" Chapter 5, page 64-79 (1991).

The author presents more data to support that young males in poverty are at great risk for dying violent deaths. The FBI has collected data since 1929 that supports young black males are at 6 to 12 timeís greater risk of dying as the victim of a homicide. From 1948 to 1988, the CDC reports the murder rates of African-American males between the ages of 15 and 24 rose by 68 percent. Those same rates for young African-American males between the ages of 15 and 19 rose 100 percent! For further statistical information, see http://www.cdc.gov/scientific.htm

The author relates information from sociologists that reveal many poor, and a disproportionate number of blacks, are becoming a permanently isolated underclass. Much of this data was compiled after studying the Henry Morner and Robert Taylor housing projects. Chronic poverty is being passed from generation to generation much like a genetic disease. Much of this chronic poverty is isolated to these inner-city projects. Until the late 1960ís, the vast majority of non-rural black Americans lived in virtually integrated neighborhoods. Many rich, poor and middle class lived in the same neighborhoods. After the expansion of legal rights for blacks, many moved out of the inner city to urban or suburban neighborhoods. Poverty becomes an assault on a childís self esteem. Combining this factor with single parent families often lead to resentment and anger in young men. Young black males in the impoverished underclass often grow to manhood robbed of their pride and self-esteem. 

Much of the authorís data has been expounded upon since the early 90ís. Many sociologists and public health officials are investigating the effects of the "socio-economic underclass." I find it interesting that little emphasis is placed on drugs and gangs in the inner city. She places more emphasis on poverty and the effects of parental involvement. I agree this is a starting point for action. However, it is much more difficult for society to make effective changes in economics and internal family structure. Public health officials need to investigate the issue of violence from a holistic perspective instead of primarily race or economically bound. 

Joseph Giuliano, Public Health Reports, "A Peer Education Program to Promote the Use of Conflict Resolution Among At-Risk School Age Males," Volume 109, Number 2, March 1, 1994

This school based program focuses on violence prevention in school age boys. The goal is to decrease violent episodes by teaching conflict resolution. The model utilizes the development of student leadership skills and building self-esteem. Statistics indicate there has been a 50 percent increase in mortality in the urban pediatric population but no significant change for suburban and national pediatric populations. Violence among African-American children has increased 252 percent. The program utilizes violence prevention in the form of conflict resolution to early school age children. The program is a four-stage implementation presented by the school nurses. The program expenses are $550 per school.

The author introduces the information in a structured, easy to read manner. The program appears to be both cost-effective and comprehensive. My primary concern is the lack of adequate evaluation of the program effectiveness. No data is provided regarding pre and post survey of violence. 

Kenneth Tardiff, et al., Public Health Reports, "A Profile of Homicides on the Streets and in the Homes of New York City," Volume 110, Number 1, January 1, 1995.

Statistical information is presented reflecting incidence of morbidity and mortality related to violence. Since violence has become the most important public health issue today, health care providers are becoming vocal regarding the need to address the issue. The research study was conducted retrospectively from the files of the Chief Medical Examiner for New York City. The results reveal males outnumbered females, six to one. The 25-34 age group was most affected but followed closely by the 15-24 age group. African-Americans comprised 48 percent of the murders and Latinos comprised 38 percent. Whites only counted for 10 percent of all murders. 

Fifty percent of all homicide in the home was related to firearms. The conclusion demonstrated that further evaluation is needed to explore the association between substance abuse, firearms and any increased risk. 

This article further supports data from the CDC regarding the alarming increase in deaths to minorities; especially African-Americans. It was informative and correlative between homicides and multiple risk factors. A good overview of the information was presented. 

Andrew Israel, et. al., Violence Issues for Health Care Educators and Providers "A School-Based Primary Violence Prevention Program" page 83-97 (1997).

The authors conducted research involving the La Familia/Almeda Wellness Project. This program was designed to utilize the public health model and aimed at enhancing adolescent self-esteem. The feeling was that self-esteem building would reduce the tendency to engage in violent activities. The study incorporated both cognitive and behavioral strategies, which included problem solving skills, communication skills, and social skills. A multidisciplinary approach included health care personnel, social workers, and legal professionals. The end results exhibited a decline in aggressive behavior; however, there was no significant improvement in student self-esteem. 

In my opinion, the results of the research do appear to indicate that positive mentoring and role models combined with skill building on aggression control will have a significant impact on decreasing adolescent violence. It is discouraging that these same strategies did not have an affect on self-esteem. The training may decrease aggressive behavior to others, but may not effect the overall poor self-image many of these teenagers hold. Further studies of this nature must be performed for these results to be entirely conclusive. 

Mark L. Rosenberg, M.D. and James A. Mercy, Violence In America: A Public Health Approach "Assaultive Violence" page 22-46 (1991).

The authors again cite alarming statistics that in 1986 homicide was the twelfth leading cause of death overall in the United States. It was the leading cause of death for black men ages 15-34. Statistical compilation has indicated that structural issues increasing violence include poverty, racial segregation and racism, social isolation, drug and alcohol consumption, increased media violence, and decreased belief of social control. See http://www.cdc.gov/scientific.htm

The approach proposed indicates that change should begin with social, cultural, and physical contexts. This includes decreasing media participation and public acceptance of violence as an appropriate manner to settle disputes. Special attention should be directed at violence in childrenís programming. Improvement should also include police to social service inter-referral. Attempts should continue to implement citizen police groups. There is also a great need to improve access to legal services and ensure once access is instituted, it is completed. The authors suggest intense strategies to reduce the danger of injuries from firearms. Structural accommodations in neighborhoods to decrease risk of violence such as well-lighted neighborhoods and decent housing for all families are imperative.

This article stresses several areas of injury prevention, which gain little attention. I feel acknowledgment by Dr. Rosenberg of the need for many of these implementations indicates that the CDC is finally aware that there are many other factors influencing violence other than poverty and racial factors. 

Joseph F. Sheley and Victoria E. Brewer, Public Health Reports, "Possession and Carrying of Firearms Among Suburban Youth" Department of Health and Human Services, Volume 110, Number 1, January 1, 1995. 

The three factors that are associated with gun carrying are sex, involvement in criminal/drug activity, and dangerous social environments. This study was completed on the youth in Jefferson Parrish, Louisiana outside of New Orleans. Statistics from the CDC were revealed regarding youth, violence, and death. The study revealed that in this test group, one in five students admitted to carrying a weapon for any of the above-cited reasons. Comparatively, the study evaluated a similar control group in Seattle with similar ethnic backgrounds. The authors can only speculate as to the difference in weapon possession between the two groups. Further research is needed to correlate their hypothesis.

I found the article to be informative yet leaves the reader with unclear data. Even though empiric methodology was utilized, the end results to the study appear to employ speculation. The suggestion was made that the threat of crime is more prevalent in the Louisiana group as opposed to Seattle. I do not consider this to be a conclusive finding. 

Alfreda A. Sellers-Diamond, Disposable Children in Black Faces: The Violence Initiative as Inner-City Containment Policy, 62 University of Missouri Kansas Law Review 423, Spring 1994.

The author addresses Dr. Fredrick Goodwinís program entitled the "Violence Initiative." The program was actually an intensive intervention at policy making with various public health agencies. One of the issues presented in the "Violence Initiative" was that there was a possible genetic link between violence and those black children where genetically subordinate. This, along with other similarly programs, are just another form of attack to racially discriminate. The program served no distinct purpose other than to devalue the worth of many African-American children. The purpose of the article was not to evaluate the effectiveness of Dr. Goodwinís research, but to employ the use of strict scrutiny when judging the constitutional validity of the "Violence Initiative" and other such programs. 

The truth to the matter is that black children suffer from a host of problems relating to poverty. They are more likely than other children to be unemployed are, more likely to commit suicide, more likely to be involved in the criminal justice system. The "Violence Initiative" did not offer any solutions to solving these problems of crime and violence. It only offered to draw further lines of demarcation around these children that rejects the notion that the trouble with inner-city life has origins in racial bias or other parts of urban life. To adequately reconcile social science with physical science and law, legislatures and governmental agencies must be able to rely on its information. When data may suggest that individualís lives may be impacted by genetic determinants, government must be overly cautious. These sciences are regarded highly and information that serves to "mark" a particular race can only lead to ominous results. The focus of the "Violence Initiative" was merely to recategorize individuals in terms of worth, it did not change inner-city poverty or the social ills that accompany.

I found this information to be alarming. Not since the Tuskegee syphilis experiment has there been such an outrage of racial discrimination. I find the demotion of Dr. Goodwin a mere slap on the hands and feel the entire Department of Health and Human Services should be reprimanded for supporting such research. The author does an excellent job at relaying this information without inflicting indignation. The text of this article will be alarming to most readers. 

Deborah Prothrow-Stith, M.D., Deadly Consequences "Free-Floating Anger" Chapter 1, page 1-10 (1991).

Dr. Prothrow-Stith presents several opinions regarding the cause of violence and aggressive behavior. The criminal justice system is built on a system of deterrent, however, since our prisons are overflowing, punishment does not appear to be effective. There is also a lack of trust between many blacks and police. She suggests an individualistic "psychiatric" approach to anger management may not be effective. Many young men of color suffer from "black self-hatred." This is not genetically influenced as has been suggested by many past sociologists. It appears to be a combination of frustration and helplessness that has resulted from barriers to the economic and social mainstream. This tendency identified by psychologist Louis Ramey has been labeled "free-floating anger." It is not confined to blacks but has been identified also in whites. The answer to this anger must be treated by the criminal justice system, mental health professionals, and health care providers. In order to save the lives of the young, an aggressive, multi-disciplinary approach must begin with the perception that violence is an assault on the public health.

I agree with many of Dr. Prothrow-Stithís assumptions. There are many issues confronting the young black men of todayís culture. Poverty is a strong factor, but there needs to be a political consensus to eliminate this throughout the nation to effectively address this factor. The basic conclusion of many health care providers suggests a multi-disciplinary approach to violence. The question I present to them is how and who will coordinate this intensive interaction? 

Deborah Prothrow-Stith, M.D., Surgeon Generalís Workshop on Violence and Public Health Report "Interdisciplinary Interventions Applicable to Prevention of Interpersonal Violence and Homicide in Black Youth" United States Department of Health and Human Services page 35-42, October 27-29, 1985.

Statistical data was provided regarding interpersonal violence and homicide among urban black youth. Homicide is the leading cause of death for black men ages 15-24 at a rate of 72.5 for every 100,000. These rates are 7-12 times higher than for the general population. A study by the Northeastern Ohio Trauma group measured data for 1977 and indicated an assault tare of 862 per 100,000 population. The incidence rate for assaults in the urban black neighborhood was over twice the total incidence rate. 

The author suggests that a health education initiative should include a national campaign to reduce interpersonal violence. The Boston Youth Program was evaluated and suggested as potential national curricula. The program is presented to tenth grade students. The program goal is to teach anger as a normal constructive emotion, suggest alternatives to fighting, role modeling at anger control, presentation of non-violent values and prevention behavior.

I feel the Boston Youth Program needs further investigation as a potential national curricula. The evaluation was completed on a small, isolated test and control group. Further test and control groups should include both smaller and larger populations. The evaluation tool was a post-test completed by the students. The evaluation tool needs to be behavior evaluative. Written post-tests are frequently poor indicators of true changes in behavior. 

Marvin Wolfgang, M.D., Surgeon Generalís Workshop on Violence and Public Health Report "Interpersonal Violence and Public Health Care: New Directions, New Challenges" United States Department of Health and Human Services page 9-17, October 27-29, 1985.

Dr. Wolfgang suggests joining forces with social service and the criminal justice system in approaching the problem of violence. It is imperative to remember the personal and collective freedom and protection collide in the arena of violence legislation. He suggests that community involvement and alliance between the public and private sectors need to attack the problem of interpersonal violence. It is acknowledge a multi-disciplinary approach is the only effective way to combat violence.

I agree totally with Dr. Wolfgang. I feel again that strength and unity between the law and health care providers would assure a competent solution. Good general overview of the law and medicine. 

Edward McGlynn Gaffney, Jr., On Ending the War on Drugs, 31 Valparaiso University Law Review XVII, Spring 1997.

This article was released as the result of a National Conference on Teenage Violence and Drug Use. This article is a multifaceted approach to problems of violence and drugs. The violence of communities was identified as early as 1942 in a Chicago neighborhood. At that time, it was identified that low socioeconomic status, ethnic heterogeneity, and residential mobility were attributable to variations in crime and delinquency. Remarkably, most of these factors prevail today as chief contributing factors. Little progress has been made in fifty-five years of research and implementation. There is further evidence that the present judicial system does not effectively deter future violent behavior.

The author does a good job at presenting a basic overview of these intertwining issues. There is some comparative values noted to the effects of religion, constitutional law, and social issues such as drugs and violence. This would have been an informative symposium to attend. The article does offer a similar perspective to judicial modification as a necessary component for violence prevention. 

Albert Reiss, Jr. and Jeffrey A. Roth, Understanding and Preventing Violence "Patterns of Violence in American Society" page 43-100 (1993).

The authors present statistical data. They do caution readers that interpreting arrest statistics against distribution of the actual people committing crimes and arrest statistics may not be representative of the offenders. These statistics may merely represent the number of criminals being "apprehended." In the nature of violent crime, blacks constitute 45 percent of all arrestees. Other minorities are also over represented in the area of violent crimes. The arrest rate is about six times greater for blacks than whites. 

I feel that although statistical data is imperative when evaluating a particular health issue, these results appear to be very skewed. Even the authors cautioned the readers when interpreting the data. Unfortunately, many programs may be developed and implemented based on this type of statistic. Therefore, the criminal justice system needs to refine and re-calculate crime statistics. There needs to be another tool for this type of data collection. Arrest records are not a true indicator when determining who is completing the crime. 

Bruce W. Goldberg, Violence Issues for Health Care Educators and Providers "Preventing Firearm Violence" page 99-111 (1997).

The author presents data correlating the incidence of firearms as a primary cause of injury and death. Recent statistics indicate that firearms are the eighth leading cause of death in the United States. Among African-American males, firearm injuries are the leading cause of death among those ages 10-34. Mr. Goldberg suggests that health professionals need to be educated regarding the basic misconceptions regarding firearms. The American Medical Association has declared firearm injuries as a critical public health issue and has demanded to treat the issue with much urgency. The suggestion is presented that a national curricula should be established to educate health professionals in how to educate their patients regarding firearm injury prevention. 

As a past inner-city, emergency room nurse, I have much passion in this area. There is nothing more traumatic than to explain a needless gun-related death to a family. I am a supporter of gun control. I also live in a family that strongly believes in our second amendment rights inscribed by our founding fathers. There needs to be cooperation between law and medicine to uphold those rights but guarantee responsibility within that right. I agree with the suggestions in the article but feel this is just a beginning to an immense problem. 

Joseph L. Wright, M.D. and Linda Cheng, Violence Among Children and Adolescents "Successful Approaches to Community Violence Intervention and Prevention" The Pediatric Clinics of North America, Volume 45 Number 2, page 454-467 (April 1998).

The authors supportive data regarding the issue of violence. There is suggestion the public health approach to violence programs should be utilized to ensure successful community-based interventions. There is suggestion that the problem needs to be further evaluated from the patientís perspective. Data from emergency room records is often incomplete and poorly documented. Therefore, focus groups and interviews with actual patients may reveal more accurate date as to the actual problem of violence. The gathering of this data should be compiled before any formal program can be implemented. This data should accurately identify key issues and will allow the participants empowerment and control over a situation that leaves them powerless. It may also identify a methodology, which will be more effective when implemented.

I agree with this approach. It seems only logical that the young African-American male feels powerless in his environment. Directly involving them in a plan to attack violence will restore some sense of control. It will also make the program more effective if there is "buy-in" from the members of the community. My only concern with this approach is that the organization may be difficult. There may not be adequate participation unless there is strong support from other community and religious leaders. 

Deborah Prothrow-Stith, M.D., Deadly Consequences "Teaching Our Kids to Kill" Chapter 3, page 29-47 (1991).

The author presents information correlating the incidence and increase in violence with the explosion of violence in the media. She agrees that aggression is a learned behavior, which can also be unlearned. She also suggests that this is further enforced in todayís music with many rap songs supporting killings and gang related activity. Young males who are growing up fatherless are at most risk for learning this aggressive behavior from television or movies. Lacking a male role model, they often identify this violent behavior as being the "norm." Positive parental support and role modeling must also support the absence of violence in the media. A child needs to hear constant encouragement to reinforce good behavior. 

I agree with Dr. Prothrow-Stith in all these observations. I do not agree with censoring the media for adults, however, if parents will not take the responsibility to limit the media in the home, then the American justice system must intervene. Children need to learn that violence is the exception, not the norm. Good overview of the role played by the media. 

David Williams, Risa Lavizzo-Mourey, and Rueben C. Warren, Public Health Reports "The Concept of Race and Health Status in America," Volume 109, Number 1, January 1, 1994. 

The authors expose that race is an unscientific, societal constructed taxonomy based on ideology that some human population groups are inherently superior to others. For many years, research has viewed racial differences in health as primarily biological in origin, which has diverted attention from the social origins of disease. This has also reinforced societal norms of racial inferiority and provided a scientific rationale for black exploitation. 

Some attention is directed to the fact that blacks may be at higher risk of violence due to racial disparity which forces them to live in isolated neighborhoods which often are not reflective of their respective socioeconomic group. Studies have also shown that living in these violence prone neighborhoods can increase risks for hypertension and other stress related illnesses. 

This is an excellent article that fully exposes the incidence and prevalence of racism in America. There is little mention of violence prevention and research data, but the article is worth reading due to the remaining text on the disease known as racism. The authors implore society to directly assess health-related aspects of belonging to a specific racial or ethnic group. Very worthy reading. 

Darnell F. Hawkins, The Nations Within: Race, Class, Region, and American Lethal Violence, 69 University of Colorado Law Review 905, Fall 1998.

The author begins by critiquing the book, Crime Is Not the Problem: Lethal Violence in America, Franklin E. Zimring & Gordon Hawkins (1997). The focus in on the chapter entitled, "New Perspectives on African-American Violence." The authors have identified two false inferences regarding violence and blacks: 1) that black violence is part of a general tendency for blacks to commit violent crimes and 2) that crime rates are higher in the United States as compared to other industrialized nations due to higher rates of violence among African-Americans. This author feels the book de-contextualizes the problems of race and violence in the United States. 

Suggestion is made that if public policy and crime control that do not address issues of race, ethnicity and class will certainly fail. It is also noted that before any attempts are successful in addressing violence, the general public must first acknowledge and deal with the problem of social inequity. The dispossession that many impoverished Americans feel is linked to a marketplace where guns are easily obtained.

I found the authors interpretation of the book interesting but found myself at a disadvantage by not being able to locate and read first for myself. It appears that many interesting new propositions are presented regarding the rationale for inner-city violence. The underlying strategies for prevention remain the same with a focus on equalization of classes prior to effective termination of underlying violence. The article was well written and is worth reading.

Alice D. Calhoun, M.D., M.P.H. and Francine Clark-Jones, R.N., Ph.D., Violence Among Children and Adolescents "Theoretical Frameworks" The Pediatric Clinics of North America, Volume 45 Number 2, page 281-292 (April 1998).

The authors agree that violence is a multidisciplinary issue. Information is presented regarding Moffittís taxonomy on the social development of violence in youth. The goal of a public health approach to violence is to preserve, promote, and improve health-emphasizing prevention. There are three levels to this model 1) primary-prevention of events that might cause injury and illness, 2) secondary-aims to prevent further injury and illness, and 3) tertiary-prevent unnecessary disability after the injury has occurred. Haddonís model of core concepts and levels of prevention have been utilized in the development of many successful programs addressing motor vehicle accidents. The evidence of success is obvious as motor vehicle accidents have dropped dramatically over the last fifteen years. Use of this model may be difficult as it also calls for the approach to be a multi-disciplinary approach. These authors acknowledge this may be difficult and is only in the conceptual stages.

I found this article to be more concrete at identifying specific goals and methodologies at the introductory level. I also found it enlightening that the authors acknowledge the difficult task in developing a violence program with a multi-disciplinary approach. I found it depressing that they did not suggest a potential solution or possible apply the theoretical frameworks to existing violence prevention programs. 

Mary Ann Fenley, et al., The Prevention of Youth Violence "A Framework for Community Action" Centers for Disease Control and Prevention, page 1-28 (1993).

This publication was developed by the staff at the CDC to offer an overview of the problem of youth violence. They address several strategies such as mentoring, conflict resolution, social skill training, parenting centers, peer education, and public information and education along with addressing target groups. There is also overall suggestions for regulatory changes concerning the use and access to weapons and alcohol. There is general discussion regarding environmental modifications. There is a general listing of many violence prevention programs along with addresses, contact persons, and phone numbers.

I found this book to be a good basic introduction to the problem of violence and the current available solutions. It is a good overview, however, is not very helpful with specific problems such as the violence issue is the young, black male. It does offer some assistance if you are interested in starting a violence prevention program. 

Deborah Prothrow-Stith, M.D., Deadly Consequences "The Public Health Approach" Chapter 9, page 130-144 (1991).

Dr. Prothrow-Stith addresses the public health approach to violence. She critiques the strengths and weaknesses of the three-step approach. Comparison is made to the use of the public health approach to the problem of cigarette smoking. In that system, it is demonstrated that the most likely to quit smoking were the affluent. The conclusion of this is that the public health approach may be prejudiced toward economics. The presumption from this is that the public health model and the public health officials can not undertake the problem of violence alone. They need the support of the community along with political and ordinary people. 

I found this chapter interesting that the author directs much more responsibility back to the individual and the community. I do not believe that she is insinuating public health officials have no role in this problem, I believe she is saying that there needs to be elevated concern and demand by the general population if any approach to violence will be effective. 

United States Code Annotated Title 20, Chapter 70, Subchapter IV, Part A "State Grants for Drug and Violence Prevention Programs" Subpart 2 National Programs (1998).

At the urgency of the Secretary of Health and Human Services, the legislatures developed this statute to designate goals and objectives for programs addressing drugs and violence. Part of the objectives includes community activities toward empowerment zones that will induce community wide efforts to reduce drug and violence problems. This also includes monies for violence prevention strategies that may include conflict resolution, peer mediation, teaching law and invoking individual student responsibility. 

The ultimate goal of the statute appears good, however, the guidelines establish that grant awards will be given on a competitive review basis. This tends to make me believe the funding is limited and lobbying and political support is needed to receive the monies. 

William H. Foege, M.D., Surgeon Generalís Workshop on Violence and Public Health Report "Violence and Public Health" United States Department of Health and Human Services page 19-34, October 27-29, 1985.

Dr. Foege traces the history of epidemics through the scrapbook of time. He relates how every few decades have acknowledged a specific illness that marks its place in time. He continues to relate how the epidemic of violence has emerged, grown tremendously, and survived with no currently identified cure. There is much discussion over the intensity of violence as a public health issue. There is little discussion of solution as this article addresses both a historical and conceptual overview of the problem.

As this article presented no specific opinion or suggestion, I found no need to agree or disagree. I felt that the information did document a fair comparison of how other epidemics such as polio have progressed. Dr. Foege did address the way society has changed values and norms to embrace current violence injuries in the same manner in which polio was once thought. 

Deborah Prothrow-Stith, M.D., Deadly Consequences "What The Kids Say" Chapter 6, page 80-94 (1991).

The author interviews many adolescents through this chapter. The insights of both gang members and their victims are related. There is also discussion that oppression has lead many young blacks to internalize these feelings and leads to potential aggression. Young men of color need to develop feelings of pride in their heritage. Books can not accomplish this goal. There must be mentoring and modeling which can only be accomplished with community support. Many of these young men have no male role models. Therefore, the only alternative is to supply a health role model for them to develop feelings of emotional challenge. These mentors can relay that anger is an emotion that is always present, but there are appropriate methods to deal with the feeling.

I felt this chapter to be the most provoking. Hearing the destitute feelings related by the very children who are living daily in these violent environments should be a wake-up call to all Americans. There must be an aggressive movement by the people to overturn the problem of violence. Whether the problem is in your individual community or hundreds of miles away, there must be concern for all these children to ensure survival of our species. Excellent chapter. 

G. Chezia Carraway, Violence Against Women of Color, 43 Stanford Law Review 1301, July 1991.

The focus of the author is primarily directed at sexual assault on women of color, however, there is interesting information that suggests accurate data regarding violence to the African-American female minimizes the toll directed at these victims. Most generally, statistics are driven by white-males whom institutional power and economic control also support. The author reinforces this control paradigm by comparing the prosecution of the exhibitors of the Mapplethorpe collection to the fact that the media continues to exploit women in every aspect of the industry.

I found it interesting to compare the spiritual demise that was related by the author to women of color who have experienced violence. Physical violence is always apparent as to the end results, but emotional and spiritual violence can play an even deeper and penetrating toll. The article expresses many views that are often left unexpressed by victims. 


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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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