immunizations against disease. Immunization has many of the ideal qualities of a primary preventive instrument: it is very low in cost, can be widely distributed, and is extremely effective.
It is difficult, however, to import this model into the world of social behavior, especially delinquency. Because of the complexity of developmental and other factors that produce these behaviors, these interventions—whether primary, secondary, or tertiary—can be very costly rather than inexpensive, especially since they must be sustained over time. Research has shown that prevention efforts to date afford quite limited protection.
Cost may cause society to depart from its preference for protecting everyone and concentrate on protecting those places, people, and circumstances that seem at particularly high risk. However, because the interventions are less reliable, society may still have to cope with incidents that were not prevented. In short, the more expensive and less reliable the interventions, the more the society will be forced to employ a portfolio of preventive activities that favor tertiary over secondary and primary preventive instruments. One can even imagine situations in which the cost and unreliability of primary and secondary instruments are so great as to make tertiary prevention the best approach to dealing with a problem. In these cases, an ounce of prevention would be worth much less than a pound of cure.
This report suggests that many different factors can potentially lead to lethal violence or school rampages, including structural community variables, the ordinary processes of child development, the risks created when children become alienated from adults, cultural influences, the stable characteristics and motivations of the individuals who become offenders, and microsocial situational processes that, although surely influenced by individual characteristics and larger community forces, take on a life of their own in the give and take of interpersonal and group interaction.
Since each of these factors is a potential cause, each is a potential target of preventive efforts. And one could attack these different causes in either a general, primary prevention effort or in a more selective secondary prevention mode. For example, one could seek to modify structural conditions across all communities in the country, or only those that are judged to be at particularly high risk. One could treat every youth as a potential offender, or concentrate on those considered to be at particularly high risk. One could treat every instance of status threat and degradation in school as something to be managed, or focus only on those situations that seemed to occur in high-risk communities and schools involving high-risk individuals.
The lethal violence and school rampages are spread across different kinds of communities, different kinds of schools, different kinds of youth,