and control of aggressive behavior (Kellam et al., 1998) or to a middle school drug prevention program (Botvin et al., 1995). These programs also have the advantage, because of inoculation, of having potential impact on not only those who are currently at risk, but also those whose risk status changes after the intervention takes place. Finally, many of these broad prevention programs target multiple outcomes, so overall risk for suicide may be reduced by diminishing developmental risk through multiple pathways.

Policy changes represent another universal strategy for reducing suicide. For example, Birckmayer and Hemenway (1999) conclude in their review of minimum drinking age policies in each state from 1970 to 1990 that increases in the legal drinking age reduce not only motor vehicle deaths but also suicides.

Media Campaigns

A traditional universal public health approach to behavior-related problems has been widespread education through mass-media campaigns. This technique has been used with varying levels of success for smoking, AIDS, and coronary heart disease (see IOM, 2002). A few countries, including the United Kingdom and Norway, have implemented such mass-media campaigns for suicide prevention as part of overall mental health promotion; evaluations of results are not yet available. Extensive media campaigns for suicide prevention are not common, largely due to fear of engendering suicide imitation. Media initiatives more often have focussed on modifying portrayals of suicide to reduce the likelihood of imitation. Since data are limited on use of media for education, this section discusses what is known about suicide imitation through the media, followed by a description of efforts to address this problem and the evidence for their effectiveness.

The Evidence for Imitation

Throughout history, people have expressed concern about suicide imitation, and have seen the opportunity for intervention in such matters, as evidenced by various anecdotal accounts in the literature of suicide imitation and clustering. For example, Goethe’s 1774 novel The Sorrows of Young Werther, in which the title character shoots himself after a failed love affair, was banned in Denmark, Saxony, and Milan in order to prevent further suicides that were thought to be a result of young men imitating the behavior of Werther (Phillips, 1974, 1985). These events led to the term the “Werther Effect” being used to describe imitation of this sort.

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