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OCR for page 192
Estimating the Incidence, Causes, and
Consequences of Interpersonal Violence
for Children and Families
Colin Loftin and James A. Mercy
Accurate data for estimating the incidence, causes, and consequences
of violence for children and families are critical to developing effective
policies and programs for prevention and control of violence. Currently,
however, federal data collection activities only incidentally address key
data needs, and methodology is not sufficiently consistent to provide a
solid underpinning for policy and program development. In this paper, we
describe the current data collection system and assess the need for im-
provement.
The paper is limited to data collection focused on serious assaultive
violence in primary relationships, such as families, and violence involving
children. As a general concept, violence is broad, including any use of
force or threats of force regardless of intent or magnitude. Accordingly, it
includes an argument in which threats were exchanged, spanking, and vi-
cious, lethal rape.
A hypothetical J-shaped distribution of the magnitude of harm from
violent behavior reveals opposite problems in trying to estimate the inci-
dence of violent behavior (Figure 1~. On the left side of the curve, the
Colin Loftin is director of the Violence Research Group. Department of Criminology and
Criminal Justice, University of Maryland. James A. Mercy is with the Division of Violence
Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
and Prevention.
192
OCR for page 193
INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
193
C'
a)
~5
a)
LL
1/x
Severity
FIGURE 1 Hypothetical Relationship Between Frequency and Severity
incidents are so frequent and so inconsequential that they should not, and
probably cannot, be estimated. On the right side, the events are so rare that
they will be missed by standard sampling schemes, yet they are so harmful
that they are of major concern.
Without specifying an exact cutoff, we are primarily interested in the
right half of the distribution. It includes violent behavior that results in
physical injury, as well as other intentional acts that pose a significant risk
of injury. A wide range of extremely harmful incidents are omitted from
consideration. We do not deal with negligence or failure to act that may
result in injury; psychological trauma, if there is no threat of force; or self-
directed violence, such as suicide or suicide attempts.
We begin by describing major approaches to collecting information on
serious assaultive violence and characterizing their methodology, without
attempting an exhaustive description of all of the major data collection
systems. We then describe what we see as some of the major problems and
pressing needs. The paper ends by suggesting some feasible approaches to
addressing these needs.
OCR for page 194
94
INTEGRATING FEDERAL STATISTICS ON CHILDREN
EXISTING DATA COLLECTION SYSTEMS AND APPROACHES
Approaches to collecting data on serious assaultive violence can be
divided according to the general sampling strategies used. Household sur-
veys sample dwelling units and obtain self-reports of offending and/or vic-
timization from persons residing in those dwellings. Organization-based
surveys sample service providers such as schools, social agencies, and emergency
departments and obtain information from either self-reports or records. Com-
plete enumerations or registries, such as the National Center for Health
Statistics' vital statistics or the Federal Bureau of Investigation's Uniform
Crime Reporting system, attempt to capture all of the incidents that occur in
a target population. The fourth approach combines several sampling strate-
gies and is used when the incidents being studied are infrequent and no
single sampling frame would yield valid estimates. The sections that follow
briefly describe some examples of each approach. The characteristics of
the major data sources are also described in Table 1.
Household Surveys
The National Crime Victimization Survey, the National Youth Survey,
and the National Family Violence Surveys are based on household samples.
There are, of course, major methodological differences in the these surveys,
but they provide useful illustrations of this approach.
The National Crime Victimization Survey
The National Crime Victimization Survey (NCVS, previously known as
the National Crime Panel and the National Crime Survey) is a large, con-
tinuous survey of people at least 12 years old who live in U.S. residential
housing units. The survey is conducted by the Bureau of the Census for the
Bureau of Justice Statistics to provide national estimates of the incidence of
criminal victimization (Bureau of Justice Statistics, 1992~. Respondents are
interviewed in person and by telephone seven times at 6-month intervals in
a rotating panel design. Considerable attention is given to placing reported
incidents in a specific time frame. For example, the first interview in a
panel is used strictly for bounding (marking the beginning of the reference
period for the second interview); thereafter, respondents are asked for the
specific month of occurrence for each incident they report. NCVS data
have been collected continuously since 1973 and include reports of victim-
izations that may not have been reported to the police.
The most distinctive feature of the NCVS is the extensive screening for
crime incidents and the completion of separate incident forms that record
specific information about each incident, including the exact month of oc
OCR for page 195
INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
195
currence, the victim-offender relationship, and the extent of injury and property
loss.
The National Youth Survey
The National Youth Survey (NYS) is a longitudinal study of a national
probability sample, selected in 1976, of 1,725 youths ages 11 to 17. The
first interviews were conducted in 1977. By late 1993, nine waves of data
had been collected (Elliott, 19941. The interview schedule contains, along
with a variety of other measures, a set of self-reported delinquency items,
and in some of the waves follow-up questions are designed to obtain some
details about circumstances associated with the offense. Of particular inter-
est are items designed to measure "serious violent offenses," defined as
aggravated assault, robbery, and rape (Elliott, 1994:3~:
"[Have] you attacked someone with the idea of seriously hurting or
killing that person?"
"[Have] you used force or strong-arm methods to get money or things
from people?"
''IHave] you had or tried to have sexual relations with someone against
their will?"
The measure of serious violent offenses is restricted to assaults, robber-
ies, and rapes that involved "some injury or a weapon." Medically treated
incidents are defined as those in which the victim was "cut or bleeding, had
broken bones/jaw/nose, was unconscious, was taken to a hospital, or died"
(Elliott, 1994:41. The survey also collects data on violent victimization of
respondents.
National Family Violence Surveys
The National Family Violence Surveys were conducted in 1975 and
1985 (Straus et al., 1980; Gelles and Straus, 1988; Straus and Gelles, l990J.
The 1975 survey was a national probability sample of 2,143 "currently
married or cohabiting persons aged 18 through 70," stratified by region and
demographic characteristics. Response Analysis Corporation conducted the
hour-long personal interviews. A random half of respondents were women
and if there was more than one child, the "referent child" was randomly
selected from the children between ages 3 and 17 who resided in the house-
hold. The completion rate for the entire sample was 65 percent.
The 1985 survey, conducted by Louis Harris & Associates by tele-
phone, included 6,002 households consisting of two married or cohabiting
adults or an adult age 18 or older who had either divorced or separated
within the last two years or a single parent living with a child under age 18.
OCR for page 196
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OCR for page 201
INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
201
Within the household, eligible respondents and a referent child were se-
lected randomly. Black and Hispanic households were oversampled, but the
entire sample is weighted to be representative of the total U.S. population.
The 1985 survey had a higher completion rate (85 percent) than did the
1975 survey, and interviews were administered in less time (35 minutes)
(Straus and Gelles, 1990: 529-532~.
Both surveys employed the conflict tactics scale (CTS), a set of ques-
tions about how interpersonal conflicts are resolved that is designed to
allow respondents to report violence directed at household members with
less response error than would alternative approaches. The CTS is not
exactly a self-report, however, because respondents provide proxy informa-
tion about their behavior and the behavior of other members of the house-
hold. As would be expected, the proxy responses have different character-
istics than the self-reports.
Other Surveys
Other important household surveys on violent behaviors include the
National Survey of Families and Households (Sweet et al., 1988; Brush,
1990~; the National Survey of Children (Moore et al., 1989~; and the Na-
tional Women's Study (National Victim Center, 1992~.
Organization-Based Surveys
Another strategy is to sample organizations such as schools, hospitals,
police departments, and other agencies that provide services to victims and
offenders. Prominent examples are school-based surveys of delinquent be-
havior such as Monitoring the Future and the school-based Youth Risk
Behavior Surveys and hospital-based surveys of injuries such as the Na-
tional Electronic Injury Surveillance System and the National Hospital Am-
bulatory Medical Care Survey (McCaig, 19941. Another important organi-
zation-based study that measures violence among families and children is
the Study of the National Incidence and Prevalence of Child Abuse and
Neglect, also called the National Incidence Study (National Center on Child
Abuse and Neglect, 1988~.
The main advantage of organization-based studies is that the per-case
cost is lower than in household samples. This is certainly the case with
school-based samples and samples of emergency departments, since one
would have to screen hundreds of households to obtain a single case of
assault or rape with serious physical injury.
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202
Monitoring the Future
INTEGRATING FEDERAL STATISTICS ON CHILDREN
The Monitoring the Future studies are national multistage probability
samples of senior classes in approximately 130 high schools. These studies
have been conducted since about 1975 by the Survey Research Center at the
University of Michigan. Among the self-report delinquency behaviors re-
spondents are asked how many times during the previous 12 months they
have (Osgood et al., 1989: 4171:
· "Hit an instructor or supervisor"
· "Taken part in a fight where a group of your friends were against anoth-
er group"
· "Hurt someone badly enough to need bandages or a doctor"
· "Used a knife of gun or some other thing (like a club) to get something
from a person."
National Electronic Injury Surveillance System
The National Electronic Injury Surveillance System (NEISS) is designed
to produce national estimates of the frequency and severity of injuries asso-
ciated with specific consumer products. The system, which uses a stratified
probability sample of hospital emergency departments in the United States
and its territories, is conducted for the U.S. Consumer Product Safety Com-
mission. Data are entered into the NEISS computer system from patient
records each day; approximately 200,000 injury reports are collected through
NEISS each year. Of these, about 1 percent are selected for follow-up
investigation (case selection is dependent on the commission's product-
specific priorities). Telephone interviews with victims or witnesses are
then conducted to gather further information on events surrounding the in-
jury incidents (U.S. Consumer Product Safety Commission, 19861. The
Centers for Disease Control and Prevention and the Bureau of Justice Sta-
tistics are currently exploring the use of the NEISS system to collect infor
. . . . .
matron on injuries c ue to V10 ence.
Complete Enumerations or Registries
There are two major systems that attempt to completely enumerate specified
classes of assaultive violence: the Federal Bureau of Investigation's Uni-
form Crime Reporting System and the homicide portion of the mortality
data from the vital statistics maintained by the National Center for Health
Statistics.
These national enumeration systems serve two unique roles. First, they
provide information on rare incidents such as homicide in specific groups
(e.g., infants and spouses) (Fingerhut and Kleinman, 1989a, 1989b; Mercy
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204
INTEGRATING FEDERAL STATISTICS ON CHILDREN
such items as age, sex, race, place of residence, and place and cause of
death, are recorded and forwarded to NCHS through state vital statistics
records offices. Codes for cause of death, including those for homicide, are
assigned according to definitions established by the International Classifi-
cation of Diseases, Ninth Revision (World Health Organization, 1977~.
Combined Strategies
The last type of design is actually a hybrid of approaches that draws on
several sampling strategies to produce the estimates of interest. This design
is motivated by the infrequency of the target incidents and the weaknesses
of any single sampling frame to yield valid estimates of its incidence.
The National Incidence Studies of Missing, Abducted, Runaway and
Thrownaway Children (NISMART) is a good example of a combined sys-
tem. NISMART collects data from six separate sources: a household sur-
vey, a survey of juvenile facilities, interviews with returned runaways, po-
lice records, FBI data, and a survey of community professionals tFinkelhor
et al., 19921. Although the focus of NISMART is on numbers of children
and not on numbers of incidents per se, the design is instructive nonethe-
less.
The use of multiple methods and sources of data by NISMART investi-
gators was partially dictated by a wide-ranging charge to examine the "missing
children problem," one that they concluded was a set of at least five differ-
ent and distinct problems (i.e., family abductions, nonfamily abductions,
runaways, thrownaways, and lost or otherwise missing children). Examin-
ing even a single area, for example, nonfamily abductions, NISMART dem-
onstrates the desirability of a combined approach. Although its large-scale
telephone survey could generate sufficient cases to estimate the number of
attempted abductions (albeit with a large standard error), it was not effec-
tive in estimating completed abductions, an apparently much rarer event.
For these, the NISMART police records study proved a better approach
(Finkelhor et al., 1992~.
AREAS OF PRESSING NEED
Existing data on violent behavior and its influence on children and
families are fragmented, variable in quality, and do not allow for addressing
many important policy issues. In this section we identify areas of the most
pressing need.
Obtaining Valid Responses
Asking respondents to report on complex, sensitive, traumatic, and even
illegal behavior committed by themselves or by members of their household
OCR for page 205
INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
205
approaches the limits of what one can reasonably expect from survey meth-
ods. Estimates based on different methodologies vary considerably and
result in confusion and even loss of confidence in the statistical estimates of
violent behavior.
A couple of examples illustrate the point. A recent paper based on the
National Youth Survey estimates that 36 percent of African-American males
and 25 percent of non-Hispanic white males report having committed at
least one aggravated assault, robbery, or rape during their 17th year, the
peak year for offending (Elliott, 1994~. This figure is surprisingly high and
several times higher than estimates based on such sources as arrests and the
reports of victims.
Similarly, the National Woman's Study estimates that, during 1990,
683,000 women age 18 or older were the victims of rape (National Victim
Center, 1992: 2-3~. This is more than five times the 1990 estimate based on
the NCVS for people age 12 and older (Bureau of Justice Statistics, 1992:
59. Research is clearly needed in two general methodological areas: (1)
eliciting candid responses about sensitive and traumatic incidents and (2)
capturing the complexity of violent events.
Eliciting Candid Responses
Substantial research exists on enhancing the validity of responses about
sensitive and illegal behaviors, such as sexual activities and drug use. Many
of these existing techniques could be profitably applied to measuring vio-
lence. Special problems arise, however, in household interviews in which
one member of the household is reported to have abused another. Reporting
violent behavior may put respondents at greater risk of victimization and
thus creates serious problems for data collection. This issue is of central
importance because these are exactly the situations that have high incidence
rates and a substantial influence on statistical estimates.
Capturing Complexity
Few existing data collection mechanisms capture much of the complex-
ity of violent incidents. The experience in the NCVS with series victimiza-
tion is one of many examples that might be cited. Many respondents are
unable to recall the details of separate incidents, even with bounded inter-
views and relatively short reference periods, because there are so many
similar assaults during a short period that they cannot remember them as
separate incidents. These "series incidents" have been characterized as
incidents with long duration rather than as individual events by Biderman
(1981: 795~. Counting them requires special methods. Although this issue
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206
INTEGRATING FEDERAL STATISTICS ON CHILDREN
is an essential feature of the underlying phenomenon, NCVS is the only
survey that has confronted it.
Other features of violent incidents that should be captured are the se-
verity of injuries and the extent of the other harmful effects of violence.
This information is important not only for estimating the impact of violence
on society, but also for defining incidents and comparing across data collec-
tion systems. Measures of self-reported offending would profit from some
of the methodology that NCVS has developed for measuring victimization.
Bounding interviews, using shorter reference periods, and requiring respon-
dents to provide details of specific incidents would contribute important
information about the nature of violence and, other things being equal,
would increase the precision of estimates.
Undercoverage in Data Collection Systems on Violence
Undercoverage is another problem in violence data collection systems.
People who are at high risk for violence, either as offenders or as victims,
are also likely to be missed in surveys of households and schools. Again, a
couple of examples illustrate the point.
Using evidence from police reports and an estimate of the case-fatality
rate for gunshot wounds, Cook (1985) estimates that the number of nonfatal
gunshot wounds is three times higher than the NCVS estimate. Although
some of the difference may be due to the quality of police data, it is likely
that many of the victims of gunshot wounds are not captured in household
surveys.
The groups that are likely to be missed in household surveys blacks,
Hispanics, and other minorities; children under the age of 10; the poor;
renters; and people who move frequently (Hogan, 1993; Robinston et al.,
1993) are also those at high risk for being victims or offenders. Those
who are at highest risk and who may contribute disproportionately to inci-
dence estimates are the ones most likely to be missed. This problem in
coverage is especially true for children and adults who are part of several
households or who otherwise live in nontraditional family settings.
Data on Risk Factors, Social Context,
Consequences, and Sequences
Existing data collection systems on violence, particularly those that
focus on the more severe forms of violence, are designed primarily for
estimating the incidence of violent events. They do not collect very much
information on risk factors, social contexts, and other covariates of violence
that might be used in evaluating causal models. Systems would be consid-
erably more valuable if they measured both incidence and important covariates.
OCR for page 207
INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
207
It is ironic that the data collection systems that have the best information
about the most serious violent incidents (such as the vital statistics mortal-
ity data and the NCVS) provide the least information about covariates,
whereas those with a lot of information about covariates (such as the Na-
tional Survey of Youth and the National Family Violence Surveys) provide
little information about the most serious violent incidents.
Data on Precursors and Long-Term Consequences of Severe Assault
Violent assaults and deaths have major consequences for both primary
and secondary victims (i.e., children, families, and friends of primary vic-
tims), but very little is known about the magnitude and long-term pattern of
those consequences. Registration systems such as vital statistics mortality
data or the files of law enforcement agencies contain virtually no informa-
tion about precursors or the long-term consequences of violence. Surveys
provide more information, but are still quite limited. The value of existing
information could be magnified severalfold by sampling cases from the
registration systems and interviewing victims or next of kin to obtain infor-
mation about the consequences of victimization. Topics of study would
include such items as long-term medical costs, disabilities, restricted activ-
ity, loss of time from work, impairment, and other circumstances surround-
ing violent incidents and lifestyles. Case-control studies comparing cases
in the registration systems with controls and prospective studies following a
group of victims and an appropriate control group of nonvictims would be
valuable.
State and Local Estimates of the Incidence of
Serious Assaultive Violence
Many of the programs and policies designed to prevent violence or
mitigate its consequences are implemented at state and local levels, and
evaluating the impact of these efforts is critical. Unfortunately, few data
collection systems are capable of producing small-area estimates of serious
assaultive violence. Of the major data collection systems, only the vital
statistics mortality data and the UCR system can produce estimates for state
and local areas, and there are major limitations in the value of these sys
tems.
The vital statistics mortality data provide only a limited amount of
information about victims besides age, race, gender, marital status, place of
residence, and cause of death; there are no data about circumstances. A
revision of the U.S. Standard Death Certificate, offered for state use begin-
ning in 1989, included new items on the decedent's educational attainment
and on Hispanic origin and expanded fields for indicating multiple or un
OCR for page 208
208
INTEGRATING FEDERAL STATISTICS ON CHILDREN
derlying causes of death (National Center for Health Statistics, 1993~. For
some states, "usual occupation" and "kind of business or industry" are also
recorded.
In addition to limited numbers of variables, confidentiality concerns
affect the availability of some types of information in the public-use data.
Estimates for small areas are particularly affected. Since 1982, the mortal-
ity detail files have identified the decedent's county or city of residence
only if the population was 100,000 or greater. Confidentiality restrictions
also prevent aggregation of daily time series after 1987 from the public
microdata because exact day of death is masked.
Data from the FBI's Supplementary Homicide Report provide informa-
tion about both victims and offenders for state and local areas, but there are
major coverage errors (whole states are missing in some years) and content
errors (Loftin, 1986; Loftin et al., 1987~.
STRATEGIES FOR IMPROVEMENT
Coordinate Federal Focus on Data Related to Violence
Chief among the strategies needed to improve data collection on vio-
lence involving children and families is the need to better coordinate and
integrate federal efforts to collect, analyze, and disseminate such data. There
is a growing interest in the problem of violence at the federal level, and
numerous departments and agencies have overlapping interests in ensuring
the availability and use of high-quality data. This coordination should
extend beyond intradepartmental efforts to go across departments, such as
health and human services, justice, education, labor, and housing and urban
development.
The benefits of better coordination and integration are clear. First,
pooling financial support for surveys and other data collection activities
will allow more efficient use of limited resources. For example, the Na-
tional Center for Injury Prevention and Control of the Centers for Disease
Control and Prevention and the Bureau of Justice Statistics are currently
working more or less independently to collect information on intentional
injuries through the National Electronic Injury Surveillance System (de-
scribed above). In addition, the National Institute for Occupational Safety
and Health of the Centers for Disease Control and Prevention is interested
in using these data for monitoring work-related violent injuries. This is a
clear instance in which coordination and integration could improve data
quality and increase efficiency in the use of federal resources.
Second, more consistent estimates of the incidence and prevalence of
violence and related behaviors could be produced through the use of consis-
tent definitions and methodologies for data collection across federal depart
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INTERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
209
meets. The violence field, particularly in the realm of family violence, is
rife with conflicting estimates of magnitude and trends. Coordinating defi-
nitions and methodologies could help improve the consistency in results
across federal surveys.
A mechanism is needed to achieve meaningful coordination and inte-
gration. The Federal Forum on Aging Statistics, which has been instrumen-
tal in this process across the National Institute on Aging, the National Cen-
ter for Health Statistics, and the Bureau of the Census, is a potential model.
An interagency committee or a third party (such as the Committee on Na-
tional Statistics) could also be useful.
Coordinated Methodological Research Program
Because the methodological problems of measuring violence and its
impact on families and children are interrelated and similar across data
collection systems, coordinated research on basic methodology would be
appropriate. A consortium of agencies or the National Science Foundation
could study issues such as:
· the relative effectiveness of different methods of screening for and
measuring the characteristics of violent behavior, especially involving chil-
dren and within households
· the effects of alternative collection methods that protect respondents'
privacy in household surveys,
· techniques for improving coverage of persons at high risk for per-
sonal violence in household surveys, and
· estimation procedures that incorporate information from multiple sampling
frames, such as household samples and the records of service organizations.
Explore More Efficient Ways of Identifying Cases
Household surveys of serious assaultive violence require large, expen-
sive screening operations because most of the households contacted will not
have experienced a target incident. As a result, most of the expense of data
collection is devoted to interviews that are not directly useful for analysis.
Any procedure that increases the efficiency of screening will vastly im-
prove the cost-effectiveness of surveys.
Two promising approaches to reducing the costs of screening are using
multipurpose screening surveys and surveys that use both household samples
and samples drawn from administrative records and registration systems.
With multipurpose screening, a survey designed to locate children for a
study of immunization could, for example, also locate them for a study of
violent behavior. The same survey could also be used to locate older re
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210
INTEGRATING FEDERAL STATISTICS ON CHILDREN
spondents for a study of elder abuse and other issues concerning older
citizens.
Household samples and samples from administrative records are comple-
mentary and used together, as in the National Incidence Studies of Missing,
Abducted, Runaway, and Thrownaway Children, provide a much broader
range of data than they do separately.
Explore the Feasibility of Collecting Data in
Key Health Care Settings
Changes in the way services are delivered provide opportunities for
new data sources. Two changes in the health care system have already led
to more accurate and informative data collection on violence. First, the
growing movement to ensure that health care providers are sensitive to
evidence that their patients are being abused has led to widespread training
programs for health care students and practitioners and to protocols for
identifying, assessing, and referring victims of violence. This advance has
the potential of greatly improving the quality and depth of data that might
be collected on violence from health care providers.
Second, the rising costs of health care in recent decades have spawned
the development of health maintenance organizations, which, as health care
reform evolves, are likely to provide primary health care to an increasingly
larger proportion of the population. These organizations may be excellent
sites for acquiring data on the incidence of violence, particularly family and
intimate violence, in defined populations and on the health consequences of
violence and its impact on child and family development. We need to
explore the feasibility of developing and testing alternative methods for
data collection in health maintenance organizations and other key health
care settings (e.g., emergency departments, public prenatal clinics).
Develop Efficient Ways for Small-Area Estimation
State and local data provide a crucial underpinning for developing and
evaluating local prevention policies and programs because patterns of vio-
lence differ across regions and localities. For these reasons and because the
great majority of violence prevention activities occur at the local level, it is
important that, whenever possible, federal data collection systems allow for
small-area estimation.
There are several models of data collection systems that allow for esti-
mating national, state, and local patterns simultaneously. For example, the
Youth Risk Behavior Surveillance System has three complementary compo-
nents: (1) a national school-based survey, (2) state and local surveys, and
(3J a national household-based survey (Kolbe et al., 19939. These three
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Il\/'TERPERSONAL VIOLENCE FOR CHILDREN AND FAMILIES
211
components provide comparable information on risk behaviors in different
subpopulations of adolescents in the United States. Another example is the
Fatal Accident Reporting System supported by the National Highway Traf-
fic Safety Administration. This system collects detailed information on all
fatal motor vehicle crashes in the United States (National Highway Traffic
Safety Administration, 19933. The system also links data on these events
across police records, medical examiner and coroner files, emergency medi-
cal service reports, and hospital medical reports. Because this system is
essentially a census, state and local data are easily obtainable. This system
has provided extremely useful data for evaluating the effectiveness of state
laws designed to prevent motor vehicle fatalities (e.g., safety belt laws,
child safety seat laws).
CONCLUSIONS
Violence is a serious problem facing American families and communi-
ties. Recognition of the enormous costs of violence in terms of direct
medical expenses, psychological trauma, and damage to community institu-
tions is growing. Given the cost of violence to communities, little has been
invested in research and data collection that would provide a rational basis
for prevention and control. Existing data collection systems that provide
information on the incidence, patterns, and consequences of violence suffer
from fragmentation, response error, undercoverage, and lack of information
about important aspects of the problem.
Coordination at the federal level to measure violence and its conse-
quences would improve the quality, consistency, and efficiency of data col-
lection efforts. Federal coordination would also encourage methodological
research on such key issues as improving the validity of responses on sensi-
tive issues, improving the efficiency of screening for violent incidents, cap-
turing the complexity of violent events, improving coverage of persons
unconventionally attached to households, and estimating the impact of vio-
lence in local areas.
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Representative terms from entire chapter:
vital statistics
