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Improving Health in the Community: A Role for Performance Monitoring
second leading cause for young white men aged 15–24. Violence leads to many injuries as well as deaths, some of which require health care in hospital emergency rooms and other settings. In 1992, about 1 per 10,000 Americans suffered assault injuries (USDHHS, 1995).
The costs of violence are high—estimated at $54,000 per attempted or completed rape, $19,200 per robbery, and $16,000 per assault. A portion of these costs are financial, but the majority reflect pain, suffering, the risk of death, psychological damage, and reduced quality of life (NRC, 1993). Although violence affects all segments of American society, minorities are substantially more likely to be victims of violent crime. In 1990, for instance, African Americans were 41 percent and Hispanics 32 percent more likely than whites to be victims of violent crime (NRC, 1993).
Violent actions including rape, domestic violence, drive-by shootings, and terrorist attacks are highlighted daily in all forms of media. The issues of violence in our society are also highlighted in the content of television fiction and nonfiction programming. It is estimated that by age 18, children will have been exposed to 18,000 televised murders and 800 suicides; most will have seen 100,000 acts of violence on television by the sixth grade (Canterwall, 1992).
Substance use and psychosocial, family-mediated factors are major risk factors for violent behavior. Social factors associated with violence include concentration of poor families in geographic areas, income inequality, population turnover, community transition, family disruption, housing density and other aspects of social disruption, and opportunities for violence such as illegal markets in drugs and firearms (NRC, 1993). Dysfunctional family life (e.g., absent or divorced parents, turmoil and fighting between family members) is an early predictor of violence, especially for youth. Witnessing violence in the home and community is harmful to children and youth exposed to the violent event, even if they are not victims of the violence. Thus, as more violence occurs in homes, in neighborhoods, and in the media, greater percentages of the population are at risk to experience violence.
Criminal justice, health care, education, social services, and other community institutions can address the effects of violence and help prevent it. Strategies range from passing and enforcing strong gun control laws, to more punitive sentencing guidelines and building more jails, to community education and outreach programs aimed at violence prevention. Others focus on address-