activities that also provided mentoring and role models. Drug activity at the new play sites was controlled by the district attorney's community outreach project. Following the implementation of these interventions, the Northern Manhattan Injury Surveillance System found a 46 percent decrease in injury due to guns and assaults (Durkin et al., 1996) and about a 50 percent reduction in traffic injury (Davidson et al., 1994; Laraque et al., 1995). The incidence of pediatric neurological trauma, the leading cause of death and disability from injury, was reduced by 44 percent in the intervention cohort (Durkin et al., 1998).

Intentional Injury Prevention

Suicide Prevention

The overall suicide rate has remained relatively stable for the past decade, as it has over much of the past 50 years (Baker et al., 1992; Kachur et al., 1995). This stability masks some disturbing trends among such subgroups as adolescents, young adults, and the elderly. From 1980 to 1992, the suicide rate increased by 121 percent for children ages 10–14, by 27 percent for adolescents ages 15–19, and by more than 10 percent for the elderly ages 70 and older (Kachur et al., 1995). The highest suicide rate is among persons ages 80–84, for whom the rate increased 36 percent over this time frame (Kachur et al., 1995). The increase in suicide among the very old is thought to be related, in part, to longer yet poorer quality of life, for which better palliative care is needed (GAO, 1998).

The majority of suicides (60 percent) in 1992 were committed with a firearm, and firearm suicides accounted for most of the increase in age-specific suicide rates during the 1980s (Kachur et al., 1995). Case-control injury studies have shown that the risk of suicide is up to five times higher for persons living in a home where firearms are present (Brent et al., 1991, 1993; Kellermann et al., 1992). Access to firearms raises suicide risk among teens without a psychiatric disorder (Brent et al., 1993), supporting the view that restrictions on firearm access can curtail suicides among teens who, as a group, are often more prone than older adults to suicide as an impulsive act.

Mental disorders constitute the most important risk factors for suicide. Many suicide victims have affective, substance abuse, personality, or other mental disorders (U.S. Preventive Services Task Force, 1996). Research also has identified environmental and social risk factors, including access to firearms, problems of social adjustment, serious medical illness, living alone, recent bereavement, family history of completed suicide, and others (Shaffer et al., 1988; U.S. Preventive Services Task Force, 1996).

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