Violence by and to young people - despite recent decreases, still among the most pressing health problems facing the nation's cities - is being targeted by a variety of programs, yet little scientific evidence exists to assess what works and what doesn't, a scientist is warning.
Michael B. Greene, PhD, director of research and evaluation at Hunter College Center on AIDS, Drugs, and Community Health in New York City, writes in the April issue of the journal, Health Education and Behavior: "Even a small percentage reduction in youth violence can substantially reduce health care costs.... Unfortunately, we have not been terribly successful in figuring out how to engage...schools, hospital centers, the juvenile justice system, and youth advocacy programs in collaborative and synergistic efforts."
This is the second of two special issues the journal has focused on community-based health education for urban populations, to help develop an urban health agenda for the next century.
In his review of violence-reduction strategies, Greene examines four basic educational approaches and the evidence related to their effectiveness:
- Conflict management skills training. "Widely embraced as a primary prevention strategy, (its) efficacy in reducing violent and aggressive behavior has not yet been established," he writes. Several outcome evaluations are underway, he reports, but the only published one that used a random assignment design revealed "equivocal results."
Greene also notes that "it is not clear how and to what extent conflict management programs can be integrated into an overall violence reduction effort, and the few efforts that have been undertaken have not been described in sufficient detail to replicate."
- Youth-operated peer mediation, education, advocacy, and community service. The impact of such programs is difficult to assess, Greene says, because it is difficult to "tease out" the youth-operated components from supplementary services the programs usually provide. Several evaluations of youth-run peer mediation are now in progress, he says, and results "should be available in the near future."
"Youth-operated programs," Greene writes, "establish an avenue for young people to create cohesion and pride in their neighborhoods, to enhance their sense of belonging, and to make friends based on mutually shared, goal-oriented projects."
- Psycho-educational strategies, such as support groups and counseling young victims of violence. Because they are usually aimed at youth who are chronically exposed to violence, such programs in effect reach those who are at significant risk of perpetrating violence on others, Greene says. "The potential for these programs to interrupt the cycle of violence is promising, (but) no rigorous evaluations...have been published."
- Family-based education. These include such programs as conflict resolution counseling for parents of very young children and giving families with high-risk adolescents a combination of therapy and stress reduction strategies. Unlike most other strategies examined by Greene, the latter have been subjected to "rigorous evaluations in multiple settings, with findings revealing a significant reduction in violence and drug use attributable to the program.... Although generally promising...we (still) need to learn a great deal more about how and in what circumstances family intervention strategies work."
Dr. Greene notes that most authorities urge "comprehensive and integrated approaches that incorporate aspects of each strategy." The variations of conditions from neighborhood to neighborhood also need to be assessed, he writes, but understanding how and whether programs can be adapted to specific local conditions remains limited. "Even programs that have stood the test of rigorous evaluation in one setting," he says, "may not 'travel' well" and need additional research.
Journal
Health Education & Behavior