From Criminal Justice to Public Health

Criminal justice approaches attend to violence with secondary and tertiary interventions after violence occurs

Public health approach implies that violence is a learned behavior that can be changed and prevented

Types of Violence in U.S. Society

Violence in the family

Domestic violence against women

Child maltreatment

Elder maltreatment

Youth violence

Workplace violence

Mass violence and war

Violence in the Family

Main theories of family violence:

First focuses on abuser and possible behavioral or psychopathological causes

Second postulates “Cycle of violence” is learned in childhood and transmitted across generations

Violence in the Family

Main theories of family violence:

Third theory speculates that stressful situations precipitate violence

Domestic Violence Against Women

Domestic violence occurs in all ethnic and cultural groups and in all educational and socioeconomic levels

Prevalence statistics available but domestic violence severely underreported and underdiagnosed

Domestic Violence: Characteristics of Batterers

Often suffer from low self-esteem and have a need to use power and control tactics over victims

Usually minimize own behavior and blame the victim for the violence

Tend to be jealous, abusive to children, and sexually aggressive to partners

Domestic Violence: Characteristics of Victims

Learned helplessness

Survivors

Learned hopefulness

Domestic Violence Against Women: Indicators

Recurrent trauma history

Proximal injuries

Patterned, multiple, or bilateral injury

Poor explanations or no explanations for injuries

Concealing or acting ashamed of injuries

Domestic Violence Against Women: Indicators

Delay in seeking treatment with wounds in various stages of healing

Physical injury during pregnancy

Signs of depression

Other psychological cues

Alcohol or substance abuse symptoms

Domestic Violence Against Women: Indicators

Chronic pain with no known cause

Seeking medical care for minor problems

Missing scheduled appointments or only coming in for acute care

Overly protective, controlling partner who visits professionals with client

Child Maltreatment

Physical abuse

Physical neglect

Sexual abuse

Emotional abuse

Incidence of Child Abuse

Poverty and single parent families are at increased risk

Younger children are at highest risk

Underestimated because approximately 85% of deaths from abuse are coded as some other cause on death certificates

Elder Maltreatment: Categories

Domestic abuse

Institutional abuse

Self-abuse

Neglect

Demographics of Elder Abuse

For every one reported incident of elder abuse, neglect or self neglect, approximately five go unreported

Age and Income affect abuse

Females experience more of all forms of abuse except abandonment

Elder Maltreatment: Types and Indicators

Physical abuse (26%)

Sexual abuse

Emotional/Psychological abuse (35%)

Neglect (49%)

Abandonment (3%)

Financial or material exploitation (30%)

Forms of Family Violence

Physical Abuse: Inflicting injury or illness, withholding necessities of health

Sexual Abuse: Coercing any sexual contact without consent, undermining sexual identity

Forms of Family Violence

Psychological Abuse: Instilling fear, isolating, undermining sense of self-worth

Economic Abuse: Taking funds, making financially dependent

Youth Violence: Scope of the Problem

Youth disproportionately affected by violent injury and death in the U.S.

At-risk group of perpetrators has shifted to younger ages and females appear to be more involved in violent behavior

Homicide and suicide rates higher in U.S. than in rest of industrialized world (<15)

Gangs

Gangs are about power, fear, intimidation, crime, and very often extreme forms of violence

Gang activities cut across all socioeconomic, racial/ethnic, and gender boundaries and exist in rural, inner-city, suburban communities

Gangs: Warning Signs

Some items not gang related, but a combination may point to an association:

Unexplained wealth

Unexplained change in types and designs of jewelry

Lack of participation in typical family activities

Gangs: Warning Signs

Unexplained and atypical music

Habitual lying

Aggressive or violent behavior toward family or former friends

Drug/alcohol use

Defiance of authority

Blaming others for troubles

Gangs: Warning Signs

Unexplained tattoos

Denial of a problem

Refurbishing or reorganizing room

Expressing feelings of rejection

Association with youngsters of similar styles of dress, grooming, writing, and language

Gangs: Levels of Involvement

Wannabes, Peripheral, Regulars, Leaders, and Imitators

Any of these levels of involvement can be dangerous for both participants and those that come into contact with them in the community setting

Gangs: Response

Prevention Strategies

Intervention Strategies

Suppression

Two most important issues to overcome:

admit that the problem exits

overcome agency & jurisdiction issues

Gun Control

The proportion of youths committing violent acts has not altered, but the lethality of those acts is greater

Risk of suicide is three times greater and the risk of homicide is five times greater when a gun is present in the home

Gun Control

Ease of access to guns is viewed as contributing to problem of youth violence, and interest in public health policy on gun control has become more intense

Both ANA and APHA have been advocates for policy proposals to decrease access to guns

Dating Violence

Depending on the definition of violence, reported nonsexual courtship violence rates range from 5% to 65%

27% female college students have experienced rape or attempted rape

80% to 90% of rapes on campuses are committed by acquaintances

Suicide

9th leading cause of death for Americans

3rd leading cause of death ages 15 to 24

90% of suicides in U.S. among whites

Males committing suicide almost 4 times more often than females

Growing problem among African American youth (157% increase)

Causes of Youth Violence

Theories on causation focus on the early development of aggressive behavior and tendencies for it to exhibit at earlier ages

Societal factors that have made youth aggression more destructive:

easy access to handguns

increasing violence in the media

Workplace Violence

Homicide

Beatings

Rape

Assault

Battery

Theft

Robbery

Threats

Harassment

Intimidation

Mass Violence and War: Scope of the Health Problem

Physical health

Psychological health

Soldiers’ postcombat health

Impact on health determinants

Roles of Nurses Related to War

Surveillance and documentation of the health effects of war and causes of war

Education and awareness-raising programs on the health effects of war

Advocation of preventive policies and actions

Roles of Nurses Related to War

Direct action to prevent war and its consequences

Direct care of those wounded and dying from combat

Interventions to Prevent Violence

Interventions are efforts to break the causal chain between potential violence and actual violence

Interventions related to violence can be directed to all three system levels

Interventions related to violence can be representative of a level of prevention


	Criminal justice approaches attend to violence with secondary and tertiary interventions after violence occurs

	Public health approach implies that violence is a learned behavior that can be changed and prevented


	Violence in the family
		Domestic violence against women
		Child maltreatment
		Elder maltreatment
	Youth violence
	Workplace violence
	Mass violence and war


	Main theories of family violence:
	First focuses on abuser and possible behavioral or psychopathological causes
	Second postulates “Cycle of violence” is learned in childhood and transmitted across generations



	Main theories of family violence:
	Third theory speculates that stressful situations precipitate violence


	Domestic violence occurs in all ethnic and cultural groups and in all educational and socioeconomic levels

	Prevalence statistics available but domestic violence severely underreported and underdiagnosed


	Often suffer from low self-esteem and have a need to use power and control tactics over victims
	Usually minimize own behavior and blame the victim for the violence
	Tend to be jealous, abusive to children, and sexually aggressive to partners


	Recurrent trauma history
	Proximal injuries
	Patterned, multiple, or bilateral injury
	Poor explanations or no explanations for injuries
	Concealing or acting ashamed of injuries


	Delay in seeking treatment with wounds in various stages of healing
	Physical injury during pregnancy
	Signs of depression
	Other psychological cues
	Alcohol or substance abuse symptoms


	Chronic pain with no known cause
	Seeking medical care for minor problems
	Missing scheduled appointments or only coming in for acute care
	Overly protective, controlling partner who visits professionals with client


	Poverty and single parent families are at increased risk
	Younger children are at highest risk
	Underestimated because approximately 85% of deaths from abuse are coded as some other cause on death certificates


	For every one reported incident of elder abuse, neglect or self neglect, approximately five go unreported
	Age and Income affect abuse
	Females experience more of all forms of abuse except abandonment


	Physical abuse (26%)
	Sexual abuse
	Emotional/Psychological abuse (35%)
	Neglect (49%)
	Abandonment (3%)
	Financial or material exploitation (30%)


	Physical Abuse: Inflicting injury or illness, withholding necessities of health

	Sexual Abuse: Coercing any sexual contact without consent, undermining sexual identity


	Psychological Abuse: Instilling fear, isolating, undermining sense of self-worth

	Economic Abuse: Taking funds, making financially dependent


	Youth disproportionately affected by violent injury and death in the U.S.
	At-risk group of perpetrators has shifted to younger ages and females appear to be more involved in violent behavior
	Homicide and suicide rates higher in U.S. than in rest of industrialized world (<15)


	Gangs are about power, fear, intimidation, crime, and very often extreme forms of violence

	Gang activities cut across all socioeconomic, racial/ethnic, and gender boundaries and exist in rural, inner-city, suburban communities


	Some items not gang related, but a combination may point to an association:
	Unexplained wealth
	Unexplained change in types and designs of jewelry
	Lack of participation in typical family activities


	Unexplained and atypical music
	Habitual lying
	Aggressive or violent behavior toward family or former friends
	Drug/alcohol use
	Defiance of authority
	Blaming others for troubles


	Unexplained tattoos
	Denial of a problem
	Refurbishing or reorganizing room
	Expressing feelings of rejection
	Association with youngsters of similar styles of dress, grooming, writing, and language


	Wannabes, Peripheral, Regulars, Leaders, and Imitators

	Any of these levels of involvement can be dangerous for both participants and those that come into contact with them in the community setting


	Prevention Strategies
	Intervention Strategies
	Suppression
	Two most important issues to overcome:
		admit that the problem exits
		overcome agency & jurisdiction issues


	The proportion of youths committing violent acts has not altered, but the lethality of those acts is greater

	Risk of suicide is three times greater and the risk of homicide is five times greater when a gun is present in the home


	Ease of access to guns is viewed as contributing to problem of youth violence, and interest in public health policy on gun control has become more intense
	Both ANA and APHA have been advocates for policy proposals to decrease access to guns


	Depending on the definition of violence, reported nonsexual courtship violence rates range from 5% to 65%
	27% female college students have experienced rape or attempted rape
	80% to 90% of rapes on campuses are committed by acquaintances


	9th leading cause of death for Americans
	3rd leading cause of death ages 15 to 24
	90% of suicides in U.S. among whites
	Males committing suicide almost 4 times more often than females
	Growing problem among African American youth (157% increase)


	Theories on causation focus on the early development of aggressive behavior and tendencies for it to exhibit at earlier ages
	Societal factors that have made youth aggression more destructive:
		easy access to handguns
		increasing violence in the media


	Homicide
	Beatings
	Rape
	Assault
	Battery
	Theft
	Robbery
	Threats
	Harassment
	Intimidation


	Physical health
	Psychological health
	Soldiers’ postcombat health
	Impact on health determinants


	Surveillance and documentation of the health effects of war and causes of war
	Education and awareness-raising programs on the health effects of war
	Advocation of preventive policies and actions


	Direct action to prevent war and its consequences
	Direct care of those wounded and dying from combat