United States Surgeon General Dr. David Satcher on youth violence prevention

(CNN) -- Although the trend of violence among young people is decreasing, it is a public health concern and efforts should be focused on prevention, according to a Surgeon General's report released on January 17. The report focused on minors from about age 10 through high school age and found effective community interventions before and during this time were beneficial.

Dr. David Satcher has served as both Surgeon General and Assistant Secretary for Health since February 18, 1998, becoming the first person to simultaneously hold these two positions. Prior this appointment, Satcher served as Director of the Centers for Disease Control and Prevention and Administrator of the Agency for Toxic Substances and Disease Registry, where he served from 1993 to 1998.

CNN Moderator: What environmental aspects can contribute to violence in young people?

Dr. David Satcher: Well, in the report, we tried to point out that the major risk factors can be summarized as gangs, guns and drugs. To some extent, that may be an over-abbreviation of the problem, but, clearly, individual characteristics such as the early exposure and use of substances and alcohol increase the risk for youth violence.

By the same token, environmental factors impact on children more than family once they become adolescents. So, experiences in the school with gangs and bullying and drugs are areas of major concern. Likewise, the ease of access to guns in the community represents another major risk factor for violence.

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Question from the chat room: How much of youth violence do you think is an effort to be "normal" by mass media presented standards?

Dr. David Satcher: The issue of the role of the media in youth violence is an important one, and some people expected it to be a major focus of our report. But, in the report, while we point out that exposure to violence in the media -- especially television -- can significantly increase aggressive behavior in youth, it is not a major long-term factor in violent behavior. This is obviously an area where the research needs to continue.

CNN Moderator: One of our audience members says, "A major factor in youth drug use and crime is what is learned at home from family members, most especially the heads of household."

Dr. David Satcher: Clearly, the major factors in youth violence in children, especially prior to puberty, are in the family. After adolescence, that shifts and the major risk factors become peer interactions, including gangs. But, without question, the role of family, the role of parents and the role of parent-child interactions are major risk factors in the development of patterns of youth violence.

Question from the chat room: We all faced challenges in our youth. Making the right choices was hard, especially the teens of the 60's. Why is youth violence such a problem with today's young people?

Dr. David Satcher: I think you're right. Youth violence is not new. One of the major findings we make in this report is that while we have made progress, the youth violence epidemic in this country is not over. We have seen a decline in arrest rates, a decline in homicide, robbery and rape by youths, but not a significant decline in aggravated assaults. The fact that these assaults are much less likely to involve the use of guns represents a major change since 1993.

MORE Report of the Surgeon General on youth violence   RESOURCES The National Youth Violence Prevention Resource Center has tips for concerned parents and teens

But whether we look at youth violence from the standpoint of aggravated assault or from the self-reporting of youth in surveys, it is clear that there is still a high level of youth violence in this country. The major factors today fall into the categories of individual and environmental factors. Prevention programs focus on both of these areas.

Question from the chat room: Do you believe that the costs of such programs would be more than offset by the economic benefit of reduced crime?

Dr. David Satcher: Clearly, investing in effective programs to reduce youth violence is a very cost-effective investment. Today, we are investing heavily, and increasingly, in the incarceration of youth -- sometimes in adult facilities. This is not the best investment we can make. The best and the most cost-effective investments are in youth violence prevention programs that have been evaluated and shown to be effective at preventing or ameliorating youth violence. One example of that kind of program that is well known to people in America is the Boys' and Girls' Clubs of America.

Question from the chat room: Can a lack of respect for today's society and attitude of "the world owes me" also be a major reason for escalation in violence?

Dr. David Satcher: Clearly the attitude of youth can affect their behavior. That includes increasing aggressiveness, but also the early use of drugs, including alcohol. By the same token, the nature of parent-child interaction and the presence of anti-social behavior in parents will increase the incidence of youth violence.

As children get older, the major risk factors shift from home and family to peer interaction in the community, including the school. But again, in school the presence of gangs and bullying and drugs as well as easy access to guns in the community are major factors in youth violence.

Question from the chat room: As a father of two pre-school children, what signs should I look for to distinguish a propensity for violence from normal childhood behavior, other than the obvious cruelty to animals type of behavior.

Dr. David Satcher: In the report, we point out that aggressive behavior in childhood and early use of drugs and difficulty in parent-child interaction can be risk factors for youth violence. We specifically say that criminal behavior that's not necessarily violent significantly increases the risk for youth violence. The effective programs for preventing youth violence involve intervening in these individual factors parent training, sometimes home visits by outside experts, and being attentive to the environment of the child beyond home and family.

Question from the chat room: Are there any theories as to why American children seem to be more violent than children overseas?

Dr. David Satcher: When we compare American children with children overseas, there's clearly a difference in the ease of access to guns and the use of guns in violent behavior. We are clearly making progress in this area. But, other than the fact of guns, I think it is fair to say that other countries are experiencing serious problems with youth violence, including drug abuse and gang behavior.

For example, when I was visiting Australia to visit their mental health programs, they pointed out the extent to which school violence was a concern and the role of bullying in interfering with safe school environments. We were also able to visit schools where programs had been developed to counteract bullying and other youth violence risk factors.

Question from the chat room: The majority of parents have to work until after school hours. What kinds of programs would benefit these children?

Dr. David Satcher: It is true that increasingly, many parents are having to work beyond school hours, creating what is called the "latchkey children culture." In these situations, parents should do their best to maximize the time they have with their children, including staying on top of their experiences at school, the nature of peer interaction, and whether there is any risk for drugs or gangs. Some communities have developed programs where parents support each other working in conjunction with the school to better protect children from environmental hazards. Those hazards include gangs, drugs and guns.

CNN Moderator: Are there any community programs now in effect where parents, the schools and the community are working together to address youth violence?

Dr. David Satcher: There are some very interesting programs involving parents, schools and communities working together to reduce the risk of youth violence. At the time of the release of the report, I mentioned a very innovative partnership among the Department of Health and Human Services, the Department of Justice and the Department of Education, called "Safe Schools, Healthy Students." Working together, these three departments conceptualized a program that could be implemented in communities that would bring together parents, schools, the criminal justice system, the mental health system, the faith-based community and others to prevent youth violence and other forms of threats to the health of children. We have now funded well over 100 school districts in the country to help implement these programs. It is important to point out that the key elements of these programs are taken from programs that have been evaluated and found to be effective in preventing or reducing youth violence or for preventing or reducing the risk factors for youth violence.

Question from the chat room: Is there any link between divorce and violence?

Dr. David Satcher: We did not look at the issues of divorce specifically, but obviously we know that next to the loss of a spouse by death, divorce is one of the most stressful experiences that a family can have. Anything that increases the amount of stress that children must deal with can increase the risk for violence. But, it would not be fair, necessarily, to look at divorce in the absence of the continuing relationship between both parents and the children.

CNN Moderator: One of our audience members says, "Schools cannot undo what they learn at home, and it shouldn't be the schools job to teach them respect, manners, etc." What role do you see for schools in addressing youth violence?

Dr. David Satcher: I think the major point that we try to make in the report was that, for children -- especially prior to puberty -- the major risk factors for violence tend to be individual and family. But after adolescence, the shift is to peer interactions, and what takes place at school in this arena is very critical. The role of gangs, drugs and bullying are especially important in the school environment, and to the extent to which the schools deal with these factors in the school environment, these factor can be ameliorated.

Question from the chat room: It is well established that in most of the school shootings, the suspects were on some type of psychiatric drug; do you feel this relationship between these drugs and violence should be further examined?

Dr. David Satcher: There are two points that are important to make here. The first is that our studies show that the high-profile school shootings represent less than 1 percent of youth violence in the country. Youth violence is much more likely to take place in the home and the community than in school. But in all of these settings, mental health is important and should continue to be a target of our research and concern. In the Surgeon General's Report on Mental Health, we point out that most of the violence in this country is not carried out by those who are mentally ill. And generally, when people who are mentally ill commit violence, it is when those people are not under treatment or are suffering from substance abuse. But our research must continue in this area.

CNN Moderator: Thank you for joining us today, Dr. David Satcher.

Dr. David Satcher: Good bye, I've enjoyed being with you and I look forward to continuing this dialogue across the country and implementing programs to prevent youth violence.

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Virtual Office of the U.S. Surgeon General
CDC:Facts About Violence Among Youth and Violence in Schools
National Campaign Against Youth Violence
Keep Schools Safe
American Psychological Association: Warning Signs of Teen Violence
Center for the Study and Prevention of Violence

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