- AAP =
- American Academy of Pediatrics
In its report titled “The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level,” the American Academy of Pediatrics (AAP) made a bold and visionary statement.1 For the first time the AAP is advocating that violence prevention and the promotion of nonviolence be thoroughly integrated into the education, clinical practice, and community activities of pediatricians. This is a historic step because it makes pediatrics the first medical specialty to fully embrace the idea that violence is a health issue and that the responsibility for violence prevention does not rest solely in the hands of the criminal justice system. This statement also reflects the growing attention that the larger medical community, through the American Medical Association and other medical organizations, is paying to the health consequences of violence and the physician's role in addressing violence.
Children and youth are the witnesses, victims, and perpetrators of violence that has become increasingly lethal in our society,2 and the victims and perpetrators involved in these events are becoming younger and younger.3 ,4 The impact of violence on our children, however, reaches far beyond the immediate physical and emotional injuries. The evidence is mounting that exposure to violence at a young age can influence the risk for adult health problems such as substance abuse, depression, suicide attempt, high-risk sexual behaviors, obesity, and smoking.5 In recognizing the profound health implications of violence, the AAP has adopted two innovative perspectives in describing the role of the pediatrician. First, in outlining the ways pediatricians can contribute to violence prevention, they go far beyond practices that directly target the issue of violence to include broader issues of promoting nurturing and nonviolent environments. This is significant in that it explicitly recognizes that violence is the product of fundamental social and environmental problems such as dysfunctional parent/child relations, limited availability of positive community and recreational activities, and the accessibility of lethal commodities. Physicians can address these problems through clinical interactions with children and parents as well as in their capacity as advocates for the health and well-being of children. Second, in adopting a developmental framework for organizing pediatric practices in this realm, the AAP recognized that perhaps the greatest promise for realizing violence prevention lies in early interventions that will interrupt or alter developmental trajectories that may lead to violent behavior. There is considerable evidence that early interventions can produce positive and persistent changes in human development, changes that are associated with a lower risk of engaging in violent behavior.6 Pediatricians are in an ideal position to intervene early through clinical practices and referrals and, through their leadership, to advance policies that broadly implement effective early interventions.
Along with parents and teachers, pediatricians are the primary advocates for children in our society. Their leadership in addressing problems such as child abuse and lead poisoning has been critical to advances in reducing the health consequences of these health problems. The problem of youth violence in our society did not appear overnight nor will it be easily controlled. The leadership and participation of pediatricians in violence prevention efforts, however, provides greater hope by broadening the horizon of possibilities for reducing the impact of violence on our children and youth and for marshaling the active participation of many more health professionals in violence prevention efforts.
- Received November 10, 1998.
- Accepted November 10, 1998.
Reprint requests to (J.A.M.) Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724.
- ↵American Academy of Pediatrics, Task Force on Violence. The role of the pediatrician in youth violence prevention in clinical practice and at the community level. Pediatrics. 1999;103;000–000
- ↵Mercy JA, Rosenberg ML. Firearms violence in and around schools. In: Hamburg B, Elliott DS, Williams KR, eds. Violence in American Schools. New York, NY: Cambridge University Press; 1998:159–187
- ↵Mahuire K, Pastore AL, eds. Source Book of Criminal Justice Statistics—1995. US Department of Justice, Bureau of Justice Statistics. Washington, DC: US Government Printing Office; 1996:423
- ↵US Department of Justice. Age-specific Arrest Rates and Race-specific Arrest Rates for Selected Offenses, 1965–1992. Washington, DC: Federal Bureau of Investigation, US Department of Justice; 1993
- Copyright © 1999 American Academy of Pediatrics