Effectiveness of a Mentor-Implemented, Violence Prevention Intervention for Assault-Injured Youths Presenting to the Emergency Department: Results of a Randomized Trial
OBJECTIVE. The goal was to assess the impact of a mentor-implemented, violence prevention intervention in reducing aggression, fighting, and reinjury among assault-injured youths.
METHODS. In a randomized, controlled trial performed in the emergency departments of 2 large urban hospitals, 10- to 15-year-old youths who presented with peer assault injuries were recruited and randomly assigned to intervention and comparison groups. In the intervention group, youths received a mentor, who implemented a 6-session problem-solving curriculum, and parents received 3 home visits with a health educator, to discuss family needs and to facilitate service use and parental monitoring. The comparison group received a list of community resources, with 2 follow-up telephone calls to facilitate service use. Youths and parents were interviewed at baseline and at 6 months, for assessment of attitudes about violence, risk factors, fighting, and repeat injury.
RESULTS. A total of 227 families were recruited, with 23% refusing participation and 4% providing partial interview completion. A total of 166 families were enrolled, with 87 assigned to the intervention group and 79 to the comparison group; 118 (71%) completed both youth and parent follow-up interviews, and 113 had usable data. The intervention and comparison groups were not significantly different at baseline with respect to demographic features or risk factors, except for increased knife-carrying and fewer deviant peers in the intervention group. After adjustment for baseline differences, there was a trend toward significant program effects, including reduced misdemeanor activity and youth-reported aggression scores and increased youth self-efficacy. Program impact was associated with the number of intervention sessions received.
CONCLUSIONS. A community-based, mentor-implemented program with assault-injured youths who presented to the emergency department trended in the direction of decreased violence, with reduced misdemeanors and increased self-efficacy.
Violent injury is a major cause of morbidity and death among adolescents. In the United States, homicide is the fourth leading cause of death among 10- to 14-year-old youths and the second leading cause of death among 15- to 24-year-old youths.1 Among black youths, homicide ranks third for 10- to 14-year-old youths and is the leading cause of death among 15- to 24-year-old youths. Youth violence often manifests as peer assault injury presenting to the emergency department (ED). In urban communities such as Washington, DC, interpersonal intentional injuries account for 25% of all adolescent injuries, 45% of hospitalizations, and 85% of injury-related deaths.2 Nonfatal violence is a major risk factor for subsequent assault injury and often precedes fatal violence.3–6 One population-based analysis found that assault victims experience recurrent injury risk 88 times that of unexposed individuals.7 Recurrent intentional injury rates of up to 44% in selected populations have been reported, leading some to characterize urban trauma as a chronic disease.8
The 2004 National Institutes of Health State-of-the-Science Conference on Preventing Youth Violence suggested that trauma centers may be important settings to initiate youth violence prevention interventions.9 Some have posited that the ED visit may be a “teachable moment,” a time of introspection and vulnerability after an injury event, and may be an opportune time to intervene with assault-injured youths to reduce violence. The American Academy of Pediatrics has advocated a system for identification, assessment, and treatment of the physical and psychosocial needs of assault victims to reduce the risk of reinjury and reactive perpetration.10 However, there have been few studies of ED interventions addressing youth violence to test this approach. Brief interventions in the ED have proved effective in addressing risky behaviors such as smoking11 and substance use12–14 and in injury prevention regarding seatbelt and bike helmet use for adolescents.15 The few studies addressing violence involved older youths and adults and had mixed results, which suggests the need for more intensive intervention with younger adolescents.16–19
The Centers for Disease Control and Prevention (CDC) comprehensively reviewed studies evaluating youth violence prevention programs.20 Interventions were categorized and assessed according to target methods and scientifically demonstrated efficacy. The CDC concluded that there are 4 strategies that offer the best hope for prevention, including (1) parent- and family-based programs, (2) early childhood home visitation, (3) social-cognitive interventions with youths, and (4) mentoring strategies. Multilevel and multicomponent interventions incorporating these strategies are needed.
We developed a violence prevention intervention targeting assault-injured youths who present to the ED and incorporating components of the 4 best-practice strategies described by the CDC, including a social-cognitive theory framework. We conducted a randomized trial of this intervention to assess the receptiveness of families to violence prevention interventions initiated after an assault injury and to assess the effectiveness of a mentor-implemented youth intervention with parent involvement in reducing risk factors for injury.
A sample of youths presenting to 2 urban EDs with assault injuries were identified for a randomized trial of a community-based intervention. Eligibility criteria included adolescents 10 to 15 years of age presenting to either a large urban children's hospital or an urban university hospital; residence in the Washington, DC-Baltimore, Maryland, metropolitan area; ED presentation with interpersonal assault injuries (codes E960, E961–E966, and E968–E969; International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Supplementary Classification of External Causes of Injury and Poisoning codes), excluding sexual assault, child abuse, sibling fights, and legal intervention; and mental, physical, and English-speaking abilities of the parent and child to participate in the intervention and assessments. Families were recruited over the period of August 2001 to August 2004. The study protocol was approved by the institutional review boards at the 2 hospitals and the National Institute of Child Health and Human Development.
We identified eligible youths who presented to the ED with assault injuries. Cases were identified from ED logs or chart copies and from computer printouts for hospitalized patients. Research assistants recruited families in the ED, in the hospital ward, or by telephone. When youths were eligible, parent informed consent and youth assent were obtained and youths and parents were interviewed independently during a home visit, as soon as possible after the ED visit. Interviews consisted of 2 components, a verbal response component and an audiotape (“Walkman”) component. For the audiotape component, subjects listened to questions asked on the Walkman and wrote numeric answers on an answer sheet that did not have the printed questions.
Opaque sealed envelopes were prepared with random assignment to 1 of the 2 groups. Interviewers opened the envelope with the family after completion of the baseline survey. Follow-up assessments were conducted 6 months later, by a research assistant. Efforts were made to ensure that that interviewer was blind to group assignment. Families were compensated for completion of baseline ($20) or 6-month ($30) assessments. Retention efforts included periodic telephone contacts and mailings, reminders to families to contact study staff members if the families moved, and home visits to families we were unable to reach.
Intervention and Comparison Conditions
Assault-injured youths in the intervention received a mentor who was to meet with them ≥6 times in the subsequent 2 to 6 months. Mentors were recruited from a partnering community mentoring organization and from employees at participating institutions. Eligible mentors were 21 to 50 years of age, had a history of working with youths, had no criminal history in their background checks, and had negative drug screen results. Mentors were gender-matched to youths, with most being matched to only 1 youth during the study. Mentors received extensive training on mentoring youths and on the project curriculum, including role playing regarding adolescent communication and conflict scenarios. Mentors were supervised by program staff members through regular telephone contacts, monitoring of mentor logs, feedback from the parents and youths, and occasional observation and retraining sessions. Mentors received a small stipend for their time and activity expenses ($240 total). The mentors picked up youths at their homes and spent time with the youths in activities at their homes or in the community. During these visits, the mentors and youths completed a 6-session, violence prevention curriculum focusing on skills building. The curriculum was grounded in social-cognitive theory and included sessions on conflict management and “hot buttons,” problem-solving, weapon safety, decision-making, and goal-setting. The curriculum also included interactive activities, role-playing scenarios, and a pledge to remain nonviolent.
Parents of youths in the intervention were offered 3 home visits from a health educator. Health educators had master's degrees in public health or psychology and were employees of the project. The parent curriculum included sessions reviewing topics covered in the youth curriculum and sessions on parental monitoring and involvement adapted from the Adolescent Transitions Program curriculum.21,22
Youths and parents in both the intervention and comparison groups were asked about services they had used and their current service needs in the baseline assessment. Families in both groups received case management services, including discussion of sequelae of assault injuries, assessment of family needs, and facilitated service use. Intervention group participants received this service through the health educator, whereas comparison group participants received 2 telephone calls. Referrals were made for mental health treatment, medical services, addiction treatment, anger management programs, recreational and after-school programs, legal aid, tutoring programs, and other social services as requested by the family. Participants in both study groups received usual care from clinicians in the ED, as well as a list of community resources.
Outcomes included attitudes and self-efficacy regarding violence (attitudes about interpersonal violence, attitudes about retaliation, social competence, and self-efficacy) and risk factors for violence (number of fights, fight injuries, weapon-carrying, misdemeanor problem behavior, friend behavior, and aggression). The interview was based primarily on previously published measures. All questions and items included in these analyses were collected at both baseline and 6-month assessments. All scales and indices were coded such that an increased score indicated more of that behavior or trait, that is, increased scores for problem behavior indicated that youths reported more frequently engaging in those behaviors and increased scores for self-efficacy indicated that youths perceived themselves as more efficacious than someone with a lower score. When scale scores were derived, missing items were replaced by the individual's mean of nonmissing scale items. If the missing items were >20% of the component items, then the scale was considered missing.
Youth assessments included questions on demographic features, attitudes, self-efficacy, and risk factors for violence. Youth attitudes toward interpersonal violence were assessed by using 6 items from the Attitude about Interpersonal Violence Scale described by Slaby and Guerra (baseline assessment: α = .65; follow-up assessment: α = .66).23,24 Youths also responded to the 8-item retaliation subscale of the Perception of Environmental Violence Scale (both baseline and follow-up assessments: α = .78).25,26 Social competence was assessed by using 8 items about problem-solving, communication, and peer pressure resistance (baseline assessment: α = .70; follow-up assessment: α = .75).27 A 11-item scale assessed conflict avoidance self-efficacy and was modified from a previously validated self-efficacy scale (baseline assessment: α = .89; follow-up assessment: α = .86).27 Questions asked how much youths agreed or disagreed that they could use tools to avoid arguments or fights, including “thinking about the consequences before I act” and “taking a time out when I start to get upset.”
Regarding risk factors for violence, youths were queried on how many times in the past 30 days they had been in fights, had been in fights with injury, and had carried a knife (from the Middle School Youth Risk Behavior Survey).28 Misdemeanors were assessed as the sum of 2 items on the number of days in the past 30 days in which youths had engaged in damaging property or stealing from a store.27 Youths reported on their friends' problem behaviors by answering how many days in the past 30 days they had hung out with friends “who get you in trouble, use drugs or alcohol, carry a weapon, start fights” and “who you were not supposed to.” Youth physical aggression over the past 30 days was measured by using an index based on the fighting subscale of the Modified Aggression Scale.24,29,30 The original scale was expanded to include location (school, home, and neighborhood). A total physical aggression score was computed on the basis of the 12 items (4 behaviors at each location) and was used in these analyses. Parents completed the 20-item aggression subscale of the Child Behavior Checklist (α = .97).31
To ensure that the assessments targeted relevant constructs and were effective with this population, development of the interview included 16 initial focus groups with adolescents regarding injury and violence,32 review of the literature on adolescent injury, and adaptation of models on adolescent risk-taking behavior.33–35 The interview instrument underwent rigorous one-on-one pretesting, including in-depth interviews probing how respondents understood and interpreted the study questions. This was followed by pilot-testing of the study process and completion of the interview under study conditions.
Analyses were conducted by using SAS 9.1 (SAS Institute, Cary, NC). Descriptive analyses were performed to assess demographic data and outcome measures at the baseline and 6-month follow-up assessments. All indices of problem and aggressive behaviors were heavily skewed toward 0; therefore, each was dichotomized such that 0 equaled none/never and 1 equaled ≥1 time/day for the purpose of prevalence descriptions. As appropriate for the type of variable, rate ratios and linear regression coefficients were calculated to examine the difference in outcomes of interest between the intervention and comparison groups. Analyses were performed for outcomes at the 6-month follow-up assessment while controlling for participant's age, gender, and baseline/pretreatment outcome finding. The analyses were conducted according to treatment group assignment, regardless of participants' adherence to the assigned intervention sessions. Subjects assigned to the intervention group who failed to start or to complete the intervention were included in the analysis. We did not impute outcome data for subjects lost to follow-up monitoring. The adherence level analyses were based on the number of sessions a family actually received, as assessed by the number of mentor visits with the youth and health educator visits with the parents. Families that received 6 mentor visits with the youth and 3 health educator visits with the parents were considered the high-adherence group; those that did not complete the full intervention were considered the low-adherence group.
Logistic regression analyses were used to compare demographic characteristics between the intervention and comparison groups at baseline. Odds ratios and associated 95% confidence intervals (CIs) were calculated. Because certain discrete outcomes were highly skewed and had zero-inflated counts (many count responses were 0), negative binomial regression was applied to model these variables (numbers of fight injuries and fights, knife-carrying, misdemeanor activity, problem behavior of friend, and aggression scores). Given that the outcomes are event counts during the 6-month period after the intervention, the regression coefficients from the negative binomial regression analyses can be interpreted as the logarithm of the ratios of event rates for the intervention and comparison groups. Standard linear regression was applied to model attitude scores, social competence, self-efficacy, and Child Behavior Checklist aggression subscale scores.
Because of the varying times (6–18 months) to follow-up assessments, a sensitivity analysis using only data for people who underwent follow-up assessment within 1 year was conducted; it yielded no differences in results. The study had 75% power with 95% confidence to detect a 0.5-SD difference in the number of fights and almost 80% power to detect a 0.5-SD difference in self-efficacy in 2-tailed tests.
Recruitment and Participation
Figure 1 presents the study recruitment yield and numbers of follow-up assessments at 6 months. Of the 227 eligible patients whose consent was sought, 23% refused. Of the patients who consented, 166 completed parent and youth baseline interviews, with 4% completing partial interviews. The 166 complete baseline interviews were assigned randomly to the intervention and comparison groups. At the 6-month follow-up assessments, 71% of subjects were interviewed, that is, 58 in the intervention group and 60 in the comparison group. Five participants were excluded either because of multiple, extreme, outlier responses on outcome variables or partial interview completion.
For the 113 participants in the analysis, the mean ages were 13.0 years (median: 13 years; SD: 1.41 years) and 12.9 years (median: 13 years; SD: 1.55 years) for the intervention and comparison groups, respectively, and 66% and 67% of youths were male. There was no difference between the intervention and comparison groups with respect to age, gender, race, maternal education, family income, or time between discharge from the ED and enrollment. The median time between discharge and completion of both parent and youth interviews was 51 days. The mean time to follow-up assessment for both the intervention and comparison groups was 8 months. The times to follow-up assessment were not significantly different between the intervention (8.6 months) and comparison (7.6 months) groups (P = .13). There were no differences in demographic features or baseline outcome variables between subjects who completed assessments and those who were lost to follow-up monitoring.
Table 1 shows that the intervention and comparison groups were comparable at baseline with respect to most risk factors for injury. At baseline, fighting behavior was common in both groups of youths, with more than one half having had a fight in the past 30 days. However, the intervention group had a higher rate of knife-carrying and fewer friends with problem behavior, compared with the comparison group. Baseline differences were controlled for in assessments of intervention effects.
Of the 56 families in the intervention group analysis, most (n = 30; 54%) received the full intervention with 6 mentor visits with youths and 3 health educator visits with parents (high-adherence group). The families that did not complete the full intervention were considered the low-adherence group. Intervention youths and parents reported high levels of satisfaction with the intervention. The vast majority of youth respondents agreed that “my mentor understands my needs” (94%) and “cares about me” (89%). Parents were asked how well the health educator understood their needs and/or concerns, and 88% of respondents stated that the health educator understood them very well. When asked, “How satisfied were you with the services that the health educator provided?,” 73% were very satisfied.
As shown in Table 2, after adjustment for baseline group differences, there were significant program effects in reducing misdemeanor activity (rate ratio: 0.29; 95% CI: 0.08–0.98) and increasing youth general self-efficacy (β = 2.28; P < .05). Program impact varied according to the number of intervention sessions completed, as demonstrated in Figs 2 and 3. When the low-adherence group was compared with the comparison group, only self-efficacy was significantly improved in the intervention group (β = 2.66; P < .05). When the high-adherence group was compared with the comparison group, greater program impact was seen, with decreased physical aggression scores (rate ratio: 0.51; 95% CI: 0.29–0.90) and decreased misdemeanor activity (rate ratio: 0.09; 95% CI: 0.01–0.63). Figure 2 demonstrates that the comparison group had increased aggression over time but the intervention moderated this effect. The prevalence of fighting in the past 30 days did decrease in both groups over time.
A rate ratio of 0.76 for 30-day reports of fighting at the follow-up assessment translates into an additional 24% reduction (38.6 fights per 100 persons; 95% CI: 0.29–2.00 fights per 100 persons) in the mean 30-day report of fights for subjects in the intervention group, compared with the control group, controlling for the baseline number of fights. Regarding fight injuries, the additional reduction for subjects in the intervention group was 42% (5.9 fight injuries per 100 persons; 95% CI: 0.09–3.94 fight injuries per 100 persons).
This study found that assault-injured youths and their families were receptive to violence prevention intervention initiated after an ED visit. The study also found that intervention might reduce aggression and problem behavior and increase self-efficacy. The literature suggests that these youths are at high risk for repeated visits and injury,5 have significant psychosocial needs,36,37 and are less likely to have follow-up care recommended after ED treatment.38 The ED may be an important access point for these high-risk youths and provides an opportunity to intervene. When these participants were asked, “How likely is it that [you/your child] may have another physical fight with the same people who caused [your/his/her] injury?,” 28% of youths and 36% of parents stated this was somewhat or very likely.39 Previous studies found that many youth assault injuries are related to long-standing, repeated disagreements that may not be over after an ED visit.40 Retaliatory feelings may fuel violence.32,41 Interrupting the cycle of reactive perpetration and traumatic reinjury could reduce the burden of injury among adolescents.
Although there has been a call to address the psychosocial needs of assault-injured youths presenting to the ED, there has been limited evaluation of this approach. ED protocols and programs have been developed, but few have published outcomes. Zun et al17,42–44 tested an ED case management model with assault-injured individuals 10 to 24 years of age and found some increased social service utilization but no change in attitudes, delinquency, or return visits to the ED. With follow-up assessments at 6 and 12 months, they found a reduction in the self-reported reinjury rate in the intervention group but no program impact on arrests, incarcerations, or state-reported (through the trauma registry) reinjuries. The authors concluded that there was a need for a more-intensive intervention with a younger population, over a longer time period. Our study suggests that focusing on a younger population and using a family approach offer promise.
On the basis of enrollment in the study and reported satisfaction with the intervention, families were receptive to violence prevention intervention after assault injuries. There were trends toward differences between the intervention and comparison groups with respect to youth-reported aggression, misdemeanor problem behavior, and self-efficacy at 6 months. This study did not find significant effects of the intervention on youth reports of fighting or carrying weapons in the past 30 days or on parent reports of youth aggression. No differences were found for other intervention targets, including social competence and attitudes about retaliation. Study power was limited, however, and all outcomes trended in the direction of decreased risk for violence. In addition, in adherence-level analysis, there was an adherence-response association between treatment group and youth-reported outcomes. Our analyses addressed program effectiveness and not efficacy. The overall program impact was likely diminished because some intervention families did not start or complete all sessions but those families were included in analyses if follow-up assessments were completed. Also, the comparison group received case management services beyond what was usual care for the participating EDs, and this minimal intervention might have been beneficial. This would have reduced our ability to detect effects and might partially account for the decreases in fighting in both groups at 6 months.
Our intervention incorporated components of the best practices described by the CDC,20 including a mentoring relationship with youths, home visitation, involvement of parents, and a social-cognitive approach. It is difficult to know which component had the greatest impact or whether the combination of strategies accounted for youth change. However, study staff members thought that the relationship-based mentoring aspect of the intervention was powerful, and youths and parents were very positive about their mentors. The presence of a positive, trusted, adult role model has been recognized as a protective factor against violence and other maladaptive outcomes among youths. Studies have found that mentoring can significantly improve academic achievement and school attendance, reduce violent behavior and drug use, and improve family and peer relationships.45–47 Mentoring program evaluations have found that more-frequent mentoring contacts, knowing families, and longer mentoring relationships are associated with better outcomes.46 Although there was a trend toward program impact at the follow-up assessments, it was not known whether effects would be sustained, because some mentoring relationships did not continue after completion of the curriculum. Finding a supply of reliable and committed mentors was a challenge in this study and in other mentoring programs.44 Additional study of mentoring models that go beyond the traditional one-on-one method and use other means of contact (eg, group mentoring, instant messaging, and telephone contact) and efforts targeted to high-risk populations are needed.
Limitations of this study include concern regarding generalizability, validity of data, study recruitment and attrition rates, and limited power. The study was conducted in 2 high-risk communities, and results may not be generalizable to other regions. The validity of self-reported data are a persistent concern in behavioral research. The need to adapt measures, because of the limited number of validated measures in the field at the time, was another potential limitation. During pretesting, however, we found that participants' responses had face validity and internal consistency.
It is possible that there existed bias in convenience sampling and nonparticipation. Despite our best efforts, only 71% of families completed follow-up assessments, which further limited our power to show a difference. The varying time to follow-up assessment past 6 months is also of concern but might be expected to underestimate the program effects. Subjects who did and did not complete follow-up assessments did not differ with regard to baseline demographic features or violence risk factors. Many families were very mobile and had complex, difficult, family circumstances, which made this research especially challenging; however, the refusal and attrition rates in our study were similar to those in other studies of assault-injured youths.17 Our refusal rate of 23% was also consistent with rates for school-based, violence prevention studies with high-risk youths in middle school in the Multisite Violence Prevention Study (participation rate: 55%–80%).48 These high-risk populations of assault-injured youths deserve support and study, and we present lessons learned. Finally, despite limited study power and a comparison group that received some intervention, we were able to identify trends for an effect of the intervention.
This study is one of the first studies evaluating a violence prevention intervention with assault-injured youths presenting to the ED. We found that a community-based, mentor-implemented program with assault-injured youths who presented to the ED demonstrated trends toward reduced aggression scores and misdemeanors and increased self-efficacy. Furthermore, the ED may be an important contact location, and injuries an important context, for augmenting self-efficacy for violence prevention.
Despite the call 12 years ago by the American Academy of Pediatrics to intervene with assault victims in EDs, there has been a paucity of research. This study demonstrates the promise of intervention with this population. Additional research is needed to corroborate the associations found and to explore more thoroughly the potential of social-cognitive and mentoring approaches to youth violence prevention. Research should also focus on engagement of high-risk populations, cost-effectiveness, and use of administrative databases (eg, juvenile justice records) for additional measures and participant tracking.49
This project was supported by the Maternal and Child Health Bureau (Title V Social Security Act), Health Resources and Services Administration (grants R40MC00174 and 4H34MC00025), and DC-Baltimore Research Center on Child Health Disparities grant P20 MD00165, from the National Center on Minority Health and Health Disparities. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, and approval of the manuscript.
- Accepted January 30, 2008.
- Address correspondence to Tina L. Cheng, MD, MPH, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University, 200 N. Wolfe St, Suite 2055, Baltimore, MD 21287. E-mail:
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.
The authors have indicated they have no financial relationships relevant to this article to disclose.
What's Known on This Subject
Despite the call 12 years ago by the American Academy of Pediatrics to intervene with assault victims in EDs, there has been a paucity of research. The few studies addressing violence involved older youths and adults and had mixed results.
What This Study Adds
We found that a community-based, mentor-implemented program with assault-injured youths who presented to the ED demonstrated trends toward reduced aggression scores and misdemeanors and increased self-efficacy. The ED may be an important contact location for violence prevention intervention.
- ↵Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System. Available at: www.cdc.gov/ncipc/wisgars/. Accessed February 20, 2007
- ↵Luckenbill DF. Criminal homicide as a situated transaction. Soc Probl.1977;25 (2):176– 186
- Moeller TG. Youth Aggression and Violence: A Psychological Approach. Mahwah, NJ: Lawrence Erlbaum Associates; 2001
- ↵Cheng TL, Schwarz D, Brenner R, et al. Adolescent assault injury: risk and protective factors and locations of contact for intervention: a matched case-control study. Pediatrics.2003;112 (4):931– 938
- ↵Redeker N, Smeltzer S, Kirkpatrick J, Parchment S. Risk factors of adolescent and young adult trauma victims. Am J Crit Care.1995;4 (5):370– 378
- ↵National Institutes of Health. State-of-the-Science Conference Statement: Preventing Violence and Related Health-Risking Social Behaviors in Adolescents: An NIH State-of-the-Science Conference, October 13–15, 2004. Available at: http://consensus.nih.gov/2004/2004YouthViolencePreventionSOS023html.htm. Accessed September 3, 2008
- ↵American Academy of Pediatrics, Task Force on Adolescent Assault Victim Needs. Adolescent assault victim needs: a review of issues and a model protocol. Pediatrics.1996;98 (5):991– 1001
- Dinh-Zarr T, Goss C, Heitman E, Roberts I, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database Syst Rev.2004;(3):CD001857
- ↵Johnston BD, Rivara FP, Droesch RM, Dunn C, Copass MK. Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial. Pediatrics.2002;110 (2):267– 274
- ↵Thornton TN, Craft CA, Dahlberg LL, Lynch BS, Baer K. Best Practices of Youth Violence Prevention: A Sourcebook for Community Action. Atlanta, GA: Centers for Disease Control and Prevention; 2002
- ↵Dishion TJ, Kavanagh K. Intervening in Adolescent Problem Behavior: A Family-Centered Approach. New York, NY: Guilford; 2003
- ↵Child and Family Center, University of Oregon. Intervention Models and Resources Adolescent Transitions Program. Available at: http://cfc.uoregon.edu/atp.htm. Accessed February 26, 2007
- ↵Dahlberg LL, Toal SB, Behrens CB. Measuring Violence-Related Attitudes, Beliefs, and Behaviors Among Youths: A Compendium of Assessment Tools. Atlanta, GA: Centers for Disease Control and Prevention; 1998
- ↵Hill HM, Noblin V. Children's Perceptions of Environmental Violence. Washington, DC: Howard University; 1991
- ↵Whalen LG, Grunbaum JA, Kinchen S, McManus T, Shanklin SL, Kann L. Middle School Youth Risk Behavior Survey 2003. Atlanta, GA: Centers for Disease Control and Prevention; 2005. Available at: www.cdc.gov/healthyyouth/yrbs/middleschool2003/pdf/fullreport.pdf. Accessed February 26, 2007
- ↵Orpinas P. Skills Training and Social Influences for Violence Prevention in Middle Schools: A Curriculum Evaluation [doctoral dissertation]. Houston, TX: University of Texas Health Science Center at Houston School of Public Health; 1993
- ↵Bosworth K, Espelage D. Teen Conflict Survey. Bloomington, IN: Center for Adolescent Studies, Indiana University; 1995
- ↵Achenbach TM. Manual for the Child Behavior Checklist 2/3 and 1992 Profile. Burlington, VT: University of Vermont; 1992
- ↵Johnson SB, Frattaroli S, Wright JL, Fields CB, Ricardo I, Cheng TL. Urban youths' perspectives on violence and the necessity of fighting. Inj Prev.2004;10 (5):287– 291
- ↵Jessor R, Jessor SL. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. New York, NY: Academic Press; 1977
- Office of the Surgeon General. Youth Violence: A Report of the Surgeon General. Washington, DC: Government Printing Office; 2001. Available at: www.surgeongeneral.gov/library/youthviolence/report.html. Accessed June 19, 2002
- ↵Irwin CE, Cataldo MF, Matheny AP, Peterson L. Health consequences of behaviors: injury as a model. Pediatrics.1992;90 (5):798– 807
- ↵Johnson SB, Bradshaw CP, Wright JL, Haynie DL, Simons-Morton BG, Cheng TL. Characterizing the teachable moment: is an emergency department visit a teachable moment for intervention among assault-injured youth and their parents? Pediatr Emerg Care.2007;23 (8):553– 559
- ↵Furano K, Roaf PA, Styles MB, Branch AY. Big Brothers/Big Sisters: A Study of Program Practice. Philadelphia, PA: Public/Private Ventures; 1993
- ↵Jekielek SM, Moore KA, Hair EC, Scarupa HJ. Mentoring: A Promising Strategy for Youth Development. Washington, DC: Child Trends; 2002. Available at: www.mentoring.ca.gov/pdf/MentoringBrief2002.pdf. Accessed February 26, 2007
- ↵Sheehan K, DiCara JA, LeBailly S, Christoffel KK. Adapting the gang model: peer mentoring for violence prevention. Pediatrics.1999;104 (1):50– 54
- ↵Romero EG, Teplin LA, McClelland GM, Abram KM, Welty LJ, Washburn JJ. A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community. Pediatrics.2007;119 (5). Available at: www.pediatrics.org/cgi/content/full/119/5/e1126
- Copyright © 2008 by the American Academy of Pediatrics