Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Monday, April 21, 2008

Youth Violence on the Rise: Society Glorifying Violence Hinders Public Health Prevention Campaigns- Sheila Jeudy

Public health methods are essential to violence prevention. Current public health anti-violence programs often limit their scope and resources to victims of domestic violence and abused children. Public health has applied its analytical expertise to enhance the understanding of risk factors for youth violence, allowing for a broader vision in the planning and development of preventative approaches. Public health practice is both systematic and concerned with the root cause of youth violence (1). Public health preventions remain ineffective when combating against the media’s portrayal of violence geared toward the youth. Public health has failed to utilize the media successfully to implement and promote anti-violence campaigns because their focus has been on identifying high risk individuals, risk factors that contribute to violent behavior and media outlets geared toward youth that glorify violence and violent behavior. Although identifying the risk factors that lead to violence is the first step in resolving youth violence, public health has failed to successfully implement and enforce new policies and procedures that would address the rise in youth violence. Public health has made attempts to create new technology and policies to educate parents and children about the repercussions of violent behavior but these interventions fail to provide the necessary means to enforce such policies and implement procedures outside of the public domain. They have yet to devise a plan that will enforce prevention policies within the home.

Public Health Approach to Youth Violence

Public health perspective on media violence considers the effects of violent imagery on the child within the broader context of child welfare, families and communities. The behavior of parents monitoring the use of televisions and computers and knowingly or unknowingly allowing access to violent imagery is considered in addition to the habits and behavior of the child or adolescent viewer. There has been an attempt to integrate theoretical approaches into a general aggression model in relation to the effects of media violence. This model is based on the principles of cognitive behavioral theory, which explains interactions between an individual and their environment. The model claims that an individual’s response to violent behavior is established by their perception of violence and their level of interaction.

Violence preventions are categorized into various levels. Primary preventions address the broadest level of the general public to reduce the level of violence that is shown on television. This would be an effort directed toward dealing with public values and attitudes that may promote or encourage the use of violence. Primary prevention instruments tend to be those providing information and education on the problem of violence through the popular media. At the primary level, efforts have been made on enhancing public awareness of risk factors and the true characteristics of violent actions. Secondary preventions identify subgroups or circumstances that are at high risk of being involved in or causing violence. Secondary prevention efforts might focus on urban poor and adolescents who are at particularly high risk of engaging in or being victimized by violence and educating them in nonviolent methods of resolving disputes. At the secondary level, public health has been involved in the development of educational interventions specifically focused on behavior modification of high risk individuals. Tertiary prevention is a response to a violent event and not a preventive measure. Its focus is on trying to reduce the negative consequences of a particular event after it has occurred; trying to find ways to use the event to reduce the likelihood of similar incidents from reoccurring in the future (2).

The World Health Organization (WHO) has emphasized the necessity of adopting a public health approach for prevention of violence. WHO’s World Report on Violence and Health does not specifically address violence in the media, however it does discuss the effect of media messages on health promotion. The report emphasizes the need for health services to be associated with the prevention of violence through family and community interventions in order to successfully address youth violence prevention. Instead of focusing on the individual who is at risk for, or who engages in violence, the public health approach considers the individual’s relationship to his or her surroundings (3). The ecological model recognizes that each person functions within a complex network of individual, family, community and environmental contexts that affect their capacity of avoidance. The ecological framework is based on public health perspective for reducing risks and preventing violence (4-6).

Public Health and the Media

Media campaigns and public service announcements offer a means of increasing public awareness. Public health has utilized the media to advertise violence prevention campaigns through the National Crime Prevention Council (NCPC) by distributing action kits, Partner With the Media To Build Safer Communities, containing reproducible materials that communities can use to reach the public with their anti-crime and anti-violence messages. NCPC has partnered with the media in a Turn Off the Violence Campaign, where the community engaged the help of local print and electronic media to convince residents that violence is an unacceptable way to resolve conflicts. The campaign also encourages the media to reevaluate their own violent entertaining programming (7).

Public health approaches have generated several contributions to the understanding and prevention of violence; professionals have applied traditional public health strategies to violence prevention. Public health brings an analytical approach that identifies risk factors and important causes that could become the focus of preventive interventions. Public health preventions should utilize the media to initiate public education campaigns addressing various social problems, provide educational information, and identify risk factors and high risk individuals. Public health informative campaigns should make effective use of innovative media efforts, such as new dissemination techniques and outreach materials to convey the causes of youth violence and the effective strategies for violence prevention.

The Telecommunications Act of 1996 is an example of a public health attempt to take advantage of the media to advertise violence prevention. The act was intended to assist parents in reducing children’s exposure to violent media. The act mandated the inclusion of V-chips in all new televisions and for the development of a rating system to enable parents to assess the violent content of specific shows. The prevention itself was unsuccessful in that it provided a means to resolve the amount of violence exposure in the media but it did not provide a means for enforcing the implementation of such devices or educating parents on the importance of implementing policies within the home.

With the unsuccessful intervention of the v-chip installation, the FCC Commissioner Tristani sent a letter to major broadcast networks asking them to recommit themselves to educating parents about the V-chip in 2000. Tristani recognized that many parents didn’t know that the chip existed even though they had been installed in television sets since 1999. Networks such as Fox and NBC have not aired public service announcements regarding the V-chip installation into television sets (8). Public health should enforce networks to broadcast public service announcements more frequently and publish electronic print informing parents of the need to monitor TV ratings of programs viewed by their children.

The V-chip inserted into all televisions sold since 1999 was an attempt to address the amount of violence in the media. The chip being no more than an electronic selection and category system, suffered the same limitations as film classifications, in that it can easily be overridden or ignored by technology-savvy children. This violence prevention attempt failed due to the limitations of the device. Public health’s use of media provided public awareness and some education but couldn’t enforce implementation (9).

Public Health Fails to Apply the Social Learning Theory to Preventions

As youth violence has increased, the media has expanded national and local coverage of the problem, often using images that build upon community fear. The media frequently overlook the more complicated messages about the causes of violence and approaches to redress the problem. Recent surveys depict the abundance of media in U.S. homes and the extensive presence of violence within the media. They also show that the proliferation of new media has expanded the opportunities for children to be exposed to media violence at home. The social learning theory provides an explanation for how violent media may influence childhood aggression. Social learning theory states that a child learns how to act and forms his or her attitudes from observing important role models in his or her life. Characters portrayed in the media may become role models for children whether they positively or negatively influence them. With constant exposure to violence, children may learn to see violence as a part of everyday life and an acceptable way to solve interpersonal problems. Because violence in the media is presented without negative consequences, youth fail to accurately assess or even understand the real life consequences of violent actions against others.

Prolonged exposure to violence in the media by children has been shown to contribute to aggressive behavior and desensitization to violence. The media contributes to the perception of violence as a normative behavior, reinforcing and sensationalizing violence as an appropriate and justifiable problem solving strategy. Public health fails to properly address this issue and their preventions focus on providing education and identifying risk factors and high risk individuals. Research indicates that media violence increases aggressive attitudes and emotions, which are theoretically linked to aggressive and violent behavior. Public health approaches fail to enforce policies that provide actions toward curbing the amount of exposure to media violence by youth. Public health should encourage the media to prevent youth violence by minimizing the sensationalist aspects of coverage of violent behavior, reinforce anti-violence messages and ideas provided by schools and communities. Violence prevention campaigns would be more successful if they could convince the media to portray the consequences of violence realistically, promote and participate in community coalitions for the prevention of youth violence and promote and publicize anti-violence programs and policies (10).

Violence in the Media

The National Television Violence Survey report notes that many television programs fail to depict the harmful consequences of violence. Specifically, it finds that of all violent behavioral interactions on television, 58% depicts no pain, 47% depict no harm, and 40% depict harm unrealistically. Of all violent scenes on television, 86% percent feature no blood or gore. Only 16% of violent programs feature long term, realistic consequences of violence. Violence in movies, television and video games has become pervasive in our society and studies have shown that media violence can lead to aggressive behavior in children. Additionally, media violence often fails to show the consequences of violence. This is especially true of cartoons, toy commercials and music videos. As a result, children learn that there are few, if any, repercussions for committing violent acts (11).

Public health preventions address media violence but haven’t addressed other media outlets such as music lyrics and videos which also have been shown to have passive effects on youth. The evidence shows that violent video games are related to later aggressive behavior and delinquency in older children and teenagers. For both passive viewing (television and film) and interactive viewing (video and computer games), there seems to be consistent evidence of an association between younger children watching media violence and showing more aggressive play and behavior. Public health approaches have identified the correlation between the two but fail to provide effective preventions.

Contributing Risk Factors

Public health has addressed the fact that multiple risk factors contribute to the likelihood that an individual will engage in violent acts or aggressive behaviors. Most risk factors for violence are not strong predictors by themselves; it is the combination of risk factors that tend to be associated with violence. Media violence may have a very strong impact on some children and no apparent impact on others. The bottom line is that there are many factors-at home, at school, and in the community, which can increase or decrease the likelihood that a youth will become violent and media violence is one of them (12).

Preventions have failed to address the fact that there are several contributing factors that lead to violent behavior. Factors that appear to influence the effects of media violence on violent behavior include characteristics of the viewer such as age, intelligence, aggressiveness, and whether the child perceives the media as realistic. Social environment (parental influences), as well as aspects of media content including characteristics of perpetrators, degree of realism and justification for violence, and depiction of consequences of violence also contribute to violent behavior (13). Research on youth violence has primarily focused on the risk factors concerning the individual and family levels. These risk factors highlight the importance of the macro influences such as poverty at the neighborhood level, gun availability and social norms. Socioeconomic status has been constantly found to be an important contributing factor to violence in many studies. The public health approach to violence prevention targets high-risk communities including low-income neighborhoods, areas with gangs, high levels of neighborhood crime, drugs, or broken homes (divorce). Children from these high-risk communities are more likely to experience significant exposure to violence and become witnesses, victims, or perpetrators of violence.

Public Health Fails to Collaborate With Other Agencies

Successful prevention effectively promotes health and reduces the risk of violent behavior. The social, environment, individual, and behavioral factors would incorporate specific health related factors as well as educational factors (i.e. increased knowledge of media). The challenge is to automate such preventions by way of collaborations between health, educational, and social institutions (14).

Recent public health approaches identify risk factors (media), they suggest how to positively utilize identified risk factors and how to address the negative effects of media violence on youth. Risk factors do no operate in isolation, the more risk factors a child is exposed to, the greater the likelihood that he or she will become violent. Risk factors can be buffered by protective factors. An adolescent with an intolerant attitude toward violence is unlikely to engage in violence, even if he or she is associating with delinquent peers. Risk factors increase the likelihood that a young person will become violent, but they may not actually cause a young person to become violent (13).

Public health fails to implement successful preventions with other agencies because it lacks a collaborative approach. The public health approach is traditionally viewed as promoting the well being of and individual and community (15). Regardless of government and other interested groups’ attempts to limit the amount of violence reaching homes, families themselves play a critical role in guiding what reaches their children. Public health succeeds in providing education to parents regarding supervision but does little to enforce the policies and preventions. Whether by adopting V-chip technology for home television programming, by using internet violence screening, or simply by monitoring closely children’s use of televisions, computers, and video games, parents can limit and shape their children’s selection of, interaction with, and response to media violence (13).

Public health interventions should be directed toward reducing the extent and effect of violence in the media for the whole population (universal interventions) and high risk individuals (targeted interventions), respectively. Research on vulnerable groups has shown that some children and adolescents are more susceptible to media influence than others. The UNESCO review of research findings suggest that everyone is negatively affected in some way by media violence, but that these effects depend on an individual’s cognitive appraisal, physical and social environment (4).


1. Castro G. et al. Code Red: A Public Health Approach to School Gun Violence. A Case Study in Assessment and Policy Development Mid America Regional Public Health Leadership Institute Year 12 Fellows

2. Prothrow-Stith D. Strengthening the Collaboration between Public Health and Criminal Justice to Prevent Violence. The Journal of Law, Medicine & Ethics, April 2004.

3. WHO: Milestones of a Global Campaign for Violence Prevention 2005: Changing the Face of Violence Prevention. Geneva, Switzerland: WHO; 2005: 1-42.

4. Dahlberg LL and Krug EG. Violence- a global public health problem. In Krug E et al. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002: 1-56.

5. A Public Health Approach to Violence Prevention. The Social-Ecological Model: A Framework for Prevention. Atlanta, GA: Center for Disease Control and Prevention, 2008.

6. The Social-Ecological Model: A Framework for Prevention.

7. Implement an Aggressive Public Outreach Campaign on Effective Strategies To Combat Juvenile Violence.

8. Press Release: FCC Commissioner Gloria Tristani, April 2000.

9. Browne K. The influence of violent media on children and adolescents: a public health approach. Birmingham, UK: Centre for Forensic and Family Psychology, 2005.

10. Knox L. Connecting the Dots to Prevent Youth Violence: A Training and Outreach Guide for Physicians and Other Health Professionals. American Medical Association June 2002.

11. Brown M. The Portrayal of Violence in the Media: Impacts and Implications for Policy. Trends & Issues 1996;55:1-6.

12. Zuckerman D. What is to Blame for Youth Violence?: The Media, Guns, Parenting, Poverty, Bad Programs, Or…Youth Today, November 2004.

13. Satcher D. “Youth Violence: A Report of the Surgeon General,” January 2001.

14. Jenkins R. The public health model for violence prevention: A partnership in medicine and education. Journal of Negro Education 1996; 1-10.

15. Skybo T. and Polivka B. Health promotion model for childhood violence prevention and exposure. Journal of Clinical Nursing 2007; 16:38-45.

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