Violence Essay, Research Paper

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Full content for this article includes illustration, table and graph.

Source: Archives of Pediatrics & Adolescent Medicine, Sept 1995 v149 n9

p953(8).

Title: Violent crime in the United States: an epidemiologic profile.

Author: Laura Rachuba, Bonita Stanton and Donna Howard

Abstract: Violent crime rates appear to have increased among youth while

declining or remaining stable among other age groups. Researchers used data

from several nationwide databases to track trends in crime from the early

1970s through 1992. Overall violent crime increased by 81% with a twofold

increase in aggravated assault, while murder rates varied little. According to

another database, violent crime rates remained stable. All databases showed

marked increases in violent crime rates in youths and young adults. Blacks

were disproportionately affected. For example, the homicide rate among

black

males aged 15 to 24 was more than nine times the rate among white males.

Particularly concerning was the increase in murders among children aged 10

to

14, which went up 93%. Guns were involved in over 60% of the murders, and

the

greatest rate of increase in murders involving guns was in children aged 10 to

14.

Author’s Abstract: COPYRIGHT American Medical Association 1995

Objectives: To determine if (1) there was an increase in the rates of acts of

violence in the United States from 1973 to 1992 and (2) there were

disproportionate changes in rates of violent crime among specific

demographic

groups. Methods: Crime data from the Uniform Crime Reporting Program

and the

National Crime Victimization Survey beginning in January 1973 and ending

in

December 1992 were examined. Homicide data from 1970 to 1991 were

examined

with the National Center for Health Statistics mortality data from the Centers

for Disease Control and Prevention. Analyses were performed for overall

crime

rates as well as for specific demographic groups. Results: Rates of

victimization from all types of violent crime have increased among

adolescents

and young adults (from ages 10 through 25 years), regardless of gender or

race. Absolute rates were highest among African Americans and males. Both

the

highest rates and the greatest increases in homicide from 1971 to 1990 were

among adolescents and young adults, while rates for those aged 25 years and

older decreased. A substantial increase in firearm-related homicides among

adolescents and young adults occurred as well, with rates decreasing for

those

aged 25 years and older. Overall rates of homicide have remained relatively

constant during the past two decades. Data addressing overall trends in the

rates of nonfatal violence during the past 20 years are inconclusive.

Conclusions: Adolescents are now experiencing the highest and most rapidly

increasing rates of lethal and non-lethal violence. The increase in violence

among youths 10 to 14 years of age is especially important and alarming. The

concentration of violence among children and adolescents has important

intervention implications. Because adolescence is a time of great

developmental changes, approaches to understanding and preventing violence

among our nation’s youths should incorporate a developmental perspective

that

also focuses on the relationship and interactions between individuals and

their environments, at the family, community, and societal levels. (Arch

Pediatr Adolesc Med. 1995;149:953-960)

Subjects: Violent crimes – Demographic aspects

Violent deaths – Demographic aspects

Electronic Collection: A17477467

RN: A17477467

Full Text COPYRIGHT American Medical Association 1995

Editor’s Note: This article documents what so many of us knew from reading

newspapers, watching television, and directly working with teenagers.

Wouldn’t

it be wonderful if some of the Department of Defense initiatives and funds

were aimed at defending our youth?

Catherine D. DeAngelis, MD

IN THE PAST DECADE, the public media and law enforcement, public

health, and

medical professionals have expressed a growing concern regarding violence

in

the United States. The establishment of the Center for Injury Prevention and

Control within the Centers for Disease Control and Prevention, the inclusion

of questions regarding violent behavior in several national surveys conducted

by the Centers for Disease Control and Prevention, and a substantial increase

in citations of “violence” in the medical literature provide evidence that

violence is now recognized as a public health issue. For example, the Index

Medicus (National Institutes of Health) listed 70 citations under “violence”

in 1970,[1] 127 in 1980,[2] 196 in 1990,[3] and 290 in 1993.[4] Despite

society’s increased focus on violence, epidemiologic characterization of the

problem remains imprecise, resulting in critical knowledge gaps as to the

definition of violence, changes in the rates and character of violence over

time, and factors associated with these changes.[5] In fact, even the widely

promulgated premise that violence is increasing has been challenged recently.

Critics argue that sensationalistic reporting of crime statistics is

responsible for this misperception.[6]

Multiple factors regarding the study of violence contribute to this imprecise

epidemiologic characterization. The study of violence as a public health issue

is a relatively new perspective compared with its study as a criminal issue.

As such, the violent act itself (as opposed to the mental and physical health

outcomes of violence) has historically been the focus of interest in studies

of violence. Indeed, except for homicide, the majority of national databases

that provide violence surveillance (eg, the Uniform Crime Report and the

National Crime Victimization Survey) do not characterize the health outcome

of

the violent act. Given the judicial perspective of the agencies sponsoring

such databases, an emphasis on the criminal nature of the violent action is,

of course, logical.

As a corollary, given the traditional disinterest among health professionals

in violence research, most existing medical databases do not differentiate

between unintentional and intentional injuries. For example, the International

Classification of Diseases, Ninth Revision,[7] the most widely used medical

nomenclature for diagnostic categories, identifies the medical injury (eg,

“penetrating wound to the abdomen”) but does not enable identification of the

mechanism of injury (eg, “gunshot wound”). Even the more precise

classification afforded by the External Cause of Injury codes[7] is used by a

few medical institutions.[8] Furthermore, in medical institutions in which

External Cause of Injury codes are used, sufficient cause-of-injury

information is not obtained from emergency providers, making the use of

these

codes difficult.[9] Similarly, the numerous immediate and long-term adverse

physical and mental health outcomes that result from the act of violence

remain poorly defined and poorly articulated. Given the interactive nature of

many acts of violence, such articulation and clarification will doubtless be a

complex process.

It is not possible to address all of the issues mentioned above in a single

article. Furthermore, many of these issues cannot be adequately examined

until

databases are expanded to include information on the acts and the outcomes.

However, existing data can be used to delineate some trends and to generate

hypotheses about relationships. In the present article, we propose to examine

whether evidence exists in the United States for (1) increased rates of acts

of violence over time and (2) a disproportionate change in the rates of acts

of violence among specific demographic groups.

RESULTS

OVERALL TEMPORAL TRENDS

Figure 1 depicts rates of violent crimes from 1973 to 1992 according to the

UCR Program data. The rate of overall violent crime increased 81%. The

largest

increase in rate (twofold) occurred for aggravated assault. The homicide rate

remained relatively consistent during a 20-year period, a finding that was

consistent with the N CHS mortality data.

The Victimization Survey data from 1973 to 1992 indicate that the rate of

violent crime fluctuated during the 20-year study interval but remained stable

overall (Figure 2). Although the Victimization Survey rates were higher than

the UCR Program rates for each type of violent crime during these years, both

data sets showed that the rate and number of violent crimes peaked in 1980,

subsequently declined, and began increasing again after 1989. For specific

types of crime, rates decreased for rape, robbery, and aggravated assault

while simple assault rates increased.

SUBANALYSES BY DEMOGRAPHIC VARIABLES

Age

The NCHS homicide data demonstrated that from 1970 to 199 1, youths aged

15 to

34 years experienced the highest rates of homicide (Figure 3). The largest

increase (220%) in homicide rates occurred for those aged 15 to 19 years,

followed by a 56% increase for those aged 20 to 24 years. A substantial

proportionate increase (47%) also occurred for youths aged 10 to 14 years,

although the absolute rates and increases were smaller than for the older

teens and young adults. Rates remained constant for those aged 30 to 34

years

and decreased for those aged 35 to 39 and 40 to 44 years.

The Victimization Survey data showed that fates of overall violent crime

increased from 1973 to 1992 for those aged 12 to 34 years, but remained the

same or decreased for those aged 35 years and older. Furthermore, rates were

highest among those aged 16 to 19 years. Robbery rates increased among

youths

aged 16 to 19 years (64%) and 25 to 34 years (40%), but decreased for those

aged 12 to 15 years and 35 years and older. Aggravated assault rates

increased

for those aged 12 to 15 years (32%) and 16 to 19 years (12%) but decreased

or

remained the same for those aged 20 years and older. Simple assault rates

increased for all age groups between 12 and 49 years, with the largest

increase among youths aged 12 to 15 years (58%). Rates decreased for those

aged 50 years and older.

Age by Gender

According to NCHS data from 1970 to 1991, an increase in the homicide rate

was

experienced by males aged 10 to 29 years and females aged 10 to 34 years

(Table 1 For males, the largest proportionate increase (93%) occurred for

youths aged 10 to 14 years, while the largest absolute increases were seen

among youths aged 15 to 19 years of age and those aged 20 to 24 years. For

females, the largest increase occurred among youths aged 15 to 19 years

(75%).

Increases in rates also occurred among those aged 10 to 14 years (44%), 20

to

24 years (32%), and 30 to 34 years (28%).

[TABULAR DATA 1 OMITTED]

According to the Victimization Survey data from 1973 to 1992, robbery rates

increased for males aged 16 to 19 years and 25 to 34 years and females aged

12

to 34 years. However, the largest proportionate increase (250%) occurred

among

females aged 16 to 19 years. Aggravated assault rates increased for males

aged

12 to 15 years (15%) and 60 years and older (50%). Female aggravated

assault

rates increased among those aged 12 to 19, 25 to 34, and 50 to 64 years, with

the largest increases experienced by persons aged 50 to 64 years (twofold)

and

12 to 15 years (80%). Rates remained the same or decreased for all other

groups. Among males, simple assault rates increased for those aged 12 to 24

years and decreased among those aged 25 years and older. Simple assault

rates

among females increased for all those younger than 50 years, with the largest

increase (90%) occurring among those aged 25 to 34 years. The highest rates

of

violent crime occurred among youths aged 12 to 24 years.

Age by Gender by Race

The age by gender by race comparison demonstrates the most striking

demographic differences in homicide rates (Table 1). According to the NCHS

data from 1970 to 1991, regardless of race, male homicide rates increased for

those aged 10 to 24 years. Homicide rates for white males increased for those

aged 10 to 34 years but remained constant among those aged 35 to 44 years.

The

largest proportionate increases occurred for those aged 10 to 14 years

(317%),

15 to 19 years (296%), and 20 to 24 years (78%), although the absolute

increase in rate among youths aged 10 to 14 years was not as great as in the

older age groups. The largest increase in homicide rates for African-American

males occurred for those aged 15 to 19 years (220%), 20 to 24 years (84%),

and

10 to 14 years (34%). Rates decreased for African-American men aged 25

years

and older. Among white females from 1970 to 1991, rates increased for those

aged 10 to 39 years, with the largest increases occurring among those aged 15

to 19 years (85%),,10 to 14 years (50%), and 20 to 24 years (43%).

African-American females aged 10 to 14 and 15 to 19 years experienced an

increase in homicide rates (65% and 47%, respectively). Rates remained

constant or decreased for African-American women aged 29 to 44 years. The

greatest racial discrepancies in homicide rates existed among those aged 15 to

24 years. In this age group, the homicide rate for African-American males

was

more than ninefold greater than that for white males. Among women aged 25

to

29 years, the homicide rate for African Americans was six times greater than

that for whites.

The Victimization Survey data for 1990 and 1992 showed that, regardless of

race and gender, those aged 12 to 24 years had the highest rates of violent

crime victimization. Among african-American males and females, youths

aged 16

to 19 years had the highest rate, followed by those aged 12 to 15 years. For

white males and females, youths aged 12 to 15 years had the highest rate,

followed by those aged 16 to 19 years. The rate of greatest magnitude

occurred

among African-American males aged 16 to 19 years. Data were not available

for

robbery, rape, or assault rates.

WEAPON INVOLVEMENT

The UCR data were used to examine weapon involvement in homicide and

aggravated assault. From 1973 to 1992, firearms accounted for more than

60% of

homicides (Figure 4). During this period, the percentage of firearms involved

in homicide and aggravated assault remained stable. The percentage of

stabbing

instrument involvement decreased slightly for homicide, while it increased for

aggravated assault. Involvement of blunt instruments remained unchanged in

homicide but increased 9% in aggravated assault. A 3% decrease occurred in

the

use of personal weapons (hands, feet, or fists) for homicide and aggravated

assault.

Firearm involvement in homicide from 1979 to 1991 increased for persons

aged

10 to 24 years (Table 2 and Table 3). The greatest rate of increase in

firearm-related homicide occurred among children aged 10 to 14 years and

decreased or remained the same for all groups aged 25 years and older

(Tables

2 and3). African-American males aged 15 to 19 years experienced the largest

absolute increase 352%); however, African-American men aged 20 to 24

years

experienced the most victimization.

Table 2. Temporal Trends in Firearm-Related Homicide

According to Age by Gender by Race(*)

Rate/1000

1979 1991

African African

Age, y White American White American

Males

10-14 0.7 2.4 1.4 8.2

15-19 7.2 34.8 11.7 122.6

20-24 12.6 88.3 14.6 162.9

25-34 12.1 104.5 10.8 96.8

35-44 9.9 78.1 7.2 53.4

Females

10-14 0.2 1.0 0.5 2.7

15-19 1.7 6.9 2.1 11.2

20-24 2.6 13.6 2.7 16.8

25-29 2.4 13.5 2.4 13.7

30-34 2.4 11.1 2.0 7.5

(*) Unpublished data are from the National

Center for Health Statistics.

Table 3. Percentae Change in Firearm-Related

Homicide Rates from 1979 Through 1991 Accordin

to Age by Gender by Race(*)

10-14 15-19 20-24 25-34 35-44

African American

Male +339 +352 +84 -7 -32

Female +257 +61 +23 … -32

White

Male +91 +62 +16 -14 -27

Female +268 +26 … … -16

(*) Unpublished data are from the National Center for Health Statistics.

Ellipses indicate no change.

COMMENT

Violence has increased substantially among African-American and white

adolescents of both genders. Both the highest rates and the greatest increases

in homicide were seen among adolescents and young adults (eg, aged *25

years).

By contrast, the overall homicide rate increased slightly from 1970 to 1991

and has remained static from 1979 to 1991. Thus, contrary to media reports

and

public perception, during the past decade the overall rate of homicide has not

been escalating but has remained relatively unchanged. Moreover, among

persons

older than 30 years, rates remained stable or declined. A similar picture was

evident for most other acts of violence, such that rates generally increased

among adolescents and young adults and generally decreased among older

adults.

The concentration of escalating violence during the adolescent and

young-adult

years was consistent across race and gender. Disparities along racial lines

were also found to be greatest in these age groups. African-American males

in

their adolescent and early adult years experienced a homicide rate ninefold

that of similar-aged white males. This difference remained, despite the fact

that the greatest increase in homicide during the past 20 years was

consistently seen among white males. African-American females in this age

range experienced rates several times higher than that of their age-matched

white counterparts. Finally, an alarming increase existed in firearm-related

homicides among adolescents and young adults under the age of 25 years. By

contrast, the proportion of homicides related to firearms decreased among all

adults older than 25 years.

IMPLICATIONS OF THE FINDINGS

Adolescents are now experiencing the highest and fastest increasing rates of

lethal and nonlethal victimization from violence. Despite their lower rates of

violent crime, as compared with older adolescents and young adults, the

increase in violence among youths aged 10 to 14 years is an especially

important–and alarming–finding. Violent juvenile crime arrest rates have

increased steadily in the past decade, reaching their highest rates in the

past 20 years.[17] Accompanying the increase in arrest rates has been a large

increase of weapon involvement in crimes committed by youths.[18] The

concentration of increasing violence during the adolescent years argues

strongly for the incorporation of a developmental approach to violence

prevention. The increasing involvement of weapons in victimization and

perpetration, largely limited to the adolescent population, centers on

firearms as the weapon of choice. Thus, before intervention or prevention

programs can address the problem of adolescent violence, research needs to

explore the appeal of firearms for adolescents, their motivation to carry

firearms, and their intention actually to use firearms.

As noted above, violence has traditionally been regarded by society as a

criminal act rather than a public health concern. Although, in the past

decade, a shift has begun in this orientation,[19,21] little attempt has been

made to examine the host of psychosodial and developmental factors

integrally

related to the act and experience of violence. Whereas much has been written

about the concentration of violence among the poor,[22] males,[23,24]

minorities,[25-27] and older adolescents and young adults,[23,28,29] a need

exists for a unifying research framework that underscores the fact that the

greatest concentration of violence is now centered among all adolescents,

with

adolescents as young as 10 to 14 years of age becoming increasingly

vulnerable.

DEVELOPMENTAL CONSIDERATIONS

The concentration of violence among our youths has important intervention

implications. Multiple developmental influences salient during adolescence

must be considered and incorporated into violence prevention and violence

treatment programs. Adolescence is a time of intense curiosity and risk

taking,[30] a time when individuals learn to think in probabilistic terms.

During adolescence, a transition occurs from concrete operational reasoning

to

more formal abstract thinking, including the ability to think beyond the

present and consider future goals. Confounding this maturation in thought,

however, is the adolescent’s feeling of invulnerability (eg, of being an

exception to the rule), resulting at times in experimentation without full

appreciation of the consequences of their actions.[31] Further examination is

required of the relationship between cognitive development and risk-taking

behavior, particularly engagement in violent activities.

Previous research suggests a potential link between increased exposure of

children to violence in their family setting or community and subsequent

increased acts of violence.[31] This finding suggests that violence may

involve a modeling process and reflect a socially learned behavioral response

to problematic situations and events, an interpretation that is consistent

with social learning theory. Social learning theory also suggests that

wide-scale changes in mass media to avoid modeling and reinforcement of

violent behavior through its glamorization will be essential to future efforts

to prevent violence in adolescents.[32,33] Furthermore, for self-directed

behavior change to occur, providing reasons to alter high-risk behavior is not

enough. Resources and social supports must be provided to facilitate change

in

behaviors.[34]

It must be recognized that violence-related activities–and, indeed, the

violent act itself–entail certain perceived benefits and appeals. For

example, there is empiric evidence of a strong association between drug

trafficking and violence (including firearms violence). 35 36 Early

adolescents involved in drug trafficking report high levels of economic

motivation[37,38] and high levels of thrill seeking.[39,40] Since the

immediate rewards from engagement in risk behaviors may be highly positive,

adolescents are likely to perceive the benefits of violence-related

activities, with little regard for the potential risks.[41-43] Furthermore,

biologic changes and transitions in relationships between the family, peers,

and intimate relationships[41]–all hallmarks of adolescence–will

significantly influence violence-related activities and interventions.

RACIAL AND SOCIOECONOMIC CONSIDERATIONS

Adolescence marks a transition in an individual’s development. It is a time

that requires the creation of a stable self-concept, both as an individual and

as a member of society. For African-American adolescents, there is the added

component of negotiating the minority experience as a member of a minority

race and an identity as an African American.[38,44,45] The integration of the

individual’s personal identity with his or her racial identity is particularly

challenging when poverty and racism interfere with the perceived pathways to

success and when local cultural systems run counter to national

norms.[38,46-48] Therefore, racial identity development must be incorporated

into a developmental model of violence prevention and intervention.

Furthermore, research efforts are needed to address the complex and

interactive sociocultural influences unique to different racial and

socioeconomic populations.

POTENTIAL LIMITATIONS OF THE STUDY

Although all three data sets (the Victimization Survey, the UCR Program, and

the NCHS mortality data) provide strong evidence of increased violence

among

adolescents, overall rates and trends are not consistent among the three data

sets. A possible explanation for differences in rates (the Victimization

Survey rates are consistently higher than the UCR Program data rates) and

trends (the UCR Program data show a steady increase in violent crime rates

while the Victimization Survey data show rates to be steady or decreasing)

lies in the different methods of data collection. The Victimization Survey is

based on active surveillance (eg, individuals are contacted and questioned

semiannually about their experience with crime), while the UCR Program

data

are acquired through passive surveillance (eg, victims are required to notify

the police of the violent act). Only 40% to 50% of crimes are reported to

police,[13] possibly explaining the lower overall rates in the UCR Program

data. There is evidence of higher rates of reporting in recent years,

explaining in part the overall increase in violent crime seen in the UCR

Program data. The NCHS data, possibly the most reliable source of homicide

surveillance, are based on medical examiners’ judgments, which are subject to

error or bias as well.[13]

FUTURE RESEARCH NEEDS

Health professionals concerned with adolescent violence have many questions

and few answers. Why are adolescents, independent of gender and race,

increasingly engaging in acts of violence? What are the consequences of early

involvement in acts of violence, as either the victim or the perpetrator? Why

are rates of violence higher among some adolescent demographic subgroups

than

others? Why are firearm-related homicides increasing among youths aged 10

to

24 years but decreasing for those aged 25 years and older?

In the late 1980s, the public health field recognized that the epidemic of the

acquired immunodeficiency syndrome had engulfed the adolescent

population.

Therefore, new developmentally appropriate intervention approaches that

built

on those targeting adults were necessary.[41,49] Evidence exists that public

health research has responded to this challenge (B.S.; Nina Kim, Ma; Jennifer

Galbraith, MA; Maureen Parrott, MD; unpublished data, September 1994).

Likewise, it is time to recognize that the highest rates of violence and the

highest increases in violence are occurring not among adults but among

children. Researchers should draw on the substantial intervention and

developmental literature regarding adolescent risk behavior to incorporate

these data into national planning activities for primary, secondary, and

tertiary prevention.

RELATIVE ARTICLE: MATERIALS AND METHODS

DATA SOURCES

Crime data from the National Crime Victimization Survey (Victimization

Survey)[10-12] and the Uniform Crime Reporting (UCR) Program,[13]

beginning in

Janary 1973 and ending in December 1992, were examined. Homicides from

1970 to

1991 were analyzed with the National Center for Health Statistics (NCHS)

mortality data[14,15] from the Centers for Disease Control and Prevention.

Firearth-related homicides from 1979 to 1991 were also analyzed with the

NCHS

mortality data from the Centers for Disease Control and Prevention.

Victimization Survey

The Victimization Survey[10-12] data were obtained from a stratified,

multistage cluster sample of housing units. Housing units included family

households and group quarters, such as dormitories, rooming houses, and

religious group dwellings. A basic screening questionnaire and a crime

incident report were used to obtain victimization data. (For further

information on the survey method, see Sourcebook of Criminal Justice

Statistics–1993,[13] Appendix 8.) Thus, the Victimization Survey addresses

crime from the perspective of the victim; homicide is not included in the

Victimization Survey, since this survey is based on self-report data.

UCR Program

Nationwide data on crimes are collected from individual law enforcement

agencies and tabulated by city, county, metropolitan statistical area,

demographic group, and geographic division.[13] Statistics are published

annually, with a lag between incidence and reporting of about 6 months. The

UCR system collects basic information about the most serious crime

committed

in a single event. Supplemental information about the circumstances of

homicides and characteristics of arrestees is also contained in this data set.

NCHS Mortality Data

These data are generated by the 50 states and the District of columbia.[14,15]

The statistics include age, gender, race, geographic data, and cause of death

coded according to the International Classification of diseases, Ninth

Revision.[15] Data were obtained from the Centers for Disease Control and

Prevention. Data on firearm-related homicides were obtained through CDC

WONDER/PC Version 2, the on-line computer software package from the

Centers

for Disease Control and Prevention.

DEFINITIONS

Although no standard definition of violence exists, violence is defined in

this article as “behaviors by individuals that intentionally threaten,

attempt, or inflict physical harm on others.”[16] This broad definition,

therefore, includes all acts of violent crime and is compatible with the

definitions used by the UCR Program and the Victimization Survey. Personal

crimes of violence include homicide, rape, robbery, and assault (both

aggravated and simple). Rates of personal crimes of violence include both

attempted and completed crimes (unless otherwise specified) and always

involve

contact between the victim and the offender.

The following definitions are those used by the UCR Program and the

Victimization Survey.[12] Assault is an unlawful physical attack or threat of

attack. Aggravated assault consists of an attack with a resultant serious

injury or an attack with a weapon regardless of whether an injury occurred.

Simple assault consists of an attack without a weapon. If there is a resultant

injury, it is minor or, if undetermined, requires less than 2 days of

hospitalization. The UCR Program data do not categorize simple assault as

violent crime. Homicide includes both murder and nonnegligent manslaughter

(the willful killing of one human being by another). Rape is defined as carnal

knowledge through the use of force or the threat of force, including attempts

(statutory rape is excluded). The UCR Program data include only

victimization

of females. Robbery is defined as completed or attempted theft, directly from

a person, of property or cash by force or threat of force, with or without a

weapon.

ANALYSES

Analyses focused on two specific questions: (1) Is there evidence for

increased rates of acts of violence? (2) Is there evidence that a specific

demographic group is experiencing this increase disproportionate to the

general population? Given the exploratory nature of these analyses, specific

hypotheses were not articulated. Rather, each of the data sources described

above was explored for data relevant to these questions. Violent crime data

were examined overall and by specific sociodemographic variables. Trend

data

were available for all analyses of violent crime except age by gender by race.

For this three-way analysis, 1992 data were used. It was anticipated that

these analyses would lead to the formulation of hypotheses that could be

empirically tested in subsequent research as well as enable targeting of

subsequent intervention efforts.

[Figure 1 to 4 ILLUSTRATION OMITTED]

Accepted for publication January 30, 1995.

Reprint requests to Center for Minority Health Research, University of

Maryland, 712 W Lombard St, Baltimore, MD 21201 (Ms Rachuba).

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From the Center for Minority Health Research, University of Maryland,

Baltimore (Ms Rachuba and Drs Stanton and Howard); and Division of

General

Pediatrics, Department of Pediatrics, University of Maryland Medical School,

Baltimore (Dr Stanton).

— End –