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Pediatric Clinics of North America
Publication Date
DOI: 10.1016/s0031-3955(05)70020-1
  • Biology
  • Design
  • Medicine


Community-based approaches have traditionally been used as an effective public health strategy in the control and prevention of morbidity and mortality due to illness. Some of the most successful community-based programs have been developed in the area of cardiovascular disease prevention. 12,23,39 Implementation of primary prevention strategies focusing on the reduction of cardiovascular risk factors across entire communities has resulted in a demonstrable decline in disease prevalence and, in at least one study community, an actual reduction in heart disease mortality rates. 36,39 These intervention efforts have focused on communities, rather than individuals, as the primary unit of evaluative analysis. They have also enjoyed the benefit of tremendous resource support and, most critically, have established sufficient longevity in the target communities such that rigorous scientific analysis and evaluation can be applied. The application of similar strategies to injury control and prevention is relatively new. It wasn't until Haddon, in the early 1960s, conceptualized injury as disease and subsequently developed a useful framework for the analysis of potential preventive measures that public health approaches to injury control became widely implemented. 13,14,42 As with the epidemiologic model for mitigating communicable disease, injury control can be achieved by altering the agent, eliminating the vector, changing host susceptibility, or modifying the environment. The application of strategies based on this approach has been successful in reducing the burden of several types of unintentional injuries, the most notable example being the steady decline in motor vehicle crash occupant fatalities over the past two decades. 2,30 In contrast, the approach to intentional injury reduction, specifically the prevention of interpersonal violence, has proven to be a much more complex and elusive task. Not only is violence a multifactorial problem of enormous proportions but also, despite the fact that violent injuries are among the leading causes of lost potential and productivity among young people in the United States, 4 federal resources to combat this problem have been woefully inadequate compared with research expenditure on other major diseases. 18 Furthermore, the success of those intervention strategies that have been funded and supported has been highly variable. There have been relatively few efforts that have either been designed using appropriate methodology to scientifically prove efficacy or simply been around long enough to analyze community impact through longitudinal markers, such as population-based injury rates. 17,19,44 In addition to scientific shortcomings, funding agencies have also recognized that a lack of community involvement in project conception, design, implementation, and analysis are critical missing elements that have plagued some violence-prevention initiatives. As such, organizations or individuals seeking funding support for violence interventions must articulate a well-conceived plan for community involvement when responding to requests for proposals. In the area of youth violence prevention, the experience and results of a few long-term population-based intervention projects have begun to appear in the literature. 8,9,15,16,21,22 In addition, baseline and pilot experience from initiatives in progress and more focused intervention projects are being systematically published and reported in compendia compiled by federal funding agencies. 24,32,41 This article focuses generically on those programmatic features and components that portend a successful community-based intervention as well as describes the strategies used in a model project that has proven efficacy.

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