Report on Violence Among Adolescents and Young Adults

REPORT ON VIOLENCE AMONG ADOLESCENTS AND YOUNG ADULTS

SUNY DOWNSTATE MEDICAL CENTER 450 CLARKSON AVENUE, BROOKLYN, NEW YORK 11203 • www.downstate.edu

LETTER FROM THE PRESIDENT

Dear residents and friends of Brooklyn:

Since the early 1990's, the number of violent crimes committed in Brooklyn and elsewhere in New York City has steadily declined. Between 1993 and 2003, for example, the number of homicides committed in Brooklyn fell by 67 percent. Today Brooklyn is a much safer place than it was just a dozen years ago, and as a result, it is a better place to live, work, go to school, visit, and do business. The problem of violence calls for a But for all the progress we have made, we can't afford to relax our efforts. In community-wide Brooklyn and throughout the City, acts of violence are still far too common. response. Violence is not just a law enforcement problem—it is a very real public health problem. Homicide is the sixth leading cause of death among all New York residents younger than 65. Each year, tens of thousands of New Yorkers are treated in emergency rooms after being injured in an assault. Thousands are hospitalized for these injuries, and some are permanently disabled. Violence can also cause serious emotional harm, and fear of violence can prevent whole communities from fulfilling their potential.

As with other major public health problems such as smoking, substance abuse, and HIV/AIDS, the problem of violence calls for a community-wide response. We believe that with our strengths in research, health care, education, and community outreach, we at Downstate can make a valuable contribution to Brooklyn's campaign against violence—and that we have an obligation to do so.

Effective community action begins with a clear understanding of the problem. Strong partnerships are needed to reduce the threat that violence poses to the health of our communities. We are pleased to offer this Report on Violence among Adolescents and Young Adults as a starting point for discussion.

John C. LaRosa, MD President

Contents

Why Focus on Violence among Adolescents and Young Adults? ...... 3

Homicide ...... 4

Assaults and Violent Behaviors ...... 9

Violent Behaviors among Youths ...... 14

Fear of Violence among Youths ...... 16

Violent Sexual Behaviors among Youths ...... 18

Suicide ...... 20

Suicide among Youths ...... 23

Where Do We Go from Here? ...... 25

Glossary ...... 26

Sources of Information ...... 26

Technical Notes ...... 27

WHY FOCUS ON VIOLENCE AMONG ADOLESCENTS AND YOUNG ADULTS?

Nationwide, violence is a serious public health concern. This report provides information on the general pattern of violence in Brooklyn and New York City. But it also pays special attention to violence among adolescents and young adults. There are several reasons for focusing on these age groups. In 2002, homicide was the fourth leading cause of death among New Yorkers younger than 15, and the leading cause of death for those between the ages of 15 and 34. Two-thirds of all murder victims in New York City are under 35.

When so many young lives are lost, we forever lose the energy and talents on which our City's future depends. Violence in our schools prevents children from learning and becoming all they can. Violence among youths increases health-care costs, takes parents away from their jobs, and makes the neighborhoods where it occurs less attractive places to live, work, and invest.

The tragedy at Columbine High School in 1999, and more recently at Red Lake High School, were wake-up calls for the nation to do more to identify the causes of youth violence and find ways to prevent it. As the Surgeon General's Report on Youth Violence makes clear, violence is not just a criminal justice matter; it is a public health concern. With this in mind, the U.S. government’s Healthy People 2010 campaign has set goals to gradually reduce youth violence all across the country.

For all of these reasons, law enforcement and public health professionals recognize the importance of focusing on violence among adolescents and young adults. If we are to break the cycle of violence in our society, this is where we have to start.



HOMICIDE

Within the last 10 years, the number of homicides has gone down nationwide, but perhaps nowhere as much as in New York City and Brooklyn. Between 1993 and 2003, the number of homicides in Brooklyn fell 67 percent—from 695 to 230. Despite this improvement, more needs to be done.

As the charts in this section show, men are more at risk than women of becoming victims of homicide, and Blacks have a far greater risk than Whites. The risk for young people between the ages of 10 and 24 is greater than for people in any other age group. For young Black men, homicide is the leading cause of death.

Homicides in New York City, 2002

Among New York City's five boroughs, Brooklyn had the largest number of homicides in absolute terms: 221 out of 625 homicides city-wide (data not shown here). However, the homicide rate—the number of reported homicides for every 100,000 residents—was highest in the Bronx.

4 Healthy People 2010 Goal adjusted death rate per 100,000 population adjusted death rate per 100,000 - 2 age

Source: 0

Bureau of Injury New York City Brooklyn Bronx Manhattan Queens Staten Island Epidemiology, NYC Department of Health and Mental Hygiene, 2004

50 

cent of live births 30 Per 20

0 New York City Queens Brooklyn Bronx Manhattan Staten Island

HOMICIDE

Homicides by Brooklyn Neighborhood, 2003

In 2003, three Brooklyn neighborhoods—Brownsville/East New York, Bedford Stuyvesant/Bushwick, and Crown Heights/Flatbush—had higher rates of homicide than the borough as a whole.

Healthy People 2010 Goal

New York City excluding Brooklyn

Brooklyn

Brownsville / East New York

Bedford Stuyvesant / Bushwick

Crown Heights / Flatbush

Borough Park / Midwood

Coney Island / Sheepshead Bay

Canarsie / Flatlands

Downtown / Heights / Park Slope

Greenpoint / Williamsburg

Sunset Park

Bensonhurst / Bay Ridge

0 51015 20 crude rate per 100,000 population

Source:

New York City Police Department, 2004



HOMICIDE

Homicide Victims in New York City by Age Group, 2002

In New York City, homicide is the fourth leading cause of death among children younger than 15 and the leading cause of death for people between the ages of 15 and 34. Of the 625 victims of homicides reported in 2002, 397 (64 percent) were less than 35 years old.

625 Homicides in NYC, 2002

Under 15 Yrs 4%

Over 65 Yrs 4% 15 - 24 Years 30%

55 - 64 Years 4%

45 - 54 Years 10%

Source: 25 - 34 Years Summary of Vital Statistics 30% 2002, The City of New York, 35 - 44 Years NYC Department of Health 18% and Mental Hygiene



HOMICIDE

Homicide Victims by Race/Ethnicity, 2000

In 2000, the homicide rate for Black New Yorkers was higher than for any other racial or ethnic group. This was true throughout the City and State. The homicide rate was higher for Hispanics living in Brooklyn than it was for the borough's White residents. But in the other four boroughs, the homicide rate was slightly lower among Hispanics than it was among Whites.

Brooklyn

New York City excluding Brooklyn

New York State excluding NYC 22 20 18 16 14 12 10 8 6 4 2 0 Source: population 100,000 per rate crude White Black Hispanic Vital Statistics of New York State 2000, New York State Department of Health

Homicides in New York City by Method, 2002

Even though New York has one of the toughest gun-control laws in the nation, guns continue to play a major role in violent deaths. In 2002, 58 percent of all homicides in the City were committed with a firearm (gun), and roughly 23 percent were stabbing or clubbing deaths. 625 Homicides in NYC, 2002

Firearms Sharp or Blunt Objects Hanging/Strangulation Legal Intervention* Late Effects* Neglect/Maltreatment Drowning or Pushing from High Place Poisoning Other/Unspecified 10 20 30 40 50 60 Source: 0 15 30 45 60 Summary of Vital Statistics percent of homicide deaths 2002, The City of New York NYC Department of Health and Mental Hygiene * See Glossary for definitions of these terms. 

HOMICIDE

Method of Homicide in New York City by Victim’s Age Group, 2002

Too many victims of gun violence are young. In 2002, 37 percent of all New Yorkers murdered with guns were between the ages of 15 and 24, even though this age group accounted for only 14 percent of the City's population. Nearly 70 percent of all homicide victims in this age group were killed with guns; another 19 percent were stabbed or clubbed to death.

365 Homicides 146 Homicides Committed Committed with a Firearm with a Sharp or Blunt Object

Under 15 Yrs 1% Over 65 Yrs 2% 55 - 64 Years 1% Under 15 Yrs 5% 15 - 24 Years 15 - 24 Years 45 - 54 Years Over 65 Yrs 3% 25% 37% 7%

55 - 64 Years 25 - 34 Years 10% 24% Source: 35 - 44 Years 17% Summary of 45 - 54 Years Vital Statistics 2002, 13% The City of New York, 25 - 34 Years NYC Department of 35% 35 - 44 Years Health and Mental 19% Hygiene

Family-Related Homicides, 2003

Of the 235 homicides that took place in Brooklyn in 2003, 24 (roughly one in ten) were family-related. These included intimate-partner homicides, as well as children killed as a result of family violence. Among New York City's five boroughs, Brooklyn had the highest rate of family-related homicides.

1.0

0.8

0.6

0.4

Source: rate per 100,000 population rate per 100,000 Domestic Violence Fact Sheet, Summer 0.2 2004, Office of the Mayor — City of New York

0.0  Brooklyn Bronx Queens Manhattan Staten Island New York City exc Brooklyn

cent of live births 30 Per

0 New York City Queens Brooklyn Bronx Manhattan Staten Island

Healthy People 2010 Goal

New York City excluding Brooklyn Brooklyn Brownsville, East New York Bedford Stuyvesant, Bushwick Crown Heights, Flatbush Borough Park, Midwood Coney Island, Sheepshead Bay Canarsie, Flatlands Downtown, Heights, Park Slope ASSAULTS AND VIOLENT BEHAVIORS Greenpoint, Williamsburg Sunset Park Bensonhurst, Bay Ridge Felony assaults (physical attacks that cause serious harm and are punishable by years in prison) and other violent behaviors are a major public health concern. Physical 0 5 10 15 20 assaults may involve guns, knives, and blunt objects or the use of hands, fists, and crude rate per 100,000 population feet.

While the number of violent assaults has gone down over the past ten years in Brooklyn and New York City, it is still too high.

Felony Assaults by Brooklyn Neighborhood, 2003

In 2003, more than a third of all felony assaults reported in New York City occurred in Brooklyn. Though not shown here, the Brooklyn neighborhoods most affected had the least improvement (lowest percentage reduction) since 2001.

New York City excluding Brooklyn

Brooklyn

Brownsville / East New York

Bedford Stuyvesant / Bushwick

Crown Heights / Flatbush

Downtown / Heights / Park Slope

Sunset Park

Greenpoint / Williamsburg

Borough Park / Midwood

Canarsie / Flatlands

Coney Island, Sheepshead Bay

Bensonhurst / Bay Ridge

Source: 0 10 20 30 40 50 60 Bureau of Injury Epidemiology, NYC crude rate per 10,000 population Department of Health and Mental Hygiene, 2004



ASSAULTS

Assaults Leading to Hospital Treatment by Borough, 2002

In addition to the damage and pain they cause victims, physical assaults place an extra burden on the health-care system. In 2003, nearly 33,000 New Yorkers were treated in an emergency room for injuries caused by assault, and over 6,300 were hospitalized. More than a quarter of these ER visits and a third of the hospitalizations were in Brooklyn.

32,942 Assaults That Led to 6,345 Assaults That Led Emergency Room Visits to Hospitalizations

Unknown or Non-resident 7% Unknown or Non-resident 4% Brooklyn Brooklyn 28% Staten Island 3% 33% Staten Island 6%

Queens Queens 18% 13% Bronx Bronx 29% 26%

Manhattan Manhattan Source: 18% 16% Bureau of Injury Epidemiology, NYC Department of Health and Mental Hygiene, 2004



ASSAULTS

Assaults Leading to Hospital Treatment in New York City by Race/Ethnicity, 2002

In 2002, Black residents of New York City had a far greater risk of being injured due to assault than members of 30 35 other racial or ethnic groups. The rate at which New Yorkers received treatment in an emergency room for injuries from an assault was roughly seven times higher for Blacks than for Whites, and nearly twice as high for Blacks as for 30 Hispanic New Yorkers. Blacks also had far higher rates of hospitalization resulting from assaults. 25

25 20 30 35 Emergency Room Visits Hospitalizations 20 800 160 15 ting no physical activity in past month 30 700 140 25 15 600 120 500 100 10 25

percent of adults surveyed 10 400 80 20 300 Healthy People 60 20

Emergency Room Visits Hospitalizations 5 cent repor 2010 Goal 200 5

40 ting no physical activity in past month 800 160 15 100 20

Per Healthy People Source 700 140 0 0 0 15 0 2010 Goal Bureau of Injury 600 120 Epidemiology, NYC population 100,000 per rate age-adjusted population age-adjusted rate per 100,000 500 White Black Hispanic Asian White Black Hispanic Asian 10 White New York State WhiNewte York CityNew YorkBrooklyn State New York City Brooklyn Department of 100 percent of adults surveyed 10 Health and Mental 400 80 Hygiene, 2004 Healthy People 300 60

5 cent repor 2010 Goal 200 40 5 Assaults Leading to Hospital Treatment in New York City by Age, 2002 100 20

Per Healthy People Compared to other age groups,0 young people between the ages of 15-24 are0 most likely to need emergency room 0 0 2010 Goal treatment or hospitalization forWhi injurieste Blackfrom anHispanic assault. Asian White Black Hispanic Asian White New York State WhiNewte York CityNew YorkBrooklyn State New York City Brooklyn age-adjusted rate per 100,000 population 100,000 per rate age-adjusted population age-adjusted rate per 100,000

Emergency Room Visits Hospitalizations

1000 200 900 175 800 150 700 600 125 500 100 400 75 300 50 200 Source : 100 25 Bureau of Injury 0 0 Epidemiology, age-adjusted rate per 100,000 population age-adjusted rate per 100,000 population age-adjusted rate per 100,000 NYC Department Under 15-24 25-34 35-44 45-54 55-64 Over Under 15-24 25-34 35-44 45-54 55-64 Over 15 Years Years Years Years Years Years 65 Years 15 Years Years Years Years Years Years 65 Years of Health and Mental Hygiene, 2004 

ASSAULTS

Rapes in New York City by Borough, 2003

In 2003, more than a third of all rapes in New York City occurred in Brooklyn.

1,431 Rapes in New York City

Staten Island 2% Brooklyn 36%

Manhattan 18%

The Bronx 28% Queens 16%

Source:

New York City Police Department, 2004



Healthy People 2010 Goal

0 5 10 15 20 crude rate per 100,000 population Rapes by Brooklyn Neighborhood, 2003

Four neighborhoods—Brownsville/East New York, Bedford Stuyvesant/Bushwick, Crown Heights/Flatbush, and Downtown/Heights/Park Slope—had higher rates for rape than Brooklyn as a whole. However, all of Brooklyn and New York City had lower rates than the guidelines established by Healthy People 2010.

Healthy People 2010 Goal New York City excluding Brooklyn

Brooklyn

Brownsville / East New York

Bedford Stuyvesant / Bushwick

Crown Heights / Flatbush

Downtown / Heights / Park Slope

Borough Park / Midwood

Sunset Park

Greenpoint / Williamsburg

Canarsie / Flatlands

Coney Island / Sheepshead Bay

Bensonhurst / Bay Ridge

0 0.25 0.50 0.75 Source: crude rate per 1,000 population over 12 years old New York City Police Department, 2004



Type of Insurance for Diabetes Hospitalizations, 1999 50

45 Brooklyn New York City 40 New York State United States 35 VIOLENT BEHAVIORS AMONG YOUTHS

30 Physical25 violence and behaviors that increase the risk of injury are widespread among Healthy People high 20school students. In a national student survey, more than 17 percent of students reported carrying a gun, knife, or other kind of weapon on at least one day in the past 2010 15 Goal month, 33 percent reported being in a fight during the past year, and 9 percent said

theyRate per 1,000 population 10had been physically hurt by a boyfriend or girlfriend. The results of a similar survey5 conducted among students in New York City public schools are reported below. 0 Medicare Medicaid Blue Cross & Self-Pay Students Who Fought or Carried a Weapon, 2003 Other Commercial Self-Insured Among high school students surveyed, nearly 40 percent of Brooklyn students said they had fought at least once in the past year. This was slightly higher than the percentage of students in New York City's other boroughs and nationwide who reported being in fights. Compared to other City students, a higher percentage of Brooklyn students said they had carried a weapon in the past month.

40 40 35 Brooklyn New York City New York State United States 35 30 Healthy 30 25 People 2010 20 Goal

15 20 25 10 Healthy People 5 2010 Goal percent of high school students surveyed 10 0 Source: Physically Fought Carried a Weapon 5 Youth Risk Behavior Survey, New York City Number of Brooklyn Students Surveyed = 82,900 Department of Health and Mental Hygiene and 15 CDC, 2003



VIOLENT BEHAVIOR

Students Who Fought or Carried a Weapon by Race/Ethnicity, 2003

Both in Brooklyn and in the rest of the City, a greater percentage of Black and Hispanic high school students than White or Asian students reported having been in a fight or carried a weapon. The percentage of high school students of all races and ethnicities who said they had carried a weapon in the past month was far greater than the Healthy People 2010 goal of 5 percent.

40 White Black

35 Hispanic Asian

percent of high school students surveyed 5 Source: 0 Youth Risk Behavior Survey, New York City Department Brooklyn New York City Brooklyn New York City of Health and Mental Hygiene, 2003 Physically Fought Carried a Weapon

Students Who Fought or Carried a Weapon by Grade Level, 2003

The 50percentage of high school students who reported fighting or carrying a weapon was greater among 9th graders than 12th graders. Younger students may feel they need to protect themselves because they are more vulnerable.

40 45 40 9th Grade 12th Grade 35 30 30 25 20 20 15

10 10 5 Source:

Youth Risk Behavior Survey, percent of high school students surveyed 0 New York City Department of Health and Mental Brooklyn New York City Brooklyn New York City Hygiene, 2003 Physically Fought Carried a Weapon 

Number of Brooklyn Students Surveyed = 82,000 40 40 35 Brooklyn New York City New York State United States 35 30 Healthy 30 25 People 2010 20 Goal

15 20 25 10 Healthy People 5 2010 Goal percent of high school students surveyed 10 0 Physically Fought Carried a Weapon 5

10 FEAR OF VIOLENCE AMONG YOUTHS 35 students surveyed

cent among high school 5 30 Per 0 School violence is a problem in all types of communities, regardless of size, income levels, race,United and States culture.New According York State to a recentBrooklyn government study,New nearly York Cityone in ten 25 high school students reported being threatened or injured with a weapon on school property in the past year. According to the Centers for Disease Control, more than half of the most serious violent incidents happened at the beginning or end of the school 20 day or during lunch. Without a safe school environment, young people are denied the

chance to learn. ting no physical activity in past month 15

10 Healthy People 2010 Goal Students Who Did Not Go to School for Fear of Violence, 2003 cent repor 5

Per Healthy People In 2003, nearly 10 percent of Brooklyn high school students said they did not go to school one or more times in 0 2010 Goal the past month because they felt unsafe at school or on the way to school. This is slightly less than the percentage for New York City as a whole. While not shown here, more younger students and more male than female students White New York State WhiNewte York CityNew YorkBrooklyn State New York City Brooklyn in Brooklyn reported staying home from school because they felt unsafe.

Number of Brooklyn Students Surveyed = 82,200 11 10

6 5

percent of high school students surveyed 2

Source: 0

Youth Risk Behavior Brooklyn New York City New York State United States Survey, New York City Department of Health and Mental Hygiene and CDC, 2003



FEAR OF VIOLENCE

High School Students Who Did Not Go to School for Fear of Violence by Race/Ethnicity 2003

A greater percentage of Hispanic students than White, Black, or Asian high school students reported missing school in the past month because of fears for their safety. Asian students were the least likely to miss school. Male 12 F emale 13 13 10 Brooklyn 12 11 New York City 8 10 9 8 6 7 6 5 4

4 cent of high school students surveyed 3 2 2 Per 1 percent of high school students surveyed Source: 0 0

Youth Risk Behavior White Black Hispanic Asian White Black Hispanic Asian Survey, New York City Department of Health and Mental Hygiene, 2003



20 25 VIOLENT SEXUAL BEHAVIORS AMONG YOUTHS ting no physical activity in past month 20 15

15 Many students who responded to the Youth Risk Behavior Survey reported that they 10 felt10 pressured to have unwanted sex. Since the survey specifically asks about sexual Healthy People students surveyed intercourse, the students may not have realized that other sex acts they engage in also 2010 Goal cent repor cent among high school 5 put5 them at risk for physical and psychological harm.

Per Healthy People Per 0 0 2010 Goal United States New York State Brooklyn New York City White New York State WhiNewte York CityNew YorkBrooklyn State New York City Brooklyn

Students Who Felt Forced to Have Sexual Intercourse, 2003

The percentage of high school students who reported that they felt forced to have unwanted sex was higher in Brooklyn—for both males and females—than it was elsewhere in the City and State. The survey shows, however, that this problem is even more common elsewhere in the United States than it is in Brooklyn and New York City.

ts surveyed Number of Brooklyn Students Surveyed = 84,300 9

2 Source:

Youth Risk Behavior Survey, percent of high school studen 1 New York City Department of Health and Mental 0 Hygiene and CDC, 2003 Brooklyn New York City New York State United States

Students Who Felt Forced to Have Sexual Intercourse by Gender, 2003

More Brooklyn high school students reported feeling forced to have unwanted sex compared to students elsewhere Male 12 in the City and State. While both female and male students reported feeling forced to have sex, the percentage of F emale female students was higher.surveyed In the nation as a whole, it was nearly double that of male students.

10 12 Female

Male 10 8 ool students 8

gh sch 6

Source: 4 Youth Risk Behavior Survey, 4 New York City Department

of Health and Mental 2 cent of high school students surveyed Hygiene and CDC, 2003

percent of hi 2  0 Per Brooklyn New York City New York State United States 0 White Black Hispanic Asian

40 45 40 Brooklyn New York City New York State United States 35 30 30 25 20 20 15

10 10 5 VIOLENT SEXUAL BEHAVIORS

percent of high school students surveyed 0

25 Brooklyn New York Brooklyn New York

Students Who Felt Forced20 to Have Sexual Intercourse by Race/Ethnicity, 2003 15 A greater percentage of Black and White high school students in Brooklyn reported that they felt forced to have sex than those who lived in the four other boroughs. Among Hispanic and Asian students, the opposite was true: 10 35

Brooklyn students were lessstudents surveyed likely to report feeling forced to have sex.

cent among high school 5

Source: 8 30 Per 0 Youth Risk Behavior 7 White Black Survey, New York City United States New York State Brooklyn New York City 25 Department of Health Hispanic Asian 8 and Mental Hygiene, 6 302003 5 20 4 7

4 ting no physical activity in past month 5 15 3 3

2 percent of adults surveyed 10 2 Healthy People 1 2010 Goal 1 cent repor 5 percent of high school students surveyed

0 Per Healthy People 0 2010 Goal Brooklyn New York City White New York State WhiNewte York CityNew YorkBrooklyn State New York City Brooklyn Students Who Felt Forced to Have Sexual Intercourse by Grade Level, 2003

Both in Brooklyn and elsewhere in the City, 12th grade students were more likely than 9th graders to report feeling forced to have sex.

Source:

Youth Risk Behavior 9th Grade Survey, New York City 9 Department of Health 12th Grade and Mental Hygiene, 8 2003 7

1 percent of high school students surveyed 0 Brooklyn New York City



SUICIDE

Suicide is a form of violence against oneself and is a significant public health problem. In the United States, some 30,000 people deliberately kill themselves each year. Suicide attempts take place much more frequently than completed suicides. Even though it is a highly personal act, age, race/ethnicity, and socioeconomic factors do play a part.

The causes of suicide or suicidal thinking are complex. Depression and family relationships can play a role, and some teenagers may see suicide as a way out of life's problems.

Suicide in New York City and Brooklyn, 2002

In 2002, 495 people committed suicide in New York City. Of the City's five boroughs, Brooklyn had the lowest suicide rate—lower, in fact12 than the nationwide goal of 5 suicides per 100,000 people set by Healthy People 2010. According to the New York City Department of Health and Mental Hygiene, the number of suicides in Brooklyn declined steadily between 1993 and 2003, from 161 to 103. 10

6 Healthy People 2010 Goal

Source: population age adjusted rate per 100,000 0 Bureau of Injury New York City Manhattan Staten Island Bronx Queens Brooklyn 30 Brooklyn Epidemiology, NYC 25 New York City Department of Health and Mental Hygiene, 20 2004 Healthy People 15 2010 Goal

students surveyed 10 5 70 0 percent among high school Male Female White Black Hispanic Asian 60

cent of live births 30

 Per 20

0 New York City Queens Brooklyn Bronx Manhattan Staten Island

SUICIDE

Suicide by Age Group in New York City, 2002

More than half of all patients hospitalized in New York City in 2002 after an attempted suicide were under the age of 35. More than a third of the 495 suicides that year were committed by people under 35.

3,106 Suicide-Related Hospitalizations 495 Suicides

15 - 24 Years 15 - 24 Years Under 15 Yrs 4% Under 15 Yrs 25% 14% 1% 25 - 34 Years 20% Over 65 Yrs 6% 25 - 34 Years Over 65 Yrs 22% 15% Source (left): 55 - 64 Years 6% 35 - 44 Years Bureau of Injury 21% Epidemiology, NYC 45 - 54 Years 55 - 64 Years Department of Health 14% 10% and Mental Hygiene, 2004 35 - 44 Years 45 - 54 Years 23% 20% Source (right): Summary of Vital Statistics 2002, The City of New York, New York City Department of Health and Mental Hygiene, 2002

Suicide by Race/Ethnicity, 2000 Over 65 Yrs 15% In 2000, the suicide rate for Whites was higher than for other racial and ethnic groups throughout the borough, city, and state. Black residents of Brooklyn had a slightly higher suicide rate than Blacks in the rest of the city.

Unknown or Non-resident 4%

White Staten Island 3% Black

Hispanic 12 10 8 6 4 2 0

Source: population crude rate per 100,000 New York City Vital Statistics of Brooklyn New York State excluding NYC excluding Brooklyn New York State 2000, New York State Department of Health



SUICIDE

Suicide by Brooklyn Neighborhoods, 2002

While Brooklyn as a whole had a lower suicide rate than New York City, one neighborhood (Coney Island/ Sheepshead Bay) had a higher rate than the City. Three neighborhoods (Coney Island/Sheepshead Bay, Bay Ridge/Bensonhurst, and Williamsburg/Greenpoint) had higher suicide rates than the borough.

Healthy People 2010 Goal

New York City excluding Brooklyn

Brooklyn

Coney Island / Sheepshead Bay

Bay Ridge / Bensonhurst

Williamsburg / Greenpoint

Brownsville / East New York

Borough Park / Midwood

Crown Heights / Flatbush

Downtown / Heights / Park Slope

Sunset Park

Bedford Stuyvesant / Bushwick

Canarsie / Flatlands

0 246 8 crude rate per 100,000 population

Source: Summary of Vital Statistics 2002, The City of New York, New York City Department of Health and Mental Hygiene



40 45 40 SUICIDE AMONG YOUTHS 35 30 30 25In recent surveys of students in New York City high schools, a surprisingly high 20 percentage reported having considered committing suicide. More than a third of the 20495 suicides in New York City and half of all patients hospitalized after attempting 15suicide in 2002 were under the age of 35.

10 10 5 percent of high school students surveyed Students Who Considered0 or Attempted Suicide, 2003 Brooklyn New York Brooklyn New York In a 2003 survey, the percentage of high school students who reported seriously thinking about suicide in the past year was lower in Brooklyn and New York City than in New York State or the nation as a whole. However, the percentage of students who actually attempted suicide was roughly equal across all regions.

14 Brooklyn New York City 16 New York State United States 12 30 14 10

8 10 6 3 4 4

2 2 8

percent of high school students surveyed 0 Source: Seriously Considered Suicide Attempted Suicide Youth Risk Behavior Survey, New York City Number of Brooklyn Students Number of Brooklyn Students Department of Health Surveyed = 84,300 Surveyed = 63,700 and Mental Hygiene, and CDC 2003



40 White Black

35 Hispanic Asian

10 SUICIDE AMONG YOUTHS

percent of high school students surveyed 5

Students Who Considered0 or Attempted Suicide by Race/Ethnicity, 2003 Brooklyn New York City Brooklyn New York City Among both Black and White highPhysically school students Fought in Brooklyn, one in sevenCarried reported a Weapon having seriously considered suicide in the past year. One in ten Black high school students in Brooklyn attempted suicide in 2003—the highest percentage reported for any borough. A higher percentage of Asian students in Brooklyn reported attempting suicide compared to the borough's Hispanic and White high school students, as well as Asian students living in other boroughs. 16

14 White Black

Hispanic Asian 12

percent of high school students surveyed 2 Source: Youth Risk Behavior 0 Survey, New York City Brooklyn Department of Health Brooklyn New York City Brooklyn New York City and Mental Hygiene, 2003 Seriously Considered Attempted Suicide Attempting Suicide

High School Students Who Considered or Attempted Suicide by Grade Level, 2003

Younger students seem to be at greatest risk of taking their own lives. Both in Brooklyn and City-wide, more 9th grade than 1812th grade students seriously considered suicide or attempted suicide in the past year. 18 16 16 14 9th Grade 14 12th Grade 12 10 12 10

8 8

6 6 4 4 Source: Youth Risk Behavior 2 2 percent of high school students surveyed Survey, New York City Department of Health 0 and Mental Hygiene, 2003 Brooklyn New York Brooklyn New York Seriously Considered Suicide Attempted Suicide 

Number of Brooklyn Students Surveyed = 82,000 40 40 35 Brooklyn New York City New York State United States 35 30 Healthy 30 25 People 2010 20 Goal

15 20 25 10 Healthy People 5 2010 Goal percent of high school students surveyed 10 0 Physically Fought Carried a Weapon 5

WHERE DO WE GO FROM HERE?

The reduction in violent crime in New York City represents a remarkable achievement. It is important not only for the thousands of lives saved and for preventing damage to families, neighborhoods, and the City's economy but also because it shows us that violence is not a fact of city life. Violence is preventable.

Even though good police work has helped to reduce violent crime, law enforcement alone is not enough. Youth and family violence need to be addressed as public health problems. To reduce the level of violence further, New York City needs a long-term, community-wide effort. We need to:

•Make it harder for people to get guns.

•Improve school safety.

•Deal with the conditions of hopelessness that lead people to take their own lives or those of other people.

Treating violence as a public health problem also means changing people's behavior. Successful programs in Brooklyn and elsewhere show that young people can learn how to avoid situations that put them at risk and to manage conflicts without fighting.

In Brooklyn we need violence prevention programs that reach people from many walks of life, including those who speak other languages and come from other cultures. Preventing violence is a community-wide effort and requires a big commitment of time, energy, and money. At a time when city, state, and federal budgets are being cut back, we have to direct our efforts and limited resources to programs that are proven to be successful.

The resources listed on page 26 provide useful information on violence prevention programs and services. By learning more about what is being done elsewhere, we can develop effective strategies for our own communities.



GLOSSARY

Abuse: To cause physical or emotional harm. Assault: To physically attack someone. Felonious Assault: An unlawful physical attack. Healthy People 2010: A set of goals developed by the U.S. Dept of Health and Human Services to prevent or reduce the risk of major diseases and health conditions by the year 2010. Homicide: The act of killing someone. Late Effects: Medical problems that result from injuries that happened a year or more before. Legal Intervention: Death at the hands of law enforcement and legal execution. Rape: To force sex on someone. Rate: A calculated number used to show how many events happened among a group of individuals within a given period of time; for example: 150 deaths per 100,000 people per year. Suicide: The act of killing oneself.

SOURCES OF INFORMATION

Children & Adolescents Helping Children and Adolescents Cope with Violence and Disasters: www.nimh.nih.gov/publicat/violence.cfm National Center for Injury Prevention and Control: www.cdc.gov/ncipc/factsheets/yvfacts.htm National Youth Prevention Resource Center: www.safeyouth.org Information on the web U.S. Surgeon General's Report on Youth Violence (2001): www.surgeongeneral.gov/library/youthviolence Domestic Violence New York State Office for the Prevention of Domestic Violence: www.opdv.state.ny.us/health_humsvc/health/index/html Suicide National Center for Injury Prevention and Control: www.cdc.gov/ncipc/factsheets/suifacts.htm National Strategy for Suicide Prevention: www.mentalhealth.samhsa.gov/suicideprevention

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TECHNICAL NOTES

Violence-related data for the state and, in some cases, city and borough come from Vital Statistics of New York State, 2000, a compendium of mortality and health-related conditions reported by cities and counties to the Bureau of Biometrics, New York State Department of Health (NYSDOH). City and borough data come from Summary of Vital Statistics 2002, The City of New York, Office of Vital Statistics, New York City Department of Health and Mental Hygiene. Injury and suicide data, which include hospitalization and emergency room visits, come from the Bureau of Injury Epidemiology, New York City Department of Health and Mental Hygiene. Survey data for adults and high school students are taken from New York City's “Community Health Survey” and “Youth Risk Behavior Survey,” respectively. They are available through an online epidemiological data query system from the New York City Department of Health and Mental Hygiene. Crime-related data, such as assaults, rapes, and homicides, come from the New York City Police Department.

Police precinct data are aggregated to form larger neighborhoods in the Borough of Brooklyn. Since police precincts correspond to community districts, the appropriate population demographics were used to calculate rates. Every effort was made to provide as much local data as possible.

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SUNY Downstate Medical Center would like to thank the following individuals for their help in preparing the Report on Violence among Adolescents and Young Adults. RESEARCH Steven D. Ritzel, MPH, MIA Director for Regional Planning and Public Health Research, Office of Planning Clinical Assistant Professor of Preventive Medicine and Community Health ADVISORY COMMITTTEE Judith LaRosa, PhD, RN Professor of Preventive Medicine and Community Health Michael A. Joseph, PhD, MPH Assistant Professor of Preventive Medicine and Community Health Michael Harrell, MPA Director of Community and Governmental Relations Doris Youdelman Senior Editor/Writer, Office of Institutional Advancement REVIEWERS Reinaldo Austin, MD Assistant Professor of Emergency Medicine Stephen M. Goldfinger, MD Professor and Chair, Department of Psychiatry Pascal J. Imperato, MD, MPH & TM SUNY Distinguished Service Professor and Chair Department of Preventive Medicine and Community Health Dewell Narvaez Senior Investigator, New York State University Police Richard E. Rodriguez, MDiv Program Manager, Victim Assistance Programs CAMBA

Design: Frank Fasano Division of Biomedical Communications Cover photos (clockwise, l. to r.): Stock Connection, RM; Foto Search; John Zubrovich, Division of Biomedical Communications, SUNY Downstate; and Identikal, Sporting Chance/Getty. Published by SUNY Downstate Medical Center, 2005

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