Prevention

Prevention efforts may focus on one or more of three levels. Primary prevention efforts attempt to prevent the onset of a condition—such as preventing violent behavior. These efforts often utilize a broad-based approach aimed at the general public, including messages urging the use of nonviolent means to resolve disputes and problems. Secondary prevention efforts target populations considered to be at high risk, such as individuals who have already committed some act of violence. Tertiary prevention is analogous to damage control after an event has already occurred, and most frequently consists of arrest and incarceration following the commission of a homicide.

Various primary prevention strategies have been utilized in an attempt to reduce the relatively high rates of homicide in the United States. Numerous jurisdictions have adopted child access prevention laws, which hold adults criminally liable for the unsafe storage of firearms in environments where children live or are present (Webster and Starnes). Such laws remain controversial, however, due to the ease with which children can obtain firearms outside of the household (Hardy). Pediatric-based counseling of parents to increase their safety-related behavior has also been recommended, but the effectiveness of this approach is questionable due to physicians' lack of time, their inability to accurately assess actual gun ownership among parents, and their perceived lack of credibility as a source of information (Hardy).

Homicide prevention efforts must also address the use of alcohol and other substances. Primary prevention efforts have included the imposition of increased excise taxes on alcohol, the use of anti-alcohol advertising and promotion, and the development of responsibility training programs for servers of alcohol (Rivara, Muller, Somes, et al.).

Secondary prevention efforts have included the counseling of individuals through court-ordered programs in an effort to intervene before violence becomes a pattern and before the violence escalates to the level of homicide. Healthcare providers are now more likely to ask female patients about domestic violence—in large part due to focused training of providers and recent accreditation requirements and legal mandates imposed on healthcare institutions. It is believed that the early identification of violence in the home, coupled with modifications in legal policy— such as the increased enforcement of laws prohibiting and punishing violence—will decrease the rate of intimate partner homicide. However, efforts also require that healthcare providers assess individuals' risk for becoming violent offenders before violence has begun, and to then refer those at high risk for appropriate intervention. Patient counseling by primary care providers to reduce excessive alcohol use and binge drinking may also help to reduce the rate of homicide by reducing the use of alcohol (Rivara, Muller, Somes, et al.).

Secondary prevention strategies also include the issuance of civil protection orders by courts. These orders prohibit individuals who have committed an act of intimate partner violence from further abusing their victims. In general, victims are more likely to seek such orders if they are financially independent from the perpetrator, if they are no longer living with him or her, and if they have seen family members or friends threatened or abused by the perpetrator (Wolf, Holt, Kernic, et al.).

TOM CHRISTOFFEL (1 995) REVISED BY SANA LOUE

SEEALSO:.Abortion;Abuse, Interpersonal; Bioterrorism; Death; Death Penalty; Embryo and Fetus; Harm; Infanticide; Insanity and Insanity Defense; Medicine, Profession of; Mistakes, Medical; Pain and Suffering; Race and Racism; Right to Die: Policy and Law; Sexism; Smoking; Warfare

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