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Youth Violence Is a Public Health Issue
“Violence is a public health seen as the starting point. ers, counselors, judges,
issue because of its tremen- As evident in the Healthy police, clergy, peers, and so
dous impact on the health People 2010 initiative on.
and well-being of our (www.health.gov/healthy Collaboration, as well as
youth.” So states the Na- people), accomplishing pub- participation, has become
tional Center for Injury Pre- lic health objectives involves especially evident in youth
vention and Control not just health professionals violence prevention. For ex-
(NCIPC), Centers for Dis- but educators, administra- ample, Youth Violence: A
ease Control and Prevention tors, community leaders, and Report of the Surgeon
(CDC), as it begins to de- government officials—all General (www.surgeon
scribe the problem, the fac- segments of society. Cer- general.gov/library/youth
tors, and the facts about tainly, broad participation is violence/report.html) was
youth violence necessary in youth violence developed by three Federal
(www.cdc.gov/ncipcfact prevention, among public agencies: CDC, the National
sheets/yvfacts.htm). The and private organizations as Institutes of Health, and the
designation of youth vio- well as groups of people Substance Abuse and
lence as a public health is- who interact with youth in Mental Health Services Ad-
Volume 15: Issue 3 2001

sue complements the more some way—parents, teach- ministration.

traditional status of the continued on next page
problem as a criminal justice

concern and incorporates
the social and developmen-
tal sciences. It allows for
broader interpretation of
violence as touching
everyone’s life; it includes
Prevention Can Be Effective
not just urban gang violence Life skills training, parenting Gun buyback programs,
but acts of aggression such workshops, essay contests… on the other hand, are inef-
as fisticuffs on suburban hundreds of youth violence fective secondary preven-
U.S. Department of Health and Human Services

playgrounds. prevention programs are be- tion strategies. Evaluation of

Public health brings a ing used across the country. gun buyback programs, a
strong problem-solving ap- Some are effective, some particularly expensive strat-
proach that has worked in are not; some are even egy, consistently has shown
many different arenas, in- harmful. The challenge is to such efforts to have no ef-
cluding safe water and air, focus resources on those fect on gun violence, includ-
childhood immunization, and that work. Youth Violence: ing firearm-related homicide
prenatal care. The approach A Report of the Surgeon and injury.
is dependent on a well-de- General (www.surgeon As Surgeon General
fined process, combining general.gov/library/youth David Satcher said in issu-
inclusivity through a broad violence/report.html) identi- ing the report, “The most ur-
degree of participation and fies more than two dozen gent need now is a national
collaboration, measurement, programs that meet rigorous resolve to confront the prob-
and communication. The scientific standards. It de- lem of youth violence sys-
process involves identifying scribes both effective and tematically using research-
the risk factors, designing ineffective strategies for based approaches and to
interventions to address primary, secondary, and correct damaging myths and
these factors, and evaluating tertiary prevention. stereotypes that interfere
the effectiveness of pro- For example, parent with the task at hand.” He
grammatic efforts. training can lead to clear im- called for an end to the
Many individuals and or- provements in children’s an- “waste of resources on inef-
ganizations participate in the tisocial behavior (including fective or harmful interven-
solution of any public health aggression) and family man- tions and strategies…”
problem; the community is agement practices. continued on page 5

See additional information following the Etcetera section.


continued from previous page persons 15 to 24 years of

The public health focus age. It is the leading Estimating the Cost of Youth Violence:
on violence has brought new cause of death for An Unmet Challenge
players and new collabora- African Americans and
tive partnerships among the second leading cause In the public health approach to prevention, one of the first
criminologists, psychologists, of death for Hispanic questions to be answered concerns the burden of suffering—
psychiatrists, sociologists, youths in this age group. the economic costs to society. Youth violence is a relatively
neuroscientists, and others. new field, so comprehensive cost estimates are not readily
Although physicians and • In 1999, 6.9 percent of available. Measures of violence in the home and the costs of
high school students treatment for victims of violence are among the missing data.
other general medical ser-
vice providers have not reported carrying a The Surgeon General’s report provides the best estimate but
been sufficiently involved in firearm on school prop- it is based on data nearly a decade old: Violence costs the
the past, that picture has erty at least once in the United States an estimated $425 billion in direct and indirect
changed with the recent for- previous 30 days. costs each year. Of these costs, approximately $90 billion is
mation of the Commission spent on the criminal justice system, $65 billion on security, $5
Information dissemina- billion on the treatment of victims, and $170 billion on lost
for the Prevention of Youth
tion is very much a part of productivity and quality of life.
Violence by the American
Academy of Child and Ado- the public health mission—
lescent Psychiatry, Ameri- getting the word out to all Youth Violence: Everyone’s Issue
can Academy of Family the participants, raising
The immediate impetus for Youth Violence: A Report of the
Physicians, American awareness about the prob-
Surgeon General was the Columbine High School tragedy that
Academy of Pediatrics, lem and the solutions, and occurred in 1999. Both the Administration and Congress re-
American College of Physi- broadening the knowledge quested a report summarizing what research has revealed
cians-American Society of base. Information on youth about youth violence, its causes, and its prevention. Many other
Internal Medicine, Ameri- violence abounds (see Re- studies, initiatives, and programs were launched or enhanced
can Medical Association, sources, page 3). For ex- during the days after the tragedy.
American Medical Associa- ample, NCIPC recently Unfortunately, the problem has not abated. The Columbine
tion Alliance, American published Best Practices of event has been followed by others, including Santee, Califor-
Nurses Association, Ameri- Youth Violence Preven- nia, where a 15-year-old has been charged with murdering
can Psychiatric Association, tion: A Sourcebook for two classmates. Every such event has been followed by wide-
American Public Health As- Community Action (www. spread media coverage—from news articles to editorials, to
sociation, and the U.S. De- cdc.gov/ncipc/dvp/best columns and interviews with experts.
partment of Health and Hu- practices.htm). Healthy Youth violence is basically everyone’s issue. And it’s a public
man Services. (Note: The People in Healthy Com- health issue…at the national level (see Focus) and locally (see
associations are members of munities: A Community Spotlight).
the Healthy People Consor- Planning Guide Using
tium – www.health.gov/ Healthy People 2010 (see
healthypeople/implementa- In Print, page 4) is another
tion/consortium/). new publication intended to
Data and surveillance stimulate and guide action. of diverse disciplines. Tap- ama-assn.org/ama/upload/
are essential to the public According to the Sur- ping into a rich but often mm/386/exesum.pdf),
health approach and to an- geon General’s report, “The fragmented knowledge base “More school suspensions
swering key questions about designation of youth vio- about risk factors, preventive and more prisons are not
program planning, imple- lence as a public health interventions, and public the answer. The answer,
mentation, and evaluation: concern is a recent education, the public health rooted in public health, is
How big is the problem? development...public health perspective calls for exam- prevention.”
How have our efforts re- offers an approach to youth ining and reconciling what
duced the problem? In the violence that focuses on are frequently contradictory
case of youth violence, the prevention rather than con- conclusions about youth See additional
data are dramatic, as just a sequences. It provides a violence.” information following
few facts affirm: framework for research As the Commission for the Etcetera section.
and intervention that draws the Prevention of Youth
• Homicide is the second on the insights and strategies Violence stated (www.
leading cause of death for
Prevention Report - 2
Billions of Bytes of Information on Youth Violence Prevention
Federal, State, and local (www.cdc.gov/ncipc/dvp/ The Office of Juvenile
governments, as well as pri- dvp.htm). The Division’s Justice and Delinquency
vate-sector organizations, site links to publications and Programs, Office of Jus-
offer a substantial array of information on evaluation tice Programs, U.S. De-
youth violence prevention- studies, data surveillance partment of Justice (http://
Healthy People 2010 related resources on the activities, community-based ojjdp. ncjrs.org/) presents
and Youth Violence World Wide Web. Some, projects, and other pro- data, program activities,
mostly Federal sites, are grams. Also part of CDC’s publications, calendar of
Prevention highlighted here; they all of- efforts is the Web site, events, and much more. The
Our Nation’s health depends fer links to even more re- “Preventing Violence & site links to the National
on preventing youth violence. sources. A search of the Suicide: Enhancing Futures” Campaign Against Youth
For communities wishing to many online indexes and (www.cdc.gov/ncipc/dvp/ Violence (www. noviolence.
address some aspect of youth databases will yield results yvpt/yvpt.htm), which in- net), a nonprofit organization
violence prevention, the on even more resources, cludes information on “What whose mission is to engage
opportunities to tie in Healthy including such specific top- can I do?” all Americans in effective
People 2010 are many and ics as support groups, youth- youth violence prevention.
include, for example, the
following objectives:
led activities, and gay youth. The Center for Mental
Health Services (CMHS), The Partnerships Against
15-3 Reduce firearm-related The recently released Youth Substance Abuse and Men- Violence Network
deaths. Violence: A Report of the tal Health Services Admin- (PAVNET) (www.pavnet.
15-7 Reduce nonfatal Surgeon General istration (www.mental org/) is a “virtual library” of
poisonings. (www.surgeongeneral.gov/ health.org/schoolviolence/ information about violence
library/youthviolence/report. index.htm) has launched an and youth at risk, represent-
15-8 Reduce deaths caused html) presents important re- initiative to enhance resil- ing data from seven differ-
by poisonings.
search findings from the sci- ience in the face of prob- ent Federal agencies.
15-9 Reduce deaths caused entific literature about what lematic behaviors and to PAVNET also offers a
by suffocation. works. Research studies prevent youth violence in mailgroup for sharing infor-
15-32 Reduce homicides. also are among the re- schools. CMHS is collabo- mation with over 650 other
sources at the National In- rating with the U.S. Depart- violence prevention profes-
15-33 Reduce maltreatment stitute on Mental Health, ment of Education, which sionals, a searchable data-
and maltreatment fatali- National Institutes of Health also offers numerous re- base of funding resources,
ties of children. Web site (http://www.nimh. sources, including “Early and information on such
15-35 Reduce the annual rate nih.gov). Warning, Timely Response: non-Federal resources as
of rape or attempted A Guide to Safe Schools” the Center for the Preven-
rape. The National Youth Vio- (www.ed.gov/offices/ tion of School Violence and
15-37 Reduce physical
lence Prevention Re- OSERS/OSEP/earlywrn. the International Association
assaults. source Center (www.safe html). This guide describes of Chiefs of Police. Of par-
youth.org/home.htm) serves research-based practices ticular value to program
18-1 Reduce the suicide rate. as a point of access to Fed- designed to assist school planners are links to dozens
18-2 Reduce the rate of eral resources, programs, communities in identifying and dozens of community
suicide attempts by and information for parents these warning signs early prevention efforts.
adolescents. and guardians, professionals, and developing prevention,
and teens. intervention, and crisis re-
For more information, the Youth violence is one of sponse plans.
Healthy People 2010 publica- four priority areas for vio-
tions are available online at lence prevention for the Di-
www.health.gov/healthy vision of Violence Preven-
people/ publications/. tion, National Center for In-
jury Prevention and Control,
Centers for Disease Control
and Prevention (CDC)

Prevention Report - 3
Mental Health and Mental Injury and Violence Prevention of Youth Vio-
In Print
Disorders Prevention lence: The Rationale for
Educational and and Characteristics of
A report by SAMHSA’s Academic–Community Four Evaluation Projects.
Community-Based Center for Mental Collaboration: An Ecol- R.M. Ikeda, et al. American
Programs Health Services and ogy for Early Childhood Journal of Preventive
The Office of Disease Pre- Center for Substance Violence Prevention. Medicine 20(1S, 2001):
vention and Health Promo- Abuse Prevention, Pre- G.D. Evans, et al. Ameri- 15-21.
tion recently released ventive Interventions Un- can Journal of Preventive In 1996, the Centers for
Healthy People in Healthy der Managed Care: Men- Medicine 20(1S, 2001): Disease Control and Pre-
Communities: A Commu- tal Health and Substance 22-30. vention funded four early
nity Planning Guide Using Abuse Services, states that Academic–community col- intervention projects aimed
Healthy People 2010. This preventive programs in spe- laboration can present a at preventing youth violence.
publication provides infor- cific areas are available that successful and efficient This article describes the
mation about the steps in- can prevent substance approach to violence-pre- characteristics and chal-
volved in forming and run- abuse and promote mental vention efforts but also can lenges of the four projects,
ning a healthy community health. To receive a copy of bring unique challenges. which were located in San
coalition. Print copies are the report in print, call Francisco, CA, Jacksonville,
available from the Govern- (800)789-2647. The report Youth Violence: Develop- FL, Kansas City, MO, and
ment Printing Office (GPO) is also available at www. mental Pathways and Columbia, SC.
at (202)512-1800 and on the samhsa.gov under Clearing- Prevention Challenges.
Internet at www.health.gov/ houses. L.L. Dahlberg, et al. Ameri- Substance Abuse;
healthypeople/publications. can Journal of Preventive Tobacco Use; STDs
Nutrition Medicine 20(1S, 2001):
Adolescent Peer Crowd
Injury and Violence The National Institutes of 3-14.
Affiliation: Linkages With
Prevention Health, Office of Dietary Youth violence occurs amid
a complex biologic, social, Health-Risk Behaviors
Under the direction of the Supplements (ODS) re- and Close Friendships.
cently released the first familial, and individual envi-
Surgeon General, the Cen- ronment; preventive pro- A.M. La Greca, et al. Jour-
ters for Disease Control and Annual Bibliography of nal of Pediatric Psychol-
grams must consider these
Prevention, the National In- Significant Advances in
myriad factors, as well as ogy 26(April 2001):131-143.
stitutes of Health, and the Dietary Supplement
the changing developmental Health promotion and dis-
Substance Abuse and Men- Research. The publication ease prevention programs
needs of children, adoles-
tal Health Services Adminis- is a joint effort by ODS and aimed at adolescents need
cents, and young adults and
tration (SAMHSA) collabo- the Consumer Healthcare to take into account the
tailor the programs to meet
rated to prepare Youth Products Association and strong influence of peer net-
those needs.
Violence: A Report of the documents the scientifically works and friendships.
Surgeon General. This re- sound research being done
A Violence-Prevention Nutrition
port focuses on action steps in this field. This publication
and Evaluation Project
that all Americans can take is available in print by call-
with Ethnically Diverse Keep Food Safe to Eat:
to help address the problem ing ODS at (301) 435-2920
Populations. R.M. Ikeda, Healthful Food Must Be
of youth violence and to or online at http://dietary-
et al. American Journal of Safe as Well as Nutri-
continue to build a legacy of supplements.info.nih.gov/.
Preventive Medicine tious. C.E. Wotecki, et al.
health and safety for our 20(1S, 2001):48-55. Journal of Nutrition
young people and the Nation Crosscutting Staff diversity and cultural 131(2001):502S-509S.
as a whole. Print copies are competence are two impor- The 2000 edition of Dietary
available from GPO at Injury and Violence tant characteristics of suc- Guidelines for Americans
(202)512-1800 and on the Prevention cessful violence-prevention includes information on food
Internet at www. programs in child care set- safety as well as nutrition
surgeongeneral.gov/library/ The National Children’s tings. This project studies and notes that food safety
youthviolence/report.html. Center for Rural and Safe Start, a violence pre- education, along with
Agricultural Health and vention program for child research and regulatory
Safety, in response to care teachers, directors, and activities, can reduce the
growing concerns about in- parents in a culturally di- incidence of foodborne
terpersonal violence-related verse population in the San illness.
continued on page 5 Francisco Bay area.
Prevention Report - 4
Immune Deficiency Founda- (continued from page 4) the Library of Congress to or expand consumer health
tion National Conference. Bal- injuries to children in rural facilitate the online publica- information collections. The
timore, MD. (800)296-4433, or communities, has compiled a tion of new medical re- manual is available at http://
visit www.primaryimmune.org. list of relevant publications. sources. By transmitting nnlm.gov/scr/conhlth/
June 21-23, 2001. The materials were selected bibliographic information in manualidx.htm.
for relevancy, comprehen- SGML format via the
National Association of siveness, availability, cur- Internet, the Library of Con- In Funding
County and City Health Offi- rency, and cost; the list is gress and NLM eliminate
cials Annual Conference: not limited to rural safety mailing and handling of pa- Disability and Secondary
Confronting Disparities. Conditions
issues. Copies are available per as well as accelerate
Raleigh, NC. (202) 783-5550, or
by calling (888) 924-SAFE the publication of new
visit www.naccho.org/files/
resource information by The National Institutes of
(7233) or visiting
several weeks. Visit NLM Health (NIH) is offering
2001.html. June 27-30, 2001. www.marshfield clinic.org/
at www.nlm.nih.gov/nlm funding for research on pri-
home.html. mary hyperoxaluria and re-
7th International Family Vio- lated stone diseases. Funds
lence Research Conference. publications.htm.
Educational and are available under the R21
Portsmouth, NH. (603)862- Award Mechanism. To find
1888, or visit www.unh.edu/frl/ Online Community-Based
Programs out more about this funding,
conf 2001home.htm.
Access visit www.ohf.org or the
July 22-July 25, 2001.
The South Central Region NIH Web page on Re-
The National Library of of the National Network search Studies on the He-
National Association of Local
Medicine (NLM) is now of Libraries of Medicine reditary Calcium Oxalate
Boards of Health Annual Con-
ference: Building Healthy
participating in the elec- has completed a Consumer Stone Diseases: http://
Communities Through Part- tronic cataloging in publica- Web Manual to help organi- grants.nih.gov/grants/guide/
nerships and Policies. Cleve- tion (E-CIP) program with zations that wish to develop pa-files/PA-00-091.html.
land, OH. (419)353-7714, or
visit www.nalboh.org/
event.htm. July 25-28, 2001.

National Criminal Justice As-

continued from page 1
sociation: National Forum
2001. Sedona, AZ. (202)624- Examples from the re- (www.fcs.iastate.edu/ in the United States and
1440, or visit www.ncja.org/ port are described below. families/) has used family- around the world. PATHS has
July 29-Aug. 1, 2001. In Eugene, Oregon, focused prevention to reduced maladaptive out-
Linking the Interests of reduce alcohol initiation comes in both normal and
109th American Psychological Families and Teachers substantially. special needs children, in-
Association Annual Conven- (LIFT) (www.oslc.org/ The Center for the Study cluding young deaf children.
tion. San Francisco, CA. dprojframe.html) decreased and Prevention of Violence The cost of programs
(202)336-6020, or visit children’s physical aggres- (CSPV) (www.colorado. varies. Cost-effectiveness
www.apa.org/convention/. sion on the playground, in- edu/cspv/) has information studies do show definite
August 24-28, 2001. creased children’s social on several programs in the benefits but comparisons
skills, and decreased aver- Surgeon General’s report. are difficult because of
Association of State and sive behavior in mothers Founded in 1992, CSPV differences in analytical
Territorial Health Officials rated most aversive at provides informed assis- approaches.
Annual Meeting: Infra- baseline. At followup, 5th- tance to groups committed The Surgeon General’s
structure: Building Public grade participants had to understanding and pre- report concludes, “The most
Health Capacity. Orlando, FL. fewer associations with de- venting violence.
(407)354-9840, or visit
effective youth violence pre-
linquent peers, were less The Prevention Research vention programs are tar-
likely to initiate patterned al- Center (www.psu.edu/dept/ geted appropriately, address
September 18-21, 2001.
cohol use, and were signifi- prevention/) at Pennsylvania several age-appropriate risk
cantly less likely than con- State University has infor- and protective factors in dif-
trols to have been arrested. mation on Promoting Alter- ferent contexts, and include
The Iowa Strengthening native Positive Thinking several program components
Families (to become the Strategies (PATHS), which is that have been shown to be
best) Program being used in many schools effective.”
Prevention Report - 5
The Centers for Disease tion of HIV-infected people mortalities. The Resource abuse treatment programs
Control and Prevention is who are linked to appropri- Mothers visit their clients that use methadone and
promoting a new program to ate care, prevention, and regularly before and after other medications to treat
combat the spread of HIV. treatment services.” delivery to teach them such heroin and similar addic-
The campaign, called Sero- topics as pregnancy, breast tions. Under the new regu-
status Approach to Fight- The South Carolina Office feeding, infant health, and lations, these treatment pro-
ing the HIV Epidemic of Rural Health, with immunizations. The experi- grams will be accredited
(SAFE), was unveiled at funding from the Federal enced women help their cli- according to standards set
the 8th Annual Retroviral Bureau of Maternal and ents find out about and link by the Substance Abuse
Conference in Chicago in Child Health, is sponsoring up with needed community and Mental Health Ser-
February. SAFE has two “Resource Mothers” to and health services. vices Administration’s
main goals: “to increase the reach out as mentors, teach- Center for Substance
proportion of HIV-infected ers, and friends to pregnant New guidelines are now in Abuse Treatment, replac-
people in the United States women in rural areas in or- place to improve the quality ing oversight by the Food
who know they’re infected” der to reduce inadequate and oversight of substance and Drug Administration.
and “to increase the propor- prenatal care and infant

PREVENTION AND The mission of the Office of Disease Prevention and Health Promotion (ODPHP) is to provide leadership for
H EALTH disease prevention and health promotion among Americans by stimulating and coordinating prevention activities.
P ROMOTION Prevention Report is a service of ODPHP. This information is in the public domain. Duplication is encouraged.

May 2001

Washington, DC 20201
200 Independence Avenue SW.
NO. G280 Hubert H. Humphrey Building, Room 738G
PERMIT and Human Services
FIRST CLASS U.S. Department of Health
Prevention Report - 6
Youth Violence: A Complex Problem
In addition to identifying 27 intervention programs that have met rigorous scientific standards, the
Surgeon General’s Report on Youth Violence (http://www.surgeongeneral.gov/library/youthviolence/
default.htm) challenges false notions about youth violence and presents serious statistics about the
epidemic in America. One major myth debunked by the report concerns race and ethnicity—data from
self-reports of youth indicate that race and ethnicity have little bearing on the overall proportion of
nonfatal violent behavior.

Self-report data reveal that the problem is bigger than perceived: Although such key indicators of vio-
lence as arrest and victimization data show significant reductions in violence since the peak of the
epidemic in 1993, involvement in some violent behaviors remains at 1993 levels, according to self-
reports of high school seniors.

Whether self-reports or surveillance data, these statistics focus on physical assault by a youth that carries
a significant risk of injuring or killing another person. The Surgeon General’s report does not address
self-directed violence—self-inflicted injury and suicide—or violence against intimate partners; or
behavioral patterns marked by aggressiveness, antisocial behavior, verbal abuse, and externalizing (the
acting out of feelings). When these issues are considered, the myths, data, and facts are most compelling,
too. For example, suicide is the third leading killer of young people between age 15 and 24 years. (See
the Surgeon General’s Report on Mental Health and the chapter on depression and suicide among
children and adults: http://www.mentalhealth.org/specials/surgeongeneralreport/chapter3/sec5.html.)
While 15- to 19-year-old girls are twice as likely to attempt suicide, boys are four times as likely to
commit suicide. This rate for boys has been attributed to an increase in firearms although data from other
countries where suicide by firearms is rare indicate marked increases in suicide rates.

Thus, the real picture of youth violence is much bigger than the public realizes. And, the solution neces-
sarily must be comprehensive and involve healthy communities and families. As the Commission for the
Prevention of Youth Violence, representing nine medical and nursing professional associations and the
U.S. Department of Health and Human Services, has set forth: “Together, we must work to overcome
those factors that place children, youth, and families at risk for violence and capitalize on factors that
promote healthy development and resilience such as close parental bonds, safe and stable communities,
and good consistent health and mental health care.” “Violence in this country can and must be pre-
vented,” said the Commission in publishing its 7 priorities and 44 recommendations for a violence
prevention agenda (http://www.ama-assn.org/ama/pub/category/3536.html).
New Guide Helps Communities Take Action

Now available on the World Wide Web (http://www.health.gov/healthypeople/Publications/

HealthyCommunities2001/default.htm) and in print is the new 40-page Healthy People in Health
Communities: A Community Planning Guide Using Healthy People 2010. Designed for people who
have decided to make their community a healthier place to live, the guide offers information on
building community coalitions, creating a vision, measuring results, and creating partnerships
dedicated to improving the health of a community. The “Strategies for Success” section presents
successful strategies and suggests resources for starting community activities.

Some Individual and Social Factors That Increase the Probability

of Violence During Adolescence and Young Adulthood


history of early poor monitoring or associate with peers poverty and diminished
aggression supervision of children engaged in high-risk economic opportunity
beliefs supportive of or problem behavior
violence exposure to violence high levels of transiency
low commitment to and family disruption
social cognitive deficits parental drug/alcohol school
abuse exposure to violence
academic failure
poor emotional attach-
ment to parents or

Source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. “Youth Violence in
the United States.” (Fact sheet.) Accessed April 3, 2001 (http://www.cdc.gov/ncipc/factsheets/yvfacts.htm).