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June 14th, 2003, 09:59 PM
June 15, 2003

Violence Offers Its Own Lessons



IF you enter this city from Interstate 280 by way of First Street, you first pass through a patchwork of overgrown lots, nondescript brick buildings and an occasional barbed wire fence. Official-looking signs tell what lies ahead. One says, "Trauma Center." Within a block or so, another says, "Justice Center."

The signs are not intended for metaphoric value. The University of Medicine and Dentistry of New Jersey is just blocks away, and beyond that the city's vast court complex. Yet together they tell a story about more than just buildings. There is a pattern that is repeated over and over here - and in other cities throughout New Jersey. First the ambulance, then the emergency room, and finally court and prison.

Historically, doctors and police officers have occupied not just separate buildings, but separate mindsets as well. However, in one building on the university's urban campus here, the disciplines have begun to merge. The Violence Institute of New Jersey - which opened about five years ago as part of the university - is a research organization dedicated to studying violence in the state, and its location in the middle of a medical-sciences institution is no accident. It is part of a relatively recent trend to look at violent crime as an epidemic and try to bring the rigor of the scientific method to studying it.

Bruce Stout, the institute's director, hopes to do for violence what other public health experts have done for automotive fatalities or heart disease - find ways to prevent it. As Dr. Stout observed, it was public health, after all, that linked smoking, blood pressure and being overweight to heart attack risk, and that definitively connected auto fatalities to the failure to wear seat belts.

"Imagine if the public health system relied solely on emergency room response to heart attack victims," said Dr. Stout, an adviser to Gov. Christie Whitman from 1994 to 1999, and who ran the state's juvenile justice commission for two years. "Epidemiologists know that the first thing you do is get a very clear sense of what's happening."

The Violence Institute, which has offices in Newark and Piscataway and a staff of 10, has an annual budget of $1.5 million, half of which comes directly from the state, and is one of many such research organizations in the United States. It was one of six chosen by the Centers for Disease Control and Prevention to take part in a $7.5 million, five-year project to develop a system for reporting on violent deaths nationwide, which will collect 100 pieces of data for incident.

To some extent, the work done at the Police Institute, a part of Rutgers University-Newark, overlaps with the Violence Institute. But while the Violence Institute tends to study victims and gather data from hospitals, the Police Institute studies the perpetrators and gathers data from the police. "We want to know who's getting killed and who's killing," said George Kelling, who runs the Police Institute.

A Society Steeped in Violence

Violence began to emerge as a public health issue in the 1980's and gained nationwide attention in 1992, when George Lund-berg, editor of The Journal of the American Medical Association, and C. Everett Koop, a former surgeon general of the United States, wrote an editorial, "Time to Bite the Bullet Back." It described "a grotesque picture of a society steeped in violence" and called for complete registration and licensing of all firearms.

"Time to Bite the Bullet Back" was the editorial equivalent of tossing a Molotov cocktail into a hospital no-honking zone. It acknowledged what had gone unsaid for years: that doctors were spending increasing amounts of time undoing the handiwork of criminals rather than fighting germs, and it pushed the public health community into a debate on criminal justice.

And as violence became a true field of public health and epidemiological inquiry, people like Thomas Cole, a contributing editor of The Journal of the American Medical Association who is responsible for its violence issue each August, began to demand more rigorous scientific analysis.

"The best of all these people say let's do some research and let the chips fall where they may," he said.

Dropping the automatic vilification of firearms has helped the discipline grow. "Once they got rid of the gun thing, lots of people got on board," Dr. Cole said.

There are many elements contributing to violence in this country, and guns are just one of them. There is, for instance, drug use, gang warfare, unstable and overtaxed families, bullying in school and neighborhoods where all of those antisocial forces thrive.

A major project undertaken by the institute was the gathering of data on assaults at six emergency rooms in the Newark area in 2001. According to the institute, Newark was chosen because it is in Essex County, which had more murders than any other county in New Jersey in 2000, and because Newark had the highest rate of total crime and most violent crimes of any of the state's urban centers. The six emergency rooms collected data on the age, race and gender of the victims as well as their relationship to the assailants, along with the type of weapon used, where the attack took place and whether drugs appeared to be involved.

Among the findings: the victims of violence in Newark were overwhelmingly young, black and male; three-quarters of them knew their assailants; one-third of all attacks happened in the home; and 12 percent of gunshot victims were 22 years old.

In fact, "victims and offenders are often one and the same," said David Livingston, director of trauma at University Hospital in Newark. "One week you're a victim. The next week you're an offender."

The project also discovered that certain neighborhoods, called "hot spots," in Newark were more likely to send assault victims to the emergency room and plotted these areas on a map. Zeroing in on the neighborhoods responsible for most assaults can be helpful to the police and other community organizations, but with the city of Newark busily promoting the notion of a "renaissance," it is a tricky public relations issue to point out bad neighborhoods.

Epicenter of the Hot Spot

In the space of three blocks, flanked at each end by schools, there were empty lots with grass sprouting through the asphalt, surrounded by barbed wire and heavily littered with packaging from McDonald's, Burger King and KFC. Many of the buildings had boarded windows or front steps in disrepair, and some appeared to be completely abandoned - an invitation for junkies and drug dealers.

In front of one house there was a collection of empty liquor bottles, lined up as neatly as bowling pins. Several houses had signs that said: "Attention. Newark police arrest any person or persons loitering in front of this building. Owner will prosecute."

As if sent by central casting, a patrol car from the Newark Police Department was parked only feet from the address that marked the epicenter of the hot spot, and it appeared to be involved in a stakeout.

Yet just around the corner were new townhouses and at the end of one block a community garden - clear signs of redemption.

Indeed, the purpose of mapping the hot spot, which is shared with the Greater Newark Safer Cities Initiative and other agencies, is to identify areas that need attention. Some help, in the form of better housing and community policing, has apparently begun to arrive.

"This is a city," Dr. Livingston commented. "It's very patchwork. Like real estate. Location, location, location."

One of the few people who lingered on the street was Dimitrius Warren, who said the area was known for drugs and stolen cars, and who acknowledged that it might not be the best neighborhood for children attending the nearby schools.

"You got to be careful as you're coming and you're going," said Mr. Warren, who was working in the area.

Asked about gunshots, the young man let out a laugh. "That would be on the next block," he said, gesturing to the place the police car had been parked.

The way society experiences violence is not unlike violence itself. A school shooting, the abduction and slaying of a child, a crazed gunman in a post office, a terrorist attack - these events all come suddenly, like a bullet, blowing a hole into the collective sense of safety. For a while the horrific events seem like the only news that matters.

Then something like 9/11 happens, and the sense of threat abruptly shifts. A year later, there is a spate of child abductions, and suddenly the front yard seems the most dangerous place in the universe. Each act of violence results in its own shift in public policy.

"We do this all the time in the Legislature when a horrible thing happens and a tragedy takes place," said Assemblywoman Mary Previte, vice chairwoman of the law and public safety committee.

But Ms. Previte, who is also administrator of the Camden County Youth Center, says reacting to events is far from the best way to run a penal system. "Shockers," she said, "invariably create bad legislation."

To that end, Ms. Previte, along with Assemblyman Peter Barnes, chairman of the committee, introduced a bill last September intended to create a commission to study criminal sentencing. In May, they introduced another bill, specifically asking the Violence Institute to study sentencing reform for nonviolent drug offenders.

"Let's let the scholars investigate," she said. "What is working elsewhere? How much would it cost? If a huge amount of crime is related to addiction, then treatment has got to be part of the solution."

The institute's expert on addiction and drug-related crime is Jack Farrell, who spent more than 30 years working for the state on issues of addiction treatment.

Mr. Farrell said that heroin was the dominant illicit drug in the Northeast, including in Newark, and that its economic importance as an illegal cartel was what led to most of the violence. "Turf issues tend to be settled violently," he said.

But drug users, who constitute the demand side of the equation, often wind up on the right side of the law if they get drug treatment. "Treatment works," Mr. Farrell said. "There are gazillions of studies that will show that."

That does not mean it is easy. Although society is now relatively forgiving of recovering alcoholics, it still stigmatizes former users of illicit drugs, Mr. Farrell said, meaning that they need help just to find a job.

Every Wednesday, Mr. Farrell attends a meeting of the Greater Newark Safer Cities Initiative, a consortium of professionals that runs the gamut from police and parole officers to social workers and religious leaders, and that is led by Dr. Kelling of the Police Institute at Rutgers.

Twice a month, a working group focuses on specific people, or "cases," who have been on the wrong side of the law. Together they consider what institutional glue might hold these lives together - who needs help with counseling, with medical care, with housing, with job hunting - and what will make Newark a safer place.

"It's a very fragile thing," said Mr. Farrell, "called the spirit of a human being."

If Mr. Farrell and his colleagues fail, the very people they talk about at these meetings may go on to commit violent crimes, or be the victims of them, and the whole cycle of headlines and blame will begin anew. If Mr. Farrell and his colleagues succeed, almost nobody will know. The process of drug addicts and minor criminals re-entering the fabric of society is a quiet one. When a person becomes a law-abiding citizen, it rarely makes headlines.

Programs at the Institute

There are literally dozens of programs that purport to prevent violence by teaching children good social skills. The Violence Institute has compiled a 196-page source book detailing 38 of these programs, including at least two created here in the state. These are the kinds of programs that usually involve role playing and group discussions, and often come with posters, T-shirts or booklets reminding students how to behave by way of pictures and acronyms.

Currently, the institute is studying a kindergarten and first-grade program called "I Can Problem Solve" in the Passaic public schools.

"If we teach conflict resolution skills in K through two, does that reduce conflict?" Dr. Stout asked. "What's the impact? We're putting good science to the test."

But Dr. Cole of The Journal of the American Medical Association is skeptical that such programs of social engineering, well intended though they may be, can be accurately measured. Dr. Cole, who has been editing the violence issues since 1995, said he could not remember publishing even one paper that presented data on a school-based intervention.

As he said, it is usually the classroom teacher who implements the anti-violence program and then evaluates it. "They've got a vested interest," he said. "The other JAMA editors are, if anything, more skeptical than I am."

Last month, Dr. Stout attended a program in Jersey City in which Dawn Reynolds, principal of the Fred W. Martin School elementary school, told how she had made her school safer.

Over the three years that she has been principal, Miss Reynolds said, she has instituted a poetry program, has had teachers trained in conflict resolution, teamed up with the Ponderosa restaurant chain on a program called, "Achieving A's Pays," and even started another one to ensure the bathrooms stay clean and free of graffiti.

"I walk down the corridor now and people want to hand me poetry," she said. "The biggest compliment is when people say: 'Wow, this is so quiet. This looks like a private school.' "

It all sounds good, but by the standards of social science, what proof is there that anything has changed? How quiet are private schools? How does one objectively measure whether an inner-city school has become more like a private school? And is that even an appropriate question?

Miss Reynolds may have produced a school environment where children are thriving creatively and behaving nicely, but will that translate into a reduction in violence in five years? In 10 years? Will these students, when they are 22, literally dodge a bullet?

The notion of predicting future behavior statistically has always been the stuff of science fiction. The movie "Minority Report" that came out last summer - in which hypersensitive humans, submerged in water, could "see" violence ahead of time - presented this conundrum: Could people apprehended by this system be punished for crimes they had not yet committed.

That problem is one that people like Dr. Stout struggle with all the time.

"We're very good at predicting what kids are likely to become delinquent," he said. "Knowing that, do we then intervene in their lives? Or do we wait until their conduct's so serious we lock them up?"

It is one thing to see a teenager lurching toward a bad end, and another to know what effect today's social tinkering might have. Or to try to tease out the effects of poetry programs and training in social skills in lives that are also affected by economic hardship and family turmoil.

That is one of the problems faced by the institute, which wants to apply the rigorous methodology of science in studying violence but also wants to acknowledge current efforts to fight violence - even ones that are untested.

Last month, the institute co-sponsored an awards ceremony for Newark's "Do the Write Thing" essay contest, in which junior high school students were asked to write about ways to reduce violence. Speeches were given, trophies handed out and the two winners - Latoya Evans and Keith Williams - read their essays and were each awarded a $500 scholarship by the institute. Dr. Stout acknowledges that there has been no research on "Do the Write Thing." There is no way of knowing whether this particular campaign against violence is a real agent of change or merely a placebo.

The Children of Violence

Latoya Evans, a slim girl who wears her hair in tightly wrapped corn rows, lives in a neighborhood infested with gangs, where even 6-year-old children know about the Bloods and the Cryps. She had a friend cut down by violence last summer, but she keeps the details of that incident to herself.

Latoya wants to be a pediatrician one day, and the $500 she received from the contest is the first money that has been earmarked for her college education.

Keith Williams, who wore a basketball jersey to the awards ceremony, lost a 22-year-old cousin to gang violence last year. These days he copes with his environment by writing rap. "I fill notebooks up with rap," he said. "If I get mad, I write rap. If I get happy, I write rap."

To him, it is not complicated at all.

When I go to bed at night I close my eyes real tight.

I pray that I may wake without having to fight.

I'll fight everyday to stay positive and to remember violence isn't cool.

I'll tell all my friends to conquer peer pressure and try to stay in school.

Because stealing, drinking, smoking and killing are all parts of sin

And "you know how one things leads to another" so they might all end up in "The Pen."

Copyright 2003 The New York Times Company