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Dating violence is a problem that starts early and can happen to anyonone. Data from a study of 8th and 9th grade students showed 25% had been victims of nonsexual dating violence and 8% had been victims of sexual dating violence

Youth violence may have peaked in the mid to late 1990’s however it remains a leading killer of young people. According to statistics released by the Centers on Disease Control (CDC) more than 877,700 young people between the ages of 10 and 24 were injured in 2002, and approximately 1 in 13 were injured.

Each day over 15 youth are murdered in the United States. Shockingly, homicide remains the second leading cause of death among young people ages 10 to 24 overall. Only vehicular accidents claim more young lives each year.

The majority of the young people who are killed, 79%, are killed by fiarms. Areas of the country that have imposed limitations on firearms and ammunitions purchases have wittnessed a decline in both murders and suicides by young people.

Between 1994 and 1999, 172 students ages 5 to 18 were killed on or near school grounds or at school-related activities (Anderson et al. 2001).

More than 50% of all school-associated violent deaths occur at the beginning or end of the school day or during lunch (Anderson et al. 2001).

In a nationwide survey, 17% of students reported carrying a weapon (e.g., gun, knife, or club) on one or more days in the 30 days preceding the survey (Grunbaum et al. 2004).

Among students nationwide, 33% reported being in a physical fight one or more times in the 12 months preceding the survey (Grunbaum et al. 2004).

Data from a study of 8th and 9th grade students showed 25% had been victims of nonsexual dating violence and 8% had been victims of sexual dating violence (Foshee et al. 1996).

Nationwide, 9% of students reported being hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend in the 12 months prior to being surveyed (Grunbaum et al. 2004).

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Groups at Risk

Among 10 to 24 year olds, homicide is the leading cause of death for African-Americans, the second leading cause of death for Hispanics, and the third leading cause of death for American Indians, Alaskan Natives, and Asian Pacific Islanders (Anderson and Smith 2003).

Of the 5,486 homicides reported in the 10 to 24 age group in 2001, 85% (4,659) were males and 15% (827) were females (CDC 2004).

A nationwide survey found male students (41%) more likely to have been involved in a physical fight than female students (25%) in the 12 months preceding the survey (Grunbaum et al. 2004).

A nationwide survey found female students (12%) more likely than male students (6%) to have been forced to have sexual intercourse (Grunbaum et al. 2004).
Risk Factors

The first step in preventing youth violence is to identify and understand the risk factors. A risk factor is anything that increases the likelihood of a person suffering harm. Risk factors are not necessarily causes. Research has identified the following risk factors for youth violence (DHHS 2001; Lipsey and Derzon 1998):

Individual

* Attention deficits/hyperactivity
* Antisocial beliefs and attitudes
* History of early aggressive behavior
* Involvement with drugs, alcohol, or tobacco
* Early involvement in general offenses
* Low IQ
* Poor behavioral control
* Social cognitive or information-processing deficits

Family

* Authoritarian childrearing attitudes
* Exposure to violence and family conflict
* Harsh, lax, or inconsistent disciplinary practices
* Lack of involvement in the child’s life
* Low emotional attachment to parents or caregivers
* Low parental education and income
* Parental substance abuse and criminality
* Poor family functioning
* Poor monitoring and supervision of children

Peer/School

* Association with delinquent peers
* Involvement in gangs
* Social rejection by peers
* Lack of involvement in conventional activities
* Poor academic performance
* Low commitment to school and school failure

Neighborhood/Community

* Diminished economic opportunity
* High concentrations of poor residents
* High levels of transiency
* High levels of family disruption
* Low community participation
* Socially disorganized neighborhoods

Protective Factors

Recent research focuses on how people recover from adverse situations, bringing a new awareness of the importance protective factors have in preventing youth violence. Protective factors are individual or environmental aspects that buffer young people from the effects of risk. Identifying and understanding protective factors are equally as important as researching risk factors.

To date, protective factors have not been studied as extensively or with the same scientific rigor as risk factors. Most existing research is preliminary; however, studies propose the following protective factors (DHHS 2001):

Individual Protective Factors

* Intolerant attitude toward deviance
* High IQ
* Positive social orientation

Peer/School Protective Factors

* Commitment to school
* Involvement in social activities

References:

Anderson MA, Kaufman J, Simon TR, Barrios L, Paulozzi L, Ryan G, et al. School-associated violent deaths in the United States, 1994-1999. Journal of the American Medical Association 2001;286:2695–702.

Anderson RN, Smith BL. Deaths: leading causes for 2001. National Vital Statistics Report 2003;52(9):1–86.

Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2004). Available from: URL: www.cdc.gov/ncipc/wisqars. [Cited 2004 May 24].

Department of Health and Human Services (US). Youth violence: a report of the Surgeon General [online] 2001 Available from: URL: www.surgeongeneral.gov/library/youthviolence. [Cited 2004 May 24].

Foshee VA, Linder GF, Bauman, KE, et al. The Safe Dates Project: theoretical basis, evaluation design, and selected baseline findings. American Journal of Preventive Medicine, Supplement 1996;12(5):39-47.

Grunbaum JA, Kann L, Kinchen S, Ross JG, Lowry R, Harris WA, et al. Youth risk behavior surveillance—United States, 2003. MMWR 2004;53(SS-2):1–100. Available from: URL: www.cdc.gov/mmwr/preview/mmwrhtml/ss5302a1.htm

Lipsey MW, Derzon JH. Predictors of violent and serious delinquency in adolescence and early adulthood: a synthesis of longitudinal research. In: Loeber R, Farrington DP, editors. Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks (CA): Sage Publications; 1998. p. 86-105.

Teens that use alcohol and/or other drugs are much more likely to attempt and die by suicide.

For teens, there is a strong relationship between the use of drugs and violence. Teens who report engaging in violent behavior are also extremely likely to report using alcohol and other drugs. One national survey found that 94% of violent teens reported using alcohol, 85% reported using marijuana and 55% reported using several illegal drugs.

The relationship between drugs and violence is complicated. Some teens may become violent under the influence of drugs. It is also likely that some teens engage in violence in order to get money to buy drugs. In most cases, however, it appears that the use of drugs does not cause violent behavior.
Instead, it seems that violence and substance use are both part of a lifestyle that involves antisocial and delinquent behavior. In many cases, the violent behavior actually comes before the substance use. The drug use is just one aspect of a risky and dangerous lifestyle.
While the use of drugs does not generally cause teens to become involved in violence, those violent teens who do use illegal drugs tend to engage in violent behavior more frequently and to continue to engage in violence much longer than those violent youth that do not use drugs.

Substance Use and Suicide
Teens that use alcohol and/or other drugs are much more likely to attempt and die by suicide. In one study of teen suicide, drug and alcohol abuse was the most common characteristic of those who attempted suicide: 70% of the youth who died by suicide frequently used alcohol and/or other drugs. However, research has not proven that drug and alcohol use actually causes suicidal behavior, only that the two behaviors are associated. It may be that teens that have emotional problems are more likely to use drugs and to contemplate suicide. Another possibility is that the use of drugs aggravates pre-existing depression or other emotional problems. Drugs and alcohol may also impair the judgment of teens considering suicide, making suicide attempts more likely.

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Teens drinking alcohol is sometimes seen as harmless.  Some parents, not understanding the potential consequences, even go so far as to supply alcohol to their own, and other people’s teens.  Teens who drink alcohol, however, are known to frequently be covering up other problems and even where this is not the case drinking alcohol can create its own unique and sometimes tragic consequences for teens.   Take a moment and educate your self on teens and alcohol consumption.

# Among 12- to 17-year-olds who were current drinkers, 31 percent exhibited extreme levels of psychological distress and 39 percent exhibited serious behavioral problems.1

# Twelve- to sixteen-year-old girls who were current drinkers were four times more likely than their nondrinking peers to suffer depression.2

# In a recent CSAT study, 48 percent of women in treatment for substance abuse had been sexually abused.3

The severity of behavioral problems in adolescents is significantly associated with increased likelihood of adolescent alcohol use.

# Past-month alcohol use was reported by approximately 14 percent of adolescents with low levels of behavioral problems, by 23 percent of those with intermediate problem scores, and by 38 percent of those with significant behavioral problems.4

Alcohol drinkers aged 12 to 17 years

# Adolescents with serious behavioral problems were nearly three times more likely to use alcohol than those with low levels of behavioral problems.5

There is a link between suicide and alcohol use in adolescents.

# Twenty-eight percent of suicides by children ages 9 to 15 could be attributed to alcohol.6

# Using a national school sample, a study reported that suicide attempts among heavy-drinking adolescents were three to four times greater than among abstainers.7

Adolescents struggling with serious emotional disturbances (SED) face even greater challenges when they use alcohol.

# Adolescents with high levels of SED were nearly twice as likely as adolescents with low levels of SED to have used alcohol in the past month.8

# Adolescents with high levels of SED were five times as likely as those with low levels of SED to report alcohol dependence.9

Co-occurring disorders prompt new federal action.

# Seven to ten million Americans have at least one mental disorder in addition to an alcohol or drug disorder.

# A 5-year blueprint for action to improve recovery chances by increasing quality prevention, diagnosis, and treatment for people with co-occurring disorders was just sent to Congress by Department of Health and Human Services Secretary Tommy Thompson.10

1Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. The Relationship Between Mental Health and Substance Abuse Among Adolescents. (SMA) 99-3286. Rockville, MD: SAMHSA, 1999.

2 Hanna EZ, Hsiao-ye Y, Dufour MC, et al. The relationship of drinking and other substance use alone and in combination to health and behavior problems among youth ages 12-16: Findings from the Third National Health and Nutrition Survey (NHANES III). Paper presented at the 23rd Annual Scientific Meeting of the Research Society on Alcoholism, June 24-29, 2000, Denver, CO.

3Burgdorf K, Chen X, Herrell J. The prevalence and prognostic significance of sexual abuse in substance abuse treatment of women. Center for Substance Abuse Treatment (CSAT), 2001.

4 SAMHSA. The Relationship Between Mental Health and Substance Abuse Among Adolescents.

5Ibid.

6Unpublished data extrapolated by National Institute on Alcohol Abuse and Alcoholism from State Trends in Alcohol Mortality, 1979- 1992; US Alcohol Epidemiolgic Data Reference Manual, Volume 5. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1996.

7Windle M, Miller-Tutzauer C, Domenico D. Alcohol use, suicidal behavior, and risky activities among adolescents. J Res Adolesc 2(4):317-330, 1992.

8SAMHSA. The Relationship Between Mental Health and Substance Abuse Among Adolescents.

9Ibid.

9Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders, SAMHSA, 2002.

To change recipient’s name or fax number or to order a catalog of substance abuse publications, call SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686, TDD 1-800-487-4889 (for the hearing impaired). See ncadi.samhsa.gov for previous Prevention Alerts online.

Prevention Alert is supported by the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration, and may be copied without permission with appropriate citation. For information about Prevention Alert, please contact CSAP by phone at 301-443-0375, or e-mail gorfalea@samhsa.gov.
HHS LogoU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention www.samhsa.gov

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Teens, especially those with low self-esteem or with family problems, are at risk for a number of self-destructive behaviors such as using drugs or alcohol or having unprotected sex. Depression and eating disorders are common health issues that teens face.

The American Academy of Child and Adolescent Psychiatry (AACAP) suggests the following ways for parents to prepare for their child’s teenage years:

The teenage years are a time of transition from childhood into adulthood. Teens often struggle with being dependent on their parents while having a strong desire to be independent. They may also feel overwhelmed by the emotional and physical changes they are going through.

At the same time, teens may be facing a number of pressures–from friends to fit in and from parents and other adults to do well in school, or activities like sports or part-time jobs. The teenage years are important as your child asserts his or her individuality.
What can I do to help my teen?

Communicating your love for your child is the single most important thing you can do. Children decide how they feel about themselves in large part by how their parents react to them. For this reason, it’s important for parents to help their children feel good about themselves. It is also important to communicate your values and to set expectations and limits, such as insisting on honesty, self-control and respect for others, while still allowing teenagers to have their own space.

Parents of teens often find themselves noticing only the problems, and they may get in the habit of giving mostly negative feedback and criticism. Although teens need feedback, they respond better to positive feedback. Remember to praise appropriate behavior in order to help your teen feel a sense of accomplishment and reinforce your family’s values.

Establishing a loving relationship from the start will help you and your child through the teenage years.

The American Academy of Child and Adolescent Psychiatry (AACAP) suggests the following ways for parents to prepare for their child’s teenage years:

* Provide a safe and loving home environment
* Create an atmosphere of honesty, trust and respect
* Allow age appropriate independence and assertiveness
* Develop a relationship that encourages your teen to talk to you when he or she is upset
* Teach responsibility for your teen’s belongings and yours
* Teach basic responsibility for household chores
* Teach the importance of accepting limits
What warning signs should I look for?

Remember that your teen may experiment with his or her values, ideas, hairstyles and clothing in order to define him- or herself. This is typically normal behavior and you shouldn’t be concerned. However, inappropriate or destructive behavior can be a sign of a problem.

Teens, especially those with low self-esteem or with family problems, are at risk for a number of self-destructive behaviors such as using drugs or alcohol or having unprotected sex. Depression and eating disorders are common health issues that teens face. The following may be warning signs that your child is having a problem:

* Agitated or restless behavior
* Weight loss or gain
* A drop in grades
* Trouble concentrating
* Ongoing feelings of sadness
* Not caring about people and things
* Lack of motivation
* Fatigue, loss of energy and lack of interest in activities
* Low self-esteem
* Trouble falling asleep
* Run-ins with the law

What should I do if there is a problem?

Work together to maintain open communication. If you suspect there is a problem, ask your teen about what is bothering him or her. Don’t ignore a problem in the hopes that it will go away. It is easier to cope with problems when they are small. This also gives you and your teen the opportunity to learn how to work through problems together. Don’t be afraid to ask for help with dealing with your teen. Many resources, including your family doctor, are available.
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Myth: The epidemic of violent behavior that marked the early 1990s is over, and young people—as well as the rest of U.S. society—are much safer today.

Fact: Although such key indicators of violence as arrest and victimization data clearly show significant reductions in violence since the peak of the epidemic in 1993, an equally important indicator warns against concluding that the problem is solved. Self-reports by youths reveal that involvement in some violent behaviors remains at 1993 levels.

Myth: Most future offenders can be identified in early childhood.

Fact: Exhibiting uncontrolled behavior or being diagnosed with conduct disorder as a young child does not predetermine violence in adolescence. A majority of young people who become violent during their adolescent years were not highly aggressive or “out of control” in early childhood, and the majority of children with mental and behavioral disorders do not become violent in adolescence (see Chapter 3).

Myth: Child abuse and neglect inevitably lead to violent behavior later in life.

Fact: Physical abuse and neglect are relatively weak predictors of violence, and sexual abuse does not predict violence. Most children who are abused or neglected will not become violent offenders during adolescence (see Chapter 4).

Myth: African American and Hispanic youths are more likely to become involved in violence than other racial or ethnic groups.

Fact: Data from confidential interviews with youths indicate that race and ethnicity have little bearing on the overall proportion of racial and ethnic groups that engage in nonfatal violent behavior. However, there are racial and ethnic differences in homicide rates. There are also differences in the timing and continuity of violence over the life course, which account in part for the overrepresentation of these groups in U.S. jails and prisons (see Chapter 2).

Myth: A new violent breed of young superpredators threatens the United States.

Fact: There is no evidence that young people involved in violence during the peak years of the early 1990s were more frequent or more vicious offenders than youths in earlier years. The increased lethality resulted from gun use, which has since decreased dramatically. There is no scientific evidence to document the claim of increased seriousness or callousness (see Chapter 3).

Myth: Getting tough with juvenile offenders by trying them in adult criminal courts reduces the likelihood that they will commit more crimes.

Fact: Youths transferred to adult criminal court have significantly higher rates of reoffending and a greater likelihood of committing subsequent felonies than youths who remain in the juvenile justice system. They are also more likely to be victimized, physically and sexually (see Chapter 5).

Myth: Nothing works with respect to treating or preventing violent behavior.

Fact: A number of prevention and intervention programs that meet very high scientific standards of effectiveness have been identified (see Chapter 5).

Myth: In the 1990s, school violence affected mostly white students or students who attended suburban or rural schools.

Fact: African American and Hispanic males attending large inner-city schools that serve very poor neighborhoods faced—and still face—the greatest risk of becoming victims or perpetrators of a violent act at school. This is true despite recent shootings in suburban, middle-class, predominantly white schools (see Chapter 2).

Myth: Weapons-related injuries in schools have increased dramatically in the last 5 years.

Fact: Weapons-related injuries have not changed significantly in the past 20 years. Compared to neighborhoods and homes, schools are relatively safe places for young people (see Chapter 2).

Myth: Most violent youths will end up being arrested for a violent crime.

Fact: Most youths involved in violent behavior will never be arrested for a violent crime (see Chapter 2).

An important reason for making research findings widely available is to challenge false notions and misconceptions about youth violence. Myths such as those listed below are intrinsically dangerous. Assumptions that a problem does not exist or failure to recognize the true nature of a problem can obscure the need for informed policy or for interventions. An example is the conventional wisdom in many circles that the epidemic of youth violence so evident in the early 1990s is over. Alternatively, myths may trigger public fears and lead to inappropriate or misguided policies that result in inefficient use of scarce public resources. An example is the current policy of waiving or transferring young offenders into adult criminal courts and prisons.

For teens, there is a strong relationship between the use of drugs and violence. Teens who report engaging in violent behavior are also extremely likely to report using alcohol and other drugs. One national survey found that 94% of violent teens reported using alcohol, 85% reported using marijuana and 55% reported using several illegal drugs.[16]

The relationship between drugs and violence is complicated. Some teens may become violent under the influence of drugs. It is also likely that some teens engage in violence in order to get money to buy drugs. In most cases, however, it appears that the use of drugs does not cause violent behavior.[17]
Instead, it seems that violence and substance use are both part of a lifestyle that involves antisocial and delinquent behavior. In many cases, the violent behavior actually comes before the substance use. The drug use is just one aspect of a risky and dangerous lifestyle.[18],[19]
While the use of drugs does not generally cause teens to become involved in violence, those violent teens who do use illegal drugs tend to engage in violent behavior more frequently and to continue to engage in violence much longer than those violent youth that do not use drugs.[20]

Substance Use and Suicide
Teens that use alcohol and/or other drugs are much more likely to attempt and die by suicide.[21] In one study of teen suicide, drug and alcohol abuse was the most common characteristic of those who attempted suicide: 70% of the youth who died by suicide frequently used alcohol and/or other drugs.[22] However, research has not proven that drug and alcohol use actually causes suicidal behavior, only that the two behaviors are associated. It may be that teens that have emotional problems are more likely to use drugs and to contemplate suicide. Anotherpossibility is that the use of drugs aggravates pre-existing depression or other emotional problems. Drugs and alcohol may also impair the judgment of teens considering suicide, making suicide attempts more likely.

“Mom, Jenny took my toy!” “Sam is looking at me again!” “Why does Angela get to stay up an hour later?”

Does this sound like your household? Sibling rivalry is a fact of life in many households where more than one child lives. Siblings may fight with each other for the attention of their parents, for possessions, or for privileges. For example, a younger child may be envious of his older sibling’s “freedoms,” such as staying up later or getting to ride in the front seat of the car. Or a child may be jealous of a new baby and all of the attention it receives. Sometimes, parents may accidentally provoke or reinforce sibling rivalry by treating their children unfairly, allowing one child to dominate, or not setting limits when their children get into heated quarrels.¹

At times, parents may feel that there is nothing they can do to stop their children from fighting and that their children just have to outgrow this stage. But if conflicts between your children are handled well, sibling rivalry can be reduced.

What To Know

Children 7 years old and younger may not fully grasp the importance of cooperating; very young children are still living in “me” centered worlds. But from age 8 and up, a child can be helped to see things from another person’s point of view. Therefore, you can talk to them about the need for cooperation and the importance of respecting others’ rights.² For example, an 8-year-old can understand why she should let her younger brother have a turn on the swing set: because she wouldn’t like it if she didn’t get her turn.

What To Do

Here are some tips to help you prevent sibling conflicts:

Give each child his own “things.” Children can’t be expected to share everything. Make sure each has some possessions of his own and his own personal space.³

Avoid comparing your children. Jealousy is often at the root of sibling rivalry. Saying things like “Why can’t you be well-behaved like your brother?” can make a child feel insecure and can provoke arguments.

Don’t show favoritism. Make sure that, as much as possible, you treat your children as equals, regardless of their ages. Younger children are bound to feel slighted if an older sibling has a lot of extra privileges. An older child may be upset if she is disciplined more than her younger sibling, who “gets away with everything.”

Pay attention to each of your children and listen to what each has to say. If you have a baby in the family who demands more attention, let your other children help with the baby’s care. But it’s a good idea to set aside some alone time with each child daily. Sibling rivalry often is a cry for attention…so make sure each child is getting enough.

Here are some tips for those times when quarrels do break out between siblings:

Use your judgment about intervening in your children’s disputes. If the argument is about something minor, such as who gets to hold the TV remote control, encourage your children to work it out themselves. Resist the urge to solve the problem for them; just pay attention to make sure the argument doesn’t get out of hand.⁴

Praise your children when they come to an agreement without fighting.

Don’t reward tattling by overreacting to it, unless your child is telling you something truly important. If a child tattles about a minor dispute with a sibling, encourage him to find a solution that everyone can live with. This will help your children learn to take responsibility for their own problems.

Intervene when necessary. If an argument gets physical, you will need to get involved. Take your children aside and tell them clearly that fighting or breaking things is not acceptable in your family and that there will be consequences for this behavior. Tell them that your family uses words to solve problems. Use “time-outs” to give your kids a chance to cool off from intense arguments.

You also will need to interrupt any name calling, yelling, threatening or dominating, or arguments in public.⁵

Sources

¹ The Family Works. Practical Steps Toward Helping Siblings Get Along, last referenced 3/14/2003.

²Ibid.

³ Urban Programs Resource Network. When Siblings Fight, last referenced 3/14/2003.

⁴ Helping Siblings To Get Along, last referenced 3/14/2003.

⁵ Ibid.

Additional Resources

• Bright Futures: Helping Siblings Get Along (PDF)
• PBS.org: Getting Along Together: Developing Social Competence in Young Children

You try to keep your teen healthy, right?

A teen negotiating the dangers of substance abuse deals with many types of risk and protective factors at home, in school, and in his neighborhood. The more risk factors a child faces, the more likely he is to have substance abuse and related problems as a teen or young adult. And the reverse is true; with more protective factors at work, a child is more likely to make healthy decisions.

Protective Factors
Parents can provide one of the most important protective factors: a strong family bond. When you and your children hang out and have fun together, you develop a sense of closeness and trust and help strengthen family ties. Time together also gives you a chance to share your values and expectations about different topics, including substance use. If you let your child know up front that you don’t approve of using alcohol, tobacco, or drugs, your child is less likely to use them.2 Research shows that parental influence is a primary reason that youth don’t do drugs3 so speak up and let your children know where you stand.

Risk Factors
Many types of risk factors are rooted in a child’s family life. Would it surprise you to learn that parents’ permissiveness is a bigger factor in teenage drug use than is peer pressure?4 Research shows that children whose parents who don’t use fair and consistent discipline are more likely to be at greater risk for drug-taking behavior.5 Making rules, explaining the need for them, and enforcing them consistently are important. Parents need to establish regularly enforced rules to guide their children in developing daily habits of self-discipline.
Risk and Protective Factors in Your Family’s Regular Routine
You have a chance to improve many of your child’s protective factors every day. Start by spending time together—eat dinner together, go for a walk, drive to the mall, play board games, or do other activities that you and your child can enjoy together. Like the steps you take to keep your child’s body healthy, a solid relationship with you can help protect her from substance use and help keep her well in body, mind, and spirit.

Sources

1 Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP). 2000. NCAPTion 1: Training Guide. Rockville, MD: CSAP.
2 SAMHSA’s CSAP. Keeping Youth Drug Free: Make Clear Rules and Enforce Them With Consistency and Appropriate Consequences, last referenced 8/4/04. (A print version of this publication was released in 2002.)
3 SAMHSA’s CSAP. Keeping Youth Drug Free: If You Love a Child, You Need To Know This, last referenced 8/4/04. (A print version of this publication was released in 2002.)
4 SAMHSA’s CSAP. Keeping Youth Drug Free: Make Clear Rules and Enforce Them With Consistency and Appropriate Consequences, last referenced 8/4/04. (A print version of this publication was released in 2002.)
5 Ibid.

National Institute on Drug Abuse. Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition, last referenced 8/6/04.