While high-profile school shootings dominate national headlines, a much greater threat to adolescent health is going less reported: Teen suicide rates have tripled over the last 35 years, outpacing homicide rates among 15-19 year olds by as much as four to one. Suicide is now the second leading cause of death among teens, following automobile crashes. And these figures don’t reflect the prevalence of failed suicide attempts, which some experts estimate may be as much as 100 times more frequent than completed suicides.

“We’re good at counting deaths,” says EDC’s Lloyd Potter, “but we’re not good at tracking hospitalization and acute care due to suicidal behavior.” Potter, one of the country’s leading experts on youth suicide, directs the Children’s Safety Network (CSN), headquartered at EDC/HHD and funded by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services. CSN comprises a group of resource centers that assist state governments and local communities in protecting the health and safety of the country’s young people. CSN provides information, training, and technical assistance to the state agencies that develop and implement injury, suicide, and violence prevention programs. It also helps state and local health departments analyze injury data and promote effective strategies in such areas as automobile, bicycle, and playground safety; poison and fire hazards; and child abuse and neglect.

In Search of Effective Suicide Prevention

The alarming suicide rate among young people presents a particularly difficult challenge to public health practitioners. “Suicide prevention research is still in its infancy,” explains Potter. “There are good interventions out there, but we’re only beginning to put the resources into studying them.” Still, Potter points to several strategies that state and local agencies can employ to help teens at risk:

• Publicize the problem. State agencies can do more to communicate with the public about the prevalence of suicide among young people and to destigmatize mental health problems. For example, agencies can collect data and disseminate reports about the significance of the problem and initiate public awareness campaigns about risk factors.
• Promote “gatekeeper” training programs. These programs train people who are in frequent contact with young people—such as school counselors, peer leaders, coaches, clergy, and youth group leaders—to recognize risk characteristics of suicide and make appropriate referrals.
• Support crisis services. Telephone hotlines provide an important service to those at risk for suicide, though to date there have been no long-term studies as to their effectiveness.
• Endorse effective school-based programs. One example is Reconnecting Youth, a school-based prevention program for at-risk teens that has shown promising results in mitigating some suicide risk factors like high truancy rates, alcohol and drug abuse, and poor academic performance.
• Educate the public about the safe handling of firearms. Guns account for close to two-thirds of all completed suicides. States can develop public awareness campaigns to educate families about the importance of keeping guns in the home safely locked and stored away from young people.

Confronting the Dangers of Automobiles

While suicide rates have seen a dramatic upswing in recent decades, automobile crashes remain the leading cause of death among young people. CSN supports state-level efforts to educate the public and policymakers about the effectiveness of child safety restraints, including seat belts, child seats, and seating children in the rear of the car. Research shows that some child passenger safety (CPS) campaigns can claim significant success: Mortality rates among children ages 0-4 appear to be declining, thanks to the widespread adoption of child safety seats. But for children ages 7-12, traffic-related mortality rates have climbed 10 percent.

“There is a gap in public awareness about motor vehicle safety for kids between the ages of 4 and 12,” explains CSN’s Julie Ross. “Only a few states have laws that sufficiently protect these children, and parents just don’t know about the importance of keeping children in the back seat.” Ross reports that a child’s risk of being killed in a car crash is reduced by more than one-third if the child is riding in the rear of the car.

Ninos Atras/Kids to the Back is a community-based program in Holyoke, Massachusetts, designed to educate the community about the importance of seating children in the rear of the car. Although the project is funded by the Centers for Disease Control and Prevention and directed jointly by EDC/HHD’s Susan Gallagher and colleagues at the Harvard School of Public Health, it is staffed and run by a local bilingual community coordinator who works closely with a community coalition made up of representatives from the board of health, the school department, Holyoke Health Center, Holyoke Children’s Museum, Nueva Esperanza, and other local organizations.

The program is unique in its focus on motor vehicle safety for children in the 6-12 age bracket and in its focus on the Latino community. To date, project staff and the coalition have developed a brochure in English and Spanish about child passenger safety that went home with every elementary school student in Holyoke. The coalition also developed a bilingual coloring and activity book on car safety for children in the community, which the National Highway Traffic Safety Administration plans to reproduce and distribute nationally. This September the coalition will follow up with an incentives program involving voluntary automobile checkpoints. Americorps and other com-munity volunteers who are trained CPS technicians will stop cars at elementary schools during pick-up time and at parking lots at McDonald’s and a local supermarket to talk to parents about how the children’s seats are installed and where the children are seated. They will also have booster seats on hand to distribute to families that don’t have them. Other smaller rewards, like travel coffee cups, reduced-price tickets to a local skating rink, and raffle tickets, will be offered to participating parents. The incentives program will be repeated several times in the community over the course of the year.

Ninos Atras includes a rigorous evaluation component that involves two control communities in addition to Holyoke. It began with studies of driver habits—counting cars with child passengers at busy intersections, brief driver interviews, in-depth focus groups, and process measures. After the interventions are complete, researchers will conduct follow-up observations and interviews in the three communities. “Community-based programs often need more than a three-year grant cycle to become self-sustaining and show results,” says Gallagher. “But we’re confident that by integrating these efforts into existing community programs, Ninos Atras will be sustained and result in fewer injuries to children in the Holyoke area.”