An examination using the PRECEDE model framework to establish a comprehensive program to prevent school violence
J.Don Chaney
Abstract: Recent school shootings have drawn heightened public attention to issues of school crime and safety. It is imperative that education, public health, and other child welfare agencies fashion rational policies and strategies for preventing crime and increasing student safety at school. The purpose of this assessment was to establish the components of a comprehensive program to prevent school violence using the PRECEDE planning model, which assesses factors that contribute to and occur as a result of school violence, as a theoretical framework. The findings underscore the importance of multiple levels of interventions and emphasis on both behavioral and environmental risk factors. This paper identifies effective levels of intervention that must be incorporated into a comprehensive approach to prevent school violence.
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Recent school shootings have drawn heightened public attention to issues of school crime and safety. Unfortunately, public perceptions of school safety are often fueled by media accounts that may exaggerate tragic events and fail to provide a real understanding of the accomplishments of schools or the problems they face. The heightened public attention provides an opportunity to closely examine the genesis of school violence. As with many social/behavioral issues this entails examination of multi-faceted risk factors. One of these factors is a social environment, which facilitates or enables violent behavior. In order to best assess a complex issue such as this it is important to utilize a theoretical framework, which allows for examination of the relationships among social, behavioral, and environmental risk factors.
One such theoretical framework is the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) model. The PRECEDE model, developed by Green and Kreuter (1974), is based on a theoretical foundation that addresses comprehensive assessment and program planning. It has been field tested in a variety of situations including: a guide to the development of local health department programs adopted by several state health departments; a federal guide to the planning, review, and evaluation of maternal and child health projects; as an analytical tool for health education policy on a national and international scale; as a model recommended by the National Committee on Injury Prevention and Control for planning and evaluating safety programs; by the American Lung Association as a Program Planning and Evaluation Guide for Lung Associations; by the American Cancer Society and the National Caner Institute for a school nutrition and cancer education curriculum; and as an organizational framework for curriculum development or training in health education for nurses, pharmacists, allied health professionals, physicians, and interdisciplinary training for behavioral scientists and health educators (Green & Kreuter, 1999).
The PRECEDE framework focuses on outputs rather than inputs. It is set up so that the question why must be answered before how. This is why the PRECEDE actually appears to read backwards, as can be seen in Figure 1.
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A program planner begins with the desired final outcome and uses the framework to determine which interventions would most likely achieve this goal. There are five basic phases of the PRECEDE model and all are interrelated. Phase 1 is concerned with identifying social indicators, and subjectively defined problems and priorities of individuals and groups that factor into their quality of life. The goal of Phase 2 is to examine epidemiological data that is associated with the particular topic. Phase 3 identifies behavioral characteristics that are linked to the health risks identified in Phase 2. Phase 4 consists of identifying predisposing, enabling, and reinforcing factors that contribute to the targeted behavior. Phase 5 examines policies that can serve to reinforce the desired behavior change (Green & Kreuter, 1999).
REVIEW OF LITERATURE
There is limited research on the topic of school violence. Several studies have examined profiling characteristics that may be used to characterize students most at risk of committing acts of violence and have identified a number of risk factors associated with violence in schools. Most of these studies also agree that a high correlation exists between male gender and the likelihood of committing a violent act on school grounds (Tomes, 1995; Komro, 1999; Courtenay, 1999; CDC, 1999; Mossie, Atkinson, Pleban, Mouzon, Wycoff, Monge, & Sarvela, 2000; Hill & Drolet, 1999). Several studies have examined community factors that may contribute to violent acts on school grounds (Menacker & Weldon, 1990; Corvo, 1997; Webber, 1997; Williams, Stiffman, & O’Neal, 1998; Bowen & Bowen, 1999; Funk, Elliot, Urman, Flores, & Mock, 1999; Kramer, 2000). All of these studies concluded that community environment does help shape students’ attitudes, perceptions, and behaviors regarding violence. Similar studies have been conducted to examine the role of family environment in contributing to a student’s violent behavior (Orphinas & Murray, 1999; Webber, 1997; Williams, et al., 1998; Bowen & Bowen, 1999; Kramer, 2000). These studies reached the conclusion that family interventions are an essential element of a violence prevention plan. Two particular studies determined that substance use had an effect on the incidence of violence in schools (Lowry & Cohen, 1999; Williams, et al., 1998). School social environments have also been examined and been found to possibly contribute to violence on school grounds (Williams, et al., 1998; Bowen & Bowen, 1999; Kramer, 2000). Peers have also been proven to have an effect on students who commit violent acts on school grounds (Howell, 1994; Williams, et al., 1998; Bowen & Bowen, 1999; Kramer, 2000). Funk, et al (1999) conducted a study that examined the desensitization of youth towards violence. They placed responsibility for desensitization on repeated exposure to violence through life experiences, as well as news media, and entertainment media.
Several studies have also examined school violence prevention programs. Prothrow-Stith (1995) concluded that no single intervention or strategy could prevent school violence, and that it would take a long-term commitment and a comprehensive set of strategies to prevent violence at school. Subsequent research examining mothers’ perceptions of school violence determined that mothers were optimistic that violence prevention programs would work well to stop or reduce school violence (Kandaki, Price, Telljohann, & Wilson, 1999). Myles and Simpson (1998) set forth a number of crisis and violence prevention strategies designed for educators such as: developing school wide and individualized behavior plans; offering a full continuum of educational, mental health, and other services; facilitating parent and family involvement; and training and empowering case managers who would deal with each aggressive or violent act. Several studies have recommended that a violence prevention program utilize an ecological approach (Fitzpatrick, 1999; Williams, et al., 1998; Bowen & Bowen, 1999; Kramer, 2000). This school of thought refers to interventions at the individual, family, school, and community levels. However, no needs assessments found in the literature have systematically outlined all of the factors that would comprise a comprehensive approaching to reduce violence on school grounds. The purpose of this paper is to establish the necessary components of a comprehensive program to prevent school violence, using the PRECEDE planning model as a theoretical foundation.
PHASE I–QUALITY OF LIFE
Violence causes many students to feel unsafe at school, which leads to a higher absenteeism rate and can have a significant impact on a student’s quality of life. In 1999, five percent of national students reported that they did not go to school on 1 or more of the past 30 days because they felt unsafe (CDC YRBS CD-ROM, 2000). Twenty five percent of national high school students reported that they fear a violent occurrence in their school (“Stats,” 2000). Almost one student in 10 (9%) reported that they avoided one or more places in their school because they feared for their own safety in those areas (“Metropolitan,” 2000). Finally, 63% of students reported that the violence in their school was a contributing factor to students transferring to attend another school (“Metropolitan,” 2000). The fear of being unsafe at school affects the quality of life of children by contributing to truancy. This increases idle time and may lead to juvenile delinquency. Research has also shown that students who miss school are more likely to suffer from an injury and girls who miss school are more likely to experience a teenage pregnancy (“Metropolitan,” 2000). Truancy will also affect students’ quality of life by leading to a higher drop out rate and a lower level of education, which in turn usually leads to a decreased future earning capacity.
PHASE II–EPIDEMIOLOGY
In 1996, 6,548 people 15-24 years of age were victims of homicide in the United States (“Youth Violence,” 1999). Homicide is the second leading cause of death for persons 15-24 years of age and the leading cause of death for African American and Hispanic youths (“Facts,” 1999). According to the Children’s Defense Fund Report on Children Dying from Gunfire in America during the time period from 1990 to 1997, an average of 14 youths (under 20 years of age) died per day in the U.S. as a result of gunfire (“Youth Gunfire,” 1999).
About 3 million crimes occur at or near school each year, and half of all violent crimes against teens occur on or near school grounds (Linquanti & Berliner, 1999). Those 3 million crimes represent 16,000 crimes committed on school campuses each day; and 1 crime committed on school grounds every 6 seconds (YCWA, 1999). Fifty percent of all crimes against teens occur on or near school grounds. In 1998, the United States Department of Education reported that 10% of all public schools experienced 1 or more serious violent crimes (i.e., murder, rape or other sexual battery, suicide, physical attack or fight with a weapon, or robbery) that were reported to police or other law enforcement officials during the school year (“1999,” 1999). However, while school violence statistics have been decreasing over the last 5 years, the number of multiple victim homicides at schools is increasing drastically (“Study,” 1999). However, the number of multiple victim homicides at schools is drastically increasing. In the 1993-1994 school year there were no multiple homicides at school and while during 1997-1998 school year there was an all-time high of 5 (“1999,” 1999).
PHASE III–BEHAVIOR
There are five primary behavioral characteristics that must be addressed in a violence prevention program for youth. A child who has a history of uncontrollable outbursts and tantrums is significantly more likely to commit an act of violence. This behavior is often mentioned in combination with that of a student who habitually makes violent threats when angry (“Youth Violence,” 1999). In 1999, approximately 4 out of every 10 students (35.7%) reported that they were in a physical fight on school property 1 or more times during the past 12 months (CDC YRBS CD-ROM, 2000). In 1998, forty percent of students in a national sample reported that they have bullied other students with threats of hitting, kicking, or slapping. In the same study, 6% of the students reported that they had threatened other students with a gun or weapon (“Stats,” 2000). If a student has previously brought a weapon to school, they are more likely to commit a violent act. Eight hundred thousand students (grades 6-12) brought a gun to school in 1998 (“Stats,” 2000). Youth who carry weapons often display other disturbing behaviors such as: 46% have used illicit drugs in the past month; 61% reported that they have been in trouble with the police; and 86% reported that they have been in trouble at school (“Stats,” 2000). Also, if a student characteristically resorts to name-calling, cursing, or abusive language, or if the student displays cruelty to animals then he/she is more likely to commit a violent act.
PHASE IV–PREDISPOSING, REINFORCING, AND ENABLING FACTORS
Predisposing factors include an individual’s or groups’ attitude, perceptions, beliefs, behavior, knowledge, and attitudes that either increase or decrease the likelihood of an individual committing an act of violence. There are several factors that predispose students to commit a violent act. If a student has a history of crime, including a background of serious disciplinary problems at school and in the community, previous truancy, suspension, or expulsion from school, they are more prone to commit an act of violence. A student’s attitude about crime is also a predisposing factor. For instance, children brought up in a violent environment usually have a significantly more positive attitude toward violence than those children who were brought up in a violence-free environment (“Youth Violence,” 1999).
Males are significantly more likely (83%) to commit a violent act on school grounds than are females (“Youth Violence,” 1999). A common misconception about gender occurs when evaluating students’ perceptions of violence. Males’ experiences with violence are greater, but perceptions of violence have been found to be nearly equal across genders (“Metropolitan,” 2000). Research has also shown that drug, alcohol and other substances usually play a major role in violent occurrences on school grounds (Lowry & Cohen, 1999). Public school students perceived that the use of drugs and alcohol was a major factor in violent occurrences at their school (“Metropolitan,” 2000). In a 1998 survey of national students, 30% reported that they had been offered drugs on school property (Stats,” 2000). Lowry and Cohen (1999) examined the availability of drugs on school property in the US, and found that school violence was positively correlated with the availability of drugs on school campuses but not with the number of users. Ethnicity is factor that is commonly used to predispose a child to the type of violent act they might commit. Although, African American and Hispanic youths are more likely to commit a violent act; Caucasian youths are more likely to commit a multiple victim violent act (“Metropolitan,” 2000). Age and location are two other predisposing factors. Statistics demonstrate that elementary school students are as likely to be a victim of violence as secondary students (“Metropolitan,” 2000). Students from metropolitan or nonmetropolitan areas are equally likely to be victims of violence at school (“Stats,” 2000).
Other predisposing factors that may contribute to a student becoming a violent offender are: low self-esteem; fear of being a victim him/herself; depression or significant mood swings; mental illness; preoccupation with weapons, explosives, or other incendiary devices; bullying behavior or being bullied; tendency to blame others for difficulties and problems he/she causes him/ herself; reflects anger, frustration, and the dark side of life reflected in school essays or writing projects; and/or suicide attempts or threats (“Youth Violence,” 1999).
Reinforcing factors are the rewards or feedback the student receives from others as a result of committing a violent act. Reinforcing factors can serve as motivation or discouragement to repeat the behavior. Sixty-five percent of a national sample of students reported that their home environment was their largest reinforcing factor (“Metropolitan,” 2000). Parents’ and siblings’ attitudes, beliefs, and behaviors are instrumental in shaping youth behavior. If a child sees violence in the home or if violence is rewarded in a tangible sense, then he/she is more likely to commit a violent act. Also, if children have been abused or been victims of neglect in the home they are more susceptible to be susceptible to committing violent acts. In 1998, a national survey of students reported that 36% felt a lack of parental supervision and 25% felt a lack of family involvement were major factors in contributing to school violence occurrences. The same survey examined teachers’ perceptions and found the following: 77% reported the lack of parental supervision at home and 69% reported a lack of family involvement as major factors in contributing to violence on school grounds (“Metropolitan,” 2000). A student’s peer environment is also instrumental in shaping his/her own behavior. Peers’ attitudes, beliefs, and behaviors affect a student’s behavior just as parents’ attitudes, beliefs, and behaviors do. If a student is on the fringe of his or her peer group with few or no close friends, or if the student is involved with a gang/clique, a student is more likely to commit a violent act to gain `acceptance’ into a particular group. Three out of every ten public school students (grades 7-12) report that gang violence is a very serious problem at their school (“Metropolitan,” 2000). The violent victimization rate of students was more than doubled in schools that had identified gangs (8%) compared to schools that reported no gang presence (3%) (“Stats,” 2000). Twenty one percent of students reported that gang members in their schools were looked up to, which emphasizes the reinforcing nature of the peer environment (“Metropolitan,” 2000). One out of two students in grades 7-12 cited peer group pressure as a major factor in violent occurrences on school property (“Stats,” 2000). Society in general may serve as a reinforcing factor for students who commit violence. The media best represents this point. Television, movies, video games, music, and books all serve as reinforcement for violent victimization. In all of these media outlets, violent victimization is usually associated with a hero. The hero, who usually shows no remorse, kills people, yet receives no punishment. News outlets are also responsible for reinforcing violent behavior of youth. A school shooting will be the lead story on not just a local newscast, but also on the national newscast. For instance, a recent example of reinforcement from the news outlets was the intense coverage of the one-year anniversary of the Columbine tragedy. Some outlets began running stories a full month before the actual anniversary. A youth who commits an act like the severe tragedy that happened at Columbine now knows that they will not only receive instant fame (even though it is bad) in the eyes of the public; they will also receive national notoriety in the years to come. The community and the school serve as reinforcing factors, as well. Teachers’ attitudes, beliefs, and behaviors can have significant impact on student behavior. Students reported that teachers had the fourth highest influence on them just behind parents, friends, and entertainment stars/pro athletes. Community leaders were the second most influential role models for students, ranking behind only teachers (“Metropolitan,” 2000).
Enabling factors are those factors that can help or hinder a student commit an act of violence on school grounds. One of the most influential factors that enables a youth to commit a violent act is the availability and accessibility of weapons. Forty-seven percent of students report that they have easy access to handguns or other firearms (“Metropolitan,” 2000). Also, weapon skills can be classified as enabling factors. Do students have the skills to use weapons so as to avoid accidents? The school environment also may contribute to the violent victimization at schools. How easy is it to get weapons into the school? Is access to the school grounds controlled?
PHASE IV–Policy DIAGNOSIS
What is being done to prevent school violence? The U.S. Department of Education conducted a survey including 1,234 regular public elementary, middle and high schools in the 50 states and the District of Columbia. Of the schools surveyed 78% reported having some type of formal violence prevention or violence reduction program. Two percent of the schools surveyed reported stringent security measures (full time guard and daily or random metal detector checks) at their school. Another 11% reported moderate security measures (full or part time guard along with restricted access to the school, or metal detectors with no guard) at their school. A substantial number (84%) reported a low level of security (restricted access to the school but no guards or metal detectors) at their school. Three percent of the schools surveyed reported that none of the security measures listed on the survey were used. The list of security measures in the survey were the following: visitors required to sign in, access to the school ground is controlled, access to the school building is controlled, school campus is closed for most students during lunch, students required to pass through metal detectors daily, random metal detector checks were performed, and school conducted drug sweeps (“1999,” 1999).
Policies that may help prevent school violence make up the fifth phase of the PRECEDE model. School policies are of extreme importance in preventing violence on school grounds. Some policies that are commonly found in schools are the following: require visitors to sign in, maintain a controlled access to school grounds, maintain a controlled access to the school building, require students to pass through metal detectors when entering the school, conduct random backpack and locker searches for drugs and weapons, maintain a police or security guard presence in the school, have security cameras in all areas of the school, and maintain a weapon free school policy. Federal, state, and community polices that deal with school violence prevention are uncommon because it is believed to be a school board issue.
DISCUSSION
Previously in this article, characteristics of youth violent offenders have been established by examining all of the components that contribute to violence. Taking this information and applying it, allows educators to establish a comprehensive program to prevent school violence. Interventions must occur on three (interpersonal, intra-personal, and community) levels to address environmental and behavioral factors. Too often, so-called school violence prevention programs address strictly environmental issues. The quick fix mentality says that it is much easier and cheaper to alter the school environment than to actually focus on behavioral issues. Although our environment does affect our behavior and in return our behavior affects our environment, adding security cameras in a school will not teach a child how to effectively cope with his/her anger. Behavioral interventions must be developed and incorporated into the students’ curriculum. The curriculum should consist of incorporating life skills including: teaching children how to positively cope with stress, teaching children how to set goals (to help increase self efficacy), teaching decision making skills, teaching communication skills, and teaching children how to deal with anger. The curriculum should also have a component geared to teaching conflict resolution skills and substance abuse prevention skills. Teachers could administer this curriculum, and be trained through teacher in-service programs. One of the recent changes seen throughout school systems is the counselor’s role. Counselors have begun spending their time developing students’ schedules instead of counseling, often resulting in less time available to counsel students. Also, social workers should be present in schools to help reinforce the behavioral changes that we target through the behavioral interventions. Social support is the defining thing that stands out on the community level. Peer mediation in schools has shown to have a positive affect on the school environment while teaching those students the life skills that were discussed earlier. Alternative schools must be reestablished for those students with serious behavioral problems. Students with serious behavioral problems are commonly expelled or suspended from school. This does no one any good. These students may be out on the street when they would normally be in school, which leads to more trouble. If there is an alternative school present then that child can be disciplined, but also worked with to alter his/her behavior at the same time. Family influence is essential in establishing social support. Also, parents must be incorporated into the behavioral interventions so that they know how to demonstrate reinforcement for any situations that might occur. If parents are not involved in the interventions, the child might be receiving mixed signals at home and at school and not know which is correct. The community must work to establish that social support of a violence free school. The community and police can work together to reduce the number of gangs. The highest number of juvenile violent crimes occurs each day between the hours of 3 p.m. and 4 p.m. (“Stats,” 2000). When students get out of school they need something to do, and that is where the community comes into play in establishing a youth violence prevention program. Federal, state, and local governments can also adopt new policies to help reduce the occurrence of violent incidences on school property. Policies are needed to decrease the availability and accessibility of weapons to youth, and the current policies in place need desperately to be enforced. Finally, no prevention plan should be established without being evaluated. Not having an evaluation component in a program design is one of the most common errors found in current programs. Evaluation provides insight to problem and success areas are in the program so that alterations can be made if needed.
REFERENCES
1999 Annual Report. (1999). Washington, D.C.: U.S. Department of Education (USDE). Retrieved March 30, 2000 from the World Wide Web: http://www.ed.gov/offices/OESE/SDFS/news.html
Bowen, N.K. & Bowen, G.L. (1999). Effects of crime and violence in neighborhoods and schools on the school behavior and performance of adolescents. Journal of Adolescent Research, 14, 3, 319-342.
Centers for Disease Control and Prevention (CDC) (1999). Nonfatal and fatal firearm-related injuries–United States, 1993-1997. Morbidity and Mortality Weekly Report, 48, 45, 1029-1034.
Corvo, K.N. (1997). Community-based youth violence prevention a framework for planners and funders. Youth and Society, 28.3, 291-316.
Courtenay, W.H. (1999). Youth violence? Let’s call it what it is. Journal of American College Health, 48, 3, 141-142.
Facts about violence among youth and violence in schools. (1999, June 2). Atlanta, GA: National Center for Injury Prevention and Control (NCIPC). Retrieved November 8, 1999 from the World Wide Web: http://www.cdc.gov/ncipc/ dvp/schoolvi.htm
Fitzpatrick, K.M. (1999). Violent victimization among America’s school children. Journal of Interpersonal Violence, 14, 10, 1055-1069.
Funk, J.B., Elliot, R., Urman, M.L., Flores, G.T., & Mock, R.M. (1999). The attitudes toward violence scale. Journal of Interpersonal Violence, 14, 11, 1123-1136.
Green, L.W. & Kreuter, M.W. (1999). Health promotion planning: An educational and ecological approach (3rd ed.). Mountain View, CA: Mayfield.
Hill, S.C. & Drolet, J.C. (1999). School-related violence among high school students in the United States, 1993-1995. Journal of School Health, 69, 7, 264-272.
Howell, J.C. (1994). Recent gang research: Programs and policy implications. Crime and Delinquency, 40.4,495-515.
Kandaki, T.L., Price, J.H., Telljohann, S.K., & Wilson, C.A. (1999). Mothers’ perceptions of factors influencing violence in schools. Journal of School Health, 69, 5, 189-195.
Komro, K.A. (1999). Adolescents’ access to firearms: Epidemiology and prevention. Journal of Health Education, 30, 5, 290-296.
Kramer, R.C. (2000). Poverty, inequality, and youth violence. The Annals of the American Academy of Political and Social Science, 567, 123-129.
Linquanti, R., & Berliner, B.A. (1999). Rebuilding schools as safe havens: A typology for selecting and integrating violence prevention strategies. Western Regional Center for Drug-Free Schools and Communities (WRCDFSC), 1-35.
Lowry, R. & Cohen, L.R. (I 999). School violence, substance use, and availability of illegal drugs on school property among U.S. high school students. Journal of School Health, 69, 9, 347-355.
Menacker, J. & Weldon, W. (1990). Community influences on school crime and violence. Urban Education, 25, 1, 68-70.
Metropolitan Life Survey of the American Teacher, 1999. (2000). Metropolitan Life Insurance Company. Retrieved April 27, 2000 from the World Wide Web: http://www.metlife.com/Companyinfo/CommunitylFound/Docs/report9.pdf
Mossie, J.E., Atkinson, D., Pleban, F.T., Mouzon, L., Wycoff, M., Monge, E. & Sarvela, P. (2000). Weapon carrying among rural southern Illinois elementary school children. Orlando, FL: Paper presented at the 2000 American Alliance of Health, Physical Education, Recreation, and Dance National Conference.
Myles, B.S. & Simpson, R.L. (1998). Aggression and violence by school age children and youth: Understanding the aggression cycle and prevention/intervention strategies. Intervention in School and Clinic, 33, 5, 259-264.
Orphinas, P. & Murray, N. (1999). Parental influences on students’ aggressive behaviors and weapon carrying. Health Education and Behavior, 26, 6, 774-787.
Prothrow-Stith, D.B. (1995). The epidemic of youth violence in America: Using public health prevention strategies to prevent violence. Journal of Health Care for the Poor and Underserved, 6, 2, 95-101.
Retrieved from Centers for Disease Control and Prevention (CDC) database [Youth Risk Behavior Survey 1999], CD-ROM, (2000).
Stats 1999: Selected School Violence Research Findings. (2000). North Carolina State University. Retrieved April 27, 2000 from the World Wide Web: http://www2.ncsu.edu/ncsu/cep/PreViolence/eoto99.htm
Study: School violence sown, but still too high. (1999, August 4). CNN. Retrieved November 7, 1999 from the World Wide Web: http://cnn.com/US/9908/04/school.violence/
Tomes, H. (1995). Research and policy directions in violence: A developmental perspective. Journal of Health Care for the Poor and Underserved, 6, 2, 146-151.
Webber, J. (1997). Comprehending youth violence. Remedial and Special Education, 18, 2, 94-104.
Williams, J.H., Stiffman, A. R., & O’Neal, J.L. (1998). Violence among urban African American youths: An analysis of environmental and behavioral risk factors. Social Work Research, 22, 1, 3-13.
Youth Crime Watch of America (YCWA). (1999, July 11). Retrieved November 7, 1999 from the World Wide Web: http://www.ycwa.org/main.htm
Youth gunfire fatalities. (1999, November 1). USA Today.
Youth violence in the United States fact sheet. (1999, May 21 ). Atlanta, GA: National Center for Injury Prevention and Control (NCIPC). Retrieved November 8, 1999 from the World Wide Web: http://www.cdc.gov/ncipc/dvp/yvpt/ newfacts.htm
J. Don Chaney, M.S., is a Doctoral Student in the Department of Health Science at The University of Alabama; Box 870311; Tuscaloosa, AL 35497-0311; dchaney@ches.ua.edu. Barry P. Hunt, Ed.D., is an Associate Professor at Mississippi State University and Jeffrey W, Schulz; Ph.D., is an Associate Professor at Eastern Michigan University. Address all correspondence to Mr. Chaney.
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