Various preventive approaches have been advocated, but their effectiveness is not known (14). These approaches include 1) teaching youths to identify and understand feelings to help them cope with the types of problems that can lead to suicide, 2) early identification of youths at high risk of committing suicide and their referral for treatment, 3) school-based screening programs, 4) crisis centers and hotlines, 5) improved training of health-care professionals in treating conditions that can lead to suicide; and 6) restriction of access to the lethal means of suicide.

By 1990, the death rate from homicide among black males ages 15 to 24 should be reduced to below 60.0/100,000 (baseline rate in 1978: 70.7/100,000).

Status: The 1984 rate was 61.5/100,000. Among black males 15-24 years of age, more lives are lost from homicide than from any other cause. During the period 1970-1984, 31,920 homicide victims were black males 15-24 years of age. In general, both the numbers and rates of homicide for this group were highest during the early 1970s and gradually declined to a 15-year low in 1984. The 1984 rate of 61.5/100,000 represents a 13% decrease from the 1978 index year rate of 70.7.

Most (61%) homicides among black males 15-24 years of age occurred in the context of an argument or other nonfelony circumstance. More than half of the victims (53%) were killed by persons they knew; 20% were killed by strangers; and, for the remainder, the victim-assailant relationship was undetermined. More than 75% of the young black victims were killed with firearms; 19% were killed with cutting or piercing instruments; 3%, with a bludgeoning instrument; and 2%, with other weapons. The homicide rate for black males 15-24 years of age is twice as high in metropolitan counties as in nonmetropolitan counties.

Promising local community efforts to develop and implement homicide prevention programs have involved the collaboration of health, criminal justice, social service agencies, and many other entities. Other approaches to intervention include decreasing the acceptance of behaviors that promote violence; developing strategies to reduce firearm-associated injuries; teaching nonviolent conflict-resolution skills; and improving the recognition, management, and treatment of victims of violence. These interventions must be evaluated for their ability to decrease injuries and deaths, their benefits and costs, and their social acceptability.

Young black males should continue to be a focus for prevention efforts, but the problem of homicide among other blacks and other minorities should also be addressed (15). In addition, future efforts should address the tremendous morbidity associated with nonfatal interpersonal violence.

Reported by: Office of Disease Prevention and Health Promotion, Public Health Svc, Dept of Health and Human Svcs. Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note: Since 1979, when the health status objectives for nonoccupational injuries were selected, injury fatality rates have declined (Figure 1) (16). A broad range of federal agencies* participated in the 1987 injury progress review to identify areas of success and failure and to highlight areas for future efforts. Each federal agency represented many different constituencies within and outside government, including state and local agencies and private entities.

*Participants represented the National Highway Traffic Safety Administration, National Institute on Aging, U.S. Consumer Product Safety Commission, U.S. Fire Administration, Health Resources and Services Administration, National Institute for Mental Health, and the Centers for Disease Control.

FIGURE 1. Progress toward meeting the 1990 objectives on injury control, by rates per 100,000 population United States, 1970-1984

Injury Prevention - Continued

In 1985, the National Academy of Sciences (NAS) provided a major impetus to expand injury control activities by reviewing the nation's injury control needs (17), as requested by Congress. Responding to the NAS recommendations, Congress appropriated $10 million in 1986 and again in 1987 for a pilot program to create a center for injury control at CDC and to expand support for injury prevention research. CDC created the Center for Environmental Health and Injury Control (CEHIC) by bringing together its units that work on both intentional and unintentional injuries (18). CEHIC is charged with 1) establishing surveillance systems and conducting and fostering prevention programs, 2) improving and expanding professional education and training, 3) collecting and analyzing data, and 4) serving as the lead federal agency in injury research and prevention.

The 1990 objectives for injury control originally addressed only unintentional injuries, but this more comprehensive review addresses homicide and suicide and reflects the philosophy behind CDC's reorganization and the mandate from NAS and Congress. Thus, this review covers aspects of both intentional and unintentional injuries. Other 1990 objectives related to intentional injury will be addressed in a future report on the control of stress and violent behavior.

Achieving the 1990 objectives in injury control and developing new objectives for the year 2000 will require the coordinated efforts of federal, state, and local agencies from health and other sectors; academic institutions; professional associations; and private entities. Injury control for the balance of the 1980s and into the next decade will focus on:

1. Establishing and improving injury surveillance systems to permit accurate, timely characterization of injury problems at national, state, and local levels.

2. Expanding injury control research focused on the 1990 objectives and other priorities and applying the findings to injury control programs.

3. Developing rigorous approaches to the evaluation of injury control methods, implementing and evaluating selected demonstration programs for injury control, and disseminating the findings.

4. Implementing effective injury control programs focused on priority problems of the locale; mobilizing the assistance of public, industrial, and private institutions; and coordinating the efforts of public agencies.

References

1. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

2. National Highway Traffic Safety Administration. Fatal accident reporting system 1985: a review of information on fatal accidents in the U.S. in 1985. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1987; DOT publication no. (HS)807-071.

3. National Highway Traffic Safety Administration. Restraint system usage in the traffic population, 1986 annual report. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1987; DOT publication no. (HS)802-0800. 4. Goryl ME. Restraint system usage in the traffic population. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1986; DOT publication no. (HS)806-987.

5. Baker SP, O'Neill B, Karpf RS. The injury fact book. Lexington, Massachusetts: Lexington Books, 1984:113.

6. Radebaugh TS, Hadley E, Suzman R, eds. Symposium on falls in the elderly: biologic and behavioral aspects. In: Clinics in geriatric medicine. Philadelphia: WB Saunders, 1985. (Vol 1, no 3).

7. National Research Council. Proceedings of the workshop on alcohol-related accidents in recreational boating. Washington, DC: Transportation Research Board, National Research Council, 1986.

8. US Consumer Product Safety Commission, National Spa and Pool Institute. National Pool and Spa Safety Conference [Report]. Washington, DC: US Consumer Product Safety Commission, National Spa and Pool Institute, 1985.

9. Karter MJ Jr. Patterns of fire deaths among the elderly and children in the home. Fire J 1986; Mar:19-22.

10. McLoughlin E, Marchone M, Hanger L, German PS, Baker SP. Smoke detector legislation: its effect on owner-occupied homes. Am J Public Health 1985;75:858-62.

11. Hall JR. A decade of detectors: measuring the effect. Fire J 1985;79:37-78.

12. Jagger J, Dietz PE. Death and injury by firearms: who cares? JAMA 1986;255:3143-4. 13. Centers for Disease Control. Youth suicide in the United States, 1970-1980. Atlanta: US Department of Health and Human Services, Public Health Service, 1986.

14. Eddy DM, Wolpert RL, Rosenberg ML. Estimating the effectiveness of interventions to prevent youth suicide. Medical Care 1987;25(12):S57-S65.

15. US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

16. Centers for Disease Control. CDC surveillance summaries. MMWR 1987;37(suppl SS-1) (in press).

17. Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine. Injury in America: a continuing public health problem. Washington, DC: National Academy Press, 1985.

18. Division of Injury Epidemiology and Control, Center for Environmental Health, Centers for Disease Control. 1986 annual report. Atlanta: US Department of Health and Human Services, Public Health Service, 1987.

Erratum: Vol. 37, No. 8

p. 122 The last sentence in the second paragraph should have read, "Approximately two-thirds of the children in three large series of HSP reported symptoms of an upper respiratory infection during the month before onset (1,2,4)."

Epidemiologic Notes and Reports

Influenza Update

United States

The following are indicators of influenza activity in the United States for the weeks ending February 13, 20, 27, and March 5. Numbers and percentages are provisional and may change as additional reports are received.

*Sporadically occurring cases, no known outbreaks. *Outbreaks in counties in which total population comprises <50% of total state population. $ Outbreaks in counties in which total population comprises 50% or more of total state population.

'Members of the American Academy of Family Physicians who submit weekly influenza surveillance reports based on their patient population.

**States without confirmed influenza A(H3N2) to date: Massachusetts, Nevada, New Hampshire, and Rhode Island.

**States reporting isolates of influenza A(H1N1) to date: Arkansas, Connecticut, Georgia, Maine, Maryland, Nebraska, New York, North Carolina, South Carolina, Texas, Virginia, and Vermont. Isolates from New York and Texas resemble influenza A/Taiwan/1/86(H1N1).

$$ States reporting isolates of influenza B to date: Alabama, Arizona, California, Connecticut, Hawaii, Illinois, Maine, Montana, Nevada, New York, Ohio, Tennessee, Virginia, Washington, and Wisconsin.