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Public Health Violence Prevention
by
Andrés Villaveces

Introduction

Violence as defined by the World Health Organization (WHO) is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation. Violence prevention or the prevention of intentional injuries is part of the subtopic of injury prevention, as it is understood from a public health perspective. Violence prevention addresses all forms of violence, including violence perpetrated between individuals (interpersonal violence) or between groups, or collective violence (i.e., war), and self-inflicted violence (i.e., self-abuse and suicide). This classification is known as the typology of violence according to the WHO and can be manifested in different forms such as physical, psychological, or sexual violence, or as neglect. It can also be explained by the type of violence inflicted on individuals throughout their lifespan, by the use of violence against persons of different sex, or by the types of weapons or factors involved in the perpetration of violence (such as firearms or alcohol). Violent behaviors have multiple manifestations, including child abuse and neglect, violence against women or intimate partners and within families, youth violence, abuse against older persons, suicide, and collective violence. Other forms of violence include hate crimes, such as those directed towards minority races, immigrants, persons with different sexual orientations, or some religious groups. The prevention of violence follows strategies that involve multiple disciplines and includes actions aimed at modifying human behaviors, establishing legal conditions or frameworks to promote safety, or using physical or engineering modifications to reduce risks or improve safety. Public health interventions to prevent or control violence include primary prevention activities (preventing violence before it happens), secondary prevention activities (mitigating the effects of violence), and tertiary prevention activities (treating the consequences of violence and providing rehabilitation).

Introductory Works

World Health Organization 1996 provides a framework for addressing violence from a public health perspective. The most comprehensive resources for understanding violence prevention from this perspective can be found through resources available from the WHO’s Department of Violence and Injury Prevention and Disability and through several WHO publications (Violence Publications and Resources) and capacity-building tools such as TEACH-VIP. Additionally, the National Center for Injury Prevention and Control provides useful information with a greater focus on the United States. These resources provide the conceptual framework and factual information that enables readers to understand the public health perspective of violence prevention and define violence in all its forms. These resources additionally provide clear information on what risk factors are involved in the perpetration of violence and how the control of these risk factors can contribute to the prevention or reduction of violence in diverse populations. In addition, publications such as National Committee for Injury Prevention and Control 1989 and World Health Organization 1996 provide justification for the need to study and use more resources to prevent violence in populations. Other resources such as the SafetyLit meta-site provide useful resources on a variety of injury topics.

  • National Center for Injury Prevention and Control (NCIPC).

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    This comprehensive website provides evidence of research on violence prevention, with eight subsections. It provides free materials for communities, aimed at improving the understanding of violence and violence prevention. Also contains the WISQARS (Web-based Injury Statistics Query and Reporting System) database, which has statistical information on violence-related events in the United States.

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  • National Committee for Injury Prevention and Control. 1989. Injury prevention: Meeting the challenge. New York: Oxford Univ. Press.

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    This is an essential read that discusses the basic scientific approach to injuries and violence prevention and puts it in the context of the US health situation. It addresses the United States’ Healthy People goals for improving the health of Americans and focuses on the techniques used to identify injury problems, to develop prevention activities, and to evaluate interventions.

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  • SafetyLit.

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    This meta-site provides links to multiple injury-related web resources, including organizations, journals, and scientific and policy-relevant literature. It contains a searchable, archived database organized by themes related to violence and injuries. It is supported by San Diego State University and is published in collaboration with the WHO.

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    • World Health Organization. 1996. Prevention of violence: A public health priority. WHA 49.25. Geneva, Switzerland: World Health Organization.

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      This 49th World Health Assembly Resolution was instrumental in giving a mandate to the WHO for studying the problem of violence globally.

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    • World Health Organization. TEACH-VIP.

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      Comprehensive training tool for public health practitioners addressing the public health approach to violence prevention and injuries. It contains a basic module of twenty-one lessons and thirty-nine sessions in the advanced modules on multiple injury topics. Modules 1–6 focus on overall injury concepts. Modules 16–30 focus on violence prevention. Modules 31–33 focus on care of victims; modules 34–39, on ethical and policy issues.

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    • World Health Organization. Capacity-Building Resources.

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      This web page section contains information and resources useful for training individuals on how to prevent and control violence and injuries. It includes access to publications focusing on injuries in general (TEACH-VIP), how to document interpersonal violence programs, and how to care for victims of sexual violence.

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    • World Health Organization. Violence and Injury Prevention and Disability (VIP).

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      This web page provides access to a variety of reference publications with a global focus on a wide variety of areas related to injuries and violence prevention. It provides free access to multiple review and reference publications related to violence prevention and facts about violence in a global setting.

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    • World Health Organization. Violence Publications and Resources.

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      This web page contains essential readings addressing violence prevention strategies, providing facts about the problem and evidence of programs that work. It also includes policy-related publications and a synthesis of economic evaluations of the consequences of violence on health.

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    Reference Works

    This section highlights publications that have a general scope either about the conceptual principles of injury prevention or that focus on general approaches to the discipline. The epidemiological basis for injury prevention and control is defined in Haddon 1968 and Haddon 1973, where the public health model is explained in terms of an acute transfer of energy that injures people through different mechanisms, as well as the necessary tools for understanding the mechanisms of injury, their classification, and prevention. The need for surveillance and the application of prevention strategies is explained in Barss 1998, Christoffel and Gallagher 2006, and Robertson 2007. Factual information about injuries is available from resources including Peden, et al. 2002. In addition, Baker 1992 presents a comprehensive view of injuries and injury risks in the United States. This book’s historical importance lies in the fact that it highlighted the relationship between different types of injuries and the magnitude of the problem in a specific country and, in doing so, contributed to defining several areas of study in the field of injuries and violence prevention. A review of risk factors for injuries and commonly used injury classification systems and clinical scoring systems is addressed in McClure, et al. 2004, in addition to providing information about interventions and countermeasures aimed at preventing or controlling injuries. A global review explaining the concept of violence and its typology from the public health perspective that addresses multiple forms of violence-related risk and protective factors as well as strategies for the prevention is available from the WHO through Krug, et al. 2002. This last publication focuses exclusively on all violence-related topics, while the previous ones address injury prevention in general.

    • Baker, S. P. 1992. The injury fact book. 2d ed. New York: Oxford Univ. Press.

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      This landmark book uses data to explore the magnitude and characteristics of the injury problem mostly in the United States. Written by one of the most respected leaders in the field, Dr. Susan Baker.

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    • Barss, P. 1998. Injury prevention: An international perspective epidemiology, surveillance, and policy. New York: Oxford Univ. Press.

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      Peter Barss documents the international magnitude of injury prevention and highlights the importance of conducting proper surveillance and documenting injury problems. A useful resource for practitioners.

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    • Christoffel, T., and S. S. Gallagher. 2006. Injury prevention and public health: Practical knowledge, skills, and strategies. 2d ed. Sudbury, MA: Jones and Bartlett.

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      The authors highlight basic injury prevention concepts and provide practical details on how to develop surveillance strategies and study injury problems. An excellent resource for understanding injuries overall.

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    • Haddon, W., Jr. 1968. The changing approach to the epidemiology, prevention, and amelioration of trauma: The transition to approaches etiologically rather than descriptively based. American Journal of Public Health and the Nations Health 58.8: 1431–1438.

      DOI: 10.2105/AJPH.58.8.1431Save Citation »Export Citation »E-mail Citation »

      In this landmark manuscript the author highlights the need for understanding and explaining injuries through the exploration of causal factors rather than limiting studies to descriptive information.

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    • Haddon, W., Jr. 1973. Energy damage and the ten countermeasure strategies. Journal of Trauma 13.4: 321–331.

      DOI: 10.1097/00005373-197304000-00011Save Citation »Export Citation »E-mail Citation »

      A clear summary of the ten main countermeasures that deal with preventing the acute transfer of energy that leads to the occurrence of injuries through multiple mechanisms.

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    • Krug, E. G., L. L. Dahlberg, J. A. Mercy, A. B. Zwi, and R. Lozano. 2002. World report on violence and health. Geneva, Switzerland: World Health Organization.

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      This free publication, which is available in eight languages, is a good introductory reference text for understanding violence from a public health perspective, its risk factors, and evidence-based and policy recommendations aimed at preventing or controlling it and reducing its health consequences.

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    • McClure, R., M. Stevenson, and S. McEvoy, eds. 2004. The scientific basis of injury prevention and control. Melbourne, Australia: IP Communications.

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      A comprehensive synthesis of the conceptual approach toward understanding injury prevention. Concisely explains injury concepts, measurement of injuries, risk factors, interventions, and program development and evaluation, in five sections.

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    • Peden, M., K. McGee, and G. Sharma. The injury chart book: A graphical overview of the global burden of injuries. Geneva, Switzerland: World Health Organization.

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      This short report highlights with useful graphics the magnitude of diverse injury problems at a global level.

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    • Robertson, L. S. 2007. Injury epidemiology: Research and control strategies. 3d ed. New York: Oxford Univ. Press.

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      This text explains the epidemiologic methods for studying injuries and evaluating interventions to prevent them. It contextualizes the use of epidemiologic methods to study injuries and discusses policy applications.

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    Textbooks

    Understanding the basic concepts of public health in relation to violence is essential. This section delves in greater detail on approaches to understanding violence in general and useful interventions that have been evaluated in a variety of settings addressing the issue of violence. Rosenberg and Fenley 1991 highlights how violence can be predicted by studying risk and protective factors at individual, community, and societal levels. Having the ability to predict such events can be useful for the development of preventative or control strategies, as noted in Doll, et al. 2007. Violence prevention draws from multiple disciplines that involve modifications of behaviors, social conditions, environments, and legal frameworks. A variety of approaches have been identified as useful in the prevention and control of multiple forms of violence. For example, behavioral strategies for violence prevention are reviewed in Gielen, et al. 2006, which focuses on effective violence prevention strategies in several settings. In addition to these publications, this section highlights in more depth publications that focus on methods for studying and understanding violence and injuries, providing more detailed examples about how to measure, analyze, and report information related to violence prevention and control.

    • Doll, L. S., S. E. Bonzo, J. A. Mercy, D. A. Sleet, and E. N. Haas. 2007. Handbook of injury and violence prevention. New York: Springer.

      DOI: 10.1007/b136518Save Citation »Export Citation »E-mail Citation »

      This excellent book highlights interventions that have been shown to be useful in the prevention of injuries and violence. Specific chapters focus on selected topics of violence prevention.

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    • Gielen, A. C., D. A. Sleet, and R. J. DiClemente. 2006. Injury and violence prevention: Behavioral science theories, methods, and applications. San Francisco: Jossey-Bass.

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      An excellent resource that provides examples of the application of multiple behavioral theories to the development of effective violence prevention strategies. It combines theoretical with practical applications of concepts related to multiple manifestations of violence.

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    • Rosenberg, M. L., and M. A. Fenley. 1991. Violence in America: A public health approach. New York: Oxford Univ. Press.

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      Multiple experts explain in eight chapters the public health concepts associated with understanding and dealing with the different forms of violence.

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    Methods

    The proper study of violence prevention, the development of interventions, and their evaluation requires sound public health, quantitative and qualitative methods and using a wide variety of approaches that include understanding behaviors, legal frameworks and environments, as noted in Robertson 2007. Good data collection strategies are highlighted in the injury surveillance guidelines (Holder, et al. 2001) and the guidelines for conducting surveys (Sethi, et al. 2004) from the WHO. Understanding data and data limitations, definitions of events, and calculations of measurements, such as rates of violence, is key when developing research studies, as highlighted in Fingerhut 2004; Rivara, et al. 2001; and Dahlberg, et al. 1998. Virtually any type of study design used in public health can be implemented to study violence. Nevertheless, data nuances and characteristics of injury events require specific understanding of the application of such methods to this area of study. The development of quantitative tools for measuring violence, such as the Revised Conflict Tactics Scale in Straus, et al. 1996, has enabled researchers to improve analytical strategies to understand associations of different exposures with the occurrence of violence. Weisburd, et al. 2008 highlights the importance of temporally and spatially locating injury data for better detection of high-crime areas, understanding neighborhood patterns of crime, and establishing prevention and control mechanisms.

    Historical Books and Manuscripts

    Historical books about violence prevention from a public health perspective are scarce. However, there is a wide array of publications that explain the changes in behaviors related to different forms of violence throughout the last two or three centuries, mostly in western Europe or the Americas. For example, Ruff 2001, Spierenburg 2008, and Muchembled 2008 focus on overall violence in Europe, while Vigarello 2001, Robertson 2005, and Ward 2008 explore violence in relation to sex and gender issues. Guly 2005 focuses more on the care of injured people. Abad 1962 is important, because it is one of the first to specifically propose the study of violence by means of epidemiological methods by highlighting the use of public health surveillance. Although many manuscripts had been published on unintentional injuries and public health prior to Abad 1962, few focused on the study of violence prevention.

    • Abad, H. 1962. La violencia necesita estudios epidemiológicos. Tribuna Médica 2.66: 1, 10–12.

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      This editorial written in Spanish highlights the importance of using epidemiologic surveillance and concepts for the study of violence, with a special focus on Colombia. One of the first public health manuscripts linking epidemiology to the study of violence.

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    • Guly, H. R. 2005. A history of accident and emergency medicine, 1948–2004. New York: Palgrave Macmillan.

      DOI: 10.1057/9780230000742Save Citation »Export Citation »E-mail Citation »

      The field of emergency medicine is essential for proper care of injured persons. This book highlights the formation of this new medical specialty of accident and emergency medicine in the context of institutional opposition in the United Kingdom.

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    • Muchembled, R. 2008. Une histoire de la violence: De la fin du moyen âge à nos jours. Paris: Seuil.

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      A comprehensive and engaging book written in French by Muchembled, a historian, that explores the history of violence in western Europe. The book highlights how the phenomenon of violence has diminished greatly in comparison with previous centuries, despite the current exposure to violence through the media.

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    • Robertson, S. 2005. Crimes against children: Sexual violence and legal culture in New York City, 1880–1960. Chapel Hill: Univ. of North Carolina Press.

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      This fascinating book explores the changing attitudes toward children in the 19th century and how the understanding of childhood development led to the creation of legal reforms that typified and classified abuse against children.

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    • Ruff, J. R. 2001. Violence in early modern Europe, 1500–1800. Cambridge, UK, and New York: Cambridge Univ. Press.

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      This book focuses mostly on historical aspects of violence in Europe and puts emphasis on the role of the state in controlling violence. It is useful for understanding the seeds of current strategies aimed at controlling violence.

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    • Spierenburg, P. C. 2008. A history of murder: Personal violence in Europe from the Middle Ages to the present. Cambridge, UK, and Malden, MA: Polity.

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      This interesting book provides an overview of seven centuries of murder in Europe and explores changes in the occurrence of violence, while documenting the decline in the incidence of homicide.

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    • Vigarello, G. 2001. A history of rape: Sexual violence in France from the 16th to the 20th century. Malden, MA: Polity.

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      Vigarello, a social historian, explores the changing attitudes and laws toward sexual violence over several centuries, using the case of France. It is an interesting resource to understand the changing attitudes toward sexual violence.

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    • Ward, J. P. 2008. Violence, politics, and gender in early modern England. New York: Palgrave Macmillan.

      DOI: 10.1057/9780230617018Save Citation »Export Citation »E-mail Citation »

      An interesting exploration of the clashes between sexes and their roles in society. Useful to understand the social role of gender. The book draws on literary works to explain some issues.

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    Journals

    The study of violence prevention and the evaluation of interventions aimed at preventing, controlling, or reducing violence involve a wide variety of disciplines, many of which had addressed the topic before public health became a discipline itself. Such is the case with criminology and sociology. Because of the wide variety of risk factors associated with violence prevention and its multiple manifestations, articles addressing these topics can be widely available in a variety of journals that address more general topics, including the American Journal of Preventive Medicine, Journal of the American Medical Association, and American Journal of Public Health. There are over sixty criminology-related journals addressing multiple manifestations of violence. Some of the most well known include Criminology and Journal of Criminal Law & Criminology. These focus on a variety of issues and disciplines such as psychology, the law, and systems analysis. A large number of sociology journals also explore violence prevention. One of the most well-known publications in this area is the journal Social Forces, which among many other themes has a sociological approach to the problem of violence and has been publishing articles on this issue since the early 20th century. There are journals that focus specifically on issues related to injury prevention overall, with a public health emphasis. The leading injury prevention journal that addresses themes on violence prevention from a public health perspective is Injury Prevention. Another journal addressing injury prevention is the International Journal of Injury Control and Safety Promotion. There are also journals that focus on the treatment and consequences of violence, such as the Journal of Trauma, Injury, Infection, and Critical Care and Injury, and a journal focusing on clinical decisions, legal problems, and public policy, which is titled Violence & Victims. Finally there are journals that address workplace violence, including the American Journal of Industrial Medicine and the Journal of Occupational and Environmental Medicine. This section is broken down into the following subsections: Child Abuse, Violence against Women and Families, Youth Violence and Interpersonal Violence, Suicide, and Elder Abuse.

    Child Abuse

    According to the WHO, child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power. Manifestations of child abuse include shaken baby syndrome, battered child syndrome, and multiple forms of sexual abuse and neglect. A variety of journals such as Child Abuse & Neglect, Child Maltreatment, and Child Abuse Review focus on all aspects of child abuse, while the Journal of Child Sexual Abuse addresses that issue and is directed to a variety of disciplines.

    Violence against Women and Family

    This term can also be defined as violence against intimate partners and family. The most common form, however, is violence against women perpetrated by husbands or male intimate partners. Intimate-partner violence occurs in all countries and at all socioeconomic levels of society. While this issue has been addressed from a human rights perspective, increasingly it is more understood as a public health problem where multiple disciplines including health-related, legal, and other social sciences are involved. There are several journals that address these topics with different approaches: the Journal of Family Violence addresses violence in the family context and the multiple forms of violence manifested within this nucleus; Violence Against Women focuses exclusively on all forms of violence against females, including child abuse of females; and Partner Abuse focuses on expressions of violence within relationships between partners.

    Youth Violence and Interpersonal Violence

    Youth violence includes homicide and nonfatal assaults, according to the WHO. This form of violence affects not only young populations but also families and communities in general. Youth violence is related to other high-risk behaviors such as being involved in fights, abusing alcohol and drugs, and being in places where firearms are available, which tends increase the lethality of violence. There are many journals in multiple disciplines that address the problem of youth violence. The most salient ones are addressed in this section, which includes some journals with a general approach to violence such as the Journal of Interpersonal Violence and the Journal of Aggression, Maltreatment & Trauma, which also addresses issues related to terrorism. The journal Trauma, Violence, & Abuse focuses on practitioners and persons with clinical training, and the Journal of School Violence focuses on the prevention of violent behaviors in educational settings.

    Suicide

    Suicide can be defined as a human act that leads to the end of life by self-inflicted injuries. Worldwide, suicide is more common than interpersonal violence. Given the difficulty of identifying the intentions of those who commit suicide, two terms have been proposed that focus more on the outcomes of certain behaviors. They are fatal suicidal behavior and nonfatal suicidal behavior. The latter has also been defined as attempted suicide (in the United States) or as parasuicide or deliberate harm (more commonly used in Europe). Other behaviors that lead to self-harm include different forms of self-mutilation. Suicide is the most common form of violent behavior in the world, and its study involves many disciplines, including legal, public health, psychiatric, and psychological, and the study of biological and the pharmacological aspects linked to it. These issues are addressed in journals such as the American Journal of Psychiatry, Archives of General Psychiatry, and Archives of Suicide Research.

    Elder Abuse

    This definition focuses mostly on abuse of older persons by family members or other individuals known to them, occurring in the home or in institutional settings. Abuse of older persons has been studied in the last decades mostly by public health disciplines and by the criminal justice system. This form of abuse is of large concern in light of the growing numbers of older populations already living in high-income countries and largely increasing in middle- and low-income countries. According to the WHO, elder abuse is defined as an act of commission or omission (such as in neglect cases), which can be intentional or unintentional, can lead to physical, psychological, or sexual harm, and can also manifest itself as financial or other forms of material maltreatment. The legal, policy, and public health aspects of this problem are addressed by the Journal of Elder Abuse and Neglect. The Gerontologist focuses more on a service delivery perspective. Focus on elder abuse in institutional settings is addressed in more detail in Social Work in Health Care, and legal aspects of elder abuse are addressed in the Journal of Legal Studies.

    Evidence-Based Practice Guidelines

    The generation of evidence has been paramount for the development, translation, and implementation of interventions that work. Efforts to identify such interventions are key for successful public health activities on violence prevention. Some of the highest-quality assessments of evidence can be found in publications produced by the Cochrane Injuries Group. In addition, there are publications focused on specific violence prevention topics such as Youth Violence or child abuse (see Child Abuse and Neglect). Excellent examples of critical appraisals of interventions are available through the Blueprints for Violence Prevention website and resources and Timothy, et al. 2002. Lutzker 2006 presents evidence of early exposure to violence and violent behavior later in life. Other literature presents successful examples of violence prevention, such as in World Health Organization 2010 or Hemenway 2009. Finally, Spinks, et al. 2009 reviews the community approach promoted by the Safe Communities movement created in Sweden in 1991.

    Policies

    In the first decade of the 21st century, the WHO increased its activities on violence prevention by addressing it as a public health priority (World Health Organization 1996). Apart from contributing to the development of key reference sources, several policy-oriented publications have focused on how governments can increase activities on violence prevention, either by explaining how to implement the recommendations in Butchart, et al. 2004 or by convening multiple stakeholders toward the development of a research agenda on the topic, an endeavor supported mostly by the US Institute of Medicine (Scott 2008). Further policy documents focus on how multilateral agencies such as the WHO can contribute to violence prevention activities by collaborating with similar institutions, as described in World Health Organization 2008, or by building coalitions such as those created through World Health Organization 2004.

    Interpersonal

    The WHO has defined interpersonal violence as violence that occurs between individuals who know each other or who are strangers. The public health approach to violence prevention is explained in Krug, et al. 2002 (cited under Reference Works), while Herrenkohl 2010 explains it from a more systemic perspective. Interpersonal violence can be manifested in multiple ways depending on the population affected, and a useful compendium of manuscripts in American Medical Association 1992 focuses on these manifestations. A US-based approach to the problem is addressed in Gellert 2010, while Mihalic, et al. 2002 focuses on factors for successful implementation of violence prevention projects. The different forms of violence include child abuse and neglect, intimate partner violence, youth violence (including gang violence), and elder abuse and neglect. Violence manifests itself in many ways, which can be physical, emotional, through sexual acts, or by means of neglect. It can also occur in diverse settings or be focused toward certain groups, such as racial minorities, persons with different sexual preferences, immigrants, or certain religious groups, and can additionally be linked to the use of devices or substances that increase the lethality of these acts. Following suicide, interpersonal violence is the second most common form of violence globally. Violence also has immense costs for communities and health systems, as reviewed by two WHO publications: World Health Organization 2004 and Butchart, et al. 2008. This section covers the following issues surrounding violence prevention: Child Abuse and Neglect, Youth Violence, Violence against Women and Intimate Partners, Elder Abuse and Neglect, and Sexual Violence.

    Child Abuse and Neglect

    Understanding child abuse and neglect is important because it is in these stages of the life cycle that the most benefits can be obtained when intervening in the individual, the family environment, or the community. Child abuse and neglect occurs in every region of the globe, and according to WHO data from the year 2000, as reported in Krug, et al. 2002 (cited under Reference Works), 57,000 deaths were attributed to homicide among children under fifteen years of age. The same report states that infants and children between birth and four years old have homicide rates of 5.8 per 100,000 population, compared to 2.1 per 100,000 population for those of five to fourteen years of age. Boys are at higher risk than girls, and these differences are greater in middle- and low-income countries. The WHO African Region reports the highest rates for the youngest children (17.9 per 100,000 population), and the lowest rates are reported from high-income countries from the WHO Eastern Mediterranean Region, Western Pacific Region, and the European Region. Exposure to violence early in life is linked to a greater chance of violence perpetration at later stages, and, hence, prevention activities at this time and in these populations are of paramount importance. A historical approach is addressed in De Hahn and Sarat 2000. Evidence-based interventions are reviewed in Lampinen and Sexton-Radek 2010, while Macdonald, et al. 2006 and Zwi, et al. 2007 focus on child sexual abuse, and Macdonald, et al. 2008 and Barlow, et al. 2006 focus on teen mothers and parenting prevention interventions, respectively.

    Youth Violence

    Most victims and perpetrators of interpersonal violence are young populations. Risky behaviors and individual and societal conditions have been linked to the perpetration and victimization of people in these age groups. In 2000, the WHO estimated that 199,000 homicides (at a rate of 9.2 per 100,000 population) occurred worldwide. Youth violence affects mostly males, and the geographic regions reporting the highest rates are Latin America (36.4 per 100,000 population) and Africa (17.6 per 100,000 population). High-income European countries and some Asian and Pacific regions report the lowest rates. Unfortunately, in the 1990s and the first decade of the 21st century, trends of youth violence rates have increased. At younger ages, youth violence can manifest itself as bullying in school environments. This is addressed extensively in Krug, et al. 2002 (cited under Reference Works). Improving school conditions, family environments, and peer group relations is key to understanding and controlling violence in these groups. Violence in schools is addressed in Jimerson and Furlong 2006, while Johnson 2009 and Frumkin 2006 more extensively address environmental aspects related to youth violence, and specific prevention interventions are evaluated in Mytton, et al. 2006. Jefferson Jones and Rodgers 2009 further addresses gang violence as a manifestation of violence among youth, by addressing cases from Latin America. At this young age, individuals can be exposed to multiple manifestations of violence and have greater access to lethal means. It is among young populations that the health burden due to violence is greatest.

    • Frumkin, H. 2006. Safe and healthy school environments. Oxford and New York: Oxford Univ. Press.

      DOI: 10.1093/acprof:oso/9780195179477.001.0001Save Citation »Export Citation »E-mail Citation »

      A book written by a leading authority in environmental sciences and public health that addresses school safety from an environmental perspective. This area of public health considers biological, physical, and societal conditions necessary for achieving safe school environments.

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    • Jefferson Jones, G., and D. Rodgers, eds. 2009. Youth violence in Latin America: Gangs and juvenile justice in perspective. Studies of the Americas. New York: Palgrave Macmillan.

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      This comprehensive book reviews cases from Latin America, with a focus on the interplay between gang-related problems and the juvenile justice system.

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    • Jimerson, S. R., and M. J. Furlong. 2006. The handbook of school violence and school safety: From research to practice. Mahwah, NJ: Lawrence Erlbaum.

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      This extensive book, written in forty-one chapters, focuses on a global overview of the field of school violence and safety research and practice. It highlights different manifestations of school violence and focuses on prevention and interventions. An excellent comprehensive tool for studying school violence.

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    • Johnson, S. L. 2009. Improving the school environment to reduce school violence: A review of the literature. Journal of School Health 79.10: 451–465.

      DOI: 10.1111/j.1746-1561.2009.00435.xSave Citation »Export Citation »E-mail Citation »

      This review manuscript highlights research on school violence and reports that although opportunities for prevention exist, existing research is insufficient to determine which interventions are useful for preventing violence in the school.

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    • Mytton, J. A., C. DiGuiseppi, D. Gough, R. S. Taylor, and S. Logan. 2006. School-based secondary prevention programmes for preventing violence. Cochrane Database of Systematic Reviews 3.

      DOI: 10.1002/14651858.CD004606.pub2Save Citation »Export Citation »E-mail Citation »

      This Cochrane Library systematic review evaluated the effectiveness of school-based programs designed to control violence.

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    Violence against Women and Intimate Partners

    Women are frequently victimized by men through different forms of abuse that include physical, emotional, and sexual violence. According to Krug, et al. 2002 (cited under Reference Works), using data from the WHO, intimate-partner violence includes any behavior that causes physical, psychological, or sexual harm to those in a relationship. These behaviors also include forced sexual intercourse and other controlling behaviors that restrict the partner’s communication or contact with families, friends, and assistance services, or that manifest as a type of economic control. Surveys from different regions of the world report prevalence rates that range from 10 percent to 69 percent of women reporting abuse in a particular community. A comparison of rates of violence against women in several countries is carefully assessed in García-Moreno 2005. A general approach to violence against women is explained in detail in Renzetti, et al. 2011. Addressing violence prevention strategies aimed at protecting women is key, because frequently they are more vulnerable in family circles, communities, and societies. Smedslund, et al. 2007 focuses on evaluating behavioral approaches aimed at men who perpetrate this form of violence, and Ramsay, et al. 2009 focuses on evaluating advocacy interventions for women exposed to intimate partner abuse. Specific ethical and methodological considerations are important when studying violence against women, such as those addressed in World Health Organization 2001.

    Elder Abuse and Neglect

    A formal definition of this problem, adopted by the International Network for the Prevention of Elder Abuse, states that it is the “single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (WHO). One of the least studied problems of violence is that perpetrated against older persons. The nature and conditions of these very vulnerable populations considerably increase their risk of death. Older populations can be exposed to violence and neglect within their families but also in institutions dedicated to their care. Because of other commonly existing concomitant health problems, abuse against older persons can have more negative health consequences. The US National Center on Elder Abuse provides US-based resources for communities, while Bonnie and Wallace 2003 discusses theoretical and practical approaches to the topic. Summers and Hoffman 2006 provides useful data for addressing elder abuse among healthcare personnel. World Health Organization 2008 discusses capacity-building strategies for screening elder abuse. Finally, Nerenberg 2007 reviews promising strategies and epidemiological data on elder abuse, mostly from North America.

    Sexual Violence

    This manifestation of violence can affect people of any gender and at any age. It is, however, more common among vulnerable populations such as women and children or populations who are subjected to hate crimes because of having different sexual preferences. Sexual violence can have devastating physical and psychological consequences for victims and requires specific approaches for prevention and treatment. Krug, et al. 2002 (cited under Reference Works) defines sexual violence as “any sexual act, attempt to obtain sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work.” Information about sexual violence comes from community surveys, police data, and hospital data. Available data on the percentage of women reporting exposure to sexual assault in urban settings vary by country and range from 0.3 percent of women reporting it to 8 percent. The percentage of women exposed to sexual violence by intimate partners is more frequent. Sexual violence can occur at any age and in any place. Among youth, it is common in school settings. This violence is associated with risk factors such as substance abuse, sex work, having multiple partners, and women becoming more empowered and economically independent. Sexual Violence provides a useful overview of the problem, with focus on the United States. Additionally, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 2011 addresses public health issues related to hate crimes related to homophobia, in the context of sexual health. In regard to data collection, two publications address strategies for effective collection of information: Basile and Saltzman 2009 provides tools that are recommended in the United States, while World Health Organization 2010 discusses how to develop evidence-based programs. From the perspective of tertiary care, World Health Organization 2003 is an excellent tool to learn how to assess and treat victims of sexual violence.

    Suicide Prevention

    Suicide is the most common form of violence in the world. Suicidal behavior exceeds behaviors of violence between individuals. As such, it is the largest and most important violence-related public health problem. According to the WHO, in the year 2000, 815,000 people died from suicide (a rate of 14.5 per 100,000 population). Suicide is overall more common among males, and the risk for both sexes increases as people age. There are considerable geographic variations, as shown in Wasserman and Wasserman 2009. Eastern European countries and Sri Lanka have much higher rates of suicide than other countries. The lowest rates are reported in Latin America. The methods used for suicide vary considerably and depend on the availability of means. In areas with easy access to firearms, such as the United States, use of guns is a common method. In other areas, such as in India, where firearms are less widely available, the use of poisons or toxic chemicals tends to be more common. There are multiple strategies to identify individuals at risk of suicide. Such strategies include considerations of biological, social, and behavioral characteristics. Risk factors for suicide include psychiatric conditions (i.e., major depression, bipolar disorders, and schizophrenia), biological markers such as family history, and life events including loss of loved ones or traumatic events; in younger populations, sexual orientation, and exposure to bullying because of it, have also been associated with increased risks of suicide. Daniel and Goldston 2009 focuses more on treatment interventions for youth. In addition, cultural or social conditions linked to unemployment and economic conditions, religious beliefs or lack of them, and social isolation, such as that experienced by persons with different sexual orientations, some indigenous minorities, or immigrant populations, have been linked to increased risk of suicide. For example, Bruce 2010 highlights suicide as a problem among populations of military veterans in the United States. The primary prevention of suicide is the main goal in public health, but early detection of suicidal behavior and knowledge of what to do when confronted with persons at risk of suicide is key for proper public health practice. Diekstra , et al.1995 discusses prevention strategies from several countries, while Minayo and Cavalcante 2010 addresses the same, with some implications for Brazil. Approaches include behavioral strategies, pharmacological treatments, relationship approaches, and community-based or school-based efforts. Some secondary prevention strategies for screening and controlling suicidal behavior are discussed in Kutchner and Chehil 2007. Reducing access to means, media reporting strategies, and interventions after suicides are social approaches to addressing this issue. In addition, Butchart, et al. 2008 (cited under Interpersonal) discusses strategies to estimate costs of self-inflicted violence. Despite its magnitude, suicide remains a taboo in many societies, and as a consequence it is hard to identify in some contexts.

    Collective Violence

    Despite frequent media exposure to collective violence (war and internal conflicts), this form of behavior between groups is fortunately the least common form of violence. It nevertheless carries immense consequences for the health of individuals, communities, and entire nations alike. Collective violence has multiple consequences for health that go beyond physical, sexual, and psychological injuries or neglect. Its relationship with public health is addressed extensively in Levy and Sidel 1997 and Taipale 2002. The focus on the mental health consequences is explored in greater detail in de Jong 2002. War affects populations in multiple ways that promote malnutrition and the development of other diseases, as explored in Ghobarah, et al. 2004, which addresses the epidemiological and health consequences of postconflict situations. Apart from the health consequences of war, multiple legal, ethical, and humanitarian reasons become evident when these mass events occur. The latter are explored in British Medical Association 2001. The role of public health in reducing, preventing, or mitigating the consequences of war is essential and is discussed in de Jong 2010, while Coupland 1991 addresses the classification of wounds linked to collective violence, as commonly used by the Red Cross.

    • British Medical Association. 2001. The medical profession and human rights: Handbook for a changing agenda. New York: Zed.

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      This interesting book focuses on the interactions between medical personnel and human rights abuses. It addresses issues such as abuse of institutionalized patients, the rehabilitation of torture victims, and medical involvement in armed conflicts and weapons research.

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    • Coupland, R. M. 1991. The Red Cross wound classification. 2d ed. Geneva, Switzerland: International Committee of the Red Cross.

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      This is an indispensable tool to understand the classification of wounds in armed conflicts. Useful mostly for medical personnel.

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    • de Jong, J. T. 2002. Trauma, war, and violence: Public mental health in socio-cultural context. New York: Kluwer Academic/Plenum.

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      This Dutch publication focuses on programs addressing mental health and psychosocial problems in low-income countries as well as conflict and postconflict regions. It focuses on public mental health characteristics of services.

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    • de Jong, J. T. 2010. A public health framework to translate risk factors related to political violence and war into multi-level preventive interventions. Social Science & Medicine 70.1: 71–79.

      DOI: 10.1016/j.socscimed.2009.09.044Save Citation »Export Citation »E-mail Citation »

      This manuscript explains the development of a public health framework to address these risk factors and protective factors in war. It presents a matrix that combines primary, secondary, and tertiary interventions implemented at different levels of society, family, and individuals.

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    • Ghobarah, H. A., P. Huth, and B. Russett. 2004. The post-war public health effects of civil conflict. Social Science & Medicine 59.4: 869–884.

      DOI: 10.1016/j.socscimed.2003.11.043Save Citation »Export Citation »E-mail Citation »

      Using WHO data on fatalities, broken down by age, gender, and type of disease or condition, the authors highlight the increased burden of mortality linked to civil conflict.

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    • Levy, B. S., and V. W. Sidel, eds. 1997. War and Public Health. New York: Oxford Univ. Press.

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      An excellent publication that examines the relationship between war and public health while documenting the public health consequences of war and helping professionals minimize them. In six sections and twenty-eight chapters, it addresses public health, legal, ethical, and humanitarian issues, with examples of specific armed conflicts.

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    • Taipale, I. 2002. War or health? A reader. New York: Zed.

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      This interesting compilation of seventy essays examines connections between warfare and human health, and the role of health practitioners in these settings.

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    Gun-Related Violence

    Firearm-related violence differs considerably between countries. Global data and the relationship of weapons with health are discussed in World Health Organization 2001. More extensive evaluations and assessments of the multiple political, health, legal, human rights, and economic problems linked to armed violence are discussed in a series of publications in the Small Arms Survey Yearbooks. Typically, countries where firearms are more readily available present higher rates of violence linked to them. In countries with less availability of firearms, populations tend to perpetrate violence with other weapons such as knives. A country example where there is wide availability of guns (the United States) is discussed in Diaz 1999, which highlights some of the health implications of firearm violence for the United States, and Wellford, et al. 2004 also discusses the situation of armed violence in this setting. In countries where guns and more lethal weapons tend to be scarcer, such as in the United Kingdom, other weapons such as knives are more commonly used, as highlighted in Hern 2005. Firearms, small arms, and light weapons are easy to transport and to use and unfortunately are quite lethal. Multiple legislative, regulatory, behavioral, and engineering approaches have been used to prevent or control firearm-related violence, and epidemiological and public health concepts have been useful in understanding the problem and evaluating preventative interventions, as addressed in Kellermann, et al. 1991. In some countries, such as the United States, legal challenges and political agendas and frameworks have modulated public health efforts, funding opportunities, and research activities.

    Violence Related to Alcohol and Other Substances

    Alcohol consumption and abuse is a common risk factor associated with most forms of violence. According to Cherpitel, et al. 2009, alcohol is responsible for approximately 2.3 million premature deaths worldwide every year. Intentional and unintentional injuries account for more than a third of the burden of disease attributable to alcohol consumption. Alcohol consumption varies considerably by country and is modulated by social, legal, and religious approaches. World Health Organization 2004 highlights the magnitude of the problem worldwide and specifically addresses health consequences including violence and violence-related problems. Based on information from ten countries and with a gender perspective, Obot and Room 2005 discusses alcohol-related violence. Violence related to alcohol can be expressed in community settings, institutional settings, the workplace, the home, and schools. It can also lead to engaging in other behaviors such as use of firearms, engaging in sexual violence, or in spousal or child abuse. Alcohol abuse can be controlled and treated in a variety of settings and by means of primary prevention strategies (i.e., avoiding exposures to alcohol), secondary prevention (i.e., control and treatment of consequences), and tertiary prevention (i.e., long-term treatment and rehabilitation for abuse and addiction). Consumption of alcohol and abuse or commercialization of other substances such as illicit drugs are associated with increased youth violence, such as that occurring due to gang activities, or to large-scale levels of violence in society, such as that seen during the first decade of the 21st century in urban areas of Colombia, Mexico, and Brazil, or during the 1990s in the United States. These forms of violence typically are accompanied by increased use of guns, as described in Blumstein 1995. A description of trends in drug-related violence in Mexico provides a useful example of the association between illicit markets and violence perpetration, as described in Ríos and Shirk 2011. Prevention of these larger and more complex forms of violence needs to be approached with comprehensive policies aimed at addressing wider social issues such as employment opportunities for youth, economic inequalities, and government efficiency and corruption, as well as with judicial and policing strategies.

    Workplace Violence

    This key issue is relevant for every type of workplace setting. Violence in the workplace occurs in every country, and proper institutional, social, legal, and individual strategies are available to prevent, control, or deal with violence in the workplace. There are multiple guidelines on how to address the problem. A great amount of work on this issue has been conducted by the International Labour Office of the United Nations (Chappell and Di Martino 2000). Specific focus has been made on health workers who are commonly exposed to violent events, as is the case in International Labour Office, et al. 2002. US research on this topic has been developed mostly in National Institute for Occupational Safety and Health 2006. Philpott and Grimme 2009 provides additional evidence of strategies for the prevention of workplace violence. Other approaches have focused more on modifications of the environment, such as in the case of Crime Prevention Through Environmental Design (CPTED), a strategy that has shown promise in community and workplace settings and that is highlighted in Cozens, et al. 2005.

    LAST MODIFIED: 05/23/2012

    DOI: 10.1093/OBO/9780199756797-0026

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