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Grassroots responses to violence against women and girls in post-earthquake Nepal: Lessons from the field
Kay Standing, Sara Parker, Sapana Bista
Gender & Development, Volume 24, Issue 2, 2016 Special Issue: Violence Against Women and Girls, pages 187-204, 2016.
Abstract: Violence against women and girls (VAWG), including sexual violence, can increase after natural disasters. This article provides evidence from Nepal, a country where progress has been made on gender equality but VAWG remains an endemic problem. Research since the earthquakes involving women activists and non-government organisations indicates the continuing challenges facing disaster response efforts to prevent VAWG and protect women. Women and girls in camps and temporary shelters feel threatened and insecure due to the risk of violence and lack of privacy. Humanitarian aid, health care, and disaster responses can challenge VAWG, and offer safe spaces for women and girls to be established. This article draws on the views of grassroots women’s activists in Nepal and shares lessons for development and humanitarian workers about steps to be taken to challenge and minimise VAWG in emergency situations.
Global development and diffusion of outcome evaluation research for interpersonal and self-directed violence prevention from 2007 to 2013: A systematic review
Professor Karen Hughes, Professor Mark Bellis, Katie Hardcastle, Alexander Butchart, Linda Dahlberg, James Mercy, Christopher Mikton
Aggression and Violent Behavior, Early online, In press, 2014.
Abstract: Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.
Incidents of harm in European drinking environments and relationships with venue and customer characteristics
Dr Zara Quigg, Professor Karen Hughes, Professor Mark Bellis, Ninette van Hasselt, Amador Calafat, Matej Kosir, Mariangels Duch, Montse Juan, Lotte Voorham, Ferry Goossens
The International Journal Of Alcohol And Drug Research, August 2014.
Abstract: Aim: Research shows there are associations between bar environments and alcohol-related harms. However, few European studies have examined such links. Our study investigates the type of harms experienced by patrons in European bars, and their relationships with individual, social and environmental factors. Design: Unobtrusive one-hour observational visits. Characteristics of the bar environment, staff and patrons, and harms observed were recorded on structured schedules. Setting: Bars in four cities in the Netherlands, Slovenia, Spain and the United Kingdom (U.K.). Participants: 238 observations across 60 bars. Measures: Analyses utilized chi-squared, analyses of variance and logistic regression. Findings: 114 incidents of harm were observed; in one-fifth of visits, at least one incident was recorded. People falling over, arguing or being so severely intoxicated that they required assistance to walk were the most common incidents observed. Bivariate analyses showed associations between a range of staffing, customer and environmental characteristics, and incidents of harm. Controlling for city and venue, only a permissive environment remained significant in multivariate analyses. Conclusions: Harms occurring in nightlife venues are typically minor. However, such incidents have the potential to escalate into more serious harms; thus, prevention is crucial. Prevention should focus on improving venue management practice and on the behavioral standards expected of customers.
Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in the European Region
Professor Mark Bellis, Professor Karen Hughes, Nicola Leckenby, Lisa Jones, Adriana Baban, Margarita Kachaeva, Robertas Povilaitis, Iveta Pudule, Gentiana Qirjako, Betul Ulukol, Marija Raleva, Natasa Terzic
Bulletin of the World Health Organization, Online first format, 2014.
Abstract: Objective To evaluate the association between adverse childhood experiences – e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration – and the health of young adults in the eastern European Region. Methods: Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10’696 respondents – 59.7% female – aged 18–25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings: Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval (CI): 1.32–2.15) – for physical inactivity – to 48.53 (95% CI: 31.98–76.65) – for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion: Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in the eastern European Region.
Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies.
The Lancet, 379, 1621-1629, 2012, doi:10.1016/S0410-6736(11)61851-5..
Abstract: Background: About 15% of adults worldwide have a disability. These individuals are frequently reported to be at increased risk of violence, yet quantitative syntheses of studies of this issue are scarce. We aimed to quantify violence against adults with disabilities. Methods: In this systematic review and meta-analysis, we searched 12 electronic databases to identify primary research studies published between Jan 1, 1990, and Aug 17, 2010, reporting prevalence estimates of violence against adults (aged mainly ≥18 years) with disabilities, or their risk of violence compared with non-disabled adults. We included only studies reporting violence occurring within the 12 months before the study. We assessed studies with six core quality criteria, and pooled data for analysis. Findings: Of 10 663 references initially identified, 26 were eligible for inclusion, with data for 21 557 individuals with disabilities. 21 studies provided data suitable for meta-analysis of prevalence of violence, and ten for meta-analysis of risks of violence. Pooled prevalence of any (physical, sexual, or intimate partner) recent violence was 24·3% (95% CI 18·3—31·0) in people with mental illnesses, 6·1% (2·5—11·1) in those with intellectual impairments, and 3·2% (2·5—4·1) in those with non-specific impairments. We identified substantial heterogeneity in most prevalence estimates (I2 >75%). We noted large uncertainty around pooled risk estimates. Pooled crude odds ratios for the risk of violence in disabled compared with non-disabled individuals were 1·50 (95% CI 1·09—2·05) for all studies combined, 1·31 (0·93—1·84) for people with non-specific impairments, 1·60 (1·05—2·45) for people with intellectual impairments, and 3·86 (0·91—16·43) for those with mental illnesses. Interpretation: Adults with disabilities are at a higher risk of violence than are non-disabled adults, and those with mental illnesses could be particularly vulnerable. However, available studies have methodological weaknesses and gaps exist in the types of disability and violence they address. Robust studies are absent for most regions of the world, particularly low-income and middle-income countries. Funding: WHO Department of Violence and Injury Prevention and Disability.
Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms
Dr Zara Quigg, Professor Karen Hughes, Professor Mark Bellis
Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention 18(5), 315-20, 2012.
Abstract: Objective: To examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms. Methods: 6-year (2004-2010) exploratory study analysing injury attendances to one ED in the North West of England using descriptive and trend analyses. Results: Over the 6-year period, there were 242,796 ED injury attendances, including 21,683 for intentional injuries. Compared with unintentional injury patients, intentional injury patients were more likely to be men, aged 18-34 years, live in the most deprived communities, have attended the ED at night/weekends, have been injured in a public place and have consumed alcohol prior to the injury. Detailed data collected on alcohol and violence-related ED attendances were shared with local partners to monitor local trends and inform prevention activity including targeted policing and licensing enforcement. Over the 6-year period, intentional ED injury attendances decreased by 35.6% and alcohol-related assault attendances decreased by 30.3%. CONCLUSIONS: The collection of additional ED data on assault details and alcohol use prior to injury, and its integration into multi-agency policy and practice, played an important role in driving local violence prevention activity. Further research is needed to assess the direct contribution ED data sharing makes to reductions in violence.
Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services
Professor Mark Bellis, Nicola Leckenby, Professor Karen Hughes, Chris Luke, Sacha Wyke, Dr Zara Quigg
BMC Public Health 12, 746, 2012.
Abstract: Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.
Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies
Lancet, 380, 899-907, 2012.
Abstract: Background: Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities. Methods: For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities. Findings: 17 studies were selected from 10 663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8—42·1) for combined violence measures, 20·4% (13·4—28·5) for physical violence, and 13·7% (9·2—18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56—5·29) for combined violence measures, 3·56 (2·80—4·52) for physical violence, and 2·88 (2·24—3·69) for sexual violence. Huge heterogeneity was identified across most estimates (I2>75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies. Interpretation: The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed. Funding: WHO Department of Violence and Injury Prevention and Disability.
National five-year examination of inequalities and trends in emergency hospital admission for violence across England.
Professor Mark Bellis, Professor Karen Hughes, Sara Wood, Sacha Wyke, Clare Perkins
Journal of Injury Prevention, 03/2011; 17(5):319-25..
Abstract: Objectives: To examine relationships between violence, age (0–74 years), and deprivation, and to explore in which communities, age groups, and gender the potential for transmission of violent tendencies between individuals is greatest. Methods: Five year (2004/2005 to 2008/2009) ecological study of emergency admissions resulting from violence (n=170 074) into all English hospitals using trend and logistic regression analyses. Results: Hospital admissions for violence peak as individuals achieve legal adulthood (18 years). Risks of admission increase exponentially with increasing quintile of deprivation of residence, with odds overall being 5.5 times higher in the poorest quintile compared with the richest. The greatest absolute difference in violence admissions by deprivation quintile is seen in males aged 18 (218/100 000, richest; 698/100 000, poorest). However, the highest deprivation rate ratios (quintile 5:1) are seen at ages 0–10 years in both sexes and at all ages after 40 years in males (40–58 years, females). In males aged 17–19 years, violence accounts for 20% of the entire gap between wealthiest and poorest quintiles in all cause emergency hospital admissions. Conclusions: Analyses identify four lifetime periods for violence: up to 10 years (prepubescent), 11–20 years (adolescence), 21–45 years (younger adults), and over 45 years (older adults). While violence is most common in adolescence, its concentration in poorer areas during prepubescence and in younger adulthood (parenting age) suggests that poorer children are exposed to much more aggressive communities. This is likely to contribute to the disproportionate escalation in violence they experience during adolescence. Effective interventions to prevent such escalations are available and need to be implemented particularly in poor communities.
Nightlife Violence: A Gender-Specific View on Risk Factors for Violence in Nightlife Settings: A Cross-Sectional Study in Nine European Countries
Susanne Schnitzer, Professor Mark Bellis, Dr Zara Quigg, Professor Karen Hughes, Amador Calafat, Montse Juan, Anna Kokkevi
Journal of Interpersonal Violence. 25(6):, 1094-1112, 2010.
Abstract: Within nightlife settings, youth violence places large burdens on both nightlife users and wider society. Internationally, research has identified risk factors for nightlife violence. However, few empirical studies have assessed differences in risk factors between genders. Here, a pan-European cross-sectional survey of 1,341 nightlife users aged 16 to 35 assessed a variety of risk-taking traits, including violence, sexual, alcohol, and drug-related current and historic behaviors. Results show that the likelihood of having been involved in a physical fight in nightlife increases with younger age, drunkenness, and increasing preference for tolerant venues for both genders. The odds of involvement in a fight for females who were drunk five or more times in the past 4 weeks were almost five times higher than those who were never drunk (odds ratio for males 1.99). Use of cocaine more than doubled the risk of involvement in violence among males. However, no association was found for females. For heterosexual men, the odds for violence almost doubled compared with bisexual or homosexual men, whereas for women heterosexuality was a protective factor. The effects of structural risk factors (e.g., bar and club characteristics) for nightlife violence differed by gender. To develop effective violence prevention measures in nightlife, considerations need to be made regarding the demographic composition of patrons in addition to wider structural elements within the night-time environment.