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Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6.

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Contagion of Violence: Workshop Summary.

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4The Role of Contextual Factors in the Contagion of Violence


For violence to infect, certain individual, social, and environmental factors must be present. The previous chapter explored some of the individual and social mechanisms that might explain the contagion of violence. This chapter explores some of the contextual factors that might moderate the contagion. The individual and group mechanisms that provide the pathway from observation to perpetration of violence can be mediated by a number of additional elements; such a constellation of factors and circumstances vary from individual to individual and from population to population, and vary across types and modes of violence.

In the fourth session of the workshop, mediators and cofactors that affect risk of and resilience to the spread of violence were discussed. Speakers in this session highlighted some factors that create the synergistic formula that enables the infectivity of violence across cultures, groups, and types of violence. To be susceptible or immune to violence, the “right” constellation of factors need to be present or absent. This chapter focuses on such factors with respect to systems and practices that contribute to the exacerbation, reduction, or prevention of violence, leveraging the classic epidemiologic model of infectious disease: spread, susceptibility, and immunity.


Most relevant to this concept of the contagious nature of violence is the vulnerability or susceptibility of individuals and communities to violence and to the transmission of violence. There are important contextual factors within communities, such as who are marginalized or culturally isolated and who have normalized violence, and certain risk factors that accompany violence, such as alcohol and drugs. The speakers used contextual factors to frame the discussion of violence within the contagion framework.


Many speakers noted that place can have adverse impacts on health. The context in which violence occurs determines proximity to exposure, and how often a person is exposed (similar to dose). The place in which violence occurs also influences whether an individual sees violence as a “normal” response, whether they have resources that could counter violence, and whether they have opportunities to respond without violence.

Speaker Barry Krisberg of the University of California, Berkeley, School of Law spoke about place in terms of the experience of prison that “produces a whole series of dysfunctional, psychological developments.” He showed two photographs of a California treatment facility, stating, “The youth who stays in this facility has committed a violent crime, and he spends 21 hours a day in this room, getting all kinds of cognitive behavioral therapy, but this is his life. When he is fortunate enough to get out, for an hour or so, he gets to exercise in this, which is described euphemistically as his program area. … This is fairly typical. In fact, unless you live in the state of Missouri, your facilities look pretty much this way.”

Dr. Krisberg noted that many believe that if we make prison so horrible, people will avoid committing violence to stay out of these places. In addition, taking offenders “out of circulation,” or incapacitation, means that they are not “on the street” committing crime. On the contrary, Dr. Krisberg stated, prisons and juvenile facilities exacerbate and spread violence. They are much more violent than the general community, and the perpetrators of violence in prison are both staff and inmates. Much of the violence in prison is related to gangs, and the experience of being a victim increases the risk of joining a gang, which further cements these gang structures (Wolff and Shi, 2009). Dr. Krisberg went on to comment that who actually commits violence in prison is not clear. It is not necessarily true that those who commit violence outside prison are those who are most violent in prison. However, those with histories of assault and robbery (though not homicide) are at increased risk of perpetration of violence while incarcerated.

In terms of the psychological effects of incarceration, Dr. Krisberg brought up the previously hypothesized idea of “prisonization” or institutionalization, in which one adapts or develops an inmate culture or ideal. This has changed slightly, Dr. Krisberg stated, but in general, “prisons promulgate a view of the world, and inmates are expected to adopt that view of the world. It is not a view of the world that is particularly helpful if you are trying to live a successful, peaceful life.”

Another important element of place is transition across places—such as community to prison and then back to the community. Dr. Krisberg noted that 700,000 people exit American prisons every year. Of those, 93 percent return home, most of them within 3 years (West, 2008). Within 3 years, 67 percent of returning prisoners were rearrested for serious offenses, and 52 percent were returned to prison for new criminal offenses (Langan and Levin, 2002), though homicide and sexual offenders had the lowest rates of recidivism. However, released prisoners in general commit a lot of crime in the community. A 1990 study by the Department of Justice shows that released prisoners have a homicide rate 53 times that of the general population. Dr. Krisberg urged that further research on the dynamics of prisons was warranted, to understand how they might exacerbate the spread of violence, versus serving as “deterrent mechanisms.”

Another layer of the complexity of place as a contextual factor is the aging population of prisoners. Dr. Krisberg mentioned that a large percentage of prisoners are older adults—approximately 30 to 40 percent of prisoners are over age 55—and there is some suggestion that older inmates are victimized by younger ones. If violence and exploitation are central to the institution, vulnerable populations, such as older inmates, may suffer disproportionately, especially as their faculties deteriorate.

Dr. Krisberg also spoke of place in terms of juvenile justice facilities. There are studies focused on juvenile facilities suggesting that 45 to 72 percent of youth released from juvenile facilities are committing new crimes. He also stated that there is a strong body of research that indicates that placing low-level juvenile offenders in correctional facilities (versus leaving them in the community) increases recidivism and school failure, among other measures. Incarceration for youth traditionally is viewed as a social work intervention, especially in the context of bad living situations or neighborhood and family environments. But research in Florida and other places show that incarceration for youth increases risk of violence and other adverse outcomes, mainly due to peer influences (Baglivio, 2007).

Dr. Krisberg used an example to illustrate the role of place with respect to the contagion of violence. He commented on a study performed 40 years ago by Phillip Zombardo of Stanford University in which a group of Stanford students were randomly assigned, with some students as inmates and some as guards. A dormitory was converted into a mock prison. Within 3 days, the experiment was halted because several of the Stanford students who were assigned to be inmates were showing serious mental health symptoms, some as serious as psychosis. The Stanford students who were the guards were manifesting vicious, violent, and assaultive behavior against the so-called inmates. Dr. Krisberg stated, “Here are well-educated, upper class, primarily white students, who were put in the crudest form of role playing around prisons. Yet, it immediately [and] dramatically increased the level of violence, both [among] the students [who played the role of prisoners] and the ones who played the role of guards.”

Another example of contagion is clear with the growing body of research indicating that people leave prison with potential for increased rates of partner violence and child abuse. Speaker Deborah Gorman-Smith of Chapin Hall at the University of Chicago stated that “we see the contagion passing onto the next generation. As prisoners coming out take out this anger and frustration on their family members, it creates the breeding ground for an intergenerational transfer of violence” (White et al., 2002; Oliver and Hairston, 2008). Dr. Gorman-Smith applauded the fact that there is currently one of the most dramatic decarcerations in American history, as the rate of juvenile incarceration decreases, and there is a national trend to close juvenile justice facilities.

Another important consideration of place that Speaker Fariyal Ross-Sheriff of Howard University mentioned is the role of migration and displacement. Dr. Ross-Sheriff discussed violence during preuprooting, uprooting, and transition stages, and she spoke of the stages that are considered safe and protective factors and contribute to resilience.

In terms of the stages of migration, Dr. Ross-Sheriff spoke of the most difficult time as the preuprooting stage, which is considered to be between 1 year and 6 weeks before a person or group decides to leave. She then spoke of the transition stage, such as in refugee camps and countries of first asylum. She stated that despite the effort on the part of the first country of asylum to provide support, resettlement only tends to occur in the second country of asylum. In terms of intervention opportunities, Dr. Ross-Sheriff stated that “resettlement and adaptation in host societies are the times when we can provide services, when we can make differences.”

But, violence is often committed by many groups who are charged with protecting refugees, including soldiers, police, and others, such as administrators, camp staff, and other refugees. “Violence occurs for many, many women who are trying to deal with their day-to-day survival and livelihood, just for getting food, for trying to bring water, to get fuel.” Violence can also occur within the home, “if the spouse or the family finds out that the woman has been raped, then she is used property. She goes through now more problems at home.”


Another important contextual factor is poverty, especially with respect to marginalized and impoverished communities. Poverty, as a conduit of such things as hopelessness, economic repression, fear, lack of resources, and isolation, create an ideal breeding ground for the promulgation of violence. For example, Dr. Iris PrettyPaint of Native Aspirations commented that Native Americans do not understand what is meant by “recession” because, for them, it is the norm, sometimes experiencing well over 40 percent unemployment. She also commented that Native Americans are wards of the government, which creates economic dependency. She stated that needing to depend on someone else can be devastating to people.

Culture and Cultural Context

Dr. PrettyPaint summarized the importance of embracing culture in this work, saying “When the cultural context comes into your work … it is going to be very natural for you to create things that are beneficial to any culture of people. But you leave out one of them, and you run the risk of people being confused.” Dr. PrettyPaint emphasized that culture confers certain worldviews and norms that need to be heeded.

For example, Native people, especially the elders, view violence as rooted in their own cultural constructs and language of what violence means and represents, and how it impacts their communities. Dr. PrettyPaint stated that when asking Native elders to reflect on violence as contagious they stated that violence was “dangerous … we need to find the medicine to heal someone from this [contagion of violence] or protect them from it.” She further noted, “if you communicate that [violence] is incurable, that is not something that I think is in their worldview. [Native elders] don't believe that; they think there is something somewhere that they can find [to heal it].”

When cultural practices and traditions are removed from the environment of communities and individuals, then violence has a greater chance of causing infection. With respect to Native children, Dr. PrettyPaint emphasized that a journey of forced assimilation creates an environment that helps nurture violence in them. She stated, “these children have lost their ability to know who they are, and they have multiple identities.” When children are removed from their culture, they lose their place or context. Dr. PrettyPaint emphasized the importance of examining the integrity of cultural practices for violence prevention. “Today, we have young people that are relearning how to speak their language. We have tribes that are rewriting their constitutions to open up an enrollment process so that all children living in their community can be enrolled and eligible for health care [and] education.” Thus, this connection to culture and cultural practices helps create a place or meaningful connection of an individual to a greater whole. Such connection creates an environment in which there can be reduced transmission of violence.

Historical Oppression and Trauma

Dr. PrettyPaint further spoke about historical trauma in the context of the contagion of violence, noting that historical trauma creates a cumulative emotional, psychological, and physical insult on individuals and communities and increases one's vulnerability to violence. The perspective of historical trauma is critical to understanding the ability of violence to infect susceptible individuals who have experienced such trauma. She stated, “I have come to recognize … that we have internalized the oppression and discrimination, and we have allotted lateral violence. We don't have to worry about somebody from the outside hurting us; we hurt each other.”

The historical oppression of Native American people, which has been well documented, has created an environment that decreases freedoms and increases confinement, which increases the infectivity or propensity for violence. For example, Dr. PrettyPaint spoke about the lack of sovereignty:

colonization is real, it is still alive today, and it is something that, if you haven't experienced, then it is very hard to feel it…. And when you don't think someone is human, then it is easy to dehumanize people. And when you do that, what you do is a form of violence, because you take away the ability for someone to speak. We know that in our way of life, the language is the key that unlocks the foundation to our worldview. Without language, you will be challenged to find meaning. You will be challenged to understand what it feels like.

Race and Racism

Dr. Ross-Sheriff mentioned the importance of intersectionality and related theories as being important to achieve a more comprehensive and balanced understanding of susceptibility to violence. “It is the intersectionality of race, gender, nationality, religion, poverty, and status of marginalization that make a difference … and I don't mean to say racism from the whites. Racism in Kenya can come from blacks against blacks; [e.g.,] in South Africa, the whole issue of South Africans perpetrating violence against African refugees from other places.”

Racism as an act of oppression can deter resilience and immunity. There are crosscutting areas of oppression that are integral to understanding the contagion of violence. Speaker Carl Bell of Community Mental Health Council in Chicago discussed how marginalization of African American males by the U.S. criminal justice system (which reduces their ability to become resilient to or immune to violence) exacerbates their susceptibility to violence.


Dr. Gorman-Smith commented on gender and its relation to family and disruption, noting that 92 percent of incarcerated parents are men, and the number is growing. She stated that there is a lot of attention to reentry programs, but that most of those programs are focused on work and education. Dr. Gorman-Smith also noted that there are almost no programs and no single evidence-based intervention focused on helping men reenter their families as they come back from prison. Some data show that assuming an active fathering role relates to more successful reentry given that active fathering reduces depression, increases employment stability, and relates to decreased recidivism.

Dr. Ross-Sheriff spoke of resilience among migrant women who are highly impacted by violence, and out of the approximate 15–20 million global refugees (not including internally displaced people) per year, 80 percent of the refugees in refugee camps are women and children. Dr. Ross-Sheriff stated that these women and children experience physical, sexual, and emotional violence in camps, in outside spaces, and within their homes.

Mental Illness and Disabilities

Dr. Krisberg commented on the presence of mental illness and disabilities with respect to increasing an individual's susceptibility to violence. He stated that victims of violence in prisons are highly likely to be mentally ill or have cognitive or physical disabilities. Such disabilities can add increased stress and trauma in an already violent environment.


Dr. Gorman-Smith spoke about social and structural moderators with respect to the role of family and positive parenting. She stated that families are central to understanding violence and the contagion. Dr. Gorman-Smith listed important aspects of parenting and family functioning that can increase susceptibility to violence, aggression in youth, family and intimate partner violence, and child abuse and neglect. These include various aspects of parenting practices such as harsh or coercive discipline over the course of the child's life, hostility within the family, conflict, absence of warmth or connection among family members, disruptions, family instability, having multiple partners, chaos, and multiple moves.

Dr. PrettyPaint commented on the ecological levels of family and the community as being interconnected, and thus each level influences the other. It is important, she noted, that in thinking about family, one is also thinking about community. Dr. Gorman-Smith concurred and spoke about the varying developmental spectrum of influence of families on child development, which impacts what course of action families need to take in relation to important contextual changes. She noted that it is not the case that all dysfunctional families are in violent neighborhoods, and all functional families are in safe neighborhoods, but instead types of families are more or less evenly spread across types of communities. While context plays an important role, optimally, she stated that there is a combination of parenting practices and family relationship characteristics that include emotional warmth and connection, good organizational structure, strong support belief for the families, good discipline practices, and monitoring where children are; these characteristics are important regardless of setting. But parents are also managing peers and schools, interacting with others in the neighborhood, and often dealing with issues caused by concentrated poverty and a poorly built environment. Even optimal parenting might not reduce a child's exposure to violence, so approaches to building resiliency might be required.

Forum member XinQi Dong of the Rush University Medical Center in Chicago added another dimension to the discussion of family by noting that often families, including grandparents, take on larger roles if one or more parent is missing. He questioned the impact on the grandparents: whether the stress of stepping back into the parental role might increase their own vulnerability to family violence (or suicide), and how the contagion of violence might apply to the spread of violence within the family to include elder abuse. Dr. PrettyPaint noted that in Native American communities, grandparents are often forced into the role of caring for young children, even as they age and become vulnerable themselves. Dr. Ross-Sheriff reflected that in Asian populations, elderly people experience abuse and neglect because of intergenerational conflicts, often exacerbated by the involuntary caring of grandchildren or by the inability to live independently of their own children.


In this infectious disease framework, resilience to violence can be thought of as immunity. Within immunity and resilience, concepts of culture, place, religion, family, and the law play a role.

The Role of Culture in Building Resilience

Dr. Bell spoke about resilience with an example of South Asians in Durban, South Africa, where they are protected by their culture, which engages them in social and emotional skills and monitoring their children. He noted a similar mechanism with children of immigrants who lost the protective factors that social fabric conveys. He noted his work with the Illinois Department of Children and Family Services, which showed that when children who are victimized by violence are taught social-emotional skills and affect regulation, as well as life skills and hard work experience as positive motivation, traumatic symptoms are reduced. However, Dr. Bell also cautioned that “culture does protect, but culture also destroys,” in noting how black males face disproportionately higher rates of incarceration than white males because of a propensity to closer living arrangements.

Dr. PrettyPaint spoke of “miracle survivors,” noting that resilience is not necessarily taught, but can be emergent in the proper nurturing environment. The strength of Native storytelling is that it allows survivors to teach the lessons learned from violent experiences and relate them to the traditional healing practices (including song, dance, and traditional ceremonies) that exist in the culture. She described a successful Native American—focused intervention, called Native Aspirations, in Spokane, Washington. Native Aspirations empowers youth in the community with a sense of belonging and identity by providing training and technical assistance to enhance sustainable violence prevention. The program operates from the understanding that overcoming oppression is a first step toward empowerment, and imbues individuals and communities with a sense of planning and forward direction. Dr. PrettyPaint emphasized that there is not a one-size-fits-all approach and that it is possible to give data and a model to various communities, but the communities themselves need to reconstruct the program to fit the community.

Dr. Krisberg concurred that cultural context is very important when considering the contagion of violence and violence prevention programs. He emphasized the growing U.S. Latino population that is incarcerated, and noted that little research covers Latino communities and that most evidence-based programming has little understanding of cultural context.

The Role of Family in Building Resilience

Dr. Gorman-Smith highlighted family as being protective and promotive. She stated that when trying to change community-level contextual factors, it is important to also support families. Examples raised of changing context include Cure Violence (formerly known as CeaseFire) and Communities that Care, which help support the larger social environment, while working to change family functioning. Examples of impact on families include Dr. Gorman-Smith's intervention, Schools and Families Educating Children, which is an intervention delivered to all children in a neighborhood. It is delivered during first grade and uses multiple family groups, focused on issues such as discipline and monitoring, but within the context of managing the ecological niche of the neighborhoods where they live. She noted data that show an effect on the developmental trajectory through the change in parenting. She also described how the program has evidence of improved academic performance, particularly because of an emphasis of linking families and schools. The second family-level intervention she used was from the multisite study of GREAT Schools and Families. This family-focused intervention not only found effects on the aggressive kids, but also on ecological effects at the school level, with increasing divergence over time.

Forum member Clare Anderson of the Administration on Children, Youth and Families noted that a number of interventions exist for children who have experienced violence and trauma, especially to increase self-regulation, augment self-control, and create different scripts for viewing the world—and such interventions need greater uptake. The majority of these interventions include parenting elements, as well as the creation of nurturing environments.

Place/Setting as Protective

In addition to being potentially harmful, place can also be protective. Dr. Ross-Sheriff spoke of protective factors and spaces, noting that the safe spaces for refugee women are health clinics and schools, which are venues for education or training, connecting with others of shared experience, and even healing. Another protective space in terms of first countries of asylum is at houses of worship and religious community gatherings, with women who have similar experiences. After resettlement, houses of worship, social workers, and resettlement program leaders can also be helpful.

Dr. Krisberg noted changes in operations of juvenile facilities in states such as Missouri, where the intention is to create small communities where nonviolence is the norm, and life is as “normal” as possible. Some facilities are also exploring the effectiveness of having the youth create their own rules and abide by them, creating a more empowering inclusive dynamic, instead of “us versus them,” and separating the youth from the violent subculture of prisons.

The Role of Law

Laws play a role in how violence is dealt with in settings such as prisons and thus create or do not create rules that protect susceptible persons. Dr. Krisberg mentioned the U.S. Prison Rape Elimination Act and the Civil Rights of Institutionalized Persons Act as examples of such laws, and also noted that the Americans with Disabilities Act is probably the single most important piece of legislation used to challenge these situations. Dr. PrettyPaint noted the complex role that jurisdiction plays in Native populations, especially because many issues of violence and crime are addressed at federal levels. She also cautioned that while laws are useful (e.g., elder justice and laws that protect elders from abuse), more work is still needed to create safe spaces for survivors to talk about the violence and trauma.

Connectedness and Community

Dr. Bell spoke of connecting youth and giving them “connectedness”; to this end, schools have a huge role as protective factors in terms of building resilience and immunity to violence. Another protective factor is the community. The importance of building and enhancing community and breaking down institutional racism within the police force and justice system are essential. He also emphasized the need to elevate the moral authority of communities, and the need to consider the negative and positive consequences on violence of the Internet and social media. While the negatives might include cyberbullying, he argued that the Internet provides opportunities to have relationships and engage in activities off the street. Dr. Ross-Sheriff agreed that technology such as mobile phones can play an important role, especially in connecting women with other female family members who might live elsewhere. Dr. Gorman-Smith noted that for children who lack warm, supportive environments at home, the collective efficacy of a stable community could promote resilience in the face of exposure to violence.


To move toward policy and practice being informed by research, the workshop speakers cited opportunities to focus future research. Forum and planning committee member Evelyn Tomaszewski of the National Association of Social Workers emphasized the importance of connecting context to the research. Dr. Krisberg stated that the variable of incarceration, including its duration and intensity, should be incorporated into longitudinal research. Dr. Gorman-Smith also emphasized examination of middle childhood in terms of optimal interventions that work to reduce risk of violence and prevention. Dr. Ross-Sheriff stated that three types of research are needed: (1) policy research in refugee camps and with refugee populations; (2) research on the second generation, specifically, those within the United States who are resettled refugees; and (3) examination of practice evidence. Dr. PrettyPaint commented that more research should incorporate evidence- and culture-based research, both qualitative and quantitative, and that indigenous researchers should be used. Dr. Ross-Sheriff concurred, and also noted it is important for future research to move from qualitative to mixed-methods research. Forum co-chair Mark Rosenberg of the Task Force for Global Health posed important questions that remain to be answered: “We talked about the notion of immunization. Are there some times when exposure to violence will protect people? When does it not protect, but when does it produce a disease, and what is the length of protection? Is there anything such as lifelong immunity? We talked about herd immunity, can it really be produced in the area of violence?”

Theresa Kilbane from the United Nations Children's Fund (UNICEF) raised the issue of experience in building the evidence base for these interventions internationally. Dr. Gorman-Smith responded that dissemination and implementation work needs to be done with current interventions and moving them to a different context. She also emphasized that there are opportunities for natural experiments with policies that are already existent in communities, and to consider different types of outcome measures.

In taking into account the public health approach using a context-informed, ecological model that leverages the framework of infectious disease to apply to the contagion of violence, a delineation of social and structural moderators and cofactors should be considered when thinking about the exacerbation, reduction, prevention, or transmission of violence. Context and the intersectionality of contexts play a strong role in this, as does culture, race, gender, politics, historical oppression, and trauma.

Key Message Raised by Individual Speakers

  • Moderators of the contagion of violence have influence in multiple spheres of the ecological framework; they also can move from level to level (Gorman-Smith, PrettyPaint).
  • Resilience requires attention to holistic, contextual experiences (Bell, PrettyPaint, Ross-Sheriff).
  • Contextual factors have the potential for both mitigating and exacerbating the spread of violence (Bell, Gorman-Smith, Krisberg, Tomaszewski).
  • Culture is a factor that can either mitigate or exacerbate the spread of violence, and influences the effectiveness of interventions (Bell, Krisberg, PrettyPaint).


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Copyright 2013 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK207256


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