Investigating links between adverse and protective childhood contexts and violence later in life: Analysis of cohort data in England, Brazil & Uganda

每年有10多亿儿童遭受身体、性或情感暴力，暴力方面的社会不平等现象很严重。儿童生活、学习和玩耍的环境可以塑造他们的健康、就业和教育结果。该项目将产生新的证据，说明不利和保护性的童年环境如何影响儿童在成长过程中使用或经历人际暴力。我们建议在巴西(从出生到儿童后期)、英国(从出生到成年)和乌干达(从儿童到成年)的三项独立队列研究中，利用关于儿童生活的高质量纵向数据，包括暴力经历。我们的多国研究团队由社会流行病学家和社会科学家组成，他们与每个队列研究的背景有很强的联系。为了确保分析和结果得到广泛的专业知识和经验，我们将在每个研究环境中咨询当地利益相关者(年轻人、民间社会组织、卫生工作者和当地政府工作人员)，并在研究设计和传播过程中咨询来自不同学科的研究人员。世界卫生组织(WHO)的INSPIRE框架建议改变法律、社会规范、社会安全网、邻里环境、家庭和学校，以防止人际暴力。为了推进这种预防努力，暴力研究人员和实践者需要知道童年背景如何塑造未来生活中的暴力，以及背景如何中断或防止未来生活中的暴力。此外，我们需要了解环境对被边缘化的年轻人是否有不同的不利或保护作用。该项目的第一阶段将定义并实施环境措施：我们的理论是，不利的童年环境是家庭、学校和有暴力和剥夺的社区，而保护性的童年环境是高度的社会联系和支持。我们将使用收集的有关背景的数据来实施针对每个队列的背景措施，并根据当地利益相关者、年轻人和研究人员在每个背景下的投入来改进措施。这一阶段的结果将突出新的机会，应用先进的统计方法来改进暴力研究中衡量和界定背景的方式。第二阶段将测试不利的童年环境是否会增加以后生活中的暴力风险，以及保护性的童年环境是否可以减轻这种风险。我们的目标是对纵向数据进行因果分析，以揭示例如，童年时期的邻里暴力和剥夺是否会在多年后增加人际间的身体或性暴力--同时或以后生活中保护性的家庭环境是否可以防止或中断这些联系。这一阶段的调查结果为制定和安排情景干预措施以防止儿童成长过程中的暴力提供了证据。该项目的第三阶段也是最后阶段将探讨不同背景对来自历史上被边缘化群体的年轻人的影响有何不同。通过应用统计方法来检验环境的不利和保护影响是否因性别、残疾、种族、性取向和社会经济地位而不同，调查结果将突出哪些年轻人受到不利环境的不成比例影响，或不太可能从保护环境中受益。我们的方法提供了在暴力研究和更广泛的研究中改进使用背景措施的机会。背景一级的暴力预防努力将干预的地点从个人身上转移，并可能比个人一级的行为改变干预措施惠及更多的人。这项研究将从多个国家产生新的证据，研究人员和从业人员可以利用这些证据来实现世卫组织关于预防暴力的INSPIRE框架和与暴力有关的可持续发展目标。

Over one billion children experience physical, sexual or emotional violence every year and social inequalities in violence are large. The contexts children live, learn and play in can shape their health, employment, and educational outcomes. This project will generate new evidence on how adverse and protective childhood contexts affect children's use, or experiences of, interpersonal violence as they grow up. We propose to draw on high-quality longitudinal data about children's lives, including experiences of violence, in three independent cohort studies in Brazil (birth to late childhood), England (birth to adulthood) and Uganda (late childhood to adulthood). Our multi-country research team consists of social epidemiologists and social scientists with strong links to the settings of each cohort study. To ensure analyses and findings are informed by a wide range of expertise and experiences we will consult local stakeholders (young people, civil society organisations, health workers and local government staff) in each study setting and researchers from different disciplines during research design and dissemination. The World Health Organisation's (WHO) INSPIRE framework recommends changing laws, social norms, social safety nets, neighbourhood environments, households, and schools to prevent interpersonal violence. To advance such prevention efforts, violence researchers and practitioners need to know how childhood contexts shape violence later in life, and how contexts can interrupt or prevent violence later in life. Further, we need to understand if the adverse or protective effects of contexts differ for marginalised young people.The first phase of this project will define and operationalise contextual measures: we theorise that adverse childhood contexts are homes, schools, and neighbourhoods with violence and deprivation, and protective childhood contexts high social connectedness and support. We will use data collected on contexts to operationalise contextual measures specific to each cohort and refine measures based on input from local stakeholders, young people, and researchers in each context. Findings from this phase will highlight new opportunities to apply advanced statistical methods to improve how contexts are measured and defined in violence research. The second phase will test whether adverse childhood contexts increase the risk of violence later in life, and whether protective childhood contexts can mitigate this risk. We aim to conduct causal analyses of longitudinal data to uncover, for example, whether neighbourhood violence and deprivation in childhood could increase interpersonal physical or sexual violence years later - and whether a protective home environment at the same time, or later in life could prevent or interrupt these associations. Findings from this phase provide evidence for developing and situating contextual interventions to prevent violence as children grow up. The third and final phase of the project will explore how the effects of contexts differ for young people from historically marginalised groups. By applying statistical methods to test if the adverse and protective effects of contexts differ by gender, disability, ethnicity, sexuality, and socioeconomic position, findings will highlight which young people are disproportionately impacted by adverse contexts or less likely to benefit from protective contexts. Our approach offers opportunities to improve the use of contextual measures in research on violence and more broadly. Violence prevention efforts at contextual levels shift the loci of intervention away from the individual and are likely to benefit more people than individual-level behaviour change interventions. This research will generate new evidence from multiple countries that researchers and practitioners can use to realise the WHO INSPIRE framework on violence prevention and the Sustainable Development Goals related to violence.