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4
The Role of Contextual Factors
in the Contagion of Violence
INTRODUCTION
For violence to infect, certain individual, social, and environmental fac-
tors 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
a
ffect risk of and resilience to the spread of violence were discussed. peakers
S
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.
FACTORS THAT PROMOTE OR HINDER SUSCEPTIBILITY
Most relevant to this concept of the contagious nature of violence is the
vulnerability or susceptibility of individuals and communities to violence
28
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THE ROLE OF CONTEXTUAL FACTORS 29
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.
Place
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 vio-
lence, 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 “pro-
duces 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 hor-
rible, 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 vio-
lence. 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 vic-
tim 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. risberg
K
brought up the previously hypothesized idea of “prisonization” or institu-
tionalization, in which one adapts or develops an inmate culture or ideal.
This has changed slightly, Dr. Krisberg stated, but in general, “prisons
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30 CONTAGION OF VIOLENCE
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 popula-
tion. 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 per-
centage 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 per-
cent 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 Stan-
ford 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 symp-
toms, some as serious as psychosis. The Stanford students who were the
guards were manifesting vicious, violent, and assaultive behavior against
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THE ROLE OF CONTEXTUAL FACTORS 31
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 re-
search 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 an-
ger 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, up-
rooting, and transition stages, and she spoke of the stages that are consid-
ered 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 admin-
istrators, 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.”
Poverty
Another important contextual factor is poverty, especially with respect
to marginalized and impoverished communities. Poverty, as a conduit of
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32 CONTAGION OF VIOLENCE
such things as hopelessness, economic repression, fear, lack of resources,
and isolation, create an ideal breeding ground for the promulgation of vio-
lence. 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 per-
cent 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. rettyPaint
P
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 environ-
ment of communities and individuals, then violence has a greater chance
of causing infection. With respect to Native children, Dr. PrettyPaint em-
phasized 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 prac-
tices helps create a place or meaningful connection of an individual to a
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THE ROLE OF CONTEXTUAL FACTORS 33
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 cumula-
tive emotional, psychological, and physical insult on individuals and com-
munities 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 re-
lated theories as being important to achieve a more comprehensive and bal-
anced 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 Af-
rica, 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
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34 CONTAGION OF VIOLENCE
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.
Gender
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 educa-
tion. 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 mil-
lion 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 physi-
cal, 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 disabili-
ties 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.
Family
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 in-
crease 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
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THE ROLE OF CONTEXTUAL FACTORS 35
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 conta-
gion of violence might apply to the spread of violence within the family to
include elder abuse. Dr. PrettyPaint noted that in Native American com-
munities, 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.
IMMUNITY AND RESILIENCE
In this infectious disease framework, resilience to violence can be
thought of as immunity. Within immunity and resilience, concepts of cul-
ture, place, religion, family, and the law play a role.
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36 CONTAGION OF VIOLENCE
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 not-
ing 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 envi-
ronment. 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 ceremo-
nies) 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 empower-
ment, 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 pro-
motive. She stated that when trying to change community-level contex-
tual factors, it is important to also support families. Examples raised of
changing context include Cure Violence (formerly known as CeaseFire)
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THE ROLE OF CONTEXTUAL FACTORS 37
and Communities that Care, which help support the larger social environ-
ment, 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 em-
phasis 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.
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38 CONTAGION OF VIOLENCE
The Role of Law
Laws play a role in how violence is dealt with in settings such as pris-
ons 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. rettyPaint noted the complex role that jurisdiction plays in Native pop-
P
ulations, 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 posi-
tive 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 fam-
ily 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 ex-
posure to violence.
SUGGESTED RESEARCH OPPORTUNITIES
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 Associa-
tion of Social Workers emphasized the importance of connecting context
to the research. Dr. Krisberg stated that the variable of incarceration, in-
cluding its duration and intensity, should be incorporated into longitudinal
research. Dr. Gorman-Smith also emphasized examination of middle child-
hood in terms of optimal interventions that work to reduce risk of violence
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THE ROLE OF CONTEXTUAL FACTORS 39
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 ex-
posure 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 inter-
ventions 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 op-
portunities 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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40 CONTAGION OF VIOLENCE
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purl.access.gpo.gov/GPO/LPS33477 (accessed August 1, 2012).
Oliver, W., and C. F. Hairston. 2008. Intimate partner violence during the transition from
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