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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