Understanding social norms and violence in childhood: theoretical underpinnings and strategies for intervention

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

OBJECTIVE

Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs.

METHODS

Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase.

RESULTS

The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories.

CONCLUSION

The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

The Role of Community Health Agents in Promoting Social Change in Peru

BACKGROUND

Community health agents (CHAs) provide basic health services and increase health care access thereby improving health outcomes for peri-urban regions in Peru. Few studies analyze the effect that becoming a CHA has on women's interpersonal interactions. We aim to explore the impact CHAs may have on gender and social norms through their roles as trusted leaders in male-dominated communities.

METHODS

We conducted six 90-minute group discussions with CHAs working in Huancayo and Trujillo, Peru. We designed the discussions to extract data about family and community norms that changed as a result of working as a CHA.

RESULTS

A total of 53 female CHAs participated in six discussion groups. CHAs reported shifting family support (a change in how their family supported them in their role as a CHA), gaining status within their family (feeling more valued for their knowledge and experience), and shifting family gender roles (men and boys taking on more household responsibilities) as a result of their work. CHAs also reported a change in community norms and felt they were more valued and respected within their communities as women leaders.

CONCLUSIONS

Working as a CHA creates an opportunity to enact social change through altering family dynamics and community perceptions. Moreover, empowering women to become CHAs not only generates tangible benefits in community health, but can help create social change that ultimately improves the lives of women and realize their human rights.

The Mentors in Violence Prevention programme: impact on students' knowledge and attitudes related to violence, prejudice, and abuse, and willingness to intervene as a bystander in secondary schools in England

BACKGROUND

Violence is a leading cause of death and disability for young people and has serious impacts on prospects across the lifecourse. The education sector is a crucial setting for preventing youth violence through incorporating programmes that address attitudes and behaviours. The Mentors in Violence Prevention (MVP) programme aims to change harmful attitudes and norms, and increase non-violent bystander intervention, through a peer mentoring approach. To date there is limited evidence on the effectiveness of the intervention in UK school settings. The aim of the current study was to evaluate the impact of the programme on students' attitudes and knowledge related to violence prevention.

METHODS

The study employed a mixed methods design. Pre and post surveys measured changes in students' (aged 11-18) attitudes and knowledge related to violence prevention and bystander behaviour, gender stereotyping, acceptability of violence, and perceptions of others' willingness to intervene. Interviews/focus groups with programme delivers and students, and anonymised programme data were used to explore and supplement survey findings.

RESULTS

Overall, perceptions of the programme content and delivery were positive. Several beneficial impacts of the programme were found for mentors (students delivering the programme), including significant positive changes on measures of knowledge and attitudes towards violence prevention and the bystander approach, acceptability of violence perpetration, and perceptions of other students' willingness to intervene (effect sizes were small-medium). However, the study found no significant change on any of the outcomes amongst mentees (younger students receiving the programme from mentors). Despite this, qualitative evidence suggested mentees enjoyed the content of the programme and the peer-led delivery, and this built relationships with older students. Qualitative evidence also identified additional benefits of the programme for mentors, including leadership and communication skills, and increased confidence and supportive relationships.

CONCLUSIONS

Evidence from this study suggests MVP is effective as a targeted programme for mentors, but no significant evidence was found to demonstrate its effectiveness as a universal bystander and violence prevention programme for mentees. Whilst further research with more robust study design is needed, developing mentors as leaders in violence prevention is a valuable impact of the programme in its own right.

Associations between experiences of childhood maltreatment and perceived acceptability of child maltreatment: A cross-cultural and exploratory study

BACKGROUND

Acceptable parental behaviors and practices toward a child vary across countries and may impact the risk of exposure to maltreatment. Conversely, prior experiences of maltreatment as a child may influence the acceptability of child maltreatment (CM) behaviors.

OBJECTIVE

This exploratory study examined the association between CM experiences and perceived acceptability of CM using data from four countries representing different cultures, living standards, and gross national income.

PARTICIPANTS AND SETTING

We recruited a convenience sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) through online postings on social media.

METHODS

We administered questionnaires and conducted a three-stage hierarchical multiple regression with perceived acceptability of CM subscales as the dependent variable.

RESULTS

In all countries, higher scores of childhood neglect were associated with greater perceived acceptability of neglect in one's community (p < .001). Equally, our results showed that higher scores of childhood neglect or sexual abuse were associated with greater perceived acceptability of sexual abuse (p < .044). However, we did not find a significant relationship between other forms of CM (i.e., physical abuse, emotional maltreatment, exposure to domestic violence), and their perceived acceptability.

CONCLUSIONS

Our findings suggest that experiences of some CM types, namely neglect and sexual abuse, may be associated with the perception that these are more acceptable within one's community. Perceived acceptability of CM might be a driver that can either prevent or perpetuate CM. Therefore, intervention and prevention programs could incorporate a deeper cross-cultural understanding and assessment of these social norms in order to foster meaningful behavioral changes.

Access to information on gender-based violence prevention during COVID-19 lockdown in Uganda: a cross-sectional study

BACKGROUND

During the lockdowns to contain the COVID-19 pandemic in Uganda, women and girls, disproportionately, had increased exposure to gender-based violence (GBV). Access to high-quality and empowering information or knowledge to minimise the incidences of GBV for women, girls, men and boys, was, therefore, crucial. The purpose of this study was to understand the characteristics of the individuals who were unable to access such information, and if received information, was associated with more awareness in the populace.

METHODS

The data analysed were from a cross-sectional nationally representative phone survey of individuals aged 18 years and above from all four regions of Uganda. The survey was carried out by Uganda Bureau of Statistics using a purely quantitative approach, and all questions were closed-ended. The sample was stratified by sex, age, and geographical region, and executed in November 2020, six months after COVID-19 lockdown restrictions. Binary logistic regression analysis was used for data analysis in STATA software.

FINDINGS

Female respondents with tertiary education (OR = 0.47; 95% CI = 0.26, 0.85) and male respondents with tertiary education (OR = 0.70; 95% CI: 0.49, 1.00) were more likely to receive information on GBV prevention. Both female (aOR = 0.68; 95% CI: 0.52, 0.88) and male (aOR = 0.66; 95% CI: 0.50, 0.87) respondents who were working had about a third the odds of being unable to access information about GBV prevention. Female respondents living in urban areas were associated with less odds of being unable to access the information (aOR = 0.77; 95% CI: 0.59, 1.00), while unmarried male respondents had higher odds of being unable to access the information (aOR = 1.37; 95% CI: 1.00, 1.89). Respondents who reported being vulnerable to GBV were also more likely to know someone who experienced GBV. This was similar for female respondents (PR = 3.00; 95% CI: 2.26, 3.98) and male respondents (PR = 3.01, 95% CI: 2.3, 3.95) (PR = 5.49; 95% CI = 4.12-7.30). Results also indicated that both male (PR = 1.28; 95% CI: 1.14, 1.43) and female respondents (PR = 1.24; 95% CI: 1.11, 1.37) who did not perceive themselves at risk of GBV were less likely to know a GBV survivor.

INTERPRETATION

The individuals who were unable to access information had characteristics associated with GBV perpetration or victimization. Monitoring the dissemination and quality of information empowers individuals and communities to develop local solutions to GBV prevention and protection. The design of GBV prevention messages and delivery channels needs to take into consideration the risk factors at the different levels of the socio-ecological model (individual, community, institutional, and society). Interventions aimed at increasing access to information on GBV prevention should consider the different socio-demographic as well as context-specific factors.

FUNDING

There was no funding source for this study.

Addressing violence against children: A case review in the state of Qatar

Introduction

Violence against children (VAC) is a critical public health issue that affects billions of children worldwide. The combination of its prevalence and severity of effects on children creates an urgent need for effective interventions. Multiple studies associate VAC with lifelong implications that affect children through adulthood. In Qatar, multiple approaches such as legislation are being used to protect children from all forms of violence. Despite the gravity of the issue, there is still low readiness for the prevention of VAC in Qatar. This review aimed to map approaches to addressing VAC in Qatar from the panelists' perspectives on current approaches to addressing VAC.

Methods

The review obtained data from a recorded video entitled "A Public Health Approach to Addressing Violence Against Children." The panel discussion in this video clip was organized as a side event of the WISH virtual summit by UNICEF and WISH on World Children's Day, held in Qatar in November 2020. The video was transcribed and analyzed using thematic analysis.

Findings

It shows the importance of both global and national level interventions in addressing VAC. The review uses the socioecological model to show relationships among different levels of interventions addressing VAC in Qatar. The findings highlight the national approaches to addressing VAC using public health, and legislative and policy approaches.

Discussion

The interventions addressing VAC at different levels in Qatar are interconnected. Delineating each level is key to the formation of holistic interventions that leverage global, regional, national, communal, familial, and individual factors that support interventions to address VAC.

Defending or Remaining Passive as a Bystander of School Bullying in Sweden: The Role of Moral Disengagement and Antibullying Class Norms

The overall aim of the present study was to examine whether moral disengagement and perceptions of antibullying class norms at individual level and at class level were associated with defending and passive bystanding in school bullying among school-age children. More specifically, we investigated the extent to which moral disengagement would contribute to explain defending and passive bystanding, after controlling for sex and perceptions of antibullying class norms at individual level and at class level. A total of 789 Swedish students (aged 10-14) from 40 middle school classes filled out a self-report survey. The findings revealed that girls and students who were less prone to morally disengage, and who perceived that their classmates endorsed more antibullying norms, were more likely to defend victimized peers. Students who were more inclined to morally disengage and perceive that classmates do not condemn bullying were more likely to act as passive bystanders. In addition, classes with higher levels of antibullying class norms were more likely to show higher rates of defending and lower rates of passive bystanding compared to the other classes. The findings suggest that schools and teachers need to develop educational strategies, methods, and efforts designed to make students aware of moral disengagement and to reduce their likelihood of morally disengaging in bullying situations. The present findings also point to the importance of teachers establishing class rules against bullying together with the students.

Agent-Based Modeling: an Underutilized Tool in Community Violence Research

Purpose of Review

Recent Findings

Summary

Coping responses to intimate partner violence: narratives of women in North-west Tanzania

This study sought to explore the variety of coping strategies that women employ in response to intimate partner violence. Coping strategies can help women tolerate, minimise and deal with difficult challenges or conflicts in their relationships, such as learning to be independent from their husbands and surviving trauma. Drawing on 18 in-depth interviews conducted in Mwanza, Tanzania, we examined two different coping strategies - engagement and disengagement coping - with respect to how women react to economic, emotional, physical and sexual intimate partner violence. While the choice of coping methods remains a complex issue, most women employed engagement strategies as a response to economic violence and disengagement coping for sexual violence. We explore the implications of gender and societal roles for coping decisions and analyse how access to resources may provide women with the tools to limit future violence.

The Predictive Validity of Three Youth Violence Assessment Instruments: The SAVRY, VRS-YV, and SAPROF-YV

This study examined the predictive validity of three assessment instruments for violent youth, the SAVRY, the VRS-YV, and the SAPROF-YV. Files relating to a sample of 233 young male offenders aged between 12 and 18 years were retrospectively reviewed to score each instrument, with reoffending data extracted from prison, community and juvenile justice records. The analysis showed that all three assessments predicted general (any) reoffending better than violent and non-violent reoffending, with higher rates of predictive validity for the SAVRY and VRS-YV Total Scores. There were, however, only small to moderate effect sizes at 1- and 3-year follow up periods for all three instruments in predicting all types of reoffending. The SAPROF-YV had a small effect size for the prediction of violent reoffending and did not add incrementally to the predictive validity (for violent reoffending) of the SAVRY or VRS-YV.

Understanding attitudes and norms related to sexual and gender-based violence among youth in Jordan: an egocentric social network study protocol

INTRODUCTION

Sexual and gender-based violence (SGBV) is a major public health concern in Jordan, especially among youth. Social acceptance of SGBV is alarmingly high, including among youth. Refugee populations may be at particular risk given limited social support and access to health services combined with increased social and economic pressure and vulnerability. Further research is needed to understand how norms are embodied and reproduced at individual, interpersonal and community levels through relationships between partners, families, peers and community leaders. This study seeks to provide data on attitudes and norms in communities and across youth social networks in order to support gender transformative approaches that seek to change harmful social norms that perpetuate acceptance of SGBV.

METHODS AND ANALYSIS

This study will collect egocentric data from 960 youth in Jordan (480 men and 480 women) aged between 18 years and 24 years. Individuals will be asked about their perceptions of norms relating to SGBV in their community as well as their perceptions of the attitudes held by up to 15 individuals within their social network. Data will also be collected on the social, economic and demographic variables, refugee status, experience of depression and anxiety, and social support. We will use multilevel analysis to examine individual and group-level associations. We will also assess other network attributes, such as homophily, the role of social engagement, social learning and social support in the transmission of norms and attitudes.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Institutional Review Boards of the Harvard T.H. Chan School of Public Health and the University of Jordan. Rigorous ethical protections will be followed with regard to confidentiality and respondent safety. We intend to publish peer-reviewed papers of our findings in addition to a variety of tools and resources targeting diverse audiences, including policy and technical briefs.

The role of individual-, family-, and school-level resilience in the subjective well-being of children exposed to violence in Namibia

BACKGROUND

Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children's resilience in resource-limited areas such as sub-Saharan Africa, is vital.

OBJECTIVES

Using data from the International Survey of Children's Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia.

METHOD AND PARTICIPANTS

Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children.

RESULTS

Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children's relationships at home (β = 0.17, p < 0.001), and school (β = 0.07, p < 0.001) emerged as important protective factors for children's well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors.

CONCLUSIONS

Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children's proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.

Conceptualizing "agency" within child marriage: Implications for research and practice

BACKGROUND

The concept of child 'agency' has become increasingly important for international child-centric organizations, non-government organizations (NGOs) and United Nations (UN) agencies, particularly those responding to the issue of child marriage. Interventions to prevent child marriage often include awareness-raising activities focused on sharing information with children on the dangers of child marriage. Such interventions are often based on, and perpetuate, a belief that increased knowledge can lead to an increase in girls' agency. In this framing, agency is presumed to result in a 'good' decision and is positioned as a natural consequence of increased knowledge. This agency is said to enable girls to resist marriages forced upon them by their parents.

OBJECTIVE

This discussion paper aims to interrogate dominant conceptualizations of child agency through an exploration of child agency narratives on child marriage.

METHODS

This discussion paper is based on critical analysis of existing academic and grey (NGO and UN) literature that explores children's agency in the context of child marriage prevention.

RESULTS

This discussion paper suggests that academics, NGOs and UN actors use varied definitions to describe agency. While academic analysis shows that children's agency might be contested, contradictory and fraught, NGO and UN agencies tend to narrowly frame agency.

CONCLUSIONS

We suggest that adopting a broader definition of children's agency in research and implementation enables a more nuanced, complex understanding of the drivers of child marriage and the interventions required to address this practice.

Programmatic norms change to eliminate violence against children: Insights for practitioners and researchers from a UNICEF global mapping study

Interest in gender norms is rising within the field of global health and among its funders. With more resources available for norms change work, international institutions seek to develop thoughtful strategic and programmatic responses to a variety of issues, including violence against children. Yet changing deeply rooted gender norms requires sensitivity to local context. This can present a challenge for mid- to large sized organisations, as well as funders, who are typically required to develop strategies that encompass multiple contexts. This paper presents practical lessons learned from a mapping study of UNICEF's existing work to change discriminatory gender norms. As the world's leading children's rights organisation, preventing violence against children (0-9) and adolescents (ages 10-19) is a key component of UNICEF's work. This mapping formed the foundation of the institution's efforts to build out a coordinated strategy and programme of work around 'positive gender socialisation.' The mapping was unique in that it accounted for differences across and within regions and sought to develop an institutional programme of work based on local experience and existing priorities. The lessons learned are relevant to other organisations and practice-oriented research programmes embarking on work to change norms that lead to violence against children.

Emotional and Physical Child Abuse in The Context of Natural Disasters: A Focus on Haiti

OBJECTIVE

To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake.

METHODS

Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter.

RESULTS

Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%).

CONCLUSIONS

The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

How far do parenting programmes help change norms underpinning violence against adolescents? Evidence from low and middle-income countries

Recent years have seen an upsurge in parent education programmes in low and middle-income countries (LMICs) that aim to help reduce violence against children. This article draws on a narrative review that examined the impact of 42 programmes working with parents of adolescents in LMICs. Here we focus on 17 initiatives that aimed to reduce neglect of, or physical, emotional or sexual violence against adolescents, or to reduce child marriage. Programmes aiming to prevent sexual violence or child marriage generally focused more strongly on understanding and challenging prevailing norms, while those oriented to preventing physical and emotional violence emphasised sharing information and practising new communication skills. We argue that key elements of programme design (group-based participatory sessions, formative research that enabled sensitive framing and adaptation of content) have strong potential to help shift norms that underpin violence against adolescents. To fulfil their potential to change norms underpinning violence against adolescents, programmes should expand their reach, with a particular focus on embedding initiatives within institutions that can take them to scale, promoting male engagement, and support participants to maintain changes over the long-term.

Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

BACKGROUND

Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue.

OBJECTIVE

This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified by the SECA literature worldwide.

METHODS

Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA.

RESULTS

Our searches identified 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identified six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing financially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-affected contexts. Beliefs around markers that denote adolescents' readiness for sex; men's entitlement to sex; and the perceived benefits of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA.

CONCLUSIONS

Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-specific social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA.

Gender norms and social norms: differences, similarities and why they matter in prevention science

Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of work intersect, conceptual clarity is needed to understand differences and similarities between these two traditions. Increased clarity will improve efforts to address harmful norms and practices. In this article, we review similarities and differences between social and gender norms, reviewing the history of the concepts and identifying key tension points of contrast. We identified six areas of comparison that might be helpful for practitioners working for the promotion of global health as they make sense of social and gender norms. We then offer a definition of gender norms for practitioners and researchers working at the intersection between these two theories. Our definition draws from the two different streams of thought of how norms influence people's actions, acknowledging the double nature of gender norms: beliefs nested in people's minds and embedded in institutions that profoundly affect health-related behaviours and shape differential access to health services.

Why context matters for social norms interventions: The case of child marriage in Cameroon

Child marriage is a global health and human rights issue. In Cameroon, 30% of women are married before age 18 but little research exists on the drivers of child marriage in the country. This qualitative study contributes to understanding the role of social norms in sustaining child marriage in Far-North and East Cameroon. Participants in the study (N = 80) included women and men from four, ethnically different, rural communities (two in the Far-North, two in the East). Methods for data collection included 16 semi-structured focus groups, in which we investigated the system of social norms sustaining child marriage in these communities. We asked participants about typical age at marriage for girls (local practices) and whether they believed that age to be appropriate (their attitudes). We found the relation between practices and attitudes to be different in each community. We discuss the implications of these different relations for social norms interventions, enriching existing theoretical explanations. Evidence emerging from our findings suggest that effective social norms interventions should be embedded within cultural understandings of the relations between people's attitudes and practices.

Examining intersections between violence against women and violence against children: perspectives of adolescents and adults in displaced Colombian communities

BACKGROUND

Research examining the interrelated drivers of household violence against women and violence against children is nascent, particularly in humanitarian settings. Gaps remain in understanding how relocation, displacement and ongoing insecurity affect families and may exacerbate household violence.

METHODS

Employing purposive sampling, we used photo elicitation methods to facilitate semi-structured, in-depth interviews with female and male adolescents and adults aged 13-75 (n = 73) in two districts in Colombia from May to August of 2017. Participants were displaced and/or residing in neighborhoods characterized by high levels of insecurity from armed groups.

RESULTS

Using inductive thematic analysis and situating the analysis within a feminist socioecological framework, we found several shared drivers of household violence. Intersections among drivers at all socioecological levels occurred among societal gender norms, substance use, attempts to regulate women's and children's behavior with violence, and daily stressors associated with numerous community problems. A central theme of relocation was of family compositions that were in continual flux and of family members confronted by economic insecurity and increased access to substances.

CONCLUSIONS

Findings suggest interventions that systemically consider families' struggles with relocation and violence with multifaceted attention to socioecological intersections.

Review shows that Icelandic society is taking firmer steps to tackle the diverse forms of child abuse and neglect that its children are exposed to

AIM

This review examined and summarised the research published on child abuse in Iceland, which was mainly in the country's native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers.

METHOD

The review drew on published research, books and reports and compared the findings with Nordic research and global estimates of child abuse.

RESULTS

Qualitative and quantitative research revealed that the prevalence of different forms of child abuse, child neglect and intra-familial conflicts in Iceland was similar to, or higher than, global and Nordic estimates. Younger respondents reported less physical abuse than older respondents, but higher levels of emotional abuse. Legislation, greater awareness, public debates and research on child abuse in Iceland have contributed to the growing recognition of the negative consequences of child abuse and strengthened support for prevention strategies.

CONCLUSION

Icelandic children have reportedly experienced diverse forms of child abuse and neglect from their parents and other carers. Diverse initiatives have been put in place that underline the urgent need to tackle such behaviour.

Theory and practice of social norms interventions: eight common pitfalls

BACKGROUND

Recently, Global Health practitioners, scholars, and donors have expressed increased interest in "changing social norms" as a strategy to promote health and well-being in low and mid-income countries (LMIC). Despite this burgeoning interest, the ability of practitioners to use social norm theory to inform health interventions varies widely.

MAIN BODY

Here, we identify eight pitfalls that practitioners must avoid as they plan to integrate a social norms perspective in their interventions, as well as eight learnings. These learnings are: 1) Social norms and attitudes are different; 2) Social norms and attitudes can coincide; 3) Protective norms can offer important resources for achieving effective social improvement in people's health-related practices; 4) Harmful practices are sustained by a matrix of factors that need to be understood in their interactions; 5) The prevalence of a norm is not necessarily a sign of its strength; 6) Social norms can exert both direct and indirect influence; 7) Publicising the prevalence of a harmful practice can make things worse; 8) People-led social norm change is both the right and the smart thing to do.

CONCLUSIONS

As the understanding of how norms evolve in LMIC advances, practitioners will develop greater understanding of what works to help people lead change in harmful norms within their contexts. Awareness of these pitfalls has helped several of them increase the effectiveness of their interventions addressing social norms in the field. We are confident that others will benefit from these reflections as well.

Change and consistency in descriptions of child maltreatment: A comparison of caregivers' perspectives 20 years apart

Although approximately one-fifth of child maltreatment reports originate with family members, friends, neighbors, or community members, their efforts to identify and report child maltreatment are still not well understood. Nor is it well understood how these individuals' perceptions of what constitutes maltreatment may change over time. This study examined descriptions of behavior perceived as maltreatment by caregivers of minors in Cleveland, Ohio, USA neighborhoods. Data were obtained from two neighborhood-based cross-sectional surveys of caregivers of minors: one conducted in 1995-1996 and the other in 2014-2015. The sample consisted of 400 caregivers living in 20 census tracts with varying profiles of maltreatment risk in the 1995-1996 study, and 400 caregivers living in the same 20 census tracts surveyed in 2014-2015. Each time point, participants were asked to provide three examples of behaviors they considered to be child abuse and neglect. All responses were categorized using the 1995-1996 coding scheme. Logistic regression analyses including all 800 participants, adjusted for individual and neighborhood characteristics, and accounting for residential clustering in neighborhoods, showed that participating in the 2014-2015 survey was associated with 51% increased odds of mentioning an act of neglect and a 39% decreased odds of mentioning an act of physical abuse. No significant temporal changes were observed for inadequate supervision, emotional or verbal abuse, sexual abuse, and parental misbehavior. Associations between specific types of maltreatment and individual and neighborhood characteristics were observed. Potential practice implications and future research directions include seeking greater familiarity with caregivers' perceptions of maltreating behaviors to better understand how these perceptions might "translate" into child maltreatment reports and investigations.