Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children.

Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009-2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies-positive parenting, basic necessities, formal social support, and school structural support-and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children's exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience.

Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment.

INTRODUCTION: Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process. METHOD: A binational community-academic partnership adapted the Centers for Disease Control and Prevention's CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology. RESULTS: Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community's health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels. CONCLUSION: A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.