Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence.

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence / Agresores y resilientes en Medellín, Colombia: necesidad de un cambio de paradigma para superar la violencia / Agressores e resilientes em Medellín, Colômbia: necessidade de uma mudança de paradigma, a fim de superar a violência

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Los objetivos fueron estimar la proporción de jóvenes resilientes y comparar dicha proporción con la de jóvenes con conductas agresivas y con otras conductas de riesgo. Estudio transversal en una muestra representativa de personas entre los 12 a 60 años, habitantes de Medellín, Colombia, y el área metropolitana (N = 4.654). Muestreo probabilístico polietápico. Se seleccionaron los jóvenes entre 14-26 años para el presente análisis (n = 1.780). La proporción de jóvenes resilientes es de un 22,9%, la de agresores un 11,3%, la de jóvenes con otras conductas de riesgo es de un 65,8%. La alta proporción de jóvenes resilientes obliga a reorientar las políticas públicas de la prevención terciaria y el control de la violencia a la promoción de las conductas resilientes y al desarrollo positivo de los niños y jóvenes en la sociedad.

Os objetivos foram estimar a proporção de jovens resistentes e compará-la com jovens com condutas agressivas, e jovens que também apresentam comportamento sexual de risco e uso de drogas. Estudo transversal de uma amostra representativa de pessoas com idades entre 12 e 60 anos, habitantes de Medellín e sua área metropolitana, na Colômbia (N = 4.654), foi utilizado a partir de amostragem probabilística multiestágio. Jovens entre 14 e 26 anos foram selecionados para a presente análise (n = 1.780). A proporção de jovens resistentes foi de 22,9%, de agressores 11,3%, e de jovens com conduta de risco foi de 65,8%. A alta proporção de jovens resistentes força uma reorientação das políticas públicas para a prevenção e controle da violência, privilegiando a promoção de condutas de resistência ao invés de continuar com ações de prevenção terciária.

Reducing violence by transforming neighborhoods: a natural experiment in Medellín, Colombia.

Neighborhood-level interventions provide an opportunity to better understand the impact that neighborhoods have on health. In 2004, municipal authorities in Medellín, Colombia, built a public transit system to connect isolated low-income neighborhoods to the city's urban center. Transit-oriented development was accompanied by municipal investment in neighborhood infrastructure. In this study, the authors examined the effects of this exogenous change in the built environment on violence. Neighborhood conditions and violence were assessed in intervention neighborhoods (n = 25) and comparable control neighborhoods (n = 23) before (2003) and after (2008) completion of the transit project, using a longitudinal sample of 466 residents and homicide records from the Office of the Public Prosecutor. Baseline differences between these groups were of the same magnitude as random assignment of neighborhoods would have generated, and differences that remained after propensity score matching closely resembled imbalances produced by paired randomization. Permutation tests were used to estimate differential change in the outcomes of interest in intervention neighborhoods versus control neighborhoods. The decline in the homicide rate was 66% greater in intervention neighborhoods than in control neighborhoods (rate ratio = 0.33, 95% confidence interval: 0.18, 0.61), and resident reports of violence decreased 75% more in intervention neighborhoods (odds ratio = 0.25, 95% confidence interval 0.11, 0.67). These results show that interventions in neighborhood physical infrastructure can reduce violence.

Violence witnessing, perpetrating and victimization in Medellín, Colombia: a random population survey.

BACKGROUND: The burden of injury from violence and the costs attributable to violence are extremely high in Colombia. Despite a dramatic decline in homicides over the last ten years, homicide rate in Medellin, Colombia second largest city continues to rank among the highest of cities in Latin America. This study aims to estimate the prevalence and distribution of witnesses, victims and perpetrators of different forms of interpersonal violence in a representative sample of the general population in Medellin in 2007. METHODS: A face-to-face survey was carried out on a random selected, non-institutionalized population aged 12 to 60 years, with a response rate of 91% yielding 2,095 interview responses. RESULTS: We present the rates of prevalence for having been a witness, victim, or perpetrator for different forms of violence standardized using the WHO truncated population pyramid to allow for cross-national comparison. We also present data on verbal aggression, fraud and deception, yelling and heavy pranks, unarmed aggression during last year, and armed threat, other severe threats, robbery, armed physical aggression, and sexual aggression during the lifetime, by age, sex, marital and socioeconomic status, and education. Men reported the highest prevalence of being victims, perpetrators and witnesses in all forms of violence, except for robbery and sexual violence. The number of victims per perpetrator was positively correlated with the severity of the type of violence. The highest victimization proportions over the previous twelve months occurred among minors. Perpetrators are typically young unmarried males from lower socio-economic strata. CONCLUSIONS: Due to very low proportion of victimization report to authorities, periodic surveys should be included in systems for epidemiological monitoring of violence, not only of victimization but also for perpetrators. Victimization information allows quantifying the magnitude of different forms of violence, while data on factors associated with aggression and perpetrators are necessary to estimate risk and protective factors that are essential to sound policies for violence prevention formulation.

La violencia doméstica en Medellín y demás municipios del Valle de Aburrá, 2003-2004 / Domestic violence in Medellín and other municipalities of Aburrá Valley 2003-2004

Objetivo: estimar la magnitud y distribución por sexo de la violencia doméstica (de pareja, de padres a hijos y entre hermanos) en Medellín y los otros nueve municipios del Valle de Aburrá 2003-2004. Métodos: encuesta cara a cara en una muestra multietápica representativa de la población de 12 a 60 años, no institucionalizada, del área urbana de cada municipio. Resultados: en miembros de la pareja se encontró agresión y victimización verbal o sicológica (64 y 61%); física sin lesión (17 y 14%); física con lesión (2 y 3%). Se observan proporciones de agresión y victimización similares en hombres y en mujeres. La agresión verbal y física a hijos por sus padres es cercana a 60% y la que deja lesiones físicas es de 10%. En 55% de las familias hubo peleas entre hermanos y en 3%, secuelas de lesión física. En Medellín se presentan mayores proporciones de violencia doméstica que en los demás municipios agrupados. La proporción de no denuncia es muy alta (80 a 95%) y es significativamente mayor entre los hombres. Conclusiones: no es aconsejable fincar las políticas públicas y programas de prevención y control de la violencia doméstica en las estadísticas de las cuales dispone el Estado; se recomienda realizar encuestas periódicas en muestras poblacionales completas (hombres y mujeres). Se sugiere tener dos tipos de programas: unos de prevención de la violencia doméstica, considerando a la familia como una unidad total, y otros de rehabilitación de agresores crónicos y severos.

Objective: To estimate the magnitude and distribution by sex of domestic or family violence (between partners, siblings, and from parents to children) in Medellin, Colombia and nine surrounding municipalities (Medellin metropolitan area), 2003-2004. Methods: Household survey to a representative multistage sample to non institutionalized population, within 12 and 60 years of age, in the urban area of each municipality. Results: Verbal or psychological aggression and victimization: 64% and 61%, physical violence without physical injury: 17% and 14%, physical violence with physical injury: 2% and 3% between intimate partners. Intimate partners’ aggression and victimization do no differentiate by sex. Verbal, psychological and physical aggression from parents toward children is 60%, and physical aggression with physical injury is near 10%. 55% of families reported fights among siblings, and 3% with physical injury. Medellin has the highest rates of family or domestic violence compared with the other municipalities of Aburra Valley. Domestic violence charge is very low (5-20%), and masculine victims rather prefer not to report. Conclusions: We suggest not to ground public policies on current statistics, but to establish a system of periodic surveys, representative of general population or families. It seems important to have two different types of interventions: domestic or family violence prevention considering family as a unit that interaCTS with the surrounding; and rehabilitation of chronic and severe domestic aggressors.

Conductas socialmente indeseables asociadas a agresores y resilientes. Un estudio de casos y controles en Medellín, Colombia. 2003 - 2005 / Deviant behaviors associated with aggressors and resilient subjects. A case-control study in Medellin, Colombia. 2003-2005

Con base en un estudio de casos y controles realizado en Medellín, Colombia, entre 2003 y 2005 con el fin de estimar los factores asociados a formas severas de agresión y delincuencia, así como los factores de resiliencia frente a ellas, se estimaron las conductas socialmente indeseables o anómicas vinculadas a cada uno de los grupos estudiados. Metodología: Se estudiaron cinco grupos: agresores severos (n=62), agresores principalmente de riñas graves (n=81), miembros de las Autodefensas Unidas de Colombia (AUC) no reinsertados, comúnmente denominados paramilitares (n=72), resilientes (n=59) y controles comunitarios (n=103). A todos se les hizo una encuesta, respondida personalmente en las comunidades donde residen, para ello se los identificó y contactó por medio de entidades y personas de las comunidades que les merecieran respeto y confianza. Resultados: La magnitud de la prevalencia y el número de las conductas de agresión abierta, de agresión encubierta, de oposición y el consumo de sicoactivos es mayor entre los miembros de las AUC, los agresores severos y los agresores de riñas que entre los controles y resilientes. Los resilientes presentan menor número de conductas socialmente anómalas que los controles comunitarios y con una proporción de prevalencia menor. El grupo de AUC no se diferencia de los agresores más severos en cuanto a las conductas que están frecuentemente asociadas a cada uno de estos grupos.

Concurrent risky or deviant behaviors of serious offenders, resilient men and community controls were estimated through a case-control study carried out in Medellin, Colombia between 2003 and 2005. Methodology: Cases: serious offenders (n=62), men involved in violent quarrels or brawls (n=81), and members of Autodefensas Unidas de Colombia -Colombian paramilitary army- (AUC), also known as paramilitaries (n=72) were compared to resilient men (n=59) and community controls (n=103). All were interviewed face to face in their communities. Cases were interviewed at the site, day and hour agreed with the group leader. Controls and resilient men were referred by respected and trusted persons of the community and interviewed in their own communities in a place chosen by them. Results: Antecedents of overt and covert aggression, deviant behaviors and oppositional behaviors, and substance abuse was higher among AUC members (paramilitaries), serious offenders and men involved in quarrels than among community controls and resilient men. Resilient men report a smaller number of concurrent deviant and risky behaviors compared to community controls. AUC members (paramilitaries) are not different from serious offenders in their reports of concurrent risky and deviant behaviors.