Science Briefs

Centers for Disease Control: A Source of Funding for Behavioral Science Research in Violence Prevention

Public health has a far greater reach than just the control and prevention of infectious disease.

By W. Rodney Hammond, PhD

People often associate the Centers for Disease Control and Prevention (CDC) with research on diseases and biomedical issues, and rightly so. These are significant public health issues. However, public health has a far greater reach than just the control and prevention of infectious disease. Public health also extends to preventing injuries, including injuries caused by violence. In fact, the public health burden of violence in the United States is enormous. From infants to the elderly, violence affects people in all stages of life. There are an estimated 50,000 deaths each year resulting from homicide or suicide in the United States (National Center for Injury Prevention and Control, 2007). However, the number of violent deaths tells only part of the story. Many more survive violence and are left with permanent physical and emotional scars. Violence also erodes communities by reducing productivity, decreasing property values, and disrupting social services. An estimated $70 billion per year in medical costs and productivity losses is associated with medically treated injuries due to interpersonal and self-directed violence in the United States (Corso, Mercy, Simon, Finkelstein, & Miller, 2007). To address violence and better understand its causes and opportunities for prevention, CDC funds a portfolio of social and behavioral research, presenting many opportunities for psychologists interested in research and evaluation.

CDC efforts in violence prevention go back to the early 1980s following the US Surgeon General's 1979 report, Healthy People, which included violent behavior among the key priority areas for public health (Public Health Service). CDC established the violence epidemiology branch in August 1983 to focus efforts in violence prevention. Just two years later in 1985, the National Research Council in its landmark report, Injury in America: A Continuing Public Health Problem, selected CDC to study the effects of injury and violence on American life (Committee on Trauma Research et al.). Since then, we have been addressing violence and its prevention in collaboration with many partners, including federal agencies, state and local health departments, nonprofit organizations, academic institutions, international organizations, and private industry.

Characteristics of the Public Health Approach

We work to develop and assess the effectiveness of violence prevention programs and policies. Priority is given to research with direct implications for prevention, particularly the primary prevention of intimate partner violence, sexual violence, child maltreatment, youth violence, and suicide. The CDC public health approach complements other approaches such as those of the criminal justice and mental health systems. We place emphasis on rigorous science in its efforts to monitor and track trends, research risk and protective factors, evaluate interventions, and learn how best to implement and disseminate effective strategies. This multipronged effort adds to the knowledge base regarding violence and how to prevent it. The long-term goal of our prevention work is to achieve lasting change in the factors and conditions that place people at risk by making changes at the individual, family, community, and societal levels to reduce rates of violence.

CDC's Injury Research Agenda

The field of violence prevention has made a lot of progress, but there is still much work to do. CDC's National Center for Injury Prevention and Control has developed a Research Agenda to articulate our highest research priorities (National Center for Injury Prevention and Control, 2002). Many psychologists have provided input into our research priorities, and there is ongoing need for additional social and behavioral science research. Through the Research Agenda, in partnership with psychology and other disciplines, we intend to dramatically advance new discoveries in the priority areas of violence prevention based on the best available science. In addition, we also seek to more fully understand the connections, similarities, and differences between the risk factors, prevention strategies, and outcomes of each type of violence we address. CDC is currently updating the research agenda, and the new version will be unveiled later this year. You can access the current version from the Center for Disease Control.

Child Maltreatment Prevention

CDC has identified the promotion of safe, stable, and nurturing relationships (SSNRs) between caregivers and children as the foundation of a unified strategic approach and message to empower parents and caregivers and to reduce child maltreatment. Decades of research in the neurobiological, behavioral, and social sciences indicate that early childhood experiences impact the development of the brain and subsequent vulnerability to a broad range of mental and physical health problems (National Research Council and Institute of Medicine, 2000; Felitti et al., 1998; Kendall-Tackett, 2003). Infants who have SSNRs with parents and other adults build sturdy brains that provide a strong foundation for health development (Repetti, Taylor, & Seeman, 2002; National Scientific Council on the Developing Child, 2004). Further, SSNRs have been identified as a means to strengthen parenting practices that prevent child maltreatment by focusing on positive caregiving behaviors. Accordingly, promotion of SSNRs can have beneficial effects on a wide range of health outcomes as well as contribute to development of skills that enhance acquisition of healthy habits and lifestyles. In the coming years, we will want to more fully examine the role of SSNRs in maltreatment prevention strategies and begin to develop a foundation from which to study positive caregiver behaviors and child outcomes. We will also look to promote research that spans the different social contexts in which children develop and interact, including the individual, family, peer, community, and society. These nested social ecologies provide a framework and context for examining the relationships children have both within and outside the immediate family.

Youth Violence Prevention

For years, the predominant approach to youth violence was reactive; disproportionate attention and resources were given to the medical treatment of injured victims and the apprehension and incarceration of violent offenders. Prevention and treatment, social determinants, disparities, parenting practices, and school and neighborhood safety all affect trends in youth violence. Research is needed in all these areas, so that effective prevention strategies can be employed. In the coming years, we especially need to more fully identify modifiable factors that protect youths from becoming victims or perpetrators of violence. The research agenda emphasizes the need for more dissemination and translation research and rigorous evaluations of interventions, programs and policies designed to change broader community, social and environmental factors.

Intimate Partner Violence and Sexual Violence Prevention

Currently, most efforts to address intimate partner violence and sexual violence focus on reducing victims' risks for future violence, on mitigating the consequences of exposures to such violence (i.e., secondary and tertiary prevention), and holding perpetrators accountable through the criminal justice system. Greater attention to preventing intimate partner violence and sexual violence from occurring in the first place is needed. To heed this call for a primary prevention focus, researchers and practitioners must place greater emphasis on approaches directed at preventing the perpetration of intimate partner and sexual violence, while examining a full range of potential social-ecological influences. Many questions, particularly questions about early risk and protective factors related to perpetration, remain unanswered, seriously hindering the development and identification of effective violence prevention strategies. Thus, it is essential that research efforts focus on perpetration to support future development of effective prevention programs. Such research will complement efforts focused on preventing initial victimization and re-victimization.

Suicide Prevention

For the prevention of self-directed violence and suicide, one area of promise includes promotion of social connectedness as a global strategy for preventing suicidal behavior. Typically, suicide is less likely to occur among communities, schools, and families with strong social cohesion or among persons who have strong interpersonal connections. Increasing social connectedness is likely to have universal as well as targeted impacts on suicidal behavior. By supporting healthy interpersonal relationships and by encouraging communities to care about and care for their members, the population at large is likely to experience more positive health and well-being, resulting in lower risk for suicidal behavior. Many communities have implemented a wide range of programs that attempt to reduce injuries and death resulting from self-directed violence. Little is known, however, about the effectiveness of these programs (Doll, Bonzo, Sleet, Mercy, & Hass, 2007). In addition, while domestic and international research has identified many important risk and protective factors for suicidal behavior, important gaps remain in our understanding of community and societal-level factors that influence rates of suicidal behavior and the mechanisms through which these factors exert an influence. Developing a better understanding of the dynamics of suicidal behavior is essential for building effective interventions (Hammond, 2002).

Funding Opportunities

CDC funds research activities through several mechanisms, including grants, cooperative agreements, and dissertation awards. All research proposals are peer-reviewed and solicited based on the priorities set forth in the research agenda described above. In 2007, we awarded more than $1.6 million to support grants for research on the developmental pathways for the perpetration of intimate partner violence, sexual violence and child maltreatment; the efficacy/effectiveness and safety of screening interventions for intimate partner violence in primary care settings, and the efficacy/effectiveness of primary prevention strategies to prevent the perpetration of violence. In 2007, we also awarded $3 million to support research cooperative agreements in four priority areas. These areas included: assessing the association between bullying experiences and sexual violence perpetration; evaluating strategies for the prevention of abusive head trauma; secondary analyses of existing data to identify potentially modifiable protective factors for youth violence; and developing and evaluating the impact of either a family-based or dyad-based primary prevention strategy on physical intimate partner violence. Four dissertation awards were made in 2007 for a total of about $100,000. These dissertation awards for doctoral candidates focus on violence-related injury prevention research in minority communities. The aim of the awards is to encourage investigators to build research careers related to the prevention of violence-related injuries, disabilities, and deaths in minority communities.

In addition to violence specific awards, the CDC Office of the Director has other grant mechanisms that can support violence prevention work. For instance, CDC provides funds for conferences, dissertation research, mentored public health research, and translation. Information on conference support can be found at www.cdc.gov/od/pgo/funding/HM08-801.htm. The CDC Office of Public Health Research (OPHR) funds dissertations on public health issues with variable award sizes according to what is necessitated by each individual dissertation. OPHR also offers research funds to provide support and "protected time" for an intensive, supervised career development experience in the basic, behavioral, and applied sciences related to health promotion, disease prevention, injury and disability prevention, and health protection leading to research independence. Moreover, in 2007, the OPHR offered funding for research that sought to accelerate the translation of research findings into public health practice through implementation, dissemination, and diffusion research. There are abundant opportunities for behavioral scientists to get CDC research funding.

Extramural research Funding Opportunity Announcements (FOAs) for which CDC is currently accepting applications can be seen on the CDC website. Below the current open FOAs, there are links to FOAs from prior years that offer excellent background information as to the types of research funded. If you wish to be immediately informed of future FOAs as they are published, you may sign up to join the National Center for Injury Prevention and Control Listserv. To learn more about applying for grants and co-operative agreements, visit the CDC Funding page.

References

Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine. (1985). Injury in America: A continuing public health problem. Washington, DC: National Academy Press.

Corso, P.S., Mercy, J.A., Simon T.R., Finkelstein E.A., & Miller T.R. (2007). Medical Costs and Productivity Losses Due to Interpersonal Violence and Self- Directed Violence. American Journal of Preventive Medicine, 32(6), 474-482.

Doll L., Bonzo S., Sleet D., Mercy J., & Hass E., eds. (2007). Handbook of injury and violence prevention. New York, NY: Springer.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., Marks, J.S. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 14, 245-258.

Hammond, W.R. (2002). Suicide prevention: Broadening the field toward a public health approach. Suicide and Life-Threatening Behavior, 32 (Supplement), 1-2.

Kendall-Tackett, K.A. (2003). Treating the lifetime health effects of childhood victimization. Kingston, NJ: Civic Research Institute, Inc.

National Center for Injury Prevention and Control. (2007). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved September 30, 2007 from www.cdc.gov/ncipc/wisqars.

National Center for Injury Prevention and Control. (2002). CDC Injury Research Agenda. Atlanta, GA: Centers for Disease Control and Prevention.

National Research Council and Institute of Medicine. (2000). From neurons to neighborhoods. The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. Shonkoff, J.P. & Phillips, D.A. (Eds.). Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

National Scientific Council on the Developing Child. (2004). Young children develop in an environment of relationships. Working Paper No. 1. Retrieved August 10, 2006 from www.developingchild.net/reports.shtml.

Public Health Service. (1979). Healthy people: The Surgeon General's report on health promotion and disease prevention. Washington, DC: US Department of Health, Education, and Welfare, Public Health Service, DHEW publication no. (PHS)79-55071.

Repetti R.L., Taylor S.E., & Seeman T.E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330366.

About the Author

Rodney Hammond, PhD, is Director of the Division of Violence Prevention at the Centers for Disease Control and Prevention. He is a Fellow of the American Psychological Association and the APA Division of Health Psychology. He has received the U.S. Dept. of Health and Human Services Secretary's Award for Distinguished Service, for his efforts in public health and mental health collaboration. Dr. Hammond completed his PhD in psychology from Florida State University and his post-doctoral study at Harvard University.