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Violence: from the Political to the Personal Examining Links Between

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Violence: from the Political to the Personal Examining Links Between VIOLENCE: FROM THE POLITICAL TO THE PERSONAL EXAMINING LINKS BETWEEN CONFLICT AND INTERPERSONAL VIOLENCE IN LIBERIA by Jocelyn Kelly A dissertation submitted to the Johns Hopkins Bloomberg School of Public Health in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland March 17, 2017 Abstract Background: Each year, war and interpersonal violence account for a significant burden on morbidity and mortality worldwide. Roughly one third of violence-related deaths are attributed to interpersonal violence and one-fifth are attributed war. New scholarship has shown how violence can spread across populations temporally and spatially. Yet the link between armed conflict and postconflict interpersonal violence is poorly documented. Methods: This dissertation will use multilevel modeling to assess the link between levels of armed conflict at the district level and postconflict individual-level interpersonal violence in a single, conflict-affected nation (Liberia). Armed Conflict Location and Event Data ACLED data will be used to provide a measure of the extent to which a community has been affected by conflict at the district-level during the country’s civil war from 1999-2003. The primary predictor of conflict is whether a district experienced any versus no conflict-related fatalities during war. Demographic and Health Survey (DHS) data from 2007 will provide information about health and social characteristics at the individual level, including the project outcomes of past-year non-partner physical violence (NPPV) and intimate partner violence (IPV). Results: In the bivariate model, conflict as measured by a district experiencing any versus no fatalities, was associated with NPPV (OR 2.62, p<0.001). However, as individual-level demographic characteristics were added during the stepwise model fitting procedure, this association became attenuated and no longer reached significance (aOR 1.43, p=0.197). For IPV, there was a strong association with conflict in the bivariate analysis (aOR 2.10, p<0.001). This ii association remained significant, although attenuated, after individual-level characteristics were added to the final multilevel model (aOR 1.55, p<0.001). Discussion: The impact of political conflict on future interpersonal violence has implications for a country’s ability to achieve lasting peace and prosperity. This research suggests that living in a district that experienced fatalities during war can increase the risk of experiencing interpersonal violence in the postconflict period. These results were more pronounced for IPV than for NPPV. Even after adjusting for known individual-level correlates of IPV, residence in a fatality-affected district was significantly associated with a 50% increase in risk of abuse. iii Committee of Final Thesis Readers Committee Members Department Michele R. Decker, PhD Population, Family and Thesis Advisor Reproductive Health International Health and Courtland Robinson, PhD Population Elizabeth Colantuoni, PhD Biostatistics Judith Bass, PhD Mental Health Alternate Committee Members Renee Johnson Mental Health Population, Family and Kristin Mmari Reproductive Health iv Acknowledgements This dissertation is dedicated to those who have helped me learn throughout my life. To Dr. Justin Kabanga, whose kindness and tireless dedication to the women of Congo has served as an inspiration to me and to all those around him. To Dr. Michael VanRooyen, who created the Harvard Humanitarian Initiative. A space so unique and bold that it changed how I thought about humanity, public health, and the intersection between science and compassion . To my thesis committee for their patience, support and kindness is making this project possible, and to Michele Decker whose tireless dedication to this work made it immeasurably better. To my father, who saw the beauty and symmetry in the world and all the shades between black and white. To my mother - her wisdom, sense of adventure and audacity opened the world for me. To my grandmother, Catherine Noble Deverall, and my Great Aunt, Jean Nielson - and the long line of fearless women who came before them - for serving as role models. To my brother, Stephen, who journeyed with me through all of the early adventures. To my sister, Kelly, without whom I could not have achieved any of this. v Table of Contents Abstract .............................................................................................................................................. ii Committee of Final Thesis Readers .................................................................................................. iv Acknowledgements .............................................................................................................................v List of Tables .................................................................................................................................. viii List of Figures ................................................................................................................................... ix . Introduction ......................................................................................................................1 Background and Significance ......................................................................................................... 2 Specific Aims and Hypotheses ....................................................................................................... 4 Dissertation Overview .................................................................................................................... 6 Chapter One References ................................................................................................................. 7 . Background and Conceptual Framework .........................................................................9 Overview ....................................................................................................................................... 10 Quantifying the Impact of Conflict ............................................................................................... 10 Beyond Battle Deaths: The Ripple Effects of War .................................................................... 13 Violence: from the Political to the Personal .............................................................................. 14 Social Cognitive Theory and Conceptual Framework .................................................................. 20 Liberia Country Profile ................................................................................................................. 28 Chapter Two References ............................................................................................................... 33 . Methods ..........................................................................................................................42 Overview ....................................................................................................................................... 43 Data sources .................................................................................................................................. 44 Study Sample ................................................................................................................................ 48 Dependent Variables ..................................................................................................................... 50 Primary Exposure: Defining Conflict at the District-Level .......................................................... 53 Independent Variables .................................................................................................................. 54 Data Analysis ................................................................................................................................ 57 Ethical Considerations .................................................................................................................. 60 Chapter Three References ............................................................................................................. 62 . Defining the Primary Exposure ......................................................................................64 Quantification of Events and Fatalities ...................................................................................... 65 The Liberian Conflict Across Time and Space .......................................................................... 67 Ways to Measure Conflict Exposure ......................................................................................... 70 Discussion ..................................................................................................................................... 73 Chapter Four References ............................................................................................................... 78 . Non-Partner Physical Violence ......................................................................................79 vi Results ........................................................................................................................................... 80 Discussion ..................................................................................................................................... 91 Chapter Five References ............................................................................................................... 99 . Intimate Partner
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