Executive Summary
ACTIVA Project
Cultural Norms and Attitudes towards Violence in Selected Cities in Latin America and Spain
Introduction |
Objectives |
Methodology
Introduction
Project ACTIVA, a regional initiative coordinated by the Pan American Health Organization (PAHO), is a multicenter project to evaluate violence and related cultural norms and attitudes in selected cities of the Region of the Americas and Spain. The study represented an inter-American effort supported by technical cooperation provided by the Pan American Sanitary Bureau and by research centers of excellence in the Region, with joint financing by both entities. PAHO provided technical cooperation and financing for the development of the survey, meetings of investigators, revision and compilation of data sets, and dissemination of results. Investigators guaranteed financing from grants from their own country for data collection and analysis.
Violence is one of the most serious threats to public health and safety in the Region of the Americas. Violence is the first cause of death among young males in several Latin American countries and is the largest source of years of life lost (REF). However, the lack of information and the lack of comparative studies among different cultures and countries in the Region has proved to be a limitation to understand the socioeconomic, psychosocial, and cultural factors associated with violence. PAHO thus decided to undertake a comparative study of selected cities in the Region that would make it possible to comprehend the social and personal factors that lead to differences in the violent behavior patterns of urban populations—in particular, violent behaviors in the family and in the community at large.
The objectives of the study were as follows:
- to describe and compare, in a number of cities, the prevalence of verbal and physical aggressive behaviors toward family members, both children and partner, and toward other members of the community, and
- to identify the personal, environmental, and socioeconomic factors associated with such behaviors.
The goal was to generate knowledge to help orient policies and design intervention programs through a public health approach to mitigate and prevent violence in the cities of the Americas.
Design
Project ACTIVA used a cross-sectional design to survey a sample of the population between 18 and 70 years of age living in households in the metropolitan areas of selected cities. Between September 1996 and March 1997, a representative sample was selected in each city by socioeconomic stratum, using a multistage sampling procedure. The sample was stratified by clusters and was proportional in terms of socioeconomic condition and population density. The sample size was estimated at 1200 individuals per city. Individuals were selected in households by systematic sampling without substitution. This calculation assumed a variance and maximum error of a 95% confidence level. Data was collected using a common questionnaire.
In one city, Houston/Austin, a different methodology was employed. The survey was done through telephone interviews of a random sample of adults between 18 and 70 years of age. The questionnaire contained approximately one-third of the questions of the ACTIVA common questionnaire.
Instrument
Instrument development: In January 1996, the Pan-American Health Organization, in collaboration with the WHO Collaborating Center at University of Texas-Houston, organized a meeting in Houston with Latin American investigators to design a common household survey of adults. The first version of the questionnaire was developed in this meeting. During the first semester of 1996, the survey was pilot tested four times, manuals for data collection and data management were developed, and the survey methodology was specified. All the centers and investigators involved in the project were extensively involved in reviewing and refining the protocol and the final design of the questionnaire to be used in the cities. The Psychological Research Institute of the University of Costa Rica served as a processing center for data analysis resulting from the pilot testing of the questionnaire and the preliminary analysis of the final data. The Institute for Studies of Religion (ISER) of Rio de Janeiro, Brazil, facilitated the compilation of the final data set and the review of the sampling methodology.
The process of selection of the items was guided by theory, research on risk factors, and experience of the participating investigators. Social Cognitive Theory (Bandura, 1986) was the theoretical framework that informed the evaluation model. Social Cognitive Theory postulates that behavior is dynamic and that it is influenced by characteristics of the person, other behaviors of the person, and characteristics of the environment where that behavior is performed. These three elements continuously interact and influence each other simultaneously. This continuous interaction is called reciprocal determinism. The environment refers to all factors that are external to the person but can affect the behavior of that person, such as family members or social institutions. How the person reacts to the environment will be influenced by the person’s own cognitive representation of the environment, which could be real or distorted. Thus, evaluating the individual’s perception of the environment can give a good understanding of how the environment is influencing the individual’s performance.
Final questionnaire: The final questionnaire included sociodemographic characteristics of the interviewees and their families, prevalence of aggressive behaviors and of other violence-related behaviors, personal attitudes toward aggressive behaviors, self-efficacy for alternatives to violence, perception of social institutions and the government, and victimization both in the family and in the community.
Sample
The survey was administered to a random, probabilistic sample, stratified by socio-economic status, of adults of eight cities: El Salvador-Bahia (n=1384) and Rio de Janeiro (n=1114), Brazil; Santiago, Chile (n=1212); Cali, Colombia (n=2288); San José, Costa Rica (n=1131); San Salvador, El Salvador (n=1290); Madrid, Spain (n=1105); and Caracas, Venezuela (n=1297). The total sample for these eight cities was 10,821 persons. Due to sampling problems in two cities, Santiago and Cali, the sample had to be adjusted for socio-economic status and gender so that the sample would represent the distribution of the population. In all cities, women were slightly more represented in the sample than in the population. Non-response rates varied by city and socioeconomic status, being highest in the high socioeconomic stratum and lowest in the low stratum.
In Texas, 1110 persons (500 in Austin and 610 in Houston) between 18 and 70 years old were interviewed by phone.
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