For the purpose of this review, community-level indicators that met any definition of community (eg, geographic or virtual), at any community level (eg, neighborhood, county, or state), and unit of analyses (eg, census tract or census block group) were included. To manage the scope of the review, only studies that measured risk and protective factors that are common across 4 or more forms of violence and occur at the community or societal level7 were included. These risk and protective factors are consistent with those outlined in CDC’s Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence.†8 Risk factors at the community and societal levels include neighborhood poverty; diminished economic opportunities; alcohol outlet density; community violence; poor neighborhood support and cohesion; societal income inequality; health, educational, economic, and social policies/laws aligned with best available research evidence; cultural norms that support aggression toward others; and rigid norms around masculinity and femininity. Protective factors at the community and societal levels include community support and connectedness and coordination of resources and services among community agencies.7 In Connecting the Dots, these risk and protective factors were empirically linked to different forms of violence indirectly through community constructs. For example, diminished economic opportunities were empirically linked to child abuse and neglect through neighborhood unemployment rates,21 (link) intimate partner violence through concentrated disadvantage,22 sexual violence through the unemployment rate,23 suicide through the unemployment rate,24 (link) and youth violence through concentrated disadvantage.25 In some cases, the community construct was a direct measurement of the risk or protective factor (eg, alcohol outlet density, income inequality, and poverty). It is important to note that studies often use proxies to measure underlying community constructs for shared risk and protective factors (eg, using voter turnout as an indicator of social capital to measure community support and connectedness), and while overarching risk and protective factors may be linked to 4 or more forms of violence, the underlying constructs and indicators may be linked to less than 4 forms of violence in the extant literature. However, when the community construct has been empirically linked to violence, the indicator used to measure the construct is promising for violence outcomes. Consequently, we have taken the approach of being as inclusive as possible.
The literature related to the community constructs and indicators for violence outcomes is emergent. As such, the findings from this review provide opportunities for prevention researchers to expand the evidence base by testing the direct relationship between specific constructs and indicators identified in this study and multiple forms of violence. Also, while previous research has linked the community and societal risk and protective factors in Connecting the Dots to multiple forms of violence, many of these studies measured these community- and societal-level factors by aggregating data from individual-level surveys. This review sought to identify additional indicators, such as those derived from the United States (US) Census Bureau and other secondary data sources, to measure these risk and protective factors at the community level, mitigate the time-consuming nature of primary data collection of individual-level data, and avoid measurement bias of aggregating individual perceptions, attitudes, and knowledge by reporting only observable indicators of community constructs.