School of International Service, American University, Washington, DC 20016, USA.
Center on Health, Risk, and Society, American University, Washington, DC 20016, USA.
Int J Environ Res Public Health. 2019 Sep 18;16(18):3465. doi: 10.3390/ijerph16183465.
El Salvador, Guatemala, and Honduras rank among the top 10 countries experiencing violence in the world, despite not being at war. Although there is abundant literature on generalized violence in this "northern triangle" of Central America as a driver of out-migration to the United States, very little is known about the perspectives and experiences of youth who do not migrate. This study aimed to elicit the emic perspectives of youth residing in the region on how the day-to-day generalized violence produces a pervasive threat to the overall health and human security of youth as well as the key protective factors and resiliencies at work. We conducted two separate waves of qualitative research in 2015 and 2018 over a 6-month period, which included 60 in-depth interviews and six focus groups among Salvadoran, Guatemalan and Honduran youth living in urban areas. Qualitative thematic analysis revealed two meta-themes: (1) 'Lack of health,' defined as not experiencing peace within the family, the community, and the country' and (2) 'Resilience.' Thematic clusters that reflect the first meta-theme are: (1) violence as a common occurrence; (2) living in fear and insecurity; (3) victimization; and (4) lack of state protection and services. Thematic clusters for the second meta-theme are: (1) a positive future outlook and a commitment to education; (2) transnational and local family network support; and (3) engagement in community-based youth groups. To interpret the findings, we adopt the Latin American Social Medicine and Collective Health (LASM-CH) approach that prioritizes perspectives from the region. Generalized violence is conceptualized as a systemic phenomenon that is generated and reproduced through the complex interactions of structural inequities and unequal power relations. The findings of this study provide new insights into the implementation of a different approach to address the generalized violence, insights that may guide multi-sectoral health policies and interventions both in the region and transnationally.
萨尔瓦多、危地马拉和洪都拉斯是世界上暴力事件发生率最高的前 10 个国家之一，尽管它们并未处于战争状态。尽管关于中美洲“北部三角”地区的普遍暴力是导致移民到美国的主要因素，有大量文献对此进行了探讨，但对于没有移民的年轻人的观点和经历却知之甚少。本研究旨在了解居住在该地区的年轻人的看法，了解日常普遍暴力如何对年轻人的整体健康和人类安全构成普遍威胁，以及在起作用的主要保护因素和适应力。我们在 2015 年和 2018 年期间进行了两轮独立的为期 6 个月的定性研究，其中包括对居住在城市地区的萨尔瓦多、危地马拉和洪都拉斯青年进行的 60 次深入访谈和 6 次焦点小组讨论。定性主题分析揭示了两个元主题：（1）“缺乏健康”，定义为在家庭、社区和国家内都没有和平；（2）“适应力”。反映第一个元主题的主题集群是：（1）暴力是常见现象；（2）生活在恐惧和不安全之中；（3）受害；以及（4）缺乏国家保护和服务。第二个元主题的主题集群是：（1）对未来的积极展望和对教育的承诺；（2）跨国和当地家庭网络支持；以及（3）参与基于社区的青年团体。为了解释这些发现，我们采用了拉丁美洲社会医学和集体卫生（LASM-CH）方法，该方法优先考虑该地区的观点。普遍暴力被概念化为一种系统性现象，是通过结构不平等和权力关系不平等的复杂相互作用产生和再生产的。本研究的结果为以不同方式解决普遍暴力问题提供了新的见解，这些见解可能为该地区和跨国界的多部门卫生政策和干预措施提供指导。
