Contexts of Violence in Adolescence Cohort Study (CoVAC)

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy


More than one in three adult women globally have experienced physical or sexual violence by their intimate partner. We know that risk of intimate partner violence in adulthood for both women and men is linked to childhood and adolescent experiences of violence. However, less is known about why this is, particularly in low and middle-income countries. Most research on why comes from North America and Europe, where the basic patterns of childhood and adolescent violence exposure are different to many low and middle income country settings, including Uganda.

It is important to study why violence in childhood and adolescence and intimate partner violence in adulthood violence are linked so that we can figure out how to more effectively prevent violence across these time periods. Our study has three goals. The first is to get a better understanding of the patterns of prior violence exposure among young adolescents in Uganda, a low-income country setting. The second goal is to understand in more detail which types of violence exposure in early adolescence are associated with violence in later adolescence and young adulthood. The third is to explore how and why these associations occur, with a view to understanding how both characteristics of the individual, and characteristics of the contexts in which individuals find themselves, might amplify or interrupt these associations.
In order to do this, we are intending to follow 3438 young adolescents over time. We plan to use a mixture of both survey methods with more in-depth interviews and observations to understand participants' views and practices in relation to violence and experiences of growing up in Uganda.

We have already done one survey with young adolescents, their teachers and some of their caregivers in 2014, when the adolescents were aged 11-14 years. We will do a second survey in 2018, when the adolescents are aged 15-18 years, and a third survey in 2021 when they are 18-21 years. In our survey, we ask detailed questions about the use and experience of different forms of violence, the mental health of our participants, and about participants' relationships with different types of people, including romantic relationships. We will gather extensive data on participants' family, school, and other contexts where they spend time, and will analyse how these contexts can support the development of non-violent behaviour and relationships over time.

Our qualitative study will involve in-depth work with a sub-sample of about 36 girls and boys, who reported varying experiences of violence in the 2014 survey, when they were 11-14 years, and who will also be followed up over time from 2018 until 2021. We will speak with these core participants individually, and with groups of friends, and conduct observations in and around the schools and communities where participants find themselves. Through building detailed biographical case studies with these young people, we hope to gain insight into how adolescents experience different forms of violence, and the ways in which their social relationships and networks influence their safety and perspectives and practices on violence. As well as working with this core group, we will collect data from a broader sample of young people, school staff, parents, community members and officials, as well as the broader political and socio-economic landscape, in order to analyse the ways in which the contexts in which young people live enhance risks or help protect young people from violence. This research will improve understanding of what types of mechanisms we can target to help effectively prevent violence across adolescence and into adulthood. Our findings will be new and interesting because very few longitudinal studies have been conducted across this age group, and even fewer in low income country settings. We plan to use these results directly to develop programming in Uganda.

Technical Summary

Intimate partner violence, and violence during childhood are extremely common exposures, and cross-sectional data indicates they are associated. However data from cohort studies is equivocal and little is understood about mechanisms, especially in low income country settings.
We propose an efficient new cohort study that uses data from the existing Good Schools Study in Uganda as a baseline. The main aims of our cohort study are to:
1) examine the epidemiology and patterns of violence exposure in early adolescence;
2) understand which patterns of early adolescent exposure to violence are associated with violence use and experience in later adolescence and young adulthood;
3) explore the pathways by which violence in early adolescence, later adolescence and young adulthood are associated and how context encourages or interrupts these associations.

We will conduct a mixed methods study. We have already collected quantitative survey data from 3438 adolescents in 2014 when they were about age 11-14, as well as their teachers and a subsample of their caregivers. We will do a second survey in 2018 (age 15-18 years) and a third survey in 2021 (age 18-21 years). Analysis will involve fitting mixed regression models and structural equation modelling.

Qualitative data will be collected from 36 adolescent participants who will be followed up at four time points from 2018 to 2021, with data also collected from peers, families, school staff and community members. Drawing on ethnography and participatory research, our analysis will focus on how social processes shape individual biographies over time, following varying experiences of violence, and identifying the contextual dynamics that perpetuate or prevent violence.

This research will generate novel findings which inform the development of violence prevention interventions internationally. Our research team will use the results directly to develop additional programming in Uganda.

Planned Impact

Our impact objectives are to raise awareness about the issue of violence during childhood, adolescence and young adulthood and how this can impact on life trajectories amongst young people; to strengthen understanding of the role of contexts in moderating and mediating longer term effects of violence on young people in Uganda; to inform the development of interventions to prevent violence across the life course, both in Uganda and internationally; and to contribute to the building of interest and capacity in Ugandan junior academics and in the non-governmental organisation sector around violence in adolescence and young adulthood.
In Uganda in particular, nearly 60% of adult women have experienced partner violence. This project will generate information on how to identify who might be at risk very early, to inform the best timing of interventions, and on what factors should be targeted in interventions for the Ugandan context. Interventions informed by this evidence would have the potential to dramatically reduce the negative health and social consequences of violence on future generations.

To engage with the participants, young people, community members, leaders, and Ugandan policy makers, we will invite young people who have been involved in our research in advisory roles to become ambassadors, with support from trained advocates at Raising Voices. We will author written articles for the popular press. Raising Voices has partnerships with 21 radio and television stations in Uganda, who will be asked to help disseminate findings. Raising Voices will lead the development of materials in simple and plain language formats.
To engage with international policy makers, donors and academics, we will aim to publish the study in prestigious peer reviewed academic journals with high readerships. A press-release will be timed to coincide with the publication of the main findings paper, and used to launch the study findings internationally. Results will be presented directly at high level meetings of the World Health Organization, UNICEF, the Department for International Development, and the World Bank. Raising Voices coordinates the regional Gender Based Violence Prevention Network, which is a network of researchers and practitioners in sub-Saharan Africa; and has an accompanying infrastructure (website, newsletters, and so on) through which it will publicise the study findings. The team also has direct links with the Sexual Violence Research Initiative, which has a listserve and organises a biannual conference; the Gender-Based Violence Prevention Network, the Child Protection in Crisis Learning Network, which is a network of academics who do research on child protection'; and the Global Working Group to End School Related Gender Based Violence, a multi-sectoral group convened by UNGEI and UNICEF to strengthen evidence-based policy, practice and research on sexual and gender-based violence.

We also have a central capacity building commitment, led by Dr Walakira. Under the supervision of Dr. Walakira and the research team, junior staff at Makerere will be able to utilise quantitative and qualitative data from the study to support their own postgraduate research on child protection and violence against children in Uganda, and will receive one on one mentorship and support from members of the research team to improve skills in advanced qualitative and quantitative analysis methods, as well as writing for publication.
Raising Voices will be able to use the results of our study directly to inform future intervention development. We will share results directly with other NGOs and intervention developers to encourage the further development of evidence based programming in the field.
Description Education in the Time of COVID-19, field research blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact A blog (on the UCL webpage: ) written by our qualitative researchers to spark interest in the CoVAC covid phone survey report. The CoVAC qualitative study has involved annual fieldwork along with regular 'staying-in-touch' calls, to maintain contact and help reduce attrition. For this sub-study we expanded these calls to discuss with young people their experiences of Uganda's lockdown measures, which were among the most stringent measures in Africa from late March 2020, and eased in late July 2020. Findings of our study 'Young people, inequality and violence during the COVID-19 lockdown in Uganda' can be found here.
Year(s) Of Engagement Activity 2020
Description Mixed-methods emerging findings stakeholder engagement-Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Raising Voices hosted two seminars in February 2020, at which the research team shared emerging findings on the themes of family contexts, punishment in homes and schools, sexual and intimate partner violence, and youth (un)employment and violence. This is an example of how researchers can enhance the practical work of NGOs by sharing research skills, real time analysis of data and how it can inform refinement of interventions. The workshops engaged national and district government officials from different sectors, including education, gender, police and child protection, along with NGOs and donors in discussions about how to target interventions to create safer contexts for young women and men. 
Year(s) Of Engagement Activity 2020
Description Stakeholder engagement: workplace violence 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact Makerere University, Kampala, hosted workshop: presented violence at work for adolescents in and out of school using CoVAC data. Engaged Ugandan national government officials from different sectors, including work, education, gender, police and child protection, along with NGOs and donors
Year(s) Of Engagement Activity 2020