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International Review of Psychiatry

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Canaries in the coal mine: Interpersonal violence,gang violence, and violent extremism through apublic health prevention lens

David P. Eisenman & Louise Flavahan

To cite this article: David P. Eisenman & Louise Flavahan (2017) Canaries in the coal mine:Interpersonal violence, gang violence, and violent extremism through a public health preventionlens, International Review of Psychiatry, 29:4, 341-349, DOI: 10.1080/09540261.2017.1343527

To link to this article: http://dx.doi.org/10.1080/09540261.2017.1343527

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ARTICLE

Canaries in the coal mine: Interpersonal violence, gang violence, and violentextremism through a public health prevention lens

David P. Eisenmana and Louise Flavahanb

aDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of CaliforniaLos Angeles, Los Angeles, CA, USA; bHealth and Medicine Division, National Academies of Sciences, Engineering, and Medicine,Washington DC, USA

ABSTRACTThis paper asks what programmes and policies for preventing violent extremism (also called‘countering violent extremism’, or CVE) can learn from the public health violence preventionfield. The general answer is that addressing violent extremism within the wider domain of publichealth violence prevention connects the effort to a relevant field of research, evidence-basedpolicy and programming, and a broader population reach. This answer is reached by examiningconceptual alignments between the two fields at both the case-level and the theoretical level.To address extremist violence within the wider reach of violence prevention, having a sharedmodel is seen as a first step. The World Health Organization uses the social-ecological frameworkfor assessing the risk and protective factors for violence and developing effective public-healthbased programmes. This study illustrates how this model has been used for gang violence pre-vention and explores overlaps between gang violence prevention and preventing violentextremism. Finally, it provides policy and programme recommendations to align CVE with publichealth violence prevention.

ARTICLE HISTORYReceived 14 February 2017Revised 20 April 2017Accepted 23 April 2017

KEYWORDSTerrorism; extremism;violence; violenceprevention; gang violence;public health

Introduction

Policy-makers and professionals working to preventideologically-motivated violence are turning to publichealth for frameworks and collaboration. Extremistviolence has population-level health effects, as do thepossible policy and programme responses (Boscarino,Adams, Figley, Galea, & Foa, 2006; Eisenman, et al.,2009). Public health approaches and professionals canhelp by convening and integrating the knowledge andparticipation of diverse communities and organiza-tions, facilitating needs assessments and logical pro-gramme planning, identifying and adapting evidence-based programmes, and conducting and disseminatingrigorous programme evaluations (National Academiesof Sciences Engineering and Medicine 2017; Weine,Eisenman, Kinsler, Glik, & Polutnik, 2016).

When asking what a public health approach mightlook like we find an answer in the alignments betweenpreventing violent extremism and the broader vio-lence prevention field. This paper asks what prevent-ing violent extremism (also called ‘countering violentextremism’, or CVE) can learn from the experience,knowledge, and successes of the violence prevention

field. The general answer is that addressing violentextremism within the wider domain of public healthviolence prevention connects the effort to applicabletheoretical frameworks, a relevant field of research,evidence-based programming, and broader populationreach and resources. We focus on gang violence, apotentially comparable form of violence, to illustratethe successes and challenges of prevention modelsthat are used across the field of violence prevention.With few empirical studies to draw from, the argu-ment presented here is a conceptual one, and we pro-vide evidence supporting it where it is available. Ourgoal is to align the field of CVE with the broader fieldof violence prevention in programme, policy, andresearch.

The case for a violence prevention approach

Recent terrorist cases illustrate how violent extremismmay overlap with other forms of violence. AhmadKhan Rahami, the 28 year old who planted bombs inNew York City and New Jersey in 2016, was sur-rounded by violence—his own and his family’s. He

CONTACT David P. Eisenman deisenman@mednet.ucla.edu Division of General Internal Medicine and Health Services Research, David GeffenSchool of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA, USA� 2017 Institute of Psychiatry and Johns Hopkins University

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was arrested in 2012 for violating a domestic violencerestraining order. In 2014, he was arrested andcharged with aggravated assault. He was againarrested and spent 2 months in jail in 2014 for stab-bing his family. Rahami’s mother, Najiba Rahami, hadbeen charged with child abuse in 2010 after inflictingcorporal punishment on her 7-year-old child, accord-ing to court documents. Omar Mateen, who killed 49and wounded 53 in an Orlando nightclub, reportedlybeat his ex-wife, even holding her hostage at onepoint. Mohamed Lahouaiej Bouhlel, who drove atruck into crowds gathered for Bastille Day celebra-tions in the French city of Nice, killing 84, had a his-tory of violence convictions for armed theft, domesticviolence, and attacking a motorist after a traffic acci-dent. Boston Marathon bomber, Tamerlan Tsarnaev,was arrested for domestic assault and battery of awoman. Colleen LaRose, a.k.a. ‘Jihad Jane’, who wasimplicated in a plot to assassinate Swedish cartoonistLars Vilks, was a victim of physical and mental abusein her youth, including repeated rapes by her ownfather. Dylann Roof lived in a family destroyed bydomestic violence before he grew up and killed ninepeople in a church in Charleston, SC. As a child,years before he killed 14 people in San Bernardino,CA, Syed Rizwan Farook endured a home in whichthe children protected their mother from injury whenthe father, who was also often suicidal, assaulted her.

Research is sparse in the CVE field that systematic-ally accounts for history of exposure to violence,whether as a victim or as a perpetrator. Gill, Horgan,and Deckert’s (2014) review of open source docu-ments for 119 lone-actor terrorists, disclosed that37.8% of their sample had ‘previously engaged inviolent behaviour’. This likely under-estimates previ-ous violence perpetration and victimization, sinceintra-family violence and other violence are greatlyunder-reported, especially in public documents. In ananalysis of 71 terrorists, Horgan, Gill, Bouhana, Silver,and Corner (2016) reported that 57.5% had previouscriminal convictions, although the proportion thatwas for violent offenses is not provided.

Nevertheless, the cases above reflect the violenceprevention field at large, which finds the co-occur-rence of violence perpetration: persons who commitone form of violence are more likely to commit otherforms (Wilkins, Tsao, Hertz, Davis, & Klevens, 2014).Violence rarely is an isolated incident. Different typesof violence, say violence in families and violence incommunities, are linked in many important ways andshare risk factors (WHO, 2008). Also, patterns of vio-lence across the lifecycle recur in which victims of

violence and trauma in childhood are at higher risk ofviolent behaviour in later life (WHO, 2008). As PaulGill once said about Omar Mateen’s violence againsthis ex-wife, violence is, in a sense, a ‘learned psycho-logical skill … Having a history of violence mighthelp neutralize the natural barriers to committing vio-lence’ (Taub, 2016). In this way, interpersonal vio-lence, such as domestic violence for instance, maybethe ‘canary in the coal mine’, a precursor of furtherviolence to come (Chemaly, 2016).

Understanding violent extremism through asocial ecological model

To address extremist violence within the wider reachof violence prevention, we see having a shared modelas a first step. The social-ecological framework is amodel that both the World Health Organization andUS Centers for Disease Control use in violence pre-vention for assessing the problem and developingeffective public-health based preventions.

The ecological model is based on evidence that nosingle factor can explain why some people or groupsare at higher risk of interpersonal violence, while othersare more protected from it. Instead, the model viewsinterpersonal violence as the outcome of interactionamong many factors at four levels: the individual, therelationship, the community, and the societal. In thismodel, the interaction between factors at the differentlevels is just as important as the influence of factorswithin a single level. For example, longitudinal studiessuggest that complications associated with pregnancyand delivery (that is, individual risk factors that maylead to neurological damage and psychological or per-sonality disorder) seem to predict violence duringyouth and young adulthood, mainly when they occur incombination with other problems within the family (aclose relationship factor) such as poor parenting practi-ces (Butchart, Phinney, Check, & Villaveces, 2004).

The four levels can be used to describe risk factors,protective factors, as well as strategies for pro-grammes. Figure 1 presents the framework as a wayto think about potential risk factors for violentextremism, and Figure 2 shows how it can be used tothink about potential protective factors and preven-tion approaches. The social-ecological model has pro-ven useful in violence prevention. Where violenceresearchers spent many years asking why some peoplebecame violent, and identifying the strongest risks fac-tors, the ecological framework recognized that no sin-gle risk factor is sufficient, or even necessary, forviolence to occur. Combinations of risk factors andpathways may converge to cause violence, and the

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combinations may differ under different circumstan-ces (Butchart et al., 2004).

The Individual Level of the model identifies bio-logical and personal history factors that increase therisk for violent extremism. These might include fac-tors that increase the likelihood of perpetrating ideo-logically-motivated violence such as age, mentalillness, history of trauma, abuse and discrimination,grievances, and attitudes and beliefs that support vio-lence (Bhui, Hicks, Lashley, & Jones, 2012).Interventions for individual-level influences are oftendesigned to affect an individual’s social and cognitiveskills and behaviour, and include approaches such ascounselling and educational training sessions that sup-port non-violence and encourage individuals to chal-lenge violence and intolerance.

The Relationship Level examines close relationshipsthat may increase the risk of perpetration. A person’sclosest social circle—peers, partners, and family mem-bers—can shape an individual’s behaviour and influ-ence the range of experiences that increase risk.Critical domains may include social bonds and mar-ginalization (Lyons-Padilla, Gelfand, Mirahmadi,Farooq, & van Egmond, 2015). Family characteristics

producing feelings of schism between traditional cul-ture and Western culture is one suggested factorincreasing the risk of violence (Weine, 2012).Interventions at this level might include peer orbystander intervention skill development programmesthat give persons the tools to change the climate oftheir social circles by rejecting or intervening whenthey hear or witness behaviours that support violence(Horgan, Williams, & Evans, 2015).

The Community Level examines the real-worldenvironments, such as schools, workplaces, and neigh-bourhoods, in which social relationships occur, andseeks to identify the characteristics of these settingsthat are associated with becoming perpetrators of vio-lence. In one study, Al-Qaida inspired perpetratorslived in communities with higher unemployment ratesand higher percentages of households living below thepoverty level (Roberts, Fitzpatrick, Smith, &Damphousse, 2013), a finding supporting the theorythat ‘place matters’. Interventions for community levelinfluences are typically designed to impact the climate,systems, and policies in a given setting.

Finally, the Societal Level looks at the macro-levelsocietal factors, such as domestic economic,

Poverty; poor educa�on systemsLimited economic opportuni�esHigh local crime levelsLow social cohesion/connectednessInadequate social servicesSitua�onal factors

Rapid social changeEconomic inequalityGender inequalityS�gma regarding mental distress & help-seekingCultural norms that support violenceDiscrimina�onAccess to lethal methods (firearms)Global, na�onal or regional armed conflict

*Factors listed are illustrative of the model and do not reflect evidence of association.

Fragmented cultural iden�tyAnger or hos�lity to othersPsychological/personality disturbancesAlcohol/substance misuseVic�m of child maltreatmentViolent or suicidal behavior—past or currentContact with charisma�c leaders jus�fying violenceAccess to lethal means

Fractured family structuresFamily history of violence or suicideCurrent rela�onship/marital turmoil; in�mate partner violenceFinancial, work stressFriends & family that engage inviolenceAssocia�on with aggressive or delinquentpeersEmo�onally unsuppor�ve family

Societal Community Rela�onship Individual

Figure 1. Ecological model: Potential risks factors for ideologically motivated violence. (Modified from Butchart et al., PreventingViolence. WHO, 2004).

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educational, health, and social policies, as well as globalpolitical, social, and military policies, that help create aclimate in which violence is encouraged or inhibited.This would also include religious and cultural beliefs,societal norms, and media influences that address vio-lent extremism. Interventions at this level might includepolicies that reduce gaps and tensions between groupsof people and strategies to reduce societal hostility thatviews Islam, migrants, and Muslims with suspicion.

Research in gang violence often applies a socio-eco-logical model to identifying risk factors related togang matriculation and engaging in violent behaviour.Merrin, Hong, and Espelage’s (2015) study of over17,000US youths reported risk factors at multiple lev-els, including depression/suicidal ideation (individuallevel), family dysfunction, and gang-involved family(family level), and being bullied (peer level).Protective factors included a sense of belonging(school level) and adult support in the neighbourhood

(neighbourhood level) (Merrin et al., 2015). The prob-ability of gang involvement increases as the numberof risk factors increases (Howell & Egley, 2005; Katz& Fox 2010; Lenzi et al., 2015).

Understanding violent extremism through agang violence lens

A recent question is the link between what pullsyouth to join gangs and what compels persons to vio-lent extremism (Decker & Pyrooz, 2015). A large lit-erature has studied the risk factors for gangmembership, and reviewing it is beyond the scope ofthis paper. In comparison, the research on risk factorsfor extremist violence is in its infancy (Decker &Pyrooz, 2015). Risk drivers for violent extremism pur-ported to overlap with gang membership driversinclude social isolation or marginalization, the absenceof adult support in the neighbourhood, a radicalized

Societal Community Rela�onship Individual

Support policies for economic stabilityAssure food, housing, health, & educa�onReduce s�gma regarding mental distressPromote cultural norms that discourage violenceSocial media counter-narra�vesReduce access to firearms (persons on terroristwatch list)

Strengthen and coordinate faith & serviceorganiza�onsStrengthen educa�onal systems, voca�onaltraining programsEnhance community cohesionEnhance cultural integra�onCombat “culture of violence”Promote mental health help-seekingLocal counter-narra�ve campaign

Enhance capaci�es for coping & resilienceEnhance sense of belonging & self-worthIden�fy & treat mental health/substance abuseRehabilitate violent personsReduce access to lethal means

(P) Social bondsSupport high-risk parents; intervene in fractured familiesUse community, health system, & court-based screening todetect in�mate & family violenceHelp peer networks confront support of violenceNurture strong iden�fica�on to faith leaders cri�cal of VESupport families to enhance health, food security, economicopportuni�es

*Factors listed are illustrative of the model and do not reflect evidence of association.

Figure 2. Ecological model: Protective factors and Interventions to prevent ideologically motivated violence. (Modified fromButchart et al, Preventing Violence. WHO, 2004).

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social network, and transitional phases in youth devel-opment. According to a report from the US NationalInstitute of Justice exploring lessons learned in violentextremism in Canada, the UK, and the US, prelimin-ary research indicates that some common risk factorsinclude having a family member, peer, or acquaint-ance involved in radicalization; adopting belief sys-tems that accept or justify violence; and threats orperceived threats against the individual or the individ-ual’s loved ones (United States, National Institute ofJustice, Office of Justice Programs, 2015). Empiricalevidence identifies similar risk-factors for gang mem-bership, including having a peer or family memberinvolved in a gang, cultural norms that are acceptingof gang behaviour and violence; and feeling unsafe inthe neighbourhood (Howell, 1998; United StatesDepartment of Justice, Office of Justice Programs,National Gang Center, 2017). Still, risk factors forgang membership vary depending on the study sam-ple, and there is a similar absence of consistent anddeterminative risk factors for who perpetrates extrem-ist violence (Bhui et al., 2012).

Only one study has directly examined whethergang involvement and support for violent extremismare distinct or co-occur in a community sample. Elliset al. (2016) examined the relationship between ganginvolvement and openness to extremist violenceamong refugee Somali youths resettled in the US andCanada. Her latent profile analysis described fivegroups in relation to their attitudes and behavioursaround gang involvement, delinquency, openness toviolent extremism, civic engagement, and politicalengagement. No group had both high self-reportedgang involvement and support for violent extremism.However, feeling marginalized from Somali andAmerican society was associated with the groupsmarked by either gang involvement or support forviolent extremism. Feeling discriminated against washigher in groups marked by either gang involvementor support for violent extremism. PTSD and highanxiety/depression scores were significantly higher inthe group with high gang involvement than thegroups with support for violent extremism. Althoughthe study is limited by its non-random sample andcross-sectional nature, it does suggest that working toreduce social marginalization may help reduce gangviolence and a susceptibility to extremist violence.

Preventing violent extremism using gangviolence prevention models

CVE can learn from programmes preventing gangmembership and gang violence. First, the challenges

of gang violence prevention mirror current issues inthe CVE field. Both fields grapple with the first stepof a public health violence prevention approach,namely problem identification—what does it mean tobe a violent extremist and who is a gang member?What defines ideological extremism and which youthgroups are gangs? (Gebo, 2016). A recent reportfrom Bullock and Tilley (2008) illustrates the prob-lems encountered when a violence prevention pro-gramme is fielded without clear knowledge of therisk drivers. A UK-based programme aimed toreduce gang-related violence by reducing youth’smembership in gangs. The project sought to identifygang members and those at risk of becominginvolved and then to offer them preventative anddiversionary interventions. However, practitionerswere unable to come up with clear criteria for beinga gang member or at risk of becoming a gang mem-ber. As a result, the project identified over 10-timesthe number of eligible youth than it was planning towork with. Also, youth and parents felt stigmatizedby the label of gang member. CVE programmes cantake heed from this experience in gang violence pre-vention. Identifying which communities and individ-uals should be included in CVE programmes hasbeen controversial, partly because there are no vali-dated criteria for assessing risk of perpetratingextremist violence. CVE programmes that attempt toaddress the equivalent of gang membership or risk ofgang membership, for instance support for extremistbeliefs, may find themselves similarly overwhelmedand applying a stigmatizing label.

Successful gang violence prevention programmesoperate across the micro-, meso-, and macro-levels ofthe ecological model, in recognition that it is the clus-tering and accrual of risk factors across the ecologicalmodel that increases the likelihood of violent behav-iour, and multi-pronged approaches across levels ofthe model provide the greatest promise in reducingviolent outcomes.

An exemplar programme is Cure Violence (Howell,2010), which applies concepts of epidemiology andthe social-ecological model to detect and interruptconflicts. It identifies and intervenes with individualswho are at the highest risk for violent behaviour andit alters relationships and influences social norms thatunderlie the acceptance of violence within commun-ities (Cure Violence, 2016). Although evaluations havefound mixed support for positive intervention effectsin some but not all neighbourhoods (Butts, Roman,Bostwick, & Porter, 2015), the model could prove use-ful for reducing extremist violence, given its potential

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transferability. Additionally, Cure Violence is mindfulof message delivery, employing former gang membersas ‘Interrupters’, who are deployed into communitiesto deliver intervention and prevention programming.This component may prove useful in cases of violentextremism, given the cognitive biases and sense ofcommunity victimization present in individuals whoare drawn to extreme ideologies.

Another model using a multi-pronged and tieredapproach to gang-violence prevention is the GangReduction and Youth Development (GRYD) modeldeveloped in Los Angeles, CA. The GRYD approachincludes primary and secondary prevention pairedwith targeted intervention. Primary preventionapproaches included community-based effortsdesigned to build resistance to gang activities amongcommunity members, whereas secondary preventionefforts consist of youth- and family-based preventionmethods targeted towards youths identified as beingat the greatest risk of joining a gang. These effortsfocus on attitude and behaviour change that, at theindividual level, strengthen internal decision-makingprocesses, while at the macro level, focus on alteringthe community’s attitudes that lead to a widespreadacceptance or tolerance of violence. Risk is assessedusing the Youth Service Eligibility Tool (YSET), itselfderived from empirical data related to risk factorsassociated with gang membership in Los Angeles.Using the YSET assessment as a pre- and post-test,after 6 months of exposure to the programme overhalf of the youth identified as being at greatest risk nolonger met the eligibility threshold. Additionally,although criminal gang activity decreased substantiallythroughout Los Angeles during the GRYD pro-gramme’s assessment, GRYD-targeted areas experi-enced higher aggregate declines in gang violence thancomparison areas (Cahill et al., 2015; Dunworth et al.,2013).

Lessons learned from the GRYD-model are beingshared with practitioners, researchers, policy-makers,and law enforcement personnel leading counteringviolent extremism programming in Jordan, Pakistan,Tunisia, East Africa, and Europe (Cespedes, 2015), asprogrammes embedding CVE in gang prevention aregrowing in the US, UK, and Canada (Johnson, 2015;Rhodan, 2015). The GRYD model provides other les-sons for CVE. GRYD recognizes that mere gangmembership is not a crime, rather it is the violentand criminal behaviour that flows from membershipthat breaks the law. Likewise, in the US-based context,radicalization is not criminal, but it is the violencerooted in radicalization that breaks the law and is a

significant public health problem. It is likely that thisviolence-prevention-focused approach, partnered withGRYD’s conscious effort to delink from suppression-based police activities, engendered trust among thecommunity-members and youth who were engaged inthe program—in the same way that Cure Violenceengendered trust through the use of Interrupters. Theneed for trust among community members is particu-larly important when dealing with marginalized orstigmatized communities—an important componentto consider in the context of violent extremism,wherein pathways towards radicalization often includea feeling of community-victimization (Jensen &LaFree, 2016).

Finally, research efforts to better understand thelinks between gender-based/intimate-partner violenceand gang violence (The Violence PreventionCoalition of Greater Los Angeles 2016) are under-way—a connection that, as suggested in the terroristcases above, exists to some degree in perpetrators ofviolent extremism. Empirical data validating andexploring this connection remains a need in bothgang violence prevention and the prevention of vio-lent extremism. It should be noted that similar com-munity-based approaches focused on attitude andbehaviour change have shown tremendous promisein reducing intimate-partner violence (Abramskyet al., 2016); efforts to prevent both forms of violencecould possibly be integrated in future efforts. Thoseworking in violent extremism should be aware ofthese efforts and perhaps seek to incorporate thefindings of this work and related studies of violenceprevention into their work.

Recommendations

There are likely many areas of overlap between pre-venting violent extremism and the broader violenceprevention field. We discussed some of the overlapsfocusing on the field of gang violence as an example.This includes possible overlaps in risk drivers, oppor-tunities for prevention, and fundamental challengesfor the fields. The overlaps also provide an opportun-ity for CVE to learn from the successes and challengesof this field. We provide the following recommenda-tions for policies and programmes that prevent violentextremism based on the above analysis. While someof the recommendations are specific to the US, webelieve they have global relevance.

1. When we reframe violent extremism as a violenceprevention problem, it becomes clear that expert-ise in violence prevention should be at the table

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when preventing extremist violence is the topic.Public health and criminal justice agencies are thetwo parts of government most impacted by vio-lence, but public health is only sporadically apartner. The complex nature of violent extremismnecessitates collaborative approaches to preven-tion and multi-sectoral solutions.

2. We recommend funding programmes within thebroader field of violence prevention. This willallow CVE to connect to a rich set of researchand programming that may surface alignmentsand facilitate learning. We need to understandand emphasize the common features and linkagesbetween extremist violence and the other types ofviolence occurring in families, schools, and com-munities. Persons working on gangs, on preven-tion of family violence in immigrantcommunities, and on preventing violent extrem-ism have varying areas of expertise and interest.Separating CVE out as one more field encouragesa piecemeal approach to violence prevention.Lack of collaboration obscures the commonalities.In the US, violence prevention funding to publichealth has mostly come from the US Centers forDisease Control and Prevention (CDC) and theUS Department of Health and Human Services,Substance Abuse and Mental Health ServicesAdministration. Supplementing these violenceprevention funds with money for addressing vio-lent extremism may mitigate the community dis-trust of CVE accompanying funding fromsecurity agencies such as the US Department ofHomeland Security (Allam, 2017). It may avoidstigmatizing communities. Most importantly,incorporating violent extremism into existing vio-lence prevention programmes rather than creatingnew programmes from scratch produces abroader population approach and makes betteruse of societal resources.

3. Funding is growing for CVE programmes, butcommunities have few experts to help guide themin this topic. The CDC should develop and field acadre of on-call experts to provide technical assist-ance on both violence prevention and extremistviolence to the new crop of community-based,violent extremism programmes. A model for thisis the CDC-funded National Centers of Excellencein Youth Violence Prevention, which work withcommunities to implement broad-based strategiesto reduce violence.

4. It is critical to fund and conduct research on theconnectivity between other forms of violence and

violent extremism. Research on violent extremismis generally conducted in isolation from other vio-lence research. The scope and effectiveness ofCVE programmes is likely to be enhanced if thisfragmentation can be overcome. The social eco-logical model provides a framework for organiz-ing the factors that put people at risk for orreduce risk of perpetrating violence (risk and pro-tective factors) and the prevention strategies thatcan be used at each level to address these factors.Looking at the entire composite of individual,relationship, community and state factors that,when combined, correlate with violent extremismmay provide us with new opportunities for pre-vention. Rather than looking for “abnormalities”in individuals, we might attempt to understandthe interaction between the individual and thesituation.

5. As with other forms of violence, we recommendmulti-pronged approaches occurring across levelsof the ecological model to preventing ideologic-ally-motivated violence.

Conclusions

Programmes and policies for preventing violentextremism will benefit by applying theories, research,and best practices from disciplines beyond its trad-itionally dominant fields of political science, crimin-ology, and psychology. From the growing interest inthe contributions public health science and practicecan make, we recommend focusing on the contribu-tions that violence prevention science and practicemay provide. We hypothesize that violent extremismshares common risk and protective factors with otherforms of violence. We offer the social-ecologicalmodel as a framework for organizing this explorationand a shared and comparative research agenda.Looking for the commonalities between violentextremism and other forms of violence can lead tomore theory-informed programmes to prevent violentextremism. Primary and secondary prevention effortsthat are grounded in the ecological model could proveuseful counterparts to more traditional criminal just-ice approaches to suppressing violent extremism.While risk factors may continue to converge anddiverge between gang violence and ideologically-moti-vated violence as the evidence-base continues to grow,the methods and theoretical underpinnings, asdescribed in the gang violence context here, are wor-thy of deeper exploration within a violent extremismcontext.

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Our idea that violent extremism is more similar tothan dissimilar from other common forms of violencerepresents a departure from current and historicalways in which violent extremism has been character-ized. A key outcome of this proposition is it connectscountering violent extremism programmes with publichealth-based violence prevention programmes.Creating awareness in the violence prevention fieldabout how it may contribute will foster additionalresources and capacities while embedding violentextremism in broad-based programmes at the localand national levels. Further empirical data is requiredto test our assumptions and inform theories and mod-els of violent extremism prevention.

Disclosure statement

The authors report no conflicts of interest. The authorsalone are responsible for the content and writing of thepaper.

Funding

This work was supported by the Science and TechnologyDirectorate, United States Department of HomelandSecurity [Cooperative Agreement 2015-ST-108-FRG006].

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