Besides informing a country’s national action plan, VACS data analysis can help communities improve local violence prevention and response efforts by: improving awareness of childhood violence nationally, helping to build capacity and infrastructure, informing other policies and programming, and offering baseline data for funding, monitoring, and evaluation.⁹ Several countries have substantially enhanced their child protection approach after VACS implementation (Table 2). For example, after its initial 2010 VACS, Kenya implemented a multisectorial strategy to reduce the burden of childhood violence through its national action plan. Annor et al recently compared findings from the 2010 VACS and a repeat 2019 VACS and demonstrated substantial declines in the prevalence of physical, emotional, and sexual violence against boys and girls in Kenya.¹³ Although these decreases are likely multifactorial, the increased awareness, investment, and collaborative effort after the 2010 VACS may have played an important role.¹³

VACS data analyses have also helped elucidate the global magnitude of childhood violence and increase awareness. Chiang et al summarized childhood violence prevalence data from the first 7 countries with available VACS data. In most of these countries analyzed, >25% of girls and >10% of boys experienced sexual violence in their childhood; >25% of both girls and boys experienced emotional violence; and >50% girls and >60% of boys experienced physical violence.¹⁴ Although many children experience violence, few know of potential services or seek care after such experiences. Using VACS data from 6 countries, Pereira et al noted that, among children aged 13 to 17 years who experienced physical or sexual violence, 16% to 28% knew where to seek formal care or help and <1% to 25% sought care.¹⁵

VACS data analyses have demonstrated and helped reinforce the relationship between childhood violence and HIV risk, specifically several HIV acquisition risk factors, including infrequent condom use,¹⁶ transactional sex,¹⁷ and forced sexual initiation.¹⁸ Such analyses have also highlighted the association between acceptance of inequitable gender norms and occurrence of violence and HIV risk behaviors.¹⁹ Because of the strong violence–HIV link, global HIV prevention and control efforts have emphasized the importance of preventing, identifying, and responding to childhood violence. For example, PEPFAR has recommended that its programs institute child safeguarding policies and procedures to help prevent violence and adopt or expand trauma-informed services and first-line support for survivors of violence to improve identification and response.²⁰

Usage of VACS data can directly inform HIV prevention efforts such as the PEPFAR-supported multidisciplinary Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program.^21,22 DREAMS aims to help prevent HIV among disproportionately affected adolescent girls and young women (AGYW) in high HIV-incidence countries.²³ A recent analysis of 2019 Namibia VACS data estimated that 62% of all AGYW in Namibia (~140 000 in total) are eligible for the DREAMS program on the basis of having 1 or more age-appropriate HIV risk factors measured in the survey.²⁴ This type of analysis using VACS data can supplement other national health survey and programmatic data to help guide resource planning and prioritization and highlight the influence factors such as childhood violence have on HIV risk among AGYW in high HIV-incidence countries.

Given the burden and impact of childhood violence, increased familiarity with VACS and their data can benefit the domestic and global work of pediatricians and pediatric public health practitioners. Those who intend to work in countries that have completed a VACS can use the survey data, publicly available through VACS country reports and peer-reviewed publications,^25,26 to better understand the magnitude of childhood violence and its associated risk factors and health outcomes in the country. They can also help fill research and knowledge gaps by requesting and analyzing readily available VACS data sets.²⁷ Understanding the context of childhood violence in a country can have direct implications in the design and operation of public health and clinical programs and services targeting youth. For example, several strategies have been pursued in response to previously described VACS findings demonstrating high prevalence of childhood violence and concomitantly low knowledge and utilization of post-violence services: more aggressive screening of potential survivors of violence in various public health and clinical settings,²⁰ implementation of quality assurance tools to ensure survivors are screened appropriately,^28,29 and expansion of postviolence care services such as one-stop centers.¹⁴ VACS data analyses from countries such as Namibia also emphasize the importance of programs that emphasize and teach positive parenting to help strengthen parent–child relationships, prevent childhood violence, and reduce HIV risk behaviors among youth.^30,31

The use of VACS data may also directly benefit the clinical work of pediatricians domestically. For example, familiarity with VACS findings can specifically enhance the care of immigrants and refugees (including ~2 million foreign-born children in the United States³²), particularly those children and young people from countries where VACS have been completed. Although VACS has not yet been implemented in the United States, the CDC is collaborating with a department of health from a major United States city to adapt the VACS methodology and conduct a pilot implementation. This activity will yield useful information for future domestic VACS applications, with potential utility for pediatricians. Through this pilot, VACS exemplifies how a global health initiative can be adapted to have implications for United States public health and health care. In the meantime, national surveillance systems, particularly the Behavioral Risk Factor Surveillance System,³³ can offer timely data on the prevalence of childhood violence and other adverse childhood experiences in the United States to inform clinical care.

In general, findings from VACS reaffirm the substantial levels of adversity that many children experience globally and highlight the risk factors and outcomes associated with violence and other adverse childhood experiences. This understanding, supplemented with evidence-based resources,³⁴ can lead to more effective, trauma-informed care that can prevent and mitigate adversity, build resilience, and improve overall well-being. Ultimately, the high-quality data that VACS yield help understand the impact of childhood violence, aid efforts to control the childhood violence and HIV epidemics, and improve pediatric global health.