Indicators Of Child Maltreatment Research Articles

Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study.

The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. The study is registered as NIHR CRN Portfolio (42900). This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

Intensive home visiting for adolescent mothers in the Family Nurse Partnership in England 2010–2019: a population-based data linkage cohort study using propensity score matching

BackgroundWe evaluated the effectiveness of the Family Nurse Partnership (FNP), an intensive home visiting programme aiming to improve birth outcomes, child health and development, and to promote economic self-sufficiency among...

Derivation of probable child maltreatment indicators using prospectively recorded information between 5 months and 17 years in a longitudinal cohort of Canadian children

BackgroundBoth prospective and retrospective measures of child maltreatment predict mental and physical health problems, despite their weak concordance. Research remains largely based on retrospective reports spanning the entire childhood due to a scarcity of prospectively completed measures targeting maltreatment specifically. ObjectiveWe developed a prospective index of child maltreatment in the Québec Longitudinal Study of Child Development (QLSCD) using prospective information collected from ages 5 months to 17 years and examined its concordance with retrospective maltreatment. Participants and settingThe QLSCD is an ongoing population-based cohort that includes 2,120 participants born from 1997-1998 in the Canadian Province of Quebec. MethodsAs the QLSCD did not have maltreatment as a focal variable, we screened 29,600 items completed by multiple informants (mothers, children, teachers, home observations) across 14 measurement points (5 months-17 years). Items that could reflect maltreatment were first extracted. Indicators were derived across preschool, school-age and adolescence periods and by the end of childhood and adolescence, including presence (yes/no), chronicity (re-occurrence), extent of exposure and cumulative maltreatment. Two maltreatment experts reviewed these items for inclusion and determined cut-offs for possible child maltreatment (n=251 items). Retrospective maltreatment was self-reported at 23 years. ResultsAcross all developmental periods, the presence of maltreatment was as follows: physical abuse (16.3-21.8%), psychological abuse (3.3-21.9%), emotional neglect (20.4-21.6%), physical neglect (15.0-22.3%), supervisory neglect (25.8-44.9%), family violence (4.1-11.2%) and sexual abuse (9.5% in adolescence only). The degree of concordance between prospective and retrospective reports for each type of maltreatment was weak (.038-.110), yet significant (ps<.01), except for emotional neglect (p=.148). ConclusionsIn addition to the many future research opportunities offered by these prospective indicators of maltreatment, this study offers a roadmap to researchers wishing to undertake a similar task.

Association between child welfare reporting rates and the developmental vulnerability of kindergarten children at the neighborhood level

BackgroundIn Canada, more than one in four children are considered vulnerable in at least one domain of development when they enter kindergarten. Recent studies have suggested that this ratio is higher among those who were previously maltreated. However, little is known about this associations at the neighborhood level, although it may be an interesting way to identify risk areas and highlight child welfare system data to prevent public health issues. ObjectiveUsing the census tract as the unit of measurement, this study examines the association between the proportions of vulnerable children in different domains of development upon entering kindergarten, and four indicators of child maltreatment (CM) among 0–5 year olds. Participants, setting and methodThis study is based on the secondary use of data from a survey on the development of kindergartners carried out in 2017, combined with data from child welfare records for that same year. The data have been aggregated on the basis of 759 census tracts located in four health regions of Quebec, Canada. ResultsThe results of spatial regression analyses show that all indicators of maltreatment are positively and significantly associated with each indicator of developmental vulnerability. The size of these associations varies according to the indicators used (β = 0.192, p < .05 to β = 1.587, p < .001). ConclusionThe results highlight the link between CM and school readiness, including potential externalities on neighborhood children. Neighborhoods at high risk of maltreatment could help identify areas with high rate of vulnerable children in early childhood.

The Perception of Child Abuse and Neglect by Those Who Work with Children

The present cross-sectional study was carried out to assess the perception of child maltreatment, knowledge of its predictors, and the ability to identify indicators of abuse and neglect by a sample of professionals working with children in Baghdad. The study group consisted of 90 doctors working in primary health care centers, 75 primary school teachers and 35 kindergartners. Total of 200 interviewees 90were present at the time of the interview, with a response rate of 84.4%. A structured, self-administered questionnaire was used as the study instrument and the professionals were requested to complete this questionnaire. It consisted of demographic and professional data about participants and questions about their perception and recognition of child abuse and neglect. The study was carried out during the period from 15th of January through May 31st 2019, and was conducted in nineteen primary health care centers as well as eight primary schools and four kindergartens in Baghdad, which were all selected by the Simple Random Technique. The results show that primary health care doctors had a significantly higher perception with the highest being for ″severe beating that leaves marks″. 57.8% for abuse situations and ″inattention to child’s cleanliness". 84.4% for neglect situations. They showed greater capability of identifying indicators of child maltreatment, with the highest being for "stuttering″ and "thumb sucking″ 90% for both and the "child is very shy″ which is recognized by more than 80% for the three study groups. Only one factor as a predictor of child maltreatment was recognized by more than 80% of the three study groups which is ″marital and family problems″. The present study may reflect a weakness in the area of child mental health care by professionals working with children which calls for the introduction of mental health training programs to professional working with children.

Therapeutic stays of belarusian children in Italy: evaluation of their mental status, psychological consequences and physical health status

Therapeutic stays are a phenomenon of temporary reception of unaccompanied foreign children from contaminated areas in Belarus, Ukraine and Russia. Aim of the study was to analyze the physical and mental health status of children in therapeutic stays in Italy and the possible presence of a state of child abuse and neglect. The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group composed of 25 Belarusian children in temporary stays in Italy, and the remaining 30 to the control group composed of 30 italian children. Data were collected between July 2019 and July 2020. The evaluation included a careful medical history, an accurate physical examination and an interview, focusing on several factors that can be use as indicators of child maltreatment, intended as physical and emotional neglect. The survey was conducted on a total of 55 children, 25 of which belonging to the treatment group, and the remaining 30 to the control group. Of the 25 children in the treatment group, 8 (32%) are male and 17 (68%) are female, while of the 30 children in the control group, 14 (47%) are male and 16 are female (53%). For each child, we considered the Body Mass Index (BMI), the presence of dental caries, and the showing of learning disabilities or hypoacusis. These parameters can be used as indicators of child maltreatment. The analysis of BMI in the two groups shows that the BMI in the treatment group is significantly lower than the BMI in the control group (P=0.004). In the treatment group 7 (28%) children showed some form of caries whereas in the control group no forms of caries were detected. This result itself shows quite a relevant trend, and to have a quantitative measure of its statistical significancy, we performed a permutation test. The results show that the incidence of dental caries in the treatment group is significantly higher than in the control group (P=0.0023). We used the same procedure to analyse data on the presence of learning disabilities or hypoacusis. The P values we obtained are not significant, but the results still seem to show that there might be a trend of a higher incidence of learning disabilities and hypoacusis in the treatment group, and an extensive study with a larger sample might shed more light on the topic. This study shows that there are indications that suggest a higher risk of child maltreatment in the group of Belarusian children, where maltreatment is understood as physical and emotional neglect to which children are subjected in the institutions and in the group homes where they live. Despite showing only partially significant results, our work could be a starting point for more extensive studies on the topic. These future studies could be extended to other larger samples and other potential maltreatment factors could be evaluated.

Child maltreatment: knowledge, attitudes and reporting behaviour of physicians in teaching hospitals, Egypt.

Lack of diagnosis and reporting of child maltreatment are important problems worldwide. This study aimed to assess the knowledge, attitude and practice of physicians in Alexandria University teaching hospitals about the diagnosis and reporting of child maltreatment cases. A descriptive cross-sectional study was conducted at three hospitals. All physicians working regularly in emergency units were invited to complete a self-administered questionnaire. Data collected included sociodemographic characteristics, knowledge of and formal training on child maltreatment, attitude to dealing with child maltreatment, and experience of child maltreatment cases and reporting behaviour. A total of 90 physicians were included in the study. Only 11% correctly identified all the signs of child maltreatment and 29% correctly answered all questions on the social indicators of maltreatment. Only 41% of the participants had a good knowledge score (≥ 75%) on child maltreatment. Longer work experience (P = 0.019) and older age (P = 0.039) were associated with better knowledge. Of 249 suspected cases of child maltreatment that the physicians reported they had experienced, only 36% were reported. Formal training on child maltreatment (P < 0.001) and older age (P = 0.006) were associated with physicians' reporting behaviour. Over half (56%) of the participants thought their workplaces did not provide them with procedures to follow if they suspected child maltreatment. Physicians' knowledge of the signs and social indicators of child maltreatment was unsatisfactory. Clinical training and education are needed to improve their ability to diagnosis and report cases of child maltreatment.

Opioid overdose events and child maltreatment indicators: Differential county-level associations.

Concerns have been raised that the opioid epidemic has caused increases in child maltreatment and thus, increased child protective system (CPS) caseloads. Understanding the specific impact of the opioid crisis on the child welfare system is a current priority for researchers and policymakers. Yet, research is routinely limited by available measures of the opioid epidemic, maltreatment, or both. Research analyzing broader aspects of maltreatment and the opioid epidemic can improve our understanding of this link, informing decisions about how to target child welfare resources to improve child outcomes. Thus, the purpose of this study was to examine the longitudinal associations between county-level opioid overdose event rates and four indicators child maltreatment.

Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders

Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children’s symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child’s recovery process—both of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.

Effect of worker contacts on risk of child maltreatment recurrence among CPS-involved children and families

The mission and responsibility of child protective services (CPS) is to investigate maltreatment; intervene to protect children from harm; and promote safety, permanency, and well-being (DePanfilis & Salus, 2003; Goldman, Salus, Wolcott, & Kennedy, 2003). In 2015, approximately 7.2 million children in the United States were referred to CPS agencies, and 3.4 million children had an investigation or received an alternative response (US Department of Health & Human Services, 2017). Fluke, Shusterman, Hollinshead, and Yuan (2005) found that about one third of children with an allegation of maltreatment would have at least one re-report within a five-year period. Research indicates that the rates of child maltreatment or changes in indicators of child maltreatment have remained unchanged over time (Gilbert et al., 2012). Despite policies aimed at reducing or preventing maltreatment, the development of CPS systems across the United States, and a CPS workforce, the aggregate effects of the CPS system, services, and worker efforts are not well understood.

Racial and ethnic differences in the prevalence of adverse childhood experiences: Findings from a low-income sample of U.S. women

Despite great interest in adverse childhood experiences (ACEs), there has been limited research on racial and ethnic differences in their prevalence. Prior research in the United States suggests that the prevalence of ACEs varies along socioeconomic lines, but it is uncertain whether there are racial/ethnic differences in ACE rates among low-income populations. This study examined the distribution of ACEs in a sample of 1523 low-income women in Wisconsin that received home visiting services. Participants ranging in age from 16 to 50 years were coded into five racial/ethnic groups, including Hispanics and four non-Hispanic groups: blacks, whites, American Indians, and other race. Following measurement conventions, ten dichotomous indicators of child maltreatment and household dysfunction were used to create a composite ACE score. Five other potential childhood adversities were also assessed: food insecurity, homelessness, prolonged parental absence, peer victimization, and violent crime victimization. Results from bivariate and multivariate analyses revealed that, while rates of adversity were high overall, there were significant racial/ethnic differences. Total ACE scores of American Indians were comparable to the ACE scores of non-Hispanic whites, which were significantly higher than the ACE scores of non-Hispanic blacks and Hispanics. Whites were more likely than blacks to report any abuse or neglect, and they were more likely than blacks and Hispanics to report any household dysfunction. The results underscore the need to account for socioeconomic differences when making racial/ethnic comparisons. Potential explanations for the observed differences are examined.

Correlates of child abuse potential among African American and latina mothers: A developmental-ecological perspective

The child victimization rate in the US has rapidly grown over the past five years. Today, nine out of every 1000 children are victims of some type of child maltreatment, and lifetime costs of child victimization exceed $100 billion per year. Effective policies promoting fairness and child safety must target the most salient indicators of child maltreatment. In this study, we examined three groups of risk factors for child abuse potential with the goal of identifying the most prominent indicators in a sample of 170 African-American and Latina mothers. Specifically, we analyzed the effect of socio-demographic variables (e.g., SES), child-specific behaviors, maternal trauma and corresponding psychological sequelae on child abuse potential. Variables from all three groups were significantly associated with child abuse potential with maternal SES, alexithymia, depression, and child self-control as well as internalizing behaviors having the largest effects. All factors combined captured over 50% of the variation in child abuse potential. The results highlight the need for programs that not only address the financial needs of low SES mothers, but also the mental health outcomes correlated with low SES. Particular emphasis should also be placed on interventions that address children’s social needs, specifically their socio-emotional functioning.

Rethinking the Measurement of Adversity.

Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs. Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin ( N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test-retest reliability of ACEs was also explored. As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test-retest reliability. Implications and future directions toward a second generation of ACE research are discussed.

Correlates of Somatic Symptoms Among African American Males Transitioning From a Public System of Care.

Exploration of somatic symptoms and their correlates among adolescent and young adult African American males are limited in the empirical literature. In the current study, correlates of somatic symptoms among African American males ( n = 74) transitioning from a public system of care, namely, foster care, was explored. Potential correlates assessed included indicators of child maltreatment, approach and avoidance coping strategies, as well as the following emotional and behavioral problems: oppositional defiant disorder, conduct disorder, major depressive disorder, and attention-deficit hyperactivity disorder. Results indicated that meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for conduct disorder was related to increased somatic symptoms. In addition, greater use of seeking social support as a coping strategy was related to fewer somatic symptoms. The findings provide a good foundation for further exploration of individual, situational, and contextual factors that may influence the physiological and psychological stress responses of vulnerable populations of young African American males.

Are we getting the whole picture? Measuring outcomes using routinely collected data in long term follow-up: an example from BB:2-6

The Family Nurse Partnership is an intensive programme of antenatal/postnatal visiting by specially trained nurses to support young pregnant women. The Building Blocks (BB) trial assessed the short-term impact for 1600 teenage mothers and their children from a programme that has existing evidence of longer term benefits. This follow-on study, BB:2-6, will follow-up participants for an additional four years, until their child is six, to determine the longer-term impact of the intervention upon objective indicators of child maltreatment when compared to usually provided health and social care services alone. Follow up will be by linked anonymous data abstraction from the HSCIC and Department for Education, National Pupil Database (NPD). Whilst this model of linkage offers the possibility for long term evaluation and at a lower cost, what are the associated problems in measuring the proposed study outcomes? This presentation will examine the data sources utilised in the study, and how linkage is carried out by each organisation. An initial assessment of linkage rates and its quality will be reported. As child maltreatment data may also be sourced from LA departments of social services, we will discuss what might be gained and lost for the study in moving from utilising data from this source (i.e. collecting direct from LAs) to the NPD. We will also discuss the consequences for certain analyses such as the Markov Chain Modelling which requires detail about stages of progression through a process and how the quality of the NPD could be validated by sampling local authorities.

Association between child maltreatment indicators and developmental problems in early childhood education

Introdução: a experiência de maus tratos constitui-se em um importante fator de risco ao desenvolvimento humano, a curto e longo prazo. Objetivo: caracterizar uma amostra de crianças em início de escolarização quanto à presença de indicadores de maus tratos infantis e à de problemas emocionais e comportamentais e verificar a associação entre essas variáveis. Métodos: a amostra (n = 40) foi composta por todas as crianças do 1º ano de uma escola municipal cujos pais/responsáveis autorizaram, e seus respectivos professores (n = 6). Para a coleta de dados empregou-se o Inventário de Frases no Diagnóstico de Violência Doméstica contra Crianças e Adolescentes (IFVD) e o Teacher’s Report Form (TRF). Procedeu-se a análises descritivas e inferenciais. Resultados: a pontuação média no IFVD foi de 17,82, fora da faixa de risco, segundo as normas do instrumento. Porém, 30% da amostra obtiveram escore superior a 23, o preconizado para suspeitar de maus tratos. Com isso, estabeleceu-se 2 grupos para a comparação no TRF (crianças suspeitas de serem maltratadas/ crianças sem suspeita). Verificou-se diferenças significativas em Total de Problemas e em Problemas Internalizantes, ainda que em termos médios os dois grupos tenham apresentado performances em níveis normais, em todos os subitens. Conclusão: crianças apresentando indicadores de maus tratos apresentaram também indicadores de depressão e ansiedade, ainda que em níveis não clínicos, corroborando outros estudos. Deve-se, entretanto, considerar que a amostra formada por conveniência pode ter introduzido um viés no tocante à severidade/gravidade dos maus tratos abarcados no estudo. Outros estudos, com amostras maiores e mais diversificadas, devem ser realizados.

The role of parental work schedule in CPS involvement

Abstract Using data from the Fragile Families and Child Wellbeing Study (N = 2904), we investigated whether maternal work schedules were associated with Child Protective Services (CPS) involvement and child maltreatment indicators during the first five years of a child's life. We further examined if this association could be explained by demographic characteristics, child care arrangements, maternal health and social supports, economic and hardship characteristics, and parenting practices. Finally, we examined if this association differed by context (i.e., maternal marital status, maternal education, and family income-to-needs ratio). Our regression results indicate significant associations between maternal shift work and mother-reported CPS involvement and mother-reported psychological aggression behaviors. Economic and hardship characteristics explained some of the significant association between maternal shift work and CPS involvement. Economic and hardship characteristics and parenting practices also explained some of the significant association between maternal shift work and psychological aggression behaviors. The obtained significant associations were more pronounced for mothers who were not married, who were high school graduates, and whose family income was either below or near poverty. We discuss the broader social factors associated with employment demands and childcare arrangements.

Adverse childhood experiences and frequent insufficient sleep in 5 U.S. States, 2009: a retrospective cohort study

BackgroundAlthough adverse childhood experiences (ACEs) have previously been demonstrated to be adversely associated with a variety of health outcomes in adulthood, their specific association with sleep among adults has not been examined. To better address this issue, this study examines the relationship between eight self-reported ACEs and frequent insufficient sleep among community-dwelling adults residing in 5 U.S. states in 2009.MethodsTo assess whether ACEs were associated with frequent insufficient sleep (respondent did not get sufficient rest or sleep ≥14 days in past 30 days) in adulthood, we analyzed ACE data collected in the 2009 Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey in Arkansas, Louisiana, New Mexico, Tennessee, and Washington. ACEs included physical abuse, sexual abuse, verbal abuse, household mental illness, incarcerated household members, household substance abuse, parental separation/divorce, and witnessing domestic violence before age 18. Smoking status and frequent mental distress (FMD) (≥14 days in past 30 days when self-perceived mental health was not good) were assessed as potential mediators in multivariate logistic regression analyses of frequent insufficient sleep by ACEs adjusted for race/ethnicity, gender, education, and body mass index.ResultsOverall, 28.8% of 25,810 respondents reported frequent insufficient sleep, 18.8% were current smokers, 10.8% reported frequent mental distress, 59.5% percent reported ≥1 ACE, and 8.7% reported ≥ 5 ACEs. Each ACE was associated with frequent insufficient sleep in multivariate analyses. Odds of frequent insufficient sleep were 2.5 (95% CI, 2.1-3.1) times higher in persons with ≥5 ACEs compared to those with no ACEs. Most relationships were modestly attenuated by smoking and FMD, but remained significant.ConclusionsChildhood exposures to eight indicators of child maltreatment and household dysfunction were significantly associated with frequent insufficient sleep during adulthood in this population. ACEs could be potential indicators promoting further investigation of sleep insufficiency, along with consideration of FMD and smoking.

Child maltreatment: variation in trends and policies in six developed countries

We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.

Child maltreatment increases sensitivity to adverse social contexts: Neighborhood physical disorder and incident binge drinking in Detroit

IntroductionExposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure. MethodsData were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of ≥5 drinks (men) or ≥4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N=1013). ResultsChild maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (B=0.16, p=0.02) and maximum number of past 30-day drinks (B=0.15, p=0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment. ConclusionThe results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.