Prevalence Of Child Maltreatment Research Articles

Widening epidemiological data on the prevalence of child maltreatment: Validation of the German ICAST-R in a student sample and national household survey

BackgroundA number of instruments for measuring child maltreatment (CM) prevalence have repeatedly been used across different countries. Although they hold the potential for providing benchmarks to tackle the gap of lacking comparability of CM prevalence across countries, contextual information about the adverse experiences such as perpetrator, chronicity, frequency, or severity are rarely covered. The ISPCAN Child Abuse Screening Tool - Retrospective (ICAST-R) covers these important dimensions. The German version increases the number of available versions to 21 different languages. Spoken by about 120 million people, German is one of the 20 most prevalent languages around the world. Moreover, the ICAST-R is intended to be used with young adults. This study further aims at adding towards the gap of psychometrics in older age groups. MethodsAnalyses are based on both a sample of German students (n = 333) and a nationally representative household survey (n = 2515). The validation process covered six steps: (1) Analyses of missing data on single items, (2) calculation of descriptive statistics to estimate the prevalence CM as well as subjective severity and main perpetrators. (3) Structural validity of the four conceptualized subtypes of CM (neglect, physical abuse, emotional abuse and sexual abuse) was tested using confirmatory factor analyses (CFA). Next (4), equivalence testing by multigroup confirmatory factor analyses (MGCFA) on age groups was conducted within the representative sample; (5) reliability was tested by determining internal consistencies for each subscale via the McDonald's Omega, Kuder-Richardson 20 (KR-20), and Cronbach's alpha. Lastly (6), criterion validity was tested in regression models comparing depressive/anxious symptomatology for single victimization and polyvictimization. ResultsThe German ICAST-R yielded low missing values items in both samples. 16 % of the participants in the national household survey reported neglect, 20.3 % physical abuse, 22.2 % emotional abuse, and 8.6 % sexual abuse. Polyvictimization was prevalent with 20.6 % of subjects reporting >2 types of CM. Students in the pilot-survey reported much higher prevalence estimates than participants in the nationally representative sample. The types of CM subjectively rated as most harmful were emotional abuse and sexual abuse. In both samples, structural validity was similarly confirmed as CFA was reproducing the four conceptualized subtypes of CM with adequate fit (household survey: CFI 0.919, TLI 0.907, RMSEA 0.017, SRMR 0.046). Internal consistency achieved acceptable and comparable values for all three types of coefficients; criterion validity was established with a significant dose-response effect of CM experiences on both anxiety and depressive symptoms/diagnoses. Age dependent analyses on structural validity (MGCFA) and reliability in the household survey revealed potential weaknesses of items. ConclusionThe German version of the ICAST-R both widens the possibility of international CM prevalence comparison and provides novel epidemiological data for Germany on subjective severity of CM and CM perpetrators. Even in the presence of a marked selection bias, the ICAST-R had similarly good psychometric properties in the student and nationally representative household sample. Except for issues with two items, equivalence testing was comparable across age groups.

Addressing the needs of infants and toddlers exposed to maltreatment: Examining the impact of an integrated early head start & children and youth services program

Tragically, our nation is witness to the increasing prevalence of child maltreatment, with the highest prevalence among children under three years of age (Administration for Children and Families, 2020). For every 1,000 children under the age of one in the U.S., more than 25 of them are victims of maltreatment. Even more shocking is the fact that an estimated 1,840 children die from abuse and neglect with almost half (45.4%) of all fatalities from maltreatment occurring in children under one year of age (US Department of Health and Human Services, 2019). In 2002, the Office on Child Abuse and Neglect established the Early Head Start Child Welfare System Initiative as a joint effort between the Office of Head Start and the Children’s Bureau. Funding was provided to 24 grantee sites to increase integrated delivery of services to infants and toddlers who were involved in the child welfare system. Programs emerging from this initiative reflect the gold standard for integrated care among developmental and health programs. However, empirical understanding about the implementation and effectiveness of integrated services for infants and toddlers is lacking (Manz et al., 2019). Addressing this gap, this study examined the association of dosage indicators and child outcomes for an integrated Early Head Start and Children and Youth Services Program (EHS/CYS) program involving a state-led Children and Youth Services Program and Early Head Start center-based program. Program data were analyzed to determine the relative benefits of this EHS/CYS program for infants and toddlers dependent upon their age and duration of enrollment. The objective of this study was to yield information that could improve service delivery and outcomes. Results suggested that longer enrollment duration led to increased attainment of developmental milestones in the areas of cognitive, language, and social emotional development. Future directions for research as well as implications for policy are presented.

Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic.

Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic.

Culturally adapting an evidence-based parenting intervention for the Chilean context: Balancing fidelity, context, and cultural relevance.

The dissemination of evidence-based parent training (PT) interventions remains extremely limited in Latin American countries. This is concerning when considering the high prevalence of child maltreatment associated with punitive parenting practices across countries in the region. Furthermore, efforts to disseminate PT interventions must be conducted by adhering to the core parenting components that have established effectiveness for such interventions, while ensuring contextual and cultural relevance for focus populations. In this manuscript, we describe the cultural adaptation of an evidence-based PT intervention in the context of Chile. This initial phase of adaptation was informed by the theoretical tenets of the Ecological Validity Model of cultural adaptation (Bernal et al., J. Abnorm. Child Psychol., 23, 1995, 67). According to findings from a qualitative thematic analysis conducted with five interventionists in training, therapists perceived that the intervention's core components were relevant to Chilean caregivers who participated in the parenting program. Interventionists also provided specific suggestions to enhance the intervention's contextual and cultural relevance. This investigation illustrates the importance of culturally adapting evidence-based interventions according to comprehensive cultural adaptation frameworks, prior to engaging in large-scale dissemination of adapted interventions in Latin American contexts.

Child abuse and neglect in Brussels during the COVID-19-lockdown

BackgroundIt is likely that the circumstances during the COVID-19-lockdown in Belgium increased the incidence and prevalence of child abuse and neglect (CAN) due to exacerbated risk factors and new COVID-19-related stressors. However, traditional reporters had less contact with children which could lead to undetected cases of CAN. ObjectiveGain insight into the number and profile of CAN reports filed to the Brussels Confidential Center of Child Abuse and Neglect (CCCAN) during the COVID-19-lockdown. Participants and settingA dataset comprising 536 CAN reports from periods before (N = 442) and during the lockdown (N = 94). MethodsCharacteristics about the report, reporter, victim and his/her family, perpetrator(s) and the trajectory with the CCCAN were registered. The number and characteristics of reports during the lockdown were compared to those of reports before the lockdown. ResultsThe number of advisory questions (p = .506, d = .377) and allegations (p = .095, d = 1.206) remained unchanged. During the lockdown, the risk assessment of advisory questions was higher (p = .011, d = .280), they evolved more into social exigency investigations (p < .001, φ = .246) and were referred more often to judicial authorities (p = .010, φ = .163). Allegations were filed more often by the helpline, police and judicial authorities (p < .001, φ = .590) during the lockdown and involved more Dutch-speaking (p = .016, φ = .166) victims. ConclusionsThe number of CAN reports remained the same during the lockdown but their profile changed.

Does Trauma Exacerbate Criminal Behavior? An Exploratory Study of Child Maltreatment and Chronic Offending in a Sample of Chinese Juvenile Offenders.

(1) Background: Maltreated children are at increased risk for juvenile delinquency. Extant research has explored the effect of child maltreatment on either the initial risk of juvenile delinquency or general juvenile recidivism. However, little is known regarding the effect of child maltreatment on chronic offending. (2) Methods: Using a sample of 695 male juvenile offenders incarcerated in a centralized juvenile reformatory of the province X located in Southwest China, this study investigates both the prevalence of child maltreatment and the effect of child maltreatment on chronic offending among the juvenile offenders. Descriptive statistical analyses and multinomial logistic regression were utilized to conduct the analyses. (3) Results: A vast majority of the juvenile offenders experienced at least one type of child maltreatment. Moreover, maltreatment was generally found to be more prevalent in chronic offenders than in one-time offenders and recidivists. Results from a series of logistic regression analyses revealed that among five specific maltreatment types, only physical abuse exerted a statistically significant and positive impact on chronic offending. (4) Conclusions: The findings highlight the importance of providing early prevention and intervention programs to juvenile offenders who were physically abused in order to reduce general chronic offending as well as chronic violent offending.

Prevalence Versus Evidence: A Closer Look at the Research Available for Serving Children Exposed to Maltreatment and a Response to Hyter's Call for Trauma-Informed Care.

In an October 2021 post of The ASHA LeaderLive, Dr. Yvette Hyter emphasized the need for trauma-informed services for children exposed to maltreatment in the wake of the COVID-19 pandemic. Inspired by her call, we discuss how the pandemic created a high-risk context for maltreatment, the speech-language pathologists' (SLPs') role in prevention and intervention, reflect on the gap in evidence for maltreatment within empirical journals aimed at the speech-language pathology audience, and reiterate Hyter's call for trauma-informed care as a guide for clinicians serving children exposed to maltreatment. We searched for empirical evidence within journals aimed at SLPs focused on maltreatment to get an estimate of the available research. For comparison, we consulted the same journals for the number of publications covering other risk factors or conditions with similar impacts on communication skills but with lower prevalence rates. Compared to other risk factors or conditions with lower prevalence rates, the disparity between the evidence aimed at SLPs and the prevalence of childhood maltreatment was difficult to ignore. Given the current circumstances, we encourage clinicians to seek information about the communicative effects of exposure to maltreatment beyond journals aimed specifically at speech-language pathologists, stress the need for trauma-informed care instruction during graduate schooling, increase awareness of our role in preventative care, and call for more research on intervention services tailored specifically for children exposed to maltreatment.

A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children.

Child abuse is a preventable phenomenon of considerable concern resulting in significant child mortality and morbidity. We analyze various abuse lesions such as radiological (visceral and skeletal lesions and those associated with head trauma) and cutaneous (burns, bruises, bites, etc.) to enhance streamlined identification of injuries in cases of physical child abuse. For effective results, it is essential to remain mindful of all background factors, such as the caregiver setting and the prevalence of child maltreatment in the concerned community while acknowledging the possibility of natural causes (genetic diseases such as osteogenesis imperfecta and hemophilia, or acquired abnormalities) that can mimic NAT and cause confusion in diagnosis and treatment. The margin of error in cases of abuse is negligible, therefore, making its diagnosis a momentous as well as challenging clinical task. An ineffective diagnosis can have detrimental emotional consequences for the family and may even expose the child to future potentially fatal episodes of abuse. Hence, there is a need to direct special focus on the importance of accurate history taking and immediate, responsible reporting to authorities, as well as to child protective services. Therefore, considering the multifactorial approach this subject requires, this review aims to delve into prevalence statistics, various risk factors, and their effect on psychological health to offer a near-complete regulation to ensure an effective understanding of NAT on part of doctors, social workers, and other relevant authorities.

Alleviation of Child Abuse as a Religious Duty

In Kenya, cultural practices have idiomatically remained a big thorn in the flesh among the various pastoral communities of Kenya. These pastoralist regions have remained traditionally undeveloped areas; either by design or by default. Such areas have posed a major challenge to Sustainable Development Goals (SDGs) No. 5 globally, as well as in Kenya. This research article sets out to investigate the role of the Catholic Church in alleviating Child abuse in Kajiado County, which is directly addressing SDG No. 5, which requires the “Elimination of all harmful practices, such as child [abuse], early and forced marriages and female genital mutilation.” Specifically, the research article evaluates the Catholic Church's social teachings and activities which enhance the alleviation of child abuse in Kajiado County. Besides identifying the challenges faced by the Catholic Church, it equally assesses the strategies adopted by the said Church in order to overcome this enigmatic problem of child abuse. This research article is set on the premise that the failure to eradicate child abuse will lead to the continuous psychological, emotional, physical and poor developmental growth of children, hence failing to attain SDG No. 5. The research article is justified by the need to respond to the alarming reports by media, opinion leaders and members of the community concerning the prevalence of child abuse amongst the Maasai communities in Kenya. For good results, this research article has adopted a descriptive survey design in order to collect in-depth data from a diversified sample of respondents who represent the whole Kajiado County population. Simple random and purposive sampling methods were used to choose a sample size of a number of respondents. At the end of the research article it has been revealed that the Catholic Church has social teachings on caring, creating a safe environment for children and ably demands integrity from the assigned the care-givers. Although it was an uphill task and a major challenge in reporting and investigating cases of child abuse, due to some cultural restrictions, the Church has adopted measures such as forming the Diocesan children and youth departments, which helps in formulating policies and advises their respective Church committees on appropriate measures to be taken on child protection. It is finally recommended that the civil authorities and the Sub-County Children Department could protect victims of abuse through giving proper information on the children rights and also by speedily liaising with the authorities in arresting child abusers.

Legal Duties of Researchers to Protect Participants in Child Maltreatment Surveys: Advancing Legal Epidemiology

Legal Epidemiology Author Ben Mathews Studies of the prevalence of child maltreatment respond to a public policy imperative to better understand and prevent child abuse and neglect. These studies span domains of law, public health, and legal epidemiology. When conducting them, researchers must comply with legal duties to protect research participants. Australia has a complex legal environment, with additional challenges when participants are children, or are in danger. Duties arise in three bodies of law, vary across States and Territories, and require statutory interpretation, conceptual analysis, and operationalisation. This article conducts the first comprehensive analysis of researchers’ legal duties to protect participants in child maltreatment surveys. It contributes new understandings of the operation of mandatory reporting duties in child protection law, duties to report child abuse offences in criminal law, and the duty of care in negligence law. The analysis informs conclusions about the applicability of these duties, and indicates a legally compliant, ethically sound, and operationally practicable approach. Findings are relevant to multiple settings.

Use of Self-Figure Drawing as an Assessment Tool for Child Abuse: Differentiating between Sexual, Physical, and Emotional Abuse.

Child abuse is a worldwide phenomenon with adverse short- and long-term mental and physical negative consequences, with a huge gap between the prevalence of child abuse and disclosure rates. The study aimed to examine and validate the self-figure drawing as an assessment tool to differentiate between three forms of child abuse, i.e., child sexual abuse (CSA), child physical abuse (CPA), and child emotional abuse (CEA). Following the ethical approval, 1707 Thai children (13–18 years old) from the general population (schools) were asked to complete a self-report anonymous questionnaire consisting of four measures (Demographics, Childhood Trauma Questionnaire (CTQ), The Medical Somatic Dissociation Questionnaire (MSDQ), and The Disclosure of Trauma Questionnaire (DTQ)). After completion, they were asked to draw themselves. There was a significantly positive link between the reluctance to disclose and the experience of abuse, indicating that the more severe the abuse the higher the reluctance to disclose. The findings broaden the knowledge of movement and symbols as representations of inner personal conflictual material. Additionally, it substantiates self-figure drawing as an assessment tool and assists practitioners in early child abuse detection.

Māori Health Review: Oranga Tamariki and the Well Child Tamariki Ora review

It is well established that Aotearoa, New Zealand has high rates of child abuse compared to other OECD (The Organisation for Economic Co-Operation and Development) countries. From 2007 to 2017, 12% of homicides were of tamariki (children) under 12 years of age. On average, a child dies every five weeks from family violence, ranking Aotearoa 7th highest for child homicide and 35th out of 41 OECD countries for child wellbeing outcomes. Inequities in health outcomes exist outside of child abuse as well — Māori tamariki with meningococcal disease are hospitalised at 3.5 times the rate of non-Māori, non-Pasifika children. Māori tamariki with skin infections are also hospitalised at 2–2.5 times the rate of non-Māori, non-Pasifika children. These examples serve to highlight the inequitable outcomes Māori tamariki experience in both disease and abuse. With the prevalence of child abuse, there is a corresponding amount of activity in the child protection sector. Oranga Tamariki is the branch of government that oversees care for children of the state, youth offenders, and children at risk of harm from violence. In the 12 months prior to September 2021, 5100 children were entered into the care and custody of Oranga Tamariki. Out of these children in state custody, 57% identified as Māori and a further 11% identified as both Māori and Pasifika.5 These statistics serve to demonstrate the inequitable picture that makes up child protection interventions and outcomes in Aotearoa. The conclusive evidence that we have a child abuse epidemic in our country needs to be framed in the context of its inequitable representation. It is Oranga Tamariki and its subsidiaries that are responsible for upholding the legislative duty of the New Zealand Government as the Crown partner in Te Tiriti o Waitangi (the Treaty of Waitangi) to provide equitable outcomes for Māori children and their whānau (families).

\u201cAn uncomfortable topic\u201d: Health professionals' perspectives on child protection capacities, training offers and the potential need for action in Germany

BackgroundChild maltreatment, due to its high prevalence and often long-lasting (health and/or psycho-social) consequences, is one of the main reasons for global health inequalities. The medical field offers many opportunities to support affected children. This gives physicians and other health professionals the opportunity to provide protective measures and therapies to affected children at an early stage. However, the level of training concerning child protection is often too low among health professionals. This can affect the quality of care as well as providing the appropriate treatment and thus, the long-term (health) burden. The present work aims to survey the state of knowledge and capacities of health professionals regarding child protection in medicine and elicit health professionals' perspectives who absolved a child protection online course on a potential need for action in Germany.MethodsFrom June 2016 until February 2021, 3,360 health professionals were interviewed. Using quantitative and qualitative items, the questionnaire assessed demographic and professional background information as well as assessments regarding the awareness of child protection, abilities in child protection among health professionals and training offers in medicine.ResultsThe analysis indicates that the topic of child protection in medicine is not as present as the high prevalence of child maltreatment would imply. The majority (94.0%; n = 3.159) of the health professionals stated that they need more knowledge and capacities regarding child protection in medicine. More than half of the health professionals assessed the importance of the issue of child protection as low among health professionals. The reasons cited included child protection as an uncomfortable topic, an unwillingness among managers, and a lack of training on the topic.ConclusionsThere is too little awareness and importance regarding child protection in the medical field in Germany. Hence, it is difficult to ensure adequate care for those affected. Child protection topics should be mandatory in the training curricula of all health professionals, and quality standards for prevention and intervention should be implemented in medical institutions. Furthermore, networking in child protection has to be improved, and medical campaigns should address the topic to sensitize health professionals and society to the issue and to destigmatize the topic.

“A STUDY TO ASSESS THE PREVALENCE AND TYPES CHILD ABUSE AMONG CHILDREN STUDYING IN SELECTED SCHOOLS OF BARDOLI, GUJARAT WITH A VIEW TO DEVELOP INFORMATIONAL BOOKLET.”

A descriptive study was conducted to assess the prevalence and type of child abuse among children studying in selected schools of Bardoli, Gujarat. A quantitative descriptive survey approach was used for 556 school children between 7 yrs. to 10 yrs studying in selected schools of Bardoli. The sample where drawn through convenience sampling technique. The purpose of study was to assess the prevalence and type of child abuse among children and to nd out the association between the prevalence and type of child abuse with their selected socio demographic variables and to develop an informational booklet for children about child abuse and preventive strategies. A child abuse screening tool was used to assess the prevalence and type of child abuse in children and socio demographic tool used to assess socio demographic variables of samples. The collected data were analyzed by using descriptive and inferential statistics. Results depict that the prevalence of child abuse were 69.60 % among children and Majority of children had experienced physical abuse (69.42 %). and 16.73% experienced emotional abuse 12.95 % experienced child neglect and 1.26 % are the victims of Sexual abuse there was a signicant association found between the prevalence and type of child abuse in children with age, gender, year of studying, type of family, previous information regarding child abuse .It is very evident from the result that it is required to take prompt measures to improve sensitization and continuous awareness regarding child abuse in children to prevent the incidence of child abuse.

Consequences of child maltreatment victimisation in internalising and externalising mental health problems

AbstractPurposeThe literature on the prevalence of child maltreatment is extensive, but studies are required to assess the impact on mental health to enhance the effectiveness of intervention programs.MethodThus, a field study was undertaken to evaluate depression, anxiety, and anger in 65 child victims of multiple types of maltreatment.ResultsThe results showed that child maltreatment victim (CM‐V) reported more depressive (36%), anxiety (45%), and anger (69%) symptoms than the normative sample. However, subjects were asymptomatic in approximately 25% of depression, 20% anxiety, and 5% of anger. Epidemiologically, the results revealed that the probability of caseness among the CM‐Vs sample increased to around 85% for depression and anxiety and 90% for anger.ConclusionsThe clinical, social, and legal implications of the results are discussed.

Childhood Trauma in Patients With PAH-Prevalence, Impact on QoL, and Mental Health-A Preliminary Report.

Background/ObjectiveChild maltreatment is associated with increased risk of psychological consequences, contributes to morbidity and has long lasting effects on mental health and quality of life. Child maltreatment has not been assessed in patients with pulmonary arterial hypertension (PAH). We examined the prevalence of child maltreatment and determined their impact on disease severity in patients with PAH.MethodsA cross-sectional observational multicenter study at two PH centers in Germany was conducted. Patients with a confirmed diagnosis of PAH were given a self-administered questionnaire. Child maltreatment using the Childhood Trauma Questionnaire (CTQ), quality of life (QoL), anxiety, depression, and lifestyle factors were assessed and enhanced by clinical parameters 6-min walk distance (6MWD), WHO functional class (WHO FC), and serum levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Prevalence rates of child maltreatment were compared to the general population and impact of child maltreatment on disease severity was calculated by logistic regression analysis.ResultsTwo-hundred and seventeen patients, 71% female and a median age of 56 years were enrolled in this study. Patients with PAH had higher rates of emotional abuse and lower rates of physical neglect compared to the German population while rates of emotional neglect, physical abuse, and sexual abuse did not differ between patients and German population. Patients with any form of child maltreatment were more likely to be active smokers, had a worse QoL and more anxiety or depression. Moderate associations between child maltreatment, mental health, QoL, lifestyle factors and clinical parameters could be observed. Logistic regression analysis showed a significant impact of CTQ-total score on disease severity with an OR of 1.022 (95%-CI: 1.001–1.042, p = 0.035).ConclusionWe found a higher rate of child maltreatment in patients with PAH in comparison to the German population. Correlations suggest moderate associations between CTQ-scores and mental health as well as QoL. Child maltreatment had significant impact on disease severity. However, effects were moderate. We conclude that child maltreatment has effects on mental health and quality of life in patients with PAH and may have limited effect on disease severity.

Child Maltreatment During School and Childcare Closure Due to the COVID-19 Pandemic.

The aim of the present study was to examine child maltreatment prevalence rates during the first COVID-19 related national closure of schools and childcare settings (the lockdown) in the Netherlands. Based on reports of childcare professionals and primary and secondary school teachers (N = 444) the prevalence of child maltreatment during the 3 months of this first lockdown was estimated at almost 40,000 children, or 14 per 1,000 children. The prevalence of emotional neglect was found to be three times higher during the lockdown compared to a period without lockdown. This significant difference was reflected in overall emotional neglect as well as for two main subtypes of emotional neglect: educational neglect and witnessing domestic violence. No significant differences were found for other types of child maltreatment. Most of the reported cases of maltreatment were already problematic before the lockdown and became worse during the lockdown. The results of this study indicate that the closure of schools and childcare settings may have enormous negative consequences for vulnerable children.

Problems faced by Children in Ecuador: Realizing the Rights of Children

There is limited information available on the prevalence of child abuse in developing countries, particularly in South America, despite substantial study on the link between childhood physical, emotional, and sexual abuse and mental health problems. The culture of Ecuador is a colourful fusion of African, European, and American Indian customs. Even though children's situations in Ecuador have significantly improved recently, more has to be done, notably in the areas of education, healthcare, gender equality, and children's everyday living circumstances. Despite recent considerable improvements for children in Ecuador, more has to be done, particularly in the areas of education, healthcare, gender equality, and children's day-to-day living conditions. With the establishment of the Declaration of Human Rights and the Convention on the Rights of the Child, the current study seeks to develop a human rights-based strategy to realise every child's rights, particularly those of the most disadvantaged, and to heed the call to "leave no child behind" in order to uphold those rights for every child in Ecuador. The nation frequently implements fresh tactics to improve child protection. Despite these initiatives, children's concerns continue to hinder the country's development. The absence of regulations and actions by the government to protect school-aged children is one of the problems that has to be resolved first.

National Trends in Emergency Department Visits for Child Maltreatment, 2007-2014.

To understand the prevalence of child maltreatment-related emergency department (ED) visits in the United States, we examined data from the 2007 to 2014 Nationwide Emergency Department Sample. Based on existing literature, International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9 CM) ED discharge codes for children less than 10 years of age were characterized as specified child maltreatment, defined as visits with an explicit maltreatment ICD-9 CM or external causes of injury codes. The prevalence of child maltreatment visits per 100,000 children in the United States (based on Center for Disease Control Wide-ranging ONline Data for Epidemiologic Research estimates) overall and by sociodemographic factors was examined, and tests for trends over time were evaluated with Cochran-Armitage tests. Analyses were conducted in 2019. The prevalence of child maltreatment based in ICD-9 CM discharge codes ED visits dropped from 69.2 visits per 100,000 in 2007 to 65.9 visits per 100,000 in 2014; this trend was statistically significant. The prevalence was lowest in 2010 (60.1 visits per 100,000 children). There were increases observed for some demographic groups in this period. Throughout the 8-year period examined, the prevalence of child maltreatment visits was highest for physical abuse compared with other forms of maltreatment, higher for boys compared with girls; highest for children younger than 1 year, and higher for children living in neighborhoods with the lowest median income compared with children in higher-income neighborhoods. The Nationwide Emergency Department Sample data set is a valuable surveillance tool for examining trends in child maltreatment. Future studies should explore what factors may explain variations in child maltreatment over time to best develop prevention strategies.

Syndemics and the etiology of opioid misuse among women: A qualitative study

The opioid epidemic remains a public health priority in the United States. There is evidence that women are experiencing disparities within the epidemic, including an earlier onset of prescription opioid misuse and a higher prevalence of child maltreatment, interpersonal violence, and mental health disorders. The purpose of the current study was to explore the social context of opioid misuse initiation among women using a syndemics framework. In-depth interviews were conducted between July 2019 and February 2021 with 56 women who had a past-year history of opioid misuse. Interview transcripts were transcribed verbatim and analyzed with MAXQDA software. Thematic content analysis was used to develop a detailed explanation for the social process of opioid misuse initiation among women through the lens of syndemics. Women's shared experiences provide evidence of the co-occurring and synergistic factors that increase their risk for initiating opioid misuse and constitute syndemic conditions. Findings revealed the centrality of traumatic events in women's lives; child maltreatment, particularly sexual violence and parental substance misuse, were prevalent and influential to women developing patterns of substance misuse as a way to cope with emotional pain. The presence of pain conditions that conferred access to prescribed opioids further compounded women's vulnerability for opioid misuse initiation. The syndemic conditions that women experience represent a critical call to action to prioritize women's health and social needs within the opioid epidemic. Prevention strategies should address violence against women and girls, as well as pain management practices that attend to trauma and psychological distress.