Adrea D. Theodore

Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas

Context. Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies. Objective. The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports. Design, Setting, and Participants. Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced. Main Outcome Measures. The incidence of physical and sexual maltreatment determined through maternal reports. Results. Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states. Conclusions. Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.

Speak Softly—and Forget the Stick: Corporal Punishment and Child Physical Abuse

BACKGROUND Previous studies have shown an association between spanking and child physical abuse. However, the relationship between more frequent and severe corporal punishment and abuse remains unknown. The objective of this study was to examine the associations between reported spanking, spanking frequency, or spanking with an object and the odds of physical abuse in a representative sample of mothers from North and South Carolina. METHODS This study is a cross-sectional, anonymous telephone survey of adult mothers with children aged<18 years living in the Carolinas in 2002. The analysis was conducted in 2007. Survey responses were used to determine the association between corporal punishment (spanking, spanking frequency, and spanking with an object) and an index of harsh physical punishment consistent with physical abuse (beating, burning, kicking, hitting with an object somewhere other than the buttocks, or shaking a child aged<2 years). RESULTS Mothers who report that the child was spanked are 2.7 (95% CI=1.2, 6.3) times more likely to report abuse. Increases in the frequency of reported spanking in the last year are also associated with increased odds of abuse (OR=1.03, 95% CI=1.01, 1.06). Mothers reporting spanking with an object are at markedly increased odds of reporting abuse (OR=8.9, 95% CI=4.1, 19.6). CONCLUSIONS Although reported spanking increases the odds of reported physical abuse, the relationship between the reported hitting of a child with an object and reported abuse is much stronger. Reduction in this form of discipline through media, educational, and legislative efforts may reduce child physical abuse.

Measuring the Risk of Physical Neglect in a Population-Based Sample

Child neglect accounts for the majority of officially substantiated cases of child maltreatment in this country, although population-based data are lacking. This study estimates the number of children at risk for specific subtypes of physical neglect, using results of an anonymous telephone survey administered to 1,435 mothers of children ages 0 to 17 years in North and South Carolina. Children were considered “at risk for neglect” from lack of enough food, lack of access to medical care when needed, and inadequate supervision. Demographic factors were significantly related to the outcomes of interest, including lower family income with lack of enough food and access to medical care. There was little overlap in children at risk for the different subtypes of neglect. Maternal self-report data can be used to improve researchers’ understanding of children at risk for neglect and to explore gaps in knowledge that might be amenable to intervention and prevention efforts.

Psychological abuse between parents: associations with child maltreatment from a population-based sample.

OBJECTIVE This study examined the association between partner psychological abuse and child maltreatment perpetration. METHODS This cross-sectional study examined a population-based sample of mothers with children aged 0-17 years in North and South Carolina (n=1,149). Mothers were asked about the occurrence of potentially neglectful or abusive behaviors toward their children by either themselves or their husband/partner in the past year. Partner psychological abuse was categorized as no psychological abuse (reference), husband perpetrates, wife perpetrates, or both perpetrate. Outcome measures for psychological and physical abuse of the child had four categories: no abuse (reference), mother perpetrates, father/father-figure perpetrates, or both parents perpetrate, whereas child neglect was binary. Adjusted relative risk ratios (aRRRs), adjusted odds ratios, and 95% confidence intervals (CIs) were estimated with regression models. A relative risk ratio was the ratio of odds ratios derived from multinomial logistic regression. RESULTS Children were at the greatest risk of maltreatment when parents psychologically abused each other versus no abuse: the aRRR for child psychological abuse by the mother only was 16.13 (95% CI: 5.11, 50.92) compared to no abuse, controlling for child age, gender, Medicaid welfare, and mothers level of education. Both parents psychologically abuse each other versus no abuse also results in an aRRR of 14.57 (95% CI: 3.85, 55.16) for child physical abuse by both parents compared to no abuse. When only the husband perpetrates toward the wife, the odds of child neglect was 5.29 times as much as families with no psychological abuse (95% CI: 1.36, 20.62). CONCLUSIONS Partner psychological abuse was strongly related to child maltreatment. Children experienced a substantially increased risk of maltreatment when partner psychological abuse was present in the homes. PRACTICE IMPLICATIONS This study observed that intimate partner psychological abuse significantly increased risk of child maltreatment. Increased public awareness of partner psychological abuse is warranted. Primary prevention should include education about the seriousness of partner psychological abuse in families. Domestic violence and child welfare agencies must recognize the link between partner psychological abuse and child maltreatment and work together to develop effective screening for each of these problems.