Bridget Freisthler

Understanding the Ecology of Child Maltreatment: A Review of the Literature and Directions for Future Research

Studies examining neighborhood characteristics in relation to social problems, including child maltreatment, have proliferated in the past 25 years. This article reviews the current state of knowledge of ecological studies of child maltreatment. Taken as a whole, these 18 studies document a stable ecological relationship among neighborhood impoverishment, housing stress, and rates of child maltreatment, as well as some evidence that unemployment, child care burden, and alcohol availability may contribute to child abuse and neglect. The authors include a discussion of methodological difficulties in conducting research at the neighborhood level and present a set of recommendations for future research that emphasizes movement from a simple examination of neighborhood-level characteristics toward a theoretically driven explication of processes and mechanisms supported by appropriate multilevel modeling techniques. The final goal of such efforts would be to enable practitioners to develop evidence-based neighborhood interventions that would prevent and reduce child abuse and neglect.

Evaluating alcohol access and the alcohol environment in neighborhood areas.

BACKGROUND This paper examines neighborhood, outlet, and server characteristics related to successful purchases of alcohol by intoxicated patrons and underage drinkers at alcohol establishments. It is hypothesized that outlets in commercial areas near to other premises, with poor exterior maintenance, much advertising, and inexperienced youthful servers will be more likely to sell alcohol to intoxicated and underage patrons. METHODS Data were collected using pseudo-intoxicated patron and apparent minor surveys of randomly selected alcohol establishments in a metropolitan area of northern California. Data collection operations included independent surveillance of these drinking places to establish neighborhood and premise characteristics and pseudo-intoxicated patron and apparent minor stings to assess rates of these forms of illegal alcohol sales. Male actors feigning intoxication and female of-age youth identified as appearing to be 20 years or younger attempted to purchase alcohol at on- and off-premise establishments, respectively. Rates of sales (off-premise) and service (on-premise) were the primary outcomes. RESULTS Apparent minors purchased alcohol in 39% of attempts (95% CI, 34-45%) while pseudo-intoxicated patrons were served alcohol in 58% of attempts (95% CI, 50-67%). Sales to apparent minors were significantly related to percentage of Hispanic residents and areas with greater population density. Sales to pseudo-intoxicated patrons were more frequent when the server was male and appeared to be under the age of 30. These sales were also more frequent in Hispanic neighborhoods with high population density and high numbers of on-premise outlets but were less frequent in African American neighborhoods. CONCLUSION The findings suggest that underage and intoxicated patron sales differ by areas. Both forms of illegal sales of alcohol are more likely in highly populated areas of communities. The findings also suggest that server characteristics are strongly related to sales to intoxicated patrons, suggesting some leverage for responsible beverage service programs in these environments.

Exploring the Spatial Dynamics of Alcohol Outlets and Child Protective Services Referrals, Substantiations, and Foster Care Entries

Controlling for neighborhood demographic characteristics, this study examined the relationship of alcohol outlets with rates of Child Protective Services (CPS) referrals, substantiations, and foster care entries from 1998-2003 in 579 zip codes in California. Data for this panel study were analyzed using spatial random effects panel models. Zip codes with higher concentrations of off-premise alcohol outlets (e.g., convenience or liquor stores) and proportions of Black residents had higher rates of maltreatment. Higher average household size and median household income were generally related to lower child maltreatment rates. More specifically, the model derived estimates that an average decrease of one off-premise outlet per zip code would reduce total referrals to CPS in the 579 zip codes by 1,040 cases, substantiations by 180 cases, and foster care entries by 93 cases. Characteristics of adjacent zip codes also were related to maltreatment rates in local neighborhoods, indicating a spatial dynamic to this relationship. Reductions in number of alcohol outlets per zip code, particularly off-premise outlets, may result in lower rates of child maltreatment.

Moderate Alcohol Use and Depression in Young Adults: Findings From a National Longitudinal Study

OBJECTIVES We examined the association between moderate alcohol use and depressive mood among young adults before and after adjustment for demographic, health, and socioeconomic factors that may act as confounders. METHODS We analyzed 2 waves of interview data collected from 13892 young adults who participated in the National Longitudinal Study of Adolescent Health to compare frequency of depressive symptoms in moderate drinkers with frequency of symptoms in young adults in other alcohol use categories. RESULTS With adjustment for health and socioeconomic factors, frequency of depressive symptoms were similar among moderate drinkers, lifetime and long-term abstainers, and heavy/heavier moderate drinkers but remained significantly higher among heavy drinkers. CONCLUSIONS Moderate alcohol use may have no effect on depression in young adults relative to abstinence from alcohol use.

An ecological assessment of the population and environmental correlates of childhood accident, assault, and child abuse injuries.

BACKGROUND This study examines the relationships of population and environmental characteristics to hospital discharges for childhood accident, assault, and child abuse injuries among youth from 0 to 17 years of age. METHODS The analysis uses aggregate data on populations and environments in 1,646 California zip code areas that were collected for the year 2000. Zero inflated negative binomial models were used to assess ecological relationships between these characteristics and numbers of hospital discharges for childhood injuries from accidents and assaults; negative binomial models were used to assess these relationships for injuries related to child abuse. RESULTS A number of different characteristics were related to the different injury outcomes. Childhood accident injuries were related to measures female headed households, adult to child ratio, and nonalcohol retail establishments (e.g., numbers of gas stations). Assault injuries were related to measures of poverty and vacant housing. All 3 outcomes were directly related to percent of female-headed households, percent African American residents, and density of off-premise alcohol outlets. CONCLUSIONS The results demonstrate that both population and environmental characteristics are significantly correlated with rates of childhood injuries. These results suggest that some environmental characteristics, in particular the presence of many off-premise alcohol outlets in neighborhoods, may reduce the overall level of guardianship of childrens activities in zip code areas, resulting in harm to their children.

Using Bayesian Space-Time Models to Understand the Substance Use Environment and Risk for Being Referred to Child Protective Services

Parental substance misuse has often been cited as a cause of children being referred for investigation of child abuse and neglect. Research on how the substance use environment might affect this relationship is still in its infancy with primarily only cross-sectional studies finding a positive relationship of alcohol outlet density at the level of neighborhoods and alcohol prices at level of states and maltreatment. A longitudinal study shows that increasing female drug-related arrests are related to increasing rates of maltreatment in rural and urban counties. The current study incorporates three aspects of the substance use environment in a panel study of 58 California counties over 4 years (n = 232) to study this relationship for referrals to child protective services (CPS) for child abuse and neglect. We use conditionally autoregressive (CAR) Bayesian models to model the spatial and temporal structure in the data. We find that use of welfare benefits, the number of outliers per population, and the number of drug-related arrests per population are positively related to referrals while unemployment and admissions to publicly funded alcohol and drug user treatment programs are negatively correlated to referrals. Significant spatial structure and space-time relationships are also found. The findings indicate that supply of alcohol and drugs (as measured by number of alcohol outlets and arrests for drug use and sales) may increase risk for being referred to CPS, but treatment for substance use does not increase the risk for referral.

Evaluating Medical Marijuana Dispensary Policies: Spatial Methods for the Study of Environmentally-Based Interventions

In 1996, California was the first state to pass a Compassionate Use Act allowing for the legal use of marijuana for medical purposes. Here we review several current policy and land use environmental interventions designed to limit problems related to the influx of medical marijuana dispensaries across California cities. Then we discuss the special challenges, solutions, and techniques used for studying the effects of these place-based policies. Finally, we present some of the advanced spatial analytic techniques that can be used to evaluate the effectiveness of environmental interventions, such as those related to reducing problems associated with the proliferation of medical marijuana dispensaries. Further, using data from a premise survey of all the dispensaries in Sacramento, this study will examine what characteristics and practices of these dispensaries are related to crime within varying distances from the dispensaries (e.g., 100, 250, 500, and 1,000 feet). We find that some security measures, such as security cameras and having a door man outside, implemented by medical marijuana dispensary owners might be effective at reducing crime within the immediate vicinity of the dispensaries.

An Exploratory Study Examining the Spatial Dynamics of Illicit Drug Availability and Rates of Drug Use.

This study examines the spatial relationship between drug availability and rates of drug use in neighborhood areas. Responses from 16,083 individuals were analyzed at the zip code level (n = 158) and analyses were conducted separately for youth and adults using spatial regression techniques. The dependent variable is the percentage of respondents using drugs in the past year. Neighborhood drug availability (the major independent variable) was measured by the percentage of non-drug users who had been approached to purchase drugs. Data were obtained as part of the Fighting Back community evaluation. For youth (aged 12 to 18), drug sales in adjacent and surrounding areas were positively associated with self-reported drug use in areas where youth were residents. For adults, drug sales within the neighborhood were negatively associated with drug use, while drug sales in immediately adjacent neighborhoods were positively related to self-reports of drug use. Findings suggest that the areas where rates of drug users are greatest are not necessarily the same area where drugs are sold. Designing strategies to reduce the supply of drugs should receive input from city and regional planners and developers, as well as law enforcement and public health professionals.

Understanding the Interplay Between Neighborhood Structural Factors, Social Processes, and Alcohol Outlets on Child Physical Abuse

This article seeks to understand the relative influence of neighborhood structural characteristics (e.g., disadvantage) and social processes (e.g., interactions between residents) on child physical abuse. Using multilevel modeling in a sample of 3,023 parents in 194 zip codes, structural characteristics of factor scores representing residential stability and foreign-born Latino males were negatively related to child physical abuse. High proportions of naturalized and Asian/Pacific Islander families were positively related to the frequency of physical abuse. Higher levels of neighborhood social disorder were related to more frequent physical abuse, while higher levels of collective efficacy were related to less frequent physical abuse. Programs designed to alleviate disorder and increase neighborly interactions may be effective at reducing physical abuse. By understanding the relative importance of the demographic characteristics of neighborhoods and the actions and interactions of residents within the neighborhoods, policy and practice can be tailored more effectively to prevent maltreatment.

Examining the relationship between the physical availability of medical marijuana and marijuana use across fifty California cities.

BACKGROUND The purpose of the current study is to assess statistical associations between individual demographic and personality characteristics, the city-level physical availability of medical marijuana (as measured through densities per roadway mile of storefront dispensaries and delivery services), and the incidence and prevalence of marijuana use. METHOD Individual level data on marijuana use were collected during a telephone survey of 8853 respondents living in 50 mid-size cities in California. Data on medical marijuana dispensaries and delivery services were obtained via six different websites and official city lists. Three outcome variables pertaining to lifetime, past year use, and frequency of past year use were analyzed using random effects logistic models (for lifetime and past year use) and random effects tobit models (for frequency of past 365-day use). RESULTS The current study finds that the total physical availability of medical marijuana through dispensaries and delivery services per roadway mile at the city-level is positively related to current marijuana use and greater frequency of use, controlling for a variety of demographic and personality characteristics. As expected, current physical availability of medical marijuana was unrelated to lifetime use. CONCLUSIONS Regulations on the number and densities of marijuana outlets may be a sufficient means to restrain overall levels of marijuana use within cities. However, alternative use of delivery services may also provide easy access to marijuana and mitigate these effects.