Jon M. Hussey

Child maltreatment in the United States: prevalence, risk factors, and adolescent health consequences.

OBJECTIVES. The purpose of this study was to estimate the prevalence of child maltreatment in the United States and examine its relationship to sociodemographic factors and major adolescent health risks. METHODS. The National Longitudinal Study of Adolescent Health is a prospective cohort study following a national sample of adolescents into adulthood. The wave III interview, completed by 15 197 young adults in 2001–2002 (77.4% response rate), included retrospective measures of child maltreatment. We used these measures to estimate the prevalence of self-reported supervision neglect, physical neglect, physical assault, and contact sexual abuse during childhood. Next, we investigated the relationship between sociodemographic characteristics and maltreatment. Finally, we examined the association between child maltreatment and adolescent self-rated health; overweight status; depression; cigarette, alcohol, marijuana, and inhalant use; and violent behavior. RESULTS. Having been left home alone as a child, indicating possible supervision neglect, was most prevalent (reported by 41.5% of respondents), followed by physical assault (28.4%), physical neglect (11.8%), and contact sexual abuse (4.5%). Each sociodemographic characteristic was associated with ≥1 type of maltreatment, and race/ethnicity was associated with all 4. Each type of maltreatment was associated with no fewer than 8 of the 10 adolescent health risks examined. CONCLUSIONS. Self-reported childhood maltreatment was common. The likelihood of maltreatment varied across many sociodemographic characteristics. Each type of maltreatment was associated with multiple adolescent health risks.

Importance of Early Neglect for Childhood Aggression

OBJECTIVE. The goal was to examine the association between early childhood neglect (birth to age 2 years) and later childhood aggression at ages 4, 6, and 8 years, compared with aggressions associations with early childhood abuse and later abuse and neglect. METHODS. A prospective cohort of 1318 predominantly at-risk children, recruited from 4 US cities and 1 southern state, were monitored from birth to 8 years of age. Maltreatment was determined through review of local child protective services records. A hierarchical, linear model approach, a special case of general, linear, mixed modeling, was used to predict aggressive behavior scores, as reported by the childs primary caregiver at ages 4, 6, and 8 years. RESULTS. Only early neglect significantly predicted aggression scores. Early abuse, later abuse, and later neglect were not significantly predictive in a controlled model with all 4 predictors. CONCLUSION. This longitudinal study suggests that child neglect in the first 2 years of life may be a more-important precursor of childhood aggression than later neglect or physical abuse at any age.

Concordance Between Adolescent Reports of Childhood Abuse and Child Protective Service Determinations in an At-Risk Sample of Young Adolescents

This study examines the concordance between adolescent reports of abuse and abuse determinations from Child Protective Service (CPS) agencies. It also compares the utility of adolescent reports of abuse, relative to CPS determinations in predicting adolescent psychological adjustment. The sample included 350 early adolescents, ages 12 to 13 years, who were initially identified prior to age 2 years as being at elevated risk of maltreatment. An Audio-Computer Assisted Self Interview (A-CASI) was used to assess lifetime experiences of physical, sexual, and psychological abuse. The A-CASI interview elicited prevalence rates of abuse 4 to 6 times higher than those found in CPS records. However, 20 of 45 adolescents with CPS determinations of abuse failed to report abuse during the study interview. Adolescent psychological adjustment was more strongly associated with self-reports than with CPS determinations. The implications of these findings are discussed for validity of adolescent self-reports of childhood abuse and for the ongoing debate about disclosure patterns among victims of child sexual abuse.

Sexual Behavior and Drug Use Among Asian and Latino Adolescents: Association with Immigrant Status

This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7–12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation.This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7–12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation.

Discordance in National Estimates of Hypertension Among Young Adults

Background: In the United States, where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential. Methods: Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)—a nationally representative field study of 15,701 participants aged 24–32—was referenced against NHANES (2007–2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study. Results: Hypertension rates (BP: ≥140/90 mm Hg) were higher in Add Health compared with NHANES (19% vs. 4%), but self-reported history was similar (11% vs. 9%) among adults aged 24–32. Survey weights and adjustments for differences in participant characteristics, examination time, use of antihypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic examinations conducted by NHANES III (1988–1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intraclass correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively. Conclusions: The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among US young adults and warrants further scrutiny.

Perceptions of neighborhood collective efficacy moderate the impact of maltreatment on aggression.

This study examined the moderating influence of positive neighborhood factors such as social cohesion and informal social control (collective efficacy), on the relationship between child maltreatment and aggressive behavior at age 12. Caregiver (N = 861) and youth (N = 823) dyads were interviewed when youth were aged 12 as part of a longitudinal study of child abuse and neglect (LONGSCAN). Caregivers and youth provided reports of youth externalizing behaviors while caregivers provided perceptions of collective efficacy. Child Protective Services records and youth’s self-report of abuse experiences provided information on history of maltreatment. Multivariate analyses examined the moderating effect of collective efficacy on the influence of child abuse and neglect on youth externalizing behaviors. Neighborhood factors did moderate the association between earlier neglect and aggression at age 12, such that youth who experienced neglect, but not abuse, had lower externalizing scores in neighborhoods with higher levels of collective efficacy. Neighborhood-level factors such as collective efficacy should be considered as protective in preventing externalizing behaviors for youth who have experienced maltreatment.

An investigation of racial and ethnic disparities in birth weight in Chicago neighborhoods.

We examine differences in the mean birth weights of infants born to non-Hispanic black, non-Hispanic white, and Mexican-origin Hispanic mothers (of any race) in Chicago in 1990 using linear regression models with neighborhood fixed effects. Our pooled models accounted for 64% of the black-white difference and 57% of the black/Mexican-origin Hispanic difference. Differences in the relationship between measured characteristics and birth weight accounted for around half the birth-weight gap between non-Hispanic black and other infants. Efforts to close this gap must go beyond programs that aim to reduce the level of risk factors among black women to address the causes of differences in the effects of risk factors.

Early Adolescent Risk Behavior Outcomes of Childhood Externalizing Behavioral Trajectories

Little is known about the early childhood indicators of adolescent risk. The link between trajectories of externalizing behavioral problems and early adolescent risk behavior was examined in a longitudinal sample of 875 child participants in the LONGSCAN studies. Five trajectory groups of children defined by externalizing behavior problems were identified: Low, Low-Medium, Moderate, Increasing-High, and High. After controlling for demographics and maltreatment, violent/delinquent behavior was significantly predicted by membership in the Moderate and Increasing-High problem behavior groups. Substance use in early adolescence was significantly predicted by membership in the High behavior problem group. These findings suggest that there is a great deal of continuity between patterns of externalizing behavior in childhood and risk-taking in early adolescence. Understanding the course of externalizing behavior in childhood can help identify children at particular risk for more serious behavioral problems in early adolescence.

Trajectories of Maltreatment Re-Reports From Ages 4 to 12: Evidence for Persistent Risk after Early Exposure

This study identified trajectories of maltreatment re-reports between ages 4 and 12 for children first referred to Child Protective Services (CPS) for maltreatment prior to age 4 and either removed from the home or assessed by a CPS intake worker as moderately or highly likely to be abused/neglected in the future, absent intervention. Participants (n = 501) were children from the Southwest and Northwest sites of the Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). During the 8-year follow-up period, 67% of children were re-reported. Growth mixture modeling identified four trajectory classes: No re-report (33%), Continuous re-reports (10%), Intermittent re-reports (37%), and Early re-reports (20%). Membership in classes with relatively more re-reports was predicted by several factors assessed at age 4, including physical abuse; living with a biological/stepparent; caregiver alcohol abuse, depression, and lack of social support; receipt of Aid to Families with Dependent Children (AFDC); and number of children in the home. For a subpopulation of high-risk children first reported in early childhood, risk for maltreatment re-reporting may persist longer than previously documented, continuing 8 to 12 years after the first report.

Childhood Abuse and Neglect and the Risk of STDs in Early Adulthood

CONTEXT Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self-reported recent and test-identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS Among females, even after adjustment for socioeconomic and demographic characteristics, self-report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test-identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test-identified STD (1.6). CONCLUSIONS Young women who experienced physical neglect as children are at increased risk of test-identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self-reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.