Jonathan B. Kotch

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.

Adverse Behavioral and Emotional Outcomes from Child Abuse and Witnessed Violence

This article examines mental health outcomes of children who have witnessed violence in their social environment and/or have been physically abused. Participants (n = 167) come from a longitudinal study on child maltreatment. Outcomes—including depression, anger, and anxiety—are measured by the Child Behavior Checklist and the Trauma Symptom Checklist for Children. The authors used adjusted multivariate analyses to test the statistical significance of associations. The majority of children were female (57%) and non-White (64%). One third had been physically victimized; 46% had witnessed moderate-high levels of violence. Results confirm that children are negatively affected by victimization and violence they witness in their homes and neighborhoods. Victimization was a significant predictor of child aggression and depression; witnessed violence was found to be a significant predictor of aggression, depression, anger, and anxiety. Implications will be discussed.

Longscan: A consortium for longitudinal studies of maltreatment and the life course of children

The National Research Council (1993) has issued an urgent call for theory-based, longitudinal research to examine the antecedents and consequences of child maltreatment. Many of the concerns raised by the National Research Council are addressed by LONGSCAN (LONGitudinal Studies of Child Abuse and Neglect), a consortium including a coordinating center and five independent prospective longitudinal investigations sharing common protocols for data collection, entry, and management. The children in the five investigations vary by their level of risk, ranging from a community sample with no identified risk beyond low income status, to children placed in foster care. The longitudinal study has been designed with six age-specific data collection points extending from 4 through 20 years of age. The conceptual model, organization, and analytic strategy for LONGSCAN are described.

Risk of child abuse or neglect in a cohort of low-income children

The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mothers separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.

Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Objective. To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children. Design. This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs. Results. Of the 53591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1,

Impact of Poor Oral Health on Children's School Attendance and Performance

262; age 1 to 2,

A Longitudinal Study of Modifying Influences in the Relationship between Domestic Violence and Child Maltreatment

339; age 2 to 3,

Importance of Early Neglect for Childhood Aggression

449; age 3 to 4,

Prospective Study of Etiologic Agents of Acute Gastroenteritis Outbreaks in Child Care Centers

492; age 4 to 5,

Are Father Surrogates a Risk Factor for Child Maltreatment

546. Conclusions. Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population.