Michelle Bell

Identified spouse abuse as a risk factor for child abuse

CONTEXT There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN Cohort study. SETTING Analysis of a centralized US Army database PARTICIPANTS Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES The US Army Family Advocacy Programs Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse. RESULTS During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.

Illness Experiences of Homeless Youth

The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.

Punishments: what predicts adult approval.

We surveyed 449 parents to assess: (a) the prevalence of different types of physical and emotional punishment during their childhoods: (b) the prevalence of current parental approval of these types of punishments, and (c) risk factors for current approval of physical and emotional punishments. Parents in waiting rooms of pediatric clinics were asked to complete an anonymous questionnaire about their childhood punishment experiences and their current approval of various types of punishment. Reported experiences and approval were as follows: 24% experienced and 6% approved of uncommon punishments (e.g., burned), 45% experienced and 17% approved of common punishments (e.g., shaken), and 94% experienced and 88% approved of very common punishments (e.g., spanked). Having experienced each type of punishment was a highly significant risk factor for currently approving of that type of punishment (p < .01 for each). Race, income, and education were not significant risk factors for approval of different types of punishment. Many parents have experienced harsh types of punishment during their childhoods. Efforts at identifying and educating parents who approve of harsh and/or abusive types of punishment should focus on those who have experienced harsh punishment rather than on particular racial or socioeconomic groups.

A comparison of users and nonusers of a school-based health and mental health clinic

This study compares student health and mental health knowledge, behavior, and access to services for adolescents who used and did not use a school-based health and mental health clinic. Data were collected as part of an anonymous, self-administered survey completed by all students in a school housing a clinic that had been in operation for a school year. Comparisons of clinic users and nonusers revealed differences in health- and mental health-related knowledge and behavior and access to needed care. The clinic was found to be serving adolescents at high risk for a variety of psychosocial problems (e.g., drug use, depression, dropout).

Measuring Community Mobilization in the Seattle Minority Youth Health Project

This article assesses the validity and reliability of the approach used to measure community mo bilization in the Seattle Minority Youth Health Project (MYHealth), a neighborhood-based pro gram to prevent drug use, violence, teen pregnancy, and sexually transmitted diseases (STDs). Two constructs were measured: neighborhood cooperation in solving problems, and sense of pride and identification with the neighborhood. The convergent validity of the measurement ap proach was assessed by comparing several independent measures of community mobilization generatedfrom surveys of key neighborhood leaders, youth, and parents. For the neighborhood cooperation construct, correlations were uniformly positive across measuresfrom different sur veys and statistically significant about a quarter of the time. The correlations for the neighbor hood pride construct were weaker and generally not statistically significant. Interrater reliabil ity was low for all of the surveys, possibly reflecting varying ideas about what community mobili zation meant among survey respondents.

Childrearing knowledge, beliefs, and practices of Cambodian refugees

Forty Cambodian women in Seattle, Washington were interviewed to learn about their childrearing knowledge, beliefs, practices, and information resources. It was found that women who once relied on family and elders for advice now turned to pediatric providers and other clinic staff. Most women reported accurately the ages at which developmental milestones occur, with the exception of vision and hearing milestones. Their treatment of common childhood illnesses included both Western and Cambodian remedies. Beliefs about childrens nature, discipline, learning, and reincarnation were explored. Implications for providers trying to support the parenting efforts of Cambodian women in the United States are discussed.