Sarah A. Font

Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions ☆

Adverse childhood experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities. Using the Behavioral Risk Factor Surveillance System 2012 survey (N=29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks-depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions-marriage, divorce and separation, educational attainment, income and insurance status-mediate those associations. Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15-20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional, and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.

Is higher placement stability in kinship foster care by virtue or design

Prior research has repeatedly documented higher placement stability for children who enter kinship care rather than non-relative foster care. However, little is known about why, and under what circumstances, kinship care is more stable. This study uses longitudinal state administrative data to explore possible explanations. Results suggest that, while children in non-relative foster care are indeed at higher risk of any placement move than their peers in kinship care, this appears to be partly driven by child selection factors and policy preferences for kinship care. That is, the gap is not explained primarily by different rates of caregiver-requested moves. However, the gap was sizably smaller among select high-risk subgroups of foster children, suggesting that higher stability in kinship care may be partly explained by differences in the characteristics of children entering kinship care (versus non-relative foster care). Moreover, a large portion of the gap is explained by children in non-relative care being moved into kinship care; a move that is likely the result of policy preferences for kinship care rather than a defect in the initial placement. In sum, these results suggest that kinship care provides only a limited stability advantage, and the reasons for that advantage are not well understood.

Income and child maltreatment in unmarried families: evidence from the earned income tax credit

This study estimates the associations of income with both (self-reported) child protective services involvement and parenting behaviors that proxy for child abuse and neglect risk among unmarried families. Our primary strategy follows the instrumental variables approach employed by Dahl and Lochner (2012), which leverages variation between states and over time in the generosity of the total state and federal earned income tax credit for which a family is eligible to identify exogenous variation in family income. As a robustness check, we also estimate standard OLS regressions (linear probability models), reduced form OLS regressions, and OLS regressions with the inclusion of a control function (each with and without family-specific fixed effects). Our micro-level data are drawn from the Fragile Families and Child Wellbeing Study, a longitudinal birth-cohort of relatively disadvantaged urban children who have been followed from birth to age nine. Results suggest that an exogenous increase in income is associated with reductions in behaviorally approximated child neglect and CPS involvement, particularly among low-income single-mother families.

The Role of the Family and Family-Centered Programs and Policies.

Summary:Families influence their children’s health in two ways that are amenable to public policy— through their financial and other investments in children, and through the quality of care that they provide. In general, children who receive more resources or better parenting are healthier than those who don’t. Public policies, therefore, might improve children’s health either by giving families more resources or by helping parents provide better care.When it comes to financial resources, write Lawrence Berger and Sarah Font, the research is straightforward—programs that add to disadvantaged families’ incomes, whether in cash or in kind, can indeed improve their children’s health. The Earned Income Tax Credit, for example, has been linked to higher birth weights and greater cognitive achievement.When it comes to programs that target quality of care, however, the picture is more complex. At the low end of the spectrum, poor parenting shades into neglect or abuse, which can seriously harm children’s health and development. Thus we might expect that the child protective services system, which has the power to intervene and protect children in such cases, could also improve children’s health in the long run. But Berger and Font find that the system’s ability to affect children’s health is limited, largely because it becomes involved in children’s lives only after damage has already occurred.Other programs, however, have the potential to improve parenting, reduce maltreatment, and thus enhance children’s health and development. Home visiting programs show particular promise, as do large-scale, community-level primary prevention programs.

Child Protection Investigations in Out-of-Home Care Perpetrators, Victims, and Contexts

Keeping children safe in out-of-home care requires an understanding of the contexts under which maltreatment occurs. This study examines how maltreatment investigations differ across four settings (nonrelative foster, informal kinship, formal kinship, and congregate care). I focus on four elements of maltreatment: the perpetrator’s role (e.g., out-of-home caregiver and peer), maltreatment type, probability of substantiation, and victim characteristics. I use statewide Wisconsin administrative data in years 2005–2012, which has an analytic sample of over 96,000 placements. Data are analyzed using descriptive statistics and multi-level logistic regression. Alleged maltreatment is not uncommon in out-of-home care—the total investigation rate ranged from 5% (congregate care) to 15% (informal kinship care). Four percent of all placements were investigated for maltreatment by an out-of-home caregiver, of which 9% were substantiated. Maltreatment by peers (siblings or other foster children) was investigated in 1% of all placements, of which 20% were substantiated. Neglect was the most commonly alleged maltreatment type in informal kinship care, whereas physical abuse was most commonly alleged in all other placement types. Children who were female, Black, or between ages 6 and 10 experienced heightened risk of maltreatment in out-of-home care.

Community and Individual Risk Factors for Physical Child Abuse and Child Neglect: Variations by Poverty Status

Families are impacted by a variety of risk and protective factors for maltreatment at multiple levels of the social ecology. Individual- and neighborhood-level poverty has consistently been shown to be associated with higher risk for child abuse and neglect. The current study sought to understand the ways in which individual- and neighborhood-level risk and protective factors affect physical child abuse and child neglect and whether these factors differed for families based on their individual poverty status. Specifically, we used a three-level hierarchical linear model (families nested within census tracts and nested within cities) to estimate the relationships between physical child abuse and child neglect and neighborhood structural factors, neighborhood processes, and individual characteristics. We compared these relationships between lower and higher income families in a sample of approximately 3,000 families from 50 cities in the State of California. We found that neighborhood-level disadvantage was especially detrimental for families in poverty and that neighborhood-level protective processes (social) were not associated with physical child abuse and child neglect for impoverished families, but that they had a protective effect for higher income families.

Home Foreclosure and Child Protective Services Involvement

OBJECTIVE: We estimated associations between experiencing a home foreclosure filing and experiencing a child protective services (CPS) investigation or substantiation. METHODS: We linked a large sample drawn from administrative data on foreclosure filings, CPS involvement, and participation in a host of other public programs for >60 000 Wisconsin households over a 4-year period from 2008 to 2011. Our empirical analyses used piecewise exponential survival models to estimate the risk of CPS involvement (investigation or substantiation) as a function of a home foreclosure filing and a set of individual and household characteristics. We fitted these models with and without the inclusion of propensity score weights. RESULTS: Households that experienced a foreclosure filing had a much higher probability of CPS involvement. This was true in the year before the filing as well as the year after the foreclosure filing. However, these associations were generally largest in the period before or shortly afterward. CONCLUSIONS: Experiencing a foreclosure filing is associated with increased CPS involvement. However, it is not clear that this association is driven by the foreclosure filing action itself. Rather, increased risk of CPS involvement is apparent during the process of moving toward the filing as well as the year or so after the filing, both of which are likely characterized by limited economic resources as well as by financial and other stress.

The Complex Interplay of Adverse Childhood Experiences, Race, and Income

An extensive research base shows evidence of racial disparities in health outcomes, and a growing body of evidence points to associations between adverse childhood experiences (ACEs) and poor health. This study uses data from the 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System surveys to identify the relative contributions of ACEs, race, and adult income to predicting three sets of adverse adult health outcomes. The authors found that controlling for demographic factors, ACEs strongly predict health risk behaviors, indicators of poor general health, and chronic health conditions. Adult low-income status is associated with poor general health and chronic health conditions, but not health risk behaviors. African American race is marginally associated only with indicators of poor general health, and this association is attenuated when ACEs and adult income are controlled. These findings suggest a complex interplay among ACEs, race, and income.

Medical center staff attitudes about spanking

Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2580 staff at a large general medical center and 733 staff at a childrens hospital completed an online survey; respondents were roughly divided between staff who provide direct care to patients (e.g., physicians, nurses) and staff who do not (e.g., receptionists, lab technicians). Less than half (44% and 46%) of staff at each medical center agreed that spanking is harmful to children, although almost all (85% and 88%) acknowledged that spanking can lead to injury. Men, staff who report being religious, and staff who held non-direct care positions at the medical center reported stronger endorsement of spanking and perceived their co-workers to be more strongly in favor of spanking. Non-direct care staff were more supportive of spanking compared with direct care staff on every item assessed. All staff underestimated the extent to which their co-workers held negative views of spanking. If medical centers and other medical settings are to lead the charge in informing the community about the harms of spanking, comprehensive staff education about spanking is indicated.

Predicting Child Protective Services (CPS) Involvement among Low-Income U.S. Families with Young Children Receiving Nutritional Assistance

This exploratory study examines combinations of income-tested welfare benefits and earnings, as they relate to the likelihood of child maltreatment investigations among low-income families with young children participating in a nutritional assistance program in one U.S. state (Wisconsin). Using a sample of 1065 parents who received the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) benefits in late 2010 and early 2011, we find that relying on either work in the absence of other means-tested welfare benefits, or a combination of work and welfare benefits, reduces the likelihood of CPS involvement compared to parents who rely on welfare benefits in the absence of work. Additionally, we find that housing instability increases the risk of CPS involvement in this population. The findings from this investigation may be useful to programs serving low-income families with young children, as they attempt to identify safety net resources for their clientele.