The Healthy Immigrant Paradox and Child Maltreatment: A Systematic Review

Navigating the services maze: Assessing service needs, referrals, receipts, and child protective services re-report and foster care entry outcomes

BACKGROUND

Research shows that families involved with Child Protective Services (CPS) have diverse needs not fully met by service referrals and provision. Furthermore, it is still unknown whether the service provision gaps are linked to child safety and permanency outcomes.

OBJECTIVE

This study aims to address this research gap by evaluating the rereport and foster care entry outcomes of child welfare services based on the needs, referrals, and receipt of services for families involved with CPS.

PARTICIPANT AND SETTING

The National Survey on Child and Adolescent Well-being II (NSCAW II) was used for this study, excluding children with prior reports and those in foster care to focus on re-report and foster care entry outcomes, reducing the sample from 5872 to 2580 children.

METHODS

Logistic Regression analyses were performed to investigate the relationship between services needed, referred, and receipts and child welfare outcomes. The analyses were structured into three sets of models to explore different aspects of service engagement and its impact on child welfare outcomes.

RESULTS

Our study shows that specific CPS services, particularly caregivers' needs for mental health and substance misuse services, significantly impact the likelihood of re-reporting and foster care placements.

CONCLUSION

Most families contacting the child welfare system receive only case management services if their report moves beyond investigation. Such an approach requires that services are available, acceptable, and of sufficient quality to meet needs. This paper highlights crucial disparities in service needs, referrals, and receipts among families engaged with CPS.

The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study

In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N  =  136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.

The Hispanic paradox in child maltreatment: Does it fade over time?

BACKGROUND

The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally.

OBJECTIVES

To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics.

DESIGN

Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…).

PARTICIPANTS AND SETTING

We included national child maltreatment data at the county level.

RESULTS

A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship.

CONCLUSION

Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BACKGROUND

Childhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA.

OBJECTIVE

To analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI).

PARTICIPANTS AND SETTING

Data from the Global Burden of Disease 2019 Public Database.

METHODS

Summary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant.

RESULTS

In 2019, 1.63 million (95 % UI 0.23-3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78-47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87-47.77], 2019: 23.61 [95 % UI 3.55-54.94]).

CONCLUSIONS

Substantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.

Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005-2019

We used National Child Abuse and Neglect Data System and Census data to examine Black-White and Hispanic-White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005-2019 and in multivariate models from 2007-2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black-White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic-White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.

Testing a QuantCrit-Informed Approach to the Empirical Study of Race/Ethnicity and Child Maltreatment

The past several years have seen calls from QuantCrit scholars to "disaggregate" samples into same-race groups. To date, however, there has been no attempt to empirically evaluate the benefits of disaggregation within a child welfare sample. Using a child maltreatment dataset derived from the National Child Abuse and Neglect Data System and Census data, we empirically evaluate the utility of employing sample disaggregation (in which separate records are created for White, Black and Latino populations in each county) as well as variable creation disaggregation (in which we avoid using "full county" economic measures, but instead employ "same race/ethnicity" measures). Using model fit and convergence with findings from individual-level studies as evaluation metrics, we find that both kinds of disaggregation are demonstrably beneficial. We recommend that sample and variable disaggregation be considered by any future researchers using national geographically structured child maltreatment data.

Minor Forms of Parental Maltreatment and Educational Achievement of Immigrant Youths in Young Adulthood: A Longitudinal Study

Parental hostility and emotional rejection-or aggregated as general harsh family interactions with parents-have received little research attention due to such parent-child interactions being counted as minor forms of parental maltreatment and regarded as being less harmful. However, recent research showed that these minor forms of parental maltreatment on youth development are far from negligibility on account of their frequency, chronicity, and incessancy. In this longitudinal study, we investigated how parental hostility, emotional rejection, and harsh family interactions with parents of in early adolescence of immigrant youths (wave-1 M_age = 14) adversely impact successful college graduation of immigrant youths in young adulthood (wave-3 M_age = 24) through the mediation of their development of academic aspirations in late adolescence (wave-2 M_age = 17). Using data from a representative sample of the Children of Immigrants Longitudinal Study (N = 3344), the current study revealed that parental hostility, emotional rejection, and harsh family interactions with parents significantly impaired successful college graduation of immigrant youths in young adulthood, with the decreased odds of 20.1% to 30.22%. Furthermore, academic aspirations of immigrant youths in late adolescence not only significantly mediated the abovementioned relationships but also contributed to the higher odds of immigrant youths' college graduation by 2.226 to 2.257 times. Findings of this study related to educational innovations, family services, and policy implications are discussed herein.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Community disadvantage, family socioeconomic status, and racial/ethnic differences in maltreatment reporting risk during infancy

BACKGROUND

Children are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS).

OBJECTIVE

To model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy.

PARTICIPANTS/SETTING

A population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage.

METHODS

For each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates.

RESULTS

Infants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall - and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods.

CONCLUSIONS

Capturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.

How does neighborhood affect child maltreatment among immigrant families?

BACKGROUND

Child maltreatment in immigrant families is understudied, although research suggests that they are at higher risk of child abuse and neglect. While the limited studies on the etiology of child maltreatment among immigrant families have mainly focused on children and their caregivers, this study breaks new ground by examining the neighborhood as an environmental context for child maltreatment among immigrant families.

METHODS

Following social disorganization theory, this study explores the mechanisms by which neighborhood structural characteristics and social processes affect the maltreatment of children in immigrant families, using the Fragile Families and Child Wellbeing Study (N = 372).

RESULTS

Structural equation modeling revealed that negative neighborhood structural characteristics were positively associated with higher physical assault (β = 0.42, p < .001), higher psychological aggression (β = 0.29, p < .001), and higher neglect (β = 0.19, p < .001) among immigrant families. Conversely, positive neighborhood social processes were associated with lower physical assault (β = -0.37, p < .001) and lower psychological aggression (β = -0.31, p < .001) among immigrant families. In addition, neighborhood social processes mediated the relationship between neighborhood structural characteristics and child physical assault (β = -0.09, p < .001) among immigrant families.

CONCLUSIONS

The findings of this study highlighted the positive role of neighborhood social processes in reducing child physical assault among immigrant families, even in neighborhoods with negative structural characteristics.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

Social determinants of health and child maltreatment: a systematic review

BACKGROUND

Child maltreatment causes substantial numbers of injuries and deaths, but not enough is known about social determinants of health (SDH) as risk factors. The aim of this study was to conduct a systematic review of the association of SDH with child maltreatment.

METHODS

Five data sources (PubMed, Web of Science Core Collection, SCOPUS, JSTORE, and the Social Intervention Research and Evaluation Network Evidence Library) were searched for studies examining the following SDH: poverty, parental educational attainment, housing instability, food insecurity, uninsurance, access to healthcare, and transportation. Studies were selected and coded using the PICOS statement.

RESULTS

The search identified 3441 studies; 33 were included in the final database. All SDH categories were significantly associated with child maltreatment, except that there were no studies on transportation or healthcare. The greatest number of studies were found for poverty (n = 29), followed by housing instability (13), parental educational attainment (8), food insecurity (1), and uninsurance (1).

CONCLUSIONS

SDH, including poverty, parental educational attainment, housing instability, food insecurity, and uninsurance, are associated with child maltreatment. These findings suggest an urgent priority should be routinely screening families for SDH, with referrals to appropriate services, a process that could have the potential to prevent both child maltreatment and subsequent recidivism.

IMPACT

SDH, including poverty, parental educational attainment, housing instability, food insecurity, and uninsurance, are associated with child maltreatment. No prior published systematic review, to our knowledge, has examined the spectrum of SDH with respect to their associations with child maltreatment. These findings suggest an urgent priority should be routinely screening families for SDH, with referrals to appropriate services, a process that could have the potential to prevent both child maltreatment and subsequent recidivism.

Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status?

Background

While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status.

Methods

We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression.

Results

CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants.

Conclusions

Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.

Research on Injury Disparities: A Scoping Review

Background: Research on disparities in traumatic injury has not been well characterized, limiting understanding of gaps in research and development of successful interventions. We conducted a scoping review to identify and synthesize research on disparities in intentional and unintentional traumatic injuries. Methods: The review was guided by PRISMA Extension for Scoping Reviews. PubMed, PsycINFO, Web of Science, and CINAHL and systematic reviews from 2007 to 2017 were searched. Eligible articles were peer reviewed; conducted in the United States; and reported on clearly defined physical trauma and disparity, defined by Cochrane PROGRESS-Plus criteria. One reviewer assessed article titles and a second reviewer validated the inclusion with a random sample. Abstract and full-text review by two reviewers determined final inclusion. Results: Of 7382 unique articles screened, 653 articles were included; inter-rater agreement was high (K=0.995). Studies reported on disparities in the acute hospital setting (104) or postacute/rehabilitation (86), with fewer focused on prevention (57) and policy development (6). Research methods used were quantitative (593) with 25 intervention studies, qualitative (45), qualitative/quantitative (7), and community-based participatory research (8). Age ranges of included studies were all ages (124), adults (318), pediatric/youth/adolescents (172), and older adults (40). Racial disparities were most commonly measured (439 studies); 38 created a white/nonwhite binary. Other commonly measured disparities were place of residence (122), insurance (111 studies), gender (89), age (75), and socioeconomic status measures (61). Disparities were noted in all of the categories. Studies commonly aggregated all types of traumatic injuries (129) or all types of violence (105). Conclusions: The extant injury literature lacks research on prevention and policy to address disparities. Many studies aggregated types of trauma and patient groups, preventing an understanding of distinctions between groups and potential interventions. Intervention and community-based research strategies were limited. Future research can better specify measurement of understudied equity categories, trauma types and intent, and racial groups.

Risk factors for maltreatment-related infant hospitalizations in New York City, 1995-2004

BACKGROUND

Child maltreatment is a major public health problem, but population-based surveillance and research is hindered by limitations of official child welfare data. The present study used a promising complementary data source, hospital discharge data, to investigate risk factors for infant injuries suggestive of maltreatment.

METHODS

Discharge data from all hospital births to New York City residents from 1995 to 2004 were linked to birth certificates and to subsequent infant hospitalizations within 12 months after delivery. Probable maltreatment of infants was identified with 33 injury diagnosis codes highly correlated with maltreatment. Modified Poisson regression estimated the association of sociodemographic factors and pregnancy/birth characteristics with subsequent infant admission for probable maltreatment.

RESULTS

Risk factors for maltreatment included neonatal intensive care unit stays of more than 11 days (adjusted risk ratio [aRR] = 1.8; 95% confidence interval [CI]: 1.1-2.8), preterm birth (aRR = 1.6; 95% CI: 1.2-2.1), maternal age less than 20 years (aRR = 1.5; 95% CI: 1.2-1.9), and public insurance (aRR = 1.5; 95% CI: 1.2-1.9). Factors associated with reduced maltreatment risk included mother born outside the United States (aRR = 0.7; 95% CI: 0.6-0.8) and female infant (aRR = 0.7; 95% CI: 0.6-0.9).

CONCLUSIONS

Sociodemographic factors and challenges at birth (preterm, neonatal intensive care unit stays) are important risk factors for subsequent maltreatment-related hospitalization, with potential implications for prevention targeting.

Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review

Background

Child maltreatment and eating disorders are significant public health problems. Yet, to date, research has focused on the role of child physical and sexual abuse in eating-related pathology. This is despite the fact that globally, exposure to emotional abuse, emotional neglect and intimate partner violence are the three of the most common forms of child maltreatment. The objective of the present study is to systematically identify and critically review the literature examining the association between child emotional abuse (EA), emotional neglect (EN), and exposure to intimate partner violence (IPV) and adult eating-disordered behavior and eating disorders.

Methods

A systematic search was conducted of five electronic databases: Medline, Embase, PsycINFO, CINAHL, and ERIC up to October 2015 to identify original research studies that investigated the association between EA, EN and children’s exposure to IPV, with adult eating disorders or eating-disordered behavior using a quantitative research design. Database searches were complemented with forward and backward citation chaining. Studies were critically appraised using the Quality in Prognosis Studies (QUIPS) tool.

Results

A total of 5556 publications were screened for this review resulting in twenty-three articles included in the present synthesis. These studies focused predominantly on EA and EN, with a minority examining the role of child exposure to IPV in adult eating-related pathology. Prevalence of EA and EN ranged from 21.0% to 66.0%, respectively. No prevalence information was provided in relation to child exposure to IPV. Samples included predominantly White women. The methodological quality of the available literature is generally low. Currently, the available literature precludes the possibility of determining the extent to which EA, EN or child exposure to IPV have independent explanatory influence in adult eating-related pathology above what has been identified for physical and sexual abuse.

Conclusions

While a large proportion of adults with eating disorders or eating-disordered behavior report EA, EN, or child exposure to IPV , there is a paucity of high-quality evidence about these relationships.

Electronic supplementary material

The online version of this article (10.1186/s40359-017-0202-3) contains supplementary material, which is available to authorized users.