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Arneitz C, Schmitz J, Szilagyi I, Kienesberger B, Schalamon G, Senica SO, Schalamon J. Abusive head trauma and crying infant-Public awareness of newborn and infant trauma. Acta Paediatr 2024. [PMID: 38634613 DOI: 10.1111/apa.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
AIM Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.
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Affiliation(s)
- Christoph Arneitz
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
| | - Jana Schmitz
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Istvan Szilagyi
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Bernhard Kienesberger
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Georg Schalamon
- Department of Trauma Surgery, Clinic Diakonissen Schladming, Teaching Hospital of the Paracelsus Medical University, Schladming, Austria
| | - Simone Oliver Senica
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Johannes Schalamon
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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2
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Bouchelle Z, Darwiche S, Dalembert G. Financial support policies as a mechanism to reduce child welfare involvement. Curr Probl Pediatr Adolesc Health Care 2024; 54:101554. [PMID: 38184448 DOI: 10.1016/j.cppeds.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Affiliation(s)
- Zoe Bouchelle
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Denver Health, Denver, CO, United States; Guaranteed Income and Health Consortium, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Sabrina Darwiche
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - George Dalembert
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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3
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Berthold O, Fegert JM, Brähler E, Jud A, Clemens V. Abusive head trauma: The body of the iceberg - A population-based survey on prevalence and perpetrators. CHILD ABUSE & NEGLECT 2024; 149:106660. [PMID: 38295606 DOI: 10.1016/j.chiabu.2024.106660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Research on abusive head trauma (AHT) is usually research on clinically identified cases, while population-based studies, having the potential to identify cases of shaking that did not end with hospital admission, are missing to date. OBJECTIVE Thus, we aimed to assess the prevalence of AHT and associated risk factors in a representative sample of the German population. PARTICIPANTS AND SETTING We conducted a cross-sectional, observational study in Germany from July to October 2021. Using different sampling steps including a random route procedure, a probability sample of the German population was generated. The final sample consisted of 2503 persons (50.2 % female, mean age: 49.5 years). METHODS Participants were asked about sociodemographic information in a face-to-face interview and whether they had been ever responsible for the care of an infant and whether they had ever performed potential harmful methods including shaking to calm it, intimate partner violence (IPV) and adverse childhood experiences (ACEs) using a questionnaire. RESULTS In total, 1.4 % of women (N = 18) and 1.1 % of men (N = 13) reported to have at least once shaken an infant to calm it. Ever having used a potential harmful parenting method in calming an infant was reported by 4.9 % of women (N = 61) and 3.1 % (N = 39) of men. No gender differences were seen. A low income, living with someone under 16 in the household and victimization and perpetration of IPV and ACEs are associated with increased risks of shaking and other potential harmful methods to calm an infant. CONCLUSIONS Our data suggest that despite better knowledge on the dangers of shaking, the percentage of women that shake infants might be higher than previously thought. Also, intimate partner violence and ACEs are key risk factor for shaking and harmful parenting behaviors in general. This has important implications for future prevention programs.
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Affiliation(s)
- Oliver Berthold
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany; Child Abuse Clinic, DRK Kliniken Berlin, Spandauer Damm 130, 14050 Berlin, Germany.
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Jud
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
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Tolliver DG, He Y, Kistin CJ. Child Maltreatment. Pediatr Clin North Am 2023; 70:1143-1152. [PMID: 37865436 DOI: 10.1016/j.pcl.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Child maltreatment is associated with significant morbidity, and prevention is a public health priority. Given evidence of interpersonal and structural racism in child protective service assessment and response, equity must be prioritized for both acute interventions and preventive initiatives aimed at supporting children and their families. Clinicians who care for children are well positioned to support families, and the patient-centered medical home, in collaboration with community-based services, has unique potential as a locus for maltreatment prevention services. Clinicians can advocate for policies that support families and decrease the risk of child maltreatment.
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Affiliation(s)
- Destiny G Tolliver
- Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 801 Albany Street, Boston, MA 02119, USA
| | - Yuan He
- Division of General Pediatrics, Children's Hospital of Philadelphia, 4865 Market Street, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Caroline J Kistin
- Division of Health Services, Policy, and Practice, Hassenfeld Child Health and Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
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5
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Maassel NL, Graetz E, Schneider EB, Asnes AG, Solomon DG, Leventhal JM. Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic. JAMA Pediatr 2023; 177:1342-1347. [PMID: 37870839 PMCID: PMC10594171 DOI: 10.1001/jamapediatrics.2023.4519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/19/2023] [Indexed: 10/24/2023]
Abstract
Importance Several studies have demonstrated a decrease in the occurrence of child abuse in the US since the start of the COVID-19 pandemic. This finding has generated concern for missed cases due to the initial lockdowns and lack of childcare resources. Determining the association of the pandemic on hospitalizations for severe forms of abuse is essential to focus preventive efforts. Objective To examine trends in abusive head trauma (AHT) before and during the COVID-19 pandemic. Design, Setting, and Participants Retrospective, multicenter, repeated cross-sectional study, conducted January 1, 2016, through April 30, 2022, with data from tertiary care children's hospitals and contributors to the Pediatric Health Information System. Data were obtained for 2380 hospitalizations of children younger than 5 years with International Classification of Diseases, Tenth Revision, Clinical Modification codes for both abuse and head trauma. Main Outcomes and Measures Monthly hospitalizations were analyzed using interrupted time-series analysis. Hospitalization severity (eg, intensive care unit stay) and clinical characteristics (subdural hemorrhages and retinal hemorrhages) were compared before and after the start of the pandemic. Results We identified 2380 hospitalizations due to AHT (median age, 140 [IQR, 75.0-325.5] days) from 45 hospitals. The mean (SD) monthly incidence of AHT was 34.3 (5.8) before the COVID-19 pandemic compared with 25.6 (4.2) during COVID-19 (a 25.4% decrease). When the pre-COVID-19 and during COVID-19 periods were compared, there were no significant differences in severity or clinical characteristics. On interrupted time-series analysis, there was a significant decrease in the number of monthly hospitalizations (-8.1; 95% CI, -12.41 to -3.72; P < .001) in the first month of the pandemic. In the subgroup of children younger than 1 year, there was a significant decrease in monthly hospitalizations at the onset of the pandemic (-8.2; 95% CI, -12.02 to -4.43; P < .001) followed by a significant temporal increase across the COVID-19 period (P = .01). Conclusions and Relevance The findings of this cross-sectional study suggest there was a significant decrease in monthly hospitalizations for AHT following the start of the pandemic in March 2020. Although there was no corresponding increase in hospitalization severity, the decrease during the pandemic may have been transient, as monthly hospitalizations for children younger than 1 year increased significantly over time during COVID-19, after the initial decrease.
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Affiliation(s)
- Nathan L. Maassel
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Elena Graetz
- Department of Surgery, Surgery Health Services and Outcomes Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Eric B. Schneider
- Department of Surgery, Surgery Health Services and Outcomes Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Andrea G. Asnes
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel G. Solomon
- Division of Pediatric Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - John M. Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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6
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Holdroyd I, Barton G, Holdroyd D. The effect of working tax credits on child maltreatment rates: A systematic review. CHILD ABUSE & NEGLECT 2023; 143:106279. [PMID: 37331186 DOI: 10.1016/j.chiabu.2023.106279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Socioeconomic status and poverty are strongly associated with Child Maltreatment. Multiple studies have described the effects of working tax credits on Child Maltreatment with heterogeneous results. There is yet to be a comprehensive review of this research. OBJECTIVES This study aims to review all research which explores the effect of working tax credits on child maltreatment. METHODS Three databases (Ovid Medline, Scopus and Web of Science) were searched. Title and abstracts were screened according to a set of eligibility criteria. Data were extracted from eligible studies, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool. Results were synthesised narratively. RESULTS Nine studies were included. Of these, five papers investigated overall reports of child maltreatment, with three finding a positive effect of tax credits. Results suggested a protective effect against child neglect, however, no significant effect was found with respect to physical or emotional abuse. Three of four papers found that working tax credits resulted in decreased rates of entry to foster care. Mixed results were found with respect to self-reported child protective services contact. A range of methodological and temporal differences between studies was identified. CONCLUSIONS Overall, some evidence found that in work tax credits are protective against child maltreatment and that they are most effective in reducing neglect. Policymakers can take courage in these results, as they represent an example whereby the "risk factors" of child maltreatment can be countered in order to reduce rates of it.
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Affiliation(s)
- Ian Holdroyd
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
| | - George Barton
- School of Medical Education, Newcastle University, Newcastle, UK
| | - David Holdroyd
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
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7
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Darwiche SM, Scribano PV. Anti-Poverty Interventions and Their Importance in Childhood Abuse Prevention. Pediatrics 2023; 151:190633. [PMID: 36748237 DOI: 10.1542/peds.2022-060096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Sabrina M Darwiche
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of General Pediatrics and
| | - Philip V Scribano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of General Pediatrics and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Bullinger LR, Boy A. Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits. JAMA Netw Open 2023; 6:e2255639. [PMID: 36795416 PMCID: PMC9936349 DOI: 10.1001/jamanetworkopen.2022.55639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Poverty has long been associated with a higher risk for child maltreatment, and recent research suggests that income support policies are associated with reduced child abuse and neglect. However, income supports tied to employment cannot separate the associations of income from those of employment. OBJECTIVE To estimate the short-term association of universal and unconditional income payments to parents with child abuse and neglect. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, variation in the timing of the 2021 expanded child tax credit (CTC) advance payments was used to determine whether receiving unconditional income is associated with child abuse and neglect. A fixed-effects approach was used to compare child abuse and neglect before and after payments were made in 2021. The study compared 2021 trends with the same period in 2018 and 2019, during which no CTC payments were made. Participants were pediatric emergency department (ED) patients identified as experiencing child abuse or neglect at a level I pediatric hospital system in the Southeastern US from July through December 2021. Data were analyzed from July to August 2022. EXPOSURES Timing in the disbursement of the expanded CTC advance payments. MAIN OUTCOMES AND MEASURES Daily child abuse and neglect-related ED visits. RESULTS During the study period, there were 3169 ED visits related to child abuse or neglect. The 2021 advance payments of the expanded CTC were associated with fewer child abuse and neglect-related ED visits. There was a decrease in these ED visits in the 4 days following the advance CTC payments, although the reduction was not significant (point estimate, -0.22; 95% CI, -0.45 to 0.01; P = .06). There were significant reductions in such ED visits among male children (point estimate, -0.40; 95% CI, -0.75 to -0.06; P = .02) and non-Hispanic White children (point estimate, -0.69; 95% CI, -1.22 to -0.17; P = .01). These reductions did not persist, however. CONCLUSIONS AND RELEVANCE These findings suggest that federal income supports to parents are associated with immediate reductions in child abuse and neglect-related ED visits. These results are important for discussions of making the temporary expansion of the CTC permanent and are applicable to income support policies more broadly.
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Affiliation(s)
| | - Angela Boy
- Stephanie Blank Center for Safe and Healthy Children, Children’s Healthcare of Atlanta, Atlanta, Georgia
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9
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Abstract
Purpose of Review The goal of this review is to describe how socioeconomic status (SES) is evaluated in the pediatric trauma literature and further consider how differences in SES can lead to inequities in pediatric injury. Recent Findings Insurance status, area-level income, and indices of socioeconomic deprivation are the most common assessments of socioeconomic status. Children from socioeconomically disadvantaged backgrounds experience higher rates of firearm-related injuries, motor vehicle-related injuries, and violence-related injuries, contributing to inequities in morbidity and mortality after pediatric injury. Differences in SES may also lead to inequities in post-injury care and recovery, with higher rates of readmission, recidivism, and PTSD for children from socioeconomically disadvantaged backgrounds. Summary Additional research looking at family-level measures of SES and more granular measures of neighborhood deprivation are needed. SES can serve as an upstream target for interventions to reduce pediatric injury and narrow the equity gap.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH MLC 2023 USA
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH MLC 2023 USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH USA
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10
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Purtle J, Bowler S, Boughter-Dornfeld M, Nelson KL, Gollust SE. Newspaper Coverage of Adverse Childhood Experiences and Toxic Stress in the United States, 2014-2020: Consequences, Causes, and Solutions. TRAUMA, VIOLENCE & ABUSE 2023; 24:313-323. [PMID: 34269132 DOI: 10.1177/15248380211029407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
News media can shape public opinion about child adversity and influence the translation of research into public policy. Research about adverse childhood experiences (ACEs) and toxic stress has increased dramatically in recent years, but little is known about how these concepts are covered in news media. We reviewed how newspapers in the United States have portrayed the consequences of, causes of, and solutions to address ACEs and toxic stress, examined trends in newspaper coverage, and assessed differences in coverage of ACEs versus toxic stress. Quantitative content analysis was conducted of 746 newspaper articles mentioning "adverse childhood experience(s)" and/or "toxic stress" published in 25 U.S. newspapers between January 1, 2014, and May 30, 2020. κ statistics of interrater reliability were calculated, and variables with κ ≥ .60 were retained for quantitative analysis. We found that newspaper coverage of ACEs and toxic stress increased dramatically between 2014 and 2018 and then sharply declined. Only 13.3% of articles mentioned both ACEs and toxic stress. There were many statistically significant (p < .05) differences in the causes, consequences, and solutions identified in articles focused on ACEs versus toxic stress. Coverage of both concepts predominantly focused on consequences for individuals, not society. However, 54.6% of articles identified a structural cause of ACEs and/or toxic stress. Increased volume in newspaper coverage about ACEs and toxic stress could increase public awareness about the relationship between childhood adversity and adult outcomes. There is a need to portray ACEs and toxic stress as complementary concepts more coherently in news media.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, 6527Drexel University, Philadelphia, PA, USA
| | - Sarah Bowler
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, AL, USA
| | - Maura Boughter-Dornfeld
- Department of Health Management and Policy, Dornsife School of Public Health, 6527Drexel University, Philadelphia, PA, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, 6527Drexel University, Philadelphia, PA, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, 43353University of Minnesota School of Public Health, Minneapolis, MN, USA
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11
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Rostad WL, Ports KA, Merrick M, Hughes L. The moment is now: Strengthening communities and families for the future of our nation. CHILDREN AND YOUTH SERVICES REVIEW 2023; 144:106745. [PMID: 36466794 PMCID: PMC9704498 DOI: 10.1016/j.childyouth.2022.106745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/28/2021] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 has highlighted the historical lack of investment in the conditions that children need to thrive, and demonstrates how a crisis can exacerbate children's vulnerability to disease and violence. Exposure to early adversity already affects millions of children across the country and puts them at risk for poor outcomes. With the uncertainty of the pandemic, many more families are struggling and subsequently, more children are at risk for exposure to adversity. Preventing early adversity and promoting the prosperity of our nation requires assuring that all children, regardless of sociodemographic characteristics, have what they need to reach their full health and life potential. Now is the time to address the social and structural conditions that contribute to the inequitable distribution of risk for some families and which contribute to their unequal burden and impacts of adversity, COVID-19, racial injustice, and other health crises. While many look forward to "a return to normal," returning to normal would be a missed opportunity to learn from our mistakes and ensure a bright future for our nation. We must invest in children and families for the future health of Americans.
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12
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Potter MH, Littleton T, Font SA. State support policies and children's living arrangements. CHILD ABUSE & NEGLECT 2022; 134:105873. [PMID: 36099686 DOI: 10.1016/j.chiabu.2022.105873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/02/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Many children in the United States live apart from their parents, in either formal or informal foster care, due to concerns about child abuse and neglect. Prior research has established a connection between poverty and child maltreatment, but many aspects of state support to families remain unexamined in relation to child living arrangements. OBJECTIVE We test welfare access, welfare generosity, work supports, and family supports indicators as predictors of foster care removal rates and nonparental care rates. PARTICIPANTS AND SETTING We use a population of 51 states, including the District of Columbia, for years 2008 to 2018, totaling 561 state-years. METHODS We utilize negative binomial regression models with state and year fixed effects. RESULTS We find that one-dollar higher minimum wages are negatively associated with both foster care removal rates (IRR = 0.947, p < 0.001) and nonparental care rates (IRR = 0.975, p < 0.01), but that other state policies are not consistently beneficial. CONCLUSIONS Our results have implications for policies to assist families and reduce child maltreatment.
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Affiliation(s)
| | | | - Sarah A Font
- Pennsylvania State University, State College, PA 16801, United States
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13
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Pace GT, Lee JY, Schneider W, Klika JB. Supporting Fathers to Prevent Child Maltreatment: How Paid Family Leave and Child Care Subsidies are Part of a Public Health Approach. INTERNATIONAL JOURNAL ON CHILD MALTREATMENT : RESEARCH, POLICY AND PRACTICE 2022; 5:519-539. [PMID: 38328007 PMCID: PMC10848274 DOI: 10.1007/s42448-022-00124-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 02/09/2024]
Abstract
There are multiple components of a public health approach for preventing child maltreatment. One of these components is the question of who to intervene with. Fathers are an under-targeted and under-studied group for child maltreatment prevention. In this conceptual article, we describe a public health approach for intervening with fathers. Acknowledging financial stress as a key risk factor for child maltreatment among fathers, we explore two policy interventions that aim to increase economic support for families during the early years of a child's life: paid family leave and child care subsidies. During the weeks following the child's birth, paid family leave can promote child-father bonding and enable fathers to engage in more caregiving during a critical family transition. After paid family leave ends, child care subsidies can make child care affordable for families with low income, thereby promoting parents' employment and earnings. We conclude by highlighting ways in which fathers can take an active role in preventing child maltreatment.
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Affiliation(s)
| | - Joyce Y. Lee
- College of Social Work, The Ohio State University
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14
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Dalve K, Moe CA, Kovski N, Rivara FP, Mooney SJ, Hill HD, Rowhani-Rahbar A. Earned Income Tax Credit and Youth Violence: Findings from the Youth Risk Behavior Surveillance System. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1370-1378. [PMID: 35917082 DOI: 10.1007/s11121-022-01417-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/28/2023]
Abstract
Family- and neighborhood-level poverty are associated with youth violence. Economic policies may address this risk factor by reducing parental stress and increasing opportunities. The federal Earned Income Tax Credit (EITC) is the largest cash transfer program in the US providing support to low-income working families. Many states have additional EITCs that vary in structure and generosity. To estimate the association between state EITC and youth violence, we conducted a repeated cross-sectional analysis using the variation in state EITC generosity over time by state and self-reported data in the Youth Risk Behavior Surveillance System (YRBSS) from 2005 to 2019. We estimated the association for all youth and then stratified by sex and race and ethnicity. A 10-percentage point greater state EITC was significantly associated with 3.8% lower prevalence of physical fighting among youth, overall (PR: 0.96; 95% CI 0.94-0.99), and for male students, 149 fewer (95% CI: -243, -55) students per 10,000 experiencing physical fighting. A 10-percentage point greater state EITC was significantly associated with 118 fewer (95% CI: -184, -52) White students per 10,000 experiencing physical fighting in the past 12 months while reductions among Black students (75 fewer; 95% CI: -176, 26) and Hispanic/Latino students (14 fewer; 95% CI: -93, 65) were not statistically significant. State EITC generosity was not significantly associated with measures of violence at school. Economic policies that increase financial security and provide financial resources may reduce the burden of youth violence; further attention to their differential benefits among specific population subgroups is warranted.
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Affiliation(s)
- Kimberly Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA. .,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.
| | - Caitlin A Moe
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Nicole Kovski
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA
| | - Heather D Hill
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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15
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Schulz AC, Kasinger C, Beutel M, Fegert JM, Clemens V, Brähler E. Adverse childhood experiences growing up in East or West Germany or abroad. Front Psychiatry 2022; 13:908668. [PMID: 36245878 PMCID: PMC9555308 DOI: 10.3389/fpsyt.2022.908668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) are potentially traumatic events that occur before the age of 18. The term encompasses various adverse childhood experiences, e.g., physical, psychological, and sexual abuse, physical and psychological neglect, and family dysfunction. Prevalence estimates for a broad spectrum of ACEs against the background of where childhood and adolescence were spent are scarcely available in Germany. This study examines the frequencies of adverse childhood experiences, considering growing up in East or West Germany or abroad and interacting with different age cohorts and gender. Methods A total of 5,018 individuals (51.4% female) aged 14 years and older were retrospectively assessed on adverse childhood experiences using questionnaires "adverse childhood experiences" (ACE). Logistic regression models were used to analyze the association between birth cohort, gender, and where a person grew up. Descriptive statistics and univariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable. Results 37.4% (N = 1,878) of respondents reported experiencing at least one form of ACE. Individuals who grew up abroad report significantly more adverse childhood experiences than individuals in East or West Germany. Men and women who grew up in East Germany reported a lower rate of ACEs. We found significant effects for all predictors: Where childhood and adolescence were predominantly spent, year of birth, and gender. Significant differences in the prevalence of adverse childhood experiences within the gender groups were only found for sexual and physical abuse and substance dependence in the household. Conclusion The results suggest that the socio-political context plays an essential role in the experience of adverse childhood experiences, both in frequency and risk. Thus, child abuse and neglect studies should increasingly focus on societal risk and protection mechanisms.
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Affiliation(s)
- Ann-Christin Schulz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty of the University of Ulm, Ulm, Germany
| | - Vera Clemens
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty of the University of Ulm, Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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16
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Alexander SP, Kim IC, Hatcher C, Suh HS, Ha Y, Marcil LE. Embedding Financial Services in Frequented, Trusted Settings: Building on Families' Pre-existing Economic Mobility Efforts. J Dev Behav Pediatr 2022; 43:e442-e451. [PMID: 35943377 DOI: 10.1097/dbp.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to understand parents'/guardians' experiences and aspirations around economic mobility and their impact on the acceptability and use of financial services embedded in frequented, trusted settings such as schools and pediatric clinics. METHOD We recruited 18 English-speaking guardians with at least 1 child enrolled in a school for low-income families and eligible for Internal Revenue Service-sponsored free tax preparation. Each participant completed a semistructured interview before tax filing; a subset completed follow-up interviews. We used grounded theory analysis. RESULTS We developed the following theoretical model based on our key thematic findings to describe the acceptability and use of financial services within the context of guardians' lived experiences and pre-existing efforts to build economic mobility: Families experience multilevel barriers to economic mobility. Despite these barriers, guardians are proactively working to build economic mobility by empowering the next generation with knowledge, skills, and assets and resiliently pursuing economic goals. As a result, guardians will accept empowering, nonjudgmental, expert, and trustworthy financial services that contribute to their existing efforts. To move from acceptance to use, financial services must be effectively publicized, accessible, and supportive. CONCLUSION Financial services may be more acceptable and used if they are embedded in trusted organizations and have expert, supportive staff with lived experience who empower guardians to work toward their economic goals, accessible platforms, and effective publicity. These characteristics may facilitate uptake and economic mobility. Trusted organizations serving young families can partner with financial services to test these findings and help families build economic mobility.
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Affiliation(s)
| | | | - Cyndie Hatcher
- Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | | | - Yoonsook Ha
- Boston University School of Social Work, Boston, MA
| | - Lucy E Marcil
- Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
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17
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Johnson-Motoyama M, Ginther DK, Oslund P, Jorgenson L, Chung Y, Phillips R, Beer OWJ, Davis S, Sattler PL. Association Between State Supplemental Nutrition Assistance Program Policies, Child Protective Services Involvement, and Foster Care in the US, 2004-2016. JAMA Netw Open 2022; 5:e2221509. [PMID: 35816315 PMCID: PMC9280401 DOI: 10.1001/jamanetworkopen.2022.21509] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Public assistance policies may play a role in preventing child maltreatment by improving household resources among families of low incomes. The Supplemental Nutrition Assistance Program (SNAP) is one of the largest public assistance programs in the US. However, the association of state SNAP policy options to Child Protective Services (CPS) outcomes has not been rigorously examined. OBJECTIVE To model the association of state SNAP policies with changes in CPS and foster care outcomes in the US over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study used panel data to examine the association between SNAP policy options and study outcomes from 2004 to 2016 for 50 US states and the District of Columbia in 2-way fixed-effects regression models. The count of SNAP policies was used as an instrument for SNAP caseloads in instrumental variables models. Data analysis was conducted in November 2021. EXPOSURES The adoption of 1 or more state SNAP income generosity policies that improves or stabilizes household resources for SNAP participants. MAIN OUTCOMES AND MEASURES Reports of child maltreatment accepted for CPS investigation, children in substantiated reports, and children receiving foster care services for all forms of maltreatment, and specifically for child neglect per 100 000 child population. RESULTS The mean (SD) number of SNAP income generosity policies increased from 1.47 (0.95) in 2004 to 2.37 (0.94) in 2010, to 2.49 (0.86) in 2016 across states; the median increased from 1 to 3 (range, 0-4) over the same period. A count of state income generosity policies was associated with large reductions in reports accepted for CPS investigation (-352.6 per 100 000 children; 95% CI, -557.1 to -148.2). Income generosity policy was associated with -94.8 (95% CI, -155.6 to -34.0) fewer substantiated reports and -77.0 (95% CI, -125.4 to -28.6) fewer reports substantiated for neglect per 100 000. Each additional income generosity policy adopted by a state was associated with -45.1 (95% CI, -71.6 to -18.5) to -42.3 (95% CI, -64.8 to -19.8) fewer total foster care placements per 100 000 children. CONCLUSIONS AND RELEVANCE State SNAP policies that improve and stabilize household resources appear to be associated with reductions in CPS involvement and use of foster care. The number of policies implemented had cumulative outcomes beyond individual policy outcomes.
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Affiliation(s)
| | - Donna K. Ginther
- The University of Kansas Institute for Policy and Social Research, Lawrence
| | - Patricia Oslund
- The University of Kansas Institute for Policy and Social Research, Lawrence
| | - Lindsay Jorgenson
- The University of Kansas Institute for Policy and Social Research, Lawrence
| | - Yoonzie Chung
- University of Maryland School of Social Work, Baltimore
| | | | | | - Starr Davis
- The Ohio State University College of Social Work, Columbus
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18
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Fullenkamp L, Haney SB. Using Tax Credits to Prevent Child Abuse. Pediatrics 2022; 150:188243. [PMID: 35661222 DOI: 10.1542/peds.2022-057311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lynn Fullenkamp
- Department of Pediatrics, University of Nebraska Medical Center.,Children's Hospital & Medical Center, Omaha, Nebraska
| | - Suzanne B Haney
- Department of Pediatrics, University of Nebraska Medical Center.,Children's Hospital & Medical Center, Omaha, Nebraska
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19
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Kovski NL, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. Short-Term Effects of Tax Credits on Rates of Child Maltreatment Reports in the United States. Pediatrics 2022; 150:188244. [PMID: 35662354 DOI: 10.1542/peds.2021-054939] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Poverty and low income are associated with increased risk for child maltreatment. The Earned Income Tax Credit (EITC) and Child Tax Credit (CTC) are among the largest antipoverty programs in the United States. We estimated associations between income transfer payments via the EITC and CTC and child maltreatment reports in the period shortly after families receive payments from these programs. METHODS We linked weekly EITC and CTC refund data from the Internal Revenue Service to state-specific child maltreatment report data from 48 states and the District of Columbia during the 2015 through 2018 tax seasons (January - April). We leveraged the natural experiment of a legislated change in the timing of EITC and CTC transfer payments to low-income families and quasi-experimental methods to estimate the association between EITC and CTC payments and child maltreatment reports. RESULTS EITC and CTC payments were associated with lower state-level rates of child maltreatment reports. For each additional $1000 in per-child EITC and CTC tax refunds, state-level rates of reported child maltreatment declined in the week of and 4 weeks following refund payments by an overall estimated 5.0% (95% confidence interval = 2.3%-7.7%). CONCLUSIONS Federal income assistance programs are associated with immediate reductions in child maltreatment reporting. These results are particularly relevant at this time, as expansions to such programs continue to be discussed at the state and federal levels.
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Affiliation(s)
| | | | | | - Frederick P Rivara
- Department of Epidemiology, School of Public Health.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
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20
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Edmonds AT, Moe CA, Adhia A, Mooney SJ, Rivara FP, Hill HD, Rowhani-Rahbar A. The Earned Income Tax Credit and Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12519-NP12541. [PMID: 33703934 DOI: 10.1177/0886260521997440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) is a serious public health problem in the United States with adverse consequences for affected individuals and families. Recent reviews of the literature suggest that economic policies should be further investigated as part of comprehensive strategies to address IPV. The Earned Income Tax Credit (EITC) is the nation's largest anti-poverty program for working parents, and especially benefits low-income women with children, who experience an elevated risk of IPV. The EITC may prevent IPV by offering financial resources; such resources may help individuals experiencing IPV leave abusive relationships or address IPV risk factors, thereby preventing entry into abusive relationships. However, the association between EITC generosity and IPV has not been previously examined. We used state-level and individual-level datasets to examine the association between EITC generosity and IPV. Our state-level data source was the nationally representative National Crime Victimization Survey (NCVS; N = ~ 95,000 households per year). For NCVS, we used a difference-in-difference approach to investigate the relationship between state EITC generosity and IPV rates. We also used individual-level longitudinal data from the Fragile Families and Child Well-being Study (n = 13,422 person-waves). Using this cohort of US families at higher risk for IPV, we evaluated associations between estimated EITC benefits based on the mother's state of residence and number of children and self-reported IPV. In both state- and individual-level analyses, no significant association between state EITC benefits and IPV was found. Factors that may account for these null findings include program ineligibility for individuals who separate from abusive spouses. Future research efforts should more closely examine EITC policy implementation processes and the lived experience of participating in anti-poverty programs for people experiencing IPV.
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21
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Purtle J, Nelson KL, Gebrekristos L, Lê-Scherban F, Gollust SE. Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial. Implement Sci 2022; 17:38. [PMID: 35729630 PMCID: PMC9213102 DOI: 10.1186/s13012-022-01214-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health. METHODS A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts. RESULTS For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts. CONCLUSIONS Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.
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Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, New York City, USA.
| | | | | | | | - Sarah E Gollust
- University of Minnesota School of Public Health, Minneapolis, USA
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22
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Matjasko JL, Herbst JH, Estefan LF. Preventing Adverse Childhood Experiences: The Role of Etiological, Evaluation, and Implementation Research. Am J Prev Med 2022; 62:S6-S15. [PMID: 35597583 PMCID: PMC9215220 DOI: 10.1016/j.amepre.2021.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022]
Abstract
Research on adverse childhood experiences is a vital part of the data-to-action link and the development of evidence-based public health and violence prevention practice. Etiological research helps to elucidate the key risk and protective factors for adverse childhood experiences and outcome research examines the consequences of exposure to them. Evaluation research is critical to building the evidence base for strategies that are likely to have a significant impact on preventing and reducing adverse experiences during childhood. Implementation research efforts inform the movement and scale-up of evidence-based findings to public health practice. The Centers for Disease Control and Prevention's Division of Violence Prevention located in the National Center for Injury Prevention and Control is investing in a number of research initiatives that are designed to advance what is known about the causes and consequences of adverse childhood experiences (i.e., etiological research), the strategies that are effective at reducing and preventing them (i.e., evaluation research), and how to best adapt and scale effective strategies (i.e., implementation research). This article complements the other articles in this Special Supplement by briefly providing a review of reviews for each of these areas and highlighting recent research investments and strategic directions by the Centers for Disease Control and Prevention in the area of child abuse and neglect and adverse childhood experience prevention. Research investments are critical to advancing the evidence base on the prevention of adverse childhood experiences and to ensure safe, stable, and nurturing relationships and environments so that all children can live to their fullest potential.
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Affiliation(s)
- Jennifer L Matjasko
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jeffrey H Herbst
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lianne Fuino Estefan
- Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC), U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Association of Economic Recession and Social Distancing with Pediatric Non-Accidental Trauma During COVID-19. J Surg Res 2022; 276:110-119. [PMID: 35339779 PMCID: PMC8866081 DOI: 10.1016/j.jss.2022.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
Introduction There has been concern that the incidence of non-accidental trauma (NAT) cases in children would rise during the COVID-19 pandemic due to the combination of social isolation and economic depression. Our goal was to evaluate NAT incidence and severity during the pandemic across multiple US cities. Methods Multi-institutional, retrospective cohort study comparing NAT rates in children <18 y old during the COVID-19 pandemic (March-August 2020) with a recent historical data (January 2015-February 2020) and during a previous economic recession (January 2007-December 2011) at level 1 Pediatric Trauma Centers. Comparisons were made in local and national macroeconomic indicators. Results Overall rates of NAT during March-August 2020 did not increase compared to historical data (P = 0.8). Severity of injuries did not increase during the pandemic as measured by Glasgow Coma Scale (GCS) (P = 0.97) or mortality (P = 0.7), but Injury Severity Score (ISS) slightly decreased (P = 0.018). Racial differences between time periods were seen, with increased proportions of NAT occurring in African-Americans during the pandemic (P < 0.001). NAT rates over time had low correlation (r = 0.32) with historical averages, suggesting a difference from previous years. Older children (≥3 y) had increased NAT rates during the pandemic. Overall NAT rates had low inverse correlation with unemployment (r = −0.37) and moderate inverse correlation with the stock market (r = −0.6). Significant variation between sites was observed. Conclusions Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates.
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24
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Morgan ER, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. State earned income tax credits and depression and alcohol misuse among women with children. Prev Med Rep 2022; 26:101695. [PMID: 35096518 PMCID: PMC8783139 DOI: 10.1016/j.pmedr.2022.101695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/27/2021] [Accepted: 01/15/2022] [Indexed: 01/28/2023] Open
Abstract
About 30% of single mothers in the US live at or below the poverty line. Poverty is associated with higher risk of depression and substance use. We investigated associations between state earned income tax credit (EITC) policies and reported depressive symptoms and alcohol misuse among birthing parents who responded to Pregnancy Risk Assessment Monitoring Survey spanning 1990-2017. Nearly half of birthing parents reported no more than a high school education (45.4%; 95% CI: 45.3%-45.6%). An estimated 28.5% of birthing parents reported binge drinking in the three months prior to conception (95% CI: 28.3-28.8%). Among birthing parents, each 10 percentage-point increase in the generosity of state EITC relative to the federal EITC was associated with a lower prevalence of binge drinking (prevalence ratio = 0.96; 95% CI: 0.93-0.99) prior to conception. This association was more pronounced among birthing parents with no more than high school education (prevalence ratio = 0.92; 95% CI: 0.88-0.97). There was no association between state EITC and number of reported depressive symptoms prior to conception or after birth, except among those with lower educational attainment (prevalence ratio = 0.94; 95% CI: 0.89-0.99). Anti-poverty policies such as EITC may reduce the burden of alcohol misuse, especially among people with children.
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Affiliation(s)
- Erin R. Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA,Corresponding author at: University of Washington, School of Public Health, Department of Epidemiology, University of Washington, Box 351619, Seattle, WA 98195, USA.
| | - Heather D. Hill
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, WA, USA
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Frederick P. Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
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25
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Puls HT, Hall M, Anderst JD, Gurley T, Perrin J, Chung PJ. State Spending on Public Benefit Programs and Child Maltreatment. Pediatrics 2021; 148:peds.2021-050685. [PMID: 34663680 DOI: 10.1542/peds.2021-050685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the association between states' total spending on benefit programs and child maltreatment outcomes. METHODS This was an ecological study of all US states during federal fiscal years 2010-2017. The primary predictor was states' total annual spending on local, state, and federal benefit programs per person living ≤100% federal poverty limit, which was the sum of (1) cash, housing, and in-kind assistance, (2) housing infrastructure, (3) child care assistance, (4) refundable Earned Income Tax Credit, and (5) Medical Assistance Programs. The main outcomes were rates of maltreatment reporting, substantiations, foster care placements, and fatalities after adjustment for relevant confounders. Generalized estimating equations adjusted for federal spending and estimated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS States' total spending was inversely associated with all maltreatment outcomes. For each additional $1000 states spent on benefit programs per person living in poverty, there was an associated -4.3% (adjusted IRR: 0.9573 [95% CI: 0.9486 to 0.9661]) difference in reporting, -4.0% (adjusted IRR: 0.903 [95% CI: 0.9534 to 0.9672]) difference in substantiations, -2.1% (adjusted IRR: 0.9795 [95% CI: 0.9759 to 0.9832]) difference in foster care placements, and -7.7% (adjusted IRR: 0.9229 [95% CI: 0.9128 to 0.9330]) difference in fatalities. In 2017, extrapolating $1000 of additional spending for each person living in poverty ($46.5 billion nationally, or 13.3% increase) might have resulted in 181 850 fewer reports, 28 575 fewer substantiations, 4168 fewer foster care placements, and 130 fewer fatalities. CONCLUSIONS State spending on benefit programs was associated with reductions in child maltreatment, which might offset some benefit program costs.
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Affiliation(s)
- Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri .,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Matthew Hall
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,Children's Hospital Association; Lenexa, Kansas
| | - James D Anderst
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Tami Gurley
- Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas
| | - James Perrin
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Paul J Chung
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California.,Departments of Pediatrics and Health Policy & Management, University of California, Los Angeles, Los Angeles, California
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26
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Runyan CW, Brandspigel S, Doyle CK, Myers L. Public Health Needs to Engage in the Primary Prevention of Child Maltreatment. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E37-E39. [PMID: 32332482 DOI: 10.1097/phh.0000000000001158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carol W Runyan
- Program for Injury Prevention, Education and Research, Colorado School of Public Health, Aurora Colorado (Dr Runyan and Ms Brandspigel); and Violence and Injury Prevention-Mental Health Promotion Branch, Colorado Department of Public Health and the Environment, Denver, Colorado (Mss Doyle and Myers)
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27
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Ports KA, Tang S, Treves-Kagan S, Rostad W. Breaking the cycle of Adverse Childhood Experiences (ACEs): Economic position moderates the relationship between mother and child ACE scores among Black and Hispanic families. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106067. [PMID: 35125581 PMCID: PMC8815463 DOI: 10.1016/j.childyouth.2021.106067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
IMPORTANCE Adverse Childhood Experiences (ACEs) are prevalent, preventable, and a public health issue that cycles from one generation to the next with serious implications for health and wellbeing, particularly. Research is needed to identify factors, including those related to economic position (i.e., wage, net family wealth, home ownership), that break the cycle of ACEs and inform decisions about policies, practices, and programs. OBJECTIVE To determine whether economic position moderates the association between mother's ACE score and child's ACE score and whether these pathways differ by race and ethnicity. DESIGN Conducted regression and moderation analysis using mother-child dyadic data from panel surveys, stratified by race. The simple slopes for the interactions were probed to determine the magnitude and significance of the interaction. SETTING Secondary data analysis utilizing data from two cohorts of the National Longitudinal Surveys: 1) National Longitudinal Survey of Youth 1979; and 2) National Longitudinal Survey of Youth 1979 Children and Young Adults. PARTICIPANTS The sample included 6,261 children and 2,967 matched mothers. MAIN OUTCOMES S AND MEASURES The outcome variable was the child's ACE score. Mother's ACE score was the independent variable. Three economic position moderators were examined: mother's and her spouse's average wage and salary, average net family wealth, and percent of time owning a home during her child's first five years of life. RESULTS Mother's ACE score was positively associated with her child's ACE score. Economic position was a significant moderator for Black families. Higher wages and net family wealth during children's first five years were associated with weakened associations between mother and child ACEs for Black families. For Hispanic families, higher wages and salary were significantly associated with weakened associations. Among White families, higher net family wealth was associated with stronger ACEs transmission. CONCLUSIONS AND RELEVANCE Taken together, these findings highlight the important role that economic position may play on breaking the cycle of ACEs. This information can inform decisions about what public assistance policies, practices, and programs may be used to improve economic stability among families as an effective ACEs prevention strategy, and for whom these strategies might be most effective at reducing the cycle of ACEs.
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Affiliation(s)
- Katie A. Ports
- Corresponding author at: Health Equity Research Applied, Atlanta, GA 30316, United States. , (K.A. Ports)
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Dias MS, Cappos KM, Rottmund CM, Reed ME, Smith KM, deGuehery KA, Wang M. Preventing abusive head trauma: can educating parents reduce the incidence? Pediatr Radiol 2021; 51:1093-1096. [PMID: 33999251 DOI: 10.1007/s00247-020-04819-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/25/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
Abusive head trauma (AHT) is the most lethal form of child abuse; preventing AHT should be a national priority, but research into this area is woefully underfunded. Prevention programs have primarily focused on universal parent education during the neonatal period, a time when parents are a captive audience of the health care establishment whose focus is on the needs of their newborn infant, and who will soon be exposed to the frustration and anger of infant crying. Research has suggested a strong causal link between infant crying and AHT, and parents - particularly fathers and father figures - have been identified as the most common perpetrators of AHT. A number of studies have suggested that educating parents during the postnatal period about the normalcy of inconsolable infant crying and its evolution over the first several months of postnatal life improves parental knowledge about infant crying and a number of positive parenting behaviors, and decreases emergency room visits for crying. In 1998, we began a pilot program in Upstate New York near Buffalo that led to a 47% reduction in AHT incidence. Similar studies have demonstrated 35-75% reductions in incidence, which has led to enthusiasm for this approach to preventing AHT. We, as well as another group, have enacted statewide programs in Pennsylvania and North Carolina; unfortunately, these two large statewide replication trials failed to demonstrate any impact of such an intervention on AHT rates. Serial messages for parents, provided repeatedly over the period of greatest risk for AHT, might be another avenue of research.
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Affiliation(s)
- Mark S Dias
- Department of Neurosurgery, Penn State College of Medicine, Penn State Health Hershey Medical Center, 30 Hope Drive, Suite 2750, EC110, Hershey, PA, 17033, USA.
| | - Kelly M Cappos
- Department of Neurosurgery, Penn State College of Medicine, Penn State Health Hershey Medical Center, 30 Hope Drive, Suite 2750, EC110, Hershey, PA, 17033, USA
| | - Carroll M Rottmund
- Department of Neurosurgery, Penn State College of Medicine, Penn State Health Hershey Medical Center, 30 Hope Drive, Suite 2750, EC110, Hershey, PA, 17033, USA
| | - Marie E Reed
- Department of Neurosurgery, Penn State College of Medicine, Penn State Health Hershey Medical Center, 30 Hope Drive, Suite 2750, EC110, Hershey, PA, 17033, USA
| | - Kim M Smith
- Women and Children's Hospital of Buffalo, University of Buffalo, Buffalo, NY, USA
| | - Kathleen A deGuehery
- Women and Children's Hospital of Buffalo, University of Buffalo, Buffalo, NY, USA
| | - Ming Wang
- Public Health Sciences, Penn State College of Medicine,, Penn State Health Hershey Medical Center, Hershey, PA, USA
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Tang S, Jones CM, Wisdom A, Lin HC, Bacon S, Houry D. Adverse childhood experiences and stimulant use disorders among adults in the United States. Psychiatry Res 2021; 299:113870. [PMID: 33780857 PMCID: PMC8211100 DOI: 10.1016/j.psychres.2021.113870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
Recent data indicate a resurgence of stimulant use and harms in the United States; thus, there is a need to identify risk factors to inform development of effective prevention strategies. Prior research suggests adverse childhood experiences (ACEs) are common among individuals using stimulants and may be an important target for prevention. National Epidemiological Survey on Alcohol and Related Conditions was used to estimate prevalence of ACEs among U.S. adults using amphetamine-type stimulants (ATS), cocaine, or both. Multivariable logistic regression examined associations between ACEs and stimulant use and use disorders. Among adults reporting lifetime ATS use, 22.1% had ≥4 ACEs, 24.9% had 2-3 ACEs, 22.4% had 1 ACE, 30.6% reported no ACEs. Among adults with lifetime ATS use disorder, 29.3% reported ≥4 ACEs, 28.7% reported 2-3 ACEs, 21.6% reported 1 ACE, and 20.4% reported no ACEs. Multivariable logistic regression found a significant relationship between number of ACEs and stimulant use and use disorders. In conclusion, we found a strong relationship between increasing ACE exposures and stimulant use and use disorders. Advancing comprehensive strategies to prevent ACEs and treating underlying trauma among those using stimulants holds great promise to reduce stimulant use and its health and social consequences in the United States.
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Affiliation(s)
- Shichao Tang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA.
| | - Christopher M Jones
- Office of the Director, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
| | - April Wisdom
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
| | - Hsien-Chang Lin
- School of Public Health, Indiana University, Bloomington, USA
| | - Sarah Bacon
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
| | - Debra Houry
- Office of the Director, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
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Morgan ER, DeCou CR, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. State earned income tax credits and suicidal behavior: A repeated cross-sectional study. Prev Med 2021; 145:106403. [PMID: 33388334 DOI: 10.1016/j.ypmed.2020.106403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/28/2023]
Abstract
Suicide is an increasingly common cause of death in the United States and recent increases in suicide rates disproportionately impact low income individuals. We sought to assess the impact of income support in the form of state earned income tax credit policies on suicide-related behaviors. This state-level study used repeated cross-sectional data from vital records and the National Survey of Drug Use and Health data representative at the state-level. The population included adults who either died by suicide or were selected for in-person NSDUH interviews between 2008 and 2018. Exposure was measured as the generosity of a refundable state earned income tax credit policy measured as a percentage of the federal policy. Outcomes assessed were suicidal ideation, suicidal planning, non-fatal suicide attempt, suicide deaths, and combined fatal and non-fatal suicide attempts. Analyses were performed between April and June 2020. A 10 percentage-point increase in the generosity of state earned income tax credit was associated with lower frequency of non-fatal suicide attempts (prevalence ratio [PR] = 0.96; 95% CI: 0.93-0.99), combined fatal and non-fatal suicide attempts (PR = 0.96; 95% CI: 0.93-0.99), and suicide deaths (PR = 0.99; 95% CI: 0.99-1.00). This translates to 4 fewer suicide attempts per 10,000 population each year. Generous state earned income tax credit policies are associated with reductions in the frequency of most severe suicidal behavior. Income support policies may be one way to reduce suicide attempts and death, especially among low-income adults.
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Affiliation(s)
- Erin R Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America.
| | - Christopher R DeCou
- Department of Psychiatry & Behavioral Science, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Heather D Hill
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, WA, United States of America
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America
| | - Frederick P Rivara
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America
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Herrenkohl TI, Scott D, Higgins DJ, Klika JB, Lonne B. How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a Different Approach to Child Welfare. CHILD MALTREATMENT 2021; 26:9-16. [PMID: 33025825 DOI: 10.1177/1077559520963916] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The onset of the COVID-19 pandemic brings new worries about the welfare of children, particularly those of families living in poverty and impacted other risk factors. These children will struggle more during the pandemic because of financial pressures and stress placed on parents, as well as their limited access to services and systems of support. In this commentary, we explain how current circumstances reinforce the need for systemic change within statutory child welfare systems and the benefits that would accrue by implementing a continuum of services that combine universal supports with early intervention strategies. We also focus on promising approaches consistent with goals for public health prevention and draw out ideas related workforce development and cross-sector collaboration.
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Affiliation(s)
- Todd I Herrenkohl
- 1259University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Debbie Scott
- 2541Monash University, Richmond, Victoria, Australia
| | - Daryl J Higgins
- Institute of Child Protection Studies, 95359Australian Catholic University, Melbourne, Victoria, Australia
| | - J Bart Klika
- 141164Prevent Child Abuse America, Chicago, IL, USA
| | - Bob Lonne
- School of Health, 1319University of New England, Armidale, New South Wales, Australia
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Rostad WL, Ports KA, Tang S, Klevens J. Reducing the Number of Children Entering Foster Care: Effects of State Earned Income Tax Credits. CHILD MALTREATMENT 2020; 25:393-397. [PMID: 31973550 PMCID: PMC7377953 DOI: 10.1177/1077559519900922] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Foster care caseloads, an indicator of child maltreatment, are increasing. Children living in poverty are significantly more likely to be reported to the child welfare system and are overrepresented in foster care. Thus, it is critical to identify prevention strategies that can stem the flow of foster care entries, particularly among populations at higher risk. We used variations in the adoption and refund status of state-level Earned Income Tax Credit (EITC), a socioeconomic policy intended to reduce poverty, to examine their effect on foster care entry rates. Fixed-effects models, accounting for year- and state-fixed effects, demonstrated that a refundable EITC was associated with an 11% decrease in foster care entries compared to states without a state-level EITC after controlling for child poverty rate, racial/ethnic composition, education, and unemployment. Policies that strengthen economic supports for families may prevent child maltreatment and reduce foster care entries and associated costs.
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Affiliation(s)
- Whitney L. Rostad
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Casey Family Programs, Seattle, WA, USA
| | - Katie A. Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shichao Tang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joanne Klevens
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Austin AE, Lesak AM, Shanahan ME. Risk and protective factors for child maltreatment: A review. CURR EPIDEMIOL REP 2020; 7:334-342. [PMID: 34141519 PMCID: PMC8205446 DOI: 10.1007/s40471-020-00252-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to synthesize the empirical literature regarding key risk and protective factors for child maltreatment at each level of the socioecological model and to identify directions for future research and practice. RECENT FINDINGS Prior research has largely focused on risk and protective factors at the individual and interpersonal levels of the socioecological model. More recently, research has begun to examine risk and protective factors at the community and societal levels, with results suggesting that programmatic and policy interventions that reduce risk and enhance protection at these levels are promising primary prevention strategies for child maltreatment. SUMMARY Future research should continue to focus on risk and protective factors at the community and societal levels with the aim of building the evidence base for population-wide prevention strategies. Such strategies have the potential to create contexts in which families and children thrive.
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Affiliation(s)
- Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandria M. Lesak
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghan E. Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Beaulieu E, Jiang A, Zheng A, Rajabali F, Pike I. Inequities in Pediatric Abusive Head Trauma According to Neighborhood Social and Material Deprivation: A Population-Level Study in British Columbia, Canada. CHILD MALTREATMENT 2020; 25:300-307. [PMID: 31826660 DOI: 10.1177/1077559519892332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To explore the relationship between neighborhood social and material deprivation and the rates of abusive head trauma (AHT), and whether it differs according to sex, and following the implementation of the Period of PURPLE Crying (PURPLE) program. METHOD A cross-sectional study design was applied to data from children 0 to 24 months old with a confirmed AHT diagnosis between 2005 and 2017 in British Columbia. Dissemination area-based social and material deprivation scores were assigned to residential areas, where AHT cases were recorded. Poisson regression models tested the relationship between deprivation scores and AHT rates, adding sex and pre-post program implementation as interaction terms. RESULTS With each increase in material and social deprivation quintiles, AHT rates increased by 42% (95% CI [1.18, 1.72]) and 25% (95% CI [1.06, 1.51]), respectively, following a social gradient. AHT rate disparities between neighborhoods did not change following the PURPLE program implementation. CONCLUSIONS This study stresses the need to provide additional AHT prevention services proportionately to the levels of neighborhood disadvantage, in addition to universal AHT programs, to successfully protect all children.
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Affiliation(s)
- Emilie Beaulieu
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Faculty of Medicine, Department of Pediatrics, The University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Andy Jiang
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Faculty of Medicine, Department of Pediatrics, The University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
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Abstract
Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.
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Affiliation(s)
- Sandeep K Narang
- Division of Child Abuse Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Amanda Fingarson
- Division of Child Abuse Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - James Lukefahr
- Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Bell ON, Hole MK, Johnson K, Marcil LE, Solomon BS, Schickedanz A. Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health. Acad Pediatr 2020; 20:166-174. [PMID: 31618676 PMCID: PMC7331932 DOI: 10.1016/j.acap.2019.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/04/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Abstract
Financial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine 8 established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.
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Affiliation(s)
- Orly N Bell
- David Geffen School of Medicine at UCLA (ON Bell), Los Angeles, Calif.
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin (MK Hole), Austin, Tex
| | - Karl Johnson
- Krieger School of Arts and Sciences, Johns Hopkins University (K Johnson), Baltimore, Md
| | - Lucy E Marcil
- Department of Pediatrics, Boston University School of Medicine (LE Marcil), Boston, Mass
| | - Barry S Solomon
- Department of Pediatrics, Johns Hopkins University School of Medicine (BS Solomon), Baltimore, Md
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz), Los Angeles, Calif
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Courtin E, Allchin E, Ding AJ, Layte R. The Role of Socioeconomic Interventions in Reducing Exposure to Adverse Childhood Experiences: a Systematic Review. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00216-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Purtle J, Lê-Scherban F, Wang X, Brown E, Chilton M. State Legislators' Opinions About Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions. Psychiatr Serv 2019; 70:894-900. [PMID: 31272336 PMCID: PMC6773502 DOI: 10.1176/appi.ps.201900175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. METHODS A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. RESULTS Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p<.001). CONCLUSIONS Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Félice Lê-Scherban
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Xi Wang
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Emily Brown
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Mariana Chilton
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
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Bullinger LR, Feely M, Raissian KM, Schneider W. Heed Neglect, Disrupt Child Maltreatment: a Call to Action for Researchers. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42448-019-00026-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bright MA, Lynne SD, Masyn KE, Waldman MR, Graber J, Alexander R. Association of Friday School Report Card Release With Saturday Incidence Rates of Agency-Verified Physical Child Abuse. JAMA Pediatr 2019; 173:176-182. [PMID: 30556830 PMCID: PMC6439612 DOI: 10.1001/jamapediatrics.2018.4346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/07/2018] [Indexed: 11/14/2022]
Abstract
Importance Corporal punishment is a leading risk factor for physical abuse. Strong anecdotal evidence from physicians and other professionals working in child protection suggest that punishment-initiated physical abuse for school-aged children increases after release of report cards. However, no empirical examination of this association has occurred. Objective To examine the temporal association between school report card release and incidence rates (IRs) of physical abuse. Design, Setting, and Participants This retrospective study reviewed calls to a state child abuse hotline and school report card release dates across a single academic year in Florida. Data were collected in a 265-day window from September 8, 2015, to May 30, 2016, in the 64 of 67 Florida counties with report card release dates available (16 960 days). Participants included all children aged 5 to 11 years for whom calls were made. A total of 1943 verified cases of physical abuse were reported in the study period in the 64 counties. Data were analyzed from October 2017 through May 2018. Exposures School report cards release across a single academic year, measured daily by county. Main Outcomes and Measures Daily counts of calls to a child abuse hotline that later resulted in agency-verified incidents of child physical abuse across a single academic year by county. Results During the academic year, 167 906 calls came in to the child abuse hotline for children aged 5 to 11 years; 17.8% (n = 29 887) of these calls were suspected incidents of physical abuse, and 2017 (6.7%) of these suspected incidents were later verified as cases of physical abuse before excluding the 3 counties with no release dates available. Among the 1943 cases included in the analysis (58.9% males [n = 1145]; mean [SD] age, 7.69 [1.92] years), calls resulting in verified reports of child physical abuse occurred at a higher rate on Saturdays after a Friday report card release compared with Saturdays that do not follow a Friday report card release (IR ratio, 3.75; 95% CI, 1.21-11.63; P = .02). No significant association of report card release with IRs was found for any other days of the week. Conclusion and Relevance This association of school report card release and physical abuse appears to illustrate a unique systems-based opportunity for prevention.
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Affiliation(s)
- Melissa A. Bright
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, Gainesville
| | - Sarah D. Lynne
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville
| | - Katherine E. Masyn
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Marcus R. Waldman
- Quantitative Policy Analysis in Education, Harvard University, Cambridge, Massachusetts
| | - Julia Graber
- Department of Psychology, University of Florida, Gainesville
| | - Randell Alexander
- Division of Child Protection and Forensic Pediatrics, Department of Pediatrics, University of Florida, Jacksonville
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Rostad WL, Klevens J, Ports KA, Ford DC. Impact of the United States federal child tax credit on childhood injuries and behavior problems. CHILDREN AND YOUTH SERVICES REVIEW 2019; 107:10.1016/j.childyouth.2019.104718. [PMID: 32322131 PMCID: PMC7176404 DOI: 10.1016/j.childyouth.2019.104718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Children who grow up in poverty are at risk for various poor outcomes. Socioeconomic policies can shape the conditions in which families are raising children and may be effective at reducing financial strain and helping families obtain economic sufficiency, thereby reducing risk for poor health outcomes. This study used data from two surveys conducted in the US, the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Young Adult survey to determine whether the U.S. Federal Child Tax Credit (CTC), a socioeconomic policy that provides tax relief to low- and middle-income families to offset the costs of raising children, is associated with child well-being, as indicated by whether the child had injuries requiring medical attention and behavioral problems. Fixed-effects models, accounting for year and state of residence, detected a lower likelihood of injuries requiring medical attention (OR = 0.58, 95% CI [0.40, 0.86]) and significantly fewer behavior problems (b = -2.07, 95% CI [-4.06, -0.08]) among children with mothers eligible to receive a CTC, but only when it was partially refundable (i.e., mothers could receive a tax refund for a portion of the CTC that exceeds their tax liability) for families making as little as $3000 a year. Tax credits like the CTC have the potential to alleviate financial strain among families, and consequently, may have impacts on injury and behavior problems.
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Affiliation(s)
- Whitney L. Rostad
- Corresponding author at: 3030 14 Ave W, Seattle, WA, United States. (W.L. Rostad)
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Hsin YC, Chang YC, Lee EP, Chiu CH, Chou I.J, Hsia SH, Lin KL, Lee J, Huang JL, Wang CJ, Wu HP. Risk factors for child maltreatment by the utilization of medical service and socioeconomic environment in Taiwan. Medicine (Baltimore) 2018; 97:e13728. [PMID: 30593145 PMCID: PMC6314714 DOI: 10.1097/md.0000000000013728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Child maltreatment is complicated by cultural, welfare, and socioeconomic factors. However, the relationship between child maltreatment and socioeconomic factors has not been completely understood. We investigated risk factors for child abuse and neglect in Taiwan.The data in our study was obtained from Taiwan National Statistics at county level from 2004 to 2015. We included 4 areas (eastern, western, southern, northern) involving 20 cities and counties. The trends of child maltreatment rate based on different years and different areas were surveyed. In addition, panel data analysis was used to analyze the links between child maltreatment rate and socioeconomic factors.An increasing trend of child maltreatment rate in Taiwan was observed. During the past decade, child maltreatment rate increased from 14.5 in 2004 to 23.4 cases per 10000 children in 2014. The peak, which was 43 cases per 10000 children, occurred in 2012. Significant geographical differences were observed, and the highest child maltreatment rate was seen in eastern Taiwan. Panel data analysis revealed a lag effect of the unemployment rate on child maltreatment rate at the county level: the child maltreatment rate increased by 7 percent, while the prior unemployment rate increased by one percent. In addition, the medical personnel density was related to the child maltreatment rate within the county.Previous unemployment rate had a lag impact on child maltreatment occurrence. Unemployment rate has not only a direct impact on the economy but also sequential effects on child maltreatment.
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Affiliation(s)
- Yi-Chen Hsin
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Yu-Ching Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - En-Pei Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University
- Division of Pediatric Infectious Diseases
| | - I.-.Jun Chou
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
| | - Shao-Hsuan Hsia
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Jing-Long Huang
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Chao-Jan Wang
- College of Medicine, Chang Gung University
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan
| | - Han-Ping Wu
- Department of Pediatric Emergency Medicine
- Department of Medical Research, Children's Hospital
- Department of Medicine, College of Medicine, China Medical University, Taichung
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D’Inverno AS, Kearns MC, Reidy DE. Introduction to the Special Issue: The Role of Public Policies in Preventing IPV, TDV, and SV. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:3259-3266. [PMID: 30253724 PMCID: PMC6456897 DOI: 10.1177/0886260518798360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Megan C. Kearns
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dennis E. Reidy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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