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Objective: To review the literature on the relationships between neighborhoods and child maltreatment and identify future directions for research in this area. Method: A search of electronic databases and a survey of experts yielded a list of 25 studies on the influence of geographically defined neighborhoods on child maltreatment. These studies were then critically reviewed by an interdisciplinary research team. Results: Numerous studies demonstrate that child maltreatment cases are concentrated in disadvantaged areas. A number of socio-economic characteristics of neighborhoods have been shown to correlate with child maltreatment rates as measured by official reports to child protective service agencies. Only a few studies examine direct measures of parenting behaviors associated with maltreatment, and these show a weaker relationship with neighborhood disadvantage. Moreover, the processes that link neighborhood conditions to either maltreatment reports or parenting behaviors are not yet confirmed by the research literature. Selection bias, neighborhood definitions and spatial influences are largely uncontrolled in the existing research. Conclusions: We propose a framework for pursuing further study of neighborhoods and child maltreatment that addresses the gaps in the current literature. Neighborhood-based strategies to prevent and reduce child maltreatment will be enhanced by research that provides a better understanding of how neighborhood conditions act as stressors or supports for families at risk of child maltreatment. Keywords: Child maltreatment; Neighborhoods; Etiology

Objective: While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors. Methods: A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior. Results: A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology. Conclusions: Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology. Keywords: Child abuse; Rape; Domestic violence; Sexual risk behavior; Sexual assault

This research examines whether women who have experienced intimate partner violence (IPV) during pregnancy have a higher child abuse potential than women who have not experienced IPV. Data were analyzed from a longitudinal investigation of IPV during pregnancy. This study recruited 88 pregnant women during prenatal care and followed them for 1 1/2 years. IPV was assessed using the Conflict Tactics Scale 2 (CTS2). The woman's potential for child abuse was assessed using the Child Abuse Potential Inventory (CAPI). There was a significant positive association between IPV and child abuse potential scores (p = .003), even after controlling for sociodemographics. The odds of having a high level of child abuse potential were 3 times greater for women who were victims of IPV compared to nonvictims. Higher child abuse potential scores of the victimized women resulted mainly from the Distress and Problems with Others CAPI scales. Keywords: child abuse potential; intimate partner violence; pregnancy

A dynamic equilibrium model for analyzing child maltreatment and the influence of parent-child relations on these scenarios is presented.

To explore cognitive and emotional factors that may exacerbate child-abuse potential among domestic violence victims, 80 participants reported on their depression, hopelessness, anxiety, and anger as well as their attachment style and attributional style. Increased emotional difficulties as well as insecure attachment styles were significantly positively correlated with child abuse potential, although depression and anxiety were the strongest predictors. Externalizing blame for the spousal abuse was not associated with abuse risk. Women residing in shelters demonstrated significantly greater abuse risk than those in transitional housing programs, suggesting that greater temporal proximity to the spousal abuse may in part account for the increased abuse potential. Depression and hopelessness, however, appeared particularly relevant to increased abuse risk in domestic violence victims in the transitional housing system. Implications of these findings for working with battered women in terms of their emotional functioning and attachment style are discussed. Keywords: battered women; child maltreatment; attachment style; depression; anxiety; anger

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families. Keywords: Physical abuse; Sexual abuse; Substance abuse

Objective: The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused On obtaining great detail on homicides and suspicious deaths occurring within a fixed population. Methods: For purposes of this study, cases included Jefferson County deaths attributed to 'homicide' or that were 'undetermined' as noted in the coroner files among 'children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998, Victim and offender characteristics were obtained from the Jefferson County Coroner Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well. Results: The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%). Conclusions: The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive. Keywords: Epidemiology; Homicide; Children; Coroner data

How do different types of child maltreatment relate to parental drug/alcohol problems? A series of confirmatory factor models were tested with cross-sectional data from a community sample (N = 477). Findings suggest that childhood maltreatment and parental drug problems are two distinct conditions that co-occur about 30% of the time; they are not completely independent, nor are they always related to each other. When they co-occur, greater problems characterized by global parental dysfunction are suggested. Furthermore, several reported experiences differed by gender: Family abuse and parent drug problems were more strongly related for men.

Objective. Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment. Methodology. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992-1994. Households were categorized based on adult residents' relationship to the deceased child. Cases were all maltreatment injury deaths among children Results. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6-21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6-12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1-4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8-2.0). Conclusions. Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home. Pediatrics 2002; 109:615-621; epidemiology, injury, child abuse and neglect, fatalities, mortality, maltreatment, case-control study, death, risk factors, behavior. ABBREVIATIONS. CFRP, Missouri Child Fatality Review Panel; SIDS, sudden infant death syndrome; aOR, adjusted odds ratio; CI, confidence interval., Maltreatment of children causes an estimated 2000 deaths annually in the United States. (1) Ninety percent of these deaths occur among children Several studies have identified the following maternal risk [...]

Objective: The study sought to determine if high-risk, compared to low-risk, mothers make more emotion recognition errors when they attempt to recognize emotions in children and adults. Method: Thirty-two demographically matched high-risk (n = 16) and low-risk (n = 16) mothers were asked to identify different emotions expressed by children and adults. Sets of high- and low-intensity, visual and auditory emotions were presented. Mothers also completed measures of stress, depression, and ego-strength. Results: High-risk, compared to low-risk, mothers showed a tendency to make more errors on the visual and auditory emotion recognition tasks, with a trend toward more errors on the low-intensity, visual stimuli. However, the observed trends were not significant. Only a post-hoc test of error rates across all stimuli indicated that high-risk, compared to low-risk, mothers made significantly more emotion recognition errors. Although situational stress differences were not found, high-risk mothers reported significantly higher levels of general parenting stress and depression and lower levels of ego-strength. Conclusions: Since only trends and a significant post hoc finding of more overall emotion recognition errors in high-risk mothers were observed, additional research is needed to determine if high-risk mothers have emotion recognition deficits that may impact parent-child interactions. As in prior research, the study found that high-risk mothers reported more parenting stress and depression and less ego-strength.

Objectives: The article constructed an integrated conceptual framework for understanding child physical abuse based on a content analysis of different theories. Three major determinants of physical abuse were identified: exposure to aggression, exposure to stressors, and access to resources. To test the framework, we included variables from all three major categories in the analyses. Methodology: Data from a case-comparison study that included 81 physically abusive and 148 nonabusive mothers was used. Logistic regression determined the relative importance of the predictors. Results: The probability of child physical abuse varied in the expected direction with the number of emotional resources received (listening, help with decision-making, companionship), the number of stressors experienced, and the mothers exposure to physical abuse by their own mothers, current partners, and former partners. The estimation results showed that exposure to aggression in one's own childhood (abused by one's own mother) and exposure to domestic violence in one's adult life (abused by one's previous and current partners) were the most potent factors for predicting whether a mother physically abused her child. Conclusion: The results suggest further research on the interdependencies between domestic violence and child physical abuse. Key Words - Child abuse, Child maltreatment, Domestic violence, Battered women.

Historical documents and case files suggest that single, widowed and abandoned mothers are responsible for child neglect, and that the concept of child neglect was coined in relation to the problems of abandoned and neglected children. The first child welfare agency was started in Canada in 1891 and two years later the Children's Protection Act was passed which made the state responsible for the neglected children. Traditional ideas regarding child neglect impose serious constraints on social changes, and a radical break from the past in needed to completely erase this social problem.

A review of child abuse literature shows that poverty is the main cause for the increasing number of child abuse cases in the US because poverty reduces the ability of parents to provide a healthy environment for child rearing. Parents in very poor families discipline their children harshly and fail to offer them support. They are more likely to fight with each other, to separate and to have a negative view of their children. Children with adolescent or divorced parents, adopted children and difficult children are more likely to be abused. Legal definitions of child abuse must take into account differing cultural perceptions of child rearing, as findings from studies of white, middle class families may not apply to poor African-American families.

Studies of child abuse risk potential and parenting attitudes of adolescent mothers during the perinatal period reveal that younger adolescent mothers are more likely to abuse their children due to risk factors such as distress, rigidity in their parenting attitudes and inappropriate expectations of children. Younger adolescents complain of greater unhappiness than older adolescents and view physical punishment as a form of discipline. Social support to these adolescent mothers will reduce their distress and minimize the risk of child abuse.

* Objective.--To investigate the relationship between maternal cocaine dependency and child maltreatment in a cohort of young children. Design.--Historical cohort study at an urban, tertiary care medical center. Patients.--47 infants, born between january and September 1989, whose mothers were regular users of cocaine during pregnancy, based on history and the results of newborns' urine toxicology screens. These cocaine-exposed infants were matched to a comparison group of 47 infants whose mothers did not use cocaine during pregnancy. Matching was on the basis of birth date, race, method of payment for the hospitalization, and marital status of the mother. Main Outcome Measures.--Occurrence of maltreatment (physical abuse, sexual abuse, or neglect), and placement either in foster care or with a substitute caretaker. Results.--By 24 months of life, maltreatment had occurred in 23% of the cocaine group vs 4% of the comparison group (risk ratio, 5.5; 95% confidence interval, 1.3 to 23.5). Physical abuse had occurred in 11% of the cocaine group vs 2% of the comparison group, while neglect had occurred in 11% vs 0% (P, Young children whose mothers used cocaine while pregnant may be at increased risk of maltreatment and changes in primary caretaker. Maltreatment encompasses physical abuse, sexual abuse and neglect. Forty-seven cocaine-exposed children were evaluated at the age of 24 months and compared with 47 children of similar socioeconomic status whose mothers had not used cocaine. Among the cocaine-exposed children, 38% experienced either maltreatment or a change in caretaker, while only 4% of the comparison children did. There were 12 incidences of maltreatment among the cocaine-exposed children and only two among the comparison children. Ten cocaine-exposed children and one child from the comparison group had at least one change of primary caretaker. This was considered a negative experience for such young children, although it could turn out to be a positive change if it resulted in a more stable and nurturing environment.

This article applies a developmental-ecological perspective to the question of the etiology of physical child abuse and neglect by organizing the paper around a variety of 'contexts of maltreatment.' The roles of parent and child characteristics and processes are considered ('developmental context'), including an examination of intergenerational transmission. The 'immediate interactional context' of maltreatment, which focuses on the parenting and parent-child interactional processes associated with abuse and neglect, is analyzed. Finally, the 'broader context' is discussed with 3 specific subsections dealing with the community, cultural, and evolutionary contexts of child maltreatment. Implications for intervention are considered and future research directions are outlined.

A study assessing child, parent, and family factors connected to parents' capacity for physical child abuse was conducted. Categories of high, moderate, and low risk child abuse was assigned to mothers of child psychiatric patients and nonpatients. The study also revealed high-abuse-potential mothers to report child externalizing and depressive symptoms, child rejection, personal psychological dysfunction, stressful life events, and family problems. The child reports showed few group differences in child dysfunction and violence.

This study was an investigation of factors contributing to blame attributions directed toward victims of physical child abuse. The total sample consisted of 897 college undergraduates. Subjects read eight vignettes describing physically abusive parent-child interactions, and indicated their attributions of responsibility toward parent and child. We predicted that: (a) aggressively provocative children (compared to nonprovocative) would be ascribed greater blame; (b) male subjects would be more likely to blame the child; (c) in situations in which the abusive parent is male (compared to female), the child would be blamed more; and (d) male children (compared to females) would receive greater blame. The results supported all hypotheses. The data also suggested several interaction effects. Significance tests were supplemented with effect size analyses.

Results of a survey revealed that most of the public is aware of the relationship between child abuse and factors such as violence in the media, wife-abuse, and socio-economic status. Most parents believed that maltreatment of children is an extension of general domestic violence and that the public can play an important role in preventing child abuse. Respondents revealed a strong commitment towards child abuse prevention. Fifty-three percent of the 1,250 adults surveyed admitted using physical punishment while disciplining their children.

Results of a research study indicate that there is a significant correlation between child neglect by adolescent mothers and certain maternal characteristics such as educational success and mothers' age at the birth of their first child. Childhood experiences and emotional characteristics of 22 neglectful and 80 non-neglectful mothers were assessed through several psychological tests and a model for predicting child neglect was developed. Child neglect was found to be a multidimensional problem mediated by several situational and psychological variables.

Cet article examine l'etiologie de l'agression parentale envers les enfants, basee sur un echantillonnage aleatoire de familles Torontoises. Plusieurs questions qui demeuraient sans reponses dans l'etude de l'abus des enfants sont clarifiees par l'analyse d'un echantillonnage aleatoire et par une perspective plus large des determinants de la discipline des enfants. Ces questions sont tirees de trois theories sociologiques principales souvent citees dans la literature sur l'abus des enfants - l'argument sur le cycle de la violence, la theorie sociale-situationnelle, et le modele culturel. Les analyses factorielles et de regressions multiples demontrent qu'il existe des styles distincts de discipline; que differents groupes de variables causatives operent dans chaque style de discipline; et que differents facteurs influencent le style de discipline des meres et des peres. Les facteurs ayant rapport a la socialisation infantile des parents sont des causes determinantes particulierement importantes a leurs choix de methodes proactives d'instruction de discipline des enfants, tandis que les facteurs ayant rapport a la distribution des pouvoirs dans la famille, et dans la societe en generale, sont les causes les plus importantes de la selection de methodes de discipline reactives et violentes. This paper examines the etiology of parents' aggression towards their children in a random sample of Toronto families. Several outstanding issues in the study of child abuse are clarified by analysing a random sample and by viewing the problem in the larger context of the determinants of child discipline. These issues are derived from three main sociological theories of child abuse frequently cited in the literature - the cycle of violence argument, social situational theory and the cultural model. Factor and multiple regression analyses demonstrate that distinct styles of discipline exist; different subsets of causal variables operate for each discipline style; and mothers' and fathers' discipline styles are affected by different factors. Factors related to parents' childhood socialization are particularly important determinants of whether they adopt a proactive, teaching style of child discipline, while factors related to the distribution of power in the family and in society at large are the most important causes of whether parents adopt a reactive, violent discipline style., Techniques of child discipline and abuse by [...]

This paper reports the results of 10 years of research into the prenatal identification of mothers likely to have major parenting problems. Previous published research reported the development of a set of criteria for determining risk status. These criteria were used to classify into four levels of risk a sample of mothers who were consecutive enrolments for prenatal care. The sample was monitored through various social agencies for 2 years. Results of this monitoring indicate the predictive validity of the risk code in an unselected sample. The value of prenatal identification of the 'at risk' is discussed together with the procedures adopted for implementing routine screening in the maternity hospital. The issue of causation, as distinct from prediction, is addressed.

A study revealed that females offended in 44% of child sexual abuse cases and that 53% were a result of parental incest by mothers. The historical conceptualization of nonoffending mothers of sexually abused children and the development of child abuse is described.

Objective. It has long been assumed that mandated reporting statutes regarding child abuse are self-explanatory and that broad consensus exists as to the meaning and proper application of reasonable suspicion. However, no systematic investigation has examined how mandated reporters interpret and apply the concept of reasonable suspicion. The purpose of this study was to identify Pennsylvania pediatricians' understanding and interpretation of reasonable suspicion in the context of mandated reporting of suspected child abuse. Methodology. An anonymous survey was sent (Spring 2004) to all members of the Pennsylvania chapter of the American Academy of Pediatrics (n = 2051). Participants were given several operational frameworks to elicit their understanding of the concept of reasonable suspicion, 2 of which are reported here. Respondents were asked to imagine that they had examined a child for an injury that may have been caused by abuse and that they had gathered as much information as they felt was possible. They then were asked to quantify (in 2 different ways) the degree of likelihood needed for suspicion of child abuse to rise to the level of reasonable suspicion. The physicians were asked to identify (using a differential-diagnosis framework) how high on a rank-order list "abuse" would have to be for it to rise to the level of reasonable suspicion (ie, first on the list, second, third, and so on, down to tenth). The second framework, estimated probability, used a visual analog scale of 0% to 100% to determine how likely suspected abuse would have to be for physicians for them to feel that they had reasonable suspicion. That is, would they need to feel that there was a 99% likelihood that abuse occurred before they felt that they had reasonable suspicion, a 1% likelihood, or something in between? In addition to standard demographic features, respondents were queried regarding their education on child abuse, education on reasonable suspicion, frequency of reporting child abuse, and (self-reported) expertise regarding child abuse. The main outcome measures were physician responses on the 2 scales for interpreting reasonable suspicion. Results. Pediatricians (n = 1249) completed the survey (61% response rate). Their mean age was 43 years; 55% were female; and 78% were white. Seventy-six percent were board certified, and 65% reported being in primary care. There were no remarkable differences in responses based on age, gender, expertise with child abuse, frequency of reporting child abuse, or practice type. The responses of pediatric residents were indistinguishable from experienced physicians, and the responses of primary care pediatricians were no different from pediatric subspecialists. Wide variation was found in the thresholds that pediatricians set for what constituted reasonable suspicion. On the differential-diagnosis scale (DDS), 12% of pediatricians responded that abuse would have to rank first or second on the DDS before the possibility rose to the level of reasonable suspicion, 41% indicated a rank of third or fourth, and 47% reported that a rank anywhere from fifth to as low as tenth still qualified as reasonable suspicion. On the estimated-probability scale (EPS), 35% of pediatricians responded that for reasonable suspicion to exist, the probability of abuse needed to be 10% to 35%. By contrast, 25% of respondents identified a 40% to 50% probability, 25% stipulated a 60% to 70% probability, and 15% required a probability of [greater than or equal to] 75%. In comparing individual responses for the 2 scales fie, paired comparisons between each pediatrician's DDS ranking and the estimated probability he or she identified), 85% were found to be internally inconsistent. To be logically consistent, any score [greater than or equal to] 50% on the EPS would need to correspond to a DDS ranking of 1; an EPS score of [greater than or equal to] 34% would need to correspond with a DDS ranking no lower than 2; an EPS score of [greater than or equal to] 25% no lower than a DDS ranking of 3; and so on. What we found, however, was that pediatricians commonly indicated that reasonable suspicion required a 50% to 60% probability that abuse occurred, but at the same time, they responded that child abuse could rank as low as fourth or fifth on the DDS and still qualify as reasonable suspicion. Conclusions. The majority of states use the term "suspicion" in their mandated reporting statutes, and according to legal experts, "reasonable suspicion" represents an accurate generalization of most mandated reporting thresholds. Our data show significant variability in how pediatricians interpret reasonable suspicion, with a range of responses so broad as to question the assumption that the threshold for mandated reporting is understood, interpreted, or applied in a coherent and consistent manner. If the variability described here proves generalizable, it will require rethinking what society can expect from mandated reporters and what sort of training will be necessary to warrant those expectations. URL: www.pediatrics.org/cgi/doi/ 10.1542/peds.2004-2649; child abuse, mandated reporting, pediatricians, suspicion.