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Research suggests that breastfeeding may reduce child maltreatment risk. Alaska has high rates of both breastfeeding initiation and maltreatment reports to Child Protective Services (CPS). The present study assessed any and exclusive breastfeeding duration and child maltreatment reports to CPS among Alaskan mother-infant dyads, controlling for demographics and shared risk factors. We used a prospective, population-representative dataset linking 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with 2009-2016 Alaska CPS and administrative state data (n = 3,459). Breastfeeding duration was derived from PRAMS breastfeeding questions and categorized as never, < 1 weeks, 1-9 weeks, and [greater than or equal to] 10 weeks. Age at first report of maltreatment to Alaska CPS included physical or sexual abuse, neglect, or mental injury. Hazard ratios and 95% confidence intervals (CI) were calculated using Cox proportional hazard models, adjusting for confounders. There was no increase in risk of maltreatment report among children never breastfed compared to those breastfed for [greater than or equal to] 10 weeks. Risk of maltreatment report during the observation period was 1.7 times as high among children breastfed for < 1 week (CI: 1.06, 2.73), and 1.5 times as high among those breastfed for 1-9 weeks (CI: 1.17, 1.80), compared to those breastfed for [greater than or equal to] 10 weeks. Estimates were attenuated for exclusive breastfeeding. Feeding method did not predict maltreatment reports in this population. Among mothers who initiated breastfeeding, shorter duration was associated with elevated risk of maltreatment reports. Addressing factors that facilitate or prohibit sustained breastfeeding may reduce risk of child maltreatment reports., Author(s): Helena J. Hutchins [sup.1] , Kim G. Harley [sup.1] , Jordyn T. Wallenborn [sup.1] , Barbara Abrams [sup.1] [sup.2] , Rebecca Reno [sup.1] , Jared W. Parrish [sup.3] Author [...]

Objectives Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child. Methods Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012-2014 Alaska Child Understanding Behaviors Survey. We used latent class analysis and Vermunt's three-step approach to examine predictors of latent classes of risk and protective factors among Alaska children. Results Among children of Alaska Native/American Indian mothers, financial (OR 2.02, 95% CI 1.04, 3.90) and partner stress (OR 2.06, 95% CI 1.02, 4.10) prior to childbirth, maternal education < 12 years (OR 2.29, 95% CI 1.05, 4.96), and maternal substance use (OR 2.52, 95% CI 1.30, 4.89) were associated with a higher likelihood of membership in a high risk/moderate protection class as compared to a low socioeconomic status/high protection class. Among children of non-Native mothers, partner stress prior to childbirth (OR 3.92, 95% CI 1.08, 14.19), maternal education < 12 years (OR 2.69, 95% CI 1.24, 5.81), maternal substance use (OR 2.69, 95% CI 1.24, 5.81), younger maternal age (OR 0.87, 95% CI 0.80, 0.95), and a greater number of children (OR 1.62, 95% CI 1.09, 2.41) were associated with a higher likelihood of membership in a moderate risk/high protection class as compared to a low risk/moderate protection class. Conclusions Results can inform eligibility criteria for prenatal home visiting programs and prenatal screening in Alaska to ensure prevention programming and referrals are directed to families most in need of additional support., Author(s): Anna E. Austin [sup.1] [sup.2] , Nisha C. Gottfredson [sup.3] , Adam J. Zolotor [sup.4] , Carolyn T. Halpern [sup.1] , Stephen W. Marshall [sup.2] [sup.5] , Jared W. [...]

Introduction The U.S. infant mortality rate has been steadily declining since 2007. Although the downward trend has been notable in Alaska since 2006 when the rate was 6.9 infant deaths per 1000 live births, a dramatic drop in infant mortality occurred in 2010 and 2011 when the infant mortality rate fell to 3.8 infant deaths per 1000 live births during both years. The purpose of this study was to investigate the sudden decrease in fetal and infant mortality rates (FIMR) using the perinatal periods of risk (PPOR) method, an approach that has not been used previously in Alaska. Methods The study was conducted for 251 fetal and infant deaths in 2004-2006, 265 deaths in 2007-2009, and 129 deaths in 2010-2011. Data were stratified by Alaska Native (AN) and White maternal race and urban/rural residence. Results Among both urban and rural White women, the rate ratios (RR) for FIMRs between the earlier and later time periods were not significantly different. The postneonatal mortality rate (PNMR) among AN infants living in rural areas decreased significantly (RR 0.40; 95 % confidence interval 0.21-0.76) between 2007-2009 and 2010-2011. An unexplained increase in sudden unexplained infant death was noted in 2009, followed by a precipitous decrease in 2010-2011. No other unusual distribution of the cause specific mortality rates was observed. Discussion The decrease in the Alaska Native FIMR might have been due to focused efforts for preventing postneonatal sleep associated deaths. Education for prevention of sleep related deaths, particularly in rural communities, is necessary to maintain Alaska's low PNMR., Author(s): Cheryl B. Prince[sup.1] , Margaret B. Young[sup.2] , William Sappenfield[sup.3] , Jared W. Parrish[sup.2] Author Affiliations: (1) Atlanta, GA, USA (2) MCH-Epidemiology Unit, Section of Women's, Children's, and Family [...]

Objectives: To accurately count the number of infant maltreatment-related fatalities and to use information from the birth certificates to predict infant maltreatment-related deaths. Methods: A population-based retrospective cohort study of infants born in Alaska for the years 1992 through 2005 was conducted. Risk factor variables were ascertained from birth record data and linked with a multi-source data collection system (Alaska Surveillance of Child Abuse and Neglect [SCAN]) to identify maltreatment-related fatalities. Maltreatment-related mortality was classified as 1) confirmed, that is, infant homicide as documented by vital records, 2) probable, as determined by an expert multidisciplinary infant death review committee, and 3) suspect, as determined by the review committee and supported through additional data sources. Results: During the 12-year study period, 143,025 births and 955 infant deaths occurred. Among the 955 deaths, SCAN identified 133 (13.9%) total maltreatment-related fatalities including 22 confirmed, 52 probable, and 59 suspect cases (respective maltreatment-specific infant mortality rates of 0.2, 0.6, and 0.9 per 1000 live births). During multivariate analysis, the strongest risk factors for any infant maltreatment mortality were maternal prenatal substance use (population attributable risk percent [PAR%], 25.2%), one or more other children in the family (PAR%, 34.8%), and having an unmarried mother with (PAR%, 32.4) or without (PAR%, 33.8) the father's name on the birth certificate. Compared to infants with none of these 3 risk factors, the relative risk of maltreatment-related mortality among infants with all 3 plus a father's name identified was 22.2 (95% confidence interval [CI], 8.6-76.7) and for those with all 3 risk factors plus no father's name 79.4 (95% CI, 29.1-283.4). Conclusions: Infant maltreatment-related mortality in Alaska is underestimated using only vital records. Three variables obtainable from birth certificates (or potentially other sources) were highly predictive of maltreatment mortality risk and could be used by clinicians and public health officials for early screening and intervention. (Contains 4 tables and 1 figure.)

We conducted a population-based prospective cohort study to help elucidate the predictive relationship between a maternal prebirth selfreported history of intimate partner violence (IPV) and any postbirth reported allegation to Child Protective Services (CPS) by age 2. We linked data from the 2009–2010 Alaska Pregnancy Risk Assessment Monitoring System with CPS data through 2012. Among this cohort, we found that 8.0%w self-reported experiencing IPV 12 months prior or during pregnancy, and 8.0%w of the offspring experienced at least one CPS report of alleged maltreatment during the study period. The predictive relationship varied by maternal educational attainment. Among mothers with 12+ years education completed, the odds of a CPS report were 3.9 times compared to those with no IPV, while among mothers with <12 years education completed, no association was noted. These results suggest that for a subset of Alaskan families, maternal history of IPV is a strong independent predictor of future CPS contact. [ABSTRACT FROM AUTHOR]

Background. The Alaska Native (AN) population has endured multiple historical traumatic events. This population has poorer health outcomes on nearly all factors compared with Alaska non-Natives with more than 75% reportedly being physically assaulted in their lifetime, and child sexual abuse nearly 6 times the national average. Objective. This article describes the Pathway to Hope (PTH) program, which is an indigenous approach to ending silence and denial related to child sexual abuse and encourages multigenerational healing. Design. PTH was developed by ANs who believe that each community is unique, thus strategies for ending denial and support for healing must be woven from the historical context, cultural strengths of individual communities. Strengths-based solutions built on truth, honesty, compassion and shared responsibility for healing and protecting today's children have been profound and successful. The PTH curriculum addresses child sexual abuse from a historical perspective; that the higher rates of sexual abuse among certain Tribes, regions and communities is linked in part to years of victimisation, but may also be perpetuated by internalised oppression and lateral violence among Tribal members. Results. Data suggest that community-based dialogue and wisdom of Native elders and spiritual leaders paired with readiness of community service providers are necessary for sustained change. At all levels, this Indigenous model for learning, sharing, helping and healing brings hope for an end to denial and silence about child sexual abuse for Native people. Conclusions. The PTH program utilises the wisdom and values that have sustained Native people for generations. Ending silence and denial about child sexual abuse and building upon strengths have assisted many Indigenous communities begin the journey toward wellness. Through the PTH, communities have taken steps to accept the challenges associated with establishing safety for children, supporting child victims in healing and to holding offenders accountable. [ABSTRACT FROM AUTHOR]

Limited research describes approaches for applying a public health lens to fatal child maltreatment classification. Specialized terminology and tools could help improve consistency in classifying deaths resulting from caregiver behavior. A six-criterion classification tool was developed via expert panel review of over 100 child deaths by the Alaska Division of Public Health's Child Death Review (CDR) program. Next, accuracy and acceptability were assessed by inviting staff from other CDRs using a national listserv to classify 21 brief case scenarios with the tool. Among the 47 respondents, sensitivity was 0.87, specificity 0.77, and accuracy 0.84. Variability by tool criterion ranged from 97% to 74% accurate. Most respondents (66%) reported the tool as being helpful for classifying deaths and moderate reliability was found. Study participants found it difficult to consistently apply specific criteria which resulted in a modification of the tool to improve the potential for universal adoption., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.