Addressing Systemic Racism in the American Professional Society on the Abuse of Children Publications.

The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.

Our Commitment to Promoting Diversity, Equity, Inclusion, and Justice in Child Maltreatment.

In this commentary, the editorial team of Child Maltreatment extends and expands on APSAC's position on diversity, equity, inclusion, and justice, affirms our commitment and plans for addressing these issues in this publication, and highlights articles in this issue that continue the discussion about race and racism in the child welfare and child protection systems.

Variability in Opioid-Related Drug Overdoses, Social Distancing, and Area-Level Deprivation during the COVID-19 Pandemic: a Bayesian Spatiotemporal Analysis.

Monitoring the spatial and temporal course of opioid-related drug overdose mortality is a key public health determinant. Despite previous studies exploring the evolution of drug-related fatalities following the stay-at-home mandates during the COVID-19 pandemic, little is known about the spatiotemporal dynamics that mitigation efforts had on overdose deaths. The purpose of this study was to describe the spatial and temporal dynamics of overdose death relative risk using a 4-week interval over a span of 5 months following the implementation of the COVID-19 lockdown in the city of Chicago, IL. A Bayesian space-time model was used to produce posterior risk estimates and exceedance probabilities of opioid-related overdose deaths controlling for measures of area-level deprivation and stay-at-home mandates. We found that area-level temporal risk and inequalities in drug overdose mortality increased significantly in the initial months of the pandemic. We further found that a change in the area-level deprivation from the first to the fourth quintile increased the relative risk of a drug overdose risk by 44.5%. The social distancing index measuring the proportion of persons who stayed at home in each census block group was not associated with drug overdose mortality. We conclude by highlighting the importance of contextualizing the spatial and temporal risk in overdose mortality for implementing effective and safe harm reduction strategies during a global pandemic.

Dual trajectories of parenting self-efficacy and depressive symptoms in new, postpartum mothers and socioemotional adjustment in early childhood: A growth mixture model.

Postpartum depression and low parental self-efficacy (PSE) are risk factors for poor child behavior. Little is known, however, about the course of dual trajectories of cooccurring depressive symptoms and PSE or its impact on children's socioemotional development. This study sought to identify trajectories of postpartum PSE and depressive symptoms in new, first-time mothers using growth mixture modeling. Results demonstrated a class of women with "low risk" (88.8%) who manifested low levels of depression and high levels of PSE during the postpartum period; a second group of women, labeled "early risk" (6.3%) with high levels of depression that decreased over time but lower levels of PSE that remained fairly stable; and a final trajectory group deemed the "late-risk" class (4.9%) with initially low levels of depression and high levels of PSE that significantly increased and decreased, respectively, over the period. Early childhood trauma, parenting stress, and poor parenting practices were associated membership in a high-risk class. Mothers in the high-risk groups reported children with more aggressive and defiant behavior at age 3. We conclude by discussing the implications of our findings for developing effective and sensitive interventions.

La depresión posterior al parto y la autoeficacia de los padres (PSE) son factores de riesgo para la débil conducta del niño. Poco se sabe, sin embargo, acerca del curso de las trayectorias duales de síntomas depresivos que ocurren simultáneamente y PSE o su impacto en el desarrollo socioemocional de los niños. Este estudio se propuso identificar las trayectorias del PSE posterior al parto y los síntomas depresivos en nuevas, primerizas mamás usando un modelo de mezcla de crecimiento. Los resultados mostraron una clase de mujeres con 'bajo riesgo' (88.8%) que manifestaron bajos niveles de depresión y altos niveles de PSE durante el período posterior al parto; un segundo grupo de mujeres, llamado 'de temprano riesgo' (6.3%) con altos niveles de depresión que disminuyeron a lo largo del tiempo, pero más bajos niveles de PSE que se mantuvieron equitativamente estables; y un final grupo de trayectoria denominado la clase del 'riesgo tardío' (4.9%) con iniciales bajos niveles de depresión y altos niveles de PSE que significativamente aumentaron y disminuyeron, respectivamente, a lo largo del período. El trauma en la temprana niñez, el estés de crianza, así como las débiles prácticas de crianza fueron afiliaciones asociadas dentro de una clase de alto riesgo. Las mamás en los grupos de alto riesgo reportaron niños con conductas más agresivas y desafiantes a la edad de tres años. Concluimos con una discusión de las implicaciones de nuestros resultados para desarrollar intervenciones eficaces y sensibles.

La dépression postpartum et l'auto-efficacité parentale (abrégé en français ici AEP) sont des facteurs de risque pour les problèmes de comportement de l'enfant. On sait peu de choses, cependant, à propos du cours des trajectoires duels des symptômes dépressifs concomitants et l'AEP ou son impact sur le développement socio-émotionnel des enfants. Cette étude a cherché à identifier les trajectoires d'AEP postpartum et de symptômes dépressifs chez des mères étant mères pour la première fois, en utilisant un modèle de croissance mixte. Les résultats ont fait état d'une classe de femmes avec un "risque moindre" (88,8%) qui faisaient preuve de niveaux peu élevés de dépression et de niveaux élevés d'AEP durant la période postpartum; un deuxième groupe de femmes, appelé "risque précoce" (6,3%) avec des niveaux élevés de dépression qui ont décru au fil du temps et avec des niveaux plus bas d'AEP qui restaient relativement stables; et un groupe de trajectoire finale estimé comme étant la classe de 'risque tardif' (4,9%) avec initialement des niveaux moindres de dépression et des niveaux élevés d'AEP qui ont respectivement augmenté et baissé de manière importante, au fil de cette période. Le trauma de la petite enfance, le stress de parentage et de mauvaises pratiques parentales étaient liés à l'appartenance à la classe à haut risque. Les mères des groupes à risque élevé ont fait état d'enfants avec un comportement plus agressif et défiant à l'âge de trois ans. Nous concluons en discutant les implications pour le développement d'interventions efficaces et sensibles.

Child Maltreatment, School Bonds, and Adult Violence: A Serial Mediation Model.

Physically abused youth are vulnerable to experiencing difficulties across multiple domains of school functioning. Most of the literature examining the relationship between child physical abuse (CPA) and adult violence has focused narrowly on academic outcomes rather than taking a broader view that explores the processes undergirding school engagement and connections. The present study adopted Connell's model of school engagement, connectedness and outcomes within a social bond framework to examine (a) the link between CPA and school social bonds, (b) the link between CPA and adult violence persistence, and (c) the mediational (parallel, serial) effects of school bonds (engagement, connection, and achievement) on violence perpetration in adulthood. Consistent with previous research, results indicated that children who experience physical abuse have poorer academic performance, which, in turn, is related to future violent trajectories. We further found that the relationship between CPA and violence persistence is mediated by a process of bonding to school that begins with being actively engaged in school activities and ends with higher levels of academic achievement. In particular, some of the "school achievement" effect found in previous research operates through behavioral and emotional manifestations and may be partly explained through physically abused children's lessened ability to be engaged with and connected to school activities. We conclude with a discussion of the policy implications stemming from our findings.

A spatiotemporal analysis of the impact of COVID-19 on child abuse and neglect in the city of Los Angeles, California.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) has created an urgent need to identify child abuse and neglect (CAN) and efficiently allocate resources to improve the coordination of responses during a public health crisis. OBJECTIVE: To provide unique insights into the spatial and temporal distribution of CAN in relation to COVID-19 outcomes and identify areas where CAN has increased or decreased during the pandemic. PARTICIPANTS: Children under 18 years old reported to the Los Angeles Police Department for CAN. SETTING: CAN incidents in the city of Los Angeles. METHODS: Negative binomial regression was used to explore associations between the implementation of social distancing protocols and reported CAN during COVID-19. Spatiotemporal analysis identified locations of emerging hot and cold spots during the pandemic. Associations between neighborhood structural factors (e.g., school absenteeism, poverty, unemployment, housing insecurity and birth assets) and hot and cold spot patterns were explored. RESULTS: There was a statistically significant decline in reports of CAN during the COVID-19 pandemic but no significant trends following the implementation of social distancing measures (e.g. safer at home orders, school closures). Compared to consecutive cold spots, severe housing burden, the number of assets children have at birth, poverty, school absenteeism and labor force participation were significantly associated with new and intensifying hotspots of CAN during the COVID-19 pandemic. CONCLUSIONS: Our findings reinforce the utility of developing intervention strategies that minimize harm to children by targeting resources to specific challenges facing families enduring the COVID-19 experience.

Child maltreatment data in the state of New Mexico across space and time.

Child maltreatment is a serious public health problem. Previous research demonstrates that child maltreatment clusters in low-income, racially homogenous neighborhoods. Little is known, however, about the structural correlates of spatial risk in small areas such as census tracts. Here we present additional information regarding the data and methods used in the recent article published in Child Abuse & Neglect entitled "Variability and stability in child maltreatment risk across time and space and its association with neighborhood social & housing vulnerability in New Mexico: A Bayesian space-time model" [1]. The present dataset merges child maltreatment data from the New Mexico Department of Public Health with multiple sources of publicly available data to create a novel public health analysis. Bayesian spatio-temporal modeling techniques were used to map the relative risk of substantiated child maltreatment across census tracts in the state, and to elucidate spatial and temporal heterogeneity in risk. The data was initially collected by the New Mexico Children, Youth and Families Department, the state organization that suspected child abuse and neglect cases are reported to and the organization that then substantiates these cases. The data were then sent to the New Mexico Community Data Collaborative, a data analytic organization under the umbrella of the New Mexico Department of Health. The point file consisting of home addresses of substantiated cases of child abuse was then aggregated by census tract, mapped for the entire state of New Mexico and made available to the public for research and analysis by different public health organizations and researchers (including the present researchers). The very purpose of making the data available to the public was to allow deeper investigations into trends and associations with other social determinants of health. This analysis demonstrates the public health importance of data sharing and accessibility.

A descriptive study of racial and ethnic differences of drug overdoses and naloxone administration in Pennsylvania.

INTRODUCTION: Drug overdose is a significant public health problem, yet little is known about racial/ethnic differences in drug overdose rates and/or in responses to a drug overdose following naloxone administration. This paper examines differences in rates of survivorship, response, revival and administration of naloxone by race and ethnicity among those who experienced a drug overdose in Pennsylvania between January 1, 2018 and December 31, 2019. Spatio-temporal variations in drug overdose locations were examined to facilitate understanding of service development, planning, and delivery of effective treatment need. METHODS: Ten thousand two hundred and ninety drug overdose incidents were analyzed from the Pennsylvania Overdose Information Network (ODIN). The ODIN is a centralized repository that contains information on drug overdoses victims including age, gender and race/ethnicity, naloxone administrations and survivorship, drug(s) suspected of causing the overdose, victim outcomes (e.g. hospitalizations and arrests) and average naloxone dosage per victim. Between group differences were tested using χ2 -tests of independence. Multivariate logistic regression was used to estimate the predicted probability of survivorship according to victim characteristics. All statistical analyses and mapping were performed using the R statistical programming environment. RESULTS: About eighty-seven percent of drug overdose response victims were white, and seventy-one percent were between the ages of 20-39. White females were more likely to receive an overdose response compared to black or Hispanic females. A non-opioid was indicated more frequently in overdoses involving black victims compared to either whites or Latinos. Latinos and blacks were more likely to survive a drug overdose. However, following naloxone administration, no racial or ethnic differences in survivorship were noted. Differences in responsiveness to naloxone and transitions to care following the drug overdose event were also found. Finally, overdoses among Blacks and Latinos demonstrated a stronger spatial patterning across counties compared to whites. CONCLUSIONS: This study found a significant, disparate impact of race/ethnicity on fatal drug overdoses when naloxone is not administered. Further, individuals who were administered naloxone and subsequently received medical care in a hospital experienced lower drug-related mortality, suggesting that first responders are critical intervention points for individuals in need of medical treatment following a drug overdose. However, while naloxone administration is a necessary first step in the recovery process, longitudinal pathways towards treatment are critical to stem the drug overdose crisis.

The Geography of Child Maltreatment: A Spatiotemporal Analysis Using Bayesian Hierarchical Analysis With Integrated Nested Laplace Approximation.

This study quantifies the spatiotemporal risk of child abuse and neglect in Los Angeles at the census tract level over a recent 4-year period, identifies areas of increased risk, and evaluates the role of structural disadvantage in substantiated child maltreatment referrals. Child maltreatment data on 83,379 child maltreatment cases in 1,678 census tracts spanning 2006-2009 were obtained from the Los Angeles County Department of Children and Family Services. Substantiated referral counts were analyzed across census tracts with Bayesian hierarchical spatial models using integrated nested Laplace approximations. Results showed that the unadjusted yearly rate of child abuse and neglect held fairly steady over the study period decreasing by only 2.57%. However, the temporal term in the spatiotemporal model reflected a downward trend beginning in 2007. High rates of abuse and neglect were predicted by several neighborhood-level measures of structural burden. Every 1-unit decrease in the social vulnerability index reduced the risk of child abuse and neglect by 98.3% (95% CrI = 1.869-2.1042) while every 1-unit increase in the Black-White dissimilarity index decreased child abuse and neglect risk by 70.6%. The interaction of these variables demonstrated the protective effect of racial heterogeneity in socially vulnerable neighborhoods. No such effect was found in neighborhoods characterized by low levels of vulnerability. Population-based child abuse and neglect prevention and intervention efforts should be aided by the characteristics of neighborhoods that demonstrate strong spatial patterns even after accounting for the role of race and place.

A Secondary Spatial Analysis of Gun Violence near Boston Schools: a Public Health Approach.

School neighborhood violence continues to be a major public health problem among urban students. A large body of research addresses violence at school; however, fewer studies have explored concentrations of violence in areas proximal to schools. This study aimed to quantify the concentration of shootings near schools to elucidate the place-based dynamics that may be focal points for violence prevention. Geocoded databases of shooting and school locations were used to examine locational patterns of firearm shootings and elementary, middle, and high schools in Boston, Massachusetts. Analyses utilized spatial statistics for point pattern data including distance matrix and K function methodology to quantify the degree of spatial dependence of shootings around schools. Results suggested that between 2012 and 2015, there were 678 shooting incidents in Boston; the average density was 5.1 per square kilometer. The nearest neighbor index (NNI = 0.335 km, p < .001, O = 0.95 km, E = 0.28 km) and G function analysis revealed a clustered pattern of gun shooting incidents indicative of a spatially non-random process. The mean and median distance from any school to the nearest shooting location was 0.35 and 0.33 km, respectively. A majority (56%, 74/133) of schools in Boston had at least one shooting incident within 400 m, a distance that would take about 5 min to walk if traveling by foot. The bivariate K function indicated that a significantly greater number of shootings were clustered within short distances from schools than would be expected under a null hypothesis of no spatial dependence. Implications for students attending schools in racially homogenous neighborhoods across all income levels are discussed.

Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe.

A meta-analysis by Van Howe of 109 populations confirms the well-known association of male circumcision (MC) with reduced HIV prevalence. He then performed meta-regression adjusting for location, risk and MC prevalence. When one or two of these adjustments in combination were applied MC appeared protective, but when all three were introduced the association remained significant in high-risk populations, but not in general populations within Africa with a hypothetical MC prevalence of <25% or elsewhere with hypothetical MC prevalence of <75%. However, many MC prevalence values given differed from those reported in references cited (including all US studies). This and other problems invalidate his adjustments for MC prevalence, undermining most of his meta-regression results. Meta-regression is a highly sophisticated statistical tool and is prone to error if not applied correctly. The study contained a high risk of bias arising from confounding. We also question his use of crude, rather than adjusted, odds ratios and his inclusion of unpublished data, so precluding replication by others. Flawed statistics, opaque presentation of results and inclusion of previously repudiated arguments downplaying a role for MC in HIV prevention programmes should lead readers to be sceptical of the findings and conclusions of Van Howe's study.

Latent Classes and Cumulative Impacts of Adverse Childhood Experiences.

Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n = 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n = 3,303), (3) sexual abuse only (4.3%, n = 2,260), (4) emotionally abusive and alcoholic (30.3%, n = 17,460), and (5) normative, low risk (56.3%, n = 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model.

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.

Physical victimization, gender identity and suicide risk among transgender men and women.

We investigated whether being attacked physically due to one's gender identity or expression was associated with suicide risk among trans men and women living in Virginia. The sample consisted of 350 transgender men and women who participated in the Virginia Transgender Health Initiative Survey (THIS). Multivariate multinomial logistic regression was used to explore the competing outcomes associated with suicidal risk. Thirty-seven percent of trans men and women experienced at least one physical attack since the age of 13. On average, individuals experienced 3.97 (SD = 2.86) physical attacks; among these about half were attributed to one's gender identity or expression (mean = 2.08, SD = 1.96). In the multivariate multinomial regression, compared to those with no risk, being physically attacked increased the odds of both attempting and contemplating suicide regardless of gender attribution. Nevertheless, the relative impact of physical victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression. Finally, no significant association was found between multiple measures of institutional discrimination and suicide risk once discriminatory and non-discriminatory physical victimization was taken into account. Trans men and women experience high levels of physical abuse and face multiple forms of discrimination. They are also at an increased risk for suicidal tendencies. Interventions that help transindividuals cope with discrimination and physical victimization simultaneously may be more effective in saving lives.

Using Behavioral Risk Factor Data as a surveillance tool to monitor the prevalence of initiation, continuation and completion of Human Papilloma Virus vaccination in children.

The Human Papilloma Virus ("HPV") is a common sexually transmitted disease that has infected approximately 79 million men and women in the United States alone. A vaccination is available but in order to be effective it must be received prior to becoming sexually active and recipients must complete a three-dose sequence. In this article we explore the predisposing, enabling and need-based factors associated with parents' or guardians' decision to have their child initiate, continue and complete the Human Papilloma Virus (HPV) vaccine. The data file includes 5531 parents and guardians with presumptive knowledge regarding the number of HPV vaccination their child received. Data includes information on the child (e.g. child׳s age) as well as the adult respondent (e.g. health insurance status). A smaller subset of the dataset along with the code to run the model are supplied with this article. The interpretation of these data can be found in the research article published by the authors in the Journal of Preventive Medicine in 2015 http://dx.doi.org/10.1016/j.ypmed.2016.01.010[1].

A sequential logit model of caretakers' decision to vaccinate children for the human papillomavirus virus in the general population.

OBJECTIVES: This study explores the predisposing, enabling, and need-based factors associated with parents' or guardians' decision to have their child initiate, continue, and complete the human papillomavirus (HPV) vaccine. METHODS: Parents and guardians of children between the ages of 9 and 17years who completed the 2010 Behavioral Risk Factor Surveillance System survey collected by the Center for Disease Control (CDC, 2010) were analyzed. Utilizing Andersen's health care beliefs model, we explored the sequential nature of the decision to vaccinate (i.e., the decision to receive the first, second, and third dose), thereby allowing the independent variables to vary across each transition. RESULTS: Among all children, 3.7% received exactly 1 shot, 16.3% received at least one shot, and 8.9% received all three shots. Among those who received at least one shot, 22.4% received exactly one shot, 23.7% received exactly 2 shots, and 54.9% completed all 3 shots. A differential impact was observed across transitions. Predisposing factors, such as being Hispanic (OR=1.9) and child age (OR=1.4), significantly predicted the decision to receive the first dose but enabling factors, such as having a regular physician (OR=4.5) and income (OR=.74) were more important for predicting completion. CONCLUSIONS: The decision to initiate and complete HPV vaccination depends on a specific mix of enabling, predisposing, and need-based factors. Our analysis underscores the importance of modeling the vaccination decision in a manner that is consistent with how primary caregivers navigate real-life health care decisions for their children.

The association between school exclusion, delinquency and subtypes of cyber- and F2F-victimizations: identifying and predicting risk profiles and subtypes using latent class analysis.

This purpose of this paper is to identify risk profiles of youth who are victimized by on- and offline harassment and to explore the consequences of victimization on school outcomes. Latent class analysis is used to explore the overlap and co-occurrence of different clusters of victims and to examine the relationship between class membership and school exclusion and delinquency. Participants were a random sample of youth between the ages of 12 and 18 selected for inclusion to participate in the 2011 National Crime Victimization Survey: School Supplement. The latent class analysis resulted in four categories of victims: approximately 3.1% of students were highly victimized by both bullying and cyberbullying behaviors; 11.6% of youth were classified as being victims of relational bullying, verbal bullying and cyberbullying; a third class of students were victims of relational bullying, verbal bullying and physical bullying but were not cyberbullied (8%); the fourth and final class, characteristic of the majority of students (77.3%), was comprised of non-victims. The inclusion of covariates to the latent class model indicated that gender, grade and race were significant predictors of at least one of the four victim classes. School delinquency measures were included as distal outcomes to test for both overall and pairwise associations between classes. With one exception, the results were indicative of a significant relationship between school delinquency and the victim subtypes. Implications for these findings are discussed.

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home.

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.

Elder abuse in nursing homes: an ecological perspective.

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.

Neglect of older adults in Michigan nursing homes.

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.