Perceived Worries and Spirituality: A Mixed Methods Study of the Primary Caregiver Well-Being of Orphan and Vulnerable Children in Ethiopia.

This study investigates the well-being of primary caregivers responsible for orphaned and vulnerable children. Well-being is defined as overall wellness, happiness, and satisfaction. Through mixed methods case studies and purposive sampling, we analyzed data from the Ziway Food for the Hungry Ethiopia program in 2017. Our explanatory analytic approach highlighted issues including resource constraints, chronic illnesses, and community challenges faced by the respondents. Nonetheless, spiritual well-being emerged as a crucial factor for their coping mechanisms. The findings underscore that critical well-being deficiencies require immediate attention. Strategies should prioritize financial and emotional support, emphasizing community capital to enhance the well-being of primary caregivers.

Protective role of family mealtime frequency against disordered eating behaviors: Racial and ethnic differences.

Family mealtimes have been recognized for their positive effect on child and adolescent health outcomes. Frequent family meals have been shown to have protective effects in reducing disordered eating behaviors, but the variability of these effects across different racial and ethnic backgrounds has been less explored. To address the gap, the current study utilizes a sample of 33,417 families with children (ages 6-17) in the United States who participated in the 2022 National Surveys of Children's Health (NSCH). Logistic regressions were conducted to examine the association between family mealtime frequency and the manifestation of disordered eating across youth from diverse racial/ethnic backgrounds. Our findings revealed that frequent family mealtimes are associated with a lower risk of engaging in disordered eating behaviors in youth. However, there were disparities in the associations between family mealtime frequency and the prevalence of disordered eating behaviors among children from different racial/ethnic backgrounds. Youth who never participated in family mealtimes were at a greater risk of engaging in disordered eating behaviors among those identifying as non-Hispanic Black or of 'other' racial groups. In youth identifying with multiple races, the frequency of family was not associated with the odds of disordered eating behaviors. The results provide insights into the nuanced influence of family mealtime frequency on disordered eating based on diverse racial/ethnic groups. This highlights the need for future studies to identify factors associated with racial/ethnic identities that may contribute to disordered eating behaviors in youth to identify the unique needs and challenges faced by families in leveraging the protective effect of family mealtimes.

Racial Discrimination of Adolescents With Special Healthcare Needs.

PURPOSE: Examine racial discrimination of adolescents of color by type of special healthcare need (SHCN). METHODS: Pooled cross-sectional data of youth over 10 years of age from 2018 to 2020 National Surveys of Children's Health were used (n = 48,220). Rates of discrimination by SHCN diagnoses within racial and ethnic groups were examined. RESULTS: Adolescents of color with SHCNs were almost twice as likely to experience racial discrimination as peers of color without SHCNs. Asian youth with SHCNs were over 3.5 times likely to experience racial discrimination as peers without. Youth with depression experienced highest rates of racial discrimination. Compared to peers without, Black youth with asthma or a genetic disorder, and Hispanic youth with autism or intellectual disabilities, experienced higher rates of racial discrimination. DISCUSSION: SHCN status heightens racial discrimination for adolescents of color. However, this risk was not uniform by racial or ethnic group for every SHCN type.

The effect of adverse childhood experiences on family mealtime frequency: Examining racial and ethnic differences.

Eating meals as a family is associated with multiple positive nutritional and emotional outcomes for parents and children. Although the benefits of mealtimes extend to all families, families of color and those in poverty face disproportional barriers to eating frequent meals together. No previous study has properly attended to the heterogeneity of racial and ethnic groups in the United States when assessing mealtime barriers. Focusing on adverse childhood experiences (ACEs), our analyses tested whether an increased number of adversities, and particular types of adversities, were associated with a decrease in mealtime frequency for different racial/ethnic families in the United States. Utilizing a large, nationally representative sample of families (n = 59,963), results showed that higher cumulative ACE scores reduced the number of days a family eats meals together in a given week. For specific ACE items, seven out of nine individual ACE items were associated with decreased mealtimes (excluding parental death and racial discrimination). Stratification resulted in varied associations between accumulated and individual ACE items and mealtime frequency depending on racial/ethnic group. Asian families in particular had greater odds of infrequent meals than other families, while Native American, Alaskan Native, Pacific Islander, and other racial/ethnic families were unaffected by increased ACEs. Results indicate that a family's accumulation of multiple adversities may impede mealtimes by either forcing families to prioritize the management of other stressors or by depleting the physical and mental resources needed to establish a routine. Focusing on family cultural traditions as protective factors may be an area of future intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Why twin studies are important for health span science research: the case of maltreatment of aging adults.

Average life expectancies have lengthened across human history. As a result, there is an increased need to care for a greater number of individuals experiencing common age-related declines in health. This has helped to spur a rapidly increasing focus on understanding "health span", the portion of the life-course spent functionally healthy. Yet to penetrate the science of health span, however, is a topic which seems fundamental to the ability to age in functional and healthy ways, and has received considerable attention in other fields. As more of the population ages, the risk of exposure to abuse and neglect among older citizens not only rises, but can manifest as both cause and effect of declining health span. Among our goals here is to make a case for including this subject among the other central components of health span science. In so doing, we also outline reasons why quantitative genetic designs using samples of twins can be a versatile tool for improving causal inference when studying maltreatment among older persons specifically, but also on a range of other health span topics in general.

Expanding adverse child experiences to inequality and racial discrimination.

There is a well-established correlation between health and adverse childhood experiences (ACEs). Arguments have been made to expand ACE scales to include indicators of racism and structural inequalities. In this paper, we use nationally representative data to examine the relationships between latent groups of an expanded adversity scale and a broad range of child health outcomes. Data were obtained from a merger of the 2017 and 2018 National Survey of Children's Health (NSCH) and analyzed in 2021 (n = 52,129). Adversities were defined as violent victimization, violence exposure, a range of parental problems, racial discrimination, food insecurity, and unkempt housing. Latent class analysis (LCA) was used to uncover emergent groups of adversities, and logistic regression was used to assess group relationship to global and diagnosed measures of health. Four groups emerged: high all (3.6%), material and food hardship (11.9%), parental problems (10.3%), and low all (74.2%). Results showed the high all groups at greater odds of almost all outcomes. Compared to low all group, high all had particularly higher odds of any special (OR = 2.29) or complex (OR = 2.53) healthcare need, frequent severe headaches (OR = 2.07), and depression (OR = 3.4) or anxiety (OR = 2.11). Our analysis noted separation of experiences based on additional items related to structural inequalities: food insecurity, poverty, and unkempt housing. However, augmenting existing ACE scales with these indicators may be unnecessary as children most at-risk for poor health were a very small group (1 in 28) that experienced multiple forms of violence and parental problems.

Aggregate-level Lead Exposure and Child Maltreatment.

The purpose of this study was to examine the possible ecological association between aggregate blood lead levels (BLL) and rates of child maltreatment. To this end, we employed an ecologic study design, analyzing results from 59,645 child BLL tests between the years 1996 and 2007, and 6,640 substantiated maltreatment investigations from 2006 to 2016 in a large Midwest city. Separate Bayesian spatial Poisson conditional autoregressive (CAR) and Bayesian spatial zero-inflated Poisson CAR models were used to predict the occurrence of maltreatment.Bivariate results showed that aggregate rates of maltreatment increased as aggregate BLL increased. Multivariate results showed that medium-exposure BLL census tracts (OR = 1.38) and high-exposure BLL tracts (OR = 1.38) had increased odds of substantiated investigations for any maltreatment compared to low BLL census tracts even after controlling for crime rates, age of the housing stock, and concentrated disadvantage. Our findings, considered with prior research, continue to reveal a confluence of deleterious outcomes in areas where exposure to lead seems elevated. In this case, child maltreatment also appears to represent a macro-level correlate of aggregate lead exposure. Yet our results preclude any causal inference, and further research on the intersection of child maltreatment with environmental toxins is needed to determine if contaminant abatement should be considered as a possible maltreatment prevention strategy.

IPV and Health Consequences Among CPS-Involved Caregivers: A Fixed Effects Analysis Stratified by Race and Ethnicity.

Intimate partner violence (IPV) is a public health dilemma that disproportionately affects minority women in the United States. The present study utilized data from the National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the longitudinal course of IPV outcomes reported by minority women involved with Child Protective Services (CPS). Our findings highlight the heterogeneity of the relationship between IPV and mental or physical health based on race/ethnicity. Nonetheless, additional research is necessary to investigate the impact of IPV severity on physical and mental health outcomes to ultimately facilitate race-specific interventions for women involved with CPS.

The accrual of parent reported adverse childhood experiences following a child protective services investigation: A prospective approach.

INTRODUCTION: Most studies on adverse childhood experiences (ACEs) have largely employed retrospective measures from adults, eschewing prospective measures in child samples. In this paper, we tracked the accrual of ACEs during childhood in a sample of children left in-home following a Child Protection Services investigation. METHODS: Data from three waves of the 2010 National Survey of Child and Adolescent Well-Being were used (n = 1880). ACEs included 5 forms of child maltreatment and parental domestic violence, mental health problems, substance or alcohol abuse, separation, and arrest. At each wave, parents reported child ACE exposure for the previous year. ACE accrual over three years was traced as mean scores, discrete events, and compounding risk. OLS regression predicted accrual of ACEs over time controlling for important covariates. RESULTS: At baseline, children experienced an average of 2.2 ACEs, which increased by 3.2 by W3 (5.4 total ACEs). The predicted number of ACEs over time increased by 0.58 with each increase of 1 ACE at baseline (t = 11.74, p < .001). As compound risk, children with 0 ACE at baseline accrued an additional 1.7 by W3, while those experiencing 6 ACEs at baseline accrued 5.9 by W3. Children who experienced emotional neglect and psychological aggression accumulated a greater number of ACEs. CONCLUSION: The average number of ACEs for in-home children increased precipitously over 3 years, and higher ACE scores at baseline were associated with greater accumulation. This indicates that retrospective measurements may not convey the unremitting nature of ACE accrual.

Safe From Harm? Youth Self-Report of Physical Assault in Child Welfare Placements.

Although most child welfare placements receive a rigorous assessment and ongoing safety monitoring, it is still unclear which is safest in terms of physical abuse. Our goals for this study were to assess the relative risk of physical assault for different child welfare placements in a national sample of youth and examine that risk within placement types for children with various levels of behavioral problems. Unlike previous studies of assault prevalence, we constrained our analysis to youth self-reports of assaults within a current placement to increase validity. Data from the 2010 National Survey of Child and Adolescent Well-Being (NSCAW II) were used. The final analytic sample included children 8-18 years of age at Wave 3 interview in 2012 (n = 1,302). Physical assault was measured using youth reports of being thrown at, shoved, slapped, beat-up, or stabbed, shot, or threatened with a knife or gun. Multiple bivariate contingency table analyses using Pearson χ2 tests and ordinal logistic regressions were used. Overall, 8% of youth reported a minor assault, 9% a serious assault, and 14% any assault. Ordinal logistic regression models showed that children with more severe behavioral problems were at increased odds of more serious physical assault (odds ratio [OR] = 1.03, 95% confidence interval [CI] = [1.01, 1.05]) and youth in adoptive homes were at decreased odds of assault (OR = 0.22, 95% CI = [0.03, 0.82]). Interaction effects showed that one point increase in behavioral problems resulted in increased odds of more serious assaults only for youth reunified with biological parents (OR = 1.11, p = .01) and youth living with traditional foster parents (OR = 1.06, p = .02). Our results indicate that permanent adoptive homes are the safest child welfare placements irrespective of child characteristics, which is supportive of recent efforts to increase number of youth exiting care to adoption.

Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults.

OBJECTIVE: Exposure to violent victimization is associated with higher rates of mental health and substance use disorders (SUD). Some youth who experience multiple victimizations and associated characteristics (i.e. poly-victims) are at heightened risk for long term problems. Thus, we conducted the first study to examine how heterogeneity in experiences of victimization vary in terms of latency to illicit drug use following treatment completion. We also examined if victimization profiles vary across gender and if comorbid conditions (e.g., posttraumatic stress disorder and major depressive disorder) differentially predict latentcy to illicit drug use across groups. METHODS: Adolescents and young adults (N = 5956; Mage  = 17.5 years; 64.0% male) with SUDs in treatment for illicit drug use completed a battery of measures at baseline. At 3-, 6- and 12-month follow-ups, they reported on the number of days before they used any illicit drug following their last assessment. RESULTS: Continuous time survival mixture modeling revealed that, as hypothesized, females who experienced high rates of all victimization and related characteristics had a higher hazard for latency to first illicit drug use as compared to females in the low victimization group. This was not the case for males; rather, those who experienced high rates of sexual abuse were quickest to return to illicit drug use. Finally, comorbid conditions led to a higher hazard rate, but only for certain profiles across females. DISCUSSION: Findings emphasize the necessity for professionals to more fully integrate poly-victimization research and theory into their clinical practices and research.

Unintentional child injury in child welfare placements.

BACKGROUND: Child welfare professionals are charged with protecting children from non-accidental caregiving behaviors resulting in intentional injuries as well as environmental risks and parenting behaviors resulting in unintentional injuries. Yet little is known about unintentional injury prevalence and risk factors by child welfare placement type. OBJECTIVE: To examine factors related to unintentional child injury requiring medical attention, including child welfare placement type, child behavioral problems, caregiver characteristics, and neighborhood factors. METHODS: Data from the second and third wave of the 2010 National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Stable child welfare placements between waves 2 and 3 included investigated biological, reunified, adopted, licensed and unlicensed kin, and nonkin foster homes. Logistic regression analysis modeled injury as a function of placement type while controlling for other covariates. Interaction effects between placement and child behavioral scores were also modeled. RESULTS: Children with more behavioral problems were at greater odds of an injury (OR = 1.05, p < .01) compared to children with fewer behavioral problems. However, interaction models showed that children with more behavioral problems were at decreased odds of injury if living with unlicensed kin (OR = .91, p < .05), licensed kin (OR = .92, p < .001), or foster care (OR = .92, p < .001) compared to biological homes. CONCLUSION: The absence of a behavioral problem was associated with higher risk of injury for children placed in foster care. More research is needed to better understand injury type, prevalence and specific risk factors.

Household Food Insecurity and Parent-to-Child Aggression.

Nearly 13 million children in the United States live in households struggling with food insecurity. Although biosocial theories suggest a strong link between the lack of food and child maltreatment, and a handful of studies have established a correlation between nutritional deficits and family violence, it is unclear if household food insecurity itself is associated with physical and psychological child abuse apart from other issues related to poverty. The current study examines this possibility by analyzing data from the Fragile Families and Child Wellbeing Study ( n = 2,330). Sixteen percent of households were food insecure, and food insecurity at Wave 3 was associated with an increased use of parent-to-child psychological and physical aggression at the follow-up interview. This relationship held even after controlling for important covariates, such as maternal depression and impulsivity. We conclude by discussing what additional research is required, as well as how our findings might intersect with social policy on this topic.

Prevalence and Severity of Child Impairment in a US Sample of Child Maltreatment Investigations.

OBJECTIVES: Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States. METHODS: We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills. RESULTS: Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup. CONCLUSION: When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.

Food Insecurity and Violence in the Home: Investigating Exposure to Violence and Victimization Among Preschool-Aged Children.

Children experiencing or witnessing violence in the home are at risk of a number of cognitive, social, and behavioral challenges as they age. A handful of recent studies have suggested that food insecurity may be one factor associated with violence against children in the home. The present study uses data from the Early Childhood Longitudinal Study-Birth Cohort to explore the link between household food insecurity during the first three waves of data collection (i.e., the first few years of life) and witnessing or being the victim of violence in the home among very young children (~ age 4). The results suggest that the predicted probability of early childhood exposure to violence and/or victimization in the home is nearly 6 times greater in persistently food-insecure households (i.e., households that are food insecure across all three waves) relative to food secure households. Limitations and avenues for future research are noted.

FOOD NEGLECT AND INFANT DEVELOPMENT.

The impact of food insecurity on child development in the general U.S. population is well-established, yet little is known about the harm of food neglect relative to other types of maltreatment. Due to the harmful physiological impact of inadequate nutrients and the social impact of food-related stress, it was hypothesized that food neglect would be more likely to impair infant cognitive and language development than physical abuse, sexual abuse, and other forms of neglect. Families of infants (N = 1,951) investigated by Child Protective Services were studied using the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II; NSCAW Research Group, 2002). Results from multivariable logistic regression models that controlled for likely confounding variables showed that the odds of impairment in cognition and language were significantly greater when food neglect was the most serious form of maltreatment. Considering that both food insecurity and child neglect are associated with poverty and parental mental health problems, it will be important for child welfare and mental health professionals to work collaboratively to better the health of these vulnerable children.

Sexual Abuse of Children With Learning Disabilities.

Although children with a learning disability (LD) are at an increased risk of sexual abuse, it is unclear whether conditions specific to their impairment are associated with sexual assault or if risk derives from other comorbid conditions such as behavioral problems, social skill deficits, or loneliness. Using a national probability study of child maltreatment investigations in the United States ( n = 2,033), we hypothesized that children over the age of 4 with a LD are target congruent to a sexual perpetrator. Seven percent of children were identified as having a LD, and the odds of a sexual abuse allegation was 2.5 times greater for children with a LD relative to children without a LD regardless of confounders. Further, type and severity of assaults varied by group: over 3 times more children with a LD experienced digital or oral copulation compared to those without a LD. Results suggest that children with LDs may require tailored prevention efforts to protect them from sexual abuse.

The relative safety of paternal, maternal, and traditional foster care placements.

When children are placed into foster care the caseworker must give preference to an adult relative, many of whom are grandparents, over an unrelated caregiver. This kinship preference is based in evolutionary biology, which suggests that the imperative to care for a child should be greater for kin versus non-kin. However, not all kin are related to a child in the same way, and level of paternity uncertainty may influence level of care provided. For instance, maternal grandparents can be assured that they share genetic material with their grandchild, while paternal grandparents may not have the same level of certainty. Owing to the possibility of paternity uncertainty, we hypothesize that out-of-home placements with paternal grandparents will be at a greater risk of subsequent investigations than placements with maternal grandparents or with foster parents. We secured data on placements n=560 of children ages 1.5 to 17 following a maltreatment investigation from a merger of the National Survey of Child and Adolescent Well-Being NSCAW II and the National Child Abuse and Neglect Data System NCANDS. Kaplan-Meier and multivariate Cox regression were used to examine the difference in time to the first new investigation by type of out-of-home placement while controlling for covariates. Consistent with our hypothesis, placements with paternal grandparents were at a higher risk of a subsequent investigations than placements with maternal grandparents or non-kin foster parents. Results suggest a need for further considerations of child safety in foster care based on genetic relatedness of caregivers.

Adverse Childhood Experiences Among Immigrants to the United States.

A growing number of studies have examined the "immigrant paradox" with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of first- and second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified-limited adverse experience ( n = 3,497), emotional and physical abuse ( n = 1,262), family violence ( n = 358), and global adversity ( n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards.