Using Bayesian space-time models to understand the substance use environment and risk for being referred to child protective services

Dimensions of early life adversity are differentially associated with patterns of delayed and accelerated brain maturation

BACKGROUND

Different types of early-life adversity have been associated with children's brain structure and function. However, understanding the disparate influence of distinct adversity exposures on the developing brain remains a major challenge.

METHODS

This study investigates the neural correlates of 10 robust dimensions of early-life adversity identified through exploratory factor analysis in a large community sample of youth from the Adolescent Brain Cognitive Development (ABCD) Study. Brain age models were trained, validated, and tested separately on T1-weighted (T1; N = 9524), diffusion tensor (DTI; N = 8834), and resting-state functional (rs-fMRI; N = 8233) magnetic resonance imaging (MRI) data from two time points (mean age = 10.7 years, SD = 1.2, range = 8.9-13.8 years).

RESULTS

Bayesian multilevel modelling supported distinct associations between different types of early-life adversity exposures and younger- and older-looking brains. Dimensions generally related to emotional neglect, such as lack of primary and secondary caregiver support, and lack of caregiver supervision, were associated with lower brain age gaps (BAGs), i.e., younger-looking brains. In contrast, dimensions generally related to caregiver psychopathology, trauma exposure, family aggression, substance use and separation from biological parent, and socio-economic disadvantage and neighbourhood safety were associated with higher BAGs, i.e., older-looking brains.

CONCLUSIONS

The findings suggest that dimensions of early-life adversity are differentially associated with distinct neurodevelopmental patterns, indicative of dimension-specific delayed and accelerated brain maturation.

Characterizing the dimensional structure of early-life adversity in the Adolescent Brain Cognitive Development (ABCD) Study

Early-life adversity has profound consequences for youth neurodevelopment and adjustment; however, experiences of adversity are heterogeneous and interrelated in complex ways that can be difficult to operationalize and organize in developmental research. We sought to characterize the underlying dimensional structure of co-occurring adverse experiences among a subset of youth (ages 9-10) from the Adolescent Brain Cognitive Development (ABCD) Study (N = 7115), a community sample of youth in the United States. We identified 60 environmental and experiential variables that reflect adverse experiences. Exploratory factor analysis identified 10 robust dimensions of early-life adversity co-occurrence, corresponding to conceptual domains such as caregiver substance use and biological caregiver separation, caregiver psychopathology, caregiver lack of support, and socioeconomic disadvantage / neighborhood lack of safety. These dimensions demonstrated distinct associations with internalizing problems, externalizing problems, cognitive flexibility, and inhibitory control. Non-metric multidimensional scaling characterized qualitative similarity among the 10 identified dimensions. Results supported a nonlinear three-dimensional structure representing early-life adversity, including continuous gradients of "perspective", "environmental uncertainty", and "acts of omission/commission". Our findings suggest that there are distinct dimensions of early-life adversity co-occurrence in the ABCD sample at baseline, and the resulting dimensions may have unique implications for neurodevelopment and youth behavior.

Assessing the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) on child abuse and neglect

BACKGROUND

The role of alcohol use in the etiology of abusive and neglectful parenting is significant. We examined how the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) may have reduced rates of substantiated child maltreatment, entries into foster care, and entries into foster care where alcohol use was a factor.

PARTICIPANTS AND SETTING

The study sample is 326 Census block groups: 21 and 16 in the South and North intervention areas, respectively, and 289 in the At-Large comparison area in Sacramento, California.

METHODS

SNAPP used a quasi-experimental design to reduce alcohol supply and alcohol-related problems among 15-29 year olds in two economically, racially, and ethnically diverse neighborhoods. The dependent variables are substantiated child abuse and neglect; total foster care entries; and alcohol-related foster care entries.

RESULTS

Substantiated child abuse and neglect was inconclusive for both intervention areas. In the North, total (RR = 0.822, 95 % CI [0.721, 0.933]) and alcohol-related (RR = 0.760, 95 % CI [0.634, 0.914]) foster care entries decreased by 17.8 % and 24.0 %, respectively. Intervention effects in the South were not well-supported for foster care entries (RR = 1.118, 95 % CI [0.988, 1.258]), but increased alcohol-related foster care entries (RR = 1.264, 95 % CI [1.075, 1.484]).

CONCLUSIONS

Environmental intervention strategies may be effective at reducing child abuse and neglect. However, given the mixed findings from our work, we need to identify under what conditions these interventions work best and whether some components of these strategies (e.g. awareness vs. enforcement of underage sales) differentially affect child abuse and neglect.

Neighborhood market potentials for alcohol use and rates of child abuse and neglect

BACKGROUND

Alcohol use can lead to child abuse and neglect even if the person using alcohol does not use heavily. Yet relatively few measures that reflect alcohol use are available at smaller geographic units. We assess whether the estimated level of total alcohol use per capita is related to measures of child abuse and neglect that include substantiated reports of maltreatment, total entries into foster care, and alcohol-related entries into foster care.

METHODS

Our sample consists of 326 Census block groups in Sacramento, California over three time points (978 space-time units). Administrative data for substantiations of child abuse and neglect and foster care entries are our outcomes. We create market potentials for alcohol use among 18- to 29-year-olds as our primary independent variable. Data are analyzed using Bayesian conditionally autoregressive spatio-temporal models.

RESULTS

Higher alcohol use potentials (as measured by total volume per capita of 18- to 29-year olds) are related to more children entering foster care due to drinking-related concerns by a parent or caregiver (RR = 1.032, 95% CI = [1.013, 1.051]), but not total substantiations for foster care entries. Neighborhoods with higher total volume of alcohol per 18- to 29-year-olds had more foster care entries when we used number of substantiations as the denominator (RR = 1.012, 95% CI = [1.0001, 1.023]) but were not related to foster care entries with alcohol misuse as a concern as a subset of all foster care entries.

CONCLUSIONS

Higher estimated volume of alcohol use per capita among young adults (aged 18 to 29) was related to more children entering foster care due to alcohol-related concerns. Reducing alcohol supply in alcohol outlets, specifically through off-premise establishments, might reduce rates for all entries into foster care or other out-of-home placement and substantiated child abuse and neglect.

Contrasting Methods of Measurement in Spatial Analyses Examining the Alcohol Environment and Child Maltreatment

Child physical abuse is a major public health issue in the United States. Environmental child welfare research has focused on neighborhood characteristics and the influence of alcohol and marijuana establishments. To our knowledge, child welfare studies have singularly examined the outcome in terms of victims, that is, at the level of child population, and have not considered the parent population. Thus, in this exploratory study, we use spatial scan statistics to analyze patterns of child physical abuse at the child and household level, and we use Bayesian hierarchical spatial conditional autoregressive models to determine the relative influence of alcohol availability and other environmental factors. We find that household clusters are nested in child clusters and that controlling for alcohol establishments reduces cluster size. In the Bayesian regression models, alcohol availability increased risk slightly, while neighborhood diversity (measured using Blau's Index) elevated risk considerably. Immediate implications for child welfare agencies are discussed.

Spatiotemporal Analysis of Overall Health in the United States Between 2010 and 2018

Background

Although many previous studies have documented spatial heterogeneity in health outcomes across the United States at different geographic scales, spatiotemporal analyses to understand overall health are scant.

Methodology

We used the County Health Rankings (CHR) data to analyze the three types of health outcomes, viz., overall health, length of life, and quality of life for 2010-2018 in the contiguous United States employing hierarchal Bayesian methods. Composite scores were created to proxy these outcomes utilizing predefined weights of several variables as recommended by CHR. Our methods assumed a convolution of spatially structured and unstructured errors to model the overall spatial error. Spatial effects were modeled using conditional autoregressive distribution.

Results

The substantial disparity in these health outcomes was evident, with counties having poorer health outcomes mostly concentrated in the southeastern United States. Models that incorporated county-level demographic and socioeconomic characteristics partially explained the observed spatial heterogeneity in health outcomes. Interestingly, there was no time effect in any of the outcomes suggesting a perpetuation of health disparity over the years.

Conclusions

County-specific health policy interventions that take into account the contextual factors might be beneficial in improving population health and breaking the perpetuation of health disparity.

Chronic high risk of intimate partner violence against women in disadvantaged neighborhoods: An eight-year space-time analysis

We conducted a small-area ecological longitudinal study to analyze neighborhood contextual influences on the spatio-temporal variations in intimate partner violence against women (IPVAW) risk in a southern European city over an eight-year period. We used geocoded data of IPVAW cases with associated protection orders (n = 5867) in the city of Valencia, Spain (2011-2018). The city's 552 census block groups were used as the neighborhood units. Neighborhood-level covariates were: income, education, immigrant concentration, residential instability, alcohol outlet density, and criminality. We used a Bayesian autoregressive approach to spatio-temporal disease mapping. Neighborhoods with low levels of income and education and high levels of residential mobility and criminality had higher relative risk of IPVAW. Spatial patterns of high risk of IPVAW persisted over time during the eight-year period analyzed. Areas of stable low risk and with increasing or decreasing risk were also identified. Our findings link neighborhood disadvantage to the existence and persistence over time of spatial inequalities in IPVAW risk, showing that high risk of IPVAW can become chronic in disadvantaged neighborhoods. Our analytic approach provides specific risk estimates at the small-area level that are informative for intervention purposes, and can be useful to assess the effectiveness of prevention efforts in reducing IPVAW.

The Spatial Overlap of Police Calls Reporting Street-Level and Behind-Closed-Doors Crime: A Bayesian Modeling Approach

Traditionally, intimate-partner violence has been considered a special type of crime that occurs behind closed doors, with different characteristics from street-level crime. The aim of this study is to analyze the spatial overlap of police calls reporting street-level and behind-closed-doors crime. We analyzed geocoded police calls in the 552 census-block groups of the city of Valencia, Spain, related to street-level crime (N = 26,624) and to intimate-partner violence against women (N = 11,673). A Bayesian joint model was run to analyze the spatial overlap. In addition, two Bayesian hierarchical models controlled for different neighborhood characteristics to analyze the relative risks. Results showed that 66.5% of the total between-area variation in risk of reporting street-level crime was captured by a shared spatial component, while for reporting IPVAW the shared component was 91.1%. The log relative risks showed a correlation of 0.53, with 73.6% of the census-block groups having either low or high values in both outcomes, and 26.4% of the areas with mismatched risks. Maps of the shared component and the relative risks are shown to detect spatial differences. These results suggest that although there are some spatial differences between police calls reporting street-level and behind-closed-doors crime, there is also a shared distribution that should be considered to inform better-targeted police interventions.

Space-Time Conditional Autoregressive Modeling to Estimate Neighborhood-Level Risks for Dengue Fever in Cali, Colombia

Vector-borne diseases affect more than 1 billion people a year worldwide, causing more than 1 million deaths, and cost hundreds of billions of dollars in societal costs. Mosquitoes are the most common vectors responsible for transmitting a variety of arboviruses. Dengue fever (DENF) has been responsible for nearly 400 million infections annually. Dengue fever is primarily transmitted by female Aedes aegypti and Aedes albopictus mosquitoes. Because both Aedes species are peri-domestic and container-breeding mosquitoes, dengue surveillance should begin at the local level—where a variety of local factors may increase the risk of transmission. Dengue has been endemic in Colombia for decades and is notably hyperendemic in the city of Cali. For this study, we use weekly cases of DENF in Cali, Colombia, from 2015 to 2016 and develop space–time conditional autoregressive models to quantify how DENF risk is influenced by socioeconomic, environmental, and accessibility risk factors, and lagged weather variables. Our models identify high-risk neighborhoods for DENF throughout Cali. Statistical inference is drawn under Bayesian paradigm using Markov chain Monte Carlo techniques. The results provide detailed insight about the spatial heterogeneity of DENF risk and the associated risk factors (such as weather, proximity to Aedes habitats, and socioeconomic classification) at a fine level, informing public health officials to motivate at-risk neighborhoods to take an active role in vector surveillance and control, and improving educational and surveillance resources throughout the city of Cali.

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

BACKGROUND

Modeling the spatio-temporal characteristics of substantiated child maltreatment risk has significant implications for child welfare policy.

OBJECTIVE

This study quantifies the spatiotemporal risk of child abuse and neglect in New Mexico at the census tract level over 9 years, identifies areas of increased risk, and evaluates the role of multiple measures of social and housing insecurity on substantiated child maltreatment referrals.

PARTICIPANTS AND SETTING

Child maltreatment substantiation data across 499 census tracts from 2007 to 2015 were obtained from the New Mexico Department of Public Health.

METHODS

Substantiated referral counts were analyzed within census tracts with Bayesian hierarchical space-time models using Laplace approximation. Standardized incidence ratios, spatial risk, and probability exceedances were calculated and mapped.

RESULTS

Multiple neighborhood structural factors were associated with an increased risk of substantiated child maltreatment, including the eviction rate (Incidence Density Ratio [IDR] = 1.09 [95 % CrI = 1.01-1.12]), rent burden (IDR = 1.11 [95 % CrI = 1.01-1.13]), urban tracts (IDR = 1.36 [95 % CrI = 1.05-1.77]), food desert tracts (IDR = 1.21 [95 % CrI = 1.04-1.41]), low income tracts (IDR = 1.27 [95 % CrI = 1.09-1.49]), percent of households with no vehicle access ([IDR] = 1.27 [95 % CrI = .247-6.47]), and percent of persons with a disability (IDR = 1.05 [95 % CrI = 1.03-1.06]). The racial/ethnic diversity ratio, however, was associated with lower incidence of child maltreatment allegation risk (IDR = .988 [95 % CrI = .982-.995]).

CONCLUSIONS

Population-based child abuse and neglect prevention and intervention efforts should be aided by the characteristics of neighborhoods that demonstrate strong spatial patterns of household and housing vulnerability, particularly in low income, racially segregated neighborhoods.

Opioid prescription rates and risk for substantiated child abuse and neglect: A Bayesian spatiotemporal analysis

OBJECTIVES

To determine the association between opioid prescribing rates and substantiated abuse and neglect across Tennessee counties during an 11-year period.

METHODS

We adopted a Bayesian spatiotemporal approach to determine the association between opioid prescribing and rates of substantiated child abuse and neglect over and above environmental and population-level covariates. Annual county-level data for Tennessee (2006-2016) included rates of substantiated child abuse and neglect, rates of drug and non-drug crime incidents, racial and Hispanic composition, per capita income, child poverty and teen birth rates, and vacant housing.

RESULTS

Higher opioid prescribing rates were associated with greater risk for substantiated child abuse and neglect across Tennessee counties. Risk for substantiated child abuse and neglect was positively associated with vacant housing, child poverty, teen birth rates, and rates of both drug and non-drug criminal incidents - including stimulant arrests. Risk for substantiated child abuse and neglect was negatively associated with percentages of African Americans.

CONCLUSIONS

Results underscore the importance of opioid prescribing and crime rates as independent determinants of spatial and temporal variation in risk for substantiated child abuse and neglect. Policies that regulate and reduce opioid prescribing have the potential to reduce risk for child abuse and neglect.

Impact of Alcohol Outlet Density on Reported Cases of Child Maltreatment in Japan: Fixed Effects Analysis

Background: Parental drinking habits or binge drinking are a known risk factor of child maltreatment. Though drinking habits are affected by alcohol outlet density, the direct association between alcohol outlet density and child maltreatment is still controversial.

Purpose: This study aimed to examine the impact of off-premises alcohol outlet density on child maltreatment cases reported to Child Guidance Centers in Japan.

Methods: A fixed effects model was used to investigate the association between a change in off-premises alcohol outlet density and a change in child maltreatment cases in each unit. Time-series of cross-sectional ecological data collected from across Japan over 16 years (2000 to 2015) was used, and maltreatment cases were further sub-grouped by type of maltreatment (physical, sexual, psychological abuse and neglect) and by perpetrators (father, stepfather, mother, and stepmother).

Results: The association between alcohol outlet density and total cases of child maltreatment was not observed (coefficient = 0.98, 95% confidence interval: −6.30, 8.25). However, alcohol outlet density was shown to be positively associated with neglect (coefficient = 3.08, 95% confidence interval: 0.54, 5.62), which indicates that 1 alcohol outlet per 1,000 adults increase would lead to 3 more neglect cases per 10,000 children. Also, a negative association was observed between a change in the incidence of total child maltreatment by father and a change in alcohol outlet density (coefficient = −3.03, 95% confidence interval: −5.78, −0.28).

Conclusion: The findings suggest that off-premises alcohol outlet density may have a causal effect on the increasing cases of neglect and decrease in maltreatment by father in Japan.

Child maltreatment and alcohol outlets in Spain: Does the country drinking culture matters?

BACKGROUND

Alcohol outlet density has been linked to rates of substantiated maltreatment both cross-sectionally and over time. Most of these studies have been conducted in Anglo-Saxon countries, especially in the U.S., but other countries, where alcohol outlets and alcohol consumption may have different social meanings, are clearly underrepresented in the literature.

OBJECTIVE

The aim of this study was to analyze whether alcohol outlet density is associated with neighborhood-level child maltreatment risk in a South-European city.

PARTICIPANTS AND SETTING

A longitudinal study was conducted in the city of Valencia (Spain). As spatial units, we used 552 census block groups. Family units with child maltreatment protection measures from 2004 to 2015 were geocoded (n = 1799).

METHODS

A Bayesian spatio-temporal autoregression model was conducted to model the outcome variable.

RESULTS

Results indicated that, once controlled for other neighborhood-level characteristics, the influence of off-premise density and restaurant/cafe density were not relevant, while bar density showed a negative relationship with child maltreatment risk. Spatially lagged alcohol outlet variables were also not relevant in the model.

CONCLUSIONS

Our results suggest the importance of taking into account the cultural influences on the relationship between alcohol outlets and child maltreatment risk. Future cross-cultural research is needed for better understanding this relationship.

Connecting Child Maltreatment Risk With Crime and Neighborhood Disadvantage Across Time and Place: A Bayesian Spatiotemporal Analysis

Child maltreatment is a major public health problem. Although maltreatment rates vary over time and are influenced by neighborhood characteristics, the unique effects of crime and disadvantage on risk are not well understood. This study utilized a Bayesian spatiotemporal approach to examine risk factors for substantiated child abuse and neglect over a 9-year period across zip codes in Davidson County, TN. Risk of child sexual and physical abuse decreased from 2008 to 2016. In contrast, risk of child neglect increased from 2011 to 2014, followed by a rapid decrease in risk. Whereas higher percentages of families living in poverty were associated with higher risk of all maltreatment subtypes, higher unemployment rates were uniquely associated with risk of child neglect. Crime rates were positively associated with risk of child physical and sexual abuse but not neglect. Results have implications for tailoring prevention strategies according to geographic area and maltreatment subtype.

County-level socioeconomic and crime risk factors for substantiated child abuse and neglect

Rates of substantiated child abuse and neglect vary significantly across counties. Despite strong cross-sectional support for links between social-contextual characteristics and abuse and neglect, few longitudinal studies have tested relations between these risk factors and substantiated rates of abuse/neglect. The goal of this study was to identify county-level socioeconomic and crime factors associated with substantiated abuse/neglect rates over 13 years (2004-2016). Annual county-level data for Tennessee, obtained from the KIDS COUNT Data Center, included rates of substantiated child abuse and neglect, children's race and ethnicity, births to unmarried women, teen birth rate, children in families receiving Supplemental Nutrition Assistance Program (SNAP) benefits, and children in families receiving Temporary Assistance for Needy Families. Annual county-level crime report data, obtained from the Tennessee Incident Based Reporting System, included sexual offenses, non-sexual assaults, stalking incidents, thefts, property damage, and drug-related offenses. Bayesian spatio-temporal models indicated that substantiated child abuse and neglect rates were independently and positively associated with teen birth rates, percentages of births to unmarried mothers, drug-related offenses, and percentages of children receiving SNAP benefits. In contrast, substantiated child abuse and neglect rates were negatively associated with percentages of African-American youth. The findings highlighted distinct demographic, socioeconomic, and crime factors associated with substantiated child abuse and neglect rates and have the potential to enhance identification of high-risk counties that could benefit from targeted abuse and neglect prevention efforts.

Service Engagement and Retention: Lessons from the Early Childhood Connections Program

The high attrition rates found in studies of early childhood home visitation create barriers to measuring the effectiveness of such programs. Most studies examine attrition at program completion. This practice may mask important differences in characteristics between families that end participation at various time points. This study helps address this gap by examining factors associated with percent attrition for early drop out (before three months) compared to the program midpoint (nine months or more) and program completion (18 months) using data from the treatment arm of a small feasibility study of enhanced referral to home visitation among child welfare-involved families (n = 64). Caregivers who identified as White tended to leave by the program midpoint and caregivers who had better social support were more likely to stay at the end of the program. This study is the only published study to date of participation in a community-based home visitation program by child welfare-involved families but several trends identified were consistent with prior studies with other populations. Given the very small sample size, both statistically significant and near significant trends are discussed in the context of existing literature. The practical variation found has implications for continuing to build knowledge of attrition in early childhood home visitation.

What calls for service tell us about suicide: A 7-year spatio-temporal analysis of neighborhood correlates of suicide-related calls

Previous research has shown that neighborhood-level variables such as social deprivation, social fragmentation or rurality are related to suicide risk, but most of these studies have been conducted in the U.S. or northern European countries. The aim of this study was to analyze the spatio-temporal distribution of suicide in a southern European city (Valencia, Spain), and determine whether this distribution was related to a set of neighborhood-level characteristics. We used suicide-related calls for service as an indicator of suicide cases (n = 6,537), and analyzed the relationship of the outcome variable with several neighborhood-level variables: economic status, education level, population density, residential instability, one-person households, immigrant concentration, and population aging. A Bayesian autoregressive model was used to study the spatio-temporal distribution at the census block group level for a 7-year period (2010–2016). Results showed that neighborhoods with lower levels of education and population density, and higher levels of residential instability, one-person households, and an aging population had higher levels of suicide-related calls for service. Immigrant concentration and economic status did not make a relevant contribution to the model. These results could help to develop better-targeted community-level suicide prevention strategies.

Mapping child maltreatment risk: a 12-year spatio-temporal analysis of neighborhood influences

Background

‘Place’ matters in understanding prevalence variations and inequalities in child maltreatment risk. However, most studies examining ecological variations in child maltreatment risk fail to take into account the implications of the spatial and temporal dimensions of neighborhoods. In this study, we conduct a high-resolution small-area study to analyze the influence of neighborhood characteristics on the spatio-temporal epidemiology of child maltreatment risk.

Methods

We conducted a 12-year (2004–2015) small-area Bayesian spatio-temporal epidemiological study with all families with child maltreatment protection measures in the city of Valencia, Spain. As neighborhood units, we used 552 census block groups. Cases were geocoded using the family address. Neighborhood-level characteristics analyzed included three indicators of neighborhood disadvantage—neighborhood economic status, neighborhood education level, and levels of policing activity—, immigrant concentration, and residential instability. Bayesian spatio-temporal modelling and disease mapping methods were used to provide area-specific risk estimations.

Results

Results from a spatio-temporal autoregressive model showed that neighborhoods with low levels of economic and educational status, with high levels of policing activity, and high immigrant concentration had higher levels of substantiated child maltreatment risk. Disease mapping methods were used to analyze areas of excess risk. Results showed chronic spatial patterns of high child maltreatment risk during the years analyzed, as well as stability over time in areas of low risk. Areas with increased or decreased child maltreatment risk over the years were also observed.

Conclusions

A spatio-temporal epidemiological approach to study the geographical patterns, trends over time, and the contextual determinants of child maltreatment risk can provide a useful method to inform policy and action. This method can offer a more accurate description of the problem, and help to inform more localized prevention and intervention strategies. This new approach can also contribute to an improved epidemiological surveillance system to detect ecological variations in risk, and to assess the effectiveness of the initiatives to reduce this risk.

Drug Use, the Drug Environment, and Child Physical Abuse and Neglect

Although drug use is considered a risk factor for child maltreatment, very little work has examined how the drug environment may affect physical abuse and neglect by parents. Utilizing information from a telephone survey with 2,597 respondents from 43 cities with valid police data on narcotics incidents, we analyzed the relationship between drug use, drug availability, and child maltreatment using multilevel models. City-level rates of drug abuse and dependence were related to more frequent physical abuse. Parents who use drugs in areas with greater availability of drugs reported more physical abuse and physical neglect. Emotional support was protective of all types of maltreatment. While most child welfare interventions focus on reducing parental drug use in order to reduce child abuse, these findings suggest environmental prevention or neighborhood strengthening approaches designed to reduce the supply of illicit drugs may also reduce child abuse through multiple mechanisms.

Public housing agency preferences for the homeless as a policy lever: Examining county-level housing subsidy receipt and maltreatment rates

This study examines the relationship between county Public Housing Agency (PHA) practices that prioritize families experiencing homelessness and county-level child maltreatment rates. Using data from a survey of PHAs and the National Child Abuse and Neglect Data System (NCANDS) with a sample of 534 counties, we find that policies which give preference to homeless households for housing assistance are associated with reduced victimization and substantiation rates, while policies that reduce barriers to assistance eligibility are associated with reporting rates. Our findings suggest that beyond prioritizing homeless families for housing assistance as a means of ending homelessness, providing families with more expedient access to a valuable public subsidy may have important positive externalities, such as reduced CPS involvement. Additional partnerships between child welfare agencies and housing providers, particularly those that provide housing subsidies, may be worthy of additional investment and evaluation.

Testing a Social Mechanism: Does Alcohol Outlet Density Moderate the Relationship Between Levels of Alcohol Use and Child Physical Abuse?

OBJECTIVES

Parental alcohol use and alcohol outlet density are both associated with child abuse. Guided by alcohol availability theory, this article examines whether alcohol outlet density moderates the relationship between parental alcohol use and child physical abuse.

METHODS

A general population telephone survey of 3,023 parents or legal guardians 18 years or older was conducted across 50 California cities, whereas densities of alcohol outlets were measured for by zip code. Data were analyzed via overdispersed multilevel Poisson models.

RESULTS

Ex-drinkers, light drinkers, and heavy drinkers use physical abuse more often than lifetime abstainers. Moderate drinking was not related to child physical abuse. Proportion of bars was negatively related to frequency of physical abuse. Moderating relationships between alcohol outlet density and drinking categories were found for all drinking patterns.

CONCLUSION

Different types of alcohol outlets may be differentially related to drinking patterns, indicating that the interaction of drinking patterns and the drinking environment may place children at greater risk for being physically abused.

Are community level prescription opioid overdoses associated with child harm? A spatial analysis of California zip codes, 2001-2011

BACKGROUND

Non-medical prescription opioid use is increasing globally within high-income countries, particularly the United States. However, little is known about whether it is associated with negative outcomes for children. In this study, we use prescription opioid overdose as a proxy measure for non-medical prescription opioid use and ask the following: Do California communities with greater rates of non-medical prescription opioid use also have higher rates of child maltreatment and unintentional child injury?

METHODS

We used longitudinal population data to examine ecological associations between hospital discharges involving overdose of prescription opioids and those for child maltreatment or child injury in California zip codes between 2001 and 2011 (n=18,517 zip-code year units) using Bayesian space-time misalignment models.

RESULTS

The percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate=1.089, 95% credible interval (1.004, 1.165)) and child injury (relative rate=1.055, 95% credible interval (1.012, 1.096)) over the ten-year period, controlling for other substance use and environmental factors.

CONCLUSIONS

Increases in community level prescription opioid overdoses between 2001 and 2011 are associated with a 2.06% increase in child maltreatment discharges and a 1.27% increase in discharges for child injury. Communities with higher rates of non-medical prescription opioid use may experience greater levels of child harms.

Race, Ethnicity, and Exposure to Alcohol Outlets

OBJECTIVE

Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets, potentially contributing to health disparities between these populations and the White majority. We tested the alternative hypothesis that urban economic systems cause outlets to concentrate in low-income areas and, controlling for these effects, lower demand among minority populations leads to fewer outlets.

METHOD

Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Hierarchical Bayesian conditional autoregressive Poisson models then estimated relationships between observed geographic distributions of outlets and the market potential for alcohol, income, population size, and racial and ethnic composition.

RESULTS

Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations. Block groups with greater market potential and lower income had greater concentrations of outlets. When we controlled for these effects, the racial and ethnic group composition of block groups was mostly unrelated to outlet concentrations.

CONCLUSIONS

Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods.

The relationship between electronic gaming machine accessibility and police-recorded domestic violence: A spatio-temporal analysis of 654 postcodes in Victoria, Australia, 2005-2014

An emerging body of research has documented an association between problem gambling and domestic violence in a range of study populations and locations. Yet little research has analysed this relationship at ecological scales. This study investigates the proposition that gambling accessibility and the incidence of domestic violence might be linked. The association between police-recorded domestic violence and electronic gaming machine accessibility is described at the postcode level. Police recorded family incidents per 10,000 and domestic-violence related physical assault offenses per 10,000 were used as outcome variables. Electronic gaming machine accessibility was measured as electronic gaming machines per 10,000 and gambling venues per 100,000. Bayesian spatio-temporal mixed-effects models were used to estimate the associations between gambling accessibility and domestic violence, using annual postcode-level data in Victoria, Australia between 2005 and 2014, adjusting for a range of covariates. Significant associations of policy-relevant magnitudes were found between all domestic violence and EGM accessibility variables. Postcodes with no electronic gaming machines were associated with 20% (95% credibility interval [C.I.]: 15%, 24%) fewer family incidents per 10,000 and 30% (95% C.I.: 24%, 35%) fewer domestic-violence assaults per 10,000, when compared with postcodes with 75 electronic gaming machine per 10,000. The causal relations underlying these associations are unclear. Quasi-experimental research is required to determine if reducing gambling accessibility is likely to reduce the incidence of domestic violence.

Socioeconomic determinants of exposure to alcohol outlets

OBJECTIVE

Alcohol outlets tend to be located in lower income areas, exposing lower income populations to excess risks associated with alcohol sales through these establishments. The objective of this study was to test two hypotheses about the etiology of these differential exposures based on theories of the economic geography of retail markets: (a) outlets will locate within or near areas of high alcohol demand, and (b) outlets will be excluded from areas with high land and structure rents.

METHOD

Data from the 2010 National Drug Strategy Household Survey were used to develop a surrogate for alcohol demand (i.e., market potential) at two census geographies for the city of Melbourne, Australia. Bayesian conditional autoregressive Poisson models estimated multilevel spatial relationships between counts of bars, restaurants, and off-premise outlets and market potential, income, and zoning ordinances (Level 1: n = 8,914).

RESULTS

Market potentials were greatest in areas with larger older age, male, English-speaking, high-income populations. Independent of zoning characteristics, greater numbers of outlets appeared in areas with greater market potentials and the immediately surrounding areas. Greater income excluded outlets in local and surrounding areas.

CONCLUSIONS

These findings are consistent with the hypothesis that alcohol outlets are located in areas with high demand and are excluded from high-income areas. These processes appear to take place at relatively small geographic scales, encourage the concentration of outlets in specific low-income areas, and represent a very general economic process likely to take place in communities throughout the world.

Understanding the Interplay Between Neighborhood Structural Factors, Social Processes, and Alcohol Outlets on Child Physical Abuse

This article seeks to understand the relative influence of neighborhood structural characteristics (e.g., disadvantage) and social processes (e.g., interactions between residents) on child physical abuse. Using multilevel modeling in a sample of 3,023 parents in 194 zip codes, structural characteristics of factor scores representing residential stability and foreign-born Latino males were negatively related to child physical abuse. High proportions of naturalized and Asian/Pacific Islander families were positively related to the frequency of physical abuse. Higher levels of neighborhood social disorder were related to more frequent physical abuse, while higher levels of collective efficacy were related to less frequent physical abuse. Programs designed to alleviate disorder and increase neighborly interactions may be effective at reducing physical abuse. By understanding the relative importance of the demographic characteristics of neighborhoods and the actions and interactions of residents within the neighborhoods, policy and practice can be tailored more effectively to prevent maltreatment.

Geographic variation in racial disparities in child maltreatment: The influence of county poverty and population density

There are documented disparities in the rates at which black children come into contact with the child welfare system in the United States compared to white children. A great deal of research has proliferated aimed at understanding whether systematic biases or differential rates of risk among different groups drive these disparities (Drake et al., 2011). In the current study, county rates of maltreatment disparity are compared across the United States and examined in relation to rates of poverty disparity as well as population density. Specifically, using hierarchical linear modeling with a spatially lagged dependent variable, the current study examined data from the National Child Abuse and Neglect Data System (NCANDS) and found that poverty disparities were associated with rates of maltreatment disparities, and densely populated metropolitan counties tended to have the greatest levels of maltreatment disparity for both black and Hispanic children. A significant curvilinear relationship was also observed between these variables, such that in addition to the most densely populated counties, the most sparsely populated counties also tended to have higher rates of maltreatment disparity for black and Hispanic children.

The economic geography of medical cannabis dispensaries in California

BACKGROUND

The introduction of laws that permit the use of cannabis for medical purposes has led to the emergence of a medical cannabis industry in some US states. This study assessed the spatial distribution of medical cannabis dispensaries according to estimated cannabis demand, socioeconomic indicators, alcohol outlets and other socio-demographic factors.

METHODS

Telephone survey data from 5940 residents of 39 California cities were used to estimate social and demographic correlates of cannabis consumption. These individual-level estimates were then used to calculate aggregate cannabis demand (i.e. market potential) for 7538 census block groups. Locations of actively operating cannabis dispensaries were then related to the measure of demand and the socio-demographic characteristics of census block groups using multilevel Bayesian conditional autoregressive logit models.

RESULTS

Cannabis dispensaries were located in block groups with greater cannabis demand, higher rates of poverty, alcohol outlets, and in areas just outside city boundaries. For the sampled block groups, a 10% increase in demand within a block group was associated with 2.4% greater likelihood of having a dispensary, and a 10% increase in the city-wide demand was associated with a 6.7% greater likelihood of having a dispensary.

CONCLUSION

High demand for cannabis within individual block groups and within cities is related to the location of cannabis dispensaries at a block-group level. The relationship to low income, alcohol outlets and unincorporated areas indicates that dispensaries may open in areas that lack the resources to resist their establishment.

Assessing the Validity of On-Premise Alcohol License Data in Six Communities in California: Operating Characteristics and Outlet Densities

This study evaluated State of California alcohol license records as a measure of businesses selling alcohol for consumption on premise. In 2008, researchers attempted to visit all 799 licensed restaurants, bars, and pubs in six medium-sized cities near San Francisco. Surveys collected detailed business characteristics for a subsample of 151 bars or restaurants that included a separate bar area. Results suggest inaccuracies of official records regarding license locations and types (bar/pub vs. restaurant). Analyses also indicate that establishment characteristics are related to local alcohol outlet densities. Study implications and limitations are discussed.

Where the individual meets the ecological: a study of parent drinking patterns, alcohol outlets, and child physical abuse

BACKGROUND

Despite well-known associations between heavy drinking and child physical abuse, little is known about specific risks related to drinking different amounts of alcohol in different drinking venues. This study uses a context-specific dose-response model to examine how drinking in various venues (e.g., at bars or parties) is related to physically abusive parenting practices while controlling for individual and psychosocial characteristics.

METHODS

Data were collected via a telephone survey of parents in 50 cities in California, resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse and corporal punishment were measured using the Conflict Tactics Scale, Parent-Child version. Drinking behaviors were measured using continued drinking measures. Data were analyzed using zero-inflated Poisson models.

RESULTS

Drinking at homes, parties, or bars more frequently was related to greater frequencies of physically abusive parenting practices. The use of greater amounts of alcohol in association with drinking at bars appeared to increase risks of corporal punishment, a dose-response effect. Dose-response relationships were not found for drinking at homes or parties or drinking at bars for physical abuse nor for drinking at home and parties for corporal punishment.

CONCLUSIONS

Frequencies of using drinking venues, particularly bars and home or parties, are associated with greater use of abusive parenting practices. These findings suggest that a parent's routine drinking activities place children at different risks of being physically abused. They also suggest that interventions that take into account parents' alcohol use at drinking venues are an important avenue for secondary prevention efforts.

Alcohol outlet densities and alcohol price: the British Columbia experiment in the partial privatization of alcohol sales off-premise

BACKGROUND

Alcohol beverage prices or taxes have been shown to be related to alcohol sales and use and related problems. What is not clear are the mechanisms underlying these relationships.

METHODS

This study examines the relationship between alcohol outlet density under conditions of the partial privatization of off-premise consumption in British Columbia (BC) occurring over the past decade. Two hypotheses are tested. First, reflecting basic supply-demand principles, greater geographic densities of alcohol outlets will be directly related to reductions in beverage prices in response to greater competition. Second, reflecting the effects of niche marketing and resulting market stratification, increased densities of private liquor stores will be especially related to reductions in beverage prices within this outlet category. Data were collected from: (i) a survey of BC private store prices and practices, (ii) alcohol outlet location information, and (iii) data on demographic characteristics. Multilevel models examine the relationships between prices at individual private liquor stores and the densities of government liquor stores, private liquor stores, bars, and restaurants, controlling for background demographics and geographic unit level effects. Spatial dependencies were also examined.

RESULTS

Increased densities of private liquor stores were associated with lower mean prices of beer and all alcohol aggregated across brands at the store level. There appeared to be no outlet level effect on discounting patterns, however, with the mean price differences apparently reflecting differences in the quality of brands carried rather than unequal prices for any given brand.

CONCLUSIONS

Increased densities of private off-sale alcohol outlets appear to result in lower prices charged at said establishments independently of other types of alcohol outlets suggesting that they represent an emerging marketing niche in the context of off-sale outlet privatization.

The geography of drug market activities and child maltreatment

This study examines how drug market activities place children at risk of maltreatment over space and time. Data were collected for 95 Census tracts in Sacramento, California, over 7 years and were analyzed using Bayesian space-time models. Referrals for child maltreatment investigations were less likely to occur in places where current drug market activity was present. However, past-year local and spatially lagged drugs sales were positively related to referrals. After the investigative phase, Census tracts with more drug sales had higher numbers of substantiations, and those with more possessions also had more entries into foster care. The temporal delay between drug sales and child maltreatment referrals may indicate that the surveillance systems designed to protect children may not be responsive to changing neighborhood conditions or be indicative of the time it takes for the detrimental effects of the drug use to appear.

Alcohol outlet density and harm: comparing the impacts on violence and chronic harms

INTRODUCTION AND AIMS

A number of studies have previously identified relationships between the density of alcohol outlets and rates of violence, with different types of outlets related to violence in different locations. The previous work in Australia has been limited to studies based on police data, which are subject to numerous biases. This study extends the previous work by utilising hospital admissions as a less biased outcome measure, incorporating a 14 year longitudinal design and by developing comparative models for violence and rates of alcohol use disorders.

DESIGN AND METHODS

The study examines trends in postcode-level hospital admission data for assault and for alcohol use disorders over a 14 year period (n = 186) and their relationship with the density of three kinds of alcohol outlets. Fixed-effects models are developed to control for the differences between postcodes and for the overall trends in outlet density and morbidity rates.

RESULTS

The results of this study suggest that the density of alcohol outlets where the main activity is alcohol consumption (i.e. pubs) is positively related to rates of assault-related hospital admissions, while the density of off-premise alcohol outlets is related to the rate of alcohol use disorders.

DISCUSSION AND CONCLUSIONS

These findings have significant implications for alcohol policies in Victoria, in particular pointing to the significant contribution of packaged alcohol outlets to both acute and chronic alcohol-related harm.

The availability of neighborhood early care and education resources and the maltreatment of young children

Using Census and administrative data for 2052 Census tracts in a large urban county, this study explores the relationship between several indicators of social organization and neighborhood rates of child maltreatment for 0- to 5-year-olds. Spatial regression models demonstrate that neighborhoods with a higher percentage of 3- and 4-year-olds attending preschool or nursery school, both locally and in adjacent neighborhoods, had lower rates of early maltreatment referrals and substantiations. Neighborhoods with more licensed child care spaces relative to child care need, as defined by the number of 0- to 5-year-old in the neighborhood with working parents, had lower rates of early child maltreatment referrals. However, neighborhoods with a greater spatial density of child care center spaces, defined as the number of licensed child care center spaces or "slots" per square mile, had higher rates of early child maltreatment referrals. Neighborhoods characterized by concentrated socioeconomic disadvantage, inadequate resources for informal child supervision, and ethnic heterogeneity experienced higher rates of early child maltreatment referrals and substantiations, while neighborhoods with larger concentrations of affluent residents and immigrants experienced lower rates. These results point to the importance of community context in understanding child maltreatment risk. They also suggest that early care and education resources may deserve special attention when developing community-based prevention programs to reduce the maltreatment of young children.

Correlation between drugs of abuse and alcohol by hair analysis: parents at risk for having children with fetal alcohol spectrum disorder

The fatty acid ethyl esters (FAEEs) hair test, a biomarker of excessive alcohol exposure, has demonstrated its potential for use in fetal alcohol spectrum disorder (FASD) diagnosis. FASD may be compounded by polydrug exposure. Our objective was to determine the likelihood of positive FAEE test among parents testing positive for other drugs of abuse. Samples submitted for FAEE hair analysis by Children's Aid Societies between October 2005 and May 2007, also concurrently tested for cocaine, cannabinoids, opiates, methamphetamine, amphetamine, benzodiazepines, methadone, and/or oxycodone, were included in our analysis. Subjects consisted of parents suspected of using excessive amounts of alcohol. Parents testing positive for drugs of abuse had a significantly increased risk for testing positive for high FAEE. Mothers testing positive for heavy chronic alcohol use were found to have a threefold increased risk of testing positive for cocaine (odds ratio=3.26, 1.1-9.7). Our results suggest that parents abusing stimulants are at risk of high alcohol exposure, which put their unborn children at risk for FASD.

Opioid detection in maternal and neonatal hair and meconium: characterization of an at-risk population and implications to fetal toxicology

Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.