Associations between 11 parental discipline behaviours and child outcomes across 60 countries

OBJECTIVES

To test associations between 11 caregiver aggressive and non-aggressive discipline behaviours and outcomes (aggression, distraction and prosocial peer relations) of children under 5 years in low-income and middle-income countries (LMICs).

PARTICIPANTS

Data came from the fourth (2009-2013) and fifth (2012-2017) rounds of the UNICEF Multiple Indicator Cluster Surveys. Analyses were restricted to households with children under 5 years, leaving a sample of 229 465 respondents across 60 LMICs. Data were analysed using Bayesian multilevel logistic regression.

RESULTS

Verbal reasoning (80%) and shouting (66%) were the most common parental discipline behaviours towards young children. Psychological and physical aggression were associated with higher child aggression and distraction. Compared with not using verbal reasoning, verbal reasoning was associated with lower odds of aggression (OR)=0.92, 95% credible interval (CI)=0.86 to 0.99) and higher odds of prosocial peer relations (OR=1.30, 95% CI=1.20 to 1.42). Taking away privileges was associated with higher odds of distraction (OR=1.09, 95% CI=1.03 to 1.15) and lower odds of prosocial peer relations (OR=0.92, 95% CI=0.87 to 0.98). Giving the child something else to do was associated with higher odds of distraction (OR=1.06, 95% CI=1.01 to 1.12). The results indicated country-level variation in the associations between parenting behaviours and child socioemotional outcomes.

CONCLUSIONS

Psychological and physical aggression were disadvantageous for children's socioemotional development across countries. Only verbal reasoning was associated with positive child socioemotional development. No form of psychological aggression or physical aggression benefited child socioemotional development in any country. Greater emphasis should be dedicated to reducing parental use of psychological and physical aggression across cultural contexts.

Effects of a Parenting and Nutrition Intervention on Siblings: A Cluster-RCT

OBJECTIVES

The majority of the evidence about the effectiveness of early parenting and nutrition interventions pertains to 1 targeted index child in a given household. We evaluated whether nontargeted sibling children benefited from a bundled parenting and nutrition intervention.

METHODS

We designed a sub-study within a broader cluster-randomized trial that evaluated the effects of engaging both mothers and fathers and bundling parenting and nutrition interventions in Mara, Tanzania. Trained community health workers delivered interventions to parents through peer groups and home visits. Interventions encompassed various content including responsive parenting, infant and young child feeding, and positive couples' relationships. The main trial enrolled mothers and fathers and 1-index children <18 months of age in 80 clusters. Between June and July 2021, in 32 clusters (16 intervention, 16 control), we reenrolled 222 households (118 intervention, 104 control) from the main trial that had another child <6 years of age (ie, sibling to the index child). We compared caregiving practices and child development and nutrition outcomes among siblings in intervention versus control households.

RESULTS

Compared with control siblings, intervention siblings had improved expressive language development (β = 0.33 [95% confidence interval: 0.03 to 0.62]) and dietary intake (β = 0.52 [0.10 to 0.93]) and reduced internalizing behaviors (β = -0.56 [-1.07 to -0.06]). Intervention caregivers reported greater maternal stimulation (β = 0.31 [0.00 to 0.61]) and paternal stimulation (β = 0.33 [0.02 to 0.65]) and displayed more responsive caregiving behaviors (β = 0.40 [0.09 to 0.72]) with sibling children.

CONCLUSIONS

A father-inclusive, bundled parenting and nutrition intervention can achieve positive spillover effects on sibling children's developmental and nutritional outcomes.

Physical discipline as a normative childhood experience in Singapore

BACKGROUND

The cultural normativeness theory posits that specific parenting behaviors can be interpreted as displays of appropriate parenting in contexts where they are deemed normative. Previous studies suggest high acceptance of physical discipline in Singapore, where strict parenting could be interpreted as care for the child. However, there is a lack of studies on the local prevalence and implications of physical discipline. This study aimed to investigate the prevalence of Singaporean children experiencing parental physical discipline, longitudinal changes in this prevalence, and how exposure to physical discipline relates to children's evaluation of their parents' parenting.

METHODS

Participants were 710 children with parental reports of physical discipline at one or more assessments at ages 4.5, 6, 9, and 11 years in the Growing Up in Singapore Towards healthy Outcomes birth cohort study. Parental reports of physical discipline were obtained using the Parenting Styles and Dimensions Questionnaire or the Alabama Parenting Questionnaire across the four assessments. Child reports of their parents' care and control were obtained using the Parental Bonding Instrument for Children at the age 9 assessment. Prevalence was specified as being exposed to at least one physical discipline at any frequency. A generalized linear mixed model was performed to examine whether children's age predicted their exposure to physical discipline. Linear regression analyses were conducted to investigate whether children's exposure to physical discipline predicted their evaluation of their parents' parenting.

RESULTS

The prevalence of children experiencing at least one physical discipline was above 80% at all ages. There was a decrease in this prevalence from age 4.5 to 11 years (B = - 0.14, SE = 0.01, OR = 0.87, p < 0.001). The more frequent the paternal physical discipline children were exposed to, the more likely they were to report lower levels of care (B = - 1.74, SE = 0.66, p = 0.03) and higher levels of denial of psychological autonomy by fathers (B = 1.05, SE = 0.45, p = 0.04). Maternal physical discipline was not significantly associated with children's evaluation of their mothers' parenting (ps ≥ 0.53).

CONCLUSIONS

Physical discipline was a common experience among our Singaporean sample, consistent with the notion that strict parenting could be regarded as a form of care. However, exposure to physical discipline did not translate to children reporting their parents as caring, with paternal physical discipline being negatively associated with children's evaluations of paternal care.

Physical Violence and Scapegoating Within the Family: An Exploration of Biblical Texts and Contemporary Psychology

To understand physical violence in the family, it is important to define the role of the victim. The term "scapegoat" is a universal anthropological concept, often used in sociological theories, where a certain group of people and/or minorities are often victimized or blamed (e.g., social ills). We may note that the phenomenon of scapegoating is most clearly expressed in the Bible. Therefore, we will use relevant biblical texts that refer to parental use of corporal punishment in which a child is scapegoated and/or victimized by parental violence. In this sense, the Bible is the most profound explanation and manifestation of the cultural, social, and especially religious development of humanity. At the same time, the concept of scapegoating is also demonstrated in psychology and therapy, where it also serves as a basis for understanding, for example, physical violence in the family, and where it is also crucial to define the role of the victim. In this article, therefore, we will explain the biblical background of this concept and highlight two basic dynamics of violence against children in the family: when the child is the "scapegoat" for unresolved tensions in the family and when the child becomes the "sacrifice" or victim of the dysregulated emotional response of his or her parents.

The Process of Scaling Early Childhood Violence Prevention Programs in Jamaica

BACKGROUND

Violence is a global public health problem, and early childhood interventions are a core component of violence prevention programming. Interventions to support parents and teachers of young children can prevent violence against children by caregivers and prevent the early development of antisocial behavior. However, there is limited guidance on how to scale up these programs in low- and middle-income countries.

METHODS

In this article, we describe how we applied implementation science principles in the design, implementation, evaluation, and initial scaling of 2 complementary early childhood, violence prevention, caregiver training programs in Jamaica: the Irie Classroom Toolbox (a teacher-training program) and the Irie Homes Toolbox (a parenting program).

RESULTS

We identified 7 implementation science principles most relevant to our work in scaling the Irie Toolbox programs and describe how these principles were operationalized in the Jamaican context. The principles are: (1) design programs for scale from the outset; (2) use learning cycles for quality improvement; (3) plan strategically for government agency adoption; (4) provide high-quality initial and ongoing training and regular supervision; (5) monitor implementation quality; (6) use flexible delivery modes; and (7) plan for program sustainment.

CONCLUSIONS

Through applying these principles to scale the Irie Toolbox programs, we aim to promote a consistent approach to reducing violence against children, reducing child behavior problems, and increasing caregiver and child competencies across both home and school contexts at the population level. The principles and processes described in this article are relevant to other behavior change interventions in early childhood development, education, and public health.

Corporal punishment of children in Australia: The evidence-based case for legislative reform

OBJECTIVE

Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform.

METHODS

We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment.

RESULTS

Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies.

CONCLUSIONS

Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease.

IMPLICATIONS FOR PUBLIC HEALTH

We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

The Occurrence and Co-Occurrence of Harsh Parenting and Family Conflict in Hong Kong

The violation of children's right to a safe home environment is a major public health problem in need of serious attention. Evidence has been limited about the family characteristics that go with the co-occurrence of harsh parenting and family conflict. By using a representative community sample of Hong Kong families, this study aims to examine the prevalence and risk factors of harsh parenting and family conflict. This study was conducted using a secondary analysis obtained from the 2017 Hong Kong Family Survey with a sample size of 1926 respondents who have children. Results showed that participants' ages are negatively related to the occurrence and co-occurrence of harsh parenting and/or family conflict. Married mothers reported less family conflict. Fathers with lower education levels reported more experiences of family violence. Mothers reporting a higher level of family satisfaction were less associated with harsh parenting. This study provides insights into the unique and shared familial elements that prevent harsh parenting and family conflict and help facilitate the development of effective intervention strategies for family violence co-occurrence. Family-based prevention for family violence may screen for the presence of harsh parenting and family conflict and take into consideration these signals to better support families in need.

A qualitative evaluation of the mechanisms of action in an early childhood parenting programme to prevent violence against children in Jamaica

BACKGROUND

Violence against children (VAC) is a global public health problem, and parenting programmes are a key strategy to reduce VAC at home. We developed and evaluated a preschool-based, early childhood, violence prevention, parenting programme (the Irie Homes Toolbox) in Jamaica and reported significant reductions in parents' use of VAC [Effect size (ES) = -0.29] and increases in parents' positive practices (ES = 0.30). This study presents qualitative findings on the mechanisms of action of the programme.

METHODS

As part of a cluster randomized trial, 115 parents from nine preschools participated in the Irie Homes Toolbox parenting programme. The programme consisted of eight 90-min sessions with groups of six parents and focussed on strengthening parent-child relationships, understanding children's behaviour, using appropriate discipline strategies and understanding and managing emotions. We conducted in-depth, semi-structured interviews with a stratified random sample of 28 parents (two to four parents per school) and with nine preschool teachers (one teacher per preschool). Topic guides were developed to explore participants' perspectives of the mechanisms of action of the programme. All interviews were audio-recorded and transcribed, and data were analysed using the framework approach.

RESULTS

The most salient direct pathways to reduced VAC by both parent and teacher reports were through parents' use of alternative strategies to manage child misbehaviour and through improved parent well-being, especially parents' self-management skills. Other factors leading to reduced VAC by parents, reported by both parents and teachers, included self-identification as an 'Irie parent', use of proactive parenting strategies and improved child behaviour. Parents reported that the main factors leading to continued use of VAC were their inconsistency in using positive discipline strategies and poor emotional self-regulation.

CONCLUSION

Reports from participating parents and preschool teachers indicate that contents related to parental self-management and how to use positive discipline strategies to manage child misbehaviour were important factors on the pathway to reduced VAC.

Intimate partner violence and child maltreatment in Scotland - Insights from nationally representative longitudinal survey data

BACKGROUND

Research on child maltreatment in the context of intimate partner violence (IPV) rarely draws on nationally representative samples, and rarely accounts for maternal, paternal and child reports of parental aggression towards children separately.

OBJECTIVE

We explore if living with IPV makes children more likely to be smacked or slapped by their parents.

PARTICIPANTS AND SETTING

A prospective longitudinal and nationally representative child cohort study for Scotland (starting sample N:5217).

METHODS

Questions for children at ages 2-7 include: maternal and paternal reports of aggression towards children; children's reports of being 'smacked' by parents; maternal reports of IPV. Multivariate logit models explore how maternal IPV is associated with child maltreatment, controlling for socio-economic confounders.

RESULTS

In homes with a long-term abusive partner, children are more likely to have been smacked/slapped by the father (OR1.91, p ≤ 0.05), mother (OR1.84 p ≤ 0.05), and both parents (OR2.31, p ≤ 0.05). Maternal IPV frequency and intensity was incrementally associated with children's odds of being smacked/slapped (OR range 1.47-1.70, p ≤ 0.05). Ethnic minority boys were more likely (predicted probability of 42 % p ≤ 0.05) to have been smacked/slapped by their mother frequently compared to other children (predicted probability range: 19-27 %).

CONCLUSIONS

When mothers report IPV, the extent and severity of the abuse is incrementally associated with children's experiences of parental aggression, and ethnic minority boys are far more at risk. Parental aggression should be understood within the context of the stresses associated with living with an abusive partner. We discuss the fragmented picture which surveys of children provide when interviewing mainly the mother.

Gender Inequality in Low- and Middle-Income Countries: Associations with Parental Physical Abuse and Moderation by Child Gender

Gender inequality perpetuates women's economic insecurity and a culture of violence. Parental distress caused by economic pressure may increase violence against children. High levels of gender inequality and interpersonal violence may contribute to higher levels of physical abuse. Using an ecological perspective, this study examines the association of country-level gender inequality and household-level parental physical abuse, and the moderating role of child gender in this association in low- and middle-income countries. We used data on over 420,000 households from the UNICEF Multiple Indicator Cluster Surveys and country-level indicators from the United Nations Development Program Human Development data. We employed multilevel logistic regression to examine the association between gender inequality with the log-odds of physical abuse after accounting for country- and individual-level covariates. In order to more fully explore our results, we calculated predicted probabilities of abuse for several scenarios. The results indicated that higher levels of gender inequality were associated with higher probabilities of physical abuse. This association was stronger for female children than for male children. The probabilities of abuse by child gender were indistinguishable, although rates of physical abuse converged as gender inequality increased, at a statistically marginal level. These findings indicate that macro-level interventions that reduce gender inequality are necessary to prevent and reduce child physical abuse.

The association between spanking and physical abuse of young children in 56 low- and middle-income countries

BACKGROUND

Nearly one third of children under five in low- and middle-income countries (LMICs) experience spanking. Studies from North America suggest that spanking is associated with heightened risk of physical abuse. However, the link between spanking and physical abuse in the international context remains understudied.

OBJECTIVE

To examine the association between caregivers' spanking and physical abuse of young children in LMICs, and to estimate the extent to which physical abuse might be reduced if spanking were eliminated.

PARTICIPANTS

We used nationally representative data from 156,166 1- to 4-year-old children in 56 LMICs from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys.

METHODS

A nationally weighted multilevel logistic regression model examined the association between spanking and physical abuse. We calculated predicted probabilities of physical abuse, which we present using natural frequencies.

RESULTS

Spanking was associated with higher odds of physical abuse (OR = 5.74, p < .001). The predicted probability of physical abuse decreased by 14% comparing children who were spanked (22%) and who were not spanked (8%). When our estimates were translated to a hypothetical sample of 100 children using a natural frequency approach, 32 children were spanked; of those, seven experienced physical abuse. The elimination of spanking would result in four fewer children who were exposed to physical abuse. In relation to the population of abused children, estimates suggest that physical abuse could reduce by up to 33% if spanking were eliminated.

CONCLUSIONS

Results support the UN Sustainable Development Goals Target 16.2 that calls for eliminating all forms of violence against children. Child welfare advocates should discourage caregivers from using spanking, in order to prevent physical abuse.

Patterns of caregiver aggressive and nonaggressive discipline toward young children in low- and middle-income countries: A latent class approach

BACKGROUND

Caregivers use a variety of disciplinary methods to respond to undesired child behavior. Many caregivers use nonaggressive forms of discipline, such as verbal reasoning and redirection. Some caregivers use aggressive forms of discipline, such as spanking and yelling. However, most caregivers use a combination of aggressive and nonaggressive discipline. To date, a disproportionately small number of caregiver discipline studies are conducted in low- and middle-income countries (LMICs), and few studies in low-resource contexts examine aggressive and nonaggressive behaviors simultaneously.

OBJECTIVE

This study aims to elucidate caregiver patterns of 11 disciplinary behaviors used in LMICs, and examine how these patterns relate to child outcomes and household characteristics.

PARTICIPANTS AND SETTING

Data came from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys (MICS) distributed between 2009 and 2017 (N = 218,824 respondents across 63 countries). Focal children were 3-4 years old.

METHODS

Patterns of disciplinary behaviors were estimated using a multilevel latent class analysis (LCA). Multinomial regression analyses examined associations of disciplinary patterns with caregiver-reported child outcomes and household characteristics.

RESULTS

The LCA suggested caregiver discipline fell into three overall patterns: high behavioral control, moderate behavior control, and lower behavioral control. The lower behavioral control class was associated with the most advantageous child outcomes and household socio-demographic characteristics, whereas the high behavioral control class was associated with the most disadvantageous child outcomes and household characteristics.

CONCLUSIONS

Efforts should be employed to reduce aggressive behaviors and promote positive parenting among caregivers in LMICs.

A Ugandan Parenting Programme to Prevent Gender-Based Violence: Description and Formative Evaluation

Purpose: To develop a culturally-sensitive intervention for the early prevention of gender-based violence (GBV) in Uganda. Methods: Programme design followed the 6SQuID model of intervention development and multi-sectorial advice. A formative evaluation was conducted in two communities with six groups and 138 participants. Findings: Four familial predictors of GBV were identified as potentially malleable: poor parent-child attachment, harsh parenting, inequitable gendered socialization and parental conflict. A community-based parenting programme was developed to address them. Its programme theory incorporates Attachment Theory, the concept that positive behavioural control develops emotional control, and Social Learning Theory. Its rationale, structure and content are presented using the TIDieR checklist. A formative evaluation showed the programme to be widely acceptable, culturally appropriate, and perceived to be effective, but also identified challenges. Conclusion: The careful development of this community-based parenting programme shows promise for the early prevention of GBV.

Annual Research Review: Cross-cultural similarities and differences in parenting

This article reviews contemporary research on cross-cultural similarities and differences in parenting. The article begins by providing a definition of culture and how both parenting and culture can change over historical time. The article then presents some classic theoretical frameworks for understanding culture and parenting before considering why parenting may be similar across cultures and why parenting may be different across cultures. The article next turns to a review of cross-cultural similarities and differences in several aspects of parenting, including physical caregiving, cognitive stimulation, warmth and acceptance, control and monitoring, and discipline. Cultural normativeness and beliefs on the legitimacy of parental authority are then considered as potential moderators that contribute to cross-cultural similarities and differences in relations between parenting and child outcomes. The article then considers implications for parenting interventions and laws and policies related to parenting. Finally, the article suggests directions for future research.

A longitudinal study of the impact of parental discipline on wellbeing among primary school students in China: The roles of school attachment and growth mindset

BACKGROUND

Various parental disciplinary strategies may have different impacts on children's wellbeing. Protective factors, such as school attachment and a growth mindset, may mitigate the influence of harsh discipline on a child's wellbeing.

OBJECTIVE

Based on the strengths-based trauma-informed positive education model, the current study investigated the impacts of three types of parental discipline (corporal punishment, psychological aggression, and nonviolent discipline) on primary school students' wellbeing and examined the moderating roles of school attachment and a growth mindset (both disjunctive and conjunctive moderating effects) in the relationship between parental discipline and student wellbeing.

METHODS

A sample of 854 primary school students (M = 9.40) from eight schools in Hong Kong, China, completed the questionnaire survey at two time points (Time 1 and Time 2), one year apart. Hierarchical regression analysis was applied for data analysis.

RESULTS

Parental psychological aggression at Time 1 (T1) was significantly and negatively related to student wellbeing at Time 2 (T2). Parental nonviolent discipline students' school attachment and growth mindset at T1 were significantly and positively correlated with student wellbeing at T2, when controlling for the students' initial wellbeing and important confounding demographic variables. School attachment moderated the association between parental psychological aggression and student wellbeing.

CONCLUSIONS

Parental psychological aggression has negative impacts while nonviolent discipline has positive impacts on primary school students' wellbeing. Students who are more attached to school and have a growth mindset show higher levels of wellbeing. The study provides further evidence of the role of school attachment in moderating the effect of parental psychological aggression on children's wellbeing in the trauma-informed positive education model.

The Irie Classroom Toolbox: Mixed method assessment to inform future implementation and scale-up of an early childhood, teacher-training, violence-prevention programme

Introduction

Violence against children (VAC) is a violation of child rights, has high prevalence in low- and middle-income countries, is associated with long-term negative effects on child functioning, and with high economic and social costs. Ending VAC at home and at school is thus a global public health priority.

Methods

In Jamaica, we evaluated an early childhood, teacher-training, violence-prevention programme, (the Irie Classroom Toolbox), in a cluster-randomised trial in 76 preschools. The programme led to large reductions to teachers' use of VAC, although the majority of teachers continued to use VAC at times. In this paper, we describe a mixed-method evaluation of the Irie Classroom Toolbox in the 38 Jamaican preschools that were assigned to the wait-list control group of the trial. In a quantitative evaluation, 108 preschool teachers in 38 preschools were evaluated at pre-test and 91 teachers from 37 preschools were evaluated at post-test. One preschool teacher from each of these 37 preschools were randomly selected to participate in an in-depth interview as part of the qualitative evaluation.

Results

Preschool teachers were observed to use 83% fewer instances of VAC across one school day after participating in the programme, although 68% were observed to use VAC at least once across two days. The qualitative evaluation confirmed these findings with all teachers reporting reduced use of violence, but 70% reporting continued use of VAC at times. Teachers reported that the behaviour change techniques used to deliver the intervention increased their motivation, knowledge and skills which in turn led to improved child behaviour, improved relationships and improved professional well-being. Direct pathways to reduced use of VAC by teachers were through improved child behaviour and teacher well-being. The main reasons for continued use of VAC were due to barriers teachers faced using positive discipline techniques, teachers' negative affect, and child behaviours that teachers perceived to be severe.

Discussion

We describe how we used the results from the mixed-method evaluation to inform revisions to the programme to further reduce teachers' use of VAC and to inform the processes of training, supervision and ongoing monitoring as the programme is scaled-up through government services.

The role of sociodemographic and psychosocial variables in early childhood development: A secondary data analysis of the 2014 and 2019 Multiple Indicator Cluster Surveys in the Dominican Republic

The association between sociodemographic factors-poverty, lack of maternal schooling, being male at birth-, childhood developmental delay, and poor educational outcomes has been established in the Dominican Republic (DR). However, family moderating factors present or introduced to buffer sociodemographic factors effects on early childhood development (ECD) are still unknown. We conducted a secondary analysis of the DR's 2014 and 2019 Multiple Indicator Cluster Surveys. We had four study aims: 1) confirm the relationship between socioeconomic position (SP), parenting practices, and ECD; 2) determine if a sociodemographic model predicted ECD; 3) determine if a psychosocial model (family childrearing practices, discipline, and early childhood stimulation) predicted ECD above and beyond the sociodemographic model; 4) explore mothers' beliefs about physical punishment and its relationship with ECD and psychosocial variables. We found that both models predicted ECD significantly, but the psychosocial model explained more variance than the sociodemographic model (6.3% in 2014 and 4.4% in 2019). The most relevant sociodemographic predictors were SP (explaining 21.6% of ECD variance in 2014 and 18.6% in 2019) and mother's education (explaining 13.9% in 2014 and 14.1% in 2019). The most salient ECD psychosocial predictors were: negative discipline, number of children's books at home, stimulating activities at home, and attendance to an early childhood education program. The predicting weights of the independent variables were similar for both years. These results have multiple implications for social programs that aim to improve children's potential in contexts of poverty. Although the results show a protective effect of psychosocial factors, sustainable and large-scale interventions should not be limited to just buffering effects, but to solve the underlying problem, which is that poverty prevents children from reaching their developmental potential and exposes them to life-long greater risk for chronic disease. Addressing delays early in life can therefore contribute to achieving health equity.

Harsh parenting and child conduct and emotional problems: parent- and child-effects in the 2004 Pelotas Birth Cohort

In high-income countries, links between harsh and abusive parenting and child conduct and emotional problems are well-documented. However, less is known about these relationships in low- and middle-income countries, where harsh parenting may be more widely accepted and higher rates of conduct or emotional problems may exist which could influence the strength of these associations. We sought to investigate these relationships in a large population-based, prospective longitudinal study from Brazil, which also allowed us to test for sex differences. Using data from the 2004 Pelotas Birth Cohort Study (N = 4231) at ages 6 and 11 years, we applied cross-lagged path analysis to examine the relationships between harsh parenting (Conflict Tactics Scale Parent-Child version), and child conduct and emotional problems (Strengths and Difficulties Questionnaire). We found reciprocal relationships between harsh parenting and child conduct problems, with harsh parenting at age 6 predicting child conduct problems at age 11, and vice versa, even after adjusting for initial levels of conduct problems and harsh parenting, respectively. For child emotional problems, only unidirectional effects were found, with harsh parenting at age 6 predicting child emotional problems at age 11, after adjusting for initial levels of emotional problems, but not vice versa. No significant sex differences were observed in these relationships. These observations based on a middle-income country birth cohort highlight the potential universality of detrimental effects of harsh parenting on child conduct and emotional problems and affirm the importance of addressing parent- and child-effects in preventive and treatment interventions, especially those targeting conduct problems.

Co-occurring violent discipline of children and intimate partner violence against women in Latin America and the Caribbean: a systematic search and secondary analysis of national datasets

Introduction

Intersections between violent discipline (physical punishment and/or verbal aggression) of children and intimate partner violence (IPV) against women have received growing international attention. This study aimed to determine how many Latin American and Caribbean (LAC) countries had national data on co-occurring IPV and violent discipline in the same household, how estimates compared and whether violent discipline was significantly associated with IPV.

Methods

A systematic search (following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) was used to identify which LAC countries had eligible, national co-occurrence data. The most recent eligible dataset in each country was obtained and reanalysed for comparability. Standardised national estimates were produced for prevalence of violent discipline, physical and/or sexual IPV and co-occurrence among ever partnered women of reproductive age living with a child aged 1–14. Bivariate analyses and logistic regressions produced levels and odds ratios (ORs) of physical punishment and verbal aggression in households affected by IPV (past year and before past year) compared with never, adjusted for sociodemographic characteristics.

Results

Nine countries had eligible datasets. Co-occurring physical punishment with past year IPV ranged from 1.7% (Nicaragua) to 17.5% (Bolivia); and with IPV ever from 6.0% (Nicaragua) to 21.2% (Haiti). In almost all countries, children in IPV affected households experienced significantly higher levels and ORs of physical punishment and verbal aggression, whether IPV occurred during or before the past year. Significant adjusted ORs of physical punishment ranged from 1.52 (95% CI 1.11 to 2.10) in Jamaica to 3.63 (95% CI 3.26 to 4.05) in Mexico for past year IPV; and from 1.50 (95% CI 1.23 to 1.83) in Nicaragua to 2.52 (95% CI 2.30 to 2.77) in Mexico for IPV before past year.

Conclusions

IPV is a significant risk factor for violent discipline, but few national surveys in LAC measure both. Co-occurrence merits greater attention from policymakers and researchers.

Book-Sharing for Parenting and Child Development in South Africa: A Randomized Controlled Trial

This study evaluated the impact of a parenting intervention on children's cognitive and socioemotional development in a group of caregivers and their 21-to-28-month-old children in a low-income South African township. A randomized controlled trial compared an experimental group (n = 70) receiving training in dialogic book-sharing (8 weekly group sessions) with a wait-list control group (n = 70). They were assessed before the intervention, immediately following it, and at a six month follow-up. The intervention had positive effects on child language and attention, but not behavior problems, prosocial behavior, or theory of mind. Intervention caregivers were less verbally and psychologically harsh, showed more sensitivity and reciprocity and more complex cognitive talk. This program benefitted parenting and child development and holds promise for low-income contexts.

Multilevel ecological analysis of the predictors of spanking across 65 countries

OBJECTIVE

Ending violence against children is critical to promote the health and socioemotional development of children across the globe. To this end, the UNICEF and the WHO have called for the abolishment of spanking, which is the most pervasive form of physical violence against children worldwide. This study used an ecological perspective to examine micro-level and macro-level predictors of parental spanking across 65 countries.

PARTICIPANTS

Data came from the fourth and fifth rounds of the UNICEF Multiple Indicator Cluster Surveys, which were administered between 2009 and 2017 (N=613 861 households). We examined the predictors of spanking using multilevel logistic regression analysis.

RESULTS

Micro-level factors (ie, those observed at the familial level) were stronger predictors of spanking in comparison to macro-level factors (ie, those observed at the community and country level). Caregiver belief that children need physical punishment in order to be raised properly was the largest risk factor for spanking (OR=2.55, p<0.001). Older child age, the child being female, the head of the household having a secondary education or higher, and higher household wealth were protective factors against spanking, while a higher number of people living in the household was a risk factor for spanking. Living in an urban community was the only macro-level factor associated with spanking.

CONCLUSIONS

Intervention at the micro-level and macro-level are important to reduce violence against children across the globe.

Personal and Environmental Predictors of Aggression in Adolescence

This study aims to find causal factors of aggression in a group of Latino adolescents to achieve a greater understanding of human nature, taking into account personal and contextual variables. The fundamental hypothesis is that moral disengagement, personality traits, self-esteem, values, parenting, sex, and socioeconomic situation can function as possible casual factors of aggression in adolescents. The study examined the variables using the structural equations model (SEM) to determine causal factors of aggression in a sample of 827 adolescents (54% men and 46% women) between 11 and 16 years of age. According to the scientific literature review, sociodemographic, personal, and familiar variables were included in the causal model. The influence of the variables occurred in two ways: one that inhibits aggression and the other that reinforces it. The results are discussed based on identifying protective and risk factors against aggression: biological sex and values of conformity and transcendence as aggression’s inhibitors and, on the other hand, openness, moral disengagement, and leadership values as the most important predictors of aggression.

Feasibility pilot of an adapted parenting program embedded within the Thai public health system

BACKGROUND

This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators.

METHOD

Sixty primary caregivers of children aged 2-9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman's ANOVA, and thematic analysis.

RESULTS

Participants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d = - 0.58, p < 0.001), as well as reductions in physical (d = - 0.58, p < 0.001) and emotional abuse (d = - 0.40, p < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting (d = - 0.52, p < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress.

CONCLUSIONS

This study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results.

TRIAL REGISTRATION

11/01/2019, ClinicalTrials.gov, ID# NCT03539341 .

Global Burden of Violence

This article documents the increasing numbers of children impacted annually by 1 or more types of violence against children and describes the range of types of injuries and their immediate and long-term impacts on child outcomes. The article describes the growing number of international collaborations to decrease the numbers of children impacted by violence and to mitigate the consequences thereof, with a particular emphasis on children living in war zones.

Psychological maltreatment: Definition and reporting barriers among American professionals in the field of child abuse

BACKGROUND

Despite reliable definitions and evidence of harm to children, psychological maltreatment (PM) is significantly less reported to Child Protective Services than physical or sexual abuse in the United States (U.S. Department of Health and Human Services, 2016).

OBJECTIVE

The goal of this study was to identify factors influencing identification and intent to report psychological maltreatment.

PARTICIPANTS AND SETTING

The sample was comprised of membership of the American Professional Society on the Abuse of Children (APSAC), a multi-disciplinary group of professionals in the field of child maltreatment.

METHODS

An anonymous online survey was administered with a 39 % (N = 538) response rate.

RESULTS

Only 4 of the 18 items, preselected by experts as representing all PM subtypes in the APSAC- endorsed definition (Hart, Brassard, Baker, & Chiel, 2019), were identified by most respondents as definitely PM. Most respondents believed that PM was associated with harmful outcomes "sometimes" or "mostly." Respondents revealed an intent to report to CPS only 4 of the 18 PM behaviors. Identification of a behavior as PM and as harmful predicted intent to report, explaining between 8-11 percent of the variance.

CONCLUSION

Professionals in the field of maltreatment need more training on identification and reporting of PM. A model definition of PM should be developed in order to increase reliability of identification of psychological maltreatment.

Protective role of breastfeeding status, chronic health problems, and temperament of children in maltreatment by mothers

Objective

In order to reduce parental violence against children, it is necessary to establish risk factors associated with maltreatment of children in different societies. This study aims to evaluate the impact of mother-child characteristics on self-reported mother's maltreatment (physical or emotional abuse) against pre-school children.

Material and Methods

The general characteristics of mother-infant pairs and maternal knowledge and attitudes about violence were taken using a questionnaire at routine child health supervision. Overall, 244 mother-infant pairs were enrolled and mothers described their child as easy-going (27.0%), normal (61.1%), and naughty (11.9%).

Results

Of all mothers, 32.8% had been exposed to violence in their childhood. According to maternal self-reports, 82.4% of the mothers abused their children emotionally and 24.6% physically. Multiple logistic regression analysis revealed that older child age, naughty or normal defined child, maternal exposure to violence during her childhood period were identified as predictors. Older child age, breastfeeding for less than 6 months, and naughty-defined child were associated with elevated odds ratio of physical abuse; however, those with a chronic disease were less likely to be abused.

Conclusion

Pediatricians should be aware of the fact that older preschool children, being breastfed for less than 6 months, and naughty children could be at risk for victimization.

Psychological maltreatment: An international challenge to children's safety and well being

BACKGROUND

Child psychological maltreatment (PM), also known as emotional abuse and neglect, mental violence, and emotional maltreatment, is the least recognized and addressed of the four major forms of child maltreatment.

OBJECTIVES

This article provides an 1) the history of PM and its relationship to children's rights, 2) an overview of the current state of knowledge, 3) implications of diversity for the topic of PM, 4) an example of a topic-relevant intervention, and 5) a vision for further progress in addressing this form of child maltreatment.

PARTICIPANTS AND SETTINGS

NA.

METHOD

Literature review, intervention description of fabricated or induced illness, and expert opinion.

RESULTS

PM is directly implicated in seven of the articles of the Convention. PM is common, reliable definitions of PM exist and need to be applied to practice and public health surveillance, harmfulness has been empirically established but is not fully appreciated, and countries vary dramatically in terms of incidence.

CONCLUSIONS

PM is a human rights issue that must be addressed through child protection and promotion of child wellbeing. Adoption of reliable definitions of the different aspects of PM for Child Protective Service practice is a top policy goal. The development of empirically supported curricula on PM for training professionals and parents and culturally sensitive interventions to change social norms on the use of psychologically aggressive disciplinary practices and other forms of PM are critical research needs. Well-validated interventions to support quality parent-child relationships and support families exist and need to be widely adopted. Individual child protective measures should be confined to cases of ongoing serious PM when interventions have failed to reduce harm to the child.

Interventions for reducing violence against children in low- and middle-income countries: An evidence and gap map

BACKGROUND

More than half of the children in the world experience some form of interpersonal violence every year. As compared with high-income countries, policy responses in low- and middle-income countries (LMICs) are limited due to resource constraints and paucity of evidence for effective interventions to reduce violence against children in their own contexts, amongst other factors.

OBJECTIVES

The aim of this evidence and gap map (EGM) is to provide an overview of the existing evidence available and to identify gaps in the evidence base on the effectiveness of interventions to reduce violence against children in LMICs. This report covers evidence published in English; a follow-up study is under preparation focusing on evidence in five additional languages-Arabic, Chinese, French, Portuguese and Spanish.

METHODS

The intervention-outcome framework for this EGM is based on INSPIRE-Seven Strategies for Ending Violence against Children, published by WHO and other partners in 2016. The seven strategies include implementation and enforcement of laws; norms and values, safe environment; parent-child and caregiver support; income and economic strengthening; response and support services; education and life skills. The search included both academic and grey literature available online. We included impact evaluations and systematic reviews that assessed the effectiveness of interventions to reduce interpersonal violence against children (0-18 years) in LMICs (World Bank, 2018b). Interventions targeting subpopulation of parents, teachers and caregivers of 0-18 years' age group were also included. A critical appraisal of all included studies was carried out using standardised tools.

RESULTS

The map includes 152 studies published in English of which 55 are systematic reviews and 97 are impact evaluations. Most studies in the map are from Sub-Saharan Africa. Education and life skills are the most widely populated intervention area of the map followed by income and economic strengthening interventions. Very few studies measure impact on economic and social outcomes, and few conduct cost-analysis.

CONCLUSION

More studies focusing on low-income and fragile and conflict-affected settings (FCS) and studying and reporting on cost-analysis are required to address gaps in the evidence. Most interventions covered in the literature focused on addressing a wide range of forms of violence and harm, which limited understanding of how and for whom the interventions work in a given context, for specific forms of violence. More impact evaluation studies are required that assess specific forms of violence, gendered effects of interventions and on diverse social groups in a given context, utilising mixed methods.

Design and Implementation of the Irie Homes Toolbox: A Violence Prevention, Early Childhood, Parenting Program

This paper describes the development of the Irie Homes Toolbox, a violence prevention program targeting parents of children aged two to six years. The intervention was designed to complement an existing, teacher-training, violence prevention program, the Irie Classroom Toolbox, thus promoting an integrated approach across home and school settings. The Irie Homes Toolbox was developed through a four-stage process by integrating data from theory, formative research, and practice to ensure the intervention is acceptable, feasible, relevant, and effective in the context. The perspectives of Jamaican preschool teachers and parents of preschool children, who are the end users, were integrated into the design of the intervention throughout the development process. Stage one involved integrating theory and formative research to inform the initial intervention design. Stages two and three involved iterative cycles of design, implementation and evaluation of the intervention content, process of delivery, structure and materials. Stage four involved a further cycle of learning through a process evaluation conducted as part of a cluster-randomized controlled trial. Data from each of these four stages was used to inform the design and ongoing revisions of the toolbox with the aim of developing a low-cost, scalable and sustainable intervention for the Jamaican context. The resulting program is theory-informed and uses empirically derived content and behavior change principles operationalized for the context in which it will be delivered. The Irie Homes Toolbox is suitable for integration into the existing preschool provision in Jamaica, thus utilizing an existing service and existing staff and increasing the likelihood for wide-scale dissemination.

Observing sensitivity in slums in Yemen: the veiled challenge

This study represents the first video observation of parenting practices conducted in Yemen, where women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 minutes during free interaction. The mothers' veils did not hamper the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. Mothers with a higher educational level and those experiencing more social support were more sensitive. About half of the mothers had their child perform household chores, which was related to lower sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

Men's and women's views on acceptability of husband-to-wife violence and use of corporal punishment with children in 21 low- and middle-income countries

BACKGROUND

Monitoring violence against women and children, and understanding risk factors and consequences of such violence, are key parts of the action plan for the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015.

OBJECTIVE

We examined how men's and women's views about the acceptability of husband-to-wife violence are related within households and how views about the acceptability of husband-to-wife violence are related to beliefs in the necessity of using corporal punishment to rear children and to reported use of corporal punishment with children.

PARTICIPANTS AND SETTING

We used nationally representative samples of men and women in 37,641 households in 21 low- and middle-income countries that participated in UNICEF's Multiple Indicator Cluster Survey.

METHODS

We conducted a series of logistic regression models, controlling for clustering within country, with outcomes of whether participants believe corporal punishment is necessary in childrearing, and whether a child in their household experienced corporal punishment in the last month.

RESULTS

In 46 % of households, men, women, or both men and women believed husbands are justified in hitting their wives. Children in households in which both men and women believe husbands are justified in hitting their wives had 1.83 times the odds of experiencing corporal punishment as children in households in which neither men nor women believe husbands are justified in hitting their wives (95 % CI: 1.12, 2.97).

CONCLUSIONS

Working toward the realization of SDG 5 and SDG 16 involving prevention of violence against women and children, respectively, should be complementary undertakings.

Punitive Violence against Children: A Psychoeducational Parenting Program to Reduce Harsh Disciplining Practices and Child Beating in the Home

While parental harsh disciplining of children is a global concern, children living in Nigeria often experience particularly high levels of harsh discipline. Constrained by the lack of parenting skills to effectively manage children, most Nigerian parents rely too heavily on the use of violent methods in the disciplining of their children, which poses a huge threat to their well-being and development. Given the high levels of harsh parenting and the lack of understanding of its harms, we set out to develop a program of intervention called Psychoeducational parenting program to prevent violence against children (PEPVAC), guided by psychological principles of social learning theory, to help parents reverse the trend. We tested the effectiveness of the program using a quasi-experimental design with questionnaire and observation as data collection tools. Participants were 300 parents of children age 3-12 years, who endorsed using harsh discipline. Parents (n = 150) who received the 8-week intervention were compared with parents in the control group (n = 150). A mixed-model ANOVA revealed that the PEPVAC parents demonstrated a reduced use of harsh disciplinary tactics and a decreased incidence of parents beating their children compared to parents in the control group who continued with business-as-usual. Findings suggest that PEPVAC can be a useful intervention tool in the prevention of punitive violence against children, especially in a culturally-oriented country like Nigeria with over 91 million population of children who are at risk of disciplinary violence in the home.

Corporal Punishment and Child Aggression: Ethnic-Level Family Cohesion as a Moderator

Ethnicity has been examined as a putative moderator between parents' use of corporal punishment and children's externalizing behaviors. Yet, the reasons for this potential ethnic-level moderator have not been fully examined. The primary objective of this study was to examine whether the effect of corporal punishment on aggression is ethnic-specific using major racial groups inside and outside the U.S. samples and how the mean levels of cohesion in family relationships as found in different ethnic groups moderate the association between mothers' use of corporal punishment and children's aggression. A total of 729 mothers who had children aged 7 to 13 years were sampled from five ethnic groups (i.e., European American, African American, Hispanic American, Korean, and Chinese). Several hypotheses were tested to examine the moderating effect of ethnic-level, family cohesion on the relation of corporal punishment to children's aggression. As expected, the mean level of family cohesion was significantly different across ethnicities. Consistent results across parallel multilevel and fixed effect models showed that high corporal punishment was associated with more aggression in all ethnicities, but there was a significant variation in the association across ethnicities, and the variation was explained by ethnic-level family cohesion. There were weaker associations between corporal punishment and child aggression among ethnic groups with high family cohesion and stronger associations among ethnic groups with low family cohesion. Ethnic/cultural variation in this study emphasizes the importance of understanding family environment of diverse ethnic groups when evaluating the influence of corporal punishment on child behavior in different ethnic/cultural contexts.

Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia: A systematic review and multi-level meta-analysis

BACKGROUND

Currently, the strongest evidence for preventing violence against children lies with social learning theory-based parenting interventions. An increasing number of experimental studies on such interventions have been conducted in low- and middle-income countries (LMICs) in East and Southeast Asia.

OBJECTIVE

To conduct a systematic review and meta-analysis on the effectiveness of parenting interventions in preventing violence against children.

PARTICIPANTS AND SETTING

Parents and primary caregivers living in LMICs in East and Southeast Asia.

METHODS

Eleven studies were retrieved through electronic databases, expert contacts, and the reference sections of previous reviews. Studies were appraised for risk of bias and effect estimates pooled using random effects multilevel meta-analysis.

RESULTS

Forty-four effect estimates were meta-analyzed based on five outcome category models, finding a small effect on abusive, harsh, or negative parenting (n = 3, d = -0.42, 95 % CI [- 0.81, -0.02], p < .01, I² = 72 %); a large, non-significant effect on parental knowledge or attitudes (n = 5, d = 1.40, 95 % CI [-0.30, 3.10], I² = 95 %); a small effect on positive parent-child interactions (n = 5, d = 0.25, 95 % CI [0.19, 0.32], p < .001, I² = 0); a small, non-significant effect on parental stress (n = 2, d = -0.13, 95 % CI [-0.38, 0.11], I² = 0); and a small, non-significant effect on family environment (n = 3, d = 0.21, 95 % CI [-0.12, 0.53], I² = 85 %).

CONCLUSIONS

The results suggest that parenting interventions can reduce rates of particular forms of violence against children, as well as promote positive parent-child interactions.

Acceptability and feasibility of a brief substance use intervention for adolescents in Cape Town, South Africa: A pilot study

Substance use is prevalent among South African adolescents, but few interventions exist to reduce risk of harm. This study assesses the feasibility, acceptability and preliminary effects of a brief intervention for reducing adolescent substance use and other risk behaviours. This single-arm feasibility test recruited 30 substance-using adolescents and their primary caregiver. Participants received separate interventions (2 sessions for adolescents, 1 session for caregivers), with a subsample randomly selected for post-intervention interviews. Feasibility was measured by the proportion of eligible adolescents who were enrolled and retained in the study. Interviews explored acceptability, and changes in outcomes from baseline to 1-month follow-up assessed preliminary effects of the intervention. Thirty of 43 (69.8%) eligible adolescents and their caregivers were enrolled, with 29 adolescents (96.7%) and 28 caregivers (93.3%) completing the intervention. Twenty-eight adolescents (93.3%) and 29 caregivers (96.7%) were retained at follow-up. Frequency of alcohol, cannabis use and delinquent-type behaviours decreased significantly from baseline to follow-up. Participants appreciated the intervention content and delivery and felt that it facilitated behaviour change. Suggestions for improving the intervention were provided. This study found that the intervention is feasible, acceptable and had promising effects on adolescent behaviour. Efficacy must be established with a randomised controlled trial.

Child-parent interactions in American and Turkish families: Examining measurement invariance analysis of child-parent relationship scale

The parent-child relationship is a cornerstone of early childhood development and one-way early childhood programs can have a positive influence on early development is to adopt programmatic features to enhance this relationship. Research supports these conclusions in both U.S. and cross-cultural contexts, even though assumptions about parenting and the parent-child relationship may differ across cultures. However, for true understanding of cultural differences, it is important to have comparable measures across cultures. The purpose of the study is to assess measurement invariance of the two constructs of the Child-parent Relationship Scale using data gathered in programs serving low-income preschool children in the U.S.(n = 4,450) and Turkey (n = 592) from 2014 to 2015. Using Single-group Confirmatory Factor Analysis, the original factor structures of the Turkish and the English versions were tested. Besides, Multigroup Confirmatory Factor Analysis provided evidence for configural, metric, scalar invariance, strict factorial invariance or error variance invariance and construct level invariance across the two versions. Only configural invariance was established, which showed an agreement for the existence of an underlying theoretical construct for each subscale (Conflict and Closeness) of the Turkish and the English versions. However, item CPRS 4 was a non-significant item for Conflict in the Turkish version that affected the possibility to conduct further analyses. Findings encourage researchers to propose and assess cultural and linguistic adaptations for the Child-parent Relationship Scale before cross-cultural comparisons related to family relationships.

Crossing boundaries: A pilot study of maternal attitudes about child maltreatment in nine countries

BACKGROUND

Definitions of child maltreatment vary widely between studies, and even more so between different cultural contexts.

OBJECTIVE

In this pilot study, we examine between-country variations in maternal notions about what constitutes child maltreatment.

PARTICIPANTS AND SETTING

The sample consisted of 466 mothers recruited in Chile, China, Greece, Iran, the Netherlands, Portugal, South Africa, Turkey, and Uruguay.

METHODS

All mothers completed a new Q-sort measure, ranking 90 parenting behaviors linked to subtypes of maltreatment (emotional neglect, emotional abuse, physical neglect, and physical abuse) from least to most detrimental to child development.

RESULTS

Between-country agreement regarding the harmfulness of the parenting behaviors was high (r = .45), but there were different patterns of reported harmfulness of subtypes of maltreatment (although driven mostly by deviating patterns in the South African sample). Further, there were significant country effects on the number and type of behaviors labeled as maltreatment (pƞ² = .15), and the number of items labeled as requiring intervention (pƞ² = .19).

CONCLUSIONS

Variations in conceptions of maltreatment need to be studied in larger more representative samples and taken into account in the assessment and treatment of child maltreatment across cultures.

Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.

Evaluation of a Violence-Prevention Programme with Jamaican Primary School Teachers: A Cluster Randomised Trial

This study investigated the effect of a school-based violence prevention programme implemented in Grade 1 classrooms in Jamaican primary schools. Fourteen primary schools were randomly assigned to receive training in classroom behaviour management (n = 7 schools, 27 teachers/classrooms) or to a control group (n = 7 schools, 28 teachers/classrooms). Four children from each class were randomly selected to participate in the evaluation (n = 220 children). Teachers were trained through a combination of workshop and in-class support sessions, and received a mean of 11.5 h of training (range = 3–20) over 8 months. The primary outcomes were observations of (1) teachers’ use of violence against children and (2) class-wide child aggression. Teachers in intervention schools used significantly less violence against children (effect size (ES) = −0.73); benefits to class-wide child aggression were not significant (ES = −0.20). Intervention teachers also provided a more emotionally supportive classroom environment (ES = 1.22). No benefits were found to class-wide prosocial behaviour, teacher wellbeing, or child mental health. The intervention benefited children’s early learning skills, especially oral language and self-regulation skills (ES = 0.25), although no benefits were found to achievement in maths calculation, reading and spelling. A relatively brief teacher-training programme reduced violence against children by teachers and increased the quality of the classroom environment.

Child discipline in low- and middle-income countries: Socioeconomic disparities at the household- and country-level

BACKGROUND

In the past month, an estimated eight of ten children worldwide have experienced violent discipline. Understanding the economic and social contexts in which parents are more likely to use particular disciplinary practices is necessary to reduce violence against children. Critical examination of disciplinary practices and beliefs in cross-country analysis of low- and middle-income countries (LMICS) has been limited.

OBJECTIVE

To estimate the association of country-level stressors and household-level economic stressors with disciplinary behaviors and beliefs.

PARTICIPANTS AND SETTING

Using Multiple Indicator Cluster Survey data between 2010 and 2013, 231,221 parents from 32 LMICS were included.

METHODS

The prevalence of past-month nonviolent discipline, physical discipline, psychological aggression, belief in the utility of physical discipline, and incongruence of disciplinary practice and belief were estimated. Country-level prevalence was regressed on country-level stressors (economic burden, economic inequality, human security, and human development). Individual-level disciplinary practices and beliefs were regressed on household wealth.

RESULTS

Country-level stressors predicted psychological and physical discipline use and belief in the utility of physical discipline. Lower household wealth was associated with increased violent disciplinary practice and belief. Lower household wealth was associated with increased likelihood of using violent discipline, even when the caregiver did not believe in its utility (OR = 1.63 [1.34, 1.98]).

CONCLUSIONS

Discipline use and belief in LMICS should be understood within the context of salient societal and household stressors.Parental disciplinary beliefs and practices reflect complex interplay with broader social, political and economic contexts and should not be taken to be defined by monolithic views of culture.

Measuring Adverse Child Experiences Among Young Adolescents Globally: Relationships With Depressive Symptoms and Violence Perpetration

PURPOSE

The purpose of the study was to develop a measure of ACEs applicable for young adolescents in low- and middle-income countries (ACEs) and to analyze the relationships of ACEs against two outcomes: depressive symptoms and violence perpetration. There is a paucity of research on the consequences of adverse child experiences (ACEs) on adolescent health and behavior from low- and middle-income countries and virtually no multinational studies.

METHODS

As part of the Global Early Adolescent Study, an 11-item measure of ACEs was developed and piloted with 1,284 adolescents aged 10-14 years in 14 urban communities in an equal number of countries. With one exception where interviewers were used, data were self-reported anonymously using tablets. Results compared a summative ACEs index score and latent class analysis.

RESULTS

Findings show high rates of ACEs exposure experienced by young adolescents in resource-poor neighborhoods in low- and middle-income countries; disproportionate exposures of boys and strong associations between ACEs and both depressive symptoms and violence perpetration. Latent class analysis provided modest refinement over a summed ACEs score.

CONCLUSION

While interventions tend to focus on behavioral outcomes, evidence suggests that ACEs exposure is a strong antecedent related to both depressive symptoms and violence perpetration.

Early childhood exposure to non-violent discipline and physical and psychological aggression in low- and middle-income countries: National, regional, and global prevalence estimates

BACKGROUND

Advocates for children's rights have recommended the elimination of all forms of violent discipline given its detrimental effects on children's development. Yet, little is known about the global prevalence of various forms of discipline, including physical and psychological aggression, as well as alternative forms of non-violent discipline, especially in low- and middle-income countries (LMICs).

OBJECTIVE

This study aims to obtain national, regional, and global prevalence estimates of the percentage and number of 2- to- 4-y-olds in LMICs exposed to these disciplinary practices by their caregivers.

PARTICIPANTS AND SETTING

We use data collected between 2010 and 2016 from 107,063 2- to- 4-y-old children living in 49 LMICs as part of the Multiple Indicator Cluster Survey (MICS).

METHODS

Using the best-fitting model based on cross-validation techniques, we performed predictive modeling to generate country-level prevalence estimates for 131 LMICs in 2013, as well as 95% confidence intervals around these estimates.

RESULTS

We estimate that 296.2 million 2- to- 4-y-olds (95% CI 256.9, 300.9) were exposed to non-violent discipline in 2013, which corresponds to 83.9% of the population. Furthermore, 220.4 million (95% CI 138.1, 283.7) and 230.7 million (95% CI 128.4, 300.6) children were exposed to aggressive physical and psychological discipline, respectively, which corresponds to prevalence of 62.5% and 65.4%. We also identify a high heterogeneity in the estimates across and within regions, finding a higher prevalence of both violent disciplinary methods in South Asia and Sub-Saharan Africa.

CONCLUSIONS

These results suggest the need for new policies and programs to minimize violent discipline around the world.

Parent discipline in Thailand: Corporal punishment use and associations with myths and psychological outcomes

A basic human right of all children is protection from physical punishment in all settings. Yet, corporal punishment remains common place within families, at home, at school, and elsewhere. In Thailand, cultural beliefs and values might preserve its use. This research sought to explore the use of corporal punishment in Thai homes. It also aimed to investigate young adult retrospective accounts of parent use of corporal punishment and their associations with psychological attributes and the acceptance of certain myths that might perpetuate its use. Two hundred and fifty young people (Mage = 20.26 years, SD = 1.19) recounted their parent's disciplining strategies related to when they were 10 years old. They also completed the Personality Assessment Questionnaire (Rohner, 1999), the Corporal Punishment Myth Scale (Kish & Newcombe, 2015) and responded as parents to a number of child misbehavior scenarios. Overall, 80.4% reported some instance of corporal punishment as a 10-year-old with lifetime prevalence at 85.5%. Receiving corporal punishment was related to poorer psychological outcomes as a young adult. Myths about corporal punishment significantly predicted the use of that discipline strategy in the scenarios. The results are discussed in relation to Thai cultural values and beliefs and the need to gather further evidence to support further policy and legislative changes.

Spanking and young children's socioemotional development in low- and middle-income countries

Spanking is one of the most common forms of child discipline used by parents around the world. Research on children in high-income countries has shown that parental spanking is associated with adverse child outcomes, yet less is known about how spanking is related to child well-being in low- and middle-income countries. This study uses data from 215,885 children in 62 countries from the fourth and fifth rounds of UNICEF's Multiple Indicator Cluster Surveys (MICS) to examine the relationship between spanking and child well-being. In this large international sample which includes data from nearly one-third of the world's countries, 43% of children were spanked, or resided in a household where another child was spanked, in the past month. Results from multilevel models show that reports of spanking of children in the household were associated with lower scores on a 3-item socioemotional development index among 3- and 4-year-old children. Country-level results from the multilevel model showed 59 countries (95%) had a negative relationship between spanking and socioemotional development and 3 countries (5%) had a null relationship. Spanking was not associated with higher socioemotional development for children in any country. While the cross-sectional association between spanking and socioemotional development is small, findings suggest that spanking may be harmful for children on a more global scale than was previously known.

Protocol for a cluster randomised controlled trial evaluating a parenting with home visitation programme to prevent physical and emotional abuse of children in Indonesia: the Families First Programme

INTRODUCTION

Every year, up to 1 billion children are victims of violence worldwide. Most child abuse takes place in the context of punishment. The Families First Programme, an adaptation of the Positive Discipline in Everyday Parenting Programme to the West Java context, is a parenting support programme anchored on children's rights that gives parents guidance on child development, parenting and positive discipline practices. This trial will evaluate the effectiveness of the Families First Programme compared with a waitlist control group.

METHODS AND ANALYSIS

This is a pragmatic, parallel-group, stratified, cluster-randomised controlled trial. Twenty rural and urban villages in the Cianjur District, Indonesia, involving 720 caregivers of children up to 7 years of age, will be randomised. Villages will receive either a parenting programme consisting of 10 group sessions and four home visits over 3 months and standard community health and social services or just the latter. After completion of the trial period, the programme will be offered to those in the delayed group. Outcome data will be collected before randomisation (baseline), immediately postintervention (3 months postrandomisation) and 6 months later (9 months postrandomisation). The primary outcome will be frequency of physical and emotional punishment as measured by a weighted sum from three self-report items. Primary outcome analysis will use Poisson regression with generalised estimating equations and assess the interaction between intervention and time over baseline and 3 and 9 months postrandomisation assessments. Concurrent process evaluation will be conducted to assess programme satisfaction and facilitators and barriers to the implementation of the programme generalisable to other settings.

ETHICS AND DISSEMINATION

Ethics approval was obtained from McGill University and Universitas Katolik Indonesia Atma Jaya. Results will be published in peer-reviewed journals and presented at scientific conferences and events for decision-makers, including in the participating communities.

TRIAL REGISTRATION NUMBER

NCT03374761.

Parenting, culture, and the development of externalizing behaviors from age 7 to 14 in nine countries

Using multilevel models, we examined mother-, father-, and child-reported (N = 1,336 families) externalizing behavior problem trajectories from age 7 to 14 in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). The intercept and slope of children's externalizing behavior trajectories varied both across individuals within culture and across cultures, and the variance was larger at the individual level than at the culture level. Mothers' and children's endorsement of aggression as well as mothers' authoritarian attitudes predicted higher age 8 intercepts of child externalizing behaviors. Furthermore, prediction from individual-level endorsement of aggression and authoritarian attitudes to more child externalizing behaviors was augmented by prediction from cultural-level endorsement of aggression and authoritarian attitudes, respectively. Cultures in which father-reported endorsement of aggression was higher and both mother- and father-reported authoritarian attitudes were higher also reported more child externalizing behavior problems at age 8. Among fathers, greater attributions regarding uncontrollable success in caregiving situations were associated with steeper declines in externalizing over time. Understanding cultural-level as well as individual-level correlates of children's externalizing behavior offers potential insights into prevention and intervention efforts that can be more effectively targeted at individual children and parents as well as targeted at changing cultural norms that increase the risk of children's and adolescents' externalizing behavior.

Parents' use of harsh punishment and young children's behaviour and achievement: a longitudinal study of Jamaican children with conduct problems

INTRODUCTION

Harsh punishment by parents is common in low- and middle-income countries (LMIC), yet there is limited evidence from LMIC of the effects of harsh punishment on child outcomes.

METHODS

A longitudinal, prospective study was conducted with children with conduct problems to examine the associations between parents' use of harsh punishment during the preschool years on child behaviour and school achievement in grade one of primary school. As part of an efficacy trial in 24 preschools, 225 children with the highest level of teacher-reported conduct problems were evaluated and their parents reported on how often they used harsh punishment. Outcome measures in grade one included child conduct problems by independent observation, teacher and parent report, child social skills by teacher and parent report, direct tests of children's academic achievement and language skills, and tester ratings of child attention and impulse control.

RESULTS

Children had a mean age of 6.92 years and 61% were boys. All parents reported using harsh punishment. After controlling for child age and sex, socio-economic status, parents' involvement with child and maternal education, frequency of harsh punishment was associated with growth in child conduct problems by independent classroom observations (p  =  0.037), parent (p  =  0.018) and teacher (p  =  0.044) report, a reduction in child social skills by teacher (p  =  0.024) and parent (p  =  0.014) report and poorer attention during the test session (p  =  0.049).

CONCLUSION

The associations between frequency of parents' use of harsh punishment with their preschoolers with conduct problems and later child behaviour indicate a need to train parents in non-violent behaviour management.