Neighborhood Poverty, Family Economic Well-Being, and Child Maltreatment

The combined effects of adverse childhood experiences and neighborhood quality on child health and well-being

BACKGROUND

Many studies have investigated the effects of adverse childhood experiences (ACEs) on the health, development, and well-being of children and adolescents. However, most studies have failed to examine whether childhood adversity and ecological factors interact to influence relevant health outcomes.

OBJECTIVE

We used pooled data from the 2018-19 National Survey of Children's Health (n = 24,817) to assess the relationship between ACEs, neighborhood quality, and three domains of adolescent health and well-being: mental health (i.e., symptoms of anxiety problems and depression), neurodevelopmental health, and behavioral problems.

METHODS

Nine types of ACEs were captured in the NSCH data. Logistic regression models were employed to explore the relationship between ACEs, neighborhood quality, and adolescent health and well-being.

RESULTS

Our results indicate that ACEs are associated with each of these domains, with higher ACE scores associated with a higher risk of detrimental outcomes. Neighborhood disorder is also associated with several outcomes. Consistent with our expectations, in the presence of neighborhood disorder the association between higher ACEs exposure and behavior/conduct problems or neurodevelopmental disorders is larger.

CONCLUSIONS

Our results have important implications for understanding how individual and contextual factors may combine to influence child health and behaviors, as well as offering policy recommendations that might help children who experience traumatic events.

Pediatric Hospital Admissions with Concern for Neglect: Correlations Between Neglect Types and Other Clinical and Environmental Risk Factors

OBJECTIVE

Child neglect is a public health concern with negative consequences that impact children, families, and society. While neglect is involved with many pediatric hospitalizations, few studies explore characteristics associated with neglect types, social needs, and post-discharge care.

METHODS

Data on neglect type, sociodemographics, social needs, inpatient consultations, and post-discharge care were collected from the electronic medical record for children aged 0-5 years who were hospitalized with concern for neglect during 2016-2020. Frequencies and percentages were calculated to determine sample characteristics. The Chi-square Test for Independence was used to evaluate associations between neglect type and other variables.

RESULTS

The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%). Common characteristics among neglect types included age less than 1 year, male sex, Hispanic ethnicity, public insurance, past involvement with Child Protective Services, and inpatient consultation services (social work, physical therapy, and occupational therapy), and post-discharge recommendations (primary care, physical therapy, and regional center). Neglect type groups varied by child medical history, social needs, and discharge recommendations. Statistically significant associations supported differences per neglect type.

CONCLUSIONS

Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region. Post-discharge care needs should focus on removing social barriers and optimizing resources, in particular mental health, to mitigate the risk of continued neglect. Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations per neglect type and discharge location.

Disentangling Poverty From Neglect: Using a Person-Centered Approach to Examine Risk Factors for Neglect Among Families in Poverty

Approximately 18% of U.S. children under 5 years old live in poverty, which is one of the strongest predictors of child neglect. However, most families in poverty do not engage in neglect and this may be due to heterogeneity in risk factors. This study examined how risk factors co-occurred among families in poverty across early childhood and whether risk profiles were differentially related to physical and supervisory neglect across time. Results suggested there were four risk profiles across early childhood (i.e., years 1 and 3). At year 1, the four profiles in order of prevalence were: Low Risk, High Risk, Depressed and Uninsured, and Stressed with Health Problems. At year 3, the profiles were: Low Risk, High Risk, Depressed with Residential Instability, and Stressed with Health Problems. Overall, the High Risk profile was associated with more physical and supervisory neglect across time compared to the Low Risk profile; however, the Stress with Health Problems profile was also associated with greater physical neglect. These findings illustrate heterogeneity in the risk factors among families in poverty and demonstrate the differential impact of risk exposure on later neglect. Results also provide evidence to practitioners and policymakers about target risk experiences to prevent neglect.