In U.S. counties where personal incomes cluster on opposite sides of the rich and poor spectrum, children appear to endure more neglect and abuse, according to new research by John Eckenrode and colleagues reported in Reuters, February 11th. Using statistical methods to gauge income inequality, the team found a steep rise in the rate of child maltreatment with rising inequality. The relationship held after researchers adjusted for poverty itself, and other factors such as the racial and ethnic makeup of regions, education levels and the number of people receiving public assistance income. Read more.
By H. Roger Segelken
Reprinted from Cornell Chronicle, February 11, 2014
In the aftermath of the Great Recession and the increased attention to the widening income gap, concern over the impact of inequality on children and families has risen. According to a nationwide study by Cornell researchers, the list of bad outcomes associated with income inequality now includes child abuse and neglect.
The income inequality-child maltreatment study, covering all 3,142 U.S. counties from 2005 to 2009, is said to be the most comprehensive of its kind and the first to link higher risk of child maltreatment to localities where the gap between rich and poor is greatest.
“More equal societies, states and communities have fewer health and social problems than less equal ones – that much was known. Our study extends the list of unfavorable child outcomes associated with income inequality to include child abuse and neglect,” said John Eckenrode, professor of human development and director of the Bronfenbrenner Center for Translational Research in the College of Human Ecology.
Results of the nationwide study were published in the Feb. 10 online edition of the journal Pediatrics as “Income Inequality and Child Maltreatment in the United States.” In addition to Eckenrode, who directs the National Data Archive of Child Abuse and Neglect, other report authors include Elliott Smith, Margaret McCarthy and Michael Dineen, researchers in Cornell’s Bronfenbrenner Center for Translational Research.
Nearly 3 million children younger than 18 years of age are abused physically, sexually or emotionally or are physically neglected each year in the United States, the Cornell researchers noted. That is about 4 percent of the youth population.
“We have known for some time that poverty is one of the strongest precursors of child abuse and neglect,” Eckenrode said. “In this paper we were also interested in areas with wide variations in income – think of counties encompassing affluent suburbs and impoverished inner cities – and in the U.S. there is quite a lot of variation in inequality from county to county and state to state.”
The damage inflicted on children by maltreatment doesn’t stop when kids graduate – if they do – from school, the Cornell researchers observed. “Child maltreatment is a toxic stressor in the lives of children that may result in childhood mortality and morbidities and have lifelong effects on leading causes of death in adults,” they wrote. “This is in addition to long-term effects on mental health, substance use, risky sexual behavior and criminal behavior ... increased rates of unemployment, poverty and Medicaid use in adulthood.” Eckenrode noted that “reducing poverty and inequality would be the single most effective way to prevent maltreatment of children, but in addition there are proven programs that work to support parents and children and help to reduce the chances of abuse and neglect – clearly a multifaceted strategy is needed.”
Support for the study came from the Children’s Bureau, Administration for Children and Families, a division of the U.S. Department of Health and Human Services.
In 2009 some 1,770 children died from maltreatment by parents or caregivers and 702,000 were victims of abuse or neglect, according to the latest statistics.
Recognizing the value of the National Data Archive on Child Abuse and Neglect (NDACAN), part of the Family Life Development Center at Cornell, to combat child maltreatment, the U.S. Department of Health and Human Services' Children's Bureau has renewed the archive's funding with $3.6 million over the next five years.
NDACAN makes high-quality datasets available for researchers nationwide to study child maltreatment. Analysis of this data is used to better understand child abuse and neglect, identify new approaches to prevention and shed light on the effectiveness of programs to protect children and strengthen families. The archive houses data from individual studies as well as from annual federal data collection efforts, such as state child abuse and neglect and foster care statistics. NDACAN prepares these datasets for further analysis and provides training and technical assistance for users of the data.
NDACAN services include an annual summer research institute to assist child maltreatment researchers with their research projects and an e-mail list to facilitate information exchange and networking among more than 1,000 subscribers. The archive also hosts a Web-based database of references related to the datasets, called the Child Abuse and Neglect Digital Library. With this tool, researchers can easily find publications based on NDACAN-archived studies to inform their work.
"Our experienced staff have had a real impact in assuring that the research data that is collected is maximally used to understand and address this significant social problem," said John Eckenrode, director of NDACAN, professor of human development and director of the Family Life Development Center.
"We also conduct data analyses for professional groups and organizations, which may be used for informing public policy," he added. "For example, NDACAN provided analyses of national foster care data for a series of reports for the Pew Charitable Trusts' Kids Are Waiting campaign. This information supported the passage of the Fostering Connections to Success and Increasing Adoptions Act of 2008, signed by President George Bush."
Over the past five years. NDACAN has distributed more than 2,000 datasets to the research community and annually responds to more than 1,000 requests for technical assistance. This has resulted in the publication of 30 to 50 research and scholarly articles and reports each year by data users.
"Looking ahead, NDACAN will expand the datasets available, develop innovative products and services, expand its intramural research capacity and provide the field with unique opportunities for networking, training and scholarly work," Eckenrode said.
April is National Child Abuse Prevention Month.
For more information
Kimberly Kopko, Ph.D., Associate Director of Cornell Cooperative Extension and Associate Director of Extension and Outreach in the College of Human Ecology
John Eckenrode, Ph.D., Professor of Human Development and Associate Director of the Bronfenbrenner Center for Translational Research, conducts research and participates in extension-related activities in the area of child abuse and neglect. Dr. Eckenrode has spent part of his academic career examining the long-term effects of the Nurse-Family Partnership program (NFP) on the life-course of high-risk mothers and the development of their children. This research-based and theory driven early intervention program has been successful in reducing the incidence of child abuse and neglect in at-risk families and has evolved into a nationally-known and recognized applied program with both practice and policy applications.
Dr. David Olds, who received his Ph.D. in Human Development, initially conducted the Nurse-Family Partnership Project in 1977 in Elmira, New York. Four hundred young women, most of whom were young, unmarried, low-income and pregnant for the first time, participated in this study. The participants were assigned to different groups: a treatment group of mothers who received an average of 9 nurse home visits during pregnancy and 23 home visits from the child’s birth until the child’s second birthday, and a control group of mothers who did not receive nurse visits. During the visits, the nurses discussed 1) health-related behaviors during pregnancy and the early years of the child’s life; 2) the care parents provide to their children; and 3) personal life course development for mothers (family planning, educational achievement, and work force participation).
Fifteen-Year Follow-up Studies
Fifteen years following the original study, Eckenrode joined Dr. Olds and his colleagues to investigate the long-term effects of this intervention on the health and development of these women and children. Results from this study revealed the beneficial, long-term effects of the nurse home visitation program, including a reduction in the number of reports of child abuse and neglect, the number of subsequent pregnancies and births, use of welfare, fewer behavioral problems resulting from drug and alcohol abuse and a reduction in criminal behavior among the study participants.
A separate study headed by Eckenrode sought to answer a specific question: whether the presence of domestic violence limited the effects of nurse home visitation in reducing reports of child abuse and neglect. Findings showed that reports of child maltreatment did not decrease in those households where domestic violence was the highest during the 15-year period following the birth of the first child. This finding prompted the researchers to conclude that the presence of domestic violence may limit the effectiveness of interventions to reduce the incidence of child abuse and neglect. However, it is important to note that the impact of domestic violence did not affect the other program outcomes (e.g. subsequent birth rate, use dependence on welfare) but rather was specific to child abuse and neglect.
In addition to the positive maternal outcomes, analyses using the same 15-year follow up data revealed that nurse home visitation also reduced the prevalence of certain problematic behaviors—including arrests, alcohol use, and promiscuous sexual behavior—among the 15-year-old children born to the high risk mothers.
The positive outcomes for youth in the nurse-visited group prompted a further study in which Eckenrode and his colleagues examined the early onset of antisocial behaviors for the 15-year-old youth. Findings revealed a relationship between child maltreatment and early-onset problem behaviors for youth who did not receive home visits. However, no relationship between maltreatment and early onset problem behaviors was found for the youth in the nurse-visited group.
Eckenrode and his collaborators suggest that the nurse home visits prevented the occurrence of many types and chronic forms of maltreatment and also prevented maltreatment that extended across several important development stages (e.g., maltreatment that occurred both in childhood and early adolescence). The maltreatment that did occur in the treatment group children tended to occur earlier in the children’s lives and did not continue over long periods of time. These findings suggest that home visiting by nurses reduces the risk of child maltreatment as well as potential future conduct problems and antisocial behavior among children and youth born into at-risk families.
Many of the beneficial effects of the program found in the Elmira trial and concentrated in higher risk groups were reproduced in a trial in Memphis, Tennessee (1988). Similar results were likewise found in a Denver, Colorado trial (1994). Consistent program effects from the Elmira and Memphis trials include: improvement in women’s prenatal health, fewer childhood injuries, fewer subsequent pregnancies, increased intervals between births, increased employment for mothers, reductions in welfare and food stamps, and improved school readiness for children. Overall, The Elmira and Memphis trials demonstrate that the nurse home visitation program achieved two of its most important goals—improved prenatal and subsequent care of children and improved effects on women’s life course. Findings from NFP research has received national attention from the United States Advisory Board on Child Abuse and Neglect which recommended the availability of home visitation services to all parents of newborns as a preventive measure against child abuse and neglect.
From Science to Practice
The National Center for Children, Families, and Communities was established at the University of Colorado Health Sciences Center to help new communities develop the Nurse-Family Partnership. The National Center is organized around nurturing community and state development of the capacities necessary for the success of the program. As of 2006, the Nurse-Family Partnership served clients in approximately 150 sites across 21 states.
This program of prenatal and infancy home visiting by nurses shows considerable promise for reducing some of the most damaging and widespread problems faced by low-income children and families in our society.
For Further Information:
Family Life Development Center: http://www.human.cornell.edu/fldc/
Nurse-Family Partnership: www.nursefamilypartnership.org
Nurse-Family Partnership Newsletter: http://www.nursefamilypartnership.org/about/news/nfp-newsletter
National Data Archive on Child Abuse and Neglect: http://www.ndacan.cornell.edu/
Child Abuse Prevention Network: http://child.cornell.edu/
Child Abuse Recovery Programs: http://www.recovery.org/topics/choosing-the-best-inpatient-child-abuse-and-addiction-recovery-center/
STATISTICS: 15-YEAR FOLLOW-UP STUDIES
Long-term effects of nurse home visitation on low-income, unmarried mothers’ behavior:
79% fewer verified reports of child abuse and neglect
32% fewer subsequent births 30 fewer months of welfare use
44% fewer behavioral problems due to alcohol and drug abuse
61% fewer arrests
Long-term effects of nurse home visitation on children’s criminal and antisocial behavior:
59% fewer arrests
69% fewer convictions
58% fewer sexual partners
28% fewer cigarettes smoked per day
51% fewer days having consumed alcohol (last 6 months)
Eckenrode, J., Ganzel, B., Henderson, C.R., Smith, E., Olds, D., Powers, J., Cole, R., Kitzman, H., & Sidora, K. (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. Journal of the American Medical Association, 284, 1385-1391.
Eckenrode, J., Zielinski, D., Smith, E., Marcynyszyn, L.A., Henderson, C.R., Jr., Kitzman, H., Cole, R., Powers, J., & Olds, D.L. (2001). Child maltreatment and the early onset of problem behaviors: Can a program of nurse home visitation break the link? Development and Psychopathology, 13, 873-890.
Olds, D.L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3, 153-172.
Olds, D.L., Eckenrode, J., Henderson, C.R., Jr., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt. L.M., & Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: 15-year follow-up of a randomized trial. Journal of the American Medical Association, 278, 637- 643.