Browsing by Subject "Adverse childhood experiences"

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    An Epidemiologic Analysis of Intergenerational Child Maltreatment
    (2017-05) Galos, Dylan
    Abstract Objective: Child maltreatment is a serious social and population health problem in the United States, with an estimated incidence proportion of 9.2 victims per 1,000 children. Prior research identifies experiencing maltreatment as a risk factor for perpetrating maltreatment, also called intergenerational child maltreatment (IMT). Many prior studies of IMT have been conducted in individualistic methodologies that are well-suited to describe nuanced mechanisms and individual treatments. A public health approach, focused on surveillance, risk factor identification, and intervention development and implementation can inform this literature by examining IMT as a population health issue. This dissertation used 15 years of linked administrative records from child protection and public schools to examine: 1) the incidence of IMT; 2) the association between IMT and academic achievement, and; 3) the accuracy of offenders’ self-report of maltreatment when compared to their prior CPS records. Methods: In Manuscript 1, child protection records (N = 8,701) from 2000 through 2014 were linked to public school records for demographics. The transmission probability of IMT was estimated by measuring the proportion of childhood victims in accepted CPS reports who appeared as offenders when they became adults. Adjusted transmission probabilities were estimated using log-binomial regression. In Manuscript 2, statewide records from child protection (years 2000 – 2014) and public schools (academic years 2011 – 2012, 2012 – 2013, and 2013 – 2014) were linked to create a dataset of students in third to eighth grades who had contact with both child protection and public school systems. The association between caregivers’ history of maltreatment and the child’s academic achievement (i.e., test proficiency, school mobility, and school attendance) was estimated by using multilevel logit and ordered logit regression. Finally, in Manuscript 3, the self-report of 253 offenders with prior CPS contact as potential victims were compared to their records. Misclassification in reporting was defined using the proportion of offenders in households where no offender reported a history of maltreatment who had prior CPS contact. Associations with demographic variables and maltreatment-related risk factors were measured using chi-square statistics. Results: In Manuscript 1, the total transmission probability among all groups was 11.26%. Transmission probabilities were highest among those who experienced multiple forms of maltreatment and were lowest among those who experienced sexual abuse. Transmission probabilities were lowest among Asians and highest among Native American/American Indian subjects. Prior substantiation and out-of-home placement were both associated with higher IMT probabilities. In Manuscript 2, a caregiver’s history of maltreatment had no association with test proficiency, school mobility or attendance after adjustment for school-related covariates, demographics and maltreatment-related risk factors. Regardless of caregivers’ history, there were differences by maltreatment type experienced by the child for reading proficiency, science proficiency, mobility and attendance. In Manuscript 3, 54.55% of caregivers with prior contact reported never experiencing abuse. Proportions with misclassification differed by offender’s gender, age, relationship to the victim, and prior experience of out of home placement. Substantiation and type of maltreatment experienced were not associated with misclassification. Conclusions: This dissertation offers three major contributions to the existing literature. First, it examined IMT as a population health issue, unprecedented in Minnesota. Second, it examined the intergenerational association between maltreatment and education in late childhood, a developmental stage with high potential for intervention. Last, it highlighted the methodological potential of state-level administrative records for surveillance, as well as the limitations in capability of administrative records for population health research on IMT.