Publication year
2014
Citation Title
The prevalence of confirmed maltreatment among US children, 2004 to 2011.
Journal Name
JAMA Pediatrics
Journal Volume
168
Issue Number
8
Page Numbers
706-713
DOI
10.1001/jamapediatrics.2014.410
Summary
Child maltreatment is prominent in the United States making it a public health issue; maltreatment during childhood results in higher risk of physical and mental health problems. Previously data on the prevalence of maltreatment was based on retrospective self-reports. This study generated data on the prevalence of maltreatment based on official Child Protective Services (CPS) reports.
Key Findings
In 2011, 670,000 children in the United States (12.5%) experienced a confirmed report of maltreatment.
Black children experience maltreatment at a higher rate (1.5%) followed by Native Americans (1.1%), Hispanic (.9%), White (.8%), and Asian/Pacific Islander (.2%).
Girls experienced a slightly higher rate of confirmed reports of maltreatment than boys.
Geographical regions differed in rate of confirmed reports of maltreatment, the highest being the Northeast (1.0%) and the South (1.0%), then the Midwest (.9%) and West (.8%).
Implications for Military Professionals
Collaborate with schools to facilitate support groups for military children who are reported by the CPS as having experienced maltreatment
Examine ways to prevent maltreatment in at-risk populations
Implications for Program Leaders
Provide programs for military couples which provide information on preventative measures against maltreatment for parents
Tailor efforts to girls, Black, and Native American military children to reduce their elevated risks for maltreatment.
Implications for Policy Makers
Continue to maintain programs that offer support to children survivors of maltreatment
Recommend education of professionals who work with military children (e.g., child care providers, teachers and pediatricians) on the warning signs of child maltreatment
Methods
Data were collected from the National Child Abuse and Neglect Data System child files from 2004 to 2011.
Researchers generated 5 multiply imputed data sets for missing information in the NCANDS reports.
Data were organized into synthetic cohort life tables, which showed the rate of maltreatment in a cohort by the age of 18 years from 2004 to 2011.
Participants
The sample included 670,000 children who had a confirmed report of maltreatment in 2011.
The sample included included data on 326,800 boys, 343,200 girls, of which 317,900 were White children, 174,400 Black children, 153,400 Hispanic children, 9,300 Asian/Pacific Islander children, and 15,000 Native American children.
Eighty percent of the cases in the reported data were cases of neglect, not abuse.
About one-quarter of children with confirmed reports of maltreatment experienced maltreatment prior to 2 years of age.
Limitations
CPS gathered data based on states and then calculated the rates; however, it is possible for a child to have been counted multiple times if they resided in more than one state during the time period which would have skewed the data.
Each state follows their own definition of maltreatment resulting in national estimates which are not based on an established single definition, which was not accounted for in the analyses.
The data lack information on the rates of different kinds of maltreatment (e.g., neglect, physical abuse and sexual abuse), restricting the ability to analyze the data.
Avenues for Future Research
Filter data to avoid a child who is maltreated in more than one state during the time period from being counted more than once
Define a single definition for maltreatment to be used for all states establishing a nationwide standard for the data
Gather data on the rates of the different kinds of maltreatment(e.g. neglect, physical abuse and sexual abuse) to allow for more detailed estimates
Focus
Civilian
Target Population
Population Focus
Abstract
Importance Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals.
Objective To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.
Design, Setting, and Participants The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.
Main Outcomes and Measures The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.
Results At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.
Conclusions and Relevance Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
Child maltreatment—encompassing neglect and physical, sexual, and emotional abuse of children—is associated with myriad negative physical, mental, and social outcomes. Childhood maltreatment is associated with significantly higher rates of mortality,1- 3 obesity,1,4- 7 and human immunodeficiency virus infection.1,8 Children who experience maltreatment also have significantly more mental health problems1,9- 14 and are as much as 5 times more likely to attempt suicide.1,15 Maltreated children are also more likely to engage in criminal behavior than other children1,16,17 and are more than 50% more likely to have a juvenile record than other children.17 Child maltreatment also has substantial social costs. Estimates suggest that child maltreatment costs the United States $124 billion annually, with per-person lifetime costs higher than or comparable to those of diseases such as a stroke or type 2 diabetes mellitus.18 Childhood maltreatment has thus been referred to as “a human rights violation and a global public health problem [that] incurs huge costs for both individuals and society.”19(p332)
However, a large disparity exists between estimates of the prevalence of maltreatment based on retrospective self-reports and those derived from officially documented maltreatment by Child Protective Services (CPS). Retrospective self-reports indicate that child maltreatment is widespread annually and cumulatively during the course of childhood, with 2 studies20,21 using recent data to report that more than 40% of children will be maltreated during childhood. In contrast, official CPS data indicate that far fewer children experience maltreatment. For example, in 2011, only 0.9% of children were confirmed as victims of maltreatment.22 We do not know the extent to which the difference between these 2 estimates can be attributed to the fact that estimates of confirmed maltreatment only capture the number of children maltreated annually and thus do not reflect the population of children maltreated during the entirety of childhood.
Although other fields have used synthetic cohort life tables to document the cumulative risk of experiencing an event, no such attempts have been made using official child maltreatment data.23 Therefore, the purpose of this study was to use synthetic cohort life tables to determine the percentage of US children confirmed as maltreated according to CPS from birth to 18 years of age. We also estimated differences in maltreatment by race/ethnicity, sex, and year from 2004 through 2011.
Objective To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.
Design, Setting, and Participants The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.
Main Outcomes and Measures The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.
Results At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.
Conclusions and Relevance Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
Child maltreatment—encompassing neglect and physical, sexual, and emotional abuse of children—is associated with myriad negative physical, mental, and social outcomes. Childhood maltreatment is associated with significantly higher rates of mortality,1- 3 obesity,1,4- 7 and human immunodeficiency virus infection.1,8 Children who experience maltreatment also have significantly more mental health problems1,9- 14 and are as much as 5 times more likely to attempt suicide.1,15 Maltreated children are also more likely to engage in criminal behavior than other children1,16,17 and are more than 50% more likely to have a juvenile record than other children.17 Child maltreatment also has substantial social costs. Estimates suggest that child maltreatment costs the United States $124 billion annually, with per-person lifetime costs higher than or comparable to those of diseases such as a stroke or type 2 diabetes mellitus.18 Childhood maltreatment has thus been referred to as “a human rights violation and a global public health problem [that] incurs huge costs for both individuals and society.”19(p332)
However, a large disparity exists between estimates of the prevalence of maltreatment based on retrospective self-reports and those derived from officially documented maltreatment by Child Protective Services (CPS). Retrospective self-reports indicate that child maltreatment is widespread annually and cumulatively during the course of childhood, with 2 studies20,21 using recent data to report that more than 40% of children will be maltreated during childhood. In contrast, official CPS data indicate that far fewer children experience maltreatment. For example, in 2011, only 0.9% of children were confirmed as victims of maltreatment.22 We do not know the extent to which the difference between these 2 estimates can be attributed to the fact that estimates of confirmed maltreatment only capture the number of children maltreated annually and thus do not reflect the population of children maltreated during the entirety of childhood.
Although other fields have used synthetic cohort life tables to document the cumulative risk of experiencing an event, no such attempts have been made using official child maltreatment data.23 Therefore, the purpose of this study was to use synthetic cohort life tables to determine the percentage of US children confirmed as maltreated according to CPS from birth to 18 years of age. We also estimated differences in maltreatment by race/ethnicity, sex, and year from 2004 through 2011.
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