PII S0145-2134(98)00087-8

A LONGITUDINAL ANALYSIS OF RISK FACTORS FORCHILD MALTREATMENT: FINDINGS OF A 17-YEARPROSPECTIVE STUDY OF OFFICIALLY RECORDED

AND SELF-REPORTED CHILD ABUSE AND NEGLECT

JOCELYN BROWN, PATRICIA COHEN, JEFFREY G. JOHNSON, AND SUZANNE SALZINGER

College of Physicians and Surgeons, Columbia University, New York, NY, USA

ABSTRACT

Objective: To identify demographic, family, parent, and child factors prospectively associated with risk for child abuse andneglect among families in the community, using data on child maltreatment obtained from both official records and youthself-reports.Method: Surveys assessing demographic variables, family relationships, parental behavior, and characteristics of parentsand children were administered to a representative sample of 644 families in upstate New York on four occasions between1975 and 1992. Data on child abuse and neglect were obtained from New York State records and retrospective self-reportinstruments administered when youths were$ 18 years old.Results: Logistic regression analyses indicated that different patterns of risk factors predicted the occurrence of physicalabuse, sexual abuse, and neglect, although maternal youth and maternal sociopathy predicted the occurrence of all threeforms of child maltreatment. In addition, the prevalence of child abuse or neglect increased from 3% when no risk factorswere present to 24% when$ 4 risk factors were present. State records and self-reports of child maltreatment did notcorrespond in most cases when maltreatment was reported through at least one data source, underlining the importance ofobtaining data from both official records and self-reports.Conclusions:Assessment of a number of risk factors may permit health professionals to identify parents and children whoare at high risk for child maltreatment, facilitating appropriate implementation of prevention and treatment interventions.© 1998 Elsevier Science Ltd

Key Words—Child abuse and neglect, Risk factors, Longitudinal analysis, Self-report, Official records.

INTRODUCTION

IT IS WIDELY recognized among professionals that a multiplicity of risk and protective factors areassociated with the occurrence of child abuse and neglect. It is also presumed, although littleinvestigated, that the presence of multiple risk factors increases the likelihood of child maltreat-ment, as has been found regarding childhood mental disorders (e.g., Rutter, 1979; Sameroff, 1989).However, scientific understanding of factors associated with risk for child abuse and neglect hasbeen limited for two main reasons. First, although recent longitudinal studies (McCord 1983;Milner & Chilamkurti 1991; Fergusson, Linskey, & Horwood, 1996) have contributed to the fieldof risk abuse research, based on earlier cross-sectional or retrospective data (e.g., Finkelhor &

This study was supported by grants #RO1 MH49191 to Patricia Cohen and #44791 for underrepresented minorityinvestigators to Jocelyn Brown from the National Institute of Mental Health.

Submitted for publication August 28, 1997; final revision received February 26, 1998; accepted March 5, 1998.

Requests for reprints should be sent to Dr. Jocelyn Brown, Department of Pediatrics, Columbia University, 622 West 168thSt., New York, NY 10032.

PergamonChild Abuse & Neglect, Vol. 22, No. 11, pp. 1065–1078, 1998

Copyright © 1998 Elsevier Science LtdPrinted in the USA. All rights reserved

0145-2134/98 $19.001 .00

1065

Baron, 1986), it has been difficult for researchers to ascertain the nature of the association betweenthe variables under investigation. Second, most previous studies of risk for child maltreatment haverelied on either official records or retrospective self-reports of abuse or neglect by adults who weremaltreated as children; few studies have combined these two sources of data, despite researchindicating that the use of multiple informants increases the validity of research on risks forchildhood maltreatment (e.g., McGee, Wolfe, Yuen, Wilson, & Carnochan, 1995). Further, re-search has demonstrated that the validity of retrospective self-reports may be diminished by factorsincluding the age of occurrence, type of abuse, and the perception of having deserved punishment(e.g., Briere & Conte, 1993; Feldman-Summers & Pope, 1994; Rausch & Knutson, 1991;Rosenthal, 1988), which may cause some respondents to underreport abuse (Berger, Knutson,Mehm, & Perkins, 1988; Hemenway, Solnick, & Carter, 1994; Kemper, Carlin, & Buntain-Ricklefs, 1994). Official reports are associated with problems such as report bias, investigationbias, and substantiation bias, which may cause investigators to overestimate or underestimate theprevalence of child abuse in certain populations (Eckenrode, Powers, Doris, Munsch, & Bolger,1988; Hampton & Newberger, 1985; National Center for Child Abuse & Neglect, 1988; O’Toole,Turbett, & Nalepka, 1983; Straus & Smith, 1995; Wells, 1985; Widom, 1988).

Previous research has identified four major classes of variables that are associated with risk forchild abuse: demographic variables, family relationships, parental characteristics, and child char-acteristics (Belsky & Vondra, 1989). Most research on the role of demographic variables hasfocused on the potential effects of low socioeconomic status on risk for child abuse. Data fromofficial reports and surveys have indicated that low income families tend to have the highest ratesof physical abuse (e.g., Gelles, 1989; Kohn, 1969; Kohn & Schooler, 1983; Lauderdale, Valiunas,& Anderson, 1980; Straus, 1980; Whipple & Webster-Stratton, 1991). Research has established astrong relationship between poverty and neglect (Zuravin & Greif, 1989), although other research-ers have obtained contrary findings. But, because research has indicated that neither socioeconomicstatus nor ethnicity is associated with childhood sexual abuse (Peters, Wyatt, & Finkelhor, 1986),and because official reports may be characterized by biased reporting, investigation, and substan-tiation of maltreatment in low income families (Eckenrode et al., 1988; Hampton & Newberger,1985; O’Toole et al., 1983; Straus & Smith, 1995; Wells, 1985; Widom, 1988), the associationbetween socioeconomic status and child maltreatment remains unclear.

A number of family characteristics have been reported to be associated with the occurrence ofchild abuse and neglect. Victims of child sexual abuse have frequently reported poor family andparent-child relationships (Finkelhor et al., 1990; Fergusson et al., 1996). Abusive parents havebeen reported to use severe physical punishment more frequently (Trickett & Susman, 1988), to bemore power assertive (Trickett & Kudczynski, 1986), and to punish their children more frequentlyfor moral transgressions, conventional social transgressions, and noncompliance (Trickett &Kudczynski, 1986) than nonabusive parents. Research has also indicated that conflict betweenparents (Bowker, Arbitell, & McFerron, 1988; Salzinger, Feldman, Hammer, & Rosario, 1992) andlack of social support (Garbarino & Sherman, 1980; Straus, 1980; Whipple & Webster-Statton,1991) are associated with risk for child maltreatment. In addition, female victims of sexual abuseare more likely to have lived without their biological father, and to have lived in the presence ofa stepfather (Finkelhor, Hoteling, Lewis, & Smith, 1990). Research has also indicated thatdisruption of relationships with biological parents appears to contribute to risk for sexual abuse ofgirls (Finkelhor et al., 1990; Fergusson et al., 1996), and that maternal employment outside thehome may be associated with risk for sexual abuse (Finkelhor & Baron, 1986).

Numerous parental characteristics have been found to be associated with risk for child maltreat-ment and maladaptive parenting, including maladaptive personality characteristics (Bauer &Twentyman, 1985; Lawson & Hays, 1989; Reid, Kavanagh, & Baldwin, 1987). Social andenvironmental factors such as parental substance abuse (Kelleher, Chaffin, Hollenberg, & Fischer,1994) and domestic violence (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997) have also been

1066 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger

shown to be associated with child maltreatment. It has also been reported that abusive andneglectful parents tend not to be involved in community or religious activities (e.g., Giovannonni& Billingsley, 1970; Polansky, Gaudin, Ammons, & Davis, 1985), and that parents who wereabused during their own childhoods may be more likely than others to abuse their own children(e.g., Kaufman & Zigler, 1987), although those who had supportive relationships may be less likelyto repeat the cycle of abuse (Belsky, Youngblade, & Pensky, 1990; Elder, Van Nguyen, & Caspi,1985; Salzinger, Kaplan, & Artemyeff, 1983). Several characteristics of children have also beenfound to be associated with risk for abuse and neglect. Research has consistently demonstrated thatgirls are at greater risk than boys for sexual abuse (e.g., Jason, Williams, Burton, & Rochat, 1982).In addition, research has indicated that disabilities (White, Benedict, Wulff, & Kelley, 1987),childrens’ personality, psychiatric symptoms and temperament may contribute to increased risk formaltreatment (e.g., Friedrich & Boriskin, 1976; Friedrich & Eibender, 1983).

Although the research cited above has indicated that demographic, familial, parental, and childfactors are associated with risk for child maltreatment, most of these studies have examined a smallnumber of variables, and have thus been unable to investigate the combined effects of multiple riskfactors on risk for child abuse and neglect. Further, as noted above, many previous studies in thisarea have used a single source of data, and/or cross-sectional designs. In contrast, the present studyincorporated a longitudinal design, official records and self-reports of maltreatment, and prospec-tive assessment of potential risk factors in a representative sample of families in the community.Because of these methodological advantages, the present study was able to investigate whetherpotential risk factors were prospectively associated with reports of abuse in the community, tocompare and contrast findings obtained with self-reports and official reports, and to investigate thecombined effects of demographic, family, parent, and child characteristics on risk for child abuseand neglect.

METHOD

Participants

The participants in the present study were 644 families who were part of a larger sample offamilies with children between the ages of 1 and 10 in 1975 who were randomly sampled on thebasis of residence in one of two upstate New York counties (Kogan, Smith, & Jenkins, 1977). Thegeographic area chosen for this study is broadly representative of the Northeastern region of the USwith regard to demographic variables including maternal education, family income, and familydissolution. In 1975, mothers were interviewed in their homes about family environment and childcharacteristics. In 1983, 85% of this sample was located, and 79% of families were reinterviewedin one or more followup surveys. In 1983, 1986, and 1991–1993, parents and youths wereinterviewed regarding aspects of parenting, the parent-child relationship, demographics, and mentalhealth. The followup sample was a close match to the area population of children in this age range,as compared to the US Census data on family income and structure (Cohen & Cohen, 1996). Onlysix families have refused further participation outright.

We were able to obtain information regarding child maltreatment of 644 youth by self-report ofthose over the age of 18 in 1991-1993 and from New York State records. This sample of youth is48% male, 91% Caucasian, and 8% Black. Family background is as follows: 22% were belowpoverty level at some time in the child’s life, and 10% had a history of support by public assistanceat some time. Nearly one-quarter (24.5%) of the children lived with a single parent at some timein their childhood, and 12% had been born to a teen-aged mother. Eighteen percent of mothers hadless than a high school education, and 38% had had some post high school education or training.Thirty percent of the sample lived in a rural or semi-rural area, 46% lived in the suburbs or in a

Longitudinal analysis of maltreatment risk 1067

town, and 24% lived in a city of over 20,000 population. Thirty-seven percent of the children werefirst born.

Measures and Procedure

Child maltreatment data regarding child maltreatment were obtained from the New York StateCentral Registry for Child Abuse and Neglect (NYSCR), and from self-reports of maltreatmentobtained in 1992. Information regarding whether the child or the mother was known to the NYSCRwas determined by NYSCR trained staff. Additional information, such as source of the report, typeof abuse, perpetrator’s relationship to the child was abstracted by one of the authors under thesupervision of the NYSCR staff. The identified names were matched to ID number and kept inseparate locked files, preventing identification of any case. Further, abuse history data was addedto the data files without identifying information, resulting in a “blind deck” used for statisticalanalyses. In accordance with state guidelines at the time when the present study was conducted,only those cases reported to official agencies and determined to be valid cases of abuse are retainedin the NYSCR. Self-reports of child abuse were obtained in the young adult followup in 1992.Young adults were asked whether, during childhood:

1. Anyone they lived with ever hurt them physically so that they were still injured or bruised thenext day, could not go to school as a result, or needed medical attention, and if so, how often;

2. They had been left overnight or longer without an adult caretaker before age 10;3. Any older person (not a boy/girlfriend) ever touched them or played with them sexually or

forced them to touch the older person before age 18, and if so, how often.

Sexual abuse was considered to have been experienced when more than two such experiences werereported. Previous research has supported the validity of retrospective reports of childhood abuseand neglect (e.g., Bifulco, Brown, Lillie, & Jarvis, 1997). However, because multiple screeningquestions tend to elicit more reports of sexual abuse than does one single question (Peters et al.,1986), the self-reported cases may represent an underreport of cases that would have been detectedby a more thorough interview. In addition, we did not collect information on the age of self-reported abuse, and although official records were dated, they did not indicate the probable age ofonset of abuse.

Risk Factors

A number of potential risk factors identified by previous research were assessed during the twointerviews conducted in 1975 (T1) and 1983 (T2) when the children were mean ages 6 and 14years, respectively. Table 1 provides the source of the measure for each risk, the time of datacollection, whether mother (M), child (C), or both informants provided information, and the alphareliability of the measure, where relevant. Demographic potential risks included the ethnicity andgender of the child, large family size, low income, maternal education, maternal age at the birth ofthe child, nonparticipation in organized religious activities, single parent, urbanicity of familydwelling, and welfare dependency. All demographic characteristics were provided by maternalinterview. Potential risk factors involving family environment and parental characteristics wereassessed during the first two interviews. Familial factors included separation from the mother formore than 2 weeks before age 4, harsh punishment, maladaptive parental personality traits (e.g.,hostility, low self-esteem), negative life events, parental conflict, parental psychopathology, pa-rental sociopathy (i.e., alcohol, drug problems, or problems with the police), poor marital quality,and presence of a stepfather. Parental factors included low parental warmth, low parental involve-ment, and unwanted pregnancy. The scale devised for this study and identified as maternal hostilitytoward the child included items assessing mother’s dissatisfaction with the child’s looks, manners,friends, performance, clothing, and activities. Parenting characteristics and parenting behavior were

1068 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger

assessed prior to official reports of abuse in approximately half of the participating families, asindicated by the mean date of official reports of child maltreatment. Child characteristics includedas potential risk factors were early childhood anxiety and withdrawal, handicapped status, low birthweight, low verbal intelligence, perinatal problems, serious illness, and difficult temperament.

RESULTS

Concordance Between Official Records and Self-Reports of Child Maltreatment

Fifty-eight young adults identified themselves as having been maltreated through self-report,including 29 cases of physical abuse, 18 cases of sexual abuse, and 16 cases of neglect; more than

Table 1. Measures, Informant, Timing, and Reliabilities

Demographic Risks

1. Low Frequency Church Attendance: M, T1,a 5 .802. Young Mother at Child’s Birth: M, T13. Mother Not High School Graduate: M, T24. Low Family Income: M, T1 or T25. AFDC Support: M, T1 or T26. 3 or More Children: T27. Mother Divorced or Never Married: T28. Death of Either Parent: T39. Step-Father: T2

10. Early Separation From Mother of Three Months or More: M, T1

Family Characteristics

1. Parental Conflict (Locke & Wallace, 1959) M, T2,a 5 .552. Maternal Dissatisfaction With Marriage (Hoffman & Manis, 1978) M, T2,a 5 .883. Maternal External Locus of Control (Pearlin, Menaghan, Lieberman, & Mullan, 1981) M, T2,a 5 .544. Poor Maternal Health: M, T15. Poor Paternal Health: M, T16. Maternal Alienation (Cohen, Struening, Muhlin, Genevie, Kaplan, & Peck, 1982) M, T2,a 5 .797. Maternal Impulsivity (Jackson, 1974) M, T2,a 5 .538. Maternal Low Self-esteem (Brook et al., 1986) M, T2,a 5 .639. Maternal Anger (Derogatis, Lipman, Rickles, Uhlenhuth, & Covi, 1974) M, T2,a 5 .86

10. Many Negative Life Events (Coddington, 1972) C, T311. Maternal Dissatisfaction With Neighborhood (Cohen et al., 1982) M, T2,a 5 .7512. Maternal Sociopathy (Drug, Alcohol, or Police Involvement) M, T1, or T213. Paternal Sociopathy (Drug, Alcohol, or Police Involvement) M, T1, or T214. Maternal Trauma History (Family History Interview) M, T4

Parenting and Parent-Child

1. Maternal Hostility to Child (Original, 6 Items) M, T2,a 5 .752. Power-Assertive Punishment (Cohen & Brook, 1987) M & C, T2, a 5 .673. Low Maternal Warmth (Avgar, Bronfenbrenner, & Henderson, 1977; Shaeffer, 1965) M & C, T2, a 5 .714. Low Paternal Warmth (Shaeffer, 1965) C, T2,a 5 .755. Low Maternal Involvement (Shaeffer, 1965, Shaefer, Edgerton, & Comstock, 1976) M & C, T26. Low Paternal Involvement (Shaeffer, 1965; Shaefer, Edgerton, & Comstock, 1976) M & C, T27. Unwanted Pregnancy: M, T1

Child Characteristics

1. Low Birth Weight (Under 5 Pounds) M, T12. Pregnancy/Birth Problems: M, T13. Low IQ (Ammons & Ammons, 1964) C, T24. Early Childhood Illness: M, T15. Early Difficult Temperament (Cohen & Brook, 1987) M, T1,a 5 .706. Early Immature Behavior (Cohen & Brook, 1987) M, T1,a 5 .537. Early Anxious Withdrawn (Cohen & Brook, 1987) M, T1,a 5 .638. Handicapped (Requiring Special Education) M, T4

Longitudinal analysis of maltreatment risk 1069

one type of maltreatment was reported by five young adults. Forty-six cases, including 20 cases ofphysical abuse, seven cases of sexual abuse, and 37 cases of neglect were reported and substan-tiated by NYSCR; more than one type of maltreatment was recorded in 18 cases. These proportionsare consistent with the findings of the National Incidence Study, as well as recent national trends(McCurdy & Daro, 1996). Forty-eight cases of self-reported child maltreatment were not confirmedby New York State records. In 27 cases, New York State records of child maltreatment were notconfirmed by youth self-reports.

Relationships Between Individual Risk Factors and Child Maltreatment

In order to investigate which potential risk factors were associated with combined official andself-reports of child maltreatment, logistic regression analyses were conducted, controlling for thechild’s gender. As Table 2 indicates, five demographic risk factors (low maternal education, lowreligious attendance, maternal youth, single parent, and welfare dependence), six familial riskfactors (early separation from mother, maternal dissatisfaction, maternal external locus of control,maternal sociopathy, poor marital quality, and serious maternal illness), three parenting risk factors(low father involvement, low father warmth, and low maternal involvement), and one child riskfactor (pregnancy or birth complications) were associated with combined reports of physical abuse.

As Table 3 indicates, seven demographic risk factors (ethnicity, large family size, low income,low maternal education, maternal youth, single parent, and welfare dependence), 12 family riskfactors (early separation from mother, maternal alienation, anger, dissatisfaction, external locus ofcontrol, hostility, low self-esteem, sociopathy, parental conflict, paternal psychopathology, paternalsociopathy, poor marital quality, and serious maternal illness), two parenting risk factors (lowpaternal involvement and low paternal warmth), and two child risk factors (early childhoodanxiety/withdrawal and low verbal IQ) were associated with combined official records andself-reports of child neglect.

Sexual abuse was associated with two demographic risk factors (maternal youth and parentaldeath), four familial risk factors (harsh punishment, maternal sociopathy, negative life events, andpresence of a stepfather), one parenting risk factor (unwanted pregnancy), and two child risk factors(child gender and handicap), as shown in Table 4.

Table 5 indicates risks that were associated with child abuse or neglect by either report. Eight

Table 2. Risk Factors Significantly Associated With Physical Child Abuse

Odds Ratio 95% Confidence Interval

Demographic Risk FactorsLow maternal education 2.59 1.41–4.76Low religious attendance 2.22 1.20–4.12Maternal youth 3.52 1.91–6.50Single parent 2.26 1.23–4.14Welfare 3.74 1.78–7.85

Familial Risk FactorsEarly separation from mother 4.08 1.44–11.62Maternal dissatisfaction 2.44 1.19–5.02Maternal external locus of control 2.16 1.20–3.89Maternal sociopathy 4.91 2.16–11.19Poor marital quality 1.98 1.08–3.62Serious maternal illness 2.06 1.14–3.73

Parenting Risk FactorsLow maternal involvement 2.68 1.17–6.12Low paternal involvement 3.18 1.34–7.84Low paternal warmth 3.24 1.56–6.45

Child Risk FactorsPregnancy or birth complications 2.45 1.03–5.84

1070 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger

demographic risk factors (ethnicity, large family size, low income, low maternal education, lowreligious attendance, maternal youth, single parent, and welfare dependence), nine familial riskfactors (early separation from mother, maternal alienation, anger, dissatisfaction, external locus ofcontrol, low self-esteem, sociopathy, poor marital quality, and serious maternal illness), threeparenting risk factors (low maternal involvement, low paternal involvement, and low paternalwarmth), and one child risk factor (difficult temperament) were significantly associated withcombined reports of any child maltreatment.

Analyses were also conducted to investigate the extent to which official records and self-reports

Table 3. Risk Factors Significantly Associated With Child Neglect

Odds Ratio 95% Confidence Interval

Demographic Risk FactorsEthnicity (non-white) 4.35 2.13–8.33Large family size 3.21 1.80–5.72Low income 5.11 2.59–10.07Low maternal education 5.12 2.86–9.16Maternal youth 2.22 1.26–3.92Single parent 2.57 1.43–4.60Welfare 11.01 5.61–21.58

Familial Risk FactorsEarly separation from mother 3.61 1.27–10.30Maternal alienation 2.73 1.51–4.93Maternal anger 2.81 1.51–5.25Maternal dissatisfaction 5.01 2.65–9.46Maternal external locus of control 1.79 1.01–3.15Maternal hostility 2.26 1.04–4.93Maternal low self-esteem 2.71 1.06–6.93Maternal sociopathy 4.38 1.92–9.96Parental conflict 2.44 1.24–4.81Paternal psychopathology 2.28 1.01–5.18Paternal sociopathy 2.28 1.27–4.11Poor marital quality 2.66 1.50–4.73Serious maternal illness 2.18 1.23–3.88

Parenting Risk FactorsLow paternal involvement 3.54 1.52–8.26Low paternal warmth 2.13 1.01–4.48

Child Risk FactorsAnxious/withdrawn-early childhood 2.02 1.03–3.96Low child verbal IQ 2.70 1.26–5.74

Table 4. Risk Factors Significantly Associated With Child Sexual Abuse

Odds Ratio 95% Confidence Interval

Demographic Risk FactorsMaternal youth 2.26 1.01–5.08Parental death 2.62 1.01–6.82

Familial Risk FactorsMaternal sociopathy 6.27 2.31–17.06Negative live events 4.43 1.82–10.80Presence of stepfather 3.32 1.18–9.34Harsh punishment 3.22 1.28–8.11

Parenting Risk FactorsUnwanted pregnancy 3.10 1.29–7.45

Child Risk FactorsChild gender (female) 2.44 1.01–5.88Handicapped child 11.79 1.01–126.17

Longitudinal analysis of maltreatment risk 1071

yielded different findings regarding risk factors that were associated with child maltreatment. Asin the findings reported above using both data sources, data obtained from state records, and youthself-reports independently indicated that maternal sociopathy, maternal youth, low paternal in-volvement, and low paternal warmth predicted the occurrence of child maltreatment. However, anumber of risk factors that were identified by one data source were not identified by the other datasource. Risk factors that were related only to the official records of maltreatment included ethnicity,handicapped child, large family size, low child verbal intelligence, low income, low maternaleducation, maternal alienation, maternal anger, maternal dissatisfaction, maternal illness, parentalconflict, paternal sociopathy, poor marital quality, single parent, and welfare dependency. Riskfactors that were related only to youth self-reported maltreatment included difficult child temper-ament, early separation from mother, harsh punishment, maternal external locus of control, andnegative life events.

Association Between Multiple Risk Factors and Occurrence of Child Maltreatment

To investigate the association between presence of multiple risk factors and likelihood of childmaltreatment, four risk indices were created by summing the significant risk factors for physicalabuse, neglect, sexual abuse, and any child maltreatment noted above. As Figure 1 indicates, thelikelihood of child maltreatment increased substantially with increases in the number of risk factorspresent. When no risk factors were present, maltreatment was reported for 0% (physical abuse), 2%(neglect), 1% (sexual abuse), and 3% (any abuse or neglect) of youths, respectively. Maltreatmentprevalence rates increased to 16% (physical abuse), 15% (neglect), 33% (sexual abuse), and 24%(any abuse or neglect) when four or more risk factors were present. Results of logistic regressionanalyses, controlling for child ethnicity and gender, indicated that increases in the number of riskfactors present were associated with significant increases in risk for physical abuse, neglect, sexualabuse, and any abuse or neglect.

Table 5. Risk Factors Associated With Occurrence of Any Child Abuse or Neglect

Odds Ratio 95% Confidence Interval

Demographic Risk FactorsEthnicity (non-white) 2.63 1.41–5.00Large family size 1.83 1.14–2.95Low income 3.02 1.64–5.57Low maternal education 3.09 1.94–4.93Low religious attendance 1.62 1.04–2.53Maternal youth 2.37 1.52–3.68Single parent 2.09 1.31–3.33Welfare 5.14 2.81–9.39

Familial Risk FactorsEarly separation from mother 2.80 1.11–7.06Maternal alienation 1.97 1.27–3.07Maternal anger 1.88 1.11–3.18Maternal dissatisfaction 3.15 1.81–5.48Maternal external locus of control 1.64 1.05–2.56Maternal low self-esteem 2.28 1.02–5.07Maternal sociopathy 4.91 2.41–10.01Poor martial quality 1.70 1.06–2.71Serious maternal illness 2.06 1.31–3.24

Parenting Risk FactorsLow father involvement 3.14 1.51–6.54Low father warmth 2.57 1.43–4.62Low maternal involvement 2.25 1.14–4.42

Child Risk FactorsDifficult temperament 2.02 1.05–3.91

1072 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger

DISCUSSION

The present findings, indicating that 15 risk factors were associated with physical abuse, ninefactors were associated with sexual abuse, and 21 factors were associated with child neglectindicate that different types and combinations of risk factors may be associated with child physicalabuse, sexual abuse, and neglect. Low maternal involvement, early separation from mother, andperinatal problems put the child at risk for physical abuse, whereas poverty and large family sizewere strongly associated with child neglect, and daughters rather than sons, handicapped children,children with a deceased parent, and children living with a stepfather were at risk for sexual abuse.These findings are significant because they may assist health, educational, and other professionalsin identifying children who are at high risk for abuse and neglect, and because they confirm similarfindings by other researchers (Chaffin, Kelleher, & Hollenberg, 1996; Friedrich & Eibender, 1983),indicating that future researchers may wish to focus on those risk factors which are most stronglyassociated with specific forms of maltreatment.

However, the present findings also indicated that a number of risk factors are associated withmore than one type of child maltreatment. Most notably, maternal sociopathy and maternal youthwere associated with risk for physical abuse, sexual abuse, and neglect. These findings appear toindicate that professionals with responsibility for the well-being of children should be particularlyconcerned about the possibility of child maltreatment when both of these risk factors are present.Other factors associated with risk for more than one type of abuse included early separation frommother, low maternal education, low paternal involvement, low paternal warmth, maternal dissat-isfaction with the child, maternal external locus of control, poor marital quality, serious maternalillness, single parent, and welfare dependency, all of which were associated with risk for bothphysical abuse and neglect. The latter findings are consistent with previous findings indicating that,

Figure 1. Percentage of children maltreated by number of significant risk factors present.

Longitudinal analysis of maltreatment risk 1073

in many officially identified cases of child maltreatment, both physical abuse and neglect arereported (Ney, Fung, & Wickett, 1994).

Another important finding of the present research was that, as the number of risk factorsincreased, the likelihood of child abuse and neglect increased dramatically. Overall, the prevalenceof child abuse or neglect increased from 3% when no risk factors were present to 24% when fouror more risk factors were present. This finding has considerable significance for both practitionersand researchers. For practitioners, this finding indicates that, in order to identify children who areat greatest risk for child maltreatment, a significant number of risk factors will need to be assessed.Similarly, researchers will need to assess a substantial number of risk factors in order to obtain amore comprehensive understanding of the causes of child abuse and neglect. Conversely, thepresent findings provide both practitioners and researchers with information that may assist in theidentification of risk factors that are most likely to be associated with specific types of childmaltreatment, thereby reducing the number of risk factors that will require assessment.

The present finding that official records and youth self-reports of child maltreatment did notcorrespond in most cases when maltreatment was reported through one of the two data sourcessuggests that future research on child abuse and neglect should obtain data from both officialrecords and youth self-reports (see Giovannoni, 1989; Pianta, Egeland, & Erickson, 1989). Notsurprisingly, 48 cases of self-reported maltreatment were not documented in state records, perhapsbecause abuse and neglect must often be severe before it is reported to official agencies, or whenreported after an investigation may not have been substantiated. Interestingly, however, there were27 cases in which documented maltreatment was not self-reported, which may have occurred forseveral reasons: 1) Some youths who experienced maltreatment may not have defined the experience asabuse or neglect; 2) Some youths may not have recalled experiences of abuse or neglect; 3) Some youthsmay have been reluctant to report abuse or neglect; and 4) Some cases of abuse may not have beenassessed by the self-report instrument. Further support for the use of official records and youthself-reports is provided by our findings indicating that several risk factors identified when both datasources were used would not have been identified had a single data source been used.

It is also of interest to note that the present findings provide support for a number of findings byprevious researchers. First, our findings confirm that low income families may tend to have thehighest rates of physical abuse and neglect (e.g., Gelles, 1989; Kohn, 1969; Kohn & Schooler,1983; Lauderdale et al., 1980; Straus, 1980; Straus & Gelles, 1992; Whipple & Webster-Stratton,1991; Zuravin & Greif, 1989), but not sexual abuse (Peters, Wyatt, & Finkelhor, 1986). Second,our findings that low parental involvement and low parental warmth predicted child maltreatmentare consistent with previous research indicating that poor parent-child relationships were associatedwith risk for child maltreatment (Gaudin, Polansky, Kilpatrick, & Shilton, 1996; Fergusson et al.,1996). Third, our findings support previous research indicating that conflict between parents isassociated with risk for child maltreatment (Bowker et al., 1988; Salzinger et al., 1992). Fourth, thepresent findings confirm that both disruption of relationships with biological parents and living inthe presence of a stepfather increase risk for the sexual abuse of children (Finkelhor et al., 1990;Fergusson et al., 1996). Fifth, our findings support previous research indicating that maladaptiveparental personality traits tend to increase risk for child maltreatment (Bauer & Twentyman, 1985;Lawson & Hays, 1989; Reid et al., 1987). Sixth, the present findings confirm that children whoseparents do not tend to participate in religious activities are more likely than other children to bemaltreated (e.g., Giovanni & Billingsley, 1970; Polansky et al., 1985). Seventh, the present findingsprovide support for previous research indicating that girls are at greater risk than boys for sexualabuse (e.g., Jason et al., 1982), and that maladaptive child personality traits, temperament, andpsychiatric symptoms tend to be associated with child maltreatment (e.g., Friedrich & Boriskin,1976; Friedrich & Eibender, 1983). However, it is important to note that child risk factors may havebeen the result rather than a contributing cause of subsequent maltreatment in this study in whichthe timing cannot be definitively ascertained.

1074 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger

Of additional interest, our findings confirm the existence of risk factors for child abuse andneglect across four domains: individual child or adult characteristics, family functioning, theexosystem or community level, and the macrosystem or sociocultural context. At the individuallevel, significant risk factors included child gender, handicap, low intelligence, and difficulttemperament, low maternal education, maladaptive maternal personality traits, maternal youth,parental sociopathy (particularly maternal substance abuse and paternal police involvement), perinatalproblems, and unwanted pregnancy. Familial risk factors included parental conflict, poor marital quality,presence of a single parent or stepfather, maternal illness, low parental involvement, and harshpunishment. At the community and sociocultural level, factors such as neighborhood dissatisfaction andpoverty were significant risk factors, and religious attendance was a protective factor.

Several strengths and limitations of the present study merit discussion. The principal strengthsof this study are the implementation of a 17-year longitudinal design, assessment of numerouspotential risk factors across demographic, family, parent, and child domains gathered from earlyinterviews of mothers and children, and use of data from both official records and youth self-reportsregarding child abuse and neglect. The limitations of this study include the following: First, therelatively small number of cases of physical abuse, sexual abuse, and neglect made definitivecomparisons of the effects of self versus official identifications of specific types of maltreatmentimpossible, due to poor statistical power. Second, although putative risks were assessed as early inchildhood as the data permit, timing of the risk factors relative to child abuse and neglect was notascertained. Therefore, although global associations between risk factors and child maltreatmentwere investigated, temporal associations between specific risk factors and onset of specific types ofabuse could not be investigated. Third, because data on risk factors were obtained through parentand child interviews, the occurrence of some risk factors may have been over- or under-reported.For example, it is likely that some parents may have under-reported problematic parenting, and thatyouths may have varied in the reliability of their reports of their parents’ behavior. Fourth, despite theavailability of official records and self-reports of child abuse and neglect, some actual cases ofmaltreatment may not have been detected. Further, in the present study, only family-related maltreat-ment appeared in state records, unsubstantiated abuse cases were removed from state records and reportsof maltreatment prior to 1973 may not have been listed in the registry. Fifth, few interview questionswere asked regarding abuse and neglect, which may have decreased self-reported maltreatment.

The present findings confirm that the causes of child abuse and neglect are likely to beextraordinarily complex. Because this is the first large scale longitudinal study to investigate riskfactors associated with child abuse and neglect in a representative community sample, using dataon child maltreatment obtained from both official records and youth self-reports, our findingssuggest that further longitudinal research of this kind may be useful. One important goal for futureresearch will be to further investigate the effectiveness of intervention approaches that have beendeveloped for the early prevention and treatment of child abuse and neglect (see Guterman, 1997).Another goal for future research will be to continue developing and refining screening instruments thatcan assist professionals in identifying children who are at high risk for maltreatment (Ihnat, Levanthal,Cicchetti, Wasserman, & Hamilton, 1991; Orkow, 1985). Previous research has indicated that, oncechildren are at risk are identified, prevention of maltreatment can be achieved by providing homevisiting programs during pregnancy and the first few years of life (e.g., Leventhal, 1996).

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RESUME

Objectif: Identifier les facteurs de´mographiques, et ceux lie´s a la famille, aux parents et a` l’enfant, associe´s de fac¸onprospective au risque de maltraitance et de ne´gligence parmi les familles de la communaute´, a partir des donne´es sur lamaltraitance a` partir des sources officielles et des auto-signalements de jeunes.Methode: Un echantillon repre´sentatif de 644 familles a` New York a fait l’objet a4 reprises entre 1975 et 1992 d’e´tudesevaluant les variables de´mographiques, les relations familiales, le comportement parental, les caracte´ristiques des parentset des enfants. Les donne´es sur la maltraitance ont e´te obtenues a` partir des donne´es de l’Etat de New York et de testsretrospectifs auto-administre´s applique´s ades jeunes de 18 ans ou plus.Resultats: Les analyses logistiques re´gressives indiquent que diffe´rents types de facteurs de risque pre´disent la maltraitancephysique, l’abus sexuel et la ne´gligence, bien que le jeune aˇge et la sociopathie des me`res etaient des facteurs pre´dictifsspour les 3 formes de maltraitance. La pre´valence de la maltraitance ou de la ne´gligence augmente de 3% sans facteur derisque a24% lorsque 4 facteurs de risque ou plus sont pre´sents. Les donne´es de l’Etat et les auto-signalements demaltraitance ne correspondaient pas dans la plupart des cas ou` la maltraitance avait e´te signalee apartir d’une source aumoins, soulignant l’importance de la re´colte de donne´es apartir de sources officielles et d’auto-signalements.Conclusion: L’evaluation d’un certain nombre de facteurs de risque peut aider les professionels de la sante´ a identifier lesparents et les enfants qui pre´sentent un risque e´levede maltraiter leur enfant, facilitant ainsi l’organisation d’interventionspreventives et the´rapeutiques.

RESUMEN

Objetivo: Identificar factores infantiles, demogra´ficos, familiares y parentales, asociados prospectivamente con riesgo deabuso y negligencia a los nin˜os de familias en la comunidad; utilizando datos sobre maltrato infantil obtenidos tanto derecords oficiales como de auto-reportes juveniles.Metodo: Se les administro´ en cuatro ocasiones entre 1975 y 1992, a una muestra representativa de 644 familias del estadode Nueva York encuestas evaluandovariables demogra´ficas, de las relaciones familiares, la conducta parental y lascaracterı´sticas de los padres y los hijos. Los datos sobre el abuso y la negligencia a los nin˜os se obtuvieron de los nuevosrecords del estado de Nueva York e instrumentos de auto-reportes retrospectivos administrados cuando los jo´venes tenı´an18 anos de edad o mayores.Resultados:Analisis logısticos de regresio´n indicaron que los diferentes patrones en los factores de riesgo predecı´an laocurrencia de abuso fı´sico, abuso sexual y negligencia; a pesar de que la maternidad joven, la maternidad y la sociopatı´amaternal predecı´an la ocureencia de todas las tres formas de maltrato a los nin˜os. Adema´s, la prevalencia del abuso o lanegligencia a los nin˜os aumentaba en 3% cuando estaban presente factores de riesgo al 24% cuando estaban presente cuatroo mas de los factores de riesgo. En la mayorı´a de los casos los re´cords del estado y los auto-reportes de maltrato a los nin˜osno correspondı´an cuando el maltrato habı´a sido reportado a trave´s de por lo menos una fuente de datos, subrayando laimportancia de obtener datos tanto de re´cords oficiales como de auto-reportes.Conclusiones:La evaluacio´n de un nu´mero de factores de riesgo puede permitirle a los profesionales de la salud identificarlos padres e hijos que esta´n en alto riesgo de maltrato a los nin˜os, facilitando la implementacio´n de intervenciones adecuadasde prevencio´n y tratamiento.

1078 J. Brown, P. Cohen, J. G. Johnson, and S. Salzinger