Effects of the Sacramento Neighborhood Alcohol Prevention Project on rates of child abuse and neglect 7 years post-implementation (1999-2010).

INTRODUCTION: Evaluations of alcohol environmental prevention efforts examine short-term effects of these interventions on alcohol-related problems. We examine whether the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), an alcohol environmental intervention aimed to reduce alcohol-related problems in two neighbourhoods, on child abuse and neglect remained 7 years post-implementation. METHODS: SNAPP used a quasi-experimental non-equivalent control group design, where intervention activities occurred in the South area, followed by those in the North area 2 years later. Our sample size is 3912 space-time units (326 census block groups × 12 years [1999-2010]). Outcomes were measured at the household level and included: (i) all foster care entries total; and (ii) the subset of foster care entries that were alcohol related. Data were analysed using Bayesian conditionally autoregressive space-time models. RESULTS: We find that the decreases in total (relative rate [RR] = 0.882, 95% credible interval [CrI] 0.795, 0.980) and alcohol-related (RR = 0.888, 95% CrI 0.791, 0.997) foster care entries remain in the North intervention area although the magnitude of those changes are smaller than immediately post-intervention. Increases found in alcohol-related foster care entries in the South area immediately post-intervention were not significant 7 years later (RR = 1.128, 95% CrI 0.975, 1.307). DISCUSSION AND CONCLUSIONS: Reductions in child abuse and neglect due to an alcohol environmental intervention can be maintained. Environmental interventions that provide community-level primary prevention strategies could be more easily sustained and more cost effective than individual-level interventions, although more research is needed to identify why interventions may be successful in specific contexts and not others.

Using ecological momentary assessments to understand how drinking during special occasions relates to parenting behaviors.

BACKGROUND: Drinking on special occasions (e.g., Super Bowl, Christmas) often results in more alcohol consumed. Further, police often report higher levels of crime, such as assaults and domestic violence, on days of major sporting events (e.g., Super Bowl, World Cup). Yet, drinking behaviors of parents during special occasions or large sporting events have not been assessed for their effects on parenting behaviors. Here, we assess the relationship between drinking during the Super Bowl and on Valentine's Day to determine whether they differ. METHODS: Participants, recruited from social media, completed a 40-min baseline survey and 14 days of three daily Ecological Momentary Assessments (EMAs) about parenting. Two hundred fifty-five participants (with 684 EMAs) were enrolled on the Super Bowl and 184 (492 EMAs) were enrolled on Valentine's day. Measures of parenting include aggressive, punitive, and nonpunitive discipline and positive techniques. Drinking was assessed on days 7 and 14 of the EMA and corresponded to the EMA time frame during the previous week. Participants were largely White, well-educated mothers. Data were analyzed using multilevel logistic regression models. RESULTS: Parents who reported drinking on the day of the Super Bowl were more likely to use aggressive discipline (OR = 2.560; 95% CI: 1.308, 5.150) and punitive parenting (OR = 2.701; 95% CI: 1.394, 5.257) during the time that drinking occurred. In contrast, parents who reported drinking on Valentine's Day were less likely to use aggressive discipline (OR = 0.197; 95% CI: 0.077, 0.502). CONCLUSIONS: The differential relationship between drinking and parenting measures could be the result of differing norms or differences in who is present during the special occasions studied here. Identifying and understanding how alcohol use on special occasions contributes to parenting could help to create environments that are most conducive to positive parenting behaviors and reduce harms related to harsh or aggressive parenting.

Neighborhood market potentials for alcohol use and rates of child abuse and neglect.

BACKGROUND: Alcohol use can lead to child abuse and neglect even if the person using alcohol does not use heavily. Yet relatively few measures that reflect alcohol use are available at smaller geographic units. We assess whether the estimated level of total alcohol use per capita is related to measures of child abuse and neglect that include substantiated reports of maltreatment, total entries into foster care, and alcohol-related entries into foster care. METHODS: Our sample consists of 326 Census block groups in Sacramento, California over three time points (978 space-time units). Administrative data for substantiations of child abuse and neglect and foster care entries are our outcomes. We create market potentials for alcohol use among 18- to 29-year-olds as our primary independent variable. Data are analyzed using Bayesian conditionally autoregressive spatio-temporal models. RESULTS: Higher alcohol use potentials (as measured by total volume per capita of 18- to 29-year olds) are related to more children entering foster care due to drinking-related concerns by a parent or caregiver (RR = 1.032, 95% CI = [1.013, 1.051]), but not total substantiations for foster care entries. Neighborhoods with higher total volume of alcohol per 18- to 29-year-olds had more foster care entries when we used number of substantiations as the denominator (RR = 1.012, 95% CI = [1.0001, 1.023]) but were not related to foster care entries with alcohol misuse as a concern as a subset of all foster care entries. CONCLUSIONS: Higher estimated volume of alcohol use per capita among young adults (aged 18 to 29) was related to more children entering foster care due to alcohol-related concerns. Reducing alcohol supply in alcohol outlets, specifically through off-premise establishments, might reduce rates for all entries into foster care or other out-of-home placement and substantiated child abuse and neglect.

Longitudinal Changes in Self-Reported Alcohol Consumption by Mothers' During the COVID-19 Pandemic.

Previous research shows that drinking by mothers was higher during the initial stages of the pandemic. Less is known about whether these drinking levels were maintained years after the first stay-at-home orders. Using three waves of data, each approximately a year apart, drinks per day remain elevated, whereas drinking frequency and continued volume have decreased during subsequent waves.

Sequencing drinking events and use of punitive, nonpunitive, and positive parenting behaviors with ecological momentary assessment.

BACKGROUND: The relationship between alcohol use and parenting is primarily predicated on use of both past year drinking and parenting behaviors, making it difficult to develop prevention and intervention efforts that target alcohol-related maltreatment. Here, we assess the sequencing of parenting behaviors in relation to alcohol use (e.g., whether punitive parenting and alcohol use occur simultaneously). METHODS: Using Ecological Momentary Assessment, a convenience sample of parents was asked to take three brief surveys daily (at 10 a.m., 3 p.m., and 9 p.m.) for 14 days. If the parent was with the focal child, they were asked to identify whether they had used one of six randomly assigned parenting behaviors (punitive, nonpunitive, or positive). Alcohol use was queried at the 9 p.m. survey on days 7 and 14. Logistic multilevel models were used to analyze the data. FINDINGS: Parents reported less nonpunitive parenting during the time in which they reported drinking, and less positive parenting behaviors on the morning after the drinking occurred. CONCLUSIONS: Parents may be less attentive to children's behavior while drinking, or they may be less inclined to find that behavior needing correction. Drinking may reduce the likelihood of positive parenting the next day if parents are feeling hungover or have negative aftereffects from drinking. These parents may want to explicitly have another adult provide caregiving duties during the drinking event or plan drinking when it is less likely to cause the least amount of harm (e.g., when children are in bed).

Assessing the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) on child abuse and neglect.

BACKGROUND: The role of alcohol use in the etiology of abusive and neglectful parenting is significant. We examined how the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) may have reduced rates of substantiated child maltreatment, entries into foster care, and entries into foster care where alcohol use was a factor. PARTICIPANTS AND SETTING: The study sample is 326 Census block groups: 21 and 16 in the South and North intervention areas, respectively, and 289 in the At-Large comparison area in Sacramento, California. METHODS: SNAPP used a quasi-experimental design to reduce alcohol supply and alcohol-related problems among 15-29 year olds in two economically, racially, and ethnically diverse neighborhoods. The dependent variables are substantiated child abuse and neglect; total foster care entries; and alcohol-related foster care entries. RESULTS: Substantiated child abuse and neglect was inconclusive for both intervention areas. In the North, total (RR = 0.822, 95 % CI [0.721, 0.933]) and alcohol-related (RR = 0.760, 95 % CI [0.634, 0.914]) foster care entries decreased by 17.8 % and 24.0 %, respectively. Intervention effects in the South were not well-supported for foster care entries (RR = 1.118, 95 % CI [0.988, 1.258]), but increased alcohol-related foster care entries (RR = 1.264, 95 % CI [1.075, 1.484]). CONCLUSIONS: Environmental intervention strategies may be effective at reducing child abuse and neglect. However, given the mixed findings from our work, we need to identify under what conditions these interventions work best and whether some components of these strategies (e.g. awareness vs. enforcement of underage sales) differentially affect child abuse and neglect.

Promoting permanency in families with parental substance misuse: lessons from a process evaluation of a multi-system program.

BACKGROUND: Families affected by substance misuse are at increased risk for child maltreatment and child welfare system involvement. The Enhancing Permanency in Children and Families (EPIC) program uses four evidence-based and informed multi-system practices to promote safety and permanency outcomes for children involved with the child welfare system due to parental substance misuse: 1) Peer Recovery Support (PRS), 2) Family Treatment Drug Court (FTDC), 3) Medications for Opioid Use Disorder (MOUD) and 4) Nurturing Parent Program (NPP) relational skill-building. The purpose of the current study was to identify barriers, facilitators, and lessons learned in the implementation of and client engagement with the main components of EPIC. METHODS: Seventeen key EPIC personnel participated in the study. Individual semi-structured interviews were conducted. Qualitative analysis involved the thematic coding of the interviews, and program facilitators and barriers were revealed. RESULTS: PRS were identified as a primary strength of the EPIC program, providing experiential connection to participating families and a valuable source of information. High turnover and matching PRS to families were barriers to PRS implementation. FTDC contributed to client success as judges developed interpersonal relationships with the clients that balanced support with accountability. Client attitudes toward court presented barriers to FTDC engagement. MOUD provided stabilization and was perceived by caseworkers as an engagement facilitator and a layer of client accountability; however, the lack of availability of MOUD service providers presented a barrier for some clients. Parental relational skill-building was not valued by clients and was perceived as conflicting with sobriety-focused activities. CONCLUSIONS: The EPIC program provides comprehensive, coordinated multi-system support and care to families affected by parental substance misuse. Continued efforts to improve recruitment and retention of PRS, reframing client perceptions of FTDC, and increasing access to MOUD may contribute to increased engagement in the program. Findings highlight the utility of tracking process outcomes in community-based interventions to promote participant engagement in programs set in complex systems. TRIAL REGISTRATION: NCT04700696 . Registered January 7, 2021-retrospectively registered.

Disentangling the physical, social, and situational contexts of young adolescents' initiation to alcohol use and intoxication: A mixed methods study.

BACKGROUND: The onset of alcohol use during adolescence is associated with concurrent and subsequent related problems. Research on drinking contexts that underly these key first-time experiences and how they differ by initiation type is needed. The current study examined the physical, social, and situational characteristics of three types of initiation: first drink, first heavy episodic drinking (HED), and first intoxication and considered variations between early and later initiating adolescents. METHODS: A mixed-methods approach was used to survey and interview adolescents who reported lifetime drinking. Survey responses from 471 participants were analyzed using multilevel multinomial and logistic regressions accounting for nesting of drinking events (i.e., type of initiation) within respondents. A subsample of 50 participants recruited at baseline took part in-depth interviews that were thematically coded. RESULTS: After controlling for demographics, initiation of HED and intoxication, compared to initiation of a whole drink, were more likely to occur when more close friends are present and when those close friends are also drinking. The likelihood of early initiation of a whole drink and intoxication was also positively associated with being in an outdoor setting. Narratives identified distinct and shared patterns of context characteristics across the types of alcohol initiation. CONCLUSION: The quantitative and qualitative findings revealed several parallels as well as aspects that differ, enriching our understanding of early drinking contexts. Results highlight the importance of considering contextual characteristics by initiation type for prevention efforts.

Daily Stress and Use of Aggressive Discipline by Parents during the COVID-19 Pandemic.

To assess the relationship between stress throughout the day and aggressive discipline practices by parents during COVID-19 stay at home orders. For this study, participants took baseline survey online, then provided data three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 consecutive days using Ecological Momentary Assessment procedures. Data were collected from 323 participants, covering 9,357 observations from April 13 to May 27, 2020 in Central Ohio during stay-at-home orders due to COVID-19. Use of aggressive discipline, including corporal punishment and psychological aggression, was measured using the Dimensions of Discipline Inventory. For each higher level of stress, parents had 1.3 greater odds of using aggressive discipline. Having used aggressive discipline at baseline was related to three times greater odds of using it during the study period. Higher situational stress was associated with use of aggressive parenting. When combined with less contact with mandatory reporters, this places children at risk for abuse and neglect that may go without detection and intervention for longer time-periods. First responders and medical professionals become more important in identifying and reporting suspected child maltreatment, as this may be a child's only contact with a mandated professional for six months to a year. Well child visits, routine vaccinations, and problem-focused care are important opportunities to assess parents' stress and discipline practices that may be suggestive of abuse or neglect.

Understanding at-the-moment stress for parents during COVID-19 stay-at-home restrictions.

RATIONALE: In spring 2020, many states in the United States enacted stay-at-home orders to limit the spread of COVID-19 and lessen effects on hospitals and health care workers. This required parents to act in new roles without much support. Although studies have asked parents about stress before and during the pandemic, none have examined how stress may have fluctuated throughout the day and the characteristics related to those daily changes. OBJECTIVE: Our study assesses how time-varying (e.g., presence of a focal child) and day-varying (e.g., weekend vs. weekday) factors were related to parents' level of stress. METHODS: We use Ecological Momentary Assessment to examine stress three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 days. We include two different dates hypothesized to be related to parents' stress levels: (1) when Ohio announced schools would go virtual for the rest of the academic year and (2) when most retail businesses were allowed to re-open. Our sample of 332 individuals, recruited via Facebook, Craigslist, and word of mouth, completed 13,360 of these brief surveys during April-May 2020. Data were analyzed using generalized ordered logit models. RESULTS: Parents report lower levels of stress when completing the 9 p.m. survey, but higher levels when they were at work, during weekdays (compared to weekends) or when they were with the focal child. COVID-19 milestone dates were not related to stress levels. CONCLUSIONS: Parents need some form of respite (e.g. child care, child-only activities) to reduce stress, especially during the week when parents are juggling their outside employment and their child(ren)'s schooling. Providing parents with skills and tools to identify and reduce stress, such as apps monitoring heart rate or providing deep breathing techniques, may be one way of helping parents cope with extremely stressful situations.

Investigating Relationships Between Drinking Venues, Drinking Companions, and Corporal Punishment of Children.

Limited evidence suggests that how much a parent drinks in a particular venue, such as a bar, restaurant, or a friend's home, is associated with use of corporal punishment. However, these relationships could differ depending on their drinking companions (e.g., spouse or friends). In this study, weighted zero-inflated Poisson models were used to examine whether the relationships between venue-specific drinking frequency, heavier drinking, and corporal punishment are moderated by drinking companions in a mixed-mode sample of parents ( n = 1,599). The relationships between drinking frequency, heavier drinking, and corporal punishment varied by drinking companions, with some combinations being protective and others conferring risk. While most alcohol screening tools focus on individual alcohol use, more nuanced assessment examining where and with whom parents are drinking could be helpful in understanding risk of physical discipline.

Perceived Challenges to the Sustainability of Community-Based Aging Initiatives: Findings from a National Study of Villages.

Concerns have been raised regarding the sustainability of Villages, a rapidly-expanding set of organizations that typically use a participant-directed approach to improve older adults' quality of life and ability to age in place. Using online survey and telephone-interview data from a 2013 follow-up study of Villages across the United States, this study examined organizational leaders' perceptions of the major challenges to sustainability. Major challenges identified included: (a) funding, (b) membership recruitment, (c) leadership development, (d) meeting members' service needs, and (e) limitations of the Village model itself. Findings point to a number of important considerations for the development, implementation, and sustainability of the Village model, including the role of social workers in addressing these challenges.

Social support, collective efficacy, and child physical abuse: does parent gender matter?

Social support and collective efficacy are related to child physical abuse. However, little is known about whether these relationships differ by gender, although mothers and fathers differ in the quantity and quality of time spent with children. This study examined whether the relationship between social support, collective efficacy, and physical abuse is stronger for mothers than fathers. Telephone interviews were conducted with parent respondents in 50 California cities (N = 3,023). Data were analyzed via overdispersed multi-level Poisson models. Results suggest that high levels of emotional support were inversely associated with physical abuse for women and men, although this effect was stronger for women. High levels of companionship support were positively associated with physical abuse for women; however, the opposite was true for men. There were no significant interactions between collective efficacy variables and gender. The relationships between some types of social support and physical abuse appear to vary for men and women suggesting possibilities for more targeted intervention.

The impact of the "Village" model on health, well-being, service access, and social engagement of older adults.

BACKGROUND: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of Village membership on factors associated with the likelihood of aging in place. Additionally, the research examines the characteristics and service use of members who benefit the most. METHOD: Perceived impacts of Village membership in the areas of social engagement, service access, health and well-being, and self-efficacy for maintaining independence were assessed through a survey of 282 active Village members from five sites in California. Bivariate and multivariate analyses examined associations between member characteristics, volunteerism, service use, and self-reported impacts. RESULTS: Villages have the strongest impact in the area of promoting social engagement and facilitating access to services. Three quarters of the participants report that the Village increases their ability to age in place. Positive impacts were associated with level of Village involvement, but less likely among members who had worse self-reported health. CONCLUSION: Villages represent a promising new model designed to support community-dwelling seniors with a number of positive impacts that may reduce social isolation, improve well-being, and increase confidence aging in place. Villages appear to have the greatest benefit for members who are most involved and fewer positive impacts for members in poor health, prompting questions about the long-term effectiveness of the Village model in helping more frail seniors to age in place.