Families in Crisis: The Relationship Between Opioid Overdoses and Child Maltreatment in Neighborhood Areas.

OBJECTIVE: The increase in the use of opioids in Ohio is believed to have contributed to a crisis within county child welfare agencies throughout the state. Prior research has found a connection between opioid use and child abuse and neglect, but no previous studies have examined the relationship between opioid overdoses and child maltreatment rates at the neighborhood level. METHOD: The sample is 9,231 Census block groups in Ohio for 2015. Bayesian conditionally autoregressive models were used to examine the relationship between naloxone administrations (as a proxy for overdose) and child maltreatment. We controlled for variables representing social disorganization characteristics including unemployment, racial/ethnic heterogeneity, and vacant housing rates. We specifically examined child maltreatment referrals per child population and child maltreatment substantiations per child population. RESULTS: Higher rates of naloxone administration by emergency medical services were related to higher rates of referrals for child welfare investigations (relative risk = 1.0026) and substantiations (relative risk = 1.0027) at the block group level. Neighborhoods located in Appalachia with higher rates of overdoses were at greater risk for experiencing more referrals for child welfare investigations (relative risk = 1.0043). CONCLUSIONS: As communities continue to struggle with containing opioid misuse and reducing opioid overdose deaths, they must also contend with addressing problems that may arise from overdoses, including child abuse and neglect. Our findings suggest that the relationship between overdoses and maltreatment occurs at a much smaller spatial scale than has previously been observed. This may allow resources to be targeted more effectively within counties and communities.

Contrasting Methods of Measurement in Spatial Analyses Examining the Alcohol Environment and Child Maltreatment.

Child physical abuse is a major public health issue in the United States. Environmental child welfare research has focused on neighborhood characteristics and the influence of alcohol and marijuana establishments. To our knowledge, child welfare studies have singularly examined the outcome in terms of victims, that is, at the level of child population, and have not considered the parent population. Thus, in this exploratory study, we use spatial scan statistics to analyze patterns of child physical abuse at the child and household level, and we use Bayesian hierarchical spatial conditional autoregressive models to determine the relative influence of alcohol availability and other environmental factors. We find that household clusters are nested in child clusters and that controlling for alcohol establishments reduces cluster size. In the Bayesian regression models, alcohol availability increased risk slightly, while neighborhood diversity (measured using Blau's Index) elevated risk considerably. Immediate implications for child welfare agencies are discussed.

Relationships Between Social Host Policies, Youth Drinking Contexts, and Age.

OBJECTIVE: We examined associations of city-level policies and enforcement operations (i.e., social host laws and party patrol operations) with youth drinking, heavy drinking, and drinking-related problems in private and public drinking contexts. We also examined whether these associations were modified by age. METHOD: We surveyed 580 youth (ages 16-20 years; 53% male) living in 24 midsized California cities. We used mixed-effects negative binomial and logistic regression to calculate the frequency of youth drinking and heavy drinking and odds of drinking-related problems in each context (own home, friend's home, restaurant, bar, music venue, and outdoors). RESULTS: There were positive associations between more comprehensive city-level social host policies and frequency of youth drinking and heavy drinking at music venues, and youth heavy drinking and drinking-related problems at restaurants. Younger youth who lived in cities with more comprehensive social host laws drank heavily less frequently in their own home than younger youth living in cities with less comprehensive social host laws. Youth ages 17 or under who lived in cities with more party patrol enforcement had higher odds of problems related to drinking outdoors in the past 12 months than those in cities with fewer party patrol operations. CONCLUSIONS: City-level alcohol policies and enforcement targeting underage drinking may have differential effects depending on youth drinking contexts and age. Comprehensive social host policies, which aim to decrease drinking in private contexts, may displace or increase youth drinking in other contexts, such as restaurants and music venues. Comprehensive social host policies and party patrol operations may be more influential for younger youth drinking in their own home or outdoors.

Stress, alcohol use, and punitive parenting during the COVID-19 pandemic.

BACKGROUND: Emerging research suggests that parents are experiencing heightened stress during the COVID-19 pandemic. Parental stress is a risk factor for harsh or punitive parenting, and this association may be exacerbated by the use of alcohol. OBJECTIVE: We examine whether parental stress is associated with use of punitive parenting, as well as whether this association is modified by drinking pattern. PARTICIPANTS & SETTING: We used advertisements and word-of-mouth to recruit 342 parents living in Central Ohio during the initial stay-at-home order for COVID-19. METHODS: We used geographic ecological momentary assessment (gEMA) to measure parental stress and punitive parenting during three time periods (10 a.m., 3 p.m., and 9 p.m.) over a period of fourteen days using an app downloaded to their cellular telephone. Participants also completed a longer baseline survey. We used nested multilevel ordinal regression models, where at-the-moment assessments (Level 1) were nested within individuals (Level 2) to analyze data. RESULTS: Higher levels of parental stress [OR = 1.149 (95 % CI = 1.123, 1.176)] and later time of day [OR = 1.255 (95 % CI = 1.146, 1.373)] were positively related to odds of punitive parenting. Drinking pattern was not significantly related to punitive parenting in models with demographic covariates. Parents who drank alcohol both monthly and weekly and had higher levels of stress had greater odds of punitive parenting than parents with high levels of stress who abstain from alcohol. CONCLUSIONS: Alcohol may be an accelerant in the use of punitive parenting for parents experiencing stress. As alcohol use increases during COVID-19, children may be at higher risk for punitive parenting.

Parenting in poor health: Examining associations between parental health, prescription drug use, and child maltreatment.

RATIONALE: Child maltreatment and problematic parenting are related to negative outcomes for children. Poor parental health could be a risk factor for problematic parenting through several mechanisms: 1) inadequate emotional regulation and coping; 2) impairment of parental capacity; and, 3) impairment of the parent-child relationship. OBJECTIVE: This study examines relationships between self-rated parental health, prescription drug use, and a broad array of negative parenting outcomes. METHODS: A sample of general population parents of children aged ten and younger was recruited from 30 mid-sized cities in California (n = 681). Weighted mixed-effects negative binomial and logistic regression models were used to examine associations between poor parental health, prescription drug use and child maltreatment (physical abuse, supervisory neglect, and physical neglect), and problematic parenting (psychological aggression and corporal punishment). RESULTS: Parents in poor health used physical abuse, corporal punishment, and psychological aggression more frequently and had higher odds of supervisory neglect. Parents who were taking more prescription medications had higher odds of physical neglect. Exploratory analyses suggested that prescriptions for certain medical conditions both increased and decreased the risk of problematic parenting. CONCLUSIONS: Poor health and prescription drug use are not uncommon and present largely under-recognized risk factors for a spectrum of adverse parenting outcomes. Our study provides additional evidence that parents in poor health are at heightened risk of negative parenting, and need targeted intervention supports to support family well-being.

Enhancing Permanency in Children and Families (EPIC): a child welfare intervention for parental substance abuse.

BACKGROUND: Across Ohio, parental substance abuse has contributed to a marked increase in the number of children in foster care. Children exposed to parental substance use have a higher likelihood of physical abuse and neglect, and consequently a variety of physical, psychological and cognitive problems. The Enhancing Permanency in Children and Families (EPIC) program is a collaborative effort between the Ohio State University College of Social Work, two county offices of the Ohio Department of Job and Family Services, two juvenile courts and local behavioral health agencies. The goal of EPIC is to use three evidence-based and evidence-informed practices to reduce abusive and neglectful parenting, reduce addiction severity in parents, and improve permanency outcomes for families involved with the child welfare system due to substance abuse. METHODS: EPIC is a quasi-experimental study. Under the program, child welfare-involved adults who screen positive for substances are matched with a peer recovery supporter. Participants are also incentivized to participate in family treatment drug court, medications for opioid use disorders and home-based parenting supports. Participating adults (N = 250) are matched with comparison groups from counties participating in a separate intervention (Ohio START) and to those receiving treatment as usual, resulting in a final sample of 750 adults. Primary outcomes including addiction severity, child trauma symptoms, resilience, and attachment are assessed at baseline and at program completion. Additional outcomes include timely access to treatment services, length of placement in out-of-home care and recidivism into the child welfare system. DISCUSSION: This intervention formalizes cross-system collaboration between child welfare, behavioral health and juvenile courts to support families affected by addiction. The use of three evidence-based or evidence-informed strategies presents the opportunity to determine specific strategies that are most effective for reducing addiction severity. Lastly, the intervention combines several sources of funding to bolster sustainability beyond the life of the Regional Partnership Grant (RPG). TRIAL REGISTRATION: NCT04700696 . Registered January 7, 2021-retrospectively registered.

Prescription Drug Misuse and Child Maltreatment Among High-Risk Families.

Prescription drug misuse is increasingly common in the United States. To date, little is known about how prescription drug misuse relates to negative parenting behaviors like child maltreatment, even though use of illicit drugs increases rates of both child neglect and physical abuse. This study used secondary data from the Fragile Families and Child Well-Being Study (FFCWS), a clustered national sample of families at high risk for both prescription drug misuse and child maltreatment (n = 2,917). Data from mothers who participated in the 9-year follow-up of this study were used to create logistic regression models examining prescription drug misuse and physically aggressive and neglectful parenting, while controlling for demographic and psychosocial variables. Black, non-Hispanic mothers and mothers in worse health had higher odds of physically aggressive parenting. Mothers in worse health and those who used other illicit drugs had greater odds of neglectful parenting. There were no relationships between prescription drug misuse and either parenting outcome. The findings do not provide evidence that prescription drug misuse is a risk factor for child maltreatment. Further research examining this issue and potential progression from prescription drug misuse to other illicit drug use could help clarify whether this behavior is related to negative outcomes for children.

Alcohol Use and Harm to Children by Parents and Other Adults.

This study used mixed methods to examine parent-reported harm to children (lack of supervision or physical harm) due to alcohol use by themselves or someone else as well as parent beliefs about alcohol, parenting, and harms to children. We conducted a cross-sectional general population survey of 1,599 parents who were primary caregivers to a child aged 10 or younger and follow-up interviews with 23 parents who responded "yes" to one of the questions about alcohol use causing harm their child. Survey data were analyzed using multilevel logistic models. Compared to abstainers, parents who drank at least once a year were less likely to report that someone else's drinking caused a lack of supervision or physical harm to their child. Higher continued volumes of drinking were related to fewer reports of not watching a child closely enough. Social companionship support (having people to go out with) was related to greater odds that a parent's drinking would cause physical harm to his or her child(ren). In the qualitative analysis, four relevant themes emerged: perceived effects of alcohol use, tangible support and child supervision, immediate and distal harm, and turning points in drinking behaviors.

Individual- and County-Level Religious Participation, Corporal Punishment, and Physical Abuse of Children: An Exploratory study.

Parental religiosity has been associated with corporal punishment. However, most of this research has focused exclusively on Christians and has not examined physical abuse. In addition, little is known about how the larger religious environment might be associated with discipline behaviors. In this exploratory study, we examine how individual- and county-level religious attendance are related to corporal punishment and physical abuse. We sampled and surveyed 3,023 parents of children aged 12 and younger from 50 mid-sized California cities. We used weighted Poisson models to calculate the frequency of corporal punishment and physical abuse in the past year. Parents who attend religious groups used corporal punishment more frequently than parents who did not attend religious groups. However, those who lived in counties with greater rates of religious participation used corporal punishment less frequently than those living in counties with lower rates of religious participation. There were no effects for religious participation on physical abuse at the individual or county level. This exploratory study suggests that parents who attend religious groups may be more likely to use some types of physical discipline with children. Religious groups could be imparting parenting norms supporting corporal punishment at the individual level. More research examining specific doctrines and faiths is needed to validate the study findings.

Activity Spaces: Assessing Differences in Alcohol Exposures and Alcohol Use for Parents.

Parental alcohol use and alcohol outlet densities in residential areas are related to risk for child maltreatment. However, some parents spend significant time outside of their residential neighborhood. Thus, we may not be accurately assessing how alcohol environments are related to risks for problematic parenting. Here, we examine how residential environments and activity spaces are related to outlet density and whether drinking events in our sample of parents differ by location (e.g., routine vs. rare locations) and whether their children are present. We conducted semi-structured interviews with 60 parents living in four cities in the San Francisco Bay area who provided information on where they spent time, where they drank, and whether children were present. We constructed measures of activity spaces (e.g., convex hull polygons) and activity patterns (e.g., shortest network distance) and calculated outlet density in each. Density of alcohol outlets for residential Census tract was not related to density of the activity space and activity pattern measures. Alcohol use occurred more frequently (regardless of whether their children were present) inside activity spaces operationalized as convex hull polygons or two standard deviational ellipses. Measures that capture larger activity space areas (e.g., convex hull polygons, two standard deviational ellipses) may better model where people spend time, regardless of whether the location is routine or rare. By continuing to use activity spaces to explore relationships between outlet densities, drinking behaviors, and problems, we can start to ascertain those mechanisms by which outlets may affect local problems.

"It just depends on the environment": Patterns and decisions of substance use and co-use by adolescents.

This study used rich qualitative data to examine the role that social and physical contexts play in decision-making related to simultaneous use of alcohol and marijuana among adolescents. In-depth, semi-structured interviews were conducted with 13 adolescents who used alcohol and marijuana within several hours of each other. Decisions about whether to use alcohol and marijuana simultaneously as well as use patterns (e.g. the sequence in which substances were used) were informed by the context and the desired effect of the substance(s). Also, simultaneous alcohol and marijuana use was described as occurring in multiple contexts, both destination and transitional. Interventions designed to reduce simultaneous alcohol and marijuana use could benefit from paying attention to substance use contexts.

Social Work Matters: Californians' Perceptions of Social Welfare.

This article reports on findings from a representative survey of Californians (N = 946) and their perception of social work and its professionals. Analysis of the survey data indicates that the public holds a generally positive view of social work and its "helping" nature, although social work is considered one of the least prestigious professions. Respondents primarily associated social work with child protection and behavioral health roles, and less often with tasks such as community organizing, promoting social justice, and crafting social policy. Implications are considered for renegotiating the identity of social work and foregrounding social justice.

Child maltreatment reporting in the general population: Examining the roles of community, collective efficacy, and adverse childhood experiences.

According to bystander theory, factors such as the community environment, collective efficacy, and history of adverse childhood experiences could be related to likelihood of reporting or intervening against maltreatment. An online survey was conducted with 946 general population Californians obtained through mixed-mode random probability and quota-based recruitment methods. Using an experimental vignette design, participants were randomly assigned to two scenarios: a) potential child abuse occurring in their neighborhood; b) potential child abuse in an unfamiliar neighborhood. Weighted multivariate logistic regression models assessed relationships between the vignette condition, collective efficacy, appraisal of the behavior, and likelihood of reporting or intervening. The results suggested that perceiving the vignette as occurring in your own neighborhood was associated with lower odds of viewing the behavior as appropriate and considering it abusive. Higher collective efficacy scores were associated with lower odds of viewing the incident as inappropriate but higher odds of personally intervening. Adverse childhood experiences were positively related to reporting the incident to child protective services and intervening. Bystanders may be more likely to give parents in their own neighborhood "the benefit of the doubt" by viewing their abusive behaviors as less severe, potentially leading to underreporting. Neighborhood collective efficacy might increase willingness to personally intervene, but not contact systems such as child protective services or police, suggesting that enhanced trust in communities does not extend to these institutions. Our findings have implications for neighborhood and education interventions to enhance understanding of and willingness to intervene on behalf of children.

Drug Use, the Drug Environment, and Child Physical Abuse and Neglect.

Although drug use is considered a risk factor for child maltreatment, very little work has examined how the drug environment may affect physical abuse and neglect by parents. Utilizing information from a telephone survey with 2,597 respondents from 43 cities with valid police data on narcotics incidents, we analyzed the relationship between drug use, drug availability, and child maltreatment using multilevel models. City-level rates of drug abuse and dependence were related to more frequent physical abuse. Parents who use drugs in areas with greater availability of drugs reported more physical abuse and physical neglect. Emotional support was protective of all types of maltreatment. While most child welfare interventions focus on reducing parental drug use in order to reduce child abuse, these findings suggest environmental prevention or neighborhood strengthening approaches designed to reduce the supply of illicit drugs may also reduce child abuse through multiple mechanisms.

The places parents go: understanding the breadth, scope, and experiences of activity spaces for parents.

Neighborhood environments are related to parenting behaviors, which in turn have a life-long effect on children's health and well-being. Activity spaces, which measure individual routine patterns of movement, may be helpful in assessing how physical and social environments shape parenting. In this study we use qualitative data and GIS mapping from 4 California cities to examine parental activity spaces. Parents described a number of factors that shape their activity spaces including caregiving status, the age of their children, and income. Parental activity spaces also varied between times (weekends vs. weekdays) and places (adult-only vs. child-specific places). Knowing how to best capture and study parental activity spaces could identify mechanisms by which environmental factors influence parenting behaviors and child health.

Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators.

This review provides a comprehensive investigation of the pattern and strength of findings in the literature regarding the environmental moderators of the relationship between exposure to community violence and mental health among children and adolescents. Twenty-nine studies met criteria for inclusion in our analysis of family, school, and community variables as moderators. Dependent variables included internalizing (e.g., anxiety, depression, posttraumatic stress disorder) and externalizing symptoms (e.g., aggression, substance use). Effect sizes for the interactions of exposure to violence and potential moderators were summarized by their patterns of protective processes. The majority of studies in the literature examined family characteristics as moderators of the exposure to violence-symptom relationship, rather than school- or community-level factors. Our results indicated more consistent patterns for (a) close family relationships and social support for internalizing symptoms and (b) close family relationships for externalizing symptoms. Overall, the most common type of protective pattern was protective-stabilizing, in which youth with higher levels of the environmental attribute demonstrate relative stability in mental health despite exposure to violence. We found no consistent evidence that parental monitoring-a dimension inversely associated with exposure to violence in prior studies-moderated the relationship between exposure to violence and symptoms. The study emphasizes the importance of strengthening family support for young people's exposure to community violence; more research is needed to provide a solid evidence base for the role of school and community-level protective factors for youth exposed to violence.

Testing a Social Mechanism: Does Alcohol Outlet Density Moderate the Relationship Between Levels of Alcohol Use and Child Physical Abuse?

OBJECTIVES: Parental alcohol use and alcohol outlet density are both associated with child abuse. Guided by alcohol availability theory, this article examines whether alcohol outlet density moderates the relationship between parental alcohol use and child physical abuse. METHODS: A general population telephone survey of 3,023 parents or legal guardians 18 years or older was conducted across 50 California cities, whereas densities of alcohol outlets were measured for by zip code. Data were analyzed via overdispersed multilevel Poisson models. RESULTS: Ex-drinkers, light drinkers, and heavy drinkers use physical abuse more often than lifetime abstainers. Moderate drinking was not related to child physical abuse. Proportion of bars was negatively related to frequency of physical abuse. Moderating relationships between alcohol outlet density and drinking categories were found for all drinking patterns. CONCLUSION: Different types of alcohol outlets may be differentially related to drinking patterns, indicating that the interaction of drinking patterns and the drinking environment may place children at greater risk for being physically abused.

Are community level prescription opioid overdoses associated with child harm? A spatial analysis of California zip codes, 2001-2011.

BACKGROUND: Non-medical prescription opioid use is increasing globally within high-income countries, particularly the United States. However, little is known about whether it is associated with negative outcomes for children. In this study, we use prescription opioid overdose as a proxy measure for non-medical prescription opioid use and ask the following: Do California communities with greater rates of non-medical prescription opioid use also have higher rates of child maltreatment and unintentional child injury? METHODS: We used longitudinal population data to examine ecological associations between hospital discharges involving overdose of prescription opioids and those for child maltreatment or child injury in California zip codes between 2001 and 2011 (n=18,517 zip-code year units) using Bayesian space-time misalignment models. RESULTS: The percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate=1.089, 95% credible interval (1.004, 1.165)) and child injury (relative rate=1.055, 95% credible interval (1.012, 1.096)) over the ten-year period, controlling for other substance use and environmental factors. CONCLUSIONS: Increases in community level prescription opioid overdoses between 2001 and 2011 are associated with a 2.06% increase in child maltreatment discharges and a 1.27% increase in discharges for child injury. Communities with higher rates of non-medical prescription opioid use may experience greater levels of child harms.

An Alternative to Residential Neighborhoods: An Exploratory Study of how Activity Spaces and Perception of Neighborhood Social Processes relate to Maladaptive Parenting.

BACKGROUND: The environments where parents spend time, such as at work, at their child's school, or with friends and family, may exert a greater influence on their parenting behaviors than the residential neighborhoods where they live. These environments, termed activity spaces, provide individualized information about the where parents go, offering a more detailed understanding of the environmental risks and resources to which parents are exposed. OBJECTIVE: This study conducts a preliminary examination of how neighborhood context, social processes, and individual activity spaces are related to a variety of parenting practices. METHODS: Data were collected from 42 parents via door-to-door surveys in one neighborhood area. Survey participants provided information about punitive and non-punitive parenting practices, the locations where they conducted daily living activities, social supports, and neighborhood social processes. OLS regression procedures were used to examine covariates related to the size of parent activity spaces. Negative binomial models assessed how activity spaces were related to four punitive and five non-punitive parenting practices. RESULTS: With regards to size of parents' activity spaces, male caregivers and those with a local (within neighborhood) primary support member had larger activity spaces. Size of a parent's activity space is negatively related to use of punitive parenting, but generally not related to non-punitive parenting behaviors. CONCLUSIONS: These findings suggest social workers should assess where parents spend their time and get socially isolated parents involved in activities that could result in less use of punitive parenting.

Understanding the Roles of Context, Frequency, and Quantity of Alcohol Consumption in Child Physical Abuse: Risks for Mothers and Fathers.

INTRODUCTION: Alcohol use is related to child physical abuse, although little is known about gender-specific risks factors. This study examines the relationships between alcohol outlets, context-specific drinking, dose-response drinking and child physical abuse for mothers and fathers. METHOD: Telephone interviews were conducted with 1,973 female and 1,050 male respondents in 50 California cities. Weighted negative binomial models were used to calculate the frequency of physical abuse in the past year. RESULTS: Drinking more often at restaurants was related to higher frequency of physical abuse for fathers, while mothers who drank more frequently at bars and parties used physical abuse more often. There were no significant dose-response drinking relationships for fathers. Drinking higher amounts at bars, parties, and restaurants was associated with less frequent physical abuse for mothers. DISCUSSION: Our findings suggest that a focus on drinking contexts may reveal heightened risk for many mothers who do not consume large amounts of alcohol.