Final Outcomes from a Phase 2 Trial of Posoleucel in Allogeneic Hematopoietic Cell Transplant Recipients.

Allogeneic hematopoietic cell transplantation (allo-HCT) recipients are susceptible to viral infections. We conducted a phase 2 trial evaluating the safety and rate of clinically significant infections (CSIs; viremia requiring treatment or end-organ disease) following infusion of posoleucel, a partially HLA-matched, allogeneic, off-the-shelf, multivirus-specific T cell investigational product for preventing CSIs with adenovirus, BK virus, cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, or JC virus. This open-label trial enrolled high-risk allo-HCT recipients based on receiving grafts from umbilical cord blood, haploidentical, mismatched, or matched unrelated donors; post-HCT lymphocytes <180/mm3; or use of T cell depletion. Posoleucel dosing was initiated within 15-49 days of allo-HCT and subsequently every 14 days for up to seven doses. The primary endpoint was the number of CSIs due to the six target viruses by week 14. Of the 26 patients enrolled just three (12%) had a CSI by week 14, each with a single target virus. In vivo expansion of functional virus-specific T cells detected via interferon-γ ELISpot assay was associated with viral control. Persistence of posoleucel-derived T cell clones for up to 14 weeks after the last infusion was confirmed by T cell receptor deep-sequencing. Five patients (19%) had acute GVHD grade II-IV. No patient experienced cytokine release syndrome. All six deaths were due to relapse or disease progression. High-risk allo-HCT patients who received posoleucel had low rates of CSIs from six targeted viruses. Repeat posoleucel dosing was generally safe and well tolerated and associated with functional immune reconstitution. www.clinicaltrials.gov NCT04693637.

Long-term open-label vebicorvir for chronic HBV infection: Safety and off-treatment responses.

Background & Aims: The investigational first-generation core inhibitor vebicorvir (VBR) demonstrated safety and antiviral activity over 24 weeks in two phase IIa studies in patients with chronic HBV infection. In this long-term extension study, patients received open-label VBR with nucleos(t)ide reverse transcriptase inhibitors (NrtIs). Methods: Patients in this study (NCT03780543) previously received VBR + NrtI or placebo + NrtI in parent studies 201 (NCT03576066) or 202 (NCT03577171). After receiving VBR + NrtI for ≥52 weeks, stopping criteria (based on the treatment history and hepatitis B e antigen status in the parent studies) were applied, and patients either discontinued both VBR + NrtI, discontinued VBR only, or continued both VBR + NrtI. The primary efficacy endpoint was the proportion of patients with HBV DNA <20 IU/ml at 24 weeks off treatment. Results: Ninety-two patients entered the extension study and received VBR + NrtI. Long-term VBR + NrtI treatment led to continued suppression of HBV nucleic acids and, to a lesser extent, HBV antigens. Forty-three patients met criteria to discontinue VBR + NrtI, with no patients achieving the primary endpoint; the majority of virologic rebound occurred ≥4 weeks off treatment. Treatment was generally well tolerated, with few discontinuations due to adverse events (AEs). There were no deaths. Most AEs and laboratory abnormalities were related to elevations in alanine aminotransferase and occurred during the off-treatment or NrtI-restart phases. No drug-drug interactions between VBR + NrtI and no cases of treatment-emergent resistance among patients who adhered to treatment were observed. Conclusions: Long-term VBR + NrtI was safe and resulted in continued reductions in HBV nucleic acids following completion of the 24-week parent studies. Following treatment discontinuation, virologic relapse was observed in all patients. This first-generation core inhibitor administered with NrtI for at least 52 weeks was not sufficient for HBV cure. Clinical trial number: NCT03780543. Impact and implications: Approved treatments for chronic hepatitis B virus infection (cHBV) suppress viral replication, but viral rebound is almost always observed after treatment discontinuation, highlighting an unmet need for improved therapies with finite treatment duration producing greater therapeutic responses that can be sustained off treatment. First-generation core inhibitors, such as vebicorvir, have mechanisms of action orthogonal to standard-of-care therapies that deeply suppress HBV viral replication during treatment; however, to date, durable virologic responses have not been observed after treatment discontinuation. The results reported here will help researchers with the design and interpretation of future studies investigating core inhibitors as possible components of finite treatment regimens for patients with cHBV. It is possible that next-generation core inhibitors with enhanced potency may produce deeper and more durable antiviral activity than first-generation agents, including vebicorvir.

Heterogeneous effects of spanking on child protective services involvement in early childhood: A propensity score stratification analysis.

Background: Extant literature has primarily employed linear models to estimate the average effect of spanking on children. Less is known about child and parent characteristics that may predict differential risks of children's exposure to spanking (i.e., pre-treatment heterogeneity) and the effect of spanking on child outcomes that may differ by the propensity for spanking (i.e., post-treatment heterogeneity). Objective: The present study examines pre- and post-treatment heterogeneity in the association between maternal spanking at child age 3 and subsequent household Child Protective Services (CPS) involvement that were reported by mothers between child ages 3 to 5. Methods: The sample consisted of 2,422 families from the Fragile Families and Child Wellbeing Study, a birth cohort study that oversampled children born to unmarried families. A propensity score stratification analysis procedure examined pre- and post-treatment heterogeneity in the association between spanking and subsequent household CPS involvement. Children were stratified into three strata depending on their propensity for experiencing spanking. Subsequently, the association between spanking and household CPS involvement was examined for each stratum. Results: Disadvantaged socio-economic characteristics, negative psychosocial conditions of the mother, and dysregulated temperament of the child were associated with elevated risk of spanking. The odds of subsequent household CPS involvement increased by 2.4 times (ß = 0.869, p <.01) for children in the stratum with the lowest propensity for experiencing spanking. Conclusions: Results emphasize the importance of promoting alternative disciplinary strategies to families who would be considered low-risk before they may come into contact with the child welfare system.

Associations between 11 parental discipline behaviours and child outcomes across 60 countries.

OBJECTIVES: To test associations between 11 caregiver aggressive and non-aggressive discipline behaviours and outcomes (aggression, distraction and prosocial peer relations) of children under 5 years in low-income and middle-income countries (LMICs). PARTICIPANTS: Data came from the fourth (2009-2013) and fifth (2012-2017) rounds of the UNICEF Multiple Indicator Cluster Surveys. Analyses were restricted to households with children under 5 years, leaving a sample of 229 465 respondents across 60 LMICs. Data were analysed using Bayesian multilevel logistic regression. RESULTS: Verbal reasoning (80%) and shouting (66%) were the most common parental discipline behaviours towards young children. Psychological and physical aggression were associated with higher child aggression and distraction. Compared with not using verbal reasoning, verbal reasoning was associated with lower odds of aggression (OR)=0.92, 95% credible interval (CI)=0.86 to 0.99) and higher odds of prosocial peer relations (OR=1.30, 95% CI=1.20 to 1.42). Taking away privileges was associated with higher odds of distraction (OR=1.09, 95% CI=1.03 to 1.15) and lower odds of prosocial peer relations (OR=0.92, 95% CI=0.87 to 0.98). Giving the child something else to do was associated with higher odds of distraction (OR=1.06, 95% CI=1.01 to 1.12). The results indicated country-level variation in the associations between parenting behaviours and child socioemotional outcomes. CONCLUSIONS: Psychological and physical aggression were disadvantageous for children's socioemotional development across countries. Only verbal reasoning was associated with positive child socioemotional development. No form of psychological aggression or physical aggression benefited child socioemotional development in any country. Greater emphasis should be dedicated to reducing parental use of psychological and physical aggression across cultural contexts.

Profiles of adverse childhood experiences (ACEs) and psychosocial adjustment in South Korea: Comparison between probation and non-probation youth.

BACKGROUND: Adverse Childhood Experiences (ACEs) are risk factors affecting adolescent psychosocial adjustment. Youth involved in the juvenile justice system are more likely to have ACEs, but few studies have investigated this topic outside the western context. OBJECTIVE: This study aims to (1) compare latent profiles of ACEs among probation and non-probation youth in South Korea and (2) examine which profiles pose the greatest risk of maladaptive psychosocial adjustment (offline risk-taking, online risk-taking, school adjustment, and happiness). PARTICIPANTS AND SETTING: South Korean data adopting survey questions from the Fourth International Self-Report Delinquency Study was analyzed. Adolescents with complete information on regression covariates were included (non-probation: 1846/probation: 368). METHODS: Latent profile analysis was utilized to identify distinctive patterns of ACEs. Multiple linear regression and logistic regression were performed to predict the maladjustment experiences of each latent subgroup. RESULTS: Four ACE profiles emerged for probation and non-probation samples. Three profiles were common (i.e., emotional/physical abuse, emotional neglect, high maltreatment/domestic violence) and one profile was unique (high maltreatment with family dysfunction for the probation sample; moderate maltreatment for the non-probation sample). In the probation sample, compared to the emotional neglect group, the other three profiles showed poorer adjustment in at least one domain. In the non-probation sample, profiles with high emotional/physical abuse and high maltreatment/family dysfunction had poorer outcomes than the emotional neglect group. CONCLUSIONS: These findings indicate the need for a comprehensive approach toward adolescents and their family environments for preventing delinquency and promoting positive youth adjustment.

Safety, pharmacokinetics and antiviral activity of ABI-H2158, a hepatitis B virus core inhibitor: A randomized, placebo-controlled phase 1 study.

Treatment for chronic hepatitis B virus infection (cHBV) is mostly indefinite, with new finite-duration therapies needed. We report safety, pharmacokinetics and antiviral activity of the investigational HBV core inhibitor ABI-H2158. This Phase 1a/b study (NCT03714152) had three parts: Part A, participants received a single ascending oral dose of ABI-H2158 (5-500 mg) or placebo; Part B, participants received multiple doses of ABI-H2158 300 mg once (QD) or twice (BID) daily or placebo, for 10 days; Part C, cHBV patients received ABI-H2158 (100, 300, or 500 mg QD or 300 mg BID) or placebo, for 14 days. Ninety-three participants enrolled. In Parts A/B, there were no serious adverse events (SAEs) or deaths, and all treatment-emergent AEs (TEAEs) were Grade 1. In Part C, two patients had Grade 3 TEAEs unrelated to ABI-H2158; there were no deaths, SAEs or Grade 4 TEAEs. In Part A, median time to maximum ABI-H2158 plasma concentration (Tmax ) and mean terminal elimination half-life (t½ ) were 1-4 and 9.8-20.7 h, and area under the plasma concentration-time curve increased dose proportionally. In Part B, Day 10 Tmax was 2 h, mean t½ was 15.5-18.4 h, and exposure accumulated 1.7- to 3.1-fold. In Part C, Day 14 Tmax was 1 h, exposure accumulated 1.4- to 1.8-fold, and ABI-H2158 was associated with >2 log10 declines in HBV nucleic acids. In conclusion, ABI-H2158 in cHBV patients following 14 days of dosing was well tolerated and demonstrated potent antiviral activity. Safety and pharmacokinetics supported future QD dosing.

Gender Inequality in Low- and Middle-Income Countries: Associations with Parental Physical Abuse and Moderation by Child Gender.

Gender inequality perpetuates women's economic insecurity and a culture of violence. Parental distress caused by economic pressure may increase violence against children. High levels of gender inequality and interpersonal violence may contribute to higher levels of physical abuse. Using an ecological perspective, this study examines the association of country-level gender inequality and household-level parental physical abuse, and the moderating role of child gender in this association in low- and middle-income countries. We used data on over 420,000 households from the UNICEF Multiple Indicator Cluster Surveys and country-level indicators from the United Nations Development Program Human Development data. We employed multilevel logistic regression to examine the association between gender inequality with the log-odds of physical abuse after accounting for country- and individual-level covariates. In order to more fully explore our results, we calculated predicted probabilities of abuse for several scenarios. The results indicated that higher levels of gender inequality were associated with higher probabilities of physical abuse. This association was stronger for female children than for male children. The probabilities of abuse by child gender were indistinguishable, although rates of physical abuse converged as gender inequality increased, at a statistically marginal level. These findings indicate that macro-level interventions that reduce gender inequality are necessary to prevent and reduce child physical abuse.

Safety and efficacy of vebicorvir administered with entecavir in treatment-naïve patients with chronic hepatitis B virus infection.

BACKGROUND & AIMS: Nucleos(t)ide reverse transcriptase inhibitors do not completely suppress HBV DNA in chronic HBV infection (cHBV). Vebicorvir (VBR) is an investigational core inhibitor that interferes with multiple aspects of HBV replication. This phase II trial evaluated the safety and efficacy of VBR in combination with entecavir (ETV) in treatment-naïve patients with cHBV. METHODS: HBeAg-positive, treatment-naïve patients without cirrhosis were randomised 1:1 in a double-blind manner to once-daily VBR 300 mg+ETV 0.5 mg or placebo (PBO)+ETV 0.5 mg for 24 weeks. The primary endpoint was change in mean log10 HBV DNA from Baseline to Week 12 and 24. RESULTS: All patients in both treatment groups (PBO+ETV: 12/12; VBR+ETV: 13/13) completed the study. At Week 12, VBR+ETV led to a greater mean (SD) reduction from Baseline in log10 IU/ml HBV DNA (-4.45 [1.03]) vs. PBO+ETV (-3.30 [1.18]; p = 0.0077). At Week 24, VBR+ETV led to a greater reduction from Baseline in log10 IU/ml HBV DNA (-5.33 [1.59]) vs. PBO+ETV (-4.20 [0.98]; p = 0.0084). Greater mean reductions in pregenomic RNA were observed at Week 12 and 24 in patients receiving VBR+ETV vs. PBO+ETV (p <0.0001 and p <0.0001). Changes in viral antigens were similar in both groups. No drug interaction between VBR and ETV was observed. Two patients experienced HBV DNA rebound during treatment, with no resistance breakthrough detected. The safety of VBR+ETV was similar to PBO+ETV. All treatment-emergent adverse events and laboratory abnormalities were Grade 1/2. There were no deaths, serious adverse events, or evidence of drug-induced liver injury. CONCLUSIONS: In this 24-week study, VBR+ETV provided additive antiviral activity over PBO+ETV in treatment-naïve patients with cHBV, with a favourable safety and tolerability profile. CLINICAL TRIAL NUMBER: NCT03577171 LAY SUMMARY: Hepatitis B is a long-lasting viral infection of the liver. Current treatments can suppress hepatitis B virus but do not offer the opportunity of cure, hence, new treatment approaches are required. Herein, we show that the combination of the novel core inhibitor vebicorvir with an existing antiviral (entecavir) in treatment-naïve patients chronically infected with hepatitis B virus demonstrated greater antiviral activity than entecavir alone. Additionally, vebicorvir was safe and well tolerated. Thus, further studies evaluating its potential role in the treatment of chronic hepatitis B are warranted.

The association between spanking and physical abuse of young children in 56 low- and middle-income countries.

BACKGROUND: Nearly one third of children under five in low- and middle-income countries (LMICs) experience spanking. Studies from North America suggest that spanking is associated with heightened risk of physical abuse. However, the link between spanking and physical abuse in the international context remains understudied. OBJECTIVE: To examine the association between caregivers' spanking and physical abuse of young children in LMICs, and to estimate the extent to which physical abuse might be reduced if spanking were eliminated. PARTICIPANTS: We used nationally representative data from 156,166 1- to 4-year-old children in 56 LMICs from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys. METHODS: A nationally weighted multilevel logistic regression model examined the association between spanking and physical abuse. We calculated predicted probabilities of physical abuse, which we present using natural frequencies. RESULTS: Spanking was associated with higher odds of physical abuse (OR = 5.74, p < .001). The predicted probability of physical abuse decreased by 14% comparing children who were spanked (22%) and who were not spanked (8%). When our estimates were translated to a hypothetical sample of 100 children using a natural frequency approach, 32 children were spanked; of those, seven experienced physical abuse. The elimination of spanking would result in four fewer children who were exposed to physical abuse. In relation to the population of abused children, estimates suggest that physical abuse could reduce by up to 33% if spanking were eliminated. CONCLUSIONS: Results support the UN Sustainable Development Goals Target 16.2 that calls for eliminating all forms of violence against children. Child welfare advocates should discourage caregivers from using spanking, in order to prevent physical abuse.

Safety and efficacy of vebicorvir in virologically suppressed patients with chronic hepatitis B virus infection.

BACKGROUND & AIMS: HBV nucleos(t)ide reverse transcriptase inhibitors (NrtIs) do not completely suppress HBV replication. Previous reports indicate persistent viremia during NrtI treatment despite HBV DNA being undetectable. HBV core inhibitors may enhance viral suppression when combined with NrtIs. This phase II trial (NCT03576066) evaluated the efficacy and safety of the investigational core inhibitor, vebicorvir (VBR), in virologically- suppressed patients on NrtIs. METHODS: Non-cirrhotic, NrtI-suppressed patients with chronic HBV were randomised to VBR 300 mg once daily or matching placebo (PBO) for 24 weeks. Treatment was stratified by hepatitis B e antigen (HBeAg) status. The primary endpoint was change from Baseline in serum HBeAg or hepatitis B surface antigen (HBsAg) after 24 weeks. RESULTS: Of 73 patients enrolled, 47 were HBeAg positive and 26 were HBeAg negative. In HBeAg-positive and -negative patients, there were no differences in the change from Baseline at Week 24 for HBsAg or HBeAg. Using a novel, high-sensitivity assay to detect HBV DNA, a greater proportion of patients with detectable HBV DNA at Baseline achieved undetectable HBV DNA at Week 24 in the VBR+NrtI vs. PBO+NrtI group. In HBeAg-positive patients, a greater change from Baseline in HBV pregenomic (pg)RNA was observed at Week 24 with VBR+NrtI vs. PBO+NrtI. Treatment-emergent adverse events (TEAEs) in VBR+NrtI patients included upper respiratory tract infection, nausea, and pruritus. No serious adverse events, Grade 4 TEAEs, or deaths were reported. CONCLUSIONS: In this 24-week study, VBR+NrtI demonstrated a favourable safety and tolerability profile. While there were no significant changes in viral antigen levels, enhanced viral suppression was demonstrated by greater changes in DNA and pgRNA with the addition of VBR compared to NrtI alone. CLINICAL TRIALS NUMBER: NCT03576066. LAY SUMMARY: Core inhibitors represent a novel approach for the treatment of chronic hepatitis B virus (HBV) infection, with mechanisms of action distinct from existing treatments. In this study, vebicorvir added to existing therapy reduced HBV replication to a greater extent than existing treatment and was generally safe and well tolerated.

Patterns of caregiver aggressive and nonaggressive discipline toward young children in low- and middle-income countries: A latent class approach.

BACKGROUND: Caregivers use a variety of disciplinary methods to respond to undesired child behavior. Many caregivers use nonaggressive forms of discipline, such as verbal reasoning and redirection. Some caregivers use aggressive forms of discipline, such as spanking and yelling. However, most caregivers use a combination of aggressive and nonaggressive discipline. To date, a disproportionately small number of caregiver discipline studies are conducted in low- and middle-income countries (LMICs), and few studies in low-resource contexts examine aggressive and nonaggressive behaviors simultaneously. OBJECTIVE: This study aims to elucidate caregiver patterns of 11 disciplinary behaviors used in LMICs, and examine how these patterns relate to child outcomes and household characteristics. PARTICIPANTS AND SETTING: Data came from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys (MICS) distributed between 2009 and 2017 (N = 218,824 respondents across 63 countries). Focal children were 3-4 years old. METHODS: Patterns of disciplinary behaviors were estimated using a multilevel latent class analysis (LCA). Multinomial regression analyses examined associations of disciplinary patterns with caregiver-reported child outcomes and household characteristics. RESULTS: The LCA suggested caregiver discipline fell into three overall patterns: high behavioral control, moderate behavior control, and lower behavioral control. The lower behavioral control class was associated with the most advantageous child outcomes and household socio-demographic characteristics, whereas the high behavioral control class was associated with the most disadvantageous child outcomes and household characteristics. CONCLUSIONS: Efforts should be employed to reduce aggressive behaviors and promote positive parenting among caregivers in LMICs.

Physical punishment, physical abuse, and child behavior problems in South Korea.

BACKGROUND: Prior literature has demonstrated the associations of parental physical punishment with child behavior problems and increased risk of physical abuse. In South Korea, physical punishment is a common parenting practice. In 2021, legislative reforms eliminated legal grounds for parental physical punishment in South Korea. However, research on physical punishment, physical abuse, and child behavior problems in the Korean context is scarce. OBJECTIVE: This study examined whether physical punishment and physical abuse have unique associations with child behavior problems and whether physical punishment is associated with increased exposure to physical abuse. PARTICIPANTS AND SETTING: Data came from the 2010 Korean Child and Youth Panel Survey (KCYPS), a nationally representative sample of South Korean children who attended 1st grade in 2010. Our analyses were based on three waves of the KCYPS (N = 2,180). METHODS: We employed fixed-effects regression to examine the associations of physical punishment and physical abuse with child behavior problems and the association of physical punishment with physical abuse after controlling for time-invariant characteristics. RESULTS: Exposure to physical punishment and physical abuse was associated with higher levels of aggression, depression, and lower levels of academic behavior regulation. Physical punishment was associated with increased risk of physical abuse. CONCLUSIONS: Our findings suggest that physical punishment is a risk for child behavior problems and physical abuse in South Korea. Child maltreatment prevention efforts should focus on shifting favorable social norms around physical punishment and promoting non-physical disciplinary practices.

A population-based prospective study on rest-activity rhythm and mild cognitive impairment among Hong Kong healthy community-dwelling older adults.

BACKGROUND: Relatively few studies investigated the association between rest-activity circadian rhythm and cognitive impairment in population-based study, and the evidence from Asian populations is sparse. We aimed to examine the relationship of actigraphy measured rest-activity circadian rhythm with mild cognitive impairment (MCI) or cognitive impairment in Hong Kong healthy community-dwelling older adults. METHODS: We recruited 174 Hong Kong healthy adults aged ≥65 years (36 male vs. 138 female) during April-September 2018, and followed up them for 12 months. Participants were invited to wear wrist actigraphy for 7 days in both baseline and follow-up study. We used the actigraph data to calculate their midline statistic of rhythm (MESOR), amplitude, acrophase and percent rhythm. Montreal Cognitive Assessment (MoCA) was used to assess their cognitive scores at baseline and follow-up. Multivariate logistic regression model was performed to estimate the association of rest-activity circadian rhythm parameters with MCI; whilst multinomial logistic regression model was used to examine the association between rhythm parameters and changes of cognitive scores (i.e., worsen: <-1, stable: -1 to 1, better cognition: ≥2) after 12-months follow-up respectively. RESULTS: There was no association between rest-activity circadian rhythm parameters and MCI or cognitive impairment at baseline. Compared to those with an averaged value of acrophase (1:24pm-3:00pm), results of multinominal logistic regression showed that participants with a delayed acrophase (after 3:00pm) were less likely to have better cognition (adjusted odds ratio (AOR) = 0.32, 95% confidence interval (CI) = 0.11-0.88). Upon one year of follow-up, participants who delayed their acrophase for 24 min than their baseline measurements were also less likely to have better cognitive functions (AOR = 0.26, 95%CI = 0.08-0.79). CONCLUSIONS: Results from both the baseline survey and follow-up study consistently confirmed that older adults, especially in light of the majority of participants being the females, with delayed acrophase were less likely to have better cognition in the Asian population.

Adverse Childhood Experiences and Spanking Have Similar Associations with Early Behavior Problems.

OBJECTIVES: To examine whether adverse childhood experiences (ACEs) and physical punishment (ie, spanking) are unique risk factors for behavior problems in early childhood, and whether ACEs moderate the associations of spanking with child behavior problems. STUDY DESIGN: We conducted prospective, longitudinal analyses on 2380 families in the Fragile Families and Child Wellbeing Study. Mothers reported outcomes of externalizing and internalizing behavior problems at age 5 years; and the main predictors, ACEs and spanking, at age 3 years. ACEs included 9 items: physical abuse, emotional abuse, physical neglect, emotional neglect, mother's exposure to intimate partner violence, parental mental health problem, parental substance use, parental incarceration, and parental death. Multilevel models examined the associations between ACEs, spanking, and behavior problems, and the moderating effect of ACEs in the associations of spanking with behavior problems. Analyses were adjusted for preexisting behavior problems, demographics, and neighborhood conditions. RESULTS: ACEs (ß = 0.028; P < .001) and spanking (ß = 0.041; P < .001) at 3 years were unique risk factors for increased externalizing behavior problems at 5 years, after controlling for covariates. The magnitude of the associations of ACEs and spanking with externalizing behavior were statistically indistinguishable. ACEs did not moderate the association between spanking and externalizing behavior. CONCLUSIONS: ACEs and spanking have similar associations in predicting child externalizing behavior. Results support calls to consider physical punishment as a form of ACE. Our findings also underscore the importance of assessing exposure to ACEs and physical punishment among young children and providing appropriate intervention to children at risk.

Household economic hardship as a moderator of the associations between maternal spanking and child externalizing behavior problems.

BACKGROUND: Spanking is associated with detrimental outcomes for young children. Research shows that spanking is more commonly used in low-income households. OBJECTIVE: To examine whether economic hardship, measured by household income-to-poverty ratio at the time of the child's birth, moderated the longitudinal associations between maternal spanking and child externalizing behavior problems during the first nine years of childhood. PARTICIPANTS AND SETTING: Mother-child pairs (N = 4,149) from a cohort study of urban families in 20 US cities. METHODS: Cross-lagged path models examined associations between maternal spanking and externalizing behavior when children were between the ages of 1 and 9. Multigroup analyses examined whether income-to-poverty ratio moderated these associations. RESULTS: Bivariate analyses showed that income-to-poverty ratio was associated with child externalizing behavior problems at each time point; income-to-poverty ratio was associated with maternal spanking at age 3 only. Longitudinal path model results indicated that, for low- and middle-income groups, maternal spanking at each age had significant associations with child externalizing behavior at each subsequent age. For the high-income group, maternal spanking at age 1 and age 3 had significant associations with child externalizing behavior at each subsequent age; however, spanking at age 5 was not associated with child externalizing behavior at age 9. CONCLUSIONS: Spanking is disadvantageous for children at all income levels, with more persistent effects in low- and middle-income families. For higher-income families, the associations of maternal spanking with child externalizing behavior problems may be attenuated as child age increases. Regardless of income level, parents should be advised against spanking.

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3-5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (ß = .037, p < .001) and internalizing (ß = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (ß = .071, p < .01) and internalizing (ß = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.

Attachment Style and the Association of Spanking and Child Externalizing Behavior.

OBJECTIVE: To examine whether the longitudinal associations between maternal spanking and child externalizing behavior are moderated by attachment style. METHODS: This study used data from the Fragile Families and Child Wellbeing Study (n = 2211), a large cohort sample of low-income urban families. Multiple-group autoregressive cross-lagged models examined the associations between maternal spanking and child externalizing behavior when children were ages 1, 3, and 5. Moderation by attachment style was examined using structural invariance testing. RESULTS: For children with an insecure mother-child attachment style, spanking at age 1 was associated with externalizing behavior at age 3. However, for children with a secure mother-child attachment style, the association between maternal spanking at age 1 and child externalizing behavior at age 3 was absent. Attachment style did not moderate the association between maternal spanking at age 3 and externalizing behavior at age 5, suggesting that spanking at age 3 is associated with deleterious outcomes at age 5, regardless of attachment style. CONCLUSIONS: Results suggest that even in the context of a secure attachment style, spanking is associated with adverse outcomes in early childhood. Findings support the American Academy of Pediatrics 2018 policy statement, which encourages parents to avoid spanking when disciplining children. Results suggest that children, regardless of attachment style, may benefit from policies and services that promote non-violent forms of discipline.

A longitudinal analysis of the spatial spread of police-investigated physical child abuse.

BACKGROUND: Research has shown that problematic behaviors, such as violence and drug use, may spread through shared physical space and social norms, lending rise to the notion of contagion theories of human behavior. OBJECTIVE: This study examines whether physical child abuse spreads across time and space in a pattern reflective of a contagion model. PARTICIPANTS AND SETTING: This study uses 15 years of data from a large U.S. city police department. Data points are geo-located police-investigated physical child abuse incidents that occurred from 2001 to 2015. METHODS: Police department data are combined with U.S. Census estimates of the number of child residents in each of the Census Tract comprising the study site to derive annual rates of police-investigated physical child abuse cases per 1000 children residing in each Census tract. A panel data spatial regression model is used to analyze the association between this dependent variable, the rate of police-investigated physical child abuse cases in surrounding Census tracts, and time. The analysis statistically controls for multiple covariates commonly associated with Census tract-level estimates of child maltreatment, specifically household median income, residential instability, racial composition, population density, and the concentration of child residents. RESULTS: The rate of physical child abuse in a Census tract is positively associated with the rate of physical child abuse in the surrounding Census tracts, net of the covariates and the effect of time (ß = 0.461, p <  .001). CONCLUSION: This finding provides preliminary evidence that physical child abuse, like some other problematic human behaviors, may spread spatially.