The Hispanic paradox in child maltreatment: Does it fade over time?

BACKGROUND: The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally. OBJECTIVES: To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics. DESIGN: Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). PARTICIPANTS AND SETTING: We included national child maltreatment data at the county level. RESULTS: A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. CONCLUSION: Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Childhood poverty and foster care placement: Implications for practice and policy.

BACKGROUND: About 6 % of US children enter foster care (FC) at some point before age 18. Children living in poverty enter more frequently than non-poor children. Still, it is less clear if specific dimensions of poverty place a child at risk of FC entry. OBJECTIVE: This study aids our understanding of the relationships between poverty and FC entry. PARTICIPANTS AND SETTING: Data were drawn from a large linked administrative data study following low-income and/or children with maltreatment reports at baseline and followed them through 2010 (n = 9382). METHODS: Separate analyses compared low-income children and children reported for maltreatment. Cox regression analyses were used to account for clustering at the tract level. Poverty was measured at birth, receipt of income maintenance (IM) during the study period, and census tract poverty at baseline. RESULTS: The results showed that within a low-income sample, both family poverty and community poverty measures were significant factors in predicting later FC entry. However, when analyses were run comparing children with maltreatment reports with and without baseline AFDC use, the various measures of poverty diminished in impact once the type of maltreatment and report dispositions were controlled. Furthermore, we found that children living in families with more spells on income maintenance were less likely to enter FC. CONCLUSIONS: Results indicate that specific dimensions of poverty during childhood are associated with later FC entry. The lowered risk associated with a number of spells suggests connections between time limits for income assistance and the risk of entering FC.

Comparison of Terminal Elbow Extension between Humans and Baboons (Papio anubis).

It is assumed that hyperextension of the elbow joint beyond 0° in humans is due to local ligament and other soft tissue laxity. The common extant old-world olive baboon (Papio anubis), with a quadrupedal gait, commonly has a mild elbow joint flexion contracture. This study compares anatomic and functional roles of the olecranon-coronoid notch angle of the proximal ulna and the anterior direction of its opening on terminal elbow extension in humans and baboons. Active terminal elbow extension was measured in 211 elbows of skeletally mature humans using the neutral zero method. Passive elbow extension and radiographs were performed on 60 extremities of 30 anesthetized baboons. The mean olecranon-coronoid notch angle for humans and baboons was 22.2 ± 6.0° and 11.3 ± 3.2°, respectively (P < 0.001). Mixed effect regression analysis showed that the magnitude of the angle was a significant predictor of terminal elbow extension (P < 0.001) when accounting for species. Also, the causal mediation analysis showed that 18% of the difference in terminal elbow extension between species could be attributed to the olecranon-coronoid notch angle (P < 0.001). Anatomic dissection of 16 baboon arms showed that sectioning of all the anterior soft tissue structures increased mean terminal elbow extension from -18.2 ± 5.9° to -7.1 ± 6.0° and that further elbow extension was blocked primarily by the intact humeroulnar joint. The size of the notch angle and the positioning of its anterior proximal opening played a significant role in deciding terminal elbow extension in both species.

Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics.

BACKGROUND: Orthopaedic surgery has a diversity gap, as it is not representative of the racial or sex proportions of the U.S. population. This gap can lead to communication barriers stemming from health literacy, language proficiency, or cultural discordance that may contribute to current health inequities. This study assesses the influence of educational attainment, language, and cultural concordance on patient-physician communication. METHODS: In this cross-sectional study, 394 patients from an urban orthopaedic clinic were administered a Likert-type survey regarding race or ethnicity, educational level, communication, patient satisfaction, language proficiency, and culture. One-way analysis of variance, chi-square tests, and Welch t tests were used to evaluate responses. RESULTS: The majority of subjects identified as African-American/Black (50%) or Hispanic/Latino (30%). Completing high school was associated with a better ability of the subjects to communicate with their orthopaedic surgeon (p < 0.001). Hispanic subjects reported lower English proficiency (p < 0.001) and decreased ability to communicate with their physician (p < 0.001) compared with other subjects, with educational attainment influencing their ability to understand their orthopaedic surgeon in English (p < 0.001). African-American and Hispanic patients placed greater importance on orthopaedic surgeons understanding their culture than White patients (p < 0.001). Hispanic patients who saw a language and culture-concordant surgeon valued having a Spanish-speaking surgeon more than Hispanic patients who did not see a concordant surgeon (p = 0.04). CONCLUSIONS: These results suggest that patient-physician language concordance, particularly in patients with lower education, may be essential to delivering high-quality patient care. Hispanic and African-American patients placed significantly greater importance on their orthopaedic surgeons understanding their culture. Hispanic patients frequently sought care with language-concordant surgeons and placed higher value on physicians understanding their culture. To better serve minority communities, efforts should be made to increase orthopaedic surgeons' cultural humility and to recruit a diverse multilingual surgeon workforce. CLINICAL RELEVANCE: This research demonstrates that cultural and language concordance, specifically between Hispanic patients and Hispanic, Spanish-speaking surgeons, can significantly enhance patient preference and potentially improve patient satisfaction and outcomes in orthopaedic care. Additionally, it underscores the importance of understanding and addressing the diversity within the field and the patient population to better meet the needs of a multicultural society.

Do the benefits of homeownership on mental health vary by race and poverty status? An application of doubly robust estimation for causal inference.

While empirical studies have observed that homeownership is associated with improved mental health conditions, research indicates that this relationship might vary by race. Moreover, such a White-Black disparity in the impacts of homeownership on mental health could be complexed by poverty status, as maintaining one's homeownership could be a financial burden for people living in poverty status, defined by the US official poverty threshold. We add to the existing literature by analyzing the impacts of homeownership on psychological distress, simultaneously disaggregating by race and poverty status using survey data from the Panel Study on Income Dynamics from the 2017 and 2019 waves (N = 7059). Propensity score weighting and doubly robust estimation are applied to estimate causal inference for the impact of 2017 homeownership on 2019 psychological distress using negative binomial models. First, we found the impacts of homeownership on reducing psychological distress are significant for White Americans, not for Black Americans. Second, we found such a White-Black disparity is only observable for populations not living in poverty. On the other hand, for populations living in poverty, homeownership no longer lowers psychological distress for either race. Findings suggest that financial support and mental health support are needy to address inequality in the impacts of homeownership on mental health, which could simultaneously vary by poverty status and race. Implications are discussed.

Life-course trajectories of children through the U. S foster care system.

OBJECTIVE: Foster care is surprisingly commonplace in the United States, with more than one in twenty children experiencing placement in their lifetimes. Due to the complexity of foster care (e.g. age at contact, length of stay), we still lack a clear idea of how children move through the child welfare system. We pose the question, "do distinct typologies of system trajectories exist that may be used to inform policy analyses?" METHODS: We used child maltreatment reports and foster care case records for all U.S. children born in FY2006 and placed in care between birth and age 15. Using sequence analysis, we classified child-level system trajectories into distinct clusters. Then, we employed multilevel multinomial regression to explore child and system characteristics associated with each. RESULTS: Three typologies were identified: 1) early-entry-exit, 2) school-age-entry, and 3) late-entry. Early-entry-exit cases typically entered and left foster care before turning three, were frequently adopted, and had little ongoing system contact. School-age-entry children typically entered between ages 5-10, were in care for the shortest amount of time, and mostly exited to reunification. Late-entry children typically entered between ages 9-11, entered with substantial CPS history and remained in care into mid-adolescence. CONCLUSIONS: Our findings provide the first description of foster care trajectories in the US. Both practice and policy formulation can benefit from these empirically supported descriptions. Using such trajectory typologies, researchers can now explore how trajectories may predict wellbeing outcomes. We discuss how the differences among the typologies may inform identification of service needs and outcomes.

A Commentary on Recent Announcements by The American Professional Society on the Abuse of Children and Child Maltreatment.

In a recent issue of Child Maltreatment (2023 vol. 28 (4)), an editorial by Palusci et al. and a commentary by Briggs et al. were published. These two publications express the American Professional Society on the Abuse of Children (APSAC) Board's and the Child Maltreatment editorial team's stance relative to Diversity, Equity, Inclusion and Justice (DEIJ). The current commentary expresses a range of concerns regarding how APSAC and Child Maltreatment plan to advance DEIJ through their editorial policies.

Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty.

Introduction: The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Methods: Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. Results: A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Discussion: Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.

Trauma and Incarceration: A Latent Class Analysis of Lifetime Trauma Exposures for Individuals in Prison.

This paper aims to contribute to the knowledge base about the lives of individuals who experience incarceration in the U.S. in order to advance post-release intervention services. Research has shown that among the millions of Americans who cycle through prisons and jails each year, the majority are poor, in poor health, living in contexts of chronic violence, often with mental illness, and more than half are people of color. Of particular concern for this population are high rates of trauma exposure and PTSD, though the research in this area is underdeveloped, particularly for men. Using survey data gathered during a large (n = 1,516, 90% male) multi-state randomized control trial of a reentry intervention, this study used latent class analysis (LCA) to explore types and timing of trauma exposures across the life course. LCA has been found to be an effective statistical tool in intervention research for identifying high-risk groups and for informing the tailoring of interventions. This study found three latent classes: 1) Lifetime Interpersonal Polyvictimization, 2) Lifetime Environmental Exposures, and 3) Low Exposure. About one third of the sample fell within each class. Study findings indicate that not only should trauma-informed and trauma-specific interventions be the norm in reentry services, including for men, but that these interventions should target both individual and environmental factors.

Does a child maltreatment report source predict differences in immediate and subsequent report outcomes?

BACKGROUND: Mandated reporting policies, a core response to the identification of child maltreatment, are widely debated. Currently, there are calls to abolish or scale back these policies to include only certain professionals. These calls warrant evaluation of whether there are any differences in child welfare outcomes based on report source. OBJECTIVE: To determine if the initial report source predicts immediate and long-term risk of re-referral, substantiation, and placement. PARTICIPANTS AND SETTING: We used yearly National Child Abuse and Neglect Data System (NCANDS) hotline report and placement data. Children (0-14y) with a first ever hotline report in 2012-2014 were followed for three years. The final sample included 2,101,397 children from 32 states. METHODS: We use descriptive and bivariate statistics to show initial report outcomes by reporter source type and logistic regression models to evaluate the effect of report source on immediate and subsequent report outcomes. RESULTS: Professional sources varied in levels of substantiation and placement, with law enforcement, medical, and social service sources showing much higher rates. Reports from professional sources have higher odds of initial report substantiation and foster care entry, and slightly lower odds of later re-report than nonprofessional sources. We found no differences between professional and nonprofessional sources in subsequent foster care entry. CONCLUSIONS: Reports from professional, nonprofessional, and unclassified sources have varying levels of risk in some of their short- and long-term outcomes. To the degree that child protective services embrace a long-term preventative role, reports by nonprofessional report sources may provide opportunities for prevention.

Dementia and Hip Fractures: A Comprehensive Review of Management Approaches.

¼ The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.¼ Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.¼ Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.¼ Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.¼ Coordination of care within a "orthogeriatric" team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

Foster children in care due to parental incarceration: A national longitudinal study.

Using national child welfare data, we created a longitudinal data set (N = 142,143) to examine a subset of foster children (7%) who entered care due to parental incarceration (PI). Spanning FY 2005-2017, the dataset allowed us to compare children who entered care due to PI to children entering for other reasons. We found children of incarcerated parents were younger (median age of 4 vs. 6), more often White (47% vs. 42%), and less often Black (15% vs. 20%) when compared to other foster children. Parental use of alcohol (12% v. 6%) and drugs (42% v. 26%) were both more common among children who entered due to PI compared to those who entered for other reasons. Our understanding of this population is limited by inadequate data collection procedures that fail to account for societal changes created by mass incarceration. Our data indicate that investments in substance use treatment could decrease the number of children entering care.

The Application of Family Stress Model to Investigating Adolescent Problematic Behaviors: The Moderating Role of Assets.

The Family Stress Model framework proposes that household income can influence child and youth development through caregiver psychological distress. While prior studies have observed stronger associations among households with lower income, the role of assets has been ignored. This is unfortunate, as many existing policies and practices that intend to improve child and family well-being are focused on assets. The purpose of this study is to clarify whether asset poverty moderates the direct and indirect effects of paths linking household income, caregiver psychological distress, and adolescent problematic behaviors. Using the 2017 and 2019 Panel Study of Income Dynamic Main Study and 2019 and 2020 Child Development Supplements, we find that the family stress processes consisting of household income, caregiver psychological distress, and adolescent problematic behaviors are less intensive for families with more assets. These findings not only add our knowledge of FSM by taking account the moderating role of assets but also advance our understanding that assets can benefit child and family well-being through alleviating family stress processes.

Has the relationship between community poverty and child maltreatment report rates become stronger or weaker over time?

BACKGROUND: Poverty is among the most powerful predictors of child maltreatment risk and reporting. To date, however, there have been no studies assessing the stability of this relationship over time. OBJECTIVE: To examine whether the county-level relationship between child poverty rates and child maltreatment report (CMR) rates changed over time in the United States in 2009-2018, overall and across of child age, sex, race/ethnicity, and maltreatment type. PARTICIPANTS AND SETTING: U.S. Counties in 2009-2018. METHODS: Linear multilevel models estimated this relationship and its longitudinal change, while controlling for potential confounding variables. RESULTS: We found that the county-level relationship between child poverty rates and CMR rates had intensified almost linearly from 2009 to 2018. Per one-percentage-point increase in child poverty rates, CMR rates significantly increased by 1.26 per 1000 children in 2009 and by 1.74 per 1000 children in 2018, indicating an almost 40 % increase in the poverty-CMR relationship. This increasing trend was also found within all subgroups of child age and sex. This trend was found among White and Black children, but not among Latino children. This trend was strong among neglect reports, weaker among physical abuse reports, and not found among sexual abuse reports. CONCLUSIONS: Our findings highlight the continued, perhaps increasing importance of poverty as a predictor of CMR. To the degree that our findings can be replicated, they could be interpreted as supporting an increased emphasis on reducing child maltreatment incidents and reports through poverty amelioration efforts and the provision of material family supports.

Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005-2019.

We used National Child Abuse and Neglect Data System and Census data to examine Black-White and Hispanic-White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005-2019 and in multivariate models from 2007-2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black-White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic-White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.

Testing a QuantCrit-Informed Approach to the Empirical Study of Race/Ethnicity and Child Maltreatment.

The past several years have seen calls from QuantCrit scholars to "disaggregate" samples into same-race groups. To date, however, there has been no attempt to empirically evaluate the benefits of disaggregation within a child welfare sample. Using a child maltreatment dataset derived from the National Child Abuse and Neglect Data System and Census data, we empirically evaluate the utility of employing sample disaggregation (in which separate records are created for White, Black and Latino populations in each county) as well as variable creation disaggregation (in which we avoid using "full county" economic measures, but instead employ "same race/ethnicity" measures). Using model fit and convergence with findings from individual-level studies as evaluation metrics, we find that both kinds of disaggregation are demonstrably beneficial. We recommend that sample and variable disaggregation be considered by any future researchers using national geographically structured child maltreatment data.

Parameterizing Toxic Stress in Early Childhood: Maternal Depression, Maltreatment, and HPA-Axis Variation in a Pilot Intervention Study.

Adverse experiences superseding a child's capacity to sustain regulation of emotion and adaptive function are theorized to constitute "toxic stressors" when they induce a deleterious biological response within an individual. We ascertained presumptive parameters of toxic stress among 164 low-income infants and toddlers (ages 4-48 months) from 132 families enrolled in Early Head Start (EHS). We randomized a subset of these families into a pilot intervention arm of parenting education (the Incredible Years, TIY), which supplemented the EHS curriculum. Official report child abuse and neglect (CAN) and child behavior were serially ascertained over the course of the study. We observed relatively low associations among maternal depression, CAN, caregiver-child relationship quality, hair cortisol, and adverse child behavioral outcomes. Moreover, despite poverty and the high prevalence (51%) of CAN in this sample, the frequency of clinical-level internalizing and externalizing behavior among the children did not exceed that of the general population, by their parents' report. The pilot supplementation of EHS with TIY improved attendance in group meetings but did not significantly reduce adverse behavioral outcomes or CAN. This study revealed marked independence of standard indices of toxic stress (child maltreatment, maternal depression, caregiver emotional unavailability) which have been presumed to be risk factors for the development of psychopathology. That they were weakly inter-correlated, and only modestly predictive of child behavioral outcomes in this EHS sample, caution against presumptions about the toxicity of individual stressors, highlight the importance of ascertaining risk (and compensatory influences) comprehensively, suggest buffering effects of programs like EHS, and demonstrate the need for greater understanding of what parameterizes resilience in early childhood.

Neighborhood Contexts and Child Maltreatment Reports Among Families Receiving AFDC/TANF: A Longitudinal and Multilevel Study.

Attention to the relationship between neighborhood context and child maltreatment is growing. However, no study exists that considers families' residential moves and neighborhood changes longitudinally. This is particularly relevant to disadvantaged families who move frequently. Our sample includes children who experienced a child maltreatment report (CMR) or an AFDC case in early childhood. We followed up these children from 1995 to 2009 through various administrative databases. We used multilevel logistic growth curve models to estimate the CMR likelihood at each age from 1 to 16. Estimates were limited to ages on AFDC/TANF to trace families' residential addresses based on AFDC/TANF payee records. Our findings highlight the importance of tracing residential neighborhoods in a longitudinal study. While doing so, we identify some possible neighborhood contextual influences. These, however, are small in contribution to overall risk and are less observable among children that are more vulnerable.