Neglect, online invasive exploitation, and childhood sexual abuse in Hong Kong: Breaking the links.

BACKGROUND: Childhood sexual abuse (CSA) is a form of maltreatment that involves a child in sexual activity that she or he cannot fully comprehend or is unable to give informed consent to. The empirical link between child neglect and contact child sexual abuse is well established but little research examines mediators that explain this link. OBJECTIVE: This study tests online risk behaviors and unwanted sexual experiences online as sequential mediators of the neglect - CSA relationship. PARTICIPANT AND SETTING: The study uses a representative cross-sectional sample of 1097 Hong Kong adolescents. METHODS: Preacher and Hayes' (2008) non-parametric bootstrap approach was used to test three mediation hypotheses. RESULTS: Baseline logistic regression models showed neglected children had 11.2 times higher odds of reporting contact CSA (p < .001). Similarly, neglect was associated with 3.5 times higher odds of more online risk behavior (p < .001), which in turn was associated with 2.7 times higher odds of more online invasive exploitation (p < .001). Online invasive exploitation was associated with 2.7 times higher odds of reporting offline contact CSA (p < .001). The study found online risk behaviors to be a significant mediator of the relationship between neglect and online invasive exploitation (unwanted online sexual experiences). Online invasive exploitation, in turn, mediated the relationship between online risk behaviors and offline contact CSA. CONCLUSION: The findings highlight the importance of intervening against neglect as it appears to play a vital role in the etiology of contact CSA in Hong Kong.

Childhood emotional abuse and alcohol use disorders in a national Nepali women sample: The mediating role of borderline personality traits.

While many studies have found an association between childhood emotional abuse and alcohol use disorders (AUD) during adulthood, underlying psychological mechanisms linking the two remain inadequately understood. Drawing on the developmental psychopathology perspective, this study examined the relationship between childhood emotional abuse and AUD during adulthood with a national sample of women in Nepal (N = 1,100, M age = 37.73), focusing on the mediating role of borderline personality traits. Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method and bootstrapping confidence intervals. Results indicated that Nepali women's borderline personality traits significantly mediated the relationship between childhood emotional abuse and AUD. Hence, emotional abuse in childhood increases the risk for AUD during adulthood for Nepali women by increasing the risk of borderline personality traits. Findings underscore the necessity of continued emphasis on developing and implementing early interventions for childhood emotional abuse and therapeutic interventions for borderline personality traits in reducing AUD among vulnerable women in Nepal.

Gendered Dimensions of Demand for Commercial Sexual Exploitation of Children (CSEC) in Kathmandu, Nepal.

Breaking the demand chain for sex from minors would render supply worthless, contributing to the elimination of commercial sexual exploitation of children (CSEC). Using a novel sampling technique, this study reports on actual and potential adult customers of CSEC in two areas in Kathmandu (n = 466). Controlling for refusal conversion, age, education, and income, higher scores on a new Love-Fantasy Scale (LFS) were associated with increased odds of purchasing sex from young girls, as were patriarchal norms emphasizing the power of men. Further research is needed to design interventions that include aspects related to sexual fantasy for young girls to combat demand for CSEC.

The protective effects of the collective cultural value of abiriwatia against child neglect: Results from a nationally representative survey.

BACKGROUND: Over the past 20 years, there has been a growing commitment to strengthen community norms-to foster informal support for families and enhance community commitment to protect children from child abuse and neglect. The current study examined the relationship between child neglect and normative interpretations of the dominant cultural value of abiriwatia in Ghana. It was hypothesized that the norms of abiriwatia were associated with lower incidence of child neglect. METHODS: We used a random, stratified four-stage cluster design to select a nationally representative sample of 1100 female caregivers in Ghana. Norms of the cultural value of abiriwatia were measured using a new 11-item Likert scale questionnaire developed by the authors, and child neglect was measured using the Conflict Tactics Scale. RESULTS: Factor analysis of the abiriwatia scale retained three factors, community authority, collective childcare, and lineage, as the core norms of abiriwatia. We found that the abiriwatia norm of community authority was associated with fewer instances of child neglect. Norms of community responsibility for childcare were negatively associated with child neglect frequency (B = -0.31, p < .05). However, the relationship between the abiriwatia norm of lineage and child neglect was positive (B = 0.24, p < .05). CONCLUSION: The protective associations among the norms of community authority and collective childcare and child neglect suggest that traditional practices that strengthen and enforce the collective norms of abiriwatia, including storytelling, family byelaws, community durbars (community meetings), taboos, and reciprocal farming activities (nnoboa) could be protective against neglect.

Protective Community Norms and Mental Health Risks for Severe Physical Abuse: Lessons From a Nationally Representative Study of Ghana.

Although it has become axiomatic to quote an African proverb in discussions of child well-being, attempts to draw concrete and positive lessons from how African communities respond to and mitigate child maltreatment are comparatively few. This study tested the hypothesis that the collective value of Abiriwatia in Ghana, which supports legitimate norms of community obligations to care for children, could be protective against physical abuse. It also examined the claim that knowledge of the familial situation of community members, generated through Abiriwatia, may help them to act to mitigate the risk of caregiver's borderline personality disorder (BPD) features. We obtained a nationally representative sample of 1,100 female caregivers from 22 Ghanaian settlements and tested the hypotheses using multilevel models. Controlling for community-level physical abuse, living in a community with high levels of Abiriwatia childcare and community authority values is associated with lower levels of very severe physical abuse, and Abiriwatia childcare may mitigate risk from the caregiver's BPD features. Within Ghana, encouraging positive and protective aspects of traditional Ghanaian values and working to reinstate respect for these values may have positive outcomes for children. Interventions to reduce child maltreatment should be developed with reference to Abiriwatia childcare values.

Dose-Response Relationship Between Protective Family Informal Social Control and Chronic Child Neglect: Does Household Size Matter?

Larger households, involving more children, are theorized as potential risk factors for child maltreatment-resource dilution theory. But qualitative evidence shows that in collective societies, like Ghana, more adult family members may act against neglect, through protective informal social control, which helps to reduce the frequency of neglect. Family members intervention in neglect situations will be more consistent and sustained due to the sanctioned collective responsibility to care for children in the community. The purpose of this study is to test the hypothesis that having more adult family members in the household, who have the will and agency to intervene, will predict less chronic neglect. A three-stage probability proportional to size cluster sample of Ghana was collected from 1,100 primary caregiving mothers. One mother was interviewed in each household, and responses were limited to one focal child. When sample was restricted to those with chronic neglect (neglect > 1), 596 mothers remained in the data. The children have experienced 11 times neglect in the past year, and lived in households with average size of 6 members. Chronic neglect was measured using the Conflict Tactics Scale. Dose-response protective informal social control by family members was measured using the newly developed context-based scale for measuring protective informal social control of child neglect (ISC_CM2). Results from the random effects regressions models showed a negative relationship between dose-response protective informal social control and chronic neglect, and the interaction with household size was negative and significant. Ghanaian families should be sensitized to take advantage of the communal living practices, extended family systems and compound housing structures, as traditional mechanisms to promote collectivity and interventions in observed acts of neglect to protect children. The evidence contradicts the resource dilution theory's conceptualization of large household as risks factors of neglect.

Collective value of Abiriwatia and protective informal social control of child neglect: Findings from a Nationally Representative Survey in Ghana.

Evidence of the protective role of informal social control by community members (family members, friends, and neighbours) in child neglect has received considerable attention. Likewise, the protective effects of informal social control interventions in neglect are theorised to be common and highly efficacious in communities that have sanctioned informal interventions through collective social values and norms. Yet, no research has examined this theoretical postulation within the field of community/neighbourhood research in child maltreatment. We tested the theory-driven hypothesis by examining the interaction effects of protective informal social control of neglect and the collective value of Abiriwatia (a collective value based on lineage with norms on collective childcare duties) against the frequency of child neglect. Data consist of 616 caregivers' self-report of child neglect in the past year, from the Ghana Families and Neighbourhood Study. Hypotheses were tested using random effects regression models with standard errors corrected for settlement/community clusters. Protective informal social control of child neglect was significantly associated with fewer neglect in the past year (B = -0.79, p < 0.05). The interaction between protective informal social control of child neglect and the collective value of Abiriwatia was negative (B = -0.07, p < 0.05). The findings suggest that strengthening the collective normative commitment to childcare would promote family members' intervention to protect against neglect situations, and their intervention can deter further acts of neglect. Community neglect prevention programmes should take advantage of the findings to strengthen community norms that sanction collective childcare duties. Community child protection committees of the Department of Social Welfare should develop social groups and informal associations to strengthen Abiriwatia in Ghana.

Caregivers' perceptions of informal social control practices to reduce child neglect: A qualitative study in Ghana.

BACKGROUND: Rational choice deterrence theory suggests that caregiving behavior, which includes abusive and neglectful behavior, can be influenced or manipulated via informal social control strategies enacted by neighbors, family members and friends in the social network. The literature identifies two forms of informal social control that have the potential to influence maltreating caregiver behavior, protective vs punitive, with the latter having more contrasting evidence related to its influence on maltreating caregiving practices. OBJECTIVE: To examine the perceptions and meanings female caregivers associate with protective and punitive informal social control strategies that have been enacted against them. METHODS: 17 female caregivers from Ghana, who self-reported their involvement in neglectful acts, were purposively selected to engage in river of life oral history narrative interviews. Narrative accounts from the caregivers were analyzed thematically using Taguette software package. RESULTS: The findings showed that protective informal social control in child neglect are interpreted via values and norms of childcare that have been institutionalized in the community. Caregivers perceived protective informal social control to have impact on their level of respect/influence, authority in the family or community, and to elicit internal consequences: shame, guilty feelings and embarrassment. Punitive informal social control approaches were considered as misplaced interventions that had ulterior motives of satisfying the neighbors' hatred/dislike of the perpetrator and quest for revenge. CONCLUSION: The findings suggest that the development of a fruitful theoretical framework to explain the effectiveness of informal social control should prioritize the social values and legitimate norms of the community. Implications for practice and theory development are discussed.

Legitimacy, incipience, and perception of informal social control of intimate partner violence: Experiment on a Korean parent sample.

Evidence from a growing research literature on the causes and effects of informal social control (ISC) and bystander interventions carried out by nonprofessionals against intimate partner violence (IPV) shows anomalies and unexplained counterintuitive findings. This study employs a new experimental vignette design to examine the hypothesis: high bystander legitimacy (in the eyes of potential perpetrators) will moderate the effects of (1) incipient ISC and (2) perceived ISC, on parent's self-estimated likelihood of perpetrating IPV. The data consist of 210 rural Korean parents randomly drawn from Kyunggi province using a three-stage cluster probability proportional to size approach. Parents were randomly assigned to low and high incipient ISC, perceived ISC, and collective legitimacy conditions, following a 2 × 2 × 2 experimental vignette approach. Hypotheses were tested using regression models with standard errors corrected for district clusters. Incipient ISC was associated with significantly less self-estimated likelihood of perpetrating IPV. An interaction between high bystander legitimacy and incipient ISC was negative (B = -8.88, p < 0.01). The interaction between perceived ISC and legitimacy was not significant. However, the interaction between perceived ISC and female gender was positively associated with self-estimated likelihood of perpetrating IPV (B = 8.61, p < 0.05). The findings suggest that the presence of a legitimate bystander (whom the potential perpetrator believes has a legitimate right to be concerned about his or her family) may deter parents from perpetrating IPV. Programs to boost ISC and bystander intervention should include modules that strengthen collective legitimacy.

Modeling the relationship between mentoring and depression symptoms among adolescent North Korean refugees.

This study examined the conditions for, and mechanisms of, mentoring efficacy against depression symptoms in a random sample of 202 adolescent North Korean refugees living in South Korea. Rhodes (2005) argued that mentoring may benefit adolescents with high parental attachment because social engagement comes easily to them, and that it also may benefit adolescents with weak attachment because of greater need. The present study drew on Rhodes' (2005) theory to postulate curvilinear moderation of the mentoring-depression relationship by parental attachment. Teacher and peer attachment were posited as mediators of the relationship between mentoring and depression. Using fixed effects regression models, Sobel tests, and non-parametric bootstraps to test the hypotheses, a negative association was identified between mentoring and depression symptoms. Results suggested mediation by social withdrawal, and models also found a significant curvilinear moderating effect of parental attachment on the mentoring-depression relationship. These findings suggest that adolescent North Korean refugees with strong parental attachment and adolescent North Korean refugees with weak parental attachment may disproportionately benefit from mentoring as compared with adolescent North Korean refugees who scored in the middle in parental attachment. These results are also consistent with the idea that mentoring may reduce social withdrawal which, in turn, reduces depression.

Social Norms and Family Child Labor: A Systematic Literature Review.

BACKGROUND: Research has established the family as the predominant context for child labor practices. Decisions to involve children in child labor within the family or by a family member (herein family child labor) is strongly motivated by cultural beliefs that normalize child labor. This systematic review sought to synthesize evidence on the social norms that support child labor practices, and the normative interpretation of international child labor legislation/standards. METHODS: We followed the PRISMA procedure for systematic review by reviewing empirical articles published between 2000 to 2021 and contained within the four key databases: Scopus, ISI Web of Sciences, PubMed and Embase. Findings from 13 articles that met the inclusion criteria were analyzed thematically. RESULTS: The review included studies from three continents: Africa, Asia and Europe. Gender norms, informal apprenticeship norm, norms on succession and sustenance as well as obedience, were key social norms that influenced child labor practices in the family. Parents' decision to involve children in child labor was strongly influenced by the collective acceptance of some occupations (e.g., cocoa farming and fishing) as family occupations, which need to be preserved, undertaken and passed on to children. Child rights and the UNCRC principle of children's participation were considered foreign to most non-western countries and interpreted as contravention to the cherished social norm of obedience. The findings underlie the link between social norms and the common social values of resilience, hard work, and respect. CONCLUSION: The results provide foundations and target to develop normative change intervention programs to re-orient the negative interpretations of common social values and provide alternative pathways that prevent child labor within the social context.

Filicide as a cultural practice in Ghana: The qualitative understanding of a family tragedy and its implications for child protection practice.

BACKGROUND: Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public. OBJECTIVE: The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context. PARTICIPANTS AND SETTING: Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred. METHODS: Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide. RESULTS: Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide. CONCLUSION: The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.

"Invisible" children: A multiple case study on the experiences and protection of hospital-stranded children.

BACKGROUND: Hospital-stranded children are defined as children who are left by parents in medical settings for over six months. These children, who legally are not classified as orphans, are excluded from existing permanent placement policies in China. Yet, little is known about this vulnerable population of children. OBJECTIVE: This study explores the experiences of hospital-stranded children and the causes for their plight, and examines the strengths and weaknesses of existing child protection practices in medical settings. METHODS: Using a multiple-case design, 20 hospital-stranded children from three children's hospitals in a first-tier Chinese city were included in this study. Sixteen hospital personnel participated in semi-structured interviews. Interview findings, case records, and field observations were analyzed using a thematic analysis approach. Current child protection practices were analyzed through a child protection system model. RESULTS: The children in this study were well cared for by the hospitals, but their rights to provision, participation, and protection were violated due to the lack of a national child protection system. Three key weaknesses of child protection practices were identified: underreporting of suspected cases, delayed action after reporting, and inadequate follow-up services. The ineffectiveness of the national child welfare system and the family-oriented cultural values in China also created barriers to the protection of hospital-stranded children. CONCLUSIONS: The findings suggest an urgent need for a national child protection system. Professional child protection training for healthcare workers and collaboration among departments within and outside hospitals are also necessary to offer a systematic protective network for hospital-stranded children.

Invasive Exploitation and the Multiplicative Hypothesis: Polyvictimization and Adolescent Depression Symptoms in Nepal.

Adverse effects of childhood maltreatment experience and adolescent depression symptoms are theorized to be more profound for adolescents who have suffered multiple maltreatments (polyvictimization). New theoretical insights into the study of polyvictimization suggest that it must be studied using a multiplicative logic, particularly when maltreatment is characterized by invasive exploitation. This study, for the first time, examined the concept of invasive exploitation in the context of polyvictimization and its association with adolescent depression symptoms. The study used a random, three stage probability proportional to size (PPS) cluster sample of 565 mother-adolescent dyads in Kathmandu, Nepal, and also examined the protective effects of maternal empathy. We hypothesized that (a) singly, the empirical categories of maltreatment (neglect, physical abuse, and child sexual abuse) would associate positively with adolescent depressive symptoms and (b) main effects held constant, the interaction effects of a child sexual abuse X neglect and a child sexual abuse X physical abuse would be positive. Regression with clustering corrections found that neglect (B = 3.17, p < .01) and sexual abuse (B = 3.48, p < .05) positively associated with adolescent depression symptoms. Results support the multiplicative invasive exploitation polyvictimization hypothesis (child sexual abuse X neglect interaction; B = 6.14, p < .05). The positive neglect X sexual abuse interaction is consistent with the theory that sexual abuse is distinct as invasive exploitation, and demonstrates that the multiplicative hypothesis can be fruitfully applied to the study of polyvictimization. Interventions targeting polyvictims with experience of invasive exploitation and studies aiming to provide deeper insights into sexual abuse as invasive exploitation are needed.

Using suicide notes to understand suicide among cancer patients: A mixed-method study.

BACKGROUND: Cancer patients are at risk of suicide. However, no studies have used suicide notes to investigate their expressed reasons for suicide. The objectives of this study were to compare the characteristics between note leavers and non-leavers among cancer suicide cases and to understand the patterns in expressed reasons for suicide using suicide notes. METHOD: Suicide cases (2012-2017) were identified from the Hong Kong Coroner's Court reports, which provide detailed information as well as the content of suicide notes. Bivariate tests and multiple logistic regression were performed to compare the characteristics of note leavers and non-leavers among suicide cases with cancer. Thematic analysis was performed on suicide notes to extract themes of expressed reasons for suicides by cancer status and age group. RESULTS: Among cancer suicide cases and compared to non-leavers, note leavers were younger, more likely to be male, use non-violent suicide methods, have better housing conditions, and live alone. Suffering from physical disease was a major theme identified among cancer note leavers across all age groups. Young and middle-aged non-cancer note leavers had various themes identified. Physical illness was the major theme for elderly non-cancer note leavers. CONCLUSIONS: Cancer note leavers had unique characteristics and suffering from physical illness was the major expressed reason identified in the suicide notes. Healthcare professionals should pay attention to the mental as well as the physical needs of patients. Improving quality of life and regaining control of life are vital for suicide prevention among cancer patients.

Child polyvictimization in Zongo communities in Ghana: Young people's reflections on systemic resilience enablers.

PURPOSE: Polyvictimization is often commonplace for young people living in violent communities. The situation is no different for young people in Ghanaian Zongo communities where poverty, social disorder and social vices are prevalent due to structural reasons. OBJECTIVE: Using the social ecology approach to resilience, the study sought the perspectives of young people about how systemic aspects of community contribute to their positive development in high-risk communities. METHODS: Following the short narrative approach, 23 young people ages 18-24 from two Zongo communities in Ghana were engaged in qualitative interviews. FINDINGS: Cultural values of solidarity and peer support were common systemic enablers that facilitated young peoples' resilience. These enablers provided context and resources which ensured their survival in cases of neglect and abuse. Cultural values of solidarity exemplified by care for each other among residents created a safe environment and cultural capital contributed to the young peoples' resilience. Additionally, the "base" within Zongo communities provided a social structure that enabled peer support and promoted young peoples' resilience in the face of polyvictimization experiences. CONCLUSION AND IMPLICATIONS: The findings shift the resilience discourse from a conception of personality traits to one of collective aspects of community systems. They also identify cultural values of solidarity within the community that provide cultural capital for the social functioning of young people dealing with polyvictimization in high-risk environments. The findings provide pathways for professionals to promote resilience and develop resilience-oriented primary preventive measures for adolescents living in high-risk environments in Africa.

Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records.

OBJECTIVE: Cancer patients have elevated suicide risk compared to the general population. However, little is known about the characteristics of cancer patients who have died by suicide. The objectives of the study were to compare the characteristics of suicide cases with, and without cancer, and determine whether age was associated with differences in characteristics. METHODS: A total of 14,446 suicide cases between 2003 and 2017 in Hong Kong were identified using Coroner's Court reports. Cases were grouped by cancer status, based on medical history in the reports. Information extracted from the reports included sociodemographic variables and detailed descriptions of the suicide event. Univariate analyses and overall and subgroup multiple logistic regressions were performed to compare characteristics between the two groups. RESULTS: Of the 14,446 suicide cases, 1,461 (10.11%) had a cancer history. Compared to noncancer cases, cancer patients were generally older and less likely to live alone; more likely to use violent methods; less likely to have histories of physical and psychiatric problems; and more likely to communicate about their suicidal intent before death. Age was significantly associated with differences between cancer and noncancer cases. CONCLUSIONS: Cancer suicide cases have different characteristics from noncancer cases. Mental health screening may not be sufficient for suicide prevention among cancer patients. Healthcare professionals and caregivers should be aware of cancer patients' suicide risk, even when there are no signs of psychiatric disturbance.

The Counterintuitive Relationship between Telomerase Activity and Childhood Emotional Abuse: Culture and Complexity.

BACKGROUND: A burgeoning literature has found relationships between telomere length, telomerase activity, and human health and longevity. Although some research links a history of childhood adversity with shortened telomere length, our review found no prior research on the relationship between child maltreatment history and telomerase activity in adulthood. We hypothesized a negative relationship between child maltreatment and telomerase activity and hypothesized that the association would be moderated by sex. METHODS: These relationships were tested on a sample of 262 Hong Kong Chinese adults (200 females versus 62 males) with mild to moderate depression. RESULTS: Counterintuitively, emotional abuse was positively associated with telomerase activity, while other maltreatment types were non-significant. The positive relationship between emotional abuse and telomerase activity was significantly moderated by the sex of the participant. CONCLUSIONS: We advance two possible explanations for this finding (1) a culturally informed resilience explanation and (2) a homeostatic complexity explanation. The two explanations are not mutually exclusive. This trial is registered under Hong Kong Clinical Trial Register number HKCTR-1929. SIGNIFICANCE STATEMENT: Emotional abuse was significantly positively associated with telomerase activity. There are at least two non-mutually exclusive explanations for the findings. Simply put, either (1) in the cultural context of Hong Kong emotional abuse was not a risk factor, and/or (2) the conceptualization of telomerase activity as a straightforward indicator of longevity is overly simplistic. The first story we might term a "resilience explanation" while the second we might call a "homeostatic complexity" story.

A Comparative Study of Totalitarian Style Partner Control in Seoul and Beijing: Confucian Sex Role Norms, Secrecy, and Missing Data.

Totalitarian style partner control is seldom studied apart from intimate partner violence (IPV) independently as an outcome. This article uses a comparative study of Beijing and Seoul to begin to address this gap in the research. We collected three-stage probability proportional to size cluster samples of married/partnered women from Beijing (n = 301) and Seoul (n = 459), using refusal conversion to keep response rates high. We hypothesized (1) totalitarian style partner control will be positively associated with Confucian sex role norms at the (a) individual and (b) neighborhood levels, (2) totalitarian style partner control will be positively associated with IPV secrecy at the (a) individual and (b) neighborhood levels, and (3) totalitarian style partner control will be positively associated with the need for refusal conversion. Mixed effects (multilevel) regression models supported all three hypotheses at the individual level. Surprisingly, neighborhood socioeconomic status was positively associated with totalitarian style partner control. The combined data conceal important differences between Beijing and Seoul. The rate of totalitarian style partner control is more than 5 times higher in Seoul, and Confucian sex role norms, at both the individual and neighborhood levels, predict totalitarian style control there. Based on our findings, we infer that cultural emphases on face may play very different roles in the etiology of totalitarian partner control in the two cities.