Depressive symptoms, parenting attitude, and violent discipline among caregivers of left-behind children in rural China: a cross-sectional study.

BACKGROUND: The situation of mental health and discipline behaviors of left-behind children's caregivers were not optimistic in rural China. Caregivers' depression might increase the risk of using violent discipline. However, the specific ways in which depressive symptoms impact violent discipline have rarely been explored in rural areas. This study aims to assess the prevalence of violent discipline among left-behind children under 6 years of age in rural China and explore the potential mechanisms of how caregivers' depressive symptoms affect violent discipline. METHODS: We enrolled a total of 396 pairs of left-behind children and their caregivers in our study, which was conducted in 5 counties of Hebei, Henan, Jiangxi, Guizhou, and Sichuan provinces in China. The depressive symptoms of caregivers were measured by using Zung Self-rating Depression Scale (ZSDS) and violent discipline was assessed by the Child Discipline Module of Multiple Indicator Cluster Surveys (MICS). A self-designed questionnaire was utilized to measure caregiver's parenting attitude. Based on the cross-sectional data, controlling for potential confounders, structural equation modeling (SEM) was used to assess the direct and indirect effects of the mediation models by applying the weighted least squares with mean and variance adjusted (WLSMV) estimate. RESULTS: The prevalence of violent discipline, psychological aggression, and physical punishment was 72.7%, 59.3%, and 60.4% respectively of left-behind children under 6 years of age. According to the results of SEM, parenting attitude acted as a suppressor, suppressing the association between caregivers' depressive symptoms and physical punishment/psychological aggression/violent discipline. The caregivers' depressive symptoms positively influenced all the outcome variables by affecting parenting attitudes (p = 0.002, p = 0.013, p = 0.002). CONCLUSIONS: The presence of depressive symptoms in caregivers increases the use of violent discipline through negative parenting attitudes. The mental health status of primary caregivers of left-behind children in rural China needed emphasis and improvement.

Violent Discipline in North Kivu, Democratic Republic of Congo: The Role of Child Gender and Disability Status in Cross-sectional Analysis.

INTRODUCTION: Violence is used to punish or educate children across the world, with detrimental effects on their physical, emotional, and social health that persist into their adulthood. This study aimed to understand the use of violent discipline by caregivers in conflict-affected communities and how it varied by the child's gender and disability level. METHODS: Using cross-sectional data collected from 394 respondents (196 men and 198 women) in North Kivu, Democratic Republic of Congo, logistic generalized estimating equations stratified by gender assessed the association between past-three-month perpetration of violent discipline, caregiver demographics, conflict experiences, and disability attitudes, as well as child demographics of age, gender, disability level, and the interaction of gender and disability. RESULTS: Compared to women with boy children with no disability, odds of perpetration of violent discipline were higher among those with girl children with no disability (aOR: 2.24; 95%CI: 1.11-4.51) and boy children with moderate or severe disability (aOR: 2.91; 95%CI: 1.14-7.33), and the interaction of girl children with a moderate or severe disability showed a 7.80 increase in odds of perpetration; however, association with women's discriminatory disability attitudes was not significant. In contrast, the interaction of child gender and disability level were not significantly associated with perpetration of violent discipline for men, but disability attitudes were significantly associated (aOR: 1.07; 95%CI: 1.00-1.15). DISCUSSION: Results suggest that levels of violence in conflict-affected households in North Kivu, DRC are high, with women reporting higher levels of violent discipline overall, and amplified use of violence against girl children with disabilities. More research and programs with an intersectional lens are needed in conflict settings to better understand and address the use of violent discipline and underlying discriminatory norms around gender and disability.

SIGNIFICANCE: Violence against children in the home varies by gender and disability level. Evidence from predominantly Global North contexts demonstrates that children with disabilities are more likely to experience violence, with heightened risk for girls. Among conflict-affected communities in DRC, women had higher odds of using violence against girls and children with disabilities, and even higher for girl children with disabilities. Violence perpetration was also associated with the caregivers' conflict experiences. This suggests that to strengthen violence prevention in conflict settings, research and programs must be more accessible to and inclusive of people with disabilities and address inequitable gender norms.

Reducing Violent Discipline by Teachers: a Matched Cluster-Randomized Controlled Trial in Tanzanian Public Primary Schools.

Violent discipline in schools infringes on children's rights and is associated with harmful developmental consequences for students. This calls for effective intervention programs, particularly in countries with high prevalence of violent discipline in schools. This study tested the effectiveness of the preventative intervention Interaction Competencies with Children-for Teachers (ICC-T) in reducing violent discipline by teachers in a two-arm matched cluster-randomized controlled trial. The sample comprised teachers (n = 173, 53.7% female) and students (n = 914, 50.5% girls) from 12 public primary schools from six regions in Tanzania. Teacher physical and emotional violent discipline reported by teachers and students was assessed before and six to eight and a half months after the intervention. The schools were randomly allocated to either intervention (6; ICC-T) or control condition (6; no intervention). Teachers were not blinded. Students and research assistants conducting the follow-up assessment were blinded. A series of multivariate multilevel models revealed significant time*intervention effects on physical violent discipline reported by teachers and students and teachers' favorable attitudes towards physical violent discipline, FDRs < .05. In addition, we found a spill-over effect on peer-to-peer violence and students' externalizing, ps < .05. There were no significant time*intervention effects either on emotional violent discipline, FDRs > .05, teachers' favorable attitudes towards emotional violent discipline or on student's internalizing problems and academic performance, ps > .05. Our results provide further evidence that ICC-T may positively change teachers' violent disciplining behavior and their attitudes towards violent discipline. ClinicalTrials.gov, NCT03893851.

The Relationship between Grandparents' Violent Discipline and School Bullying Behavior among Left-behind Children.

Most left-behind children in rural China are raised by their grandparents, whose parenting style significantly impacts children's development. This study examined the association between grandparents' violent discipline and left-behind children's school bullying. This cross-sectional study recruited a sample of 462 left-behind children aged 10 to 15 years old (Age Mean = 12.372, 49.351% girls) from four rural primary and junior high schools in Chongqing, China. There was a significant positive association between corporal punishment (ß = .236, p < .001) and psychological aggression (ß = .272, p < .001) of grandparents and children's school bullying. Empathy and moral disengagement mediate the above association. Cross-gender comparisons indicated that corporal punishment had a greater positive relationship with school bullying in boys than girls (ßgirls = .154, p < .01; ßboys = .250, p < .001). At the same time, boys' moral disengagement was also more likely to lead to school bullying (ßgirls = .233, p < .001; ßboys = .337, p < .001). We discuss the implications of these findings for preventing bullying in schools for children left behind.

The gradients of the relationship between child discipline practices at home and early childhood development of young children.

BACKGROUND: Although the literature suggests a negative association between early childhood development (ECD) and violent disciplinary measures, little is known about the gradient of this relationship. OBJECTIVE: This study examined the gradient of the relationship between the number and types of child discipline practices at home and the ECD of children aged from 36-to-59 months. PARTICIPANTS AND SETTING: The study used nationally representative data from the Multiple Indicator Cluster Survey Bangladesh 2019. METHODS: We analysed secondary data using multivariable logistic regression to examine the relationship between child discipline practices and ECD. The gradients were measured using three sets of summative indexes of disciplinary practices and psychometric approach to the physical, literacy-numeracy, learning and social-emotional domains of ECD. RESULTS: About 94 % of children had at least one of the eight violent disciplinary measures during the month preceding the survey. Approximately three-quarters of the children were on track in their ECD. The probability that children were on track in ECD significantly increased with non-violent disciplinary practices and decreased with violent disciplinary practices used. For one unit increase in the overall violent disciplinary index, the odds of children being on track in their ECD was reduced by 12 %, and the reduction was significant (adjusted odds ratio = 0.88; 95%CI: 0.86-0.91). CONCLUSIONS: Children who had experienced several forms of violent disciplinary measures were more likely than those who did not to be delayed in their ECD. Banning violent punishments in all settings and positive parenting programs are recommended.

Socio-economic and psychosocial determinants of violent discipline among parents in Asia Pacific countries during COVID-19: Focus on disadvantaged populations.

BACKGROUND: Mobility restrictions and economic downfall as a result of the COVID-19 pandemic may increase the risk of child maltreatment, including increased risk for violent discipline use by parents. OBJECTIVE: We examined the socio-economic and psychosocial determinants of violent discipline among parents against children in Asia Pacific countries. PARTICIPANTS & SETTINGS: This secondary data analysis included 7765 parents with children 6-18 years old in eight Asia Pacific countries. METHODS: 24 potential determinants were identified, including household demographic factors, parents' psychosocial status, and livelihood changes. The dependent variable was parental use of violent discipline (physical, severe physical, psycho-social aggression, and any violent discipline). Univariate and multivariable logistic regression analysis was conducted. RESULTS: A total of 41 % of households reported violent discipline. Parental demographic characteristics that were positively related to use of violent discipline were living in rural areas, not being a household head, female sex, age younger than 35 years, and large family size. Poor parental mental health status, loss of job or reduced income due to COVID-19, lack of food at household level, parent engagement in petty trade, and owning a business also predicted violent discipline. Mandatory curfew and receiving pandemic-related education materials were also positive predictors. CONCLUSION: Some socio-demographic factors, economic hardship due to COVID-19, and poor mental health status of parents are associated with the use of violent discipline against children in the Asia Pacific region. These results highlight several potential target areas for child protection interventions by governmental and non-profit organizations, including economic, social, and mental health interventions.

The use of corporal punishment against children in Myanmar: An analysis of data from the 2015-2016 Myanmar Demographic and Health Survey.

BACKGROUND: The corporal punishment of children is a significant public health concern; corporal punishment also violates children's rights and may have negative impacts on children's long-term health. OBJECTIVE: This study investigates the prevalence of corporal punishment of children in Myanmar and associated factors. PARTICIPANT AND SETTING: This study is a secondary data analysis of the 2015-2016 Myanmar Demographic and Health Survey (MDHS). The study targeted 13,235 (weighted) children between 2 and 14 years old. METHODS: Corporal punishment of children by caregivers was assessed using six questions that utilized UNICEF's child disciplinary module. Multiple logistic regression analyses were carried out to identify associated factors. RESULTS: Nearly half of the children in the study (44.5 %; 95 % confidence interval (CI): 42.60, 46.50) were found to have been subjected to corporal punishment, and the most common form of corporal punishment was "spanking, hitting, or slapping the child on the bottom with a bare hand" (29.1 %; 95 % CI: 27.53, 30.80). Multivariable analyses revealed that a child's sex, age, education level, location of residence, and number of family members; the primary caregiver's sex and attitude toward corporal punishment; and the family's socio-economic status were all factors significantly associated with corporal punishment. The prevalence of corporal punishment of children in Myanmar was high, and many significant predictors were identified. CONCLUSION: The implementation of child protection policies and the promotion of nonviolent parenting methods should be conducted immediately to community members. Community education should particularly focus on uneducated caregivers and families with low socioeconomic status.

Association between Household Crowding and Violent Discipline and Neglect of Children: Analysis of Multiple Indicator Cluster Surveys in 26 Low- and Middle-Income Countries.

The influence of household crowding on physical and mental health has been well documented. However, research on the influence of household crowding on violent discipline and neglect of children is scarce. Therefore, we aimed to investigate whether household crowding was associated with violent discipline and neglect of children in low- and- middle-income countries (LMICs). Cross-sectional data for 280,005 and 73,030 children in 26 LMICs surveyed using the Multiple Indicator Cluster Survey were analyzed for (1) violent discipline and (2) neglect, respectively. In each country, we used logistic regression models to estimate the effects of household crowding on multiple forms of violent discipline and stimulation activities (as a proxy of the level of child neglect). Estimates were pooled using random effects meta-analyses. After adjusting for confounding variables, household crowding was associated with higher odds of any violent discipline (odds ratio (OR) = 1.09, 95% CI 1.03 to 1.15, p = 0.002) and lower odds of engaging in four or more stimulation activities (OR = 0.88, 95% CI 0.83 to 0.94, p < 0.001). The associations were stronger for urban children and children living in low- and lower-middle-income countries. The findings suggest that screenings and interventions aimed at reducing the effects of household crowding might be effective in preventing and controlling violent discipline and neglect of children in LMICs.

Modelling the effect of the COVID-19 pandemic on violent discipline against children.

BACKGROUND: The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns. OBJECTIVE: This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models. PARTICIPANTS: Children aged 1-14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included. METHODS: A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a "high restrictions" pandemic scenario, approximating conditions expected during a period of intense response measures, and a "lower restrictions" scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores. RESULTS: Under a "high restrictions" scenario there would be a 35%-46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a "lower restrictions" scenario there would be between a 4%-6% increase in violent discipline scores in these countries. CONCLUSION: Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.

Reducing violent discipline by teachers using Interaction Competencies with Children for Teachers (ICC-T): study protocol for a matched cluster randomized controlled trial in Tanzanian public primary schools.

BACKGROUND: Despite the existing national and international plans of action to end violent discipline strategies used by teachers in schools, they still prevail in Tanzanian schools. This underlines the need to implement school-based interventions that aim at reducing violent discipline by teachers. In this study, we will evaluate the feasibility and effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in Tanzanian primary schools. Following its success in secondary schools, we hypothesize that the intervention will reduce teachers' positive attitudes towards and their use of violent discipline at school. METHODS/DESIGN: The study will be conducted in six randomly selected regions in Tanzania. We have already randomly selected two schools in each region (12 in total) that fulfill our inclusion criteria. From each region, one school will be randomly assigned to the intervention and the other to the monitoring group (no intervention). Eighty students between the ages of 9 to 12 years (N = 960) and 20 teachers from each school (N = 240) will be included in the trial. We will collect data directly before the intervention (t1) and 6 months after the intervention (t2) both at intervention and monitoring schools. Using guided questionnaire assessments, we will measure violence by teachers using students' reports on their exposure to and teachers' reports on their use of violence using the Conflict Tactics Scale. Furthermore, we will assess teachers' positive attitudes towards violent discipline using a modified version of the Conflict Tactic Scale. The feasibility of the intervention will be evaluated using purpose-built measures assessing the demand, applicability, acceptability, and integration of core elements into daily work in the participating schools. DISCUSSION: The proposed study will allow us to test the feasibility and effectiveness of an intervention aiming to reduce positive attitudes towards and the use of violent discipline by teachers in school settings. With the reduction of violent discipline by teachers, this study contributes to national and international efforts towards ending violence against children as well as the attainment of the United Nations' Sustainable Development Goals that also aim to prevent all types of maltreatment of children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03893851. Registered on 28 March 2019.

Stress and positive attitudes towards violent discipline are associated with school violence by Ugandan teachers.

BACKGROUND: Globally, the use of violent discipline methods by teachers to manage child behavior is still highly prevalent despite enactment of laws that prohibit school violence. In the case of Uganda there is a dearth of accurate prevalence statistics on school violence and factors associated with the use of violence by teachers. OBJECTIVES: Therefore, the current study examined the prevalence of and attitudes towards violence. The study also explored the association between teachers' stress, positive attitudes towards violence and the use of violent discipline management methods. METHODS: A representative sample of 291 teachers and 702 students from 12 public secondary schools in southwestern Uganda responded to anonymous self-administered questionnaires. Data were collected from April to November 2017. RESULTS: Findings indicated that 86.5% of the teachers reported having used violent disciplinary methods on students in the past month while 91.5% of the students reported experiencing violence by teachers. Teachers (88.3%, n = 256) endorsed positive attitudes towards violent discipline. Teachers' stress was related to higher levels of violent discipline (ß = 0.20). This relation was mediated by positive attitudes towards violence (0.06, SE: 0.01, 95%-CI: 0.035-0.092). CONCLUSIONS: Our findings indicate that teacher reported stress was associated with their use of violent behavior and positive attitudes and that positive attitudes reduced the association between teachers' stress and violent behavior. Therefore, interventions aiming to reduce violence by teachers may need to integrate effective stress management skills, in addition to nonviolent discipline strategies, and fostering attitudinal change towards the use of violent methods.

Early childhood exposure to non-violent discipline and physical and psychological aggression in low- and middle-income countries: National, regional, and global prevalence estimates.

BACKGROUND: Advocates for children's rights have recommended the elimination of all forms of violent discipline given its detrimental effects on children's development. Yet, little is known about the global prevalence of various forms of discipline, including physical and psychological aggression, as well as alternative forms of non-violent discipline, especially in low- and middle-income countries (LMICs). OBJECTIVE: This study aims to obtain national, regional, and global prevalence estimates of the percentage and number of 2- to- 4-y-olds in LMICs exposed to these disciplinary practices by their caregivers. PARTICIPANTS AND SETTING: We use data collected between 2010 and 2016 from 107,063 2- to- 4-y-old children living in 49 LMICs as part of the Multiple Indicator Cluster Survey (MICS). METHODS: Using the best-fitting model based on cross-validation techniques, we performed predictive modeling to generate country-level prevalence estimates for 131 LMICs in 2013, as well as 95% confidence intervals around these estimates. RESULTS: We estimate that 296.2 million 2- to- 4-y-olds (95% CI 256.9, 300.9) were exposed to non-violent discipline in 2013, which corresponds to 83.9% of the population. Furthermore, 220.4 million (95% CI 138.1, 283.7) and 230.7 million (95% CI 128.4, 300.6) children were exposed to aggressive physical and psychological discipline, respectively, which corresponds to prevalence of 62.5% and 65.4%. We also identify a high heterogeneity in the estimates across and within regions, finding a higher prevalence of both violent disciplinary methods in South Asia and Sub-Saharan Africa. CONCLUSIONS: These results suggest the need for new policies and programs to minimize violent discipline around the world.