Child physical and sexual abuse in a community sample of young adults: Results from the Ontario Child Health Study☆,☆☆
Introduction
Despite increasing recognition that child maltreatment is a major public health problem, there continues to be relatively little community-based information available about the distribution and determinants of child abuse in Canada. The Canadian Incidence Study (CIS) provides important data about official reports of maltreatment (PHAC, 2010, Trocmé et al., 2005), but only a small proportion of child abuse victims come to the attention of child protection agencies (MacMillan, Jamieson, & Walsh, 2003). The Ontario Health Supplement, a 1990–1991 province-wide survey, examined the prevalence and correlates of mental health in a probability sample of residents 15 years of age and older and included questions about exposure to child physical and sexual abuse (Boyle et al., 1996, MacMillan et al., 1997, Offord et al., 1996). Although this information served to quantify the extent of the problem, it was collected retrospectively from a predominantly adult population at a single point in time. Furthermore, the Supplement was conducted more than 20 years ago. It is important to examine more recent information about the prevalence of maltreatment, and predictors of its occurrence from longitudinal studies.
Based on the ecological approach, risk factors for abuse can be divided into four categories: demographic, familial, parental, and child (Belsky & Vondra, 1989). Of the longitudinal studies examining these factors, three involve general population samples. In two, exposure to child maltreatment was measured through retrospective self-reports and official agency reports, and in one study it was measured by retrospective self-report. The first study involved 644 families who were part of a larger sample of families randomly selected in 1975 from two upstate New York counties who were re-interviewed in 1983, 1986, and 1991–1993. Brown, Cohen, Johnson, and Salzinger (1998) identified variables linked to physical abuse, including low religious attendance, poor marital quality, single parent status, welfare, low parental involvement and other maternal factors such as serious illness, low education, youth and perinatal complications. The factors associated with child sexual abuse included being female, presence of disability in a child, harsh punishment, negative life events experienced by a child, parental death, presence of a stepfather, maternal youth, maternal sociopathy, and unwanted pregnancy. The second study, the Christchurch Health and Development Study, involved a birth cohort of 1,265 children in the Christchurch, New Zealand region recruited during mid-1977 and followed at four months and then annually until age 16 and then at 18 years followed by further assessments in adulthood. The following risk factors for child sexual abuse were identified: being female, marital conflict, low parental attachment, a high level of overprotection, and parental alcohol problems (Fergusson, Lynskey, & Horwood, 1996). The third study, the National Longitudinal Study of Adolescent Health (Add Health) followed by a US national sample of 20,745 adolescents (grades 7 through 12) into young adulthood (ages 18–26 years). Hussey, Chang, and Kotch (2006) identified the associations between lower parental education and physical neglect and physical assault, and the associations between lower family income and neglect and contact sexual abuse. In this study, child maltreatment experienced by the start of the 6th grade was measured. In general, risk factors for physical abuse include those associated with psychosocial disadvantage while risk factors for sexual abuse in childhood included family dysfunction, parental absence, and/or economic disadvantage.
The Ontario Child Health Study (OCHS), a province-wide longitudinal study, included self-report questions regarding childhood abuse in the third wave when the original participants were young adults (Boyle et al., 1987, Boyle et al., 2007). The OCHS provides data about exposure to child abuse within a time frame closer to its occurrence than the earlier Ontario Health Supplement for most participants (more than 70% of Supplement respondents were over age 35 at the time of the survey), and prospective information on correlates. Additionally, the OCHS offers the opportunity to study childhood abuse within families. This study summarizes results from the OCHS regarding the prevalence of and risk factors for physical and sexual abuse in childhood.
Section snippets
Methods
The OCHS was conducted in 1983 to investigate the distribution and determinants of health status in children aged 4–16 years (Offord et al., 1987); a second wave in 1987 assessed continuity and change in health status (Offord et al., 1992); and a third wave in 2000–2001 investigated functional outcomes in young adulthood. Information was collected about children who were 4–16 years of age in 1983 for the first wave, and about the same children when they were four years older in 1987 for the
Results
Twenty-one (1.1%) respondents out of 1,928 did not have sufficient data to make a determination of child physical abuse; a further 14 (0.7%) did not answer the child sexual abuse item; 69 respondents were missing covariate data and were retained in the analysis. The final unweighted analysis sample was 1,893 (98.2% of 1,928). These 1,893 respondents came from 1,253 families; 757 individuals (40.0%) were the sole respondent in their family and 748 respondents (39.5%) were from two-respondent
Discussion
The OCHS provides population-based information about the prevalence of exposure to child physical and sexual abuse. Although the measures and timing of retrospective reports are somewhat different, some comparison is warranted with the earlier Ontario community data from the Ontario Health Supplement discussed in the Introduction. In the Supplement, the Child Maltreatment History Self-Report (CMHSR) assessed physical abuse (6 items) and sexual abuse (4 items) by an adult while the respondent
Conclusions
The OCHS provides important information about the high prevalence of exposure to child physical and sexual abuse. Noteworthy is the strong evidence for the association between young maternal age at the time of first birth, living in poverty in childhood and urban residence, and both types of abuse. This is new information for health care providers and child protection workers, as previous studies have suggested that these factors were associated primarily with child physical abuse, but not
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This work was carried out at the Offord Centre for Child Studies, McMaster University.
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This study was funded by a grant from the Canadian Institutes of Health Research (CIHR). The research was also supported by the CIHR Institutes of Gender and Health; Aging; Human Development, Child and Youth Health; Neurosciences, Mental Health and Addiction; and Population and Public Health. Harriet MacMillan is supported by the David R. (Dan) Offord Chair in Child Studies. Michael Boyle is supported by a Canada Research Chair in the Social Determinants of Child Health.