Is domestic violence learned? The contribution of five forms of child maltreatment to men's violence and adjustment

On the basis of a learning-theory approach to the intergenerational transmission of violence, researchers have focused almost exclusively on violent men's childhood experiences of physical abuse and witnessing family violence. Little consideration has been given to the coexistence of other forms of child maltreatment or the role of family dysfunction in contributing to violence. This study shows the relationships between the level of child maltreatment (physical abuse, psychological maltreatment, sexual abuse, neglect, and witnessing family violence), childhood family characteristics, current alcohol abuse, trauma symptomatology, and the level of physical and psychological spouse abuse perpetrated by 36 men with a history of perpetrating domestic violence who had attended counseling. As hypothesized, a high degree of overlap between risk factors was found. Child maltreatment, low family cohesion and adaptability, and alcohol abuse was significantly associated with frequency of physical spouse abuse and trauma symptomatology scores, but not psychological spouse abuse. Rather than physical abuse or witnessing family violence, childhood neglect uniquely predicted the level of physical spouse abuse. Witnessing family violence (but not physical abuse) was found to have a unique association with psychological spouse abuse and trauma symptomatology. These results present a challenge to the understanding of domestic violence obtained from learning theory.

Factors associated with functioning style and coping strategies of familes with a child with an autism spectrum disorder

A survey of parents/caregivers of a child with an autism spectrum disorder (ASD) was conducted to examine the relationship between ASD characteristics, family functioning and coping strategies. Having a child with ASD places considerable stress on the family. Primary caregivers of a child with ASD from a regional and rural area in Victoria, Australia (N = 53) were surveyed concerning their child with ASD, family functioning (adaptability and cohesion), marital satisfaction, self-esteem and coping strategies. Results suggest that these caregivers had healthy self-esteem, although they reported somewhat lower marital happiness, family cohesion and family adaptability than did norm groups. Coping strategies were not significant predictors of these outcome variables. Results highlight the need for support programmes to target family and relationship variables as well as ASD children and their behaviours, in order to sustain the family unit and improve quality of life for parents and caregivers as well as those children.

Family structure and children's television viewing and physical activity

Objectives: This study aimed to examine how physical activity (PA) and television (TV) viewing time of children varied according to family structure.

Methods: In 2001, 5- to 6-yr-old (N = 296) and 10- to 12-yr-old (N = 919) children and their parents were recruited from 19 state elementary schools in Melbourne, Australia. Children's PA was objectively assessed using accelerometers worn for 8 d. Sociodemographic and family structure information and time spent watching TV was collected via questionnaire completed by parents.

Results: ANCOVA revealed that, after controlling for socioeconomic status and age of child, boys without any siblings spent more minutes per day watching TV (153.2 +/- 71.3) compared with those who have siblings (129.0 +/- 64.4, P < 0.05). There were also significant differences in TV viewing time between boys with one sibling (125.5 +/- 59.9), two siblings (141.9 +/- 70.1), or three or more siblings (111.6 +/- 62.6, P < 0.001). Girls from single-parent families (145.7 +/- 85.1) spent significantly more minutes per day watching TV compared with girls from two-parent families (125.1 +/- 67.7, P < 0.05). Girls with siblings spent more minutes per day in PA (148.3 +/- 67.7) compared with those who were an only child (131.0 +/- 58.9, P < 0.05). There were significant interactions between parental status and having a sibling, with PA, and also with TV viewing for girls and between parental status and having a brother with PA for boys. There were also significant interactions between having an older sibling and child's sex with PA and between number of siblings and sex with TV viewing.

Conclusions: Family structure may be an important source of influence on children's PA and TV viewing time. Aspects of family structure interact differently with PA and TV viewing, suggesting interventions may need to be tailored with consideration of the family structure of children.

The health and well-being of adolescents: a school-based population study of the self-report child health questionnaire

Purpose: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being.

Methods: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics.

Results: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X2 linear trend, p = .00) with deterioration in health of 5–20% on all scales for emotional health concerns (40% of sample).

Conclusions: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

Associations between family circumstance and weight status of Australian children

To examine associations between weight status and multiple indicators of family circumstance in Australian elementary school children. Data were combined from the 2001 Children's Leisure Activities Study (CLAS Study) and 2002/3 Health, Eating and Play Study (HEAP Study), involving 2520 children in Grades Prep (mean age 6 years) and 5-6 (mean age 11 years) in Melbourne, Australia. Children's body mass index (BMI) was calculated from measured height and weight. Weight status (non-overweight or overweight) was determined according to International Obesity Taskforce cut-off points and BMI was transformed to z-scores based on the 2000 US growth chart data. Parents reported family circumstance (number of parents in the home, marital status, presence of siblings, parental education, parental employment status, parental work hours [HEAP Study only]) and parental BMI. Regression analyses were conducted for the sample overall and separately for young girls, young boys, older girls and older boys. Children in single-parent homes, those without siblings, and those with less educated mothers and fathers tended to have higher z-BMIs (p=0.002, p=0.003, p<0.001 and p<0.001, respectively) and were more likely to be overweight (p=0.003, p<0.001, p<0.001 and p=0.02, respectively). Associations were stronger for older children. Parental employment and work hours were not consistently associated with child weight status. The multivariable models did not demonstrate a cumulative explanatory effect (R2=0.02), except when maternal BMI was included (R2=0.07). Individual measures of family circumstance were differentially associated with child weight status and appeared to be largely independent of other measures of family circumstance. Childhood overweight interventions may need to be tailored based on the age, gender, maternal BMI and family circumstances of the target group.

Association between the family environment and television viewing in Australian children

Aim: To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status.

Methods: Parents reported the amount of time children watched TV/video both for ‘the previous school day’ and ‘usually’ and described aspects of the family environment influencing TV access as part of a large cross-sectional study in the Barwon South-western region of Victoria, Australia. Child weight status was  based on measured height and weight. All data were collected in 2003/2004.

Results: A total of 1926 children aged 4–12 years participated. Parent-reported mean ± SE TV time for the previous school day was 83 ± 1.5 min. Children who lived in a family with tight rules governing TV viewing time (22%), or who never watched TV during dinner (33%), or had only one TV in the household (23%) or had no TV in their bedroom (81%) had significantly less TV time than their  counterparts. Overweight or obese children had more TV time than healthy weight children 88 ± 2.9 versus 82 ± 1.7 min per day (P = 0.04). They were also more likely to live in a household where children had a TV in their bedroom than healthy weight children (25% vs. 17%, P < 0.001).

Conclusion: Strategies to reduce TV time should be included as part of broader strategies to prevent childhood obesity. They should include messages to parents about not having a TV in children’s bedrooms, encouraging family rules restricting TV viewing, and not having the TV on during dinner.

Healthy eating, activity and obesity prevention: a qualitive study of parent and child perceptions in Australia

Preventative health strategies incorporating the views of target participants have improved the likelihood of success. This qualitative study aimed to elicit child and parent views regarding social and environmental barriers to healthy eating, physical activity and child obesity prevention programmes, acceptable foci, and appropriate modes of delivery. To obtain views across a range of social circumstances three demographically diverse primary schools in Victoria, Australia were selected. Children in Grades 2 (aged 7–8 years) and 5 (aged 10–11 years) participated in focus groups of three to six children. Groups were semi-structured using photo-based activities to initiate discussion. Focus groups with established parent groups were also conducted. Comments were recorded, collated, and themes extracted using grounded theory. 119 children and 17 parents participated. Nine themes emerged: information and awareness, contradiction between knowledge and behaviour, lifestyle balance, local environment, barriers to a healthy lifestyle, contradictory messages, myths, roles of the school and family, and timing and content of prevention strategies for childhood obesity. In conclusion, awareness of food ‘healthiness’ was high however perceptions of the ‘healthiness’ of some sedentary activities that are otherwise of benefit (e.g. reading) were uncertain. The contradictions in messages children receive were reported to be a barrier to a healthy lifestyle. Parent recommendations regarding the timing and content of childhood obesity prevention strategies were consistent with quantitative research. Contradictions in the explicit and implicit messages children receive around diet and physical activity need to be prevented. Consistent promotion of healthy food and activity choices across settings is core to population prevention programmes for childhood obesity.

Early detection of emotional and behavioural problems in children with diabetes: the validity of the child health questionnaire as a screening instrument

Aims: To assess the validity of the Child Health Questionnaire (CHQ) as a screening tool for detecting 'at risk' emotional and behavioural  maladjustment in children with diabetes, using the Behaviour Assessment System for Children (BASC) as a gold standard measure. Methods: CHQ and BASC were administered to 103 parents of children with Type 1 diabetes, aged 7–12 years. Sub-scales of the two measures were compared using Pearson's bivariate correlations. CHQ sensitivity and specificity cut-points were optimized against the BASC borderline category using receiver operating characteristic curves. Results: The BASC Externalizing Problems scale correlated strongly with CHQ Behaviour, Global Behaviour, Mental Health, Family Activities and Family Cohesion scales (r-values −0.68, −0.54, −0.51, −0.59, and −0.42, respectively). BASC Internalizing Problems scale correlated strongly with CHQ Behaviour, Mental Health and Family Cohesion scales (r-values −0.40, −0.43 and −0.45, respectively). Using receiver operating characteristic curve analysis, the CHQ Mental Health scale most effectively identified children classified as borderline on the BASC Internalizing Problems scale (sensitivity 87%, specificity 78%), while the CHQ Global Behaviour scale most effectively identified children classified as borderline on the BASC Externalizing Problems scale (sensitivity 73%, specificity 82%). Conclusions: Significant correlations were seen between the CHQ Global Behaviour and Mental Health scales and the BASC Externalizing and Internalizing scales, respectively. Sequential use of the CHQ, as a screening tool, followed by an established mental health measure such as the BASC, may help identify children with diabetes 'at risk' for chronic maladjustment and poor health outcomes.

Social, cultural and environmental influences on child activity and eating in Australian migrant communities

Aim: This study set out to examine the socio-cultural, familial and environmental factors influencing health, eating habits and patterns of physical activity contributing to child and adolescent overweight and obesity. Methods: Semi-structured, community-based interviews were conducted with contrasting key informant three-generation families; and generation by generation focus groups of grandparents, parents and children from four cultural communities in the state of Victoria, Australia. Purposive sampling occurred from Turkish, Greek, Indian and Chinese communities that have migrated to Australia within the last three generations (n = 160, eight families, 47 children aged 5–15 years, 29 parents, 42 grandparents). Results: Evidence of two-way influences on eating and physical activity across three generations was evident, with children reporting the greatest cross-cultural diversity. A range of dietary restrictions was reported across all cultural groups. Efforts to foster healthy eating and lifestyle patterns within communities were evident. Parents, as a generation in particular, felt the need for more access to education and support regarding healthy limits for pre-puberty and puberty stages. Conclusion: There is a dynamic influence of culture on many aspects of family lifestyle across three generations. To achieve successful intervention design, childhood obesity researchers need to collaborate with diverse groups and communities. Considering the role and influence of extended family, a multigenerational, whole-of-community approach beyond that of parent and child populations ought to be considered.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

Background: Exposure to other people’s cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue.
Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.
Search strategy: The Tobacco Addiction Group register of studies was searched.MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted.
Selection criteria: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children’s environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social behavioural therapies, technology, education and clinical interventions.
Data collection and analysis: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.
Main results: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers.
Authors’ conclusions: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children’s ETS exposure.

Foucauldian analysis and 'the best interests of the child'

In this thesis I have developed a theoretical framework using Michel Foucault’s metaphor of the panopticon and applied the resulting discursive methodology to prominent risk assessment texts in Tasmanian Government child protection services. From the analysis I have developed an innovation poststructural practice of discursive empathy for use in child protection social work. Previous research has examined discourses such as madness, mothering, the family and masculinity using Foucault’s ideas and argued that each is a performance of social government. However my interest is in ‘the best interests of the child’ as governmentality; risk as the apparatus through which it is conducted and child abuse its social effect. In applying a discursive analysis, practices of risk assessment are therefore understood to actually produce intellectual and material conditions favourable to child abuse, rather than protect children from maltreatment. The theoretical framework produces in this thesis incorporates three distinct components of Foucault’s interpretive analytics of power: archaeology, genealogy and ethics. These components provide a structure for discourse analysis that is also a coherent methodical practice of Foucault’s notion of ‘parrhesia’. The practice of parrhesia involves social workers recognised that social power is subjectively dispersed yet also hierarchical. Using this notion I have analysed ‘the best interest of the child’ as a panopticon and argued that child abuse is a consequence. This thesis therefore demonstrates how child protection social workers can expose the political purpose involved in the discourse ‘the best interests of the child’, and in doing so challenge the hostile intellectual and material conditions that exist for children in our community. In concluding, I identify how discursive empathy is a readily accessible skill that social workers can use to practice parrhesia in a creative way.

The development and validation of Australian indices of child development — part II : validity support

The two outcome indices described in a companion paper (Sanson et al., Child Indicators Research, 2009) were developed using data from the Longitudinal Study of Australian Children (LSAC). These indices, one for infants and the other for 4 year to 5 year old children, were designed to fill the need for parsimonious measures of children’s developmental status to be used in analyses by a broad range of data users and to guide government policy and interventions to support young children’s optimal development. This paper presents evidence from Wave 1data from LSAC to support the validity of these indices and their three domain scores of Physical, Social/Emotional, and Learning. Relationships between the indices and child, maternal, family, and neighborhood factors which are known to relate concurrently to child outcomes were examined. Meaningful associations were found with the selected variables, thereby demonstrating the usefulness of the outcome indices as tools for understanding children’s development in their family and socio-cultural contexts. It is concluded that the outcome indices are valuable tools for increasing understanding of influences on children’s development, and for guiding policy and practice to optimize children’s life chances.

Early life stress and child temperament style as predictors of childhood anxiety and depressive symptoms : findings from the longitudinal study of Australian children

Objective. The purpose of this study was to determine whether the relationship between stressful infant environments and later childhood anxiety and depressive symptoms varies as a function of individual differences in temperament style.

Methods. Data was drawn fromthe Longitudinal Study of Australian Children (LSAC). This study examined 3425 infants assessed at three time points, at 1-year, at 2/3 years and at 4/5 years. Temperament was measured using a 12-item version of Toddler Temperament Scale (TTS) and was scored for reactive, avoidant, and impulsive dimensions. Logistic regression was used to model direct relationships and additive interactions between early life stress, temperament, and emotional symptoms at 4 years of age. Analyses were adjusted for socioeconomic status, parental education, andmarital status.

Results. Stressful family environments experienced in the infant’s first year of life (high versus low) and high reactive, avoidant, and impulsive temperament styles directly and independently predicted anxiety and depressive problems in children at 4 years of age. There was no evidence of interaction between temperament and family stress exposure.

Conclusions. Both infant temperament and stress exposures are independent and notable predictors of later anxiety and depressive problems in childhood. The risk relationship between stress exposure in infancy and childhood emotion problems did not vary as a function of infant temperament. Implications for preventive intervention and future research directions are discussed.

Are parental concerns for child TV viewing associated with child TV viewing and the home sedentary environment?

Background
Time spent watching television affects multiple aspects of child and adolescent health. Although a diverse range of factors have been found to be associated with young people's television viewing, parents and the home environment are particularly influential. However, little is known about whether parents, particularly those who are concerned about their child's television viewing habits, translate their concern into action by providing supportive home environments (e.g. rules restricting screen-time behaviours, limited access to screen-based media). The aim of this study was to examine associations between parental concerns for child television viewing and child television viewing and the home sedentary environment.
Methods
Parents of children aged 5-6 years ('younger' children, n = 430) and 10-12 years ('older children', n = 640) reported usual duration of their child's television (TV) viewing, their concerns regarding the amount of time their child spends watching TV, and on aspects of the home environment. Regression analyses examined associations between parental concern and child TV viewing, and between parental concern and aspects of the home environment. Analyses were stratified by age group.
Results
Children of concerned parents watched more TV than those whose parents were not concerned (B = 9.63, 95% CI = 1.58-17.68, p = 0.02 and B = 15.82, 95% CI = 8.85-22.80, p < 0.01, for younger and older children respectively). Parental concern was positively associated with younger children eating dinner in front of the television, and with parental restriction of sedentary behaviours and offering sedentary activities (i.e. TV viewing or computer use) as a reward for good behaviour among older and young children. Furthermore, parents of older children who were concerned had fewer televisions in the home and a lower count of sedentary equipment in the home.
Conclusions
Children of concerned parents watched more TV than those whose parents who were not concerned. Parents appear to recognise excessive television viewing in their children and these parents appear to engage in conflicting parental approaches despite these concerns. Interventions targeting concerned parents may be an innovative way of reaching children most in need of strategies to reduce their television viewing and harnessing this parental concern may offer considerable opportunity to change the family and home environment.

Multilevel analysis of the Be Active Eat Well intervention : environmental and behavioural influences on reductions in child obesity risk

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.

Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.

Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n=1812) at level 2 and households (n=1318) and schools (n=18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.

Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (−0.085 units, P=0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P=0.03), sweet drink consumption (P=0.03) and lack of household rules for television (TV) viewing (P=0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P=0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P=0.04).

Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.