Traumatic child death and documented maltreatment history, Los Angeles.

OBJECTIVES. Child abuse is a presumed but largely untested risk factor for child homicide. This research investigated the social and child protective service history of child homicide victims. METHODS. A pairwise matched case-control design was used to assess documented child maltreatment as a risk factor for homicide vs unintentional injury death. Homicide victims aged 0 to 14 years were identified through Los Angeles Police Department case summaries. Control subjects (children who died of an unintentional injury) were matched to case subjects (children who died from homicide) by age, sex, race/ethnicity, and date of death. Case and control subjects were linked with county service records to determine any known history of maltreatment. RESULTS. A total of 220 children were homicide victims during 1978 through 1987 in the city of Los Angeles. Only one in six children who died (of homicide or unintentional injury) or his/her family was known to county social or child protective services prior to the death. Recorded history of child protective services was associated with homicide victimization (adjusted odds ratio = 3.40, 95% confidence interval = 1.25, 9.27). CONCLUSIONS. Current service systems need assistance in identifying and protecting children at high risk of homicide.     

Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings

There is increasing evidence that in utero effects of excessive gestational weight gain may result in increased weight in children; however, studies have not controlled for shared genetic or environmental factors between mothers and children. Using 2,758 family groups from the Collaborative Perinatal Project, the authors examined the association of maternal prepregnancy body mass index (BMI) and gestational weight gain on child BMI at age 4 years using both conventional generalized estimating equations and fixed-effects models that account for shared familial factors. With generalized estimating equations, prepregnancy BMI and gestational weight gain had similar associations with the child BMI z score (β = 0.09 units, 95% confidence interval (CI): 0.08, 0.11; and β = 0.07 units, 95% CI: 0.04, 0.11, respectively. However, fixed effects resulted in null associations for both prepregnancy BMI (β = 0.03 units, 95% CI: -0.01, 0.07) and gestational weight gain (β = 0.03 units, 95% CI: -0.02, 0.08) with child BMI z score at age 4 years. The positive association between gestational weight gain and child BMI at age 4 years may be explained by shared family characteristics (e.g., genetic, behavioral, and environmental factors) rather than in utero programming. Future studies should continue to evaluate the relative roles of important familial and environmental factors that may influence BMI and obesity in children.     

Age- and sex-specific analysis of homicide mortality as a function of economic development: a cross-national comparison

AIMS: This study examined the association between homicide rates and GNP per capita (as a measure of economic development) among all age- and sex-specific groups in 53 countries. METHODS: Cross-sectional data on homicide rates by age- and sex- specific groups were obtained for 53 countries from World Health Statistics Annual 1996. The association between homicide rates and economic development was studied by using two methods: (1) with regression analysis and (2) by categorizing the data into four income-based country groups and then comparing the differences in their mean values. RESULTS: Results indicate that there was a negative correlation between homicide rates and economic development. The association between homicide rates and country GNP per capita became stronger with increasing age. Pearson's product moment correlation coefficient was strongest among older age groups (65+year) in both sexes (male, r = -0.77 and female, r = -0.71). The correlation was weakest and positive among 1- to 4-year-old children (males, r = 0.17 and females, r = 0.07). The homicide rate among females was highest for <1-year-old children in low income countries (LICs) (12.8 per 100,000). CONCLUSIONS: Lower middle-income countries are in the stage of high priority where both homicide rates and homicide as percentage of total death are high, and its impact was greatest for young males. However, infanticide as a public health problem seems highly concentrated in the poorest countries, while homicide among small children, 1-4 years old, appears to be a universal phenomenon across all nations.     

Sex- and age- specific relations between economic development,economic inequality and homicide rates in people aged 0-24 years: a cross-sectional analysis

OBJECTIVE: To test whether relations between economic development, economic inequality, and child and youth homicide rates are sex- and age-specific, and whether a country's wealth modifies the impact of economic inequality on homicide rates. METHODS: Outcome variables were homicide rates around 1994 in males and females in the age ranges 0-4, 5-9, 10-14, 15-19 and 20-24 years from 61 countries. Predictor variables were per capita gross domestic product (GDP), GINI coefficient, percentage change in per capita gross national product (GNP) and female economic activity as a percentage of male economic activity. Relations were analysed by ordinary least squares regression. FINDINGS: All predictors explained significant variances in homicide rates in those aged 15-24. Associations were stronger for males than females and weak for children aged 0-9. Models that included female economic inequality and percentage change in GNP increased the effect in children aged 0-9 and the explained variance in females aged 20-24. For children aged 0-4, country clustering by income increased the explained variance for both sexes. For males aged 15-24, the association with economic inequality was strong in countries with low incomes and weak in those with high incomes. CONCLUSION: Relations between economic factors and child and youth homicide rates varied with age and sex. Interventions to target economic factors would have the strongest impact on rates of homicide in young adults and late adolescent males. In societies with high economic inequality, redistributing wealth without increasing per capita GDP would reduce homicide rates less than redistributions linked with overall economic development.     

Familial instability and young children's physical health

This paper uses recent longitudinal data about a cohort of young children born in the United States to mostly unmarried parents to examine the association between increasingly-complex patterns of family instability and physical health in early childhood. The analyses assess whether, and how, the association between family instability and child health varies across a number of family types. We consider several measures of children's health at age five (overweight/obesity, asthma diagnosis and overall health) and examine to what extent the association between family instability and child health varies across outcomes and depends on the number and timing of any familial transitions. We also explore a number of potential mechanisms through which family instability may affect child health. The results suggest that familial instability is related to worse child health, particularly among children born to coresident (married or cohabiting) biological parents and for children who experience high levels of residential instability.     

The impact of truncation and missing family links in population-based registers on familial risk estimates

Family history information is often incomplete in population-based disease registers because of truncation and/or missing family links. In this study, the authors simulated complete populations of related individuals with realistic age, family structure, and incidence rates. After mimicking the realities of register-based data, such as left truncation of family history and missing family links due to death, the authors explored recovery of familial association parameters from standard epidemiologic models. Truncation of family history produced almost no bias for a familial risk of 2 and 50 years of follow-up, but it had a dramatic impact when the familial risk was 10. The age distribution of disease and the magnitude of background incidence rates also affected family history loss and thus the magnitude of bias. One can safeguard against bias by starting follow-up later, with the number of registration years to be ignored in the analysis depending on the value of familial risk. The missing familial links due to death had no effect, except when there was differential mortality for cases with and without a family history of disease. In summary, truncation, and to a lesser extent missing family links, induces bias in familial risk estimates from population-based registers.     

Homicide in childhood: a public health problem in need of attention

Homicide is now among the five leading causes of death in childhood, accounting for 1/20 deaths of those less than 18 years of age. Based on childrens' changing developmental vulnerabilities, it is possible to characterize three subtypes of child homicide--infanticide, fatal child abuse and neglect after infancy, and homicide in the community. Specific approaches to primary prevention include measures to strengthen families and their community support systems, and to educate adults and children concerning appropriate behaviors of children at different ages.     

The relationship between state abortion-restrictions and homicide deaths among children under 5 years of age: a longitudinal study

The purpose of this study is to explore whether, in the U.S., there are associations between state-level variations in mortality among young children and state abortion restriction policies - such as parental-consent requirements, parental-notification requirements, mandatory delay laws, and restrictions on Medicaid funding for abortion. To investigate this, we used NCHS Multiple Cause of Deaths public-use data files for the period 1983-2002, and compiled data on children ages 0-4 identified as having died as a result of assault/homicide in each state and year. Medicaid funding of abortion, mandatory delay laws, and parental involvement laws for minors seeking abortions were included as the main predictor variables of interest. Multivariate count data models using pooled state-year-age cohort data, with state and time fixed effects and other state-level controls, were estimated. Results indicated that, between 1983 and 2002, the average increase in the number of homicide deaths for children under 5 years of age was 5.70 per state among states that implemented stricter abortion policies over that time, and 2.00 per state for states that did not. In the count data models, parental-consent laws were associated with a 13 percent increase in child homicide deaths; parental-notification laws were associated with an 8 percent increase in child homicide deaths though the results were less robust to alternate model specifications; mandatory delay requirements were associated with a 13 percent increase in child homicide deaths. While these data do not allow us to discern precise pathways via which state abortion-restrictions can lead to more child homicide deaths, we speculate that state restrictions on abortion may result in a disproportionate increase in children born into relatively high-risk environments. Additional research is called for to explore the association of state abortion-restrictions with other measures of infant/child health and well-being.     

The association between the purchase of a handgun and homicide or suicide.

OBJECTIVES: The purpose of this study was to determine whether purchase of a handgun from a licensed dealer is associated with the risk of homicide or suicide and whether any association varies in relation to time since purchase. METHODS: A case-control study was done among the members of a large health maintenance organization. Case subjects were the 353 suicide victims and 117 homicide victims among the members from 1980 through 1992. Five control subjects were matched to each case subject on age, sex, and zip code of residence. Handgun purchase information was obtained from the Department of Licensing. RESULTS: The adjusted relative risk of suicide was 1.9 (95% confidence interval [CI] = 1.4, 2.5) for persons with a history of family handgun purchase from a registered dealer. The adjusted relative risk for homicide, given a history of family handgun purchase, was 2.2 (95% CI = 1.3, 3.7). For both suicide and homicide, the elevated relative risks persisted for more than 5 years after the purchase. CONCLUSIONS: Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.     

An analytical method for assessing patterns of familial aggregation in case-control studies.

This paper describes an analytical method that is used to assess patterns of disease aggregation within family based on family history information collected in case-control studies. In such a study, cases and controls are thought of as probands whose relatives are identified, and relatives' phenotypes and other covariates such as age, sex, and genealogical relationship with the probands are recorded. By modeling the dependence of relatives' phenotypes on case-control status and other covariates, this method yields adjusted odds ratios that quantify familial aggregation. The estimated standard errors are obtained for statistical inference since the method acknowledges the potential correlations between relatives' phenotypes by using the estimating equations technique. In population-based case-control studies, the estimates and statistical inferences are generalizable to the general population. To illustrate this method, we analyzed a case-control study of colorectal cancer involving 5,190 relatives of 792 cases and 4,478 relatives of 680 population-based controls conducted in Hawaii. Although detailed results will be presented elsewhere, the colorectal cancer was found to aggregate within family with an odds ratio of 2.74 (95% confidence interval (CI): 1.78-4.21). Among parents, the odds ratio for familial aggregation was 2.38 (95% CI: 1.25-4.54). The corresponding value for siblings was 3.09 (95% CI: 1.87-5.11). It was also found that the odds ratio increases from about 2.00 for relatives of the probands who were 50 years or older to 7.66 and 12.84 for relatives of the probands who were between 40 and 50 years and under 40 years, respectively, suggesting that the familial aggregation of colorectal cancer decreases as probands' age increases.     

Sensible family planning: do not have children too late, but not too early either

Due to family planning, Dutch women are increasingly having their first child between 25 and 35 years of age. Compared to 13 other EU countries, Dutch women are having fewer children both earlier and later on in life. From 1970 onwards in the Netherlands, the mean age at first childbirth has increased by 5 years to 29.4 years. The main cause for the rising age at first childbirth is the decrease in the number of young mothers. In 2006, 7% of all childbearing women had their first child after the age of 36; this is just 4.7% higher than in 1970. The percentage of women remaining childless by delaying childbearing too long increased by 0.9%. Considering the social and medical problems in later life, it would not be wise to encourage women to have their babies at a young age, certainly not before the age of 23. Women planning a family should take into account the decline in natural fertility after the age of 35; the future mothers of the Netherlands seem to be planning and deciding wisely.     

Structural factors associated with birth complications in adolescent fertility

The purpose of this study is to examine a set of demographic, economic, familial and health-related factors for their possible significance in differentiating birth complications among a sample of adolescents and their babies in London, Ontario in 1984-86 (N = 260). Variables such as age, marital status, religion, family social class, economic situation, family composition and interaction, prenatal care and smoking behaviour were related to pregnancy and birth complication outcome. For the adolescent mothers, only certain aspects of family social class differentiated those experiencing complications. Several familial factors were associated with the occurrence of infant complications based on the bivariate analyses, but only the work status of the teenager continued to display a significant relationship with infant complications when other factors were controlled through multivariate techniques. In a circumstance in which young pregnant women receive a high degree of personal and medical attention, there appears to be little in the way of structural variables to distinguish complicated birth outcome for either the adolescent mother or her child.     

Homicide surveillance--United States, 1979-1988.

From 1979 through 1988, 217,578 homicides occurred in the United States, an average of greater than 21,000 per year. Homicide rates during this 10-year period were about 1.5 times higher than the rates during the 1950s. The national homicide rate of 10.7/100,000 in 1980 was the highest ever recorded. Homicide occurs disproportionately among young adults. Among the 15- to 34-year age group, homicide is the fourth most common cause of death among white females, the third most common cause among white males, and the most common cause among both black females and black males. In 1988, nearly two-thirds (61%) of homicide victims were killed with a firearm, 75% of these with a handgun. More than half (52%) of homicide victims were killed by a family member or acquaintance, and about one-third (35%) of homicides stemmed from a conflict not associated with another felony. The homicide mortality rate among young black males 15-24 years of age has risen 54% since 1985. Ninety-nine percent of the increase was accounted for by homicides in which the victim was killed with a firearm. The surveillance data summarized in this report should assist public health practitioners, researchers, and policymakers in addressing this important public health problem.     

Poverty and resistance to family planning

Nonacceptors of family planning in the area covered by the Government Maternity Hospital, Hyderabad, Andhra Pradesh, India, were analyzed. Among the 3901 eligible couples in the area, 3314 (85%) were nonacceptors. Among those with fewer than 2 children, more than 93% were nonacceptros; among those with 3, 84%; among those with 4 or 5 children, 71%. Even after 6 children 69% refused contraception. Most were poor, illiterate, and were either ignorant of any method or had doubts about the method. These people dream of 2 meals a day and live in unsanitary conditions. If a child is born, there is no guarantee it will live. In such situations, an extra child makes little difference in living conditions and after 3 or 4 years can actually make a contribution to the family. To get more nonacceptors to increase their interest in smaller families, basic changes must be made in economic conditions, education, health care, and old age insurance and pensions. Until a certain threshold level of social and economic development is reached, there will not be a sustained drop in the birthrate.     

Youth Violence in the United States: Major Trends, Risk Factors, and Prevention Approaches

Violence among youths is an important public health problem. Between 1985 and 1991, homicide rates among youths 15–19 years of age increased 154% and remain, today, at historically high levels. This paper reviews the major trends in homicide victimization and perpetration among youths over the last decade, the key risk factors associated with violence, and summarizes the many primary prevention efforts under way to reduce violence. Previous research points to a number of factors that increase the probability of violence during adolescence and young adulthood. Some of these factors include the early onset of aggressive behavior in childhood, social problem-solving skill deficits, exposure to violence, poor parenting practices and family functioning, negative peer influences, access to firearms, and neighborhoods characterized by high rates of poverty, transiency, family disruption, and social isolation. Efforts to address some of the primary risk factors for violence are under way across the United States, but evaluations to confirm program effectiveness are needed.     

Perception and practice of child labour among parents of school‐aged children in Ibadan,southwest Nigeria

Background The problem of child labour has lingered on in many countries because of the complex combination of social, cultural and economic factors involved. Parents play a critical role in child labour as it provides much needed extra income for the family. This study was carried out among parents of school‐aged children in an urban, low‐income community to determine the factors associated with child labour and attitudes to child labour in the community. Methods A cross‐sectional study was carried out in an urban community in Ibadan, southwest Nigeria. Questionnaires were administered to parents of school‐aged children. Results A total of 473 parents were interviewed. They were aged between 23 and 56 years, mean 37.9 years. Thirty‐nine per cent of parents indicated that they thought their school‐aged children should work. More women than men, those from polygamous homes and those with lower educational status held this view. Reasons given for wanting their children to work were to supplement family income, 45%, to gain experience, 35% and to help in family business, 10%. In all, 236 (50%) respondents reported that their school‐aged children were working. Parental factors associated with practice of child labour were polygamous marriage, low educational status, unskilled or partly skilled occupation and large family size. Seventeen per cent of parents with working children were not satisfied with their children's work conditions and complained of low earnings, long working hours, work on school days and unsafe work environment. Measures suggested to control child labour include addressing the issue of household poverty, public enlightenment about the ills of child labour and free education up to junior secondary level. Enforcement of child labour laws was the least mentioned. Conclusion We conclude that control of child labour should be a multifaceted approach involving poverty alleviation, family planning to reduce family size and free, compulsory education up to junior secondary level. Public enlightenment especially for mothers will be of additional benefit.     

The relationship of family size and spacing to the growth of preschool Mayan children in Guatemala.

The height of preschool Mayan children is analyzed with respect to family size and the spacing of their siblings, controlling for parental heights and weights. Data on 643 cases were abstracted from the records of two previous longitudinal studies on the health of children under age five years living in the highlands of Guatemala. Height at age three years is estimated from the linear regression equations fitted for each child to measurements of height repeated at three-month intervals from ages one to four years. Family size is expressed in terms of birth rank, live siblings, and the number of dependent and independent family members. Family spacing is measured as birth intervals, i.e., the number of months between the birth of the index child and his previous and subsequent siblings. Most previous studies have reported that height decreases as family size increases. This study shows that Mayan children from both small and large families are taller than those from middle-sized families. Evidence is presented to support the hypothesis that children in large families are relatively tall because their early-born siblings contribute to the family fortunes. Birth intervals are positively correlated with height. The findings are discussed in terms of their implications for family planning.     

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.     

Television use and family mealtimes among a sample of US families with preschoolers

Research has connected family mealtimes with nutrition, child development, and child academic performance. However, it is not clear how television is associated with the quality of family mealtimes, especially mealtime ritualization (MR), mealtime harmony (MH), and child food intake. Parents of preschoolers (N = 278, average age 40–76 months) completed questionnaire measures of television use, MR, MH, and dietary intake. Controlling familial demographics, television use during meals was a significant predictor of less MR and preschooler fruit and vegetable intake, but not of MH. Additionally, a three-way interaction between mealtime television use, MR, and MH visualized differing patterns of mean preschooler obesogenic food intake among families with low and high TV mealtime use. Discussion focuses on the importance of continuing to investigate the impact of screen media use on family mealtimes and other rituals related to child health.     

Misclassification of childhood homicide on death certificates

Suspect classification of homicide deaths of Connecticut residents under 20 years of age was noted for 29 percent of cases examined. Misclassification was attributed to incomplete or erroneous information recorded on the death certificates, rather than errors in the designation of ICD-9 homicide codes. The results have important implications in the interpretation of vital statistics when homicide is listed as the cause of death and underscore the value of record linkage systems.