Abstract
Background:
The previous researchers have postulated that an abused child may abuse his or her abuser parent when the parent is getting old, also known as the intergenerational transmission of violence. However, few studies use data to support this model, and it has yet to be examined in the U.S. Chinese community. This study aims to examine the association between childhood abuse and elder abuse reported by Chinese adult children in the United States.
Methods:
Guided by a community-based participatory research approach, 548 Chinese adult children aged 21 years and older participated in this study. Childhood abuse was assessed by four-item Hurt–Insult–Threaten–Scream (HITS) scale. Elder abuse was assessed by a 10-item instrument derived from the Caregiver Abuse Screen (CASE). Logistic regression analysis was performed.
Results:
Childhood abuse was associated with caregiver abuse screen results (odds ratio = 1.92, 95% confidence interval = 1.24–2.95). Being physically hurt (r = .13, p < .01), insulted (r = .15, p < .001), threatened (r = .12, p < .01), and screamed at (r = .18, p < .001) as a child were significantly correlated with caregiver abuse screen results.
Conclusion:
This study suggests that childhood abuse is associated with increased risk of elder abuse among Chinese adult children in the United States. Longitudinal research should be conducted to explore the mechanisms through which childhood abuse and its subtypes links with elder abuse.
Keywords: Violence, Intergenerational transmission of violence, Chinese
Violence, defined as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation” (1), is a global public health issue. With a prevalence ranging from 2.2% to 61.1% across the world (2), elder abuse, as one subtype of violence, is prone to be underreported in official death statistics, police report, and data on injuries treated in hospital emergency departments (3). Previous studies have demonstrated that elder abuse may lead to psychological distress, increased morbidity, and mortality in older adults (4,5). It is connected with increased health services utilization, such as nursing home placement, emergency department utilization, and hospitalization (6–8). However, compared to other types of violence, elder abuse has less been studied.
Child abuse, a type of violence that has been fully recognized as a social issue in the United States since the 1960s (9). It is estimated that 22.6% and 36.3% of adults worldwide suffered physical abuse and emotional abuse respectively as a child (10,11). Childhood abuse can have a long-term impact for a person. A previous study by Mullen has proved that any form of childhood abuse, including physical, emotional, and sexual abuse, is associated with higher risk of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems in adulthood (12). A longitudinal study with 1,000 adolescents has reported that the abused children continue to be at increased risk for arrests in adult life when comparing with those not being abused nor neglected (13). The long-term influence of childhood abuse supports the belief that “Violence breed violence” (14), and more literature has further explored the transmission of violence (15–17).
Intergenerational transmission of violence, also referred as “cycle of violence,” indicates that experiencing violence as a child may result in the perpetration of violence during adulthood (18). A large amount of literature has documented associations between being the childhood violence victim and committing violence when growing up across different countries and cultural backgrounds. A U.S. National Family Violence Survey suggests that adults who report physical abuse in childhood are more likely to abuse their children and partners (19). A study conducted on 304 mothers and their 498 children in Japan shows that for those mothers, being victims of childhood physical/psychological abuse is associated with perpetrating child physical/psychological abuse toward their children (20). A study in Turkey conducted with 902 women patients in the psychiatry department indicates that the major risk factor of abusing one’s own children is having a childhood physical abuse history (21). Despite the predominant use of the intergenerational transmission of violence model to explain child abuse and intimate partner abuse, limited empirical research suggests this model could apply to elder abuse, especially for the U.S. Chinese population.
Being one of the fastest growing ethnic minority groups in the United States (22), the U.S. Chinese population’s health and aging issue deserve more attention. It is reported that the U.S. Chinese population is older in average age and less acculturated among U.S. immigrant groups (22). Currently, Chinese older adults aged 60 and older account for 14% of the total Chinese population in the United States (23), with 80% being foreign born (24). Many Chinese have the traditional value that “beating is caring and scolding is loving” and “the rod makes an obedient son.” This value may be revealed in the high prevalence of child abuse in China, with 26.6% of children younger than 18 years having suffered physical abuse and 19.6% emotional abuse (25). In addition, a survey in Hong Kong shows an association between the childhood experience of abuse and the attitudinal acceptance of elder abuse (26). However, how the childhood abuse relates to the elder abuse for the U.S. Chinese population has not been answered.
In this article, this study aims to explore the association between childhood abuse and elder abuse reported by Chinese adult children in the United States. Our primary hypothesis is that childhood abuse experience is associated with greater risk of elder abuse for Chinese adult children.
Methods
Population and Settings
This study is a community-engaged cross-sectional study of Chinese adult children aged 21 years and older in the greater Chicago area. The project was initiated by synergistic community–academic collaboration among Rush Institute for Healthy Aging, Northwestern University, and many community-based social services agencies and organizations throughout the greater Chicago area. All study procedures were approved by the Institutional Review Boards of Rush University Medical Center.
Study Design and Procedure
In order to ensure the study’s relevance to the well-being of the Chinese community and increase participation, this study implemented a community-based participatory research approach. A Community Advisory Board played an essential role in providing insights and strategies for research conduct and sustaining community partnerships. Board members included community stakeholders and residents enrolled through more than 20 civic, health, social, and advocacy groups, community centers, and clinics in the city and suburbs of Chicago.
Adult children (a) who are aged 21 years and older, (b) who reside in the greater Chicago area, and (c) whose at least one parent is Chinese aged 60 years and older were eligible participants in the study. In order to ensure cultural and linguistic sensitivity, trained interviewers were equipped with multicultural and multilingual abilities. They conducted face-to-face home interviews with participants in their preferred language and dialects, such as English, Mandarin, Cantonese, Taishanese, or Teochew dialects.
Measurements
Socio-demographics, self-reported health status, and medical conditions
Basic demographic information was collected, including age, gender, education, annual personal income, marital status, living arrangement, number of children, country of origin, and language preference. Overall health status and quality of life was measured on a four-point scale (1=very good, 2=good, 3=fair, 4=poor). Health change in last year was measured on a five-point scale (1=much better; 2=somewhat better; 3=about the same; 4=somewhat worse; and 5=much worse), and then was categorized into three groups: (a) improved health; (b) same health; and (c) worsened health. Medical conditions were assessed by asking the participants to choose all the medical conditions for which they are being treated or for which they have been treated: (a) heart disease; (b) stroke or brain hemorrhage; (c) cancer; (d) diabetes, sugar in the urine, or high blood sugar; (e) high blood pressure (f) osteoarthritis, inflammation or problems with any joints; (g) asthma/ emphysema/ COPD/inhalers for lungs; (h) tuberculosis; (i) hepatitis infection; (j) kidney disease; (k) depression. The number of medical conditions was calculated by totaling the number of “yes” responses to the eleven items.
Elder abuse reported by adult children
The elder abuse reported by adult children was assessed by Caregiver Abuse Screen (CASE). The CASE is a brief screening tool with dichotomous (yes/no) response categories and is used for detecting elder abuse, without enquiring directly about the specific abusive behaviors (27). Participants were asked (a) Do you sometimes have trouble making your parents control his/her temper or aggression? (b) Do you often feel you are being forced to act out of character or do things you feel bad about, because of your parents? (c) Do you find it difficult to manage your parents’ behavior? (d) Do you sometimes feel that you are forced to be rough with your parents? (e) Do you sometimes feel you cannot do what is really necessary or what should be done for your parents? (f) Do you often feel you have to reject or ignore for your parents? (g) Do you often feel so tired and exhausted that you cannot meet your parents’ needs? (h) Do you often feel you have to yell at your parents?
We also added two items to evaluate financial abuse: (i) Do you have access to your parents’ bank account, checks, credit cards, and investment accounts? (j) Do you sometimes feel it is your responsibility to conduct financial transactions on your parent’s behalf, for what you think is their best interest? A “yes” response to any questions indicated the risk of exercising abuse. The 10-item scale in this study sample demonstrated a moderate internal consistency (Cronbach’s α = .74; range from 0 to 10).
Childhood abuse
The questions of childhood abuse experienced by adult children before they were 18 years old were adapted from Hurt–Insult–Threaten–Scream (HITS) scale (28). HITS scale is a four-item questionnaire that originally asked participants how often their partner physically hurt, insulted, threatened with harm, and screamed at them. It was demonstrated to have good internal consistency (Cronbach’s α = .80) and concurrent validity with Conflict Tactics Scale (CTS) verbal and physical aggression items (r = .85). HITS scale is a commonly utilized screening tool of domestic violence for family practice physicians and residents.
In this study, adult children were asked “During your childhood (before 18), how often did an adult in your home physically hurt you/insult you or talk down to you/threaten you with harm/scream or curse at you?” Participants responded to each of four items with a 5-point frequency format: never, rarely, sometimes, fairly often, and frequently. “Year of age when it happened?” The options for participants to choose from included before 5, 6–9, 10–13, and 14–17. “Who did this?” Participants can choose multiple answers ranged from family members to strangers. “How serious is this problem to you?” Participants can reply “No abuse/Not serious/Somewhat serious/Very serious.”
Data analysis
The characteristics of childhood abuse were presented with descriptive statistics. We used chi-square tests to compare childhood abuse and its subitems between the “Yes” to Any Caregiver Abuse Screen Item group and “No” to All Caregiver Abuse Screen Item group. Pearson correlation coefficients were calculated to determine the relationship between childhood abuse and caregiver abuse screen results. To examine the association between childhood abuse and caregiver abuse screen results, we utilized logistic regression to control for potential confounding factors. Model A was adjusted for basic sociodemographic characteristics, including age and sex. Model B added additional socioeconomic variables, including education and income. In Model C, we added the marital status, living arrangement, and number of children to previous model. In Model D, we added country of origin and language preference. In Model E, we added quality of life, health status, and health change. In Model F, we furthermore included medical conditions as a potential confounder, with childhood abuse as the independent variable. Moreover, all of the above models (Model A–F) tested the association between childhood abuse and caregiver abuse screen results. Odds ratio, 95% confidence intervals, and significance levels were reported for the multivariate analyses. All statistical analyses were conducted using SAS version 9.2 (SAS Institute, Cary, NC).
Results
Sample Characteristics
Overall, 548 Chinese adult children participated in this study, with a mean age of 47.6 (SD = 10.4, range = 22.4–75.7) and 65.3% female. Among them, 81.5% were married, and 27.4% had an annual income less than $10,000. The majority (90.0%) of the participants were born in Mainland China, and more than half of them had lived in the United States for more than 10 years, and 67.5% were interviewed in Cantonese as their preferred dialect. Childhood abuse was found in 29.2% of the participants.
Characteristics of Childhood Abuse Reported by Adult Children
The characteristics of childhood abuse reported by adult children are presented in Table 1. Having experienced childhood abuse subitems ranged from 0.9% to 28.1%. Physical hurt was the most prevalent among childhood abuse subitems (28.1%), followed by scream (4.0%) and insult (2.9%). Threat was least reported (0.9%). For the age range of experiencing childhood abuse, physical hurt more frequently happened during 6–9 years of age; insult appeared more during 6–13 years of age, and same with threat and scream. Father and mother were more likely to be the perpetrators of childhood abuse. Regarding the seriousness, adult children perceived insult, threat, and scream as more serious than physical hurt.
Table 1.
Characteristics of Childhood Abuse Reported by Adult Children
| Characteristics of Childhood Abuse | Physical | Insult | Threat | Scream |
|---|---|---|---|---|
| Frequency of child abuse, N (%) | ||||
| Never | 392 (71.9) | 529 (97.1) | 540 (99.1) | 523 (96.0) |
| Rarely | 55 (10.1) | 4 (0.7) | 0 (0.0) | 0 (0.0) |
| Sometimes | 78 (14.3) | 9 (1.7) | 3 (0.6) | 16 (2.9) |
| Fairly often | 17 (3.1) | 1 (0.2) | 1 (0.2) | 5 (0.9) |
| Frequently | 3 (0.6) | 2 (0.4) | 1 (0.2) | 1 (0.2) |
| Age, N | ||||
| Before 5 | 46 | 6 | 1 | 8 |
| 6–9 | 119 | 11 | 4 | 20 |
| 10–13 | 58 | 15 | 3 | 20 |
| 14–17 | 28 | 7 | 2 | 12 |
| Perpetrators, N | ||||
| Father | 94 | 5 | 3 | 13 |
| Mother | 109 | 10 | 2 | 11 |
| Siblings | 4 | 4 | 1 | 1 |
| Other family member | 1 | 2 | 0 | 1 |
| Others | 0 | 4 | 0 | 6 |
| Seriousness, N (%) | ||||
| Not serious | 130 (85.0) | 4 (23.5) | 1 (20) | 9 (42.9) |
| Somewhat serious | 17 (11.1) | 8 (47.1) | 3 (60) | 9 (42.9) |
| Very serious | 6 (3.9) | 5 (29.4) | 1 (20) | 3 (14.3) |
Prevalence of Childhood Abuse by the Presence of Elder Abuse
The prevalence of childhood abuse by the presence of elder abuse is shown in Table 2. Adult children who screened positive to Caregiver Abuse Screen items (36.1% vs 19.8%, p < .001) had a significantly higher prevalence of childhood abuse than those without any elder abuse. For child abuse subitems, the prevalence of physical hurt (33.6% vs 19.4 %, p < .001) among those with elder abuse was significantly higher than those without any elder abuse. Similar findings were found in scream (6.4% vs 0.5%, p < .001) and insult (4.3% vs 0.9%, p < .05).
Table 2.
Childhood Abuse by the Presence of Elder Abuse
| Childhood Abuse and Subitems | Yes to Any Caregiver Abuse Screen Item (N = 327) | No to All Caregiver Abuse Screen Item (N = 217) | χ2 | df | p Value |
|---|---|---|---|---|---|
| Childhood abuse, N (%) | |||||
| Yes | 118 (36.1) | 42 (19.4) | 17.6 | 1 | <.001 |
| No | 209 (63.9) | 175 (80.7) | |||
| Physical hurt, N (%) | |||||
| Yes | 110 (33.6) | 42 (19.4) | 13.2 | 1 | <.001 |
| No | 217 (66.4) | 175 (80.7) | |||
| Insult, N (%) | |||||
| Yes | 14 (4.3) | 2 (0.9) | 5.2 | 1 | <.05 |
| No | 313 (95.7) | 215 (99.1) | |||
| Threat, N (%) | |||||
| Yes | 5 (1.5) | 0 (0.0) | 3.3 | 1 | .07 |
| No | 322 (98.5) | 217 (100.0) | |||
| Scream, N (%) | |||||
| Yes | 21 (6.4) | 1 (0.5) | 11.9 | 1 | <.001 |
| No | 306 (93.6) | 216 (99.5) | |||
Correlations Between Childhood Abuse and Elder Abuse
The correlation between childhood abuse and elder abuse reported by adult children is detailed in Table 3. Overall, childhood abuse (r = .17, p < .001; r = .14, p < .001) and its subitems—physical hurt (r = .13, p < .01; r = .11, p < .05), insult (r = .15, p < .001; r = .15, p < .001), threat (r = .12, p < .01; r = .12, p < .01), and scream (r = .18, p < .001; r = .20, p < .001) were significantly correlated with elder abuse and its subitem of “trouble control parents’ temper.”
Table 3.
Correlations Between Childhood Abuse and Elder Abuse
| Overall Abuse and Subitems | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Elder abuse | 1.00 | |||||||||||||||
| 2 | Trouble control parents’ temper | .62# | 1.00 | ||||||||||||||
| 3 | Act out of character | .42# | .28# | 1.00 | |||||||||||||
| 4 | Difficult to manage parents’ behavior | .59# | .49# | .39# | 1.00 | ||||||||||||
| 5 | Rough with parents | .33# | .23# | .40# | .29# | 1.00 | |||||||||||
| 6 | Cannot do what is necessary | .55# | .30# | .27# | .36# | .17# | 1.00 | ||||||||||
| 7 | Reject or ignore | .43# | .14+ | .26# | .27# | .14# | .26# | 1.00 | |||||||||
| 8 | Cannot meet needs | .48# | .32# | .25# | .28# | .17# | .24# | .40# | 1.00 | ||||||||
| 9 | Yell at parents | .55# | .30# | .36# | .38# | .36# | .30# | .27# | .27# | 1.00 | |||||||
| 10 | Access to parents’ bank | .45# | .06 | .16# | .06 | .17# | −.01 | .11* | .12+ | .11* | 1.00 | ||||||
| 11 | Financial transactions | .46# | .10* | .12+ | .07 | .08 | .00 | .09* | .07 | .04 | .50# | 1.00 | |||||
| 12 | Childhood abuse | .17# | .14# | .06 | .16# | .06 | .07 | .11* | .09* | .12+ | .05 | .02 | 1.00 | ||||
| 13 | Physical hurt | .13+ | .11* | .04 | .16# | .04 | .06 | .07 | .08 | .11* | .04 | .01 | .96# | 1.00 | |||
| 14 | Insult | .15# | .15# | .12+ | .08 | .12+ | .12+ | .15# | .13+ | .15# | .08 | .01 | .34# | .21# | 1.00 | ||
| 15 | Threat | .12+ | .12+ | .19# | .15# | .07 | .04 | .09* | .08 | .06 | .00 | −.01 | .19# | .07 | .33# | 1.00 | |
| 16 | Scream | .18# | .20# | .12+ | .09* | .13+ | .07 | .17# | .14# | .08 | .08* | .06 | .41# | .22# | .47# | .27# | 1.00 |
Note: *p < .05, +p < .01, #p < .001.
Association Between Childhood Abuse and Elder Abuse
Table 4 presents the association between childhood abuse and elder abuse reported by adult children. After adjusting for age, gender, education, income, marital status, living arrangement, number of children, country of origin, language preference, quality of life, health status, health change, and medical conditions, adult children who suffered childhood abuse when they were young were more likely to have elder abuse against their older parents (odds ratio = 1.92, 95% confidence interval = 1.24–2.95) than those not suffering childhood abuse.
Table 4.
Association Between Childhood Abuse and Elder Abuse
| Model A | Model B | Model C | Model D | Model E | Model F | |
|---|---|---|---|---|---|---|
| Covariates | OR (95% CI) | |||||
| Age | 0.98 (0.97, 1.00) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 0.99 (0.97, 1.02) |
| Female | 0.85 (0.59, 1.24) | 0.87 (0.60, 1.27) | 0.86 (0.59, 1.26) | 0.90 (0.61, 1.32) | 0.90 (0.61, 1.32) | 0.91 (0.62, 1.34) |
| Years of education | 1.09 (1.03, 1.16)+ | 1.09 (1.03, 1.16)+ | 1.09 (1.02, 1.16)+ | 1.09 (1.02, 1.16)+ | 1.09 (1.03, 1.16)* | |
| Income | 1.04 (0.96, 1.13) | 1.04 (0.96, 1.13) | 1.04 (0.96, 1.13) | 1.04 (0.96, 1.13) | 1.04 (0.96, 1.13) | |
| Marital status | 1.09 (0.93, 1.27) | 1.06 (0.90, 1.25) | 1.06 (0.90, 1.25) | 1.06 (0.90, 1.25) | ||
| Living arrangement | 0.96, (0.83, 1.10) | 0.95 (0.83, 1.10) | 0.95 (0.83, 1.10) | 0.96 (0.83, 1.10) | ||
| Number of children | 1.04 (0.83, 1.30) | 1.03 (0.82, 1.30) | 1.03 (0.82, 1.30) | 1.03 (0.81, 1.29) | ||
| Country of origin | 1.13 (0.75, 1.69) | 1.12 (0.75, 1.69) | 1.09 (0.73, 1.64) | |||
| Language preference | 0.82 (0.70, 0.95)* | 0.81 (0.70, 0.95)* | 0.81 (0.70, 0.95)+ | |||
| Quality of life | 0.98 (0.74, 1.31) | 0.99 (0.74, 1.32) | ||||
| Health status | 0.97 (0.74, 1.27) | 0.92 (0.69, 1.22) | ||||
| Health change | 1.00 (0.73, 1.36) | 1.00 (0.73, 1.36) | ||||
| Medical conditions | 1.19 (0.95, 1.48) | |||||
| Childhood abuse | 2.26 (1.50, 3.40)# | 1.98 (1.30, 3.00)+ | 1.94 (1.27, 2.96)+ | 2.00 (1.30, 3.06)+ | 1.99 (1.30, 3.05)+ | 1.92 (1.24, 2.95)+ |
Note: CI = confidence interval; OR = odds ratio.
*p < .05, +p < .01, #p < .001.
Discussion
To our knowledge, this is the first population-based study to examine the association between childhood abuse and elder abuse reported by Chinese adult children in the United States. This study demonstrates that childhood abuse before 18 years old is significantly associated with the increased risk of elder abuse for Chinese adult children after controlling for sociodemographic characteristics. The findings of this study provide important empirical support for the model of intergenerational transmission of violence.
Our findings expand existing understanding of the relationship between childhood abuse and elder abuse. Previous literature tried to use intergenerational transmission of violence model to explain elder abuse, but little data supported this statement. A study indicated that this theory should be used to explain violence against children rather than that against older parents based on the report from perpetrators of elder abuse (n = 23) and child abuse (n = 21) (29). Another study found that abused older adults did not report physically punishing their abusive adult offspring as children (30). These two studies’ findings did not show the association between being abused as a child and becoming a perpetrator in later life. However, it is worthwhile to note the differences between the current study and the previous studies make it challenging to compare the results. First, both Korbin and Pillermer’s studies targeted mainly on physical abuse rather than other types of childhood abuse like our study. Second, the measurements that were used differed from this study. Korbin (29) utilized CTS to ask participants to recall the autobiographical events, whereas Pillemer (30) employed the open-ended questions such as “How did you usually tend to punish ‘Child’ when he/she was a child and teenager?”. Third, different from our current study that focusing on community-dwelled adult children, the participants in Korbin’s study were identified abusive individuals, and those in Pillemer’s study were abused older adults.
Our findings are more consistent with an attitudinal study on 464 Chinese living in Hong Kong, with the mean age being 28.3 years (26), which suggested childhood abuse was the strongest predictor for the endorsement of proclivity to elder abuse. However, we should note that the participants in Yan’s study might not take the target older adult as their parents because the questions were asked in a general way—whether participants would display abusive behaviors to an older adult if there were no following social constraint and punishment. In contrast, this study specifies the objects are their parents, which more focuses on the elder abuse in the family setting.
The association between childhood abuse and elder abuse provides evidence for the intergenerational transmission of violence model. According to Bandura’s (31) social learning theory, a widely accepted explanation for the intergenerational transmission of violence (32), the abused children learned the abusive behavior in response to stressful situations or conflicts, which would affect how they interact with others in the future, including the possibility of abusing their parents when they grew up. Despite the fact that our study does not assess the elder abuse behaviors directly, the findings substantiate that elder abuse, like other forms of family violence, can be learned and transmitted from generation to generation (33,34). Additionally, in our study, the childhood abuse is assessed through not only physical hurt, but also insult, threat, and scream. Insults and screaming are more closely correlated with caregiver abuse versus physical hurt, suggesting that childhood emotional abuse may have higher influence on elder abuse than childhood physical abuse, which deserves further exploration in the future.
Another intriguing finding of this study is that even though physical hurt is the most prevalent among childhood abuse subitems, adult children perceive insult, threat, and scream as more serious than physical hurt. One possible explanation is that physical discipline is normalized in Chinese culture (35), which may contribute to higher frequency of physical hurt in our study. As for the insult, threat and scream, which considered as the childhood emotional abuse, has proven to have significant impact on adults (36). Previous longitudinal studies have demonstrated that emotional abuse is associated with negative influence of a severity equal to or greater than other types of abuse (37). However, there is a paucity of research on Chinese child emotional abuse and its consequences. We have little knowledge on the reason behind the greater severity of emotional abuse. More research is needed in the future to explore the mechanisms through which childhood emotional abuse influences individuals when they grow up into adults.
Limitations should be considered when interpreting the findings of this study. First, both the childhood abuse and elder abuse are based on self-report, which may be subject to reporting bias. The participants’ childhood abuse experience may not be accurate because it relies on their own retrospective reports without any external verification, whereas the actual elder abuse could be underestimated due to the social desirability. Second, it is hard to generalize our findings to national or international Chinese populations, considering the location specificity and intra-ethnic variation. Third, although this study adjusts for potential confounders, it is possible that some unknown or unmeasured confounders we have failed to include in the analysis. Fourth, this study uses the cross-sectional design, which makes it hard to interpret the association identified. Therefore, the future longitudinal study is necessary to provide a better understanding of associations found in this study.
Despite the limitations, this study has many substantial implications for researchers, health care providers, community organizations, and policy makers. First, more research attention can focus on how the “cycle of violence” impacts the aging minority population. As childhood abuse is significantly associated with an increased risk for elder abuse among the U.S. Chinese adult children, more research efforts are needed to examine the mechanisms and the possible ways to break the “cycle of violence.” Second, the health care providers should consider the “cycle of violence” when screening or providing intervention to elder abuse cases. It is imperative to involve the psychological counseling into the intervention for adult children who experienced childhood abuse. Third, community organizations should provide more workshops or other educational opportunities to foster the Chinese traditional cultural value of “revering elders and caring the young” and enhance the public awareness of both child abuse and elder abuse issues. In addition, nurturing intergenerational communication can help to bridge the gap and to improve the relationship between adult children and older adults. Fourth, our findings suggest that policy makers should take cultural issues into consideration when designing social services and community programs to prevent child abuse and elder abuse.
Conclusion
This study indicates that childhood abuse is associated with increased risk of elder abuse among Chinese adult children in the United States. It may contribute to the screening and potential interventions toward reducing elder abuse in the U.S. Chinese communities. Longitudinal research should be conducted to explore the mechanisms through which childhood abuse and its subtypes links with elder abuse.
Funding
This work was supported by National Institute on Aging grants (R01 AG042318, R01 MD006173, R01 NR14846, R01 CA163830, R34 MH100443, R34 MH100393, and RC4 AG039085); Paul B. Beeson Award in Aging; the Starr Foundation; and the American Federation for Aging.
Conflict of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acknowledgments
We are grateful to the Community Advisory Board members for their continued effort in this project. Particular thanks are extended to Bernie Wong, Vivian Xu, Yicklun Mo with Chinese American Service League (CASL), Dr. David Lee with Illinois College of Optometry, David Wu with PuiTak Center, Dr. Hong Liu with Midwest Asian Health Association, Dr. Margaret Dolan with John H. Stroger Jr. Hospital, Mary Jane Welch with Rush University Medical Center, Florence Lei with CASL Pine Tree Council, Julia Wong with CASL Senior Housing, Dr. Jing Zhang with Asian Human Services, Marta Pereya with Coalition of Limited English Speaking Elderly, and Mona El-Shamaa with Asian Health Coalition.
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