Child Abuse and Neglect: Breaking the Intergenerational Link

From a public health perspective, preventing early adversity before it begins by promoting safe, stable, nurturing relationships and environments is strategic for achieving multiple health, well-being, and productivity goals.¹ Yet, much of the research related to childhood adversity’s impact on health and well-being across generations focuses almost exclusively on relational risk and protective factors. Although children learn and grow in the context of relationships with parents, friends, family, and community, the conditions within which these relationships exist can confer additional risk or protection.²

Research on intergenerational continuity of violence and adversity finds that individuals who experience abuse, neglect, or other forms of childhood adversity are more likely than are nonexposed individuals to have children who go on to have similar adverse childhood experiences,^2,3 which have been repeatedly linked with multiple negative health and life outcomes (e.g., high school noncompletion, unemployment).² However, exposure to childhood adversity is not deterministic of poor health and life opportunities across generations, particularly when there are sufficient protective factors present across the social ecology to buffer risk and help to ensure good health and well-being.⁴

A CDC INITIATIVE

To support a research initiative that prioritized the disruption of the intergenerational continuity of childhood adversity, such as child maltreatment, the Centers for Disease Control and Prevention (CDC) identified research teams with data sets on families that included assessment of multiple generations (e.g., grandparent, parent, and child); measures of lifetime experiences of all types of maltreatment (i.e., physical abuse, sexual abuse, emotional abuse, and neglect) across generations; and measures of safe, stable, nurturing relationships and environments in multiple generations. In 2010, researchers from CDC’s Division of Violence Prevention and partners from four identified university research sites—the Environmental Risk Longitudinal Twin Study (E-Risk), the Family Transitions Project, the Rochester Youth Development/Intergenerational Study, and the Lehigh Longitudinal Family Study—convened a panel to operationalize and analyze constructs that could break the cycle of maltreatment across generations. From this collaboration, a series of articles along with a meta-analysis⁴ documented intergenerational continuities in the cycle of maltreatment in each of the four studies and found that the presence of safe, stable, nurturing relationships had a significant moderating effect on the intergenerational transmission of maltreatment.³ This special section of AJPH expands this research to examine safe, stable, nurturing environmental-level factors that may help to break the cycle of maltreatment and other childhood adversity across generations.

Since its inception, the panel has collaborated with CDC investigators whose work focuses on the etiology and psychosocial sequelae of child maltreatment, violence prevention, and healthy child development to discuss the current state of science and identify gaps in the field; refine analysis plans that highlight common and unique aspects of each study; brainstorm, identify, and resolve methodological challenges; present preliminary and final results; and provide insight into the interpretation and public health implications of findings. All sites collected data on maltreatment history using official reports of child maltreatment, self-reports from parents and children, or observational data on abuse and neglect. Measures of community environment were extensive, consisting of self-report and administrative data on neighborhood poverty, access to community services (e.g., medical services, police and fire protection), perceived community social cohesion, neighborhood alcohol vendor density, socioeconomic disadvantage (e.g., low educational attainment, financial instability), unemployment, lack of social support, housing problems, conflicts with neighbors, and community crime and violence.

Analytic methods for the four studies included restricted maximum-likelihood estimation, path analysis, logistic regression, and latent profile analysis. An important strength of this panel was the ability of the sites to triangulate findings across studies. Rather than conducting common analyses by combining data across sites, the sites ran parallel analyses using their site-specific measures and data. This approach allowed each site to capitalize on its unique strengths and measures and provides a broader picture of the complex relationship between risk and protective factors and the intergenerational continuity of maltreatment.

AJPH SPECIAL SECTION

Across all studies, environmental factors affected the intergenerational continuity of early adversity in the next generation. Specifically, using data from the Family Transitions Project, Schofield et al. (p. 1148) found that, in a rural sample, communities with higher density of alcohol vendors had negative effects on the intergenerational continuity of early adversity, but the intergenerational continuity was disrupted within communities of higher social cohesion. However, neighborhood disadvantage was not independently associated with education or employment outcomes, nor did it amplify effects of child maltreatment.

Using data from the E-Risk Study, Jaffee et al. (p. 1142) found that UK youths with histories of maltreatment were at elevated risk for having poor educational qualifications as they transitioned to adulthood, yet the presence of a supportive adult helped to buffer this association.

Using data from the Rochester Studies, Henry et al. (p. 1134) found that parental history of child maltreatment of any type was associated with increased depressive symptoms and substance use in adolescence and with financial strain when the victim became a parent, which has been linked to increased risk for child maltreatment perpetration. Official reports of child maltreatment in the Lehigh Study predicted adult socioeconomic marginalization, backing research of environmental stressors having long-term developmental consequences for children, in addition to negative health and mental outcomes. Details of the former three studies are included in individual articles in this special section. The article describing the findings from the Lehigh Study is forthcoming, but details of the original study can be found in earlier publications.^5,6

BREAKING THE INTERGENERATIONAL LINK

The findings from these studies provide crucial evidence for the impact of the environment and make a strong case for community and societal changes and policies that ensure safe, stable, nurturing relationships and environments for all children and families.^1,7 Communities have multiple, interconnected structural policies and processes that can play an important role in preventing violence and protecting children and families.^2,7 Shaping a new narrative about intergenerational violence and the impact across generations includes creating an understanding that environmental factors can and do affect families. Although evidence-based parenting programs may be beneficial to parents and caregivers on a family level, breaking the intergenerational link of child maltreatment requires moving beyond parenting programs alone to incorporate the broader community and societal contexts that can help ensure the conditions for good health and well-being.⁷

Preventing child maltreatment requires everyone across job function and sector to play a role in developing long-term, sustainable solutions that address structural barriers that contribute to and perpetuate intergenerational violence. Efforts to prevent the intergenerational transmission of child maltreatment may be more successful if public and professional understanding of the associations between early adversity and environmental contexts are broadened. Providing more information on additional prevention aims that can ensure the conditions in which families can be healthy and can thrive is a critical step toward disrupting the continuity of childhood adversity. Future efforts are still needed to fully understand and prioritize the myriad factors that influence disruption of violence perpetration between generations; the studies presented herein provide an important step toward such an understanding.