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Emalee G. Flaherty, MD; Richard Thompson, PhD; Alan J. Litrownik, PhD; Adrea Theodore, MD, MPH; Diana J. English, PhD; Maureen M. Black, PhD; Traci Wike, MSW; Lakecia Whimper, MA; Desmond K. Runyan, MD, PhD; Howard Dubowitz, MD, MS

Arch Pediatr Adolesc Med. 2006;160:1232-1238.

Objective  To examine the effect of child abuse and other household dysfunction on child health outcomes.

Design  Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old.

Setting  Children in the South, East, Midwest, Northwest, and Southwest United States.

Participants  One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting).

Main Outcome Measures  (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention).

Results  Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31).

Conclusion  Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.

Author Affiliations: Department of Pediatrics, Children's Memorial Hospital, Chicago, Ill (Dr Flaherty) Department of Research, Juvenile Protective Association (Dr Thompson), and Department of Psychology, San Diego State University, and Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California at San Diego (Dr Litrownik); Departments of Social Medicine and Pediatrics, School of Medicine (Drs Theodore and Runyan), Department of Maternal and Child Health, School of Public Health (Ms Wike), and Department of Pediatrics, Children's Memorial Hospital (Ms Whimper), University of North Carolina at Chapel Hill; School of Social Work, University of Washington, Seattle (Dr English); and Department of Pediatrics, University of Maryland School of Medicine, Baltimore (Drs Black and Dubowitz).

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