Child abuse is a well-known child care problem. Classically, there are four main types of abuse: physical, sexual and emotional abuse, and neglect. The incidence is often underestimated because a number of cases are not severe enough for caregivers to seek medical help. However, the more severe forms of child abuse can lead to significant morbidity and even mortality. Many studies have addressed the characteristics and outcomes of child abuse. However, the financial burden of child abuse that individuals and society bear has not been well examined. In this study, the economic burden of hospitalisation for child abuse in Hong Kong is analysed. Data of 7,713 child hospitalisations and of 61,879 child visits to accident and emergency departments of public hospitals, all resulting from child abuse from 2003 to 2012, were retrieved from the Clinical Data Analysis and Reporting System. The data are analysed with particular respect to cost of child abuse. The total inpatient cost of child abuse is HK$186,046,210, which is higher than the total inpatient cost of children with acute lymphoblastic leukaemia (HK$171,895,920) but lower than that of children with asthma (HK$1,156,082,970). The average inpatient cost of child abuse per visit is HK$24,127, which is higher than the average inpatient cost of children with asthma (HK$14,458) but lower than the cost of children with acute lymphoblastic leukaemia (HK$39,165). In comparisons of the average inpatient costs of the various types of child abuse to those of asthma and acute lymphoblastic leukaemia, each type of child abuse has higher average inpatient costs than asthma but lower than acute lymphoblastic leukaemia. Neglect produces the highest average cost (HK$33,606), followed by multiple abuse (HK$25,849) and then emotional abuse (HK$25,807), unspecified abuse (HK$25,090), physical abuse (HK$24,432) and sexual abuse (HK$17,807). The overall accident and emergency department cost for child abuse is HK$43,394,400, which is much higher than the overall cost for children with acute lymphoblastic leukaemia (HK$1,193,500) but lower than that for children with asthma (HK$120,297,100). The mean cost for abuse per child is HK$5,784, which is higher than that per child with acute lymphoblastic leukaemia (HK$2,411) but lower than that per child with asthma (HK$6,389). Comparisons of the mean accident and emergency department costs of the various types of child abuse to asthma and acute lymphoblastic leukaemia showed that each type of child abuse has a higher mean cost than that of acute lymphoblastic leukaemia, while only neglect and emotional abuse have higher mean costs than asthma. Of the mean accident and emergency department charges for each type of child abuse, neglect has the highest average cost (HK$7,108), followed by emotional abuse (HK$6,489), and then sexual abuse (HK$5,890), multiple abuse (HK$5,851), unspecified abuse (HK$5,823) and physical abuse (HK$5,720). The total and average costs of hospitalisation for child abuse in the Chinese population are higher than those in the non-Chinese population. Comparisons of the total cost and the average cost of hospitalisation between sexes showed that girls account for a higher total cost but lower average cost than boys. Of the three age groups of children, the 6-12 year-olds incur the highest total hospitalisation cost and the 0- to 6-year-olds had the highest mean hospitalisation cost. The costs of hospitalisations by different pay codes for child abuse, asthma, and acute lymphoblastic leukaemia are analysed. In conclusion, compared to children with asthma, the severity of child abuse is high while the frequency of it is low. Interventions to reduce the severity of child abuse are to be considered. To compare to the other control group, the frequency of child abuse is more common and the severity of it is lower than that of children with ALL. Interventions to reduce the frequency of child abuse are in high priority compared to ALL. To the overall costs of hospitalisations for types of abuse, the financial burden of overall inpatient cost of physical abuse is high while financial burden of inpatient cost of individual cases of it is just average. Hence the frequency of physical abuse is high but its severity is low. Meanwhile, the financial burden per inpatient case of neglect is high while the total financial burden of hospitalisations for neglect is low. Hence the severity of neglect is high but its frequency is low. The data in this study could be used to further analyse the cost of child abuse, including non-medical costs and indirect costs, and for cost-effectiveness analysis. / published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Medical Sciences

Not available / text

The question of the etiology of child abuse has received growing research attention since the early 60's. This attention has moved from a strictly individual psychopathology focus to a more systemic, environmental perspective. The determination of significant correlates of child abuse, in view of this dichotomy, holds very important policy and intervention implications. This is because as the importance of environmental factors rises, so does the "depth" or systemic nature of the intervention required. The environmental model proposes that abusive behaviour is not only a function of an individual's psychological makeup. In addition, factors outside the individual are thought to be critical components in the abuse phenomenon. These factors are a part of the social environment of the individual and thus impinge upon all individuals who live in that environment. Research into environmental correlates of child abuse is still at an early phase of development. The works of James Garbarino, Blair and Rita Justice, and Ralph Catalano, David Dooley, et al. have made progress in identifying possible significant systemic correlates, in tentative connective hypotheses, and in research approaches. Garbarino, and Catalano, Dooley, et al have focused on various community-level features of economic climate. The Justices' have focused on the importance of high levels of stress in inducing abusive behaviour. However, this work has all pertained to the American environment. There are no studies which have started replicating their seminal work in Canada. The present study does precisely this. This study tests for the existence of an association between selected correlates of the economy's ability to provide jobs and the incidence of child abuse. The selected correlates of the economy are the size of the labour force and the unemployment rate in the Greater Vancouver Metropolitan area, and the rate of income assistance receipt by employable persons for a subset of municipalities found within the Greater Vancouver Metropolitan area. These variables are aggregate monthly totals. They are correlated with a monthly incidence rate of child abuse reports drawn from the same geographical area as the income assistance statistics. The ability of a community to provide jobs is a significant feature of a community's environment, and one which may create general stress. Thus, a significant correlation was expected. The series' were manipulated using the ARIMA method of time series analysis in order to remove regular, patterned behaviour in the series'. The "prewhitened" series' were then regressed from a twelve month lead through to a twelve month lag interval. This resulted in 300 correlations. The findings were very conservative, with only 13 significant correlations. The interpretation of this was based on patterns of correlation, consistency across lags and between similar variables. There did not appear to be any consistency in the significant findings. However, regression of unprewhitened series' showed very significant correlations. This lead the researcher to the conclusion that the modelling process removed whatever features were producing the correlation. This suggests, due to the nature of the modelling process, that some regular or very subtle pattern occurs within both the economic series' and the child abuse series'. Further research is needed to determine the nature of this pattern, and the degree of actual correlation it indicates, as opposed to a simple third variable explanation. / Arts, Faculty of / Social Work, School of / Graduate

This study examined the association between poverty and child neglect. The existence of a general association has been established for some time. However, there is much debate, and little detailed research, on the specific processes that create this association. This study focused on the form of neglect that involves the most health risk for children—physical neglect. It was hypothesized that poverty should increase the likelihood of a specific type of physical neglect, neglect of safety and basic needs, occurring more than other types. Using official child protective services data from a national data set three types of physical neglect were examined: abandonment, lack of safety or basic needs, and inadequate supervision. Hypothesis 1 was that poverty increases the odds of safety/basic needs neglect more than it influences the odds of either abandonment neglect or inadequate supervision neglect, controlling for prior neglect. Hypothesis 2 focused on a test of whether the link between poverty and physical neglect is not direct, but is instead mediated by caregiver stress. Three waves of longitudinal data were used for this test to establish causal time order between poverty and stress, and between stress and physical neglect. This study analyzed data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), Assessments 0-3 from the National Data Archive on Child Abuse and Neglect at Cornell University. The data was analyzed using multinominal logistic regression for both models. The results did not confirm Hypothesis 1, though the analysis was limited somewhat due to low frequencies of some physical neglect types in certain age groups. Hypothesis 2 was confirmed showing that the effect of poverty on physical neglect was completely mediated by caregiver stress for the abandonment and safety/basic needs types of physical neglect. Implications of the results for research on the effects of poverty on child neglect, and for preventing child neglect are discussed. / Graduation date: 2012