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Biomedical subjects

Jonathan B Kotch

Publications and source records attributed to Jonathan B Kotch.

14 recordsLinked to original sources
PubMed2006

Reporting participants in research studies to Child Protective Services: limited risk to attrition.

This study examines the impact of Child Protective Services (CPS) reports made by research study staff on participant retention and discusses human subjects protocols that may minimize either the need to make such reports or the negative impact of reporting on participants and on participant retention. Among 1, 354 primary caregiver-child pairs in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a total of 15 were reported to CPS by study staff. Within this group, rates of study-generated reports and study participation subsequent to having been reported by researchers were examined. There was an overall retention rate of 93% across a minimum of three interview waves in this sample. Reporting research participants to CPS may have little impact on attrition.

Child↗
PubMed2006

Child maltreatment in the United States: prevalence, risk factors, and adolescent health consequences.

OBJECTIVES: The purpose of this study was to estimate the prevalence of child maltreatment in the United States and examine its relationship to sociodemographic factors and major adolescent health risks. METHODS: The National Longitudinal Study of Adolescent Health is a prospective cohort study following a national sample of adolescents into adulthood. The wave III interview, completed by 15 197 young adults in 2001-2002 (77.4% response rate), included retrospective measures of child maltreatment. We used these measures to estimate the prevalence of self-reported supervision neglect, physical neglect, physical assault, and contact sexual abuse during childhood. Next, we investigated the relationship between sociodemographic characteristics and maltreatment. Finally, we examined the association between child maltreatment and adolescent self-rated health; overweight status; depression; cigarette, alcohol, marijuana, and inhalant use; and violent behavior. RESULTS: Having been left home alone as a child, indicating possible supervision neglect, was most prevalent (reported by 41.5% of respondents), followed by physical assault (28.4%), physical neglect (11.8%), and contact sexual abuse (4.5%). Each sociodemographic characteristic was associated with > or = 1 type of maltreatment, and race/ethnicity was associated with all 4. Each type of maltreatment was associated with no fewer than 8 of the 10 adolescent health risks examined. CONCLUSIONS: Self-reported childhood maltreatment was common. The likelihood of maltreatment varied across many sociodemographic characteristics. Each type of maltreatment was associated with multiple adolescent health risks.

Adolescent↗
PubMed2005

Defining maltreatment according to substantiation: distinction without a difference?

OBJECTIVE: To examine whether children with substantiated maltreatment reports between 4 and 8 years of age differ from children with unsubstantiated reports on any of 10 behavioral and developmental outcomes. METHOD: Longitudinal data from 806 children and their adult caregivers collected in four US study sites were pooled and analyzed using Analysis of Variance (ANOVA) and multivariate linear regression. RESULTS: There were no significant differences between the mean scores of children with unsubstantiated and substantiated maltreatment reports filed between 4 and 8 years of age for any of the 10 behavioral and developmental outcomes. In the multivariate analysis, substantiation status was not significantly associated with any of the 10 outcomes after adjusting for prior functioning, prior maltreatment status, and sociodemographic characteristics. Findings from within-site analyses were generally consistent with the pooled analyses in finding no association between substantiation status and the outcomes examined. CONCLUSIONS: In this high-risk sample, the behavioral and developmental outcomes of 8-year-old children with unsubstantiated and substantiated maltreatment reports filed between ages 4 and 8 were indistinguishable. Future research should attempt to replicate these findings on probability samples that represent the full range of childhood maltreatment risk and with models that control for the impact of social services.

Analysis of Variance↗
PubMed2005

Describing maltreatment: do child protective service reports and research definitions agree?

OBJECTIVE: The National Research Council identified inadequate research definitions for abuse and neglect as barriers to research in child maltreatment. We examine the concordance between child protective services (CPS) classifications of maltreatment type with the determinations of type from two research coding systems. We contrast the two coding systems and the CPS classification, in their ability to predict subsequent difficulties in the psychological functioning of maltreated children at age 8. METHOD: The sample included 545 children who were enrolled in Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) with a report of child maltreatment, had data collected at approximately 4 and 8 years of age, and had a lifetime review of CPS records to age 8. CPS Maltreatment reports were coded using LONGSCAN's modification of the Maltreatment Classification System (MMCS) and the Second National Incidence Study maltreatment coding system (NIS-2). The first analyses used reports as the unit of analysis to examine agreement between CPS and research determinations of allegation type. Validation analyses examined outcomes for each type of maltreatment experienced after age 4 under each coding system using the Child Behavior Checklist (CBCL), Trauma Symptom Checklist-Alternative form, and the Vineland Screener as the measures of outcome. Control variables were the CBCL and Battelle Developmental Screener, measured at age 4. RESULTS: There were a total of 1980 reports of maltreatment for 545 study children although only 1593 CPS reports specified at least one type of maltreatment. There were differences between the type of maltreatment recorded in child protective service records and the conclusions reached by either research classification system. CPS classifications were most discordant with the research systems for emotional abuse and neglect. Nearly 10% of physical and sexual abuse reports, as determined by the MMCS, were classified as neglect by the child protective service agencies. The NIS-2 system and the MMCS had very high Kappa statistics for agreement for physical and sexual abuse. The validity of the research definitions for physical and sexual abuse was demonstrated in models predicting children's functioning at age 8. Prediction of child functioning was significantly but modestly improved in several domains compared to the CPS classifications. CONCLUSION: Both research classification systems moderately improved on the prediction of the adverse effects of maltreatment compared to the characterization of a maltreatment exposure as recorded by CPS.

Child↗
PubMed2004

The effects of the Women, Infants, and Children's Supplemental Food Program on dentally related Medicaid expenditures.

OBJECTIVE: This study estimates the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dentally related Medicaid expenditures for young children. METHODS: We used a five-year cohort study design to compare dentally related Medicaid expenditures for children enrolled in WIC versus those not enrolled for each year of life up to age 5 years. There were 49,795 children born in North Carolina in 1992 who met the inclusion criteria for the study. Their birth records were linked to Medicaid enrollment and claims files, WIC master files, and the Area Resource File. Our analysis strategy included a logit and OLS two-part model with CPI dollar adjustments. RESULTS: Children who participated in WIC at ages 1 and 2 years had significantly less dentally related expenditures than those who did not participate. WIC participation at age 3 years did not have a significant effect. Fewer WIC children received dental care under general anesthesia than non-WIC children. CONCLUSIONS: The WIC program has the potential for decreasing dentally related costs to the Medicaid program, while increasing use of dental services.

Adult↗
PubMed2004

Early preventive dental visits: effects on subsequent utilization and costs.

OBJECTIVE: To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children. DESIGN: This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs. RESULTS: Of the 53591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, 262 dollars; age 1 to 2, 339 dollars; age 2 to 3, 449 dollars; age 3 to 4, 492 dollars; age 4 to 5, 546 dollars. CONCLUSIONS: Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population.

Age Factors↗
PubMed2004

Child maltreatment in families experiencing domestic violence.

This study examined the association between physical domestic violence (PDV) and reported child maltreatment in a cohort of children at risk for maltreatment. Participants were 219 6- to 7-year-old children and their caregivers. PDV was measured by combining caregivers' self-reports and children's reports, while child maltreatment was based on state Division of Social Services Central Registry records. Among 219 child-caregiver pairs studied, 42 (19.2%) had at least one maltreatment report in the 2 years following the interviews. PDV consistently predicted child maltreatment, with adjusted odds ratios ranging from 2.96 to 3.46. In addition, we investigated interactions between PDV and other predictors of child maltreatment. Among Aid to Families with Dependent Children (AFDC) participants, PDV was highly associated with child maltreatment. However, this pattern was not observed among subjects who did not have AFDC. There is an increased incidence of child maltreatment reports in families experiencing PDV. AFDC participation intensified the probability of child maltreatment in the presence of PDV. Findings also suggest that in households experiencing PDV, social supports may protect children from maltreatment.

Adult↗
PubMed2004

Effects of WIC participation on children's use of oral health services.

OBJECTIVES: We estimated the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dental services use by Medicaid children in North Carolina. METHODS: We used linked Medicaid claims and enrollment files, WIC files, and the area resource file to compare dental services use for children enrolled in WIC with those not enrolled. We used multivariate models that controlled for child clustering and employed 2-step methodology to control for selection bias. RESULTS: Children who participated in WIC had an increased probability of having a dental visit, were more likely to use preventive and restorative services, and were less likely to use emergency services. CONCLUSIONS: Children's WIC participation improved access to dental care services that should lead to improved oral health.

Aid to Families with Dependent Children↗
PubMed2003

Differences in use of health services between White and African American children enrolled in Medicaid in North Carolina.

OBJECTIVES: Racial differences in health status and use of health services persist in the United States and are not completely explained by differences in socioeconomic status. This study examines differences in use of health services between White and African American children enrolled in Medicaid, controlling for other factors that affect service use. We make comparisons for use of primary preventive services, diagnosis and treatment of selected common childhood illnesses, and Medicaid expenditures. METHODS: We linked Medicaid enrollment records, Medicaid paid claims data, and data on use of child WIC services to birth certificates for North Carolina children born in 1992 to measure use of health services and Medicaid expenditures by race for children ages 1, 2, 3, and 4. Logistic and Tobit regression models were used to estimate the independent effect of race, controlling for other variables such as low birth weight, WIC participation, and mother's age, education, and marital status. Since all children enrolled in Medicaid are in families of relatively low income, racial differences in socioeconomic status are partially controlled. RESULTS: African American children had consistently lower Medicaid expenditures and lower use of health services than did White children, after statistically controlling for other maternal and infant characteristics that affect health service use, including child WIC participation. For example, total annual Medicaid expenditures were 207-303 dollars less for African American children than for White children, controlling for other variables. African America children were significantly less likely to receive well-child and dental services than were White children. CONCLUSIONS: African American children enrolled in Medicaid use health services much less than White children, even when controlling for socioeconomic status and other factors that affect service use. Linking state administrative databases can be a cost-effective way of addressing important issues such as racial disparities in health service use.

Black or African American↗
PubMed2003

Child participation in WIC: Medicaid costs and use of health care services.

OBJECTIVES: We used data from birth certificates, Medicaid, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to examine the relationship of child participation in WIC to Medicaid costs and use of health care services in North Carolina. METHODS: We linked Medicaid enrollment, Medicaid paid claims, and WIC participation files to birth certificates for children born in North Carolina in 1992. We used multiple regression analysis to estimate the effects of WIC participation on the use of health care services and Medicaid costs. RESULTS: Medicaid-enrolled children participating in the WIC program showed greater use of all types of health care services compared with Medicaid-enrolled children who were not WIC participants. CONCLUSIONS: The health care needs of low-income children who participate in WIC may be better met than those of low-income children not participating in WIC.

Birth Certificates↗
PubMed2002

Adverse behavioral and emotional outcomes from child abuse and witnessed violence.

This article examines mental health outcomes of children who have witnessed violence in their social environment and/or have been physically abused. Participants (n = 167) come from a longitudinal study on child maltreatment. Outcomes-including depression, anger, and anxiety--are measured by the Child Behavior Checklist and the Trauma Symptom Checklist for Children. The authors used adjusted multivariate analyses to test the statistical significance of associations. The majority of children were female (57%) and non-White (64%). One third had been physically victimized; 46% had witnessed moderate-high levels of violence. Results confirm that children are negatively affected by victimization and violence they witness in their homes and neighborhoods. Victimization was a significant predictor of child aggression and depression; witnessed violence was found to be a significant predictor of aggression, depression, anger, and anxiety. Implications will be discussed.

Adult↗
PubMed2002

Behavior problems among preschool children born to adolescent mothers: effects of maternal depression and perceptions of partner relationships.

Investigated how maternal depression influenced the relation between mothers' perceptions of the quality of their partner interactions and behavior problems among their preschool children. Participants included 194 low-income families from 4 sites. Approximately three fourths of the mothers (72%, n = 139) identified a male partner and comprised the analysis sample. Mothers were adolescents (< or = age 19) at delivery, and data were gathered when children were 4 to 5 years of age. In this high-risk sample, 42.4% of the children had been maltreated, 36% had externalizing scores in the clinical range, and 10.8% had internalizing scores in the clinical range. Multiple regression analyses revealed (a) maternal perceptions of negative partner interactions were associated with more internalizing behavior problems among the children, adjusting for the effects of maltreatment; (b) maternal depression mediated the relation between the maternal perceptions of the quality of partner interactions and children's internalizing and externalizing behavior problems; and (c) maternal perceptions of positive partner interactions did not protect children from internalizing or externalizing behavior problems associated with maltreatment. Programs for adolescent mothers should provide screening and treatment for depressive symptoms and help partners negotiate caregiving roles and mutually satisfying relationships.

Adolescent↗
PubMed2002

Behavior and development of preschool children born to adolescent mothers: risk and 3-generation households.

OBJECTIVE: To investigate whether living in a 3-generation household (grandmother-mother-child) is associated with fewer behavior problems and better cognitive development among preschool children of mothers who gave birth during adolescence and whether it protects children from the behavior and developmental problems associated with maltreatment and maternal depression. DESIGN: Cohort study. SETTING: Participants included low-income families recruited from 4 sites: East, Northwest, Midwest, and South, who are part of LONGSCAN, a longitudinal study of children's health, development, and maltreatment. PARTICIPANTS: One hundred ninety-four mothers who were adolescents (less than age 19) at delivery. Data were gathered when children were 4 to 5 years of age. Twenty-six percent of the children lived in 3-generation households, 39% had a history of maltreatment, and 32% of the mothers had depression scores in the clinical range. MAIN OUTCOME MEASURES: Child behavioral problems were measured with the Child Behavior Checklist, completed by the mother, and child developmental status was assessed with the Battelle Developmental Inventory Screening Test, administered by research assistants. RESULTS: Multiple regression analyses revealed that children who had been reported for maltreatment and had mothers with depressive symptoms had more externalizing behavior problems, compared with children who experienced neither risk or only 1 risk. However, when residential status was considered, children with the greatest number of externalizing behavior problems were those who experienced both maltreatment and maternal depressive symptoms and lived in 3-generation households. Children who had been reported for maltreatment or had mothers with depressive symptoms were more likely to have internalizing problems, compared with children with neither risk. Residential status was not related to children's internalizing behavior problems or cognitive development. CONCLUSIONS: Living in a 3-generation household did not protect preschool children from the behavior problems associated with maltreatment and depression. In contrast, living in a 3-generation household was associated with more behavior problems among the highest risk group of children--those who had been maltreated and had mothers with symptoms of depression. Although 3-generation families may provide an important source of support and stability for adolescent mothers and their infants early in the parenting process, it may not be advisable to rely on 3-generation households as young mothers enter adulthood, particularly among those with a history of maltreatment or depression. Children with the fewest number of behavior problems were living with their mothers in their own household (often with the father), had not been maltreated, and had mothers with few symptoms of depression.

Adolescent↗