Editor’s Note: Claire Castellano will be graduating from Emory University School of Medicine this spring and starting her pediatric residency. In addition to her M.D., Claire pursued a Master’s in Public Health at Emory, focusing on global epidemiology. Claire hopes to combine her interests in medical education and global health in her career as a pediatrician. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Victims of child abuse, whether physical or sexual, are at an increased risk for difficulties in school, substance use, mental and physical health concerns, and re-experience abuse or intimate partner violence later in life. In addition, welfare receipt in adulthood is known to be associated with a history of poor psychological, social, and physical outcomes in childhood. But what about the relationship between child abuse and later financial hardship?
This week, Pediatrics is early releasing an article, along with an accompanying video abstract, entitled, “Early Experiences of Abuse and Social Welfare Use,” by Sylvana Côté and team at the University of Montreal investigating the relationship between child abuse and welfare receipt later in life to consider the interplay between abuse and poverty (10.1542/peds.2022-057379).
This prospective study utilized a Canadian government database to collect self-reported data on childhood abuse (physical, sexual, and both) from age 6-13 years, intimate partner violence by age 22 years, and welfare receipt from age 23–37-years. When compared to individuals who were never abused, they found:
- 2-fold increased risk of welfare receipt for victims of physical or physical and sexual child abuse
- 3-fold increased risk of welfare receipt for victims of child abuse and intimate partner violence
Although victims of abuse were more likely to come from lower socioeconomic backgrounds, when adjusting for the family’s socioeconomic background, the trends still hold.
The authors suggest that child abuse may “represent an independent pathway to economic adversity and potential intergenerational transmission of poverty,” calling readers to action: we must do more in prevention and early intervention in cases of abuse, with hopes of alleviating health concerns and economic burdens for individuals and institutions, both present and future.
Dr. Sabrina Darwiche and Dr. Philip Scribano at Children’s Hospital of Philadelphia add to this important discussion in their commentary, “Anti-Poverty Interventions and their Importance in Childhood Abuse” (10.1542/peds.2022-060096). They acknowledge that poverty still plays a role, citing a temporal relationship between tax credit money to families and a decrease in child maltreatment cases.
Additionally, they creatively frame the “vicious, cyclic interplay, between abuse and economic outcomes” in the context of a 2-hit hypothesis: where the “first hit” as poverty increases the risk that a child may struggle with mental health, physical health, and financial security, and the “second hit” as abuse increases the risk that these outcomes will be passed down to the next generation.
Whether we focus on policies to combat poverty, such as tax credits and childcare subsidies, or policies that will prevent and more quickly identify child abuse, there is a need for action to keep children—and their children—safe.
