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      Who perpetrates violence against children? A systematic analysis of age-specific and sex-specific data

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          Abstract

          Objective

          The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of childhood violence across these dimensions. We produced the first age-specific and sex-specific prevalence estimates by perpetrator type for physical, sexual and emotional violence against children globally.

          Design

          We used random effects meta-regression to estimate prevalence. Estimates were adjusted for relevant quality covariates, variation in definitions of violence and weighted by region-specific, age-specific and sex-specific population data to ensure estimates reflect country population structures.

          Data sources

          Secondary data from 600 population or school-based representative datasets and 43 publications obtained via systematic literature review, representing 13 830 estimates from 171 countries.

          Eligibility criteria for selecting studies

          Estimates for recent violence against children aged 0–19 were included.

          Results

          The most common perpetrators of physical and emotional violence for both boys and girls across a range of ages are household members, with prevalence often surpassing 50%, followed by student peers. Children reported experiencing more emotional than physical violence from both household members and students. The most common perpetrators of sexual violence against girls aged 15–19 years are intimate partners; however, few data on other perpetrators of sexual violence against children are systematically collected internationally. Few age-specific and sex-specific data are available on violence perpetration by schoolteachers; however, existing data indicate high prevalence of physical violence from teachers towards students. Data from other authority figures, strangers, siblings and other adults are limited, as are data on neglect of children.

          Conclusions

          Without further investment in data generation on violence exposure from multiple perpetrators for boys and girls of all ages, progress towards Sustainable Development Goals 4, 5 and 16 may be slow. Despite data gaps, evidence shows violence from household members, peers in school and for girls, from intimate partners, should be prioritised for prevention.

          Trial registration number

          PROSPERO 2015: CRD42015024315.

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          Most cited references19

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          Global health. The global prevalence of intimate partner violence against women.

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            Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

            Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.
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              Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span

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                Author and article information

                Journal
                BMJ Paediatr Open
                BMJ Paediatr Open
                bmjpo
                bmjpo
                BMJ Paediatrics Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2399-9772
                2018
                7 February 2018
                : 2
                : 1
                : e000180
                Affiliations
                [1 ] departmentGlobal Health and Development , London School of Hygiene & Tropical Medicine , London, UK
                [2 ] departmentHealth Metrics at Sahlgrenska Academy , University of Gothenburg , Gothenburg, Sweden
                [3 ] departmentJohns Hopkins Bloomberg School of Public Health, Departmentof International Health , Johns Hopkins University , Baltimore, Maryland, USA
                [4 ] McGill University , Montreal, Quebec, Canada
                [5 ] Brunel University , Uxbridge, UK
                [6 ] departmentData and Analytics Section, Division of Data, Research and Policy , UNICEF , New York, USA
                [7 ] departmentDepartment of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong
                [8 ] World Health Organization , Geneva, Switzerland
                [9 ] departmentNational Center for Injury Prevention and Control , US Centers for Disease Control , Atlanta, Georgia, USA
                [10 ] UNICEF Office of Research-Innocenti , Florence, Toscana, Italy
                [11 ] departmentDepartment of Criminology, Health Behaviors of School Aged children violence and injuries focus group , Bar Ian University , Israel
                [12 ] departmentThe Demographic and Health Program , International Health Division, ICF , Rockville, Maryland, USA
                [13 ] departmentDepartment of Family, Gender and Life Course , Pan American Health Organization/World Health Organization Regional Office for the Americas , Washington, USA
                [14 ] International Consultant
                [15 ] departmentGender and Health Research Unit , South African Medical Research Council , Cape Town, South Africa
                Author notes
                [Correspondence to ] Louise Knight; louise.knight@ 123456lshtm.ac.uk
                Article
                bmjpo-2017-000180
                10.1136/bmjpo-2017-000180
                5842994
                29637183
                c9aa0737-0f0a-461a-a0a8-4153390981aa
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 17 July 2017
                : 10 October 2017
                : 15 October 2017
                Funding
                Funded by: Pan-American Health Organization;
                Funded by: kNOw Violence in Childhood initiative.;
                Categories
                Original Article
                1506
                Custom metadata
                unlocked

                violence against children,child abuse,intimate partner violence,bullying,school violence

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