Alaska Division of Public Health, Maternal and Child Health Epidemiology Unit, 3601 C Street, Anchorage, AK 99503, USA.
Am J Prev Med. 2011 Jun;40(6):666-73. doi: 10.1016/j.amepre.2011.02.022.
Child maltreatment has been linked to multiple negative health outcomes and many leading causes of death. Statewide population-based evaluations are needed to identify high-risk populations early in life for targeted interventions.
To assess the utility of combining Pregnancy Risk Assessment Monitoring System (PRAMS) data with child protective services (CPS) records to identify risk factors associated with Protective Services Reports (PSR) suggestive of child maltreatment.
This was a retrospective population-based cohort study conducted in the spring of 2010 using weighted survey data from Alaska PRAMS for birth years 1997-1999. PRAMS responses were linked with CPS records for the sampled child. The outcome of interest was any PSR made to CPS after the survey was returned through 48 months after birth. Validation of the PRAMS data set occurred through direct comparison between the total population and PRAMS weighted sample for birth certificate factors. Multivariate logistic regression models were constructed to identify risk groups.
In the final multivariate model among the main effect variables, three of the top five strongest associated factors were derived all or in part from PRAMS. Public aid as a source of income had a significant interaction with Alaska Native status, and among Alaska non-Natives had an AOR of 3.37 (95% CI=2.2, 5.1). Six significant modifiable factors were identified in the multivariate model. Three quarters (75%) of the maltreatment cases occurred among children with two or more of these factors, despite being found in about one third (32%) of the total population.
Although birth certificates remained a valuable source of risk factor information for child maltreatment, PRAMS identified additional risk factors not available from birth certificates.
儿童虐待与多种负面健康结果和许多主要死因有关。需要进行全州范围的基于人群的评估，以便在生命早期识别高危人群，以便进行有针对性的干预。
评估将妊娠风险评估监测系统（PRAMS）数据与儿童保护服务（CPS）记录相结合，以识别与提示儿童虐待的保护服务报告（PSR）相关的危险因素的效用。
这是一项回顾性基于人群的队列研究，于 2010 年春季使用阿拉斯加 PRAMS 的加权调查数据进行，调查对象为 1997-1999 年出生的婴儿。PRAMS 回复与抽样儿童的 CPS 记录相关联。感兴趣的结果是在调查返回后的 48 个月内，向 CPS 提出的任何 PSR。通过与出生证明因素的总人群和 PRAMS 加权样本进行直接比较，对 PRAMS 数据集进行了验证。构建了多变量逻辑回归模型，以确定风险组。
在主要效应变量的最终多变量模型中，前五个最强相关因素中有三个全部或部分来自 PRAMS。公共援助作为收入来源与阿拉斯加原住民身份存在显著交互作用，在阿拉斯加非原住民中，比值比（AOR）为 3.37（95%CI=2.2, 5.1）。在多变量模型中确定了六个显著的可修改因素。尽管这些因素出现在三分之一（32%）的总人群中，但四分之三（75%）的虐待案件发生在有两个或更多这些因素的儿童中。
尽管出生证明仍然是儿童虐待风险因素信息的有价值来源，但 PRAMS 确定了出生证明中没有的其他危险因素。
