Environmental correlates of pediatric social illness: Preventive implications of an advocacy approach

Abstract

A controlled prospective study of child abuse and neglect, failure to thrive, accidents and poisonings included 303 inpatients and 257 outpatients. Analysis of maternal interview and clinical data demonstrated significant differences between cases and controls in summative indices of environmental stress, including housing, employment, and access to essential services. The associations with a postulated common causal underpinning of these illnesses argue for a broadened, ecologic conceptualization of etiology and a wider range of preventive approaches. A family advocacy program addressing the stress issues and utilizing community based individuals was offered to families with pediatric social illness and to a comparison group. Indirect corroboration of the impact of environmental crisis is indicated by the prevalence of requests for this help in inpatient cases of abuse (38%) and ingestions (38%) vs. controls (14%). Discriminant function regression analysis of data from the maternal interview demonstrates similarity between the attributes which most saliently describe the abuse group and those which describe the users of advocacy.