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      Associations between Lifetime Spanking/Slapping and Adolescent Physical and Mental Health and Behavioral Outcomes Translated title: Associations Entre les Fessées/Gifles de Durée de Vie et la Santé Physique et Mentale des Adolescents et les Résultats Comportementaux


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          Many parents use physical forms of punishment, including spanking to correct perceived misbehavior. While some authors suggest spanking/slapping is a distinct and “milder” form of physical punishment, parents’ use of spanking is consistently associated with poor outcomes for their children. However, less is known about the relationship between spanking/slapping and health and behavioral outcomes in adolescence independent of other childhood adversities.


          The objectives of this study were to examine the associations between lifetime experiences of spanking on the bottom and/or slapping on the hand and 3 adolescent outcomes: (a) mental health disorders, (b) physical health conditions, and (c) defiant behaviors, after adjusting for other types of childhood adversities and child maltreatment.


          Cross-sectional data from the provincially representative 2014 Ontario Child Health Study ( N = 6,537 dwellings, response rate = 50.8%) were used. The current study focused on one selected child aged 14 to 17 years within a household ( n = 1,883) with data collected from the adolescent and the parent/caregiver. Logistic regression models were used to identify associations with lifetime experiences of spanking/slapping 3 or more times (vs. 0 to 2 times).


          Lifetime spanking/slapping was independently associated with increased odds of mental health disorders, physical health conditions, and defiant behaviors in adolescence after adjusting for childhood adversities and child maltreatment (unadjusted and adjusted odds ratios ranging from 1.29 to 2.19).


          These findings suggest that lifetime spanking/slapping is uniquely associated with harmful mental, physical, and behavioral outcomes in adolescence, and efforts should focus on its prevention.

          Translated abstract


          Plusieurs parents utilisent des formes physiques de punition, notamment la fessée pour corriger une mauvaise conduite perçue. Bien que certains auteurs suggèrent que la fessée/gifle est une forme distincte « plus douce » de châtiment physique, l’usage de la fessée par les parents est constamment associé à de mauvais résultats pour leurs enfants. Cependant, on en sait moins sur la relation entre la fessée/gifle avec la santé et les résultats comportementaux à l’adolescence, indépendamment d’autres adversités au cours de l’enfance.


          Les objectifs de la présente étude étaient d’examiner les associations entre les expériences de durée de vie de fessées sur le derrière et/ou de tapes sur la main et trois résultats à l’adolescence: (a) troubles de santé mentale, (b) affections de santé physique, et (c) comportements d’opposition, après ajustement pour d’autres types d’adversités dans l’enfance et la maltraitance des enfants.


          Les données transversales de l’Enquête sur la santé des jeunes Ontariens 2014 à l’échelle provinciale ( N = 6 537 ménages, taux de réponse = 50,8%) ont été utilisées. L’étude actuelle portait sur un enfant sélectionné de 14 à 17 ans au sein d’un ménage (n = 1 883) et des données recueillies auprès de l’adolescent et du parent/soignant. Des modèles de régression logistique ont servi à identifier les associations aux expériences de durée de vie de fessée/gifle de trois fois ou plus (c. 0 à 2 fois).


          La fessée/gifle de durée de vie était indépendamment associée à des probabilités accrues de troubles de santé mentale, d’affections de santé physique et de comportements d’opposition à l’adolescence, après ajustement pour les adversités de l’enfance et la maltraitance d’un enfant (rapports de cotes non ajustés et ajustés allant de 1,29 à 2,19).


          Ces résultats suggèrent que la fessée/gifle de durée de vie est uniquement associée à des résultats mentaux, physiques et comportementaux préjudiciables à l’adolescence et les efforts devraient porter sur la prévention.

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          Most cited references52

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          Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.

          The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
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            The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

            A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done.
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              Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A).

              To present estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates. The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of participants with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2% (11.2% with mood disorders, 8.3% with anxiety disorders, and 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders. These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every four to five youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention. Copyright © 2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

                Author and article information

                Can J Psychiatry
                Can J Psychiatry
                Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
                SAGE Publications (Sage CA: Los Angeles, CA )
                9 March 2021
                April 2022
                : 67
                : 4
                : 280-288
                [1 ]Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
                [2 ]Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada
                [3 ]Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
                [4 ]Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
                [5 ]Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
                [6 ]Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
                [7 ]Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
                Author notes
                [*]Tracie O. Afifi, PhD, Department of Community Health Sciences, University of Manitoba, Medical Services Building, S113-750 Bannatyne Avenue, Winnipeg, Manitoba, Canada R3E 0W3. Email: tracie.afifi@ 123456umanitoba.ca
                Author information
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funded by: Canadian Institutes of Health Research Foundation Scheme Grant, FundRef https://doi.org/10.13039/501100003400;
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                spanking,physical punishment,mental health,physical health,defiant behaviors,childhood adversities,child maltreatment


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