Among a cohort of largely low-income, black mothers, 14% reported spanking their 11-month-old infants. Maternal physical abuse and other violent childhood experiences affected parenting attitudes and IS use. After adjusting for confounding variables, exposure to ≥2 ACEs was associated with a higher likelihood of IS. This study adds to the existing literature, which has not previously assessed the relationship between ACEs and parenting practices. Attitudes were associated with IS but did not mediate the association between ACEs and IS.
It was striking that the majority of respondents (76%) reported at least 1 ACE. The prevalence of physical abuse (52%) was higher than previous estimates of severe forms of physical abuse, measured nationally and in the ACE study.31,32
The prevalence of sexual abuse was lower than previous estimates of 20% to 40%.31,33
The prevalence of domestic violence was nearly identical to that found in the ACE study (13.4% vs 13.9%).31
Our results show a dose-response effect between ACEs and IS, adding to the adverse outcomes associated with cumulative ACEs.11,34
The finding that childhood physical abuse was associated with attitudes that value CP and with subsequent IS are consistent with previous reports. As hypothesized, exposure to ≥2 ACEs was associated with a higher (1.6 times) likelihood of IS. This suggests that, in addition to childhood physical abuse, cumulative violence exposure, including sexual abuse, verbal hostility, domestic violence, witnessing a shooting, or knowing a victim of shooting, predisposes mothers to IS use.
There are several limitations to our study. All mothers completing the prenatal survey did not complete postpartum surveys. The fact that these mothers were more likely to be uninsured suggests that they may have had more financial hardship. It is possible that they had more childhood adversity; therefore, our results may underestimate some exposure and outcome variables. Reports of childhood experiences were retrospective, with women being asked to report experiences before age 16 when they were, on average, 24 years of age. Reports are subject to recall bias, although empirical evidence suggests that this bias has been overestimated.35
Our study, building on the ACE study, may be subject to less recall bias because our sample was younger (average age of 24 vs 56 years).11
Survey questions may not capture the complexity, diversity, severity, or frequency of childhood experiences. The main outcome, IS, was based on spanking in the past week, which may have underestimated actual use. We did not assess motivations for spanking or predisposing characteristics related to the infant, such as temperament. Our assessment of sexual abuse was based on a question using the term “sexual abuse,” which may have underestimated exposure. A recent study showed that use of the word “abuse” in questions, when compared with the use of questions describing abusive experiences, resulted in lower reported abuse among community samples.36
Attitudes toward CP were associated with twice the likelihood of IS use toward 11-month-old infants in the adjusted analyses. This finding suggests that attitudes toward CP should be asked of mothers with infants. Parents may be unfamiliar with the harmful effects of IS. Health professionals should use the perinatal period as a “window of opportunity” to discuss parental experiences and attitudes. Recent evidence shows that maltreatment, including spanking, during infancy is associated with higher hormonal reactivity to stress, which in turn could impact future health outcomes.37
Additional research is needed to understand factors that link CP, ACEs, and adverse health outcomes. Early efforts to prevent CP are important because attitudes toward discipline are established early in parenting and disciplinary strategy is maintained throughout early childhood.3
Previous researchers note that negative parenting practices may occur at the expense of positive practices, showing that those who were more likely to spank also reported less reading, listening to music, playing, and hugging.9
The prevalence of IS (14%) in our study is similar to previous reports of CP in infancy.1–3
What is striking is that, even among those not exposed to physical abuse, 1 in 10 mothers reported spanking their infants, suggesting that discussions about child discipline should occur among all families, not just those with a history of violence. We found it hopeful that the majority (84%) of the participants who experienced childhood physical punishment did not report spanking their infants. This important point should be made by clinicians when counseling at-risk mothers exposed to ACEs about the harmful effects of CP. Although inter-generational transmission of CP has been described, the frequency with which this occurs is not well understood.38