title: Community Characteristics Associated With Seeking Medical Evaluation for Suspected Child Sexual Abuse in Greater Houston.
abstract: Child sexual abuse (CSA) affects over 62,000 children annually in the United States. A primary obstacle to the success of a public health prevention strategy is the lack of knowledge around community level risk factors for CSA. We evaluated community level characteristics for children seeking care for suspected CSA in the Greater Houston area for 2009. There was a total incidence rate of medical evaluations for suspected CSA of 5.9/1000 children. We abstracted the medical charts of 1982 (86 %) children who sought a medical evaluation for suspected CSA at three main medical systems in the Greater Houston area for 2009. We evaluated 18 community level variables from the American Community Survey for the 396 zip codes these children lived in. The mean number of cases per Greater Houston zip code was 2.77 (range 0-27), with 62 % of zip codes not having a case at any of the three sites surveyed. Zip codes with a higher than Houston average rate of vacant houses, never married females and unemployed labor force with high family poverty rate, were associated with an increased rate of children seeking care for suspected CSA. We demonstrated zip codes level characteristics which were associated with an increased rate of children seeking care for suspected CSA. Our modelling process and our data have implications for community based strategies aimed at improved surveillance or prevention of CSA. The process of identifying locally specific community level factors suggests target areas which have particular socioeconomic characteristics which are associated with increased rate of seeking CSA evaluations.
authors.affiliation: Center For Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX, USA. Greeley@bcm.edu.
authors.forename: Christopher Spencer
authors.initials: CS
authors.lastname: Greeley
authors.affiliation: Center For Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX, USA.|School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Chuo
authors.affiliation: Center For Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX, USA.|School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Kwak
authors.affiliation: Forensic Nursing Services, The Memorial Hermann Health System, Houston, TX, USA.
authors.forename: Sally S
authors.initials: SS
authors.lastname: Henin
authors.affiliation: Section of Emergency Medicine, The Texas Children's Hospital, Houston, TX, USA.
authors.forename: Marcella
authors.initials: M
authors.lastname: Donnaruma-Kwoh
authors.affiliation: Forensic Nursing Services, The Memorial Hermann Health System, Houston, TX, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Ferrell
authors.affiliation: Section of Academic Pediatrics, The Texas Children's Hospital, Houston, TX, USA.
authors.forename: Angelo Peter
authors.initials: AP
authors.lastname: Giardino
mesh_terms: D002648:Child; D002649:Child Abuse; D002650:Child Abuse, Sexual; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Child abuse; Geographic mapping; Primary prevention; Sexual