title: Pathways From Family Disadvantage via Abusive Parenting and Caregiver Mental Health to Adolescent Health Risks in South Africa.
abstract: Adolescent health is a major concern in low- and middle-income countries, but little is known about its predictors. Family disadvantage and abusive parenting may be important factors associated with adolescent psychological, behavioral, and physical health outcomes. This study, based in South Africa, aimed to develop an empirically based theoretical model of relationships between family factors such as deprivation, illness, parenting, and adolescent health outcomes.
  
  
  
  Cross-sectional data were collected in 2009-2010 from 2,477 adolescents (aged 10-17) and their caregivers using stratified random sampling in KwaZulu-Natal, South Africa. Participants reported on sociodemographics, psychological symptoms, parenting, and physical health. Multivariate regressions were conducted, confirmatory factor analysis employed to identify measurement models, and a structural equation model developed.
  
  
  
  The final model demonstrated that family disadvantage (caregiver AIDS illness and poverty) was associated with increased abusive parenting. Abusive parenting was in turn associated with higher adolescent health risks. Additionally, family disadvantage was directly associated with caregiver mental health distress which increased adolescent health risks. There was no direct effect of family disadvantage on adolescent health risks but indirect effects through caregiver mental health distress and abusive parenting were found.
  
  
  
  Reducing family disadvantage and abusive parenting is essential in improving adolescent health in South Africa. Combination interventions could include poverty and violence reduction, access to health care, mental health services for caregivers and adolescents, and positive parenting support. Such combination packages can improve caregiver and child outcomes by reducing disadvantage and mitigating negative pathways from disadvantage among highly vulnerable families.
authors: Department of Social Policy and Intervention, Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom. Electronic address: franziska.meinck@spi.ox.ac.uk.
authors: Franziska
authors: F
authors: Meinck
authors: Department of Social Policy and Intervention, Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom; Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors: Lucie Dale
authors: LD
authors: Cluver
authors: School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Frederick Mark
authors: FM
authors: Orkin
authors: Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Department of Behavioral and Social Sciences, Centre for Alcohol and Addiction Studies, Brown University School of Public Health, Rhode Island.
authors: Caroline
authors: C
authors: Kuo
authors: Department of International Development, University of Oxford, Oxford, United Kingdom.
authors: Amogh Dhar
authors: AD
authors: Sharma
authors: Department of Infection and Population Health, Royal Free Hospital, University College London, London, United Kingdom.
authors: Imca Sifra
authors: IS
authors: Hensels
authors: Department of Infection and Population Health, Royal Free Hospital, University College London, London, United Kingdom.
authors: Lorraine
authors: L
authors: Sherr
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health / Q000706:statistics & numerical data; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D016487:Parenting / Q000523:psychology*; D011203:Poverty; D012306:Risk; D012959:Socioeconomic Factors; D013019:South Africa
keywords: AIDS; Adolescent abuse; Adolescent behavior; Adolescent health; Mental health; Parenting; Risk factors; South Africa