Medical Treatment Following Violence Exposure in a National Sample of Children and Youth

Abstract

Importance: Children and youth experience high rates of exposure to violence, which is associated with later poor physical and mental health outcomes. The immediate injuries and impacts from these exposures are often treated in emergency departments and medical offices.

Objective: To characterize, using nationally representative data, the size and characteristics of the child and youth population being seen by medical authorities in the wake of violence exposure.

Design, setting, and participants: The survey study used a representative sample of children and youth aged 2 to 17 years, from 2 waves (2011 and 2014) of the National Survey of Children Exposed to Violence, drawn from a mix of random digit dialing and address-based sampling. Interviews were conducted (1) over the phone with caregivers of young children or (2) directly with the youth aged 10 to 17 years. Data analysis was performed from September to December 2020.

Main outcomes and measures: Violence exposures were assessed with the 53-item Juvenile Victimization Questionnaire, which had follow-up questions that asked about injury and going "to the hospital, a doctor's office, or some kind of health clinic because of what happened." Additional questions were asked about lifetime and past-year childhood adversities and current trauma symptoms using the Trauma Symptom Checklist and the Trauma Symptom Checklist for Young Children.

Results: The combined 2-survey sample had 5187 children and youth who reported a lifetime violence exposure, of whom 45.6% (95% CI, 43.1%-48.2%) were aged 2 to 9 years, and 54.4% (95% CI, 51.8%-56.9%) were aged 10 to 17 years; 53.6% (95% CI, 51.0%-56.2%) were male. Based on the full sample of 8503 children and youth, 3.4% (95% CI, 2.6%-4.4%) had a violence-related medical visit at some time in their lives. The rate of past-year medical visits due to a violence exposure was 1.9% (95% CI, 1.2%-2.7%), equivalent to a point estimate of approximately 1.4 million children and youth. Of those with medical visits, 33.3% (95% CI, 23.1%-45.4%) were aged 2 to 9 years. Those with a past-year visit had higher levels of trauma symptoms (risk ratio, 1.71; 95% CI, 1.44-2.03) adverse childhood experiences (risk ratio, 2.55; 95% CI, 2.34-2.78) and multiple violence exposures (risk ratio, 3.91; 95% CI, 3.22-4.76) compared with the general sample of children and youth.

Conclusions and relevance: The estimated large number of violence-related visits with medical professionals offers an opportunity to address a source of frequent injury, and provide counseling and referral for a high-risk segment of the population to treat and prevent further physical and mental health and social consequences.