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Environmental correlates of pediatric social illness: preventive implications of an advocacy approach.

A E Morse, J N Hyde, Jr, E H Newberger and R B Reed

A control prospective study of child abuse and neglect, failure to thrive, accidents and poisonings included 303 inpatients and 257 outpatients. Analysis of maternal interview clinical data demonstrated significant differences between cases and controls in summative indices of environmental stress, including housing, employment, and access to essential services. The associations with a postulated common causal underpinning of these illnesses argue for a broadened, ecologic conceptualization of etiology and a wider range of preventive approaches. A family advocacy program addressing the stress issues and utilizing community based individual was offered to families with pediatric social illness and to a comparison group. Indirect corroboration of the impact of environmental crisis is idicated by the prevalence of requests for this help in impatient cases of abuse (38 per cent) and ingestions (38 per cent) vs. controls (14 per cent). Discrimunant function regression analysis of data from the meternal interview demonstrates similarity between the attributes which most saliently describe the abuse group and those which decribe the users of advocacy.