Exploring associations between violent discipline and aggressive behavior in children ages 4-5 in The Republic of Nicaragua: A secondary data analysis of the 2011 Demographic and Health Survey

Thesis (Master's)--University of Washington, 2016-06Introduction: According to UNICEF 4 out of 5 children aged 2 to 14 are subjected to some kind of violent discipline in their home. Exposure to adverse child experiences, such as child maltreatment, has shown to predict aggressive behavior in children. Literature shows that aggressive behavior increases in toddlerhood, but declines in prevalence at ages 3-4 years. By 4-5 years old, children should be developed enough to corporate with other children. Continuation of aggressive behavior is an early warning sign of many child behavioral disorders. These emotional and behavioral disorders often go undiagnosed in most low-income settings, such as Nicaragua. Objective: The objective of this study was to look at population-level data to explore the potential associations between violent discipline and aggressive behavior in children ages 4-5 years old in Nicaragua. Methods: This study was a secondary data analysis of Nicaragua’s 2011/2012 Demographic and Health Survey. Our weighted sample included 1,347 women with children ages 4-5 years old. We used two selections of the Women’s Questionnaire: Section 4 Child’s Health 48-59 months, and Section 8 Roles of Gender and Interfamily Violence. Our outcome variable was whether a 4-5-year-old frequently gets into other fights with other children (e.g.: hit, bite, kick). While our main predictors of interest were whether a mother believes in physical punishment is necessary to educate her child (e.g. slap, spank, punch), and whether the child receives violent discipline. Our potential confounders of interest were maternal age, maternal education, urban/rural residency, and gender of the child. We first conducted a univariate analysis of the dataset including all individuals with information on the given variables of interest. Then, logistic regression was used to evaluate the presence of aggressive behavior as a binary outcome. Results: Of the 1,347 women in the data, we found that 17% of women believed that physical punishment was necessary to educate her child. Of women that believe in physical punishment, 81% of these women actually perform violent discipline. 49% of 4-5 year olds frequently get into physical fights (hitting, biting, kicking). When we broke this prevalence down by gender, we found that 28% of male children were getting into fights compared to 21% of female children. We found that the child had higher odds of getting into physical fights when their mother believed in physical punishment compared to children whose mother did not believe in physical punishment (AOR 1.60, 95% CI 1.06, 2.42). We found that, like the belief model, children had higher odds of getting into fights with other children if they have experienced violent discipline (AOR 1.60, 95% CI 1.07, 2.38) compared to children who have not experienced violent discipline. Conclusion: To our knowledge, this is the first study that looks at the association between violent discipline and aggressive behavior in 4-5 year-olds at the population level in Nicaragua. As anticipated, we found a very strong association with both a mother’s belief in physical punishment and violent discipline with aggressive behavior in children ages 4-5 in Nicaragua