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Updated: Feb 9, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Using time-to-event analysis to identify preconception and prenatal predictors of child protective services contact
Anna E Austin1, Jared W Parrish2, Meghan E Shanahan1
1Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7445, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 East Franlink St., Suite 500, Chapel Hill, NC, 27599-7505, United States.
Insights
Low socioeconomic status, maternal smoking, and unmarried status are key predictors of child protective services (CPS) contact. Addressing prenatal risk factors can help prevent CPS involvement for children.
Area of Science:
- Public Health
- Child Welfare
- Epidemiology
Background:
- Child protective services (CPS) involvement is a critical public health concern.
- Identifying predictors of CPS contact is essential for developing effective prevention strategies.
- Previous research has explored various risk factors, but population-representative data from Alaska is limited.
Purpose of the Study:
- To examine preconception and prenatal predictors of time to first child protective services (CPS) contact among Alaska children.
- To utilize a population-representative dataset linking maternal health information with administrative child welfare data.
- To identify key risk factors associated with early CPS involvement.
Main Methods:
- Utilized the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project data.
- Linked Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with administrative sources (2009-2015).
- Employed Kaplan-Meier methods for incidence and Cox proportional hazards regression for predictor analysis, censoring for emigration or death.
Main Results:
- Significant predictors of CPS contact included low socioeconomic status, maternal smoking during pregnancy, unmarried maternal status, urban residence, lower maternal education, and intimate partner violence.
- Alaska Native/American Indian race, higher number of living children, stressful life events, and younger maternal age were also significant predictors.
- Hazard ratios indicated increased risk associated with several socioeconomic, behavioral, and demographic factors.
Conclusions:
- Prenatal assessment and intervention for identified risk factors are crucial for mitigating CPS involvement.
- Addressing clinical, social, and environmental indicators during pregnancy can support families and potentially prevent the need for CPS contact.
- The study highlights the importance of integrated data systems for understanding child welfare issues.
Abstract:
We examined preconception and prenatal predictors of time to first child protective services (CPS) contact among Alaska children. Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a population-representative data source linking 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with administrative data sources through 2015. We examined the incidence CPS contact using the Kaplan-Meier method and predictors of CPS contact using Cox proportional hazards regression. Using data from the Alaska Permanent Fund Dividend and Child Death Review, we censored children who emigrated out-of-state or died during the study period. Significant predictors included low socioeconomic status (HR = 2.23, 95% CI 1.68, 2.96), maternal smoking during pregnancy (HR = 1.87, 95% CI 1.55, 2.24), unmarried maternal marital status (HR = 1.62, 95% CI 1.31, 1.99), urban residence (HR = 1.59, 95% CI 1.32, 1.92), lower maternal education (HR = 1.54, 95% CI 1.24, 1.92), maternal experience of intimate partner violence in the 12 months before childbirth(HR = 1.32, 95% CI 1.01, 1.74), Alaska Native/American Indian race (HR = 1.40, 95% CI 1.15, 1.71), a greater number of living children (HR = 1.20, 95% CI 1.13, 1.29), a greater number of stressful life eventsin the 12 months before childbirth (HR = 1.16, 95% CI 1.11, 1.21), and younger maternal age at childbirth (HR = 0.95, 95% CI 0.93, 0.97). Use of multiple linked data sources and time-to-event analysis methods adds to the growing literature regarding predictors of CPS contact. Results suggest that assessing for and addressing clinical, social, and environmental indicators during the prenatal period may aid prevention efforts in mitigating family need for involvement with CPS.
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