Tracie Afifi used to wonder whether Canada has a child-abuse problem.
That was before the University of Manitoba epidemiologist led a 2014 study to investigate the question. Drawing on a sample size of more than 23,000 Canadian adults, Dr. Afifi and her colleagues found that one-third reported experiencing some form of maltreatment as children. The figure, published in the Canadian Medical Association Journal, encompasses physical and sexual abuse as well as exposure to intimate-partner violence. And it comes with a pernicious legacy that includes elevated risk of learning disabilities, eating disorders, substance abuse and suicide.
Now, five years later, Dr. Afifi wants to head off those consequences by using the power of data to intervene before abuse occurs.
“If you can prevent child maltreatment from happening, you have the potential to change the whole trajectory of that individual’s life,” she said. “You’ll have better health outcomes, stronger families. That’s why we need to move upstream.”
The approach marks an inflection point for the 41-year-old scientist as she shifts from gathering evidence to translating her research into effective public policy. Her efforts have already won kudos from colleagues and front line organizations dealing with child abuse. On Thursday, the Canadian Institutes of Health Research, a federal funding agency, presented Dr. Afifi with its annual Gold Leaf award in the early-career researcher category at a ceremony in Ottawa.
The award comes with $100,000 in additional funding for Dr. Afifi’s studies of child maltreatment – work that fellow scientists say stands out for its rigorous methodology while tackling one of the most emotional and controversial areas of public health.
“She’s an exceptional scientist who cares deeply about the impact of her work,” said Harriet MacMillan, a psychiatrist and pediatrician at McMaster University in Hamilton who is working with Dr. Afifi on a project let by Andrea Gonzalez, another McMaster scientist. The project will test ways of educating new parents to help them avoid situations and responses that could lead to abuse.
“A lot of the work I do is at the population level, but you learn about individual experiences … it’s heart-wrenching to realize what some kids go through,” said Dr. Afifi during an interview at the university’s medical school and health sciences centre in downtown Winnipeg. “Every day I still think about how heavy it is."
That sense of heaviness was magnified when she became a parent herself, Dr. Afifi added, but so was her desire to help children. Her interest in children began when she was a babysitter during her high school years in Winnipeg and later a volunteer with special-needs kids. As a master’s student she studied the consequences of physical abuse in children of adolescent mothers.
Dr. Afifi later switched tracks and earned her PhD studying problem gambling among women. During her post-doctoral work, she lived in New York where her husband, a physician, was completing his surgical training. The couple returned to Winnipeg in 2010, looking to be closer to family. In a stroke of good timing, Dr. Afifi was then able to step into a new faculty position at the University of Manitoba where she had the latitude to fully develop her studies into child maltreatment and its effects. It was the opportunity of a lifetime and a chance to put science to work, systematically overturning misconceptions about child abuse and health outcomes, a connection she said that has long gone unrecognized.
Those outcomes include long term effects on physical and brain development related to continuous high stress levels when children feel they always need to be on guard for the possibility of physical harm. Learning issues related to poor sleep are a problem for children who endure sexual abuse, which often comes at night.
In 2013, Dr. Afifi made headlines with research findings that put spanking on the same spectrum as physical abuse. In doing so, she found herself running up against cultural and religious traditions as well as Section 43 of the Canadian criminal code, which allows for the use of physical force for disciplining children under the age of 18. Notwithstanding the well worn biblical proscription against “sparing the rod,” there is no evidence that spanking confers benefits while the evidence that it increases the risk of negative outcomes is clear, Dr. Afifi said. Tolerance for the practice also serves to disguise when adults are sliding into more severe forms of physical abuse.
“She’s really brought that dialogue into broad public light,” said Jitender Sareen, a professor of psychiatry and a colleague. He added that Dr. Afifi has shown courage in standing by her science in the face of pushback from some parents and communities who argue that physical discipline for children is acceptable.
Dr. Afifi said that one research thread she and her team are currently following involves looking at why some children manage to resist the effects of abuse and enjoy good health later in life. Protective factors that account for this may include positive relationships that arise from after-school activities or other areas of life that offer children some refuge from abusive situations and an opportunity to look to a better future.
“We think there’s something behind that,” she said. “It may be that the person has the hope that they can control their fate … that it doesn’t always have to be like this.”