The frequency and predictors of poly-victimisation of South African

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Full Terms Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformationjournalCodecphm20 Download by: 86.22.250.23 Date: 03 February 2017 At: 07:27 Psychology Health Medicine ISSN: 1354-8506 Print 1465-3966 Online Journal homepage: http://www.tandfonline.com/loi/cphm20 The frequency and predictors of poly-victimisation of South African children and the role of schools in its prevention Lezanne Leoschut Zuhayr Kafaar To cite this article: Lezanne Leoschut Zuhayr Kafaar 2017: The frequency and predictors of poly-victimisation of South African children and the role of schools in its prevention Psychology Health Medicine DOI: 10.1080/13548506.2016.1273533 To link to this article: http://dx.doi.org/10.1080/13548506.2016.1273533 © 2017 The Authors. Published by Informa UK Limited trading as Taylor Francis Group Published online: 10 Jan 2017. Submit your article to this journal Article views: 57 View related articles View Crossmark data

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Psychology health Medicine 2017 http://dx.doi.org/10.1080/13548506.2016.1273533 The frequency and predictors of poly-victimisation of South African children and the role of schools in its prevention Lezanne Leoschut a and Zuhayr Kafaar b a centre for Justice and crime Prevention c ape town south africa b department of Psychology stellenbosch University c ape town south a frica ABSTRACT Violence has become a characteristic feature of South African society with women and children often bearing the brunt of this. Contemporary research suggests that the key to stemming the tide of child victimisation is understanding the complete inventory of victimisations that may co-occur during childhood. There is growing recognition that children in South Africa typically experience abuse in the context of other forms of maltreatment and victimisation. This article draws on the empirical data collected for a national prevalence and incidence study on child sexual abuse and maltreatment in South Africa and draws attention to the frequency of poly-victimisation amongst South African children and highlights why some children experience multiple co-occurring forms of victimisations while others do not. Understanding the complete victim profle of young children and how the diferent forms of victimisation they experience intersect is critical to ensuring that the most vulnerable South Africans are provided with the extensive and targeted interventions required to break free from their heightened vulnerability to victimisation. Introduction Violence has become a characteristic feature of South African society with women and children ofen bearing the brunt of this. Contemporary research suggests that the key to stemming the tide of child victimisation is not focusing on individual types of child victi- misation but rather considering the complete inventory of victimisations that may co-occur during childhood. In so doing the multiple underlying causes of child victimisation will be addressed rather than merely the symptoms and more appropriate interventions can be developed. Nature and extent of child and youth victimisation South Africa’s frst national youth victimisation study found that for a large proportion of 12–22 year olds 41.4 violence and crime was a common occurrence with much of this KEYWORDS Poly-victimisation children south a frica schools violence prevention ARTICLE HISTORY Received 14 september 2016 a ccepted 9 november 2016 © 2017 t he a uthors. Published by informa UK limited trading as taylor Francis group. this is an open a ccess article distributed under the terms of the creative c ommons attribution-nonc ommercial-nod erivatives license http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits non-commercial re-use distribution and reproduction in any medium provided the original work is properly cited and is not altered transformed or built upon in any way. CONTACT l ezanne l eoschut lezannecjcp.org.za OPEN ACCESS

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2 L. LEOSCHUT AND Z. KAFAAR violence occurring within their homes 21.8 Leoschut Burton 2006. Loeber and Stouthamer-Loeber 1986 state that ‘family factors never operate in a vacuum but take place against a backdrop of other infuences’ which serves to amplify the efects of family variables on child victimisation. Te frequency with which children are exposed to violence in their communities became apparent when 50.1 of participants in a national study reported having witnessed someone in their community using threat or force to physically harm another person Leoschut 2009. Child abuse is also widespread in South Africa. According to a recent study 35.4 of children are sexually victimised before the age of 17 Artz et al. 2016. Tese fgures were consistent with an earlier study that showed that 38 of women and 17 of men had been sexually victimised before the age of 18 Jewkes Dunkle Nduna Jama Puren 2010. Although underreported the ofcial police statistics also attest to the widespread occur - rence of child sexual victimisation with between 18000 and 20000 child sexual abuse cases reported each year Artz et al. 2016. Physical abuse is pervasive with 20.8 of children reporting physical abuse by a parent or caregiver Artz et al. 2016. Similarly Dawes Kafaar Richter and De Sas Kropiwnicki 2005 found that 58 of parents reported having ever smacked their children at times using an object to do so 33. Neglect 15 Seedat V an Niekerk Jewkes Sufa Ratele 2009 and emotional abuse 16.1 are also endemic Artz et al. 2016. Te identifcation of violence as one of the leading causes of child mortality in South Africa clearly demonstrates the vulnerability of children. A study analysing data from mor - tuaries in South Africa found that in 2009 there were 1018 child murders Mathews Abrahams Jewkes Martin Lombard 2013. A total of 44.5 of these murders occurred in the context of child abuse and in 10 of these cases sexual abuse was suspected Mathews et al. 2013. Research studies also point toward the school environment as a common site for vic- timisation Stevens Wyngaard Van Niekerk 2001 with school violence rates ranging from 15.1 to 22.2 nationally Burton Leoschut 2013. Te child victimisation literature in South Africa have largely been concerned with doc - umenting the magnitude of individual forms of victimisation Ellonen Salmi 2011 Holt Finkelhor Kantor 2007 exploring the risk factors as well as identifying the deleterious outcomes associated with these specifc forms of victimisation Finkelhor Ormrod T urner Hamby 2005a Finkelhor Shattuck Turner Ormrod Hamby 2011 Ford Wasser Connor 2011 Voith Gromoske Holmes 2014. While these eforts have been lorded as useful for providing practitioners with an in-depth understanding of individual types of victimisation many authors have argued that it ignores the greater spectrum of adversities that children are susceptible to during childhood Hamby Finkelhor cited in Finkelhor et al. 2005b Price-Robertson Higgins V assallo 2013 and underestimates the full burden of child victimisation Holt et al. 2007. Poly-victimisation in South Africa Tere is growing recognition that children in South Africa ofen experience abuse in the context of other forms of victimisation. According to Finkelhor Ormrod T urner and Holt 2009 victimisation types are ofen interconnected and any one type of victimisation breeds not only susceptibility to other forms of victimisation Cole Maxwell Chipaca

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PSYCHOLOGY HEALTH MEDICINE 3 2014 but also vulnerability across contexts. Tus victimisation is rarely a one-of event but instead a condition in which children may become ensnared Finkelhor Ormrod Turner 2007 for years on end Widom Czaja Dutton 2008. In the South African context risk factors for victimisation include family and household composition frequent exposure to violence in the home living in a disorganised commu- nity harsh and inconsistent parenting poor parental supervision and monitoring parental absence due to prolonged illness or hospitalisation parental substance misuse and child disability Artz et al. 2016 Hawkins et al. 2000. Tere is evidence to suggest that experiences of victimisation tend to cumulate for certain high-risk individuals or certain high-risk environments Finkelhor et al. 2011. Finkelhor and colleagues use the term poly-victim to refer to those children who experience high levels of multiple forms of victimisation Finkelhor et al. 2011. Not only do poly-victims expe- rience high numbers of victimisations but they also experience victimisation in diferent contexts Finkelhor et al. 2009 Simmons Wijma Swahnberg 2015. For this reason poly-victims have a higher likelihood of maladjustment given the more severe symptoma- tology associated with the co-occurrence of victimisation Cyr Clement Chamberland 2014 Voith et al. 2014. Ellonen and Salmi 2011 found that poly-victimisation is asso- ciated with an increased level of psycho-social problems compared to children with no victimisation experience as well as those with fewer experiences. Holt et al. 2007 found that poly-victims ofen behave aggressively towards others. Schools in South Africa already face a myriad of challenges including poor infrastructure a lack of resources and various safety-related concerns Burton Leoschut 2013 Stevens et al. 2001. In addition schools are tasked with having to teach large numbers of learners who experience a range of emotional and behavioural difculties as a result of their exten- sive victimisation experiences Burton Leoschut 2013 Holt et al. 2007. For this reason schools have an important preventative role to play. Method Aims and objectives Tis article is based on the empirical data collected for a national prevalence and incidence study on child sexual abuse and maltreatment Artz et al. 2016. Te overall goal of this retrospective study was to provide an accurate estimation of the annual incidence and life- time prevalence of child sexual abuse and to locate this abuse within the context of other forms of victimisation. Participants Data for this study was collected using a population-based survey that was targeted at house - holds as well as schools. Te sample frame for the population survey was based on the 2001 Census data of South Africa adjusted according to the Statistics South Africa’ s 2011 census population numbers and other district council estimates. A multi-stage stratifed sample was used to achieve a nationally representative sample of 15–17 year olds at a household level. A school survey was also conducted at high schools that were clustered around the

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4 L. LEOSCHUT AND Z. KAFAAR enumerator areas identifed in the household survey the analysis for this article draws on the household survey data only. In the household survey 5635 participants were recruited nationally who described themselves as Black 80.4 Coloured 9.5 White 8.0 and Indian 2.0. Y oung peo- ple from KwaZulu-Natal 21.6 Gauteng 18.6 the Eastern Cape 14 and Limpopo 12.5 provinces comprised the greater part of the sample followed by those from the Western Cape 10.0 Mpumalanga 8.5 North West 6.9 Free State 5.3 and Northern Cape 2.6. Tere were more male 55.4 than female participants 44.6. Most of the participants were 16 years of age 36.5 followed by those who were 15 34.2 and 17 29.4 years old. Measures Te study used a combination of an interviewer-administered and self-administered ques- tionnaire to collect the survey data. Te questionnaires were designed to examine the prevalence and incidence of child sexual abuse and maltreatment the consequences of abuse as well as the risk and protective factors associated with abuse. In designing the questionnaires the study drew on two instruments namely the Juvenile Victimization Questionnaire Finkelhor Ormrod T urner Hamby 2005a and the Trauma Symptom Checklist for Children Briere et al. 2001. Minor revisions and additions were made to these instruments so that it was more appropriate to the South African context. Te result was a 38-item screener measure that explored a broad range of victimisations across several modules – conventional crime cyber-bullying and online victimisation child maltreatment sexual victimisation and witnessing and indirect victimisation. Te question- naires were comprehensively pilot-tested using cognitive interview techniques Carbone Campbell Honess-Morreale 2002 Miller Mont Maitland Altman Madans 2011. Procedure Te main questionnaire was administered by a trained enumerator where afer the partic- ipant was invited to also self-complete a short one-page version of the questionnaire the analysis for this article was done using the data generated from the interviewer-administered questionnaire only. Interviews were conducted afer informed parental consent and child assent was obtained. A number of measures were put in place to protect the privacy and confdentiality of the participants given the sensitive nature of the study. All questionnaires were stored in locked fling cabinets until it was captured electronically all identifying infor - mation recorded on the frst sheet of the questionnaire was removed and stored separately – ensuring that no information about child maltreatment and abuse could be traced back to any participant by name and access to the password-protected data fle was limited to core members of the research team only. Participants were provided with the details for counselling services in their area in the event that they required any support following their interview. Te research team was also legally obligated to report any cases of abuse that were disclosed during the course of the interviews that had not previously been reported to a child protection agency. Prior to the interviews the participants were informed of this in a manner they could understand. Enumerators were trained to fag reportable cases of sexual abuse physical abuse and child

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PSYCHOLOGY HEALTH MEDICINE 5 neglect that were later reported to a child protection agency servicing the geographic loca- tion in which the participants lived. Tis reporting procedure as well as the research study more broadly was approved by both the Human Research Ethics Committee of the Faculty of Health Sciences and the Research Ethics Committee of the Faculty of Humanities of the University of Cape Town. Limitations Te data for this article stems from a cross-sectional study. Since information on the diferent variables were all collected at the same point in time it does not allow for the exploration of cause-and-efect relationships between poly-victimisation and the risk factors explored in this article. Instead it merely points toward an association between the two. Data analysis Tis article follows the analysis of Finkelhor and his colleagues to a large degree by examining the clustering of diferent types of victimisation among a sample of 15–17 year olds. While this article does not explore the traumatic efects of poly-victimisation on children it includes an examination of the factors associated with an increased risk for poly-victimisation. Here the term poly-victimisation referred to a situation where a participant had expe- rienced several victimisations across diferent contexts ever in their lives. Calculating poly-victimisation using lifetime prevalence rather than last-year prevalence provides a more holistic picture of the victimisation profle of young children Finkelhor Ormrod Turner 2009 rather than focusing only on victimisation occurring in a one-year time period. Descriptive analysis Poly-victimisation was measured by items that asked participants whether they had experi- enced any of a number of victimisations. Items were scored 1 for Y es and 0 for No. A com- posite variable was created by summing all 38 items to create a Lifetime Poly-victimisation variable. Te potential range of scores for poly-victimisation was thus from 0 to 38. Scores for the Lifetime Poly-victimisation variable ranged from 0 to 28 with a median of 3 a mean of 4.16 and a standard deviation of 4.0 events. Inferential analysis Predictor variables were created for the following constructs: sleeping density i.e. the num - ber of people with whom the participant shares a bedroom accessing a social grant which parent/s resided with the participant parental absence due to physical ill-health parental mental health parental substance misuse child substance misuse parental incarceration participant disability child sexual risk behaviours and whether the child lived in an urban or rural area. Five binary logistic regression analyses were run with the same set of independent var - iables. Te frst regression compared no poly-victimisation to low poly-victimisation the

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6 L. LEOSCHUT AND Z. KAFAAR second compared low poly-victimisation to high poly-victimisation the third compared high poly-victimisation to very high poly-victimisation the fourth compared no poly-victi - misation to any form of poly-victimisation and the fnal binary logistic regression compared no poly-victimisation to very high poly-victimisation. Results In order to run a binary logistic regression the lifetime poly-victimisation variable was changed from an interval scale to an ordinal scale. Four categories were created using the mean and SD: 1 No or 1 victimisation i.e. no poly-victimisation 2 Low poly-victimisa- tion below the mean i.e. 2–4 events 3 High poly-victimisation between the mean and 1 SD above the mean i.e. 5–8 events and 4 Very high poly-victimisation more than 1 SD above the mean i.e. 9–28 events. Te frequencies for these categories are listed in Table 1. Table 2 lists the frequency of the diferent forms of victimisation. Te forms of victimi- sation are arranged from the most frequently to the least frequently occurring. Te most frequent form of victimisation was thef with 2133 participants 37.9 reporting that they had had an item stolen from them at least once in their lifetime. While it is comforting to note that only 37 participants .7 reported that they had been sexually abused by an adult known to them it is concerning to note that 357 participants 6.3 report having had a sexual experience with an adult. Binary logistic regression analyses predict membership of one of the categories of the binary dependent variable. Table 3 below lists the number of cases per analysis the Wald statistic statistical signifcance β and Exp β as well as model signifcance values. Te cat- egory of membership being predicted is denoted by an asterisk. Table 4 lists the signifcant predictors of poly-victimisation for all fve regression analyses followed by detailed explanations of the predictors of poly-victimisation. Of the 5635 young people interviewed 2033 had experienced no or only one type of victimisation ever in their lives while 3602 – the majority of the sample – had experienced two or more diferent forms of victimisations ever in their lives. Furthermore 35.4 had experienced fve or more types of diferent victimisations by the time they turned 17 years of age. Parental substance misuse Parental substance misuse consistently signifcantly predicted higher poly-victimisation in all fve regression analyses. Participants whose parents abused substances were 11.852 95 CI 1.325–106.010 times more likely to have experienced low poly-victimisation between one and four victimisation events compared to no poly-victimisation p  .05 3.454 95 Table 1. Frequency of poly-victimisation. Poly-victimisation category Frequency Per cent no 0–1 events 2033 36.1 l ow 2–4 events 1605 28.5 high 5–8 events 1288 22.9 Very high 8 events 709 12.6 total 5635 100.0

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PSYCHOLOGY HEALTH MEDICINE 7 CI 1.790–6.665 times more likely to experience high poly-victimisation between fve and eight victimisation events compared to low poly-victimisation p  .001 and 1.796 95 CI 1.128–2.861 times more likely to experience very high poly-victimisation more than eight victimisation events compared to high poly-victimisation p  .05 when compared to participants whose parents did not misuse substances. Table 2. Frequency of types of victimisation. Type of victimisation total sample size N  5635 Poly-victimisation category No Low High Very high had something stolen N  2133 37.85 96 691 818 528 seen anyone attacked without a weapon N  1859 32.99 43 504 750 562 seen anyone attacked with a weapon N  1774 31.48 28 495 712 539 had something forcefully removed N  1318 23.39 46 375 511 386 item stolen from home N  1109 19.68 53 286 446 324 t hreaten to hurt N  1072 19.02 26 240 406 400 Bullied N  965 17.13 10 179 396 380 Physical victimisation N  962 17.07 43 228 356 335 a ttacked without an object N  939 16.67 9 146 404 380 a ttacked with an object N  831 14.75 17 174 336 304 heard shots bombs or riots N  818 14.52 14 146 349 309 Malicious damage to property N  698 12.39 6 158 255 279 emotional abuse N  688 12.21 16 130 253 289 seen parent hurt siblings N  633 11.23 17 123 211 282 escape attack N  537 9.53 2 68 197 270 Parent threatened to hurt other parent N  524 9.30 9 76 170 269 Murder of friend/neighbour/family member N  436 7.74 16 65 177 178 Member of household assaulted other member N  416 7.38 24 112 127 153 Parent pushed other parent N  383 6.80 1 25 108 249 sexual experience with an adult N  357 6.34 33 89 122 113 neglect due to physical living conditions N  351 6.23 12 76 133 130 Parent hit or slapped other parent N  350 6.21 4 23 99 224 hit or attacked by an adult N  332 5.89 3 46 98 185 hit on purpose other than mentioned N  266 4.72 7 28 69 162 Parent damaged other parent’s property N  262 4.65 1 13 62 186 neglect due to fear of parents’ visitors N  259 4.60 5 51 77 126 Parent kicked choked or beat other parent N  217 3.85 1 9 43 164 sexual exposure abuse N  192 3.41 4 29 51 108 a ttacked due to prejudice N  131 2.33 2 13 45 71 Forced sexual intercourse actual or attempted N  128 2.27 7 23 27 71 Written or verbal sexual harassment N  121 2.15 2 15 39 65 sexual abuse by child or teen N  114 2.02 2 22 27 63 sexual abuse by known adult N  110 1.95 1 24 30 55 neglect due to alcohol or drugs N  100 1.78 3 14 22 61 a ttempted kidnapping N  86 1.53 2 8 37 39 neglect due to abandonment N  80 1.42 1 8 15 56 neglect of physical cleanliness N  75 1.33 3 9 17 46 sexual abuse by unknown adult N  37 .66 1 9 8 19 Table 3. Binary logistic regression analyses. c ategory of membership being predicted. Lifetime poly-victimisation N Wald Sig B Exp B Model sig no vs. l ow poly-victimisation 347 20.393 .000006 .5 1.649 .000004 l ow vs. high poly-victimisation 524 15.984 .000064 .355 1.426 .001 high vs. Very high poly-victimisation 532 13.152 .000287 −.138 .727 .000157 no vs. any poly-victimisation 879 338.363 .000001 1.742 5.71 .000001 no vs. Very high poly-victimisation 355 23.787 .000001 .536 1.71 .000001

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8 L. LEOSCHUT AND Z. KAFAAR Table 4. signifcant predictors for poly-victimisation. p  .05 p  .01 p  .001. Predictors No poly-victimisation vs. Low poly-victimisation Low poly-victimisation vs. High poly-victimisation High poly-victimisation vs. Very high poly-victimisation No poly-victimisation vs. Any poly-victimisation No poly-victimisation vs. Very high poly-victimisation Odds ratio 95 CI for odds ratio Odds ratio 95 CI for odds ratio Odds ratio 95 CI for odds ratio Odds ratio 95 CI for odds ratio Odds ratio 95 CI for odds ratio Lower Upper Lower Upper Lower Upper Lower Upper Lower Upper Parental sub- stance misuse 11.852 1.325 106.01 3.454 1.790 6.665 1.796 1.128 2.861 24.392 3.109 191.345 47.611 4.729 479.374 Parental absence due to physical ill-health 2.303 1.548 3.428 1.527 1.050 2.220 2.987 1.830 4.876 4.393 2.311 8.354 child sub - stance misuse 2.008 1.222 3.298 1.739 1.170 2.586 2.823 1.844 4.323 4.845 2.646 8.871 child sex - ual risk behav- iour 1.98 1.176 3.322 2.074 1.323 3.253 2.393 1.3 4.405 Parents residing with child 2.260 1.231 4.148 Urban/ rural resi- dence 2.545 1.144 5.65

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PSYCHOLOGY HEALTH MEDICINE 9 When we compare no poly-victimisation to any poly-victimisation and very high poly-victimisation the odds ratios increase substantially. Participants whose parents abused substances were 24.392 95 CI 3.109–191.345 times more likely to be members of the poly-victims category than the no poly-victims category p  .001 and 47.611 95 CI 4.729–479.374 times more likely to be very high poly-victims than participants whose parents did not misuse substances p  .001. Parental absence due to illness Parental absence due to illness signifcantly predicted poly-victimisation in all the regres- sion analysis excluding the regression analysis that compared no poly-victimisation to low poly-victimisation. Children whose parents were absent for prolonged periods due to physical health problems were 2.303 95 CI 1.548–3.428 times more likely to experience high poly-victimisation compared to low poly-victimisation p  .001 and 1.527 95 CI 1.050–2.220 times more likely to experience very high poly-victimisation compared to high poly-victimisation than children whose parents had not been absent p  .05. When we compare no poly-victimisation to any and very high poly-victimisation we see that children whose parents were absent due to ill-health were 2.987 95 CI 1.830–4.876 times more likely to experience any poly-victimisation compared to none p  .001 and 4.394 95 CI 2.311–8.354 times more likely to experience very high poly-victimisation compared to none than children whose parents had not been absent p  .001. Child substance misuse Child substance misuse signifcantly predicted poly-victimisation in all the regression anal- yses except the regression analysis that compared low to high poly-victimisation. Children who abused substances were 2.008 times 95 CI 1.222–3.298 more likely to experience low poly-victimisation p  .01 and 1.739 95 CI 1.170–2.586 times more likely to experience very high poly-victimisation 8 events than children who did not misuse substances p  .01. When we compare no poly-victimisation to any poly-victimisation and very high poly-victimisation we see that children who misuse substances are 2.823 95 CI 1.844– 4.323 times more likely to experience any poly-victimisation p  .001 and 4.845 95 CI 2.646–8.871 times more likely to experience very high poly-victimisation 8 events than children who do not abuse substances p  .001. Child sexual risk behaviour Children who engaged in sexual risk behaviour signifcantly predicted poly-victimisation in three of the fve regression analyses. When predicting membership of the low poly-vic- timisation category children who engaged in risky sexual behaviour were 1.98 CI 95 1.176–3.322 times more likely to experience low poly-victimisation than children who did not engage in sexual risk behaviour p  .05. Similarly when predicting membership of the any poly-victimisation category children who engaged in risky sexual behaviour were 2.074 95 CI 1.323–3.253 times more likely to experience poly-victimisation than children who did not engage in risky sexual behaviour p  .01. Finally when predicting membership

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10 L. LEOSCHUT AND Z. KAFAAR of the very high poly-victimisation category 8 events children who engaged in risky sexual behaviour were 2.392 95 CI 1.3–4.405 times more likely to experience very high poly-victimisation than children who did not engage in risky sexual behaviour p  .01. Stays with parents Which parent/s resided with the child was only signifcant when predicting membership of any poly-victimisation. Children who lived with one parent were 2.260 95 CI 1.231– 4.148 times more likely to experience any poly-victimisation than children who lived with both parents p  .05. Urban/rural Whether the children resided in an urban or rural area was only signifcant when predict- ing membership of the very high poly-victimisation category 8 events compared to no poly-victimisation. Children in urban areas were 2.545 95 CI 1.144–5.65 times more likely to experience very high poly-victimisation than children from rural areas. Discussion and conclusion Eaton Flisher and Aarø 2003 argue that there are three levels at which risk behaviours are infuenced: the personal the proximal the physical environment and interpersonal relationships and the distal level cultural and structural factors. It would seem that experiencing poly-victimisation is infuenced by factors at all levels. At the personal level sexual risk behaviour and substance misuse in the proximal context parental substance misuse parental absence due to physical health reasons and the number of parents the child resides with as well as in the distal context urban vs. rural. Tis article draws attention to the frequency of poly-victimisation amongst South African children and highlights why some children experience multiple co-occurring forms of victimisations while others do not. Understanding the complete victim profle of young children and how the diferent forms of victimisation they experience intersect is critical to ensuring that the most vulnerable South Africans are provided with the extensive and targeted interventions required to break free from their heightened vulnerability to victi- misation. Tis is essential given that poly-victims are likely to remain highly victimised as they get older Finkelhor et al. 2007 Finkelhor et al. 2011. Poly-victims are signifcantly more likely to be urban children living with one rather than both their biological parents whose parents abuse substances and are absent from the home due to prolonged illness and are children who themselves use substances and engage in risky sexual behaviours. For each of the victimisation types participants were asked whether they had been under the infuence of alcohol and/or drugs at the time of the incident. In the vast majority of cases the participants were found to have been sober at the time of the incident. Although this research can merely point toward an association between these descriptors and poly-victimisation and cannot make any causal claims about these variables it may suggest that participant substance abuse specifcally may have been a consequence of the poly-victimisation.

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PSYCHOLOGY HEALTH MEDICINE 11 Given the persistent nature of poly-victimisation across the life-span of children early intervention is key. Identifying children most at risk of poly-victimisation and intervening early on may bufer children from experiencing continued victimisation later on in life Finkelhor Ormrod T urner 2009. Schools are in an ideal position to do this given that children spend a large amount of time there. Te identifcation of schools as an important site for violence prevention is further under - scored by Ozer and W einstein 2004 cited in Ozer 2005 who argue that there are generally two types of protective factors for adolescents. Te frst are supportive relationships with signifcant others while the second is growing up in physically safe social environments of which the home and the school are most important Ozer Weinstein 2004 cited in Ozer 2005. Tere are also other reasons why schools are ideal sites for preventing child victimisation. Firstly schools provide a social context that comes along with established infrastructure and resources that could support violence prevention initiatives Stevens et al. 2001. When school personnel can efectively identify high risk learners they can ensure that the availa- ble resources are targeted at those children who are most prone to multiple victimisations. Secondly schools have a captive audience and can implement carefully targeted interventions for a sustained period of time. Tis will ensure that poly-victims who are attending schools can access continued support services during the years that they’ll be attending school. Tirdly schools are attended by children and youth who are at critical developmental stages in their lives. Carefully targeted interventions can positively infuence their developmental trajectories Ozer 2005. Although schools provide an important entry-point for prevention Holt et al. 2007 other interventions that fall outside the ambit of schools are required to address poly- victimisation including substance abuse treatment and prevention initiatives and parenting support programmes Finkelhor et al. 2011. Disclosure statement No potential confict of interest was reported by the authors. Funding Tis work was supported by Know Violence in Childhood. References Artz L. Burton P . Ward C. L. Leoschut L. Phyfer J. Lloyd S. … Le Mottee C. 2016. Sexual victimisation of children in South Africa. Final report of the Optimus Foundation Study: South Africa. Cape Town: UBS Optimus Foundation. Briere J. Johnson K. Bissada A. Damon L. Crouch J. Gil E. … Ernst V . 2001. Te Trauma Symptom Checklist for Y oung Children TSCYC: Reliability and association with abuse exposure in a multi-site study. Child Abuse Neglect 25 1001–1014. Burton P . Leoschut L. 2013. School violence in South Africa: Results of the 2012 national school violence study. Cape Town: Centre for Justice and Crime Prevention. Carbone E. T . Campbell M. K. Honess-Morreale L. 2002. Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations. Journal of the American Dietetic Association 102 690–696.

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PSYCHOLOGY HEALTH MEDICINE 13 Seedat M. Van Niekerk A. V . Jewkes R. Sufa S. Ratele K. 2009. Violence and injuries in South Africa: Prioritising an agenda for prevention. Te Lancet 374 1011–1022. Simmons J. Wijma B. Swahnberg K. 2015. Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: A cross-sectional study of Swedish male and female clinical and population samples. BMC Public Health 151 978–992. Stevens G. Wyngaard G. V an Niekerk A. 2001. Te Safe Schools Model: An antidote to school violence. Perspectives in Education 19 145–158. Voith L. A. Gromoske A. N. Holmes M. R. 2014. Efects of cumulative violence exposure on children’s trauma and depression symptoms: A social ecological examination using fxed efects regression. Journal of Child Adolescent Trauma 7 207–216. Widom C. S. Czaja S. J. Dutton M. A. 2008. Childhood victimization and lifetime revictimization. Child Abuse Neglect 32 785–796.

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