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252Maxia Dong, Robert F. Anda, Vincent J. Felitti, Shanta R. Dube, David F. Willamson, Theo-dore J. Thompson, Clifton M. Loo, and Wayne H. Giles, “The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction,” Child Abuse & Neglect28 (2004): 771–784; William J. Oliver, Lawrence R. Kuhns, Elaine S. Pomeranz, “Family structure and child abuse,” Clinical Pediatrics45 (2006): 111–118. As cited in Tracie O. Afifi, Jonathan Boman, William Fleisher, and Jitender Sareen, “The Relationship between Child Abuse, Parental Di-vorce, and Lifetime Mental Disorders and Suicidality in a Nationally Representative Adult Sample,” Child Abuse and Neglect33 (2009): 140. 253Patrick Leung, Russell L. Curtis, Jr., and Susan C. Mapp, “Incidences of Sexual Contacts of Children: Impacts of Family Characteristics and Family Structure from a National Sample,” Children and Youth Services Review32 (2010): 654. 254Maxia Dong, Robert F. Anda, Shanta R. Dube, Wayne H. Giles, and Vincent J. Felitti, “The Relationship of Exposure to Childhood Sexual Abuse to Other Forms of Abuse, Neglect, and Household Dysfunction during Childhood,” Child Abuse and Neglect27 (2003): 632. 255Byron Egeland, L. Alan Sroufe, and Martha Erickson, “The developmental consequence of different patterns of maltreatment,” Child Aubse and Neglect7, no. 4 (1983): 459-469; Debbie Hoffman-Plotkin and Craig T. Twentyman, “A Multimodal Assessment of Behavioral and Cognitive Deficits in Abused and Neglected Preschoolers,” Child Development 55, no. 3 (1984): 794-802. As cited in Richard Emery, “Abused and Neglected Children,” The American Psychologist44 (1989): 324. 256Yuriko Egami, “Psychiatric Profile and Sociodemographic Characteristics of Adults Who Report Physically Abusing or Neglecting Children,” American Journal of Psychiatry153 (1996): 925. 257Gisele Caldas Alexandre, Paulo Nadanovsky, Caludia Leite Moraes, and Michael Reichenheim, “The Presence of a Stepfather and Child Physical Abuse, as Reported by a Sample of Brazilian Mothers in Rio de Janeiro,” Child Abuse and Neglect34 (2010): 963.
38 Relative Rates of Physical Abuse by Family Structure Source NIS-4, 20101.05.24.310.33.13.6024681012Always IntactMarried FamilyStep MarriedFamilyIntact CohabitingFamilyStep CohabitingFamily Single ParentFamilyNot living witheither parent Living with a stepfather increases a child’s likelihood of subjection to pre-pubertal sexual contact.258The rate of sexual abuse of girls by their stepfathers is at least six or seven times higher,259and may be as much as 40 times higher,260than sexual abuse of daughters by their biological fathers who remain in intact families.A study of 26 instances of fatal child abuse reported that 62 percent of perpetrators were the stepfathers of the abused children and that 81 percent of perpetrators were engaged in cohabiting relationships with the victimized child’s mother (15 percent of perpetrators were married to the victimized child’s mother).261Another study reported that children under age five were 50 times more like to suffer fatal abuse if they lived in homes with an unrelated adult