The complex etiology and lasting consequences of child maltreatment.

Child maltreatment is a global public health problem of epidemic proportions [1]. Internationally, the prevalence is striking, with reports suggesting that 25%e50% of children report being physically abused [1]. The annual estimates of child maltreatment in the developed world are highest in the United States: 3.4 million referrals of child abuse involved 6.2 million children in 2011 [2]. It is estimated that 1,570 of these children (or about four children every day) died as a result of child abuse and neglect [2]. Child sexual abuse has consistently been associated with adverse psychological outcomes in adulthood [3]. Norman et al. [4] focused on nonsexual child maltreatment and found a consistent association between nonsexual child maltreatment (e.g., physical abuse, emotional abuse, and neglect) and negative outcomes related to both mental and physical health. These outcomes include depression, alcohol abuse, anxiety, suicidal behavior, and increased risk of infection with human immune deficiency virus and herpes simplex virus type 2 [4e8]. Recent research suggests that developmental timing of exposure to maltreatment during childhood influences the risk of negative outcomes such as depression and suicide in young adulthood [9,10], although there is little agreement as to whether earlier or later exposure is associated with worse outcomes. In response to the burden of child maltreatment on individuals, families, and society, the Centers for Disease Control and Prevention (CDC) recently launched Essentials for Childhood [11], a component of the Public Health Leadership for Child Maltreatment Prevention Initiative toolkit. The Public Health Leadership Initiative is a resource sponsored by the Doris Duke Charitable Foundation and developed in partnership with the CDC Foundation and CDC’s Division of Violence Prevention, to help state departments enhance child maltreatment efforts and serve as a foundation for building a national public health prevention system that promotes safe, stable, nurturing relationships (SSNRs) in an effort to prevent child maltreatment [12]. This special issue showcases the latest research initiatives that examine the intergenerational transmission of child maltreatment and investigate the moderating effects of SSNRs on continuity of the intergenerational cycle of maltreatment. In most families, child maltreatment is not perpetuated from one generation to the next [13,14]. However, in cases where it is, children are at elevated risk for a variety of negative health