Child maltreatment including physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, and exposure to intimate partner violence (IPV) as well as IPV in adulthood are forms of violence that have shown consistent associations with poor mental and physical health outcomes [1–18]. Child maltreatment and IPV jeopardizes the health of all family members, which significantly impacts communities and societies. It is known that an intergenerational cycle of child maltreatment exists for some families, meaning that those who were maltreated as children are more likely to maltreat to their own children [19–22]. It is also known that different types of child maltreatment commonly co-occur [5, 23–25]. However, it is currently unknown if the use of physical punishment (i.e., a physical act by a parent or guardian that causes deliberate pain in response to unwanted child behaviour) or harsh physical punishment (i.e., pushing, grabbing, shoving, hitting, and slapping) is related to more severe childhood maltreatment and to later violence in intimate relationships in adulthood. From a public health perspective, understanding this potential relationship is important because physical punishment remains common and is legal in North America [26–29]. This is the case even though 52 countries or states worldwide have banned all forms of physical punishment of children in all settings including home and schools [30]. Further, physical punishment has been found to be ineffective and related to numerous adverse health, behavioural, cognitive, and developmental outcomes [31–41]. Extending our knowledge in this area may be important for informing child maltreatment and violence prevention efforts and improving health across the lifespan both in countries with and without legal bans on the physical punishment of children.

Some researchers have examined the co-occurrence of physical punishment and more severe types of child maltreatment. For example, abusive parents have been found to be more likely to use physical punishment compared to non-abusive parents [42]. Similarly, Canadian child protection services data indicates that physical punitive violence was involved in 75% of substantiated cases of physical abuse as well as 13% of emotional maltreatment, 2% of sexual abuse, 2% of neglect, and 1% of exposure to IPV [43]. In addition, in a representative sample from North and South Carolina, physical punishment was associated with a 2.7 fold increase in the likelihood of physical abuse [44]. It may be that in some cases physical punishment as a disciplinary measure is a precursor in the progression and escalation towards child physical abuse; perhaps hitting as a disciplinary means evolves into more severe physical acts of maltreatment related to increasing anger in the person committing such acts (typically a parent) [45].

The current literature has important limitations. Many of the previous studies in the area have the used small and unrepresentative samples, which limits generalizability of the study findings. Additionally, studies have mainly focused on the relationship between physical punishment and only one type of child maltreatment – child physical abuse. However, it is possible that physical punishment may be associated with an increased likelihood of other child maltreatment types such as emotional abuse, emotional and physical neglect, sexual abuse, and exposure to IPV. We know from previous research that physical abuse commonly co-occurs with other types of child maltreatment [46, 47]. As well, physical punishment and child physical abuse both involve physical force and therefore, are believed to exist along a continuum rather than as distinct constructs [48–50]. Therefore, it is reasonable to hypothesize that physical punishment may also co-occur with other types of child maltreatment. Understanding this relationship has significant implications for child maltreatment prevention strategies. Importantly, it remains unknown if physical acts such as pushing, grabbing, shoving, hitting, or slapping are associated with other types of child maltreatment in a representative sample.

Furthermore, experiencing physical maltreatment in childhood with or without other forms of child maltreatment may make physical violence seem acceptable and may increase the likelihood of violence continuing into intimate partner relationships in adulthood [41]. Previous research has found that a child maltreatment history is associated with increased odds of violence in an intimate relationship in adulthood [2, 51]. It is possible that a similar association also exists for harsh physical punishment and violence in adult intimate relationships. Some support for this relationship has been found with research indicating a significant association between being physically punished as a teenager and increased odds of violence towards women in adulthood [52]. As well, research has indicated that maltreated children were more likely to be victims of IPV in adulthood [53]. Although these studies have examined child maltreatment and IPV in adulthood, our understanding of the association pushing, grabbing, shoving, hitting, and slapping children and later IPV in adulthood is limited. This identifies another important gap in knowledge; it is currently unknown if harsh physical punishment in childhood is linked with an increased likelihood of perpetration, victimization, and reciprocal violence in intimate adult relationships and if these associations exist independent of more severe child maltreatment.

The main objectives of the current research were to 1) examine if harsh physical punishment (i.e., pushing, grabbing, shoving, hitting, and/or slapping) is associated with increased odds of child maltreatment in childhood, including emotional abuse emotional neglect, sexual abuse, physical neglect, physical abuse, and exposure to IPV and 2) examine if harsh physical punishment is associated with increased odds of perpetration, victimization, or reciprocal IPV in adulthood in a large representative United States (US) sample after adjusting for possible confounding effects of sociodemographic variables, other types of child maltreatment, and a family history of dysfunction.

This study has two main important findings. First, harsh physical punishment was associated with increased odds of all child maltreatment types including emotional abuse, sexual abuse, physical abuse, physical neglect, emotional neglect, and exposure to IPV after adjusting for sociodemographic factors, family history of dysfunction (AOR range 1.6 to 26.6). Second, harsh physical punishment was associated with increased odds of IPV perpetration, victimization, and reciprocal violence in adulthood (AOR range 1.4 to 1.7) in adjusted models.

Previous research has indicated that physical punishment is associated with an increased likelihood of physical abuse [44, 66]. Our findings show this association as well, but also indicate that the relationship with harsh physical punishment extends beyond physical abuse to include an increased likelihood of childhood emotional abuse, sexual abuse, physical neglect, emotional neglect, and exposure to IPV, as well as perpetration, victimization, and reciprocal IPV in adult relationships. Importantly, the relationships between harsh physical punishment and each individual child maltreatment type were not accounted for by experiencing other types of child maltreatment. The strongest effects were noted between harsh physical punishment and physical abuse, emotional abuse, and exposure to IPV. The effect for physical neglect, emotional neglect, sexual abuse, IPV perpetration, IPV victimization, and reciprocal IPV had lower effect sizes, but all remained statistically significant.

This study has several limitations including the cross-sectional nature of the data, which precludes making causal inferences in the relationship between harsh physical punishment and child maltreatment and IPV in adulthood. This is especially the case when examining the relationships between harsh physical punishment and child maltreatment because the temporal nature of these relationships cannot be determined with these data. Second, all data were based on self-reports from the respondent. Third, data on childhood experiences were assessed retrospectively, which may introduce some sampling error due to recall and reporting bias. However, evidence indicates that adverse childhood events can be accurately recalled [67]. Additionally, the current data collection used a common flashcard method where respondents viewed the flashcards and indicated with codes the traumatic events that had occurred. This means neither the interviewer nor the respondent had to verbally identify the event during the interview, which may increase the accuracy of reporting. Fourth, harsh physical punishment was assessed using one item. Physical acts of pushing, grabbing, shoving, hitting, and/or slapping are harsh and may go beyond what some would consider “mild disciplinary spanking.” Finally, the measure of parental psychopathology was limited because it was assessed using the respondent’s retrospective recall and knowledge of parental problems with alcohol or drugs and being treated or hospitalized for mental illness.

These findings have important implications for clinical practice, prevention, and policy. It is essential that professionals working with children and families are aware of the statistically significant co-occurrence of harsh physical punishment and physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to IPV in childhood and also experiencing IPV victimization and/or perpetration in later adulthood. It might be that pushing, grabbing, shoving, hitting, and/or slapping children are risk indicators of poor parenting or discipline strategies linked with increased odds of child maltreatment for some families, and violence in intimate relationships in adulthood. Although a causal role for harsh physical punishment and child maltreatment in relation to violence in intimate adult relationships cannot be determined with these data, health care providers should consider the co-occurrence of these experiences and the possibility of escalating and continuation of violence when making recommendations regarding physical discipline. Based on findings from earlier studies together with these new results, it is recommended that parents or other adult caregivers should not physically punish children. This recommendation is made in an effort to protect children from potentially harmful forms of physical punishment and to reduce the likelihood of exposure to more severe forms of child maltreatment and violence in intimate adult relationships. We also know from previous research that child maltreatment and IPV is associated with poor mental and physical health outcomes [1–11, 13–18, 68]. This adds to the importance and urgency of understanding how we can successfully reduce and prevent exposure to child maltreatment and violence across the lifespan.

From a public health perspective, it is a priority to prevent children’s exposure to maltreatment during childhood as well as IPV in adulthood. Preventing or reducing the prevalence of child maltreatment and IPV is a challenging task. With regard to prevention of IPV in adulthood, the focus has mainly been on education about healthy relationships and prevention of dating violence [69]. However, for some individuals, exposure to harsh physical punishment may set the stage for acceptance regarding the use of physical force in relationships and establish some degree of tolerance of violence perpetration or victimization in an intimate relationship. Most of the research in this area has focused on the link between more severe child maltreatment and IPV [70]. Insufficient attention has been paid to the overlap between harsh physical punishment in childhood and IPV in adulthood and how this relationship can inform prevention strategies. Traditionally, research and policies have focused on reducing male violence against female partners. Another important strategy to examine is the role of both male and female caregivers in preventing IPV through reducing their use of harsh physical punishment of children. Positive parenting approaches that do not include physical discipline are important for reducing the likelihood that a child will experience physical punishment, child maltreatment, and IPV in adult intimate relationships.