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CHILD-REARING VIOLENCE

D A V I D H E M E N W A Y , S A R A S O L N I C K , AND J E N N I F E R C A R T E R

Department of Heahh Policy and Management, Hap, ard School of Public Health, Boston. MA, USA

Abstract--In 1989. a national, random sample of 8OI adt, hs was questioned al~mt the punishment they received as children and the way they discipline their own offspring. Analysis revealed that verbal and phy'~ical discipline are not substitutes, but. instead, are commonly used together. Parents v,'ho yell frequently are the ones most likely to hit frequently, and vice ~.ersa. In addition, both physical and verbal violence apl~.ar to be transgenerational. Resp~mdents v, ho v, ere spanked ()elled at) frequently as children are more prone to frequently spank (yell at~ their ov, n children. Still. most people are able to break out of the mmsgeneratiom, I cycle of punitive child rearing. This outcome may be fi~und particularly amt,ng those who consider themselves to have been abused.

Key W-rd~'--Child abuse. Family violence. Verbal abuse. Survey research.

INT RODUCTION

TIlE UNIT['~I) STATES is perhaps the most violent of all developed countries (U.S. Senate Judiciary Committee, 1991), with domestic violence among the most common of violent crimes. Within the family, child abtnse occurs at an alarmingly high rate. An estimated two million children are abused and/or neglected annt,ally (General Accounting Of lice. 1991). Child aht, se is one of the ntost pressing issues t'acing the nation (Patterson & Kim, 1991 ).

Many of the consequences o f abttse are wel l -es tab l i shed . Abused chi ldren are likely to have

h)wer se l f -es teem (Kinard, 1980; ( )a les , Forrest , & Peacock , 1985) and lower in te l l igence

(Fricdrich, Einbcnder , & l ,uecke , 1983, I lo f fman- I 'h ) tk in & T w e n t y m a n , 1984; Perry, Doran, &

Wells, 1983) and to be more agg re s s ive both phys ica l ly and verbal ly (Dodge , Bates, & Pettil,

1990; Egeland & Sroufe , 1981; G e o r g e & Main, 1979). These aggress ive tendencies last into

adulthood. Being abused as a chi ld appears to be a m o n g the risk factors for being abus ive as

a parent (Kaufman & Zigler , 1987; W i d o m , 1989).

The problem of psycho log ica l abuse is r ece iv ing increased at tent ion in the l i terature (Garbar-

ino & Vondra, 1987; Garr i son , 1987). C o m p a r e d to physical abuse, psycholog ica l mahrea tmen t

may have a greater nega t ive impact , wh ich may last for a longer per iod o f t ime (Brassard,

Germain, & tlart , 1987). A l though a broad range o f behav io r can be termed " 'p sycho log ica l

mal t reatment ," verbal assauh (e.g., ye l l ing) is s o m e t i m e s used am a proxy (Amer ican H u m a n e

Assodation, 1980; tlart. (]ernmin. & Brassard, 1987; National Center on Child Abuse & Neglect, 1981). [-vidence suggests that physically abusive parents are also more likely to inllict verbal abuse (Ney. 1987).

This analysis was SUpl~Wled in part hy tile I larvard Injury Control ('enter, funded by tile ('enters for Disease Control.

Data v, erc ohtained from Ihe Rol~.'r ( 'enter for Public ()pinion Research in Storrs, CT.

Suhrnmed for puhlicathm I)eceunber 17. 19q l: linal revision received September 2. 1993: accepted September 27. 1993.

Requests fiw reprinls shouM be addressed to David Ilcmenway. Ilcahh Policy and Management, 677 tluntington Avenue. Boston. MA |12115.

IOll

11)12 D. Hemen'~,a~. S, Solnick. and J. Carter

The transgenerational nature of abuse may be affected by many factors, including the health of the child, the parents" network of social support and their ability to resolve their own childhood treatment. It may be that parents who admit they were abused are less likely to inflict similar treatment on their offspring (Hunter & Kilstrom. 1979).

This study investigates three issues:

1. the asst~:iation between verbal and physical punishments: 2. the extent to which child-rearing violence in one generation is repeated in the next: 3. the effect of believing one was abused on subsequent child-rearing behavior.

Data were taken from a national random-digit-dial telephone survey. A few results from the questionnaire--current and past rates of spanking and a handful of other f requencies-- have been reported in a short newspaper article (Manning, 1989). This paper extends the analysis, exploring the factors associated with child-rearing violence.

METHODS

In February 1989, the Gordon S. Black Corporation, a well-known and experienced survey research organization, interviewed a random sample of 801 adult American men and women over the telephone. Phone numbers were randomly generated by computer to ensure that households with both listed and unlisted numbers were included. Respondents were not identi- liable to the researchers by either name or address.

Sample surveys are subject to sampling error. Results may differ from what would be obtained if the whole population wcrc interviewed. For a survey of 8011 respondents, the results are subject to an error margin of _-.3 percentage points for each question because of chance variation in the sample. For a survey of 325 respondents, the size of a subsamplc we investi- gated, the crn~r margin was .+_6 percentage points. Because they may not have telephones, the views of some members of the population, particularly individuals with low income, were probably underrepresentcd in the findings.

Respondents wcrc questioned about the ptmisbmcnt they received as children and whether they believe they were abused. They were als~ asked aboul whether they currently had children under 18 years of age living at home. and how they disciplined them.

Individuals were asked to recall how often they were yelled at and how often they were spanked or physically disciplined as children. Possible answers to these questions were: every day, about once a week, about once a month, less than ouce a month, never, or whenever needed, l)ummy variables for use in regression analysis were created from these categories. For yelling, "'every day" is compared to the other frequencies. For spanking, "every day" and "'about once a week'" are gnluped together. Respondents were also asked a yes/no question about whether they believed they were abused. Parents with children at home were further asked how often they yelled at and spanked them.

Univariate analysis was used to examine the distribution of responses. Cross-tabulations were used initially to address the research questions, using the chi-square test for the discrete independent variables. Multiple regression was called for to control for potential confbunding. Since the outcome variables wcrc dichotomous, logistic regression techniques were employed.

Some individuals did not answer every question, and many did not have children living at home. Thus the number of responses in the tables varies, and nmy not add up to 801.

RESULTS

Current Census Bureau data indicate that the survey respondents were demographically similar to the U.S. adult population, ill our survey, a little over half of the respondents were

Child-rearing violence

Table 1. Disciplinary Behavior. Past and Present

1013

Yelled at as Child Yell as Parent

All Respondents Those With Children tN = 801~ ~',V = 328)

Daily Weekly At Most Monthly Never Whenever Needed Refused

18% 21% 19% 35% 41% 36% 2..1% 22% 25% 9% 9% 9% 9% 6% 2% 5% 4% 10,%

Spanked as a Child Spank as Parent

All Respondents Those with Children (N = 8011 IN = 328)

Daily 2% 2% 2% Weekly 16% 18% 13% At Most Monthly 48% 49% 41% Never 16% 15% 35%*** Whenever Needed 14% 1 I% 8% Refused ,1% 5% 1%

*** p < .(R)I.

female. Forty percent had a child under 18 living at home; a quarter had more than one child. Ten percent were black, and 17% were relatively poor (less than $15,000 in annual family income).

Our survey results suggested that the frequency distribution for yelling and spanking has not changed much over the span of a generation (Table I). Fightccn percent of respondcnts were yelled at daily when they were children and 2% were spanked daily. Similar percentages of parents with children at home reported yelling and sp:mking daily. A notable exception was that more respondents claimed they never spanked their own children (35%) than report never being spanked when they themselves were children (15%).

Verbal D&cipline

Frequent spanking accompanied IYequent yelling, and vice versa. A third of parents surveyed who yell at their children every day reported spanking them at least weekly, while only 6% of those who rarely yell spank their children that often (Table 2a). More than half of those who were yelled at every day as children also received spankings at least once a week; only 4% of those yelled at monthly or less received spankings that often (not shown).

The frequency of spanking and yelling was positively related even holding other factors constant (e.g., gender, race, number of children, and income) (Tables 2a and 2b).

Family Violence Across Generations

Fifteen percent o f respondents reported spanking their children at least weekly (Table 2a); 20% yelled at their children daily (Table 2b).

Results were consistent with the hypothesis that patterns o f disciplinary behavior are passed from one generation to the next. Parents who were spanked at least weekly as children are far more likely to spank their children that often compared to those who were spanked less often as children (multivariate relative risk = 5 . 3 7 . 9 5 % CI: 2.39, 12.021 (Table 2a). Parents who, as children, were yelled at daily are signitic:mtly more likely to yell that often at their own

1014 D. H e m e n w a y , S, Solnick. and J. Car ter

T a b l e 2a. Factors Affect ing Frequency of Punishment: W h o S p a n k s W e e k l y ?

Mult ivar ia te" Relat ive e4 Spank at Risk

Least Week ly 195% Cl)

Se~ Male N = 146 18% Female N = 179 12q

Race Black N = 31 16% Whi t e /As i an /O the r N = 294 15%

N u m b e r o f ch i ldren More than 2 N = 61 21% I or 2 N = 26.-I 14"7t

Income $15.1"R)O or less N = 31 13% More than $15.1)OO N = 275 15%

Yelled at as a Child" Daily N = 69 23%* W e e k l y N = 134 14% Less than weekly N = 90 I I% W h e n e v e r n c c d c d N = 211 15%

Spanked as a Child" At least week ly N = 68 32'7~*** At most mon th ly N = 1611 8'% Never N = 48 I0'+,

W h e n e v e r needed N = 31') I I% Yell al O w n Chikl rcn"

I)~,ily N = 63 33'7,.*** Week ly N = 117 17'74. I,ess than week ly N -: 1118 6 % W h e n e v e r needed N = 32 3r~ ,

()ver:dl 15%

.63 1.77. 3 .46)

8 5 (.25. 2 .92)

.93 1.85. 4.41 )

.04 1.31. 3 .57)

.45 (.17. 1.21))

5 .37*** 12.39. 12.112)

4.41*** 11.99, 9.76)

.'gignilicaz~¢e test: Iiiosl f requent c a l e g o r y ¢ tmtparcd to all other ¢:tlegorics. " N -+ 2 8 4 * y -" .115. ""p - .01. * + " p -: .001. , :hi+square "= .I)~ M)I.

children comfmrcd to those who wcrc less often yelled at (multivariate RR = 3.78, 95% Cl: 1.84, 7.781 (Table 2b).

Perceived Abuse

Nine percent of surveycd adults believed they were abused as children (Table 3). Not surprisingly, those spanked more often were more likely to feel abused. Forty percent of those hit daily said thcy wcrc abuscd, compared to 3% of those who were never hit. Indeed, those spanked at least weekly as children were over four times as likely to perceive themselves as abused compared to those spankcd Icss often (multivariate RR = 4.63, 95% CI 2.5 I, 8.55).

Among those who received frequent physical or verbal discipline (i.e., yelled at daily and/ or spankcd at least wccklyl, individuals who believed they were abused appeared less likely to discipline their own children frequently compared to those who did not consider themselves abused (Tablc 41. Whilc the difference appears st, bstantial (i.e., 30% vs. 52%), due to the small number of observations (N = 11)41, the difference is statistically signiticant only at the lOG level.

Chi ld - rea r ing violence

Table 2b. Factors Affecting Frequency of Punishment: Who Yells Daily?

1015

Mult ivar ia te t' Relat ive Risk

'7, Yell Daily ~ 9 5 q C i l

Sex Male N = 145 18% Female N = 177 21%

Race Black N = 30 20% Whi t e /As i an /Othe r N = 292 2 0 %

N u m b e r o f ch i ldren More than 2 N = 611 25% I o r 2 N = 262 18%

Income $15.(~10 or less N = 31 2Y7,, More than $15.1R)0 N = 272 19%

Yelled at as a Ch i l& Daily N = 68 38%*** Week ly N = 131 18% Less than week ly N = 90 7 % W h e n e v e r needed N = 21) 3 0 %

Spanked as a Child" At least weekly N = 67 33%** At most mon th ly N = 160 16% Never N : 46 15% W h e n e v e r needed N = 36 17%

Spank O w n Chi ld ren ~ At least week ly N = 4q 43'7,,*** At most mon th ly N = 134 1¢)'7, Never N = I I I II)% W h e n e v e r needed N = 26 2Y7`'

O v e r a l l 211'7,

.68 1.35. 1.32)

1,38 (.49. 3.90)

1.27 1.60. 2 .68)

.61 (.19. 1.89)

3 .78"** t l . 8 4 . 7.781

1.02 (.47. 2 .22)

4 . 47"** 12.1)3. 982)

Signi t icance test: most li'etlUenl c a l c g o r y co . , Imred It) all t~lher ca tegor ies . " N = 2 8 4 * I , -" .I)5. * * I ' "" .01.

*** i , - / . (X)I . chi-s t luare • 7 .IXX) I,

DISCUSSION

While every state has passed laws to protect children from abuse, corporal punishment by parents is legal in all jurisdictions. In addition to being sanctioned, the use of physical discipline remains widespread. A natiomd survey conducted in the mid-1970s indicated that tile vast majority of children in the United States have been physically disciplined (Straus, 1983). In annual surveys between 1987 and 199 I, over half of parents admitted to spanking their children in the previous year (National Committee for Prevention of Child Abuse, 1991). Results of this survey are similar (Table I).

Verbal l)iscodine

Psychological abuse can be as detrimental as physical abuse. Indeed, a recent survey indicates that, compared to physical aggression by parents, verbal aggression by parents is more strongly related to the child 's aggression and personal problems (Vissing, Straus, Gelles, & tlarrop, 1991 ).

Like physical abuse, verbal abuse appears to be passed from generation to generation (Ncy,

1016 D. H e m e n w a y , S. Solnick, and J. Car ter

T a b l e 3. Perceived A b u t : W e r e Vou Abu.~qt as a Chi ld?

Muhi variate ' Relat i ' ,e Risk

Yes 195'k CI)

Sex Male N = 352 8% Female N = 4-10 10%

Race Black N = 82 9% Whi t e /As i an /Othe r N = 71)5 9 %

N u m b e r o f ch i ldren More than I N = 202 I I% 0 or I N = 588 8%

Income $15,(XX) or less N = 121 7 % More than $15.(X)O N = 61)5 10%

Yelled at as a Child" Dai ly N = 143 29%*** Week ly N = 279 7% At most mon th ly N = 189 3% Never N = 74 3 % W h e n e v e r needed N = 71 4 %

Spanked as a Chi ld h Daily N = 21) 4 0 ~ * * * Week ly N = 126 27% At most mon th ly N = 381 5'7,, Never N = 127 3% W h e n e v e r needed N = 11)6 4 %

Overall 9 %

.53* (.29, .96)

.58 (,19. 1.78)

1.24 (.67, 2.31))

.68 (.29. 1.62)

4 .59*** (2.51. 8.41)

4 .63*** (2.51, 8.55)

S ign i l i cance lesls: Daily versus all o ther c a t e g o r i e s

" At least weekly versus other categor ies . ' N = 684. * p < .05. * * * p < .IX)I. Chi - sqna re = <.(RH)I.

1987). Our tindings showed a signilicant correlation between being yelled at as a child and yelling as a parent (Table 2b). However, the majority of parents who were yelled at every day in childhood do not yell so frequently at their own offspring. And some who were rarely yelled at report yelling at their own children weekly or even daily.

Consistent with other surveys (Straus, Gelles, & Steinmetz, 1980), our findings indicated that verbal and physical punishment tend to cluster together. Parents who frequently yell at their children are also prone to hit then) frequently, and vice versa. (~ver half of respondents who as children were yelled at daily were also spanked weekly (not shown). By contrast, less than I in 20 of those yelled at monthly or less reported a weekly spanking (not shown). Yelling at children does not seem to be a substitute for corporal discipline.

Family Violence Across Generations

The possible transgenerational nature of child abuse has been the subject of much research and discussion (Kaufman & Zigler, 1987; Widom, 1989). The emerging consensus seems to be that being abused as a child increases the risk for becoming an abusive parent, but the pathway is neither straight nor certain.

Our evidence dealt with what Egeland, Jacobvitz, and Papatola (1987) might term a "border- line abusive group"-- those who administered daily or weekly spankings. Our findings are in

Chi ld- reanng violence

Table 4. lntergenerational Transmission of Child Rearing Violence and Perceptions of Abuse: Do Parents Who Were Frequently Disciplined" as Children Similarly

Diseipline Their Own Children?

1017

Mult ivar ia te b Relat ive Risk

% Yes (95% Ci)

Sex Male N = 52 52% Female N -- 52 42%

Race Black N -- I I 55% White /Asian/Other N = 93 46%

Number of Chi ldren > 2 N = 19 58% I or 2 N = 85 45%

Income $15,000 or less N = 84 49% More than $15,000 N = I I 27%

Believe abused as child Yes N = 23 3(1%* No N = 81 52%

Overall 47%

1.22 C51 ,2 .95 )

.94 (.24, 3.68)

2.13 (.69, 6.60)

2.31 (.54, 9.96)

.33* (.11, [.01)

' Frequently disc ipl ined = yel led at hN = 95.

* p < .10. Chi-sqtmre = .2116.

dai ly and/or spanked at least weekly.

broad agreement with most other studies: family violence is perpetuated through generations. Being hit frequently as a child stlbstantially increases the likelihood of inflicting frequent physical punishment as an adult (Table 2a). Still, only a third of those who were spanked weekly as children spank that often as parents, and nearly hall" of parents who spank weekly were spanked less often while growing up.

Perceived Abuse

One out of every 1 I adults in this sample believed he or she was abused while growing up. Twenty-nine percent of those yelled at daily, and 40% of those spanked daily felt abused (Table 3), as did nearly half of the 17 respondents who were both hit and yelled at daily (not shown). On the other hand, nine of the 17 who were hit and yelled at each day did not believe they were abused. This tinding is similar to other studies that demonstrate that many persons from severely punitive backgrounds do not classify their experience as abusive (Berger, Knut- son, Mehm, & Perkins, 1988; Rausch & Knutson, 1991).

In a study of parents of ill infants, Hunter and Kilstrom (1979) found that those who were openly angry about their own abuse were less likely to remain in the cycle of violence. Our finding was somewhat similar. Among respondents who, as children, were spanked at least weekly and/or yelled at daily, those who believed they were abused were less likely to so severely discipline their own offspring (Table 4). Although the difference was dramatic, this result is only suggestive, as the small numbers prevent it from reaching statistical signiticance at the .05 level.

Sex, race, number of children at home, and family income were used as controls in all analyses. In no case were any of these variables a significant predictor of past or present child- rearing violence. The literature on the effects of these characteristics is not unanimous. Some surveys show that women are more likely to use violence against children (American Humane

1018 D. Hemenway. S. Solnick. and J. Ca~er

Association, 1986: Straus et al., 1980) but others find no gender difference (Woifner & Gelles, 1993). Research also differs on whether girls (American Humane Association, 1986: National Center on Child Abuse and Neglect, 1988) or boys (Strauss et al., 1980; Wolfner & Gelles, 1993) are more likely to experience domestic violence.

Blacks are sometimes found more likely to be involved in child-rearing violence, both as victims and as perpetrators (American Humane Association, 1986: Wolfner & Gelles, 1993), but not always (National Center on Child Abuse and Neglect, 1988). Violence may be more common in larger families (National Center on Child Abuse and Neglect, 1988), but in some analyses the frequency of violence falls after a certain number of children (Wolfner & Gelles, 1993). The relationship of income to child-rearing violence is also unclear. Some studies report that poor children are more likely to experience violence in the home (National Center on Child Abuse and Neglect, 1988; Strauss et al.. 1980) Wolfner and Geiles (1993) find that this relationship holds only for severe violence.

This investigation suffers from many limitations. Like many other studies (e.g., Conger. Burgess, & Barrett, 1979; Hunter & Kilstrom, 1979; National Committee for Prevention of Child Abuse. 1991; Quinton, Rutter, & Liddle. 1984; Silver, Dublin. & Lourie, 1969; Smith & Hanson, 1975; Spinetta, 1978; Straus, 1979; Straus & Gelles, 1986) it relies on self-reports. These may not be highly reliable (Belsky, 1980; Finkelhor, Hotaling, Lewis, & Smith, 1990). Adults may not remember clearly the discipline they received as children, many decades ago. In particular, they may have very little memory of the early years of childhood, when officially reported abuse is most common (American Humane Association, 1989). Parents may also suffer from "retrospective recall bias" (Widom, 1989). Respondents may redefine past behavior to accord with their current situation: those who spank their own children frequently might be more likely to remember similar discipline in their own childhoods. In addition, even though they are speaking anonymously, some adults may not want to reveal child-rearing techniques that might be considered abusive.

Even if the responses were accurate, the questions themselves were quite limited. Those surveyed were asked how often they spank and were spanked--daily, weekly, monthly, never? We know nothing of what a spanking normally entailed, the motivation or the usual situation. We know whether respondents felt they were abused, but not why, nor the type of abuse (sexual?). While some demographic data were collected on respondents (e.g., race, sex, income and number of children), additional information would be useful. For example, no questions were asked concerning respondents' education (Conger, McCarty, Yang, Lahey, & Kropp, 1984), alcohol and illicit drug use (Bays, 1990) or formal and informal support systems (Belsky, 198(I). We have no demographic data or behavioral information on respondents' parents (other than how often they hit and yelled). We have little data on respondents' chi ldren--not even their exact age or sex. In addition, because questions are worded differently in different surveys, exact comparisons with other questionnaires is often impossible.

This survey was undertaken to elicit information for a newspaper story; the questionnaire was not designed for research purposes. However, this is a recent, representative national survey, performed by a prestigious polling organization. Our findings shed light on a variety of research questions concerning child rearing violence. Save for a few summary results (Manning, 1989), the data have not been previously analyzed.

Due to the aforementioned limitations, we urge caution in using the survey results to estimate the overall level of child-rearing violence in America. We believe the questionnaire is more appropriately employed to help investigate relationships among variables (e.g., risk factors for hitting and yelling).

Our three principal findings were:

i. Verbal and physical discipline seem more like complements than substitutes. Parents who

Child-rearing violence 1019

yell frequently are the ones most likely to hit frequently, while parents who rarely yell. rarely hit.

2. Both physical and verbal violence appear to be transgenerational. Adults who were often hit (yelled at) as children are more likely to become parents who hit (yell) frequently. Still, many people are able to break out of the transgenerationai cycle of punitive child rearing. The majority of adults who, as children, were spanked weekly do not hit their own children that often.

3. Nine percent of these American adults believe they were abused as children. Among those who were disciplined frequently, individuals who believe they were abused may be more able to reduce the level of violence they inflict on their own children.

Ackm,wledgenwnt--The authors would like to thank Deborah Azrael. Steve Buka. Karen Donelan, liana Lescohier. and Andrea Vandeven for advice and assistance. Special thanks are due to Susan Sorenson for her valuable comments.

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1020 D. Hemenway. S. Solnick. and J. Carter

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R~sum~.---En 1989. on a men~ un sondage aupr~s de 801 adultes concernant les punitions qu' i ls avaient revues duranl leur enfance el la fa~on dont mainetenant ils disciplinaient leur propre enfant. Les donn~es ont r~v~l~ clue ces parents ne substituent pan la violence physique ~ la violence verbale, ou vice versa, mais p]ut~'~t qu' i ls ont recours aux deux types simuhan~ment. Ken parents qui crient apr~s leurs enfants sont ceux qui sont le plus fr~quemmenl I~rt~s '~ les battre, et vice versa. De plus, la violence verbale et la violence physique semblent sc transmettre d'une g~n~ration '~ I'autre. Les r~l~mdants qui avaient eu la lessee (et qui s'~laient fails crier apr~s) souvent duranl leur enfance ~taient plus i~)rt~s '~ faire subir ces deux types de punitions "~ leurs enfants. Pourlanl. la plupart semhlent capables de se sortir du cercle vicieux des chStiments physiques qu'on leur a impos~s en enfance. Ceci est plus vrai dans le cas den parents qui se disenl avoir ~t~ abuses durant leur enfance.

Resumen--En 1989, una muestra nat ional ramada al azar de 801 aduhos rue cuestionada sobre el castigo que hablan recibido cuando ni6os y la forma en ClUe disciplinan a sus propios hijos(as). El an:ilisis revela ClUe la disciplina verbal y flsica no stun sustitutos, sino que, I~ r el contrario, se usan comunnlente juntas. Los padres Hue gritan frecuentemente son los mismos que g~dpean frecuentemente, y vicevcrsa. Adem~is. tanto la violencia fisica como la verbal parecen ser transgencracionales. Los encuestados que recibieron pelas ties gritaban) frecuentememe cuando eran nifios(as) tienen m~is tendencia a darle pelas (gritarle) frecuentemente a sus hijos(as). Asi tamhi~n, la mayoria de la genie son capaces de romper el cich~ punit ivo transgeneracional de la crianza. Este resultado puede encontrarse m6s entre los que se consideran VlClinl;is de afiuso.