Scholars@Duke
Elizabeth Joanne Gifford

Elizabeth Joanne Gifford CV

Research Professor in the Sanford School of Public Policy
Sanford School of Public Policy
Duke University, Box 90545, Durham, NC 27708-0264
214 Rubenstein Hall, 302 Towerview Rd., Durham, NC 27708
CV

Scholarly Works - Journal articles

Child Maltreatment Re-report, Substantiation, and Foster Care Placement: A Latent Class Analysis of Child, Caregiver, and Household Risk Factors Across Screened-In and Screened-Out Cases.

Journal article Child maltreatment · August 2026 Children reported to Child Protective Services (CPS) face elevated risks of adverse outcomes. It is essential to identify vulnerable populations and opportunities for early intervention. This study combined qualitative coding of CPS intake reports with lat ... Full text Cite

Observational and genetically-informed characterization of Gulf War Illness symptoms in 1990-1991 Gulf War deployed Veterans and non-deployed Gulf War Era Veterans.

Journal article Environmental health : a global access science source · June 2026 BackgroundGulf War Illness (GWI) has been identified in more than 20% of Veterans following military service in the 1990-1991 Gulf War (GW). Unfortunately, after several decades, GWI pathogenesis remains unclear and the patterns of GWI symptom co- ... Full text Cite

Unraveling the genetics of gulf war illness in diverse participants enrolled in the million veteran program.

Journal article Hum Mol Genet · May 11, 2026 Gulf War Illness (GWI) is a multi-symptom chronic condition that affects Veterans who served in the 1990-1991 Gulf War (GW). To generate novel information about GWI pathogenesis, we used genome-wide data available from 33 523 Veterans of diverse ancestral ... Full text Link to item Cite

Genomic interplay between deployment exposures and Gulf War illness in Million Veteran Program participants.

Journal article Hum Genomics · March 27, 2026 Veterans of the 1990–1991 Gulf War (GW) experienced an elevated burden of chronic health conditions, most notably Gulf War Illness (GWI). While the disease etiology remains unclear, it is hypothesized that both genetic susceptibility and deployment exposur ... Full text Link to item Cite

Juvenile Records and Adult Gun Violence: Evidence From Three States With Divergent Firearm Age Policies.

Journal article J Interpers Violence · January 31, 2026 Young adults with a history of juvenile justice involvement are more likely than their peers to be arrested for a violent gun crime, but unlike felony convictions, juvenile adjudications are typically expunged and do not convey a federal firearm prohibitio ... Full text Link to item Cite

Property dynamics and displacement: How multifamily sales, renovations, and demolitions influence moves for children

Journal article Journal of Urban Affairs · January 1, 2026 Dynamic changes to multifamily properties like sales, renovations, and demolitions are theoretically linked with housing displacement, and emergent research finds these changes are associated with increased prevalence of eviction filings. However, how dyna ... Full text Cite

Association between deployment and Gulf War Illness and adverse COVID outcomes in a nationwide cohort of 1990-1991 Gulf Era war veterans in the VA's Million Veteran Program.

Journal article PLoS One · 2026 BACKGROUND: U.S. military veterans deployed to the Persian Gulf to serve in the 1990-1991 Gulf War (GWVs) have expressed concerns about potential increased risk of experiencing adverse COVID-related health outcomes given broad near-unique exposure to multi ... Full text Link to item Cite

Barriers and facilitators to social-emotional health screening in pediatrics: Results from a qualitative study of practitioner perspectives

Journal article Social and Emotional Learning Research Practice and Policy · December 1, 2025 Social-emotional health (SEH) affects well-being and outcomes across the lifespan and is most malleable when addressed before age five. Despite the importance of early screening, SEH screening does not occur at most well-child visits. This study aimed to e ... Full text Cite

Upper gastrointestinal symptoms and Gulf War Illness in a clinical cohort of US veterans: a retrospective, cross-sectional study

Journal article BMJ Open Gastroenterology · September 2025 ObjectiveApproximately 30% of the 700 000 US Gulf War Veterans (GWVs) report symptoms collectively termed Gulf War Illness (GWI), a multisymptom illness of uncertain patho ... Full text Cite

Longitudinal Patterns of Multimorbidity in Gulf War Era Veterans With and Without Gulf War Illness.

Journal article J Aging Health · June 2025 Objectives: To examine whether severe Gulf War illness (SGWI) case status was associated with longitudinal multimorbidity patterns. Methods: Participants were users of the Veteran Health Administration Health Care System drawn from the Gulf War Era Cohort ... Full text Link to item Cite

Irritable Bowel Syndrome in Veterans With Gulf War Illness Evaluated at VA’s War-Related Illness and Injury Study Center

Journal article Military Medicine · November 5, 2024 ABSTRACTIntroductionExcess rates of Gulf War illness (GWI) and irritable bowel syndrome (IBS), two chronic multisymptom illnesses, hav ... Full text Cite

Association of deployment characteristics and exposures with persistent ill health among 1990-1991 Gulf War veterans in the VA Million Veteran Program.

Journal article Environ Health · October 25, 2024 BACKGROUND: Veterans of the 1990-1991 Gulf War have experienced excess health problems, most prominently the multisymptom condition Gulf War illness (GWI). The Department of Veterans Affairs (VA) Cooperative Studies Program #2006 "Genomics of Gulf War Illn ... Full text Link to item Cite

Child Sexual Abuse Documentation in Primary Care Settings.

Journal article Clin Pediatr (Phila) · October 2024 Primary care providers (PCPs) can play an important role in the continuity of care for children who experience sexual abuse (SA). We performed a retrospective, chart-based study of children 3 to 17 years old with SA history. Primary care medical records we ... Full text Link to item Cite

What Do Child Abuse and Neglect Medical Evaluation Consultation Notes Tell Researchers and Clinicians?

Journal article Child Maltreat · February 2024 Child abuse and neglect (CAN) medical experts provide specialized multidisciplinary care to children when there is concern for maltreatment. Their clinical notes contain valuable information on child- and family-level factors, clinical concerns, and servic ... Full text Link to item Cite

Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder.

Journal article J Trauma Stress · February 2024 Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to p ... Full text Link to item Cite

Characterizing Deficit Accumulation Among Gulf War Era Veterans.

Journal article J Frailty Aging · 2024 BACKGROUND: Veterans of the first Gulf War (1990-1991) are reaching middle and older adulthood in differing degrees of health and biological age. Many Gulf War veterans report myriad negative symptoms classified as Gulf War illness (GWI), a chronic multi-s ... Full text Link to item Cite

What do child maltreatment reports to Child Protective Services tell us about the needs families and communities are experiencing?

Journal article Child Youth Serv Rev · December 2023 Intake reports from child protective service (CPS) agencies are the foundation for subsequent decisions and services within the child welfare system. They provide valuable information for understanding children's needs, yet the unstructured way that inform ... Full text Link to item Cite

Association of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, and Hyperlipidemia With Gulf War Illness Among Gulf War Veterans.

Journal article J Am Heart Assoc · October 3, 2023 BACKGROUND: Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). Toxic deployment-related exposures have been implicated in the cause of GWI, some of which cont ... Full text Link to item Cite

Adult criminal outcomes of juvenile justice involvement.

Journal article Psychol Med · June 2023 BACKGROUND: The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes. METHO ... Full text Link to item Cite

Defining suspected child maltreatment using International Classification of Diseases codes: A scoping literature review

Journal article Children and Youth Services Review · June 1, 2023 Background: Administrative medical records and claims are increasingly used to study prevalence of and outcomes for children exposed to child maltreatment. However, suspicion of child maltreatment is often under-documented in medical records using Internat ... Full text Cite

Systematic review and meta-analysis of the effect of adverse childhood experiences (ACEs) on brain-derived neurotrophic factor (BDNF) levels.

Journal article Psychoneuroendocrinology · May 2023 There is continued interest in identifying dysregulated biomarkers that mediate associations between adverse childhood experiences (ACEs) and negative long-term health outcomes. However, little is known regarding how ACE exposure modulates neural biomarker ... Full text Cite

Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder.

Journal article Neurogastroenterol Motil · May 2023 BACKGROUND: Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we ... Full text Link to item Cite

Open Prosecution

Journal article Stanford Law Review · 2023 Link to item Cite

Cross-Sector Intervention Strategies to Target Childhood Food Insecurity in North Carolina

Journal article North Carolina Medical Journal · January 1, 2023 background Childhood food insecurity increased considerably during the COVID-19 pandemic and is associated with compromised health. Health care systems are increasingly prioritizing food insecurity interventions to improve health, but it is unclear how hea ... Full text Cite

Association of Gulf War Illness with Characteristics in Deployed vs. Non-Deployed Gulf War Era Veterans in the Cooperative Studies Program 2006/Million Veteran Program 029 Cohort: A Cross-Sectional Analysis.

Journal article Int J Environ Res Public Health · December 24, 2022 Gulf War Illness (GWI), a chronic multisymptom illness with a complex and uncertain etiology and pathophysiology, is highly prevalent among veterans deployed to the 1990-1991 GW. We examined how GWI phenotypes varied by demographic and military characteris ... Full text Link to item Cite

Gun violence among young adults with a juvenile crime record in North Carolina: Implications for firearm restrictions based on age and risk.

Journal article Prev Med · December 2022 Youth who acquire a juvenile crime record may be at increased risk of perpetrating gun violence as adults. North Carolina and 22 other states permit young adults who were adjudicated by a juvenile court - even for some felony-equivalent offenses - to legal ... Full text Link to item Cite

Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization compared to a general pediatric sample?

Journal article Child Abuse Negl · December 2022 BACKGROUND: Child maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic. ... Full text Link to item Cite

Electronic Health Record Tools to Identify Child Maltreatment: Scoping Literature Review and Key Informant Interviews.

Journal article Acad Pediatr · July 2022 OBJECTIVE: To prevent missed cases and standardize care, health systems are beginning to implement EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS) for the identification and management of child maltreatment. This study aim ... Full text Link to item Cite

Health-Related Quality of Life by Gulf War Illness Case Status.

Journal article Int J Environ Res Public Health · April 7, 2022 This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and ment ... Full text Link to item Cite

Association of Gulf War Illness-Related Symptoms with Military Exposures among 1990-1991 Gulf War Veterans Evaluated at the War-Related Illness and Injury Study Center (WRIISC).

Journal article Brain Sci · February 27, 2022 Veterans with difficult-to-diagnose conditions who receive care in the Department of Veterans Affairs (VA) healthcare system can be referred for evaluation at one of three specialty VA War-Related Illness and Injury Study Centers (WRIISC). Veterans of the ... Full text Link to item Cite

Gene-Toxicant Interactions in Gulf War Illness: Differential Effects of the PON1 Genotype.

Journal article Brain Sci · November 25, 2021 About 25-35% of United States veterans who fought in the 1990-1991 Gulf War report several moderate or severe chronic systemic symptoms, defined as Gulf War illness (GWI). Thirty years later, there is little consensus on the causes or biological underpinni ... Full text Link to item Cite

Research tool for classifying Gulf War illness using survey responses: Lessons for writing replicable algorithms for symptom-based conditions.

Journal article Life Sci · October 1, 2021 AIMS: Gulf War illness (GWI), a chronic symptom-based disorder, affects up to 30% of Veterans who served in the 1990-1991 Gulf War1. Because no diagnostic test or code for GWI exists, researchers typically determine case status using self-reported symptoms ... Full text Link to item Cite

Gulf War illness in the Gulf War Era Cohort and Biorepository: The Kansas and Centers for Disease Control definitions.

Journal article Life Sci · August 1, 2021 AIMS: This study characterizes Gulf War Illness (GWI) among U.S. veterans who participated in the Gulf War Era Cohort and Biorepository (GWECB). MAIN METHODS: Mailed questionnaires were collected between 2014 and 2016. Self-reported GWI symptoms, symptom d ... Full text Link to item Cite

Childhood Gun Access, Adult Suicidality, and Crime.

Journal article Pediatrics · August 2021 OBJECTIVES: To test the associations of childhood domestic gun access with adult criminality and suicidality. METHODS: Analyses were based on a 20+ year prospective, community-representative study of 1420 children, who were assessed up to 8 times during ch ... Full text Link to item Cite

Brief Report: Classifying Rates of Students with Autism and Intellectual Disability in North Carolina: Roles of Race and Economic Disadvantage.

Journal article J Autism Dev Disord · January 2021 We examined special education classifications among students aged 3-21 in North Carolina public schools, highlighting autism spectrum disorder (ASD) and intellectual disability (ID). Results revealed variability by county in ASD and ID prevalence, and in c ... Full text Open Access Link to item Cite

Getting Tough? The Effects of Discretionary Principal Discipline on Student Outcomes

Journal article Education Finance and Policy · 2021 Nationwide, school principals are given wide discretion to use disciplinary tools like suspension and expulsion to create a safe learning environment. There is legitimate concern that this power can have negative consequences, particularly for the ... Full text Link to item Cite

Mothers and fathers in the criminal justice system and children's child protective services involvement.

Journal article Child abuse & neglect · March 2020 BackgroundParental criminal justice system (CJS) involvement is a marker for child protective services (CPS) involvement.ObjectiveTo document how parental criminal case processing affects children's CPS involvement.Participants and se ... Full text Cite

How Incarceration Affects the Health of Communities and Families.

Journal article North Carolina medical journal · November 2019 Emerging evidence suggests that negative health consequences of incarceration are felt not only by those who have experienced it but also by their families and individuals in their communities. This article reviews the evidence of health effects of incarce ... Full text Open Access Cite

Association of Parental Incarceration With Psychiatric and Functional Outcomes of Young Adults.

Journal article JAMA Netw Open · August 2, 2019 Featured Publication IMPORTANCE: In 2016, an estimated 8% of US children younger than 18 years had experienced the incarceration of a parent, and rates were substantially higher among children from racial and ethnic minority backgrounds and disadvantaged groups. Little is know ... Full text Open Access Link to item Cite

Gender-based Differences among 1990-1991 Gulf War Era Veterans: Demographics, Lifestyle Behaviors, and Health Conditions.

Journal article Womens Health Issues · June 25, 2019 OBJECTIVE: The 1990-1991 Gulf War employed more women servicemembers than any prior conflict. Gender-based differences among veterans of this era have yet to be explored. This study is among the first and most recent to stratify Gulf War veteran demographi ... Full text Link to item Cite

Identifying and Treating Nonalcoholic Fatty Liver Disease.

Journal article Fed Pract · January 2019 NAFLD improves with 7% or greater weight loss. ... Link to item Cite

Correction to: Identifying Nonalcoholic Fatty Liver Disease Advanced Fibrosis in the Veterans Health Administration.

Journal article Dig Dis Sci · October 2018 The original version of the article unfortunately contained errors in Table 3, Risk Factor column headings "Age > 50 (n = 115)," "Age > 50-64 (n = 154)," and "Age > 65 + (n = 60)." ... Full text Open Access Link to item Cite

Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration.

Journal article Aliment Pharmacol Ther · January 2018 BACKGROUND: With its increasing incidence, nonalcoholic fatty liver disease (NAFLD) is of particular concern in the Veterans Health Administration (VHA). AIMS: To evaluate risk factors for advanced fibrosis in biopsy-proven NAFLD in the VHA, to identify pa ... Full text Link to item Cite

A new program to prevent primary school absenteeism: Results of a pilot study in five schools

Journal article Children and Youth Services Review · November 1, 2017 Featured Publication Frequent absences in the primary grades are associated with school disengagement, academic failure, and eventual dropout. The Early Truancy Prevention Project (ETPP) was designed to improve attendance of primary-grade children by facilitating communication ... Full text Cite

Prosecution, Conviction, and Deterrence in Child Maltreatment Cases

Journal article Criminal Justice and Behavior · October 1, 2017 Featured Publication This study examines how decisions made by the criminal justice system in child maltreatment cases affect defendants’ future probability of committing a child maltreatment offense, another offense, or having a child involved in child protective services (CP ... Full text Cite

Does the probability of DWI arrest fall following participation in DWI and hybrid drug treatment court programs?

Journal article Accident analysis and prevention · October 3, 2016 Using North Carolina administrative data, this study examined recidivism following participation in specialty hybrid drug and driving while intoxicated (DWI) court programs. Three court program participation levels were considered-being referred to, enroll ... Cite

Criminally Involved Parents Who Misuse Substances and Children's Odds of Being Arrested as a Young Adult: Do Drug Treatment Courts Mitigate the Risk?

Journal article Journal of child and family studies · August 2016 This paper examined (1) the association between parents who are convicted of a substance-related offense and their children's probability of being arrested as a young adult and (2) whether or not parental participation in an adult drug treatment court prog ... Full text Cite

Evaluation of a Public Awareness Campaign to Prevent High School Dropout.

Journal article The journal of primary prevention · August 2016 Many advocacy organizations devote time and resources to increasing community awareness and educating the public in an effort to gain support for their issue. One such effort, the Dropout Prevention Campaign by America's Promise Alliance, aimed to increase ... Full text Open Access Cite

Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?

Journal article Substance use & misuse · January 2016 BackgroundIn light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied.ObjectivesTo examine: ... Full text Open Access Cite

Empirical evidence on legal levers aimed at addressing child maltreatment

Journal article Children and Youth Services Review · January 1, 2016 Law is a powerful tool for combatting public health issues. This article reviews existing empirical research on the effect of eight legal levers on outcomes related to child maltreatment. Laws created with the intent to address child maltreatment are often ... Full text Open Access Cite

Factors predicting prosecution of child maltreatment cases

Journal article Children and Youth Services Review · 2016 Objectives The purpose of the current study was to examine what case characteristics increased the likelihood of a child maltreatment case being prosecuted, and upon prosecution, of being convicted. Methods Data came from 406 criminal court case files f ... Link to item Cite

Intergenerational effects of parental substance-related convictions and adult drug treatment court participation on children's school performance.

Journal article The American journal of orthopsychiatry · September 2015 This study examined the intergenerational effects of parental conviction of a substance-related charge on children's academic performance and, conditional on a conviction, whether completion of an adult drug treatment court (DTC) program was associated wit ... Full text Open Access Cite

Is implementation fidelity associated with improved access to care in a school-based Child and Family Team model?

Journal article Evaluation and program planning · April 2015 Effective child and family centered service planning is crucial to addressing vulnerable children's needs. However, there is limited evidence about what facets of these processes improve service use and outcomes. The current study used a Poisson random eff ... Full text Open Access Cite

A Network Perspective on Dropout Prevention in Two Cities

Journal article Educational Administration Quarterly · February 8, 2015 Purpose: This exploratory case study examines how school systems and other local organizations have been working within two major U.S. cities to improve high school graduation rates. Systematically assessing active interorganizational dropout prevention ne ... Full text Open Access Cite

Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?

Journal article North Carolina medical journal · January 2015 BackgroundChild maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child ... Full text Open Access Cite

How does family drug treatment court participation affect child welfare outcomes?

Journal article Child abuse & neglect · October 2014 Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectivene ... Full text Open Access Cite

The effects of participation level on recidivism: a study of drug treatment courts using propensity score matching.

Journal article Substance abuse treatment, prevention, and policy · September 2014 BackgroundEmpirical evidence has suggested that drug treatment courts (DTCs) reduce re-arrest rates. However, DTC program completion rates are low and little is known about the effectiveness of lower levels of program participation.Objectives< ... Full text Open Access Cite

Implementing a Case Management Initiative in High-Need Schools.

Journal article Children and youth services review · May 2013 States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths ... Full text Open Access Cite

Do specialty courts achieve better outcomes for children in foster care than general courts?

Journal article Evaluation review · February 2013 ObjectiveThis study assessed the effects of unified family and drug treatment courts (DTCs) on the resolution of cases involving foster care children and the resulting effects on school performance.MethodThe first analytic step was to ass ... Full text Open Access Cite

Provider-level effects on psychiatric inpatient length of stay for youth with mental health and substance abuse disorders.

Journal article Medical care · March 2008 ObjectivePrevious research on inpatient care for children and adolescents with emotional or behavioral problems indicates that patient-level factors predict length of stay (LOS) poorly. This analysis examines whether patient-level factors are poor ... Full text Open Access Cite

Low-Income Children's Preventive Services Use: Implications of Parents' Medicaid Status

Journal article Health Care Financing Review · June 1, 2005 This article examines the effect of parents' Medicaid status on the use of preventive health services by young children. Using data from the 1996 Medical Expenditure Panel Survey (MEPS), we analyzed a logit model for receipt of any well-child visits (WCVs) ... Open Access Cite