Knowledge and Attitudes Related to Child Abuse and Neglect Among High School Students in the United States: A Multicenter Questionnaire Study.

Introduction Child abuse and neglect (CAN) constitute a pervasive public health crisis affecting millions of children annually. Adolescents occupy a strategically important position in prevention efforts. However, population-level data on United States (U.S.) high school students' CAN literacy remain limited, and few psychometrically validated instruments exist for this population. This study aimed to (1) develop and validate a standardized 10-item questionnaire on the knowledge and attitudes toward child abuse and neglect (KA-CAN) and (2) characterize CAN knowledge and attitudes among a geographically diverse U.S. high school sample and to identify sociodemographic predictors. Materials and methods A cross-sectional survey was conducted across five U.S. geographic regions (February-April 2026), enrolling 478 students in grades 9-12 (mean age 16.1 ± 1.2 years). The KA-CAN instrument was developed through a five-phase process encompassing literature review, expert panel validation (Scale-Level Content Validity Index (S-CVI) = 0.91), focus group discussion, cognitive pretesting, and psychometric assessment. Descriptive statistics, bivariate comparisons, and multivariable linear regression were applied to analyze the data. Results The overall knowledge correct-response rate was 72.9% (2,090/2,868 item-responses), with mean knowledge and attitude scores of 4.37 ± 1.21 and 15.49 ± 3.62, respectively. Knowledge deficits included recognizing that abuse extends beyond physical harm (Item 1: 51.9%; 248/478) and knowledge of mandatory reporting obligations (Item 5: 60.5%; 289/478). Prior CAN education was the strongest predictor of both knowledge (B = 0.62, p < 0.001) and attitudes (B = 1.42, p < 0.001). The KA-CAN demonstrated good internal consistency (Cronbach's α = 0.81) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.83). Conclusion Substantial gaps in CAN knowledge and reporting comfort persist among U.S. adolescents. The validated KA-CAN instrument provides a reliable standardized tool for future evaluation, and findings support the universal integration of evidence-based CAN curricula into U.S. high school programs.