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CORK Bibliography: Child Abuse

86 citations. January 2009 to present

Prepared: September 2011

Afifi TO; Brownridge DA; MacMillan H; Sareen J. The relationship of gambling to intimate partner violence and child maltreatment in a nationally representative sample. Journal of Psychiatric Research 44(5): 331-337, 2010. (40 refs.)

It has been suggested that family violence is associated with gambling problems. However, to date, this relationship has not been thoroughly investigated using representative data. The purpose of the current study was to analyze the relationship between gambling problems and the perpetration and victimization of intimate partner violence (including dating and marital violence) and child maltreatment (including minor child assault and severe child abuse) using nationally representative data. Data were drawn from the US National Comorbidity Survey Replication (n = 3334; 18 years and older). Multiple logistic and multinomial logistic regression models were used to examine the relationships between gambling and the perpetration and victimization of dating violence, marital violence, and child maltreatment. The results indicated that problem gambling was associated with increased odds of the perpetration of dating violence (Adjusted Odds Ratios (AORs) ranged from 2.2 to 4.2), while pathological gambling was associated with increased odds of the perpetration of dating violence (AORs ranged from 5.7 to 11.9), severe marital violence (AOR = 20.4), and severe child abuse (AOR = 13.2). Additionally, dating violence, marital violence, and severe child abuse victimization were associated with increased odds of gambling problems. The results were attenuated when adjusted for lifetime mental disorders. These findings can be used as evidence-based research to inform healthy public gambling polices and inform prevention and intervention efforts.

Appleyard K; Berlin LJ; Rosanbalm KD; Dodge KA. Preventing early child maltreatment: Implications from a longitudinal study of maternal abuse history, substance use problems, and offspring victimization. Prevention Science 12(2): 139-149, 2011. (51 refs.)

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers' childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.

Asgeirsdottir BB; Sigfusdottir ID; Gudjonsson GH; Sigurdsson JF. Associations between sexual abuse and family conflict/violence, self-injurious behavior, and substance use: The mediating role of depressed mood and anger. Child Abuse & Neglect 35(3): 210- 219, 2011. (56 refs.)

Objective: To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use. Methods: A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger. Results: Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger. Conclusions: These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator. Practice implications: Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.

Bacskai E; Czobor P; Gerevich J. Suicidality and trait aggression related to childhood victimization in patients with alcoholism. Psychiatry Research 165(1/2): 103-110, 2009. (54 refs.)

The relationship between physical abuse in childhood and suicide attempts in adulthood has long been known. However, the phenomenon has not been examined in patients who are undergoing treatment for alcoholism. In this study we seek an answer to the questions of whether exposure to physical abuse in childhood predisposes to violence, which in turn increases the likelihood of suicidal behavior in adulthood. The sample studied comprised 172 patients with alcohol dependence and with data for childhood physical abuse, trait aggression and lifetime suicide attempts. The measuring instruments used for the investigation were the European Addiction Severity Index, the Buss and Perry Aggression Questionnaire and the Janus Questionnaire. Generalized Linear Model analysis revealed a significant gender-dependent association between physical abuse by the parents suffered in childhood and later suicide attempts. In females, childhood victimization by parents increased the likelihood of suicide attempts by approximately 15 times; in males, the increase was about two fold. Association of suicide attempts with the overall level of trait aggression also significantly interacted with gender. In females, the increase in the level of total scores of the trait aggression from 0 to 50 points (approximately the mean level in the study population) elevated the likelihood of the suicide attempts by almost ninefold, whereas the analogous increase in males was about threefold. The results draw attention to the importance of preventing suicide in clinical populations of alcohol-dependent patients.

Barth RP. Preventing child abuse and neglect with parent training: Evidence and opportunities. Future of Children 19(2): 95-118, 2009. (80 refs.)

Researchers have identified four common co-occurring parental risk factors-substance abuse, mental illness, domestic violence, and child conduct problems-that lead to child maltreatment. The extent to which maltreatment prevention programs must directly address these risk factors to improve responsiveness to parenting programs or can directly focus on improving parenting skills, says Richard Barth, remains uncertain. Barth begins by describing how each of the four parental issues is related to child maltreatment. He then examines a variety of parent education interventions aimed at preventing child abuse. He cautions that many of the interventions have not been carefully evaluated and those that have been have shown little effect on child maltreatment or its risk factors. Although some argue that parent education cannot succeed unless family problems are also addressed, much evidence suggests that first helping parents to be more effective with their children can address mental health needs and improve the chances of substance abuse recovery. Barth recommends increased public support for research trials to compare the effectiveness of programs focused on parenting education and those aiming to reduce related risk factors. Child welfare services and evidence-based parent training, says Barth, are in a period of transformation. Evidence-based methods are rapidly emerging from a development phase that has primarily involved local and highly controlled studies into more national implementation and greater engagement with the child welfare system. The next step is effectiveness trials. Citing the importance and success of multifaceted campaigns in public health policy, Barth discusses a multifaceted parenting campaign that has demonstrated substantial promise in several large trials. The goal of the Triple P-Positive Parenting Program is to help parents deal with the full gamut of children's health and behavioral issues. The campaign includes five levels of intervention, each featuring a different means of delivery and intensity of service. More broadly, Barth suggests that the evidence-based Triple P approach offers a general framework that could be used to guide the future evolution of parenting programs.

Bender K. Why do some maltreated youth become juvenile offenders? A call for further investigation and adaptation of youth services. (editorial). Children and Youth Services Review 32(3): 466-473, 2010. (99 refs.)

Experiencing maltreatment is an established risk factor for delinquency. Yet, an understanding of the maltreatment-delinquency link is incomplete as few models have elucidated how maltreated youth become juvenile delinquents. This paper utilizes the latest empirical evidence to propose a diagram detailing pathways from maltreatment to delinquency through potential intervening risk factors, including substance abuse, mental health problems, school difficulties, negative peer networks, and running away from home. Hypothesized gender differences in pathways from maltreatment to delinquency are delineated. Implications for adaptation of child welfare and juvenile justice services to address the link between maltreatment and delinquency are discussed. This paper calls for testing and refining of the proposed pathways from maltreatment to delinquency in order to advance understanding of these complex relationships.

Bryant-Davis T; Ullman SE; Tsong Y; Tillman S; Smith K. Struggling to survive: Sexual assault, poverty, and mental health outcomes of African American women. American Journal of Orthopsychiatry 80(1): 61-70, 2010. (90 refs.)

A substantial body of research documents the mental health consequences of sexual assault including, but not limited to, depression, posttraumatic stress disorder, substance use, and suicidality. Far less attention has been given to the mental health effects of sexual assault for ethnic minority women or women living in poverty. Given African American women's increased risk for sexual assault and increased risk for persistent poverty, the current study explores the relationship between income and mental health effects within a sample of 413 African American sexual assault survivors. Hierarchical regression analyses revealed that after controlling for childhood sexual abuse there were positive relationships between poverty and mental health outcomes of depression, posttraumatic stress disorder, and illicit drug use. There was no significant relationship between poverty and suicidal ideation. Counseling and research implications are discussed.

Butt S; Chou SN; Browne K. A rapid systematic review on the association between childhood physical and sexual abuse and illicit drug use among males. (review). Child Abuse Review 20(1): 6-38, 2011. (57 refs.)

This paper aims to review studies in relation to the association between childhood physical (CPA) and sexual abuse (CSA) and illicit drug use among the male clinical and general community populations using a systematic approach. Primary studies were identified using online databases which were searched comprehensively using a set of pre-determined search criteria and terms. Other sources included expert contact and the reference list of a relevant review. Associations between exposure (CPA/CSA) and outcome (illicit drug use) were considered with regards to an array of factors. A total of 5012 references were initially identified out of which 18 studies met the necessary criteria for reviewing. The review demonstrates tentative support for factors such as earlier drug initiation, intravenous drug use and greater frequency of use among some of the samples. It also demonstrates the difficulties involved in drawing conclusions due to the complex and multifaceted nature of drug use and the variability in the quality of the research available in this area. Limitations of the current review are highlighted and recommendations offered for future research with consideration given to practical implications in clinical and forensic settings.

Champion JD. Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58(1): 61-67, 2011. (37 refs.)

Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14-18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.

Chan KL. Association between childhood sexual abuse and adult sexual victimization in a representative sample in Hong Kong Chinese. Child Abuse & Neglect 35(3): 220- 229, 2011. (61 refs.)

Objective: The current study investigated the prevalence and impact of childhood sexual abuse (CSA) on adult sexual victimization (ASV) in Hong Kong, China. This study also examines correlates of demographic characteristics, depression, suicidal ideation, and self-esteem with ASV. Methods: A total of 5,049 Chinese adult respondents were interviewed face-to-face about their experiences of CSA, childhood witness of parental violence, ASV (by non-partner), and intimate partner violence (IPV). Self-reports also measured depression, suicidal ideation, self-esteem, and demographic details. Results: Of all respondents, 0.9% reported some form of CSA, with a higher percentage being women. CSA was found to pose a significant risk for preceding year IPV (sexual) after controlling for demographic factors. Gender, age, indebtedness, alcohol and drug abuse, depression, and low self-esteem significantly increased the odds of IPV (sexual), whereas suicidal ideation and being newly arrived from China increased the risk of ASV (by non-partner). Childhood witness of parental psychological aggression and physical violence were also associated with a higher risk of IPV (sexual). Conclusions: Childhood sexual abuse may have an independent association with future sexual victimization in adulthood, but many covariates can also affect the impact of CSA and increase the risk of revictimization. Practical implications: Intervention with ASV should include an assessment of CSA history and thus a screening for multiple victimization from IPV among victims. Prevention of revictimization for IPV victims with CSA histories may focus on making social and individual changes.

Chartier MJ; Walker JR; Naimark B. Health risk behaviors and mental health problems as mediators of the relationship between childhood abuse and adult health. American Journal of Public Health 99(5): 847-854, 2009. (55 refs.)

Objectives. We examined the relationship between childhood abuse and adult health risk behaviors, and we explored whether adult health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization. Methods. We used logistic regression to analyze data from the Mental Health Supplement of the Ontario Health Survey, a representative population sample (N=8116) of respondents aged 15 to 64 years. Results. We found relationships between childhood sexual abuse and smoking (odds ratio [OR]=1.52; 95% confidence interval [CI]=1.16, 1.99), alcohol problems (OR=2.44; 95% CI=134, 144), obesity (OR=1.61; 95% CI=1.14, 2.27), having more than 1 sexual partner in the previous year (OR=2.34; 95% CI=1.44, 3.80), and mental health problems (OR=2.26; 95% CI=1.78. 2.87). We also found relationships between these factors (with the exception of obesity) and childhood physical abuse. Mediation analysis suggested that health risk behaviors and particularly mental health problems are partial mediators of the relationship between childhood abuse and adult health. Conclusions. Public health approaches that aim to decrease child abuse by supporting positive parent-child relationships, reducing the development of health risk behaviors, and addressing children's mental health are likely to improve long-term population health.

Cheng HG; Huang YQ; Anthony JC. Childhood physical punishment and later alcohol drinking consequences: Evidence from a Chinese context. Journal of Studies on Alcohol and Drugs 72(1): 24-33, 2011. (78 refs.)

Objective: The aim of the current study is to estimate a link between early physical punishment in childhood and later alcohol outcomes, taking family history of drinking problems into account, with epidemiological data from China. The yield from previous studies on this relationship is mixed evidence, largely traceable to research design variations, including model specifications that concern parental alcohol or other drug problems (AODPs) that might account for both earlier discipline practices and later drinking problems in the offspring. Method: Data are from the World Mental Health Surveys metropolitan China study, with cross-sectional representative sample surveys of adult household residents living in two metropolitan cities, Beijing and Shanghai. Participants in this general mental health survey were asked about early life experiences (e.g., parental AODP, childhood misbehavior), as well as their own drinking outcomes. Stratification was used to control for parental AODP. Results: Logistic regressions found robust associations linking childhood physical punishment with drinking outcomes, even with stratification for parental AODP and childhood misbehavior. Conclusions: These results from a cross-sectional survey lay a foundation for future prospective and longitudinal research on possible causal relationships that link childhood physical punishment with later drinking outcomes in China.

Cheng TC; Lo CC. Drug use among maltreated adolescents receiving child welfare services. Children and Youth Services Review 32(12): 1735-1739, 2010. (32 refs.)

This study investigated the impact of child maltreatment, child welfare services, parental substance abuse, and parent-child relationship on adolescents' drug use In a secondary data analysis of 1799 adolescents, data were extracted from the National Survey of Child and Adolescent Well-Being Ordered probit regression showed that level of hard drug use within the past 30 days related to adolescents' lifetime use of hard drugs, emotional closeness to parent, sexual maltreatment, and receipt of in-home services. Implications for services and research are discussed.

Cohen LJ; Forman H; Steinfeld M; Fradkin Y; Frenda S; Galynker I. Comparison of childhood sexual histories in subjects with pedophilia or opiate addiction and healthy controls: Is childhood sexual abuse a risk factor for addictions? Journal of Psychiatric Practice 16(6): 394-404, 2010. (33 refs.)

Objective. Given the recent interest in the concept of sexual addictions, it is instructive to study subjects with pedophilia alongside chemically addicted individuals and non-addicted controls in order to help identify which factors may determine the objects of people's respective addictions, as well as any factors that may predispose people to developing an addictive disorder. Method. In this study, we considered whether childhood sexual abuse (CSA) is a specific risk factor for pedophilia as opposed to other types of addictive disorders by comparing the childhood sexual histories of 48 pedophilic sex offenders, 25 subjects with opiate addiction in remission, and 61 healthy controls. CSA was assessed with The Sexual History Questionnaire and the Child Trauma Questionnaire (CTQ). Results. Compared with both opiate addicted subjects and healthy controls, subjects with pedophilia were more likely to report experiencing adult sexual advances when they were children and a first sexual contact by age 13 with a partner at least 5 years older. Although both subjects with pedophilia and those with opiate addiction first had sex at a younger age than healthy controls, opiate addicted subjects, compared with healthy controls, reported neither increased reception of sexual advances as children nor increased rates of first sexual contact before age 13 with a partner at least 5 years older. Further, subjects with pedophilia but not those with opiate addiction scored significantly higher than healthy controls on the CTQ. Conclusion. Sexual abuse in childhood may be a specific risk factor for sexual addictions such as pedophilia but may not be a specific risk factor for chemical addictions.

Cohen LR; Tross S; Pavlicova M; Hu MC; Campbell AN; Nunes EV. Substance use, childhood sexual abuse, and sexual risk behavior among women in methadone treatment. American Journal of Drug and Alcohol Abuse 35(5): 305-310, 2009. (36 refs.)

Background: Substance use and a history of childhood sexual abuse (CSA) are risk factors for unprotected sex among women, yet questions remain as to how their combined influence may differentially affect sexual risk. Objective: The current study investigated how complex relationships among drug use and CSA may contribute to unprotected sexual occasions (USO). Methods: A Generalized Linear Mixed Model was used to examine the interaction between current cocaine/stimulants and opioid use and CSA on number of USOs in a sample of 214 sexually active women in outpatient methadone maintenance treatment. Results: For women with CSA, an increase in days of cocaine/stimulant use was associated with a significant increase in USOs. In contrast, an increase in days of opiate use was associated with a significant decrease in USOs. For the group of women who did not report CSA, there was a significant increase in USOs with increased opiate use. Conclusions: Findings: indicate that CSA is related to unprotected sexual occasions depending on drug type and severity of use. Scientific Significance: Women with CSA using cocaine are at particularly high risk for having unprotected sex and should be specifically targeted for HIV prevention interventions.

Conroy E; Degenhardt L; Mattick RP; Nelson EC. Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group. Child Abuse and Neglect 33(6): 343-352, 2009. (71 refs.)

Objective: To examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage. Method: The study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex and unemployment and were restricted to those with a lifetime opioid use of less than five times. The interview covered child maltreatment, family environment, drug use and psychiatric history. Results: This study found a high prevalence of child maltreatment among both cases and controls. Despite the elevated prevalence among controls, opioid-dependent males had a higher prevalence of physical and emotional abuse; female cases had a higher prevalence and greater severity of sexual abuse. The prevalence of neglect was similar for both groups. Early parental separation was more prevalent among female cases compared to female controls; otherwise the prevalence of the risk factors was comparable for both groups. The risk factors significantly associated with child maltreatment were also similar for both cases and controls. Conclusions: Given the documented association between child maltreatment and adult mental disorder, child maltreatment may be an important antecedent of current psychological distress in persons presenting to treatment for opioid dependence. Apart from a possible association between early parental separation and sexual abuse among female cases, the increased prevalence of child maltreatment associated with opioid dependence did not appear to be related to differences in early childhood risk factors considered in this paper. Other risk factors may be more pertinent for those with opioid dependence. Practice implications: The high prevalence of child maltreatment among the opioid-dependent sample has implications for the assessment and treatment of clients presenting with opioid dependence. Assessment of child maltreatment history could help inform the development of individual treatment plans to better address those factors contributing to the development and maintenance of opioid dependence. Specifically, management of comorbid mental disorder associated with child maltreatment could be the focus of relapse prevention programmes and also have a positive influence on treatment retention.

Cutajar MC; Mullen PE; Ogloff JRP; Thomas SD; Wells DL; Spataro J. Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect 34(11): 813-822, 2010. (61 refs.)

Objective: To determine the rate and risk of clinical and personality disorders diagnosed in childhood and adulthood in those known to have been sexually abused during childhood. Methods: Forensic medical records of 2,759 sexually abused children assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Cases were compared to control subjects matched on gender and age groupings drawn from the general population through a random sample of the national electoral database. Results: A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sexual abuse victims was 3.65 times higher (95% Cl, 3.09-4.32, p < 0.001). It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. Exposure to sexual abuse increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Rates of clinical disorders diagnosed in adulthood and childhood remained significantly higher among child sexual abuse cases. Older age at sexual abuse and those exposed to severe abuse involving penetration or multiple offenders were associated with greater risk for psychopathology. Conclusions: This study confirms that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood. Practice implications: Those treating victims of sexual abuse must assess not only disorders commonly associated with trauma, but also low prevalence disorders such as psychosis.

Cutajar MC; Mullen PE; Ogloff JRP; Thomas SD; Wells DL; Spataro J. Suicide and fatal drug overdose in child sexual abuse victims: A historical cohort study. Medical Journal of Australia 192(4): 184-187, 2010. (22 refs.)

Objective: To determine the rate and risk of suicide and accidental fatal drug overdose (ie, overdose deemed not to have been suicide) in individuals who had been medically ascertained as having been sexually abused during childhood. Design: A historical cohort linkage study of suicide and accidental drug-induced death among victims of child sexual abuse (CSA). Setting and patients: Forensic medical records of 2759 victims of CSA who were assessed between 1964 and 1995 were obtained from the Victorian Institute of Forensic Medicine and linked with coronial data representing a follow-up period of up to 44 years. Main outcome measures: Rates of suicide and accidental fatal drug overdose recorded in coronial databases between 1991 and 2008, and rates of psychiatric disorders and substance use recorded in public mental health databases. Results: Twenty-one cases of fatal self-harm were recorded. Relative risks for suicide and accidental fatal overdose among CSA victims, compared with age-limited national data for the general population, were 18.09 (95% Cl, 10.96-29.85; population-attributable risk, 0.37%), and 49.22 (95% Cl, 36.11-67.09; population-attributable risk, 0.01%) respectively. Relative risks were higher for female victims. Similar to the general population, CSA victims who died as a result of self-harm were predominantly aged in their 30s at time of death. Most had contact with the public mental health system and half were recorded as being diagnosed with an anxiety disorder. Conclusion: Our data highlight that CSA victims are at increased risk of suicide and accidental fatal drug overdose. CSA is a risk factor that mediates suicide and fatal overdose.

Daniel B; Taylor J; Scott J. Recognition of neglect and early response: Overview of a systematic review of the literature. (review). Child & Family Social Work 15(2): 248-257, 2010. (63 refs.)

This paper summarizes the key findings from a systematic literature review that sought to identify existing evidence about the ways in which the needs of neglected children and their parents are signalled and the response to those needs. Using systematic review guidelines, 14 databases were searched for primary research studies published in English from 1995 to 2005. An initial 20 480 items were systematically filtered down to 63 papers for inclusion. The evidence suggests that, while there is little evidence about how needs for help are directly signalled, there is considerable evidence about how needs are indirectly signalled. There is evidence that professionals can identify signs of neglect, but are not always clear about the best response. There remain gaps in evidence about how best to respond to neglected needs, especially within schools.

Delfabbro P; Borgas M; Rogers N; Jeffreys H; Wilson R. The social and family backgrounds of infants in South Australian out-of-home care 2000-2005: Predictors of subsequent abuse notifications. Children and Youth Services Review 31(2): 219-226, 2009. (33 refs.)

The study examined the social and familial characteristics of 498 infants entering South Australian out-of-home care between 2000 and 2004 (n = 225 entered only for respite. n = 273 for other formal placements). Analyses focus'ed on the extent to which background characteristics, most notably a history of prior abuse, was able to predict subsequent child abuse notifications once children has exited care. The results showed that most children entered care due to a clustering of significant background problems, including poverty, domestic violence, physical abuse, substance misuse, and neglect. Around 50% of infants were returned to homes where there were subsequent notifications of abuse. Logistic regression modelling conducted separately for respite only and those formally entering care showed that prior abuse was a reliable predictor of ongoing abuse notifications in both samples. In some models, prior abuse yielded a very high probability (>60%) of some ongoing notifications suggesting that these statistical models could be used to enhance risk assessments conducted prior to reunification decision-making in South Australia.

Dubowitz H; Kim J; Black MM; Weisbart C; Semiatin J; Magder LS. Identifying children at high risk for a child maltreatment report. Child Abuse & Neglect 35(2): 96-104, 2011. (46 refs.)

Objective: To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method: The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results: Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education <= high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, Cl = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, Cl = 1.07-1.47, p < .01). Conclusions: Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

Duncan AE; Lessov-Schlaggar CN; Nelson EC; Pergadia ML; Madden PAF; Heath AC. Body mass index and regular smoking in young adult women. Addictive Behaviors 35(11): 983-988, 2010. (56 refs.)

Little is known about the relationship between relative body weight and transition from experimentation to regular smoking in young adult women. In the current study, data from 2494 participants in wave 4 of the Missouri Adolescent Female Twin Study (aged 18-29 years) who reported ever smoking a cigarette were analyzed using logistic regression. Body mass index (BMI) at time of interview was categorized according to CDC adult guidelines, and regular smoking was defined as having ever smoked 100 or more cigarettes and having smoked at least once a week for two months in a row. Since the OR's for the overweight and obese groups did not differ significantly from one another in any model tested, these groups were combined. Forty-five percent of women who had ever smoked had become regular smokers. Testing of interactions between potential covariates and levels of the categorical BMI variable revealed a significant interaction between overweight/obesity and childhood sexual abuse (CSA; p<0.001) associated with regular smoking. Among women reporting CSA, the association between overweight/obesity and having become a regular smoker was negative (n = 374; OR = 0.48, 95% Cl: 0.28-0.81). Both underweight and overweight/obesity were positively associated with transition to regular smoking among women who did not report CSA (n = 2076; OR = 1.57,95% Cl: 1.05-2.35 and OR = 1.73, 95% Cl: 1.35-2.20, respectively). These results suggest that experiencing CSA alters the association between BMI and regular smoking in women who have experimented with cigarettes.

Fitzpatrick M; Carr A; Dooley B; Flanagan-Howard R; Flanagan E; Tierney K et al. Profiles of adult survivors of severe sexual, physical and emotional institutional abuse in Ireland. Child Abuse Review 19(6): 387-404, 2010. (49 refs.)

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post-traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services.

Freisthler B. Alcohol use, drinking venue utilization, and child physical abuse: Results from a pilot study. Journal of Family Violence 26(3): 185-193, 2011. (32 refs.)

A positive relationship between parents' drinking and child physical abuse has been established by previous research. This paper examines how a parent's use of drinking locations is related to physical abuse. A convenience sample of 103 parents answered questions on physical abuse with the Conflict Tactics Scale-Parent Child version (CTS-PC), current drinking behavior, and the frequency with which they drank at different venues, including bars and parties. Ordered probit models were used to assess relationships between parent demographics, drinking patterns, places of drinking, and CTS-PC scores. Frequent drinking, frequently going to bars, frequently going to parties in a parent's own home, and frequently going to parties in friends' homes were positively related to child physical abuse. The number of drinking locations was positively related to child physical abuse such that parents who report attending and drinking at more of these venues were more likely to be perpetrators of physical abuse. This suggests that time spent in these venues provides opportunities to mix with individuals that may share the same attitudes and norms towards acting violently.

Garcia-Rea EA; LePage JP. Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population. Psychological Trauma: Theory, Research, Practice and Policy 2(3): 201-205, 2010. (36 refs.)

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed.

Gerra G; Leonardi C; Cortese E; Zaimovic A; Dell'Agnello G; Manfredini M et al. Childhood neglect and parental care perception in cocaine addicts: Relation with psychiatric symptoms and biological correlates. (review). Neuroscience and Biobehavioral Reviews 33(4, Special Issue): 601-610, 2009. (68 refs.)

Childhood neglect and poor child-parent relationships have been reported to increase substance use disorders susceptibility. Stressful environmental factors, including emotional neglect, could affect individual personality traits and mental health, possibly inducing stable changes in hypothalamic-pituitary-adrenal (HPA) axis and brain mono-amine function, in turn involved in addictive behavior vulnerability. Therefore, we decided to investigate homovanillic (HVA) and prolactin (PRL) plasma levels, as expression of possible changes in dopamine function, ACTH and cortisol plasma levels, as measures of HPA axis function, and concomitant psychiatric symptoms profile in abstinent cocaine addicts, in relationship to their childhood history of neglect and poor parental care perception. Methods: Fifty abstinent cocaine dependent patients, and 44 normal controls, matched for age and sex, were submitted to a detailed psychiatric assessment (DSM IV criteria). All patients and controls completed the Symptoms Check List-90 (SCL-90) and the Buss Durkee Hostility Inventory (BDHI), to evaluate psychiatric symptoms frequency and aggressiveness levels. The Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and Parental Bonding Instrument (PBI) have been used to retrospectively investigate parent-child relationships. Blood samples were collected to determine HVA, PRL, ACTH and cortisol basal plasma levels. Results: Cocaine addicted individuals in general showed significantly lower HVA, and higher PRL, ACTH and cortisol basal levels respect to controls. In particular, neuroendocrine changes characterized cocaine addicts with childhood history of neglect and low perception of parental care. Obsessive-compulsive, depression and aggressiveness symptoms have been found related to poor parenting, inversely associated to HVA levels and directly associated to PRL, ACTH and cortisol levels. Conclusions: These findings suggest the possibility that childhood experience of neglect and poor parent-child attachment may partially contribute to a complex neurobiological derangement including HPA axis and dopamine system dysfunctions, playing a crucial role in addictive and affective disorders susceptibility.

Gerra G; Zaimovic A; Castaldini L; Garofano L; Manfredini M; Somaini L et al. Relevance of perceived childhood neglect, 5-HTT gene variants and hypothalamus-pituitary-adrenal axis dysregulation to substance abuse susceptibility. American Journal of Medical Genetics. Part B-Neuropsychiatric Genetics 153B(3): 715-722, 2010. (45 refs.)

The hypotheses of (1) gene x environment interaction in the susceptibility to experiment with drugs and (2) hypothalamus pituitary-adrenal (HPA) axis involvement in mediating the effects of early adverse experiences and gene variants affecting serotonin function on substance abuse vulnerability were tested by investigating in 187 healthy adolescents the possible relevance of 5-HTT "S" polymorphism, childhood parental neglect reported retrospectively and HPA axis function to the susceptibility to experiment with illicit drugs. Higher frequency of the 5-HTT SS genotype seems to be associated with an increased susceptibility to use illegal psychotropic drugs among the adolescents. At the same time, reduced maternal care perception was found to represent a key intermediate factor of the association between SS polymorphism and drug use, suggesting that genetic factors and parental behavior concur to drug use susceptibility. Our results also confirm the relationship between basal plasma levels of cortisol and adrenocorticotropic hormone (ACTH) on the one hand, and retrospective measures of neglect during childhood: the higher the mother and father neglect CECA-Q scores, the higher the plasma levels of the two HPA hormones. Such positive relationship has been proved to be particularly effective and important when associated to the S-allele, both in homozygote and heterozygote individuals. However, when tested together with genotype and parental neglect, the effect of HPA hormones such as cortisol and ACTH was not found to improve significantly the explanatory power of the risk model.

Goldman GD; Ryan SD. Direct and modifying influences of selected risk factors on children's pre-adoption functioning and post-adoption adjustment. Children and Youth Services Review 33(2): 291-300, 2011. (83 refs.)

Child adoption outcomes are influenced by child's behavior and parents' expectations (Haugaard & Hazan, 2003). Pre-adoption risk factors, such as prenatal alcohol, tobacco and/or other drug (ATOD) exposure, male sex, sexual abuse, and multiple out-of-home placements have been linked to increased externalizing (acting out) behaviors that are difficult to manage and are most closely associated with adoption disruption (Barth, 1991, 2001 Rosenthal & Groze, 1991; Smith & Howard, 1999). However, adoption researchers have found that positive outcomes (fewer externalizing behaviors) are possible for children who have been exposed to pre-adoption risk factors, suggesting that adoptive families provide protective environments that allow healing (Barth, 1991, 1993; Barth & Brooks, 2000). The current study sought to increase understanding of the influence of these pre-adoption risk factors on adoption outcome with attention to the influence of prenatal alcohol, tobacco, and/or other drug (ATOD) exposure. Results indicated that pre-adoption functioning was significantly influenced by prenatal ATOD exposure, but post-adoption adjustment was not. Structural equation modeling then was used to analyze both the direct and moderating influences of the identified risk factors on the relationship between the child's pre-adoption functioning and post-adoption adjustment. Negative influences of the risk factors on the child's externalizing behavior, individually and additively, in both direct effects and moderation analyses, were not found, with one exception. The only model to have a statistically significant effect was the moderation analysis containing the interaction of all four risk factors. Child development, child welfare, addiction professionals, and adoptive families will find this information to be of value in their quest to facilitate successful adoptions and growth of healthy children and families.

Goldstein AL; Flett GL; Wekerle C. Child maltreatment, alcohol use and drinking consequences among male and female college students: An examination of drinking motives as mediators. Addictive Behaviors 35(6): 636-639, 2010. (32 refs.)

Although the relationship between child maltreatment and alcohol use and drinking problems is well established, the mechanisms involved in this relationship remain largely unknown and research has focused primarily on women. Using the Modified Drinking Motives Questionnaire-Revised (M-DMQ-R; Grant, Stewart, O'Connor, Blackwell & Conrod, 2007), drinking motives were examined as mediators in the relationship between childhood maltreatment and alcohol consumption and consequences among male and female college student drinkers (N=218, 60.6% women). Participants completed questionnaires assessing child maltreatment, drinking motives, alcohol consumption and alcohol consequences. Enhancement motives in particular mediated the relationship between childhood abuse and alcohol consequences for men, whereas coping-depression motives mediated this relationship for women. Implications of these findings for alcohol interventions and future research are discussed, along with limitations of the present study.

Goldstein AL; Flett GL; Wekerle C; Wall AM. Personality, child maltreatment, and substance use: Examining correlates of deliberate self-harm among university students. Canadian Journal of Behavioural Science 41(4): 241-251, 2009. (72 refs.)

Despite recent interest in deliberate self-harm (DSH), the majority of DSH studies have been limited to clinical samples and have identified psychological or clinical correlates and neglected general personality factors. The present study examined personality traits, child maltreatment, and substance use as correlates of DSH in a sample of 319 (65.2% women) university students. A related goal was to describe the nature of DSH in university students. Overall, 29.4% of students reported that they had engaged in at least I act of DSH, and rates of DSH were similar across men and women. Cutting was the most frequently endorsed type of DSH. Women were more likely to have engaged in cutting than men, whereas men were more likely to have put themselves in a violent situation where risk of harm was high. There were no differences in the number of different types of DSH acts reported by men and women. Hierarchical multiple regression revealed several significant positive correlates of DSH acts, including greater depressive symptoms, higher levels of sensation seeking and openness to experience, a history of emotional abuse, and illicit drug use. These findings have important implications for the assessment and treatment of DSH among university students.

Hamelin C; Salomon C; Sitta R; Gueguen A; Cyr D; Lert F. Childhood sexual abuse and adult binge drinking among Kanak women in New Caledonia. Social Science & Medicine 68(7): 1247-1253, 2009

The long-term consequences of violence against women are poorly documented within the context of political domination, economic inequalities and rapid social change of indigenous communities. Using data from the first population study on violence against women and their consequences on health in New Caledonia, South Pacific, this article investigates the association between childhood sexual abuse and binge drinking among 441 adult Kanak women. Face-to-face standardised interviews were conducted in 2002-2003, among women aged 18-54 years drawn from the electoral rolls. Childhood sexual abuse before 15 years of age was reported by 11.6% of respondents. Nearly all the perpetrators (96%) were known to the victims (63% being a close relative). The rate of frequent binge drinking amongst the women within the last 12 months was 34%. After controlling for social and demographic factors, an independent association was found between childhood sexual abuse and current binge drinking. This study is the first to analyse the contribution of childhood sexual abuse to the likelihood of later heavy alcohol use in an indigenous population in the South Pacific. The findings call for improving and giving priority to care for children who are victims of violence to prevent long-term health consequences and to develop prevention programs aimed at alcohol-related behaviour in women, while taking into account simultaneous individual and collective factors.

Harley M; Kelleher I; Clarke M; Lynch F; Arseneault L; Connor D et al. Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychological Medicine 40(10): 1627-1634, 2010. (54 refs.)

Background. Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence. Method. Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence. Results. In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use. Conclusion. Our finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.

Hien D; Cohen LR; Caldeira NA; Flom P; Wasserman G. Depression and anger as risk factors underlying the relationship between maternal substance involvement and child abuse potential. Child Abuse & Neglect 34(2): 105-113, 2010. (46 refs.)

Objective: This study examines how emotion regulation deficits in the area of anger arousal and reactivity are associated with child abuse potential in mothers with substance use and depressive disorders in order to identify targeted areas for prevention and treatment. Methods: A sample of 152 urban mothers was interviewed on measures of substance use, diagnosis of depression, anger arousal and reactivity, and child abuse potential. Results: Linear hierarchical regressions revealed that anger arousal and reactivity exceeded diagnostic and demographic variables in predicting maternal child abuse potential. Additionally, anger arousal and reactivity was found to be a partial mediator of the relationship between diagnostic category and child abuse potential. Conclusions: Findings are discussed in relation to a multifaceted model of child abuse potential which broadens the existing literature to include an examination of depression and emotion regulation in order to more fully understand how substance use and child abuse potential are linked. Practice implications: Models and approaches which help clients to manage and regulate difficult feeling states, specifically anger, could be helpful, and may be most readily applied in such Populations.

Huang S; Trapido E; Fleming L; Arheart K; Crandall L; French M et al. The long-term effects of childhood maltreatment experiences on subsequent illicit drug use and drug-related problems in young adulthood. Addictive Behaviors 36(1-2): 95-102, 2011. (53 refs.)

Objectives: The objective of this study was to examine the associations between (a) childhood maltreatment (i e physical abuse sexual abuse and neglect) and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. Methods: Wave 1 and Wave 3 public-use data from the National Longitudinal: Study of Adolescent Health were used Logistic regressions controlling for adolescent drug use and other important family and peer contextual processes were estimated to determine the associations between (a) childhood maltreatment experiences and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. Results: Among the participants 31 9% reported some form of childhood maltreatment Childhood physical abuse was associated with a 37% (OR = 1 37 95% CI = 1 04 1 80) increase in illicit drug use during the 30 days prior to the Wave 3 survey a 48% (OR = 1 48 95% CI = 116 1 89) Increase in illicit drug use during the year prior to the Wave 3 survey and a 96% (OR = 1 96 95% CI = 1 40 2 76) increase in drug related problems in young adulthood. The latter two associations persisted even after controlling for illicit drug use in adolescence. Neglect among females was associated with a higher likelihood of past year illicit drug use in young adulthood (OR = 1 31 95% CI = 1 002 1 71) However this association was not significant once the effect of illicit drug use in adolescence was statistically controlled for. Conclusions: The present findings suggest that childhood maltreatment is related to subsequent illicit drug use and drug-related problems in young adulthood and that some of these associations differ by gender Implications for preventive intervention are discussed.

Johnson CS; Heffner JL; Blom TJ; Anthenelli RM. Exposure to traumatic events among treatment-seeking, alcohol-dependent women and men without PTSD. Journal of Traumatic Stress 23(5): 649-652, 2010. (18 refs.)

The authors examined lifetime exposure to a range of traumatic events in 106 abstinent, treatment-engaged (85% residential; 15% outpatient), alcohol-dependent women (n = 53) and men without current or lifetime posttraumatic stress disorder. Alcohol-dependent women reported greater severity of childhood trauma, but similar lifetime exposure to traumatic events compared with men. Alcohol-dependent women without cocaine abuse or dependence (n 10) reported greater severity of childhood trauma than women with (n = 43), and men with (n = 21) or without (n = 32) cocaine abuse or dependence. Results extend previously observed gender differences in trauma histories among alcohol-dependent adults and point to potential gender- and substance-specific drug coaddiction effects that may have been influenced by trauma exposure.

Jones DJ; Runyan DK; Lewis T; Litrownik AJ; Black MM; Wiley T et al. Trajectories of childhood sexual abuse and early adolescent HIV/AIDS risk behaviors: The role of other maltreatment, witnessed violence, and child gender. Journal of Clinical Child and Adolescent Psychology 39(5): 667-680, 2010. (74 refs.)

Childhood sexual abuse (CSA) has been associated with HIV/AIDS risk behavior; however, much of this work is retrospective and focuses on women. The current study used semi-parametric mixture modeling with youth (n=844; 48.8% boys) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine the link between trajectories of CSA (2 to 12 years old) and HIV/AIDS risk behavior at age 14 (i.e., sexual intercourse alcohol use). Trajectory analyses revealed a link between a history of CSA and the development of risky behavior. In addition, trajectories for physical and emotional abuse, but not neglect or witnessed violence, contributed to risky behavior over and above the role of CSA. Child gender did not moderate the findings. Findings highlight the signficance of CSA histories, as well as the broader context of maltreatment, for better understanding the development of risk behaviors in both girls and boys.

Jun HJ; Austin SB; Wylie SA; Corliss HL; Jackson B; Spiegelman D et al. The mediating effect of childhood abuse in sexual orientation disparities in tobacco and alcohol use during adolescence: Results from the Nurses' Health Study II. Cancer Causes & Control 21(11): 1817-1828, 2010. (53 refs.)

To examine the mediating effect of childhood abuse on sexual orientation disparities in tobacco and alcohol use during adolescence. We carried out analyses with data from over 62,000 women in the ongoing Nurses' Health Study II cohort who provided information on sexual orientation, childhood abuse occurring by age 11, and tobacco and alcohol use in adolescence. We used multivariate regression analyses, controlling for confounders, to estimate the mediating effect of childhood abuse on the association between sexual orientation and tobacco and alcohol use in adolescence. Lesbian and bisexual orientation and childhood abuse were positively associated with greater risk of tobacco and alcohol use during adolescence. For lesbians, the estimated proportion of excess tobacco and alcohol use in adolescence relative to use among heterosexual women that was mediated by abuse in childhood ranged from 7 to 18%; for bisexual women, the estimated proportion of excess use mediated by abuse ranged from 6 to 13%. Elevated childhood abuse in lesbian and bisexual women partially mediated excess tobacco and alcohol use in adolescence relative to heterosexual women. Interventions to prevent child abuse may reduce sexual orientation disparities in some of the leading causes of cancer in women.

Keeshin BR; Campbell K. Screening homeless youth for histories of abuse: Prevalence, enduring effects, and interest in treatment. Child Abuse & Neglect 35(6): 401-407, 2011. (34 refs.)

Objectives: To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse. Methods: Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse. Results: Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse. Conclusions: Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.

Kingston S; Raghavan C. The relationship of sexual abuse, early initiation of substance use, and adolescent trauma to PTSD. Journal of Traumatic Stress 22(1): 65-68, 2009. (22 refs.)

This study explores relationships among childhood sexual abuse (CSA), age of substance use initiation, additional traumatic events, tend posttraumatic stress disorder (PTSD) in a sample of adolescents. A history of CSA that preceded substance use was not related to an earlier age of substance use initiation. Early initiation of substance use predicted exposure to additional traumatic experiences. This relationship was partially mediated by engagement in risky behavior while under the influence of substances. Posttraumatic stress disorder was related to CM, additional traumatic experiences and engagement in risky behavior while sander the influence of substances.

Klanecky AK; Salvi S; McChargue DE. Coerced childhood sexual abuse moderates the association between cigarette smoking initiation and college drug use frequency. American Journal on Addictions 18(5): 363-366, 2009. (30 refs.)

The current study examined childhood sexual abuse (CSA) as a potential moderator of the "gateway theory" association of cigarette use onset and college drug use. Covariate adjusted hierarchical regressions showed that CSA history interacted with age of first cigarette to predict total 12-month illicit drug use frequency (Delta R-2 = .048, F(10, 76) = 4.041, Mse = 8.812, p = .021). Simple effects revealed that age of first cigarette predicted drug use frequency in individuals with CSA histories (p = .045) rather than non-CSA individuals (p = .103). Exploratory analyses further revealed that the CSA moderation was carried primarily by those exposed to forced/coerced CSA events. Implications of the findings are discussed.

Lansford JE; Dodge KA; Pettit GS; Bates JE. Does physical abuse in early childhood predict substance use in adolescence and early adulthood? Child Maltreatment 15(2): 190-194, 2010. (17 refs.)

Prospective longitudinal data from 585 families were used to examine parents' reports of child physical abuse in the first 5 years of life as a predictor of substance use at ages 12, 16, and 24. Path analyses revealed that physical abuse in the first 5 years of life predicted subsequent substance use for females but not males. We found a direct effect of early physical abuse on girls' substance use at age 12 and indirect effects on substance use at age 16 and age 24 through substance use at age 12. For boys, age 12 substance use predicted age 16 substance use, and age 16 substance use predicted age 24 substance use, but physical abuse in the first 5 years of life was unrelated to subsequent substance use. These findings suggest that for females, a mechanism of influence of early physical abuse on substance use into early adulthood appears to be through precocious initiation of substance use in early adolescence.

Lown EA; Nayak MB; Korcha RA; Greenfield TK. Child physical and sexual abuse: a comprehensive look at alcohol consumption patterns, consequences, and dependence from the National Alcohol Survey. Alcoholism: Clinical and Experimental Research 35(2): 317-325, 2011. (65 refs.)

Background: Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample. Methods: This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures. Results: Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (ORadj = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (ORadj = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (ORadj = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (ORadj = 3.5; 95% CI 2.6 to 4.8) and dependence (ORadj = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse. Conclusion: Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting.

Lynne-Landsman SD; Bradshaw CP; Ialongo NS. Testing a developmental cascade model of adolescent substance use trajectories and young adult adjustment. Development and Psychopathology 22(4, special issue): 933-948, 2010. (58 refs.)

Developmental models highlight the impact of early risk factors on both the onset and growth of substance use, yet few studies have systematically examined the indirect effects of risk factors across several domains, and at multiple developmental time points, on trajectories of substance use and adult adjustment outcomes (e. g., educational attainment, mental health problems, criminal behavior). The current study used data from a community epidemiologically defined sample of 678 urban, primarily African American youth, followed from first grade through young adulthood (age 21) to test a developmental cascade model of substance use and young adult adjustment outcomes. Drawing upon transactional developmental theories and using growth mixture modeling procedures, we found evidence for a developmental progression from behavioral risk to adjustment problems in the peer context, culminating in a high-risk trajectory of alcohol, cigarette, and marijuana use during adolescence. Substance use trajectory membership was associated with adjustment in adulthood. These findings highlight the developmental significance of early individual and interpersonal risk factors on subsequent risk for substance use and, in turn, young adult adjustment outcomes.

Mackie CJ; Castellanos-Ryan N; Conrod PJ. Developmental trajectories of psychotic-like experiences across adolescence: Impact of victimization and substance use. Psychological Medicine 41(1): 47-58, 2011. (65 refs.)

Background. Research suggests that psychotic-like experiences (PLEs) in the general population are common, but can reflect either transitory or persistent developmental phenomena. Using a general adolescent population it was examined whether different developmental subtypes of PLEs exist and whether different trajectories of PLEs are associated with certain environmental risk factors, such as victimization and substance use. Method. Self-reported PLEs were collected from 409 adolescents (mean age 14 years 7 months) at four time points, each 6 months apart. General growth mixture modelling was utilized to identify classes of adolescents who followed distinct trajectories of PLEs across this period. Predictors of class membership included demographics, personality, victimization, depression, anxiety and substance use. Results. We identified the following three developmental subgroups of PLEs: (1) persistent; (2) increasing; (3) low. Adolescents on the persistent trajectory reported frequent victimization and consistent elevated scores in depression and anxiety. Adolescents on the increasing trajectory were engaging in cigarette use prior to any increases in PLEs and were engaging in cocaine, cannabis and other drug use as PLEs increased at later time points. Conclusions. The findings suggest that different developmental subgroups of PLEs exist in adolescence and are differentially related to victimization and substance use.

Maloney E; Degenhardt L; Darke S; Nelson EC. Investigating the co-occurrence of self-mutilation and suicide attempts among opioid-dependent individuals. Suicide and Life-Threatening Behavior 40(1): 50-62, 2010. (50 refs.)

The prevalence and risk factors associated with self-mutilation among opioid dependent cases and controls were determined, and the co-occurrence of self-mutilation and attempted suicide was examined. The prevalence of self-mutilation among cases and controls did not differ significantly (25% vs. 23%, respectively), with gender differences identified among cases only. A number of risk factors were found to be associated with self-mutilation, including borderline personality disorder, alcohol dependence, childhood sexual abuse, and multiple suicide attempts. Not only is self-mutilation a clinically significant problem, but when combined with a history of attempted suicide, the psychological dysfunction observed is markedly high.

Marshall JM; Huang H; Ryan JP. Intergenerational families in child welfare: Assessing needs and estimating permanency. Children and Youth Services Review 33(6): 1024- 1030, 2011. (38 refs.)

Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1196 caregivers, most of whom are single African American females, and 2143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. We sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Our findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.

McGlade A; Ware R; Crawford M. Child protection outcomes for infants of substance-using mothers: A matched-cohort study. Pediatrics 124(1): 285-293, 2009. (31 refs.)

OBJECTIVE: Parental drug use is a critical public health issue; it is estimated to be present in up to 80% of referrals to Australian child protection agencies. However, no data regarding the child protection outcomes of infants of substance-using parents exist in Australia, and no comparisons have been made with infants of non-substance-using parents. We assessed differences in substantiated abuse between 2 groups of mothers in Brisbane to quantify this risk. METHODS: Mothers who disclosed opiate, amphetamine, or methadone use between 2000 and 2003 were identified and compared with non-substance-using mothers who were matched for gender and gestational age. All infants were linked to the Department of Child Safety Child Protection Information System database. Child protection outcomes, such as substantiated notifications and entry into foster care, were compared between groups. RESULTS: We studied 119 infants of substance-using mothers and 238 matched infants. Infants of substance-using mothers were more likely to suffer substantiated harm (hazard ratio 13.3 [95% confidence interval 4.6-38.3]) and to enter foster care (hazard ratio 13.3 [95% confidence interval 5.1-34.3]). Infants of mothers using illicit drugs were more likely to suffer substantiated harm and more likely to enter foster care than infants of mothers who were compliant with a methadone program. CONCLUSIONS: Infants of substance-using mothers have much poorer child protection outcomes than infants of non-substance-using mothers. This study adds substantial evidence toward a real association between maternal drug use and child abuse. Greater interagency collaboration is urgently required to reduce this risk.

Meade CS; Kershaw TS; Hansen NB; Sikkema KJ. Long-term correlates of childhood abuse among adults with severe mental illness: Adult victimization, substance abuse, and HIV sexual risk behavior. AIDS and Behavior 13(2): 207-216, 2009. (66 refs.)

The prevalence of childhood sexual and physical abuse among persons with severe mental illness (SMI) is disproportionately high. Adults with SMI also engage in high rates of HIV risk behaviors. This study examined the association between childhood abuse and adult victimization, substance abuse, and lifetime HIV sexual risk in a sample of 152 adults with SMI receiving community mental health services. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. Seventy percent reported childhood physical and/or sexual abuse, and 32% reported both types of abuse. Participants with childhood abuse were more likely to report adult victimization and greater HIV risk. A structural equation model found that childhood abuse was directly and indirectly associated with HIV risk through drug abuse and adult vicitimization. Integrated treatment approaches that address interpersonal violence and substance abuse may be necessary for HIV risk reduction in this population.

Mersky JP; Topitzes J. Comparing early adult outcomes of maltreated and non-maltreated children: A prospective longitudinal investigation. Children and Youth Services Review 32(8, special issue): 1086-1096, 2010. (107 refs.)

Using prospective data from the Chicago Longitudinal Study, this investigation examined associations between child maltreatment and an array of outcomes in early adulthood. Findings from bivariate and multivariate analyses indicated that verified maltreatment victims fared significantly worse than participants without an indicated maltreatment report on indicators of educational and economic attainment, criminal offending, and behavioral and mental health. Results also revealed that, while many maltreated children appeared to function well on individual outcomes, a large majority did not achieve criteria for resilience when development was assessed across domains. For example, non-maltreated participants were more than twice as likely to attain five or more positive outcomes (38.2%) on an aggregate seven-item index as the maltreated group (15.7%). These findings suggest that child maltreatment is associated with extensive and enduring impacts, reinforcing the need to develop and implement effective maltreatment prevention and intervention strategies.

Moniruzzaman A; Pearce ME; Patel SH; Chavoshi N; Teegee M; Adam W et al. THE CEDAR Project: Correlates of attempted suicide among aboriginal people who use injection and non-injection drugs in two Canadian cities. International Journal of Circumpolar Health 68(3, Special Issue): 261-273, 2009. (44 refs.)

Objectives. Aboriginal leadership and families are deeply concerned about the rate of suicide attempt among their young people. The objectives of this study were to (a) describe the prevalence of suicide attempt and (b) to describe correlates of Vulnerability to Suicide attempts within a cohort of young Aboriginal people who use drugs in 2 Canadian cities. We aimed to Situate file findings within the context of historical and lifetime trauma. Study design. The Cedar Project is a prospective cohort study involving 605 young Aboriginal people aged 14-30 sho use drugs in Vancouver and Prince George, British Columbia, Canada. Methods. Multivariable logistic regression modelling identified independent predictors of suicide attempts. Estimates of adjusted odds ratios and 95% confidence intervals were calculated. Result. In multivariable analysis, residing in Prince George (Adjusted Odds Ratio [AOR]: 1.80,95% Cl: 1.23, 2.64), ever having been sexually abused (AOR: 2.07, 95% CI: 1.39, 3.08), and ever having overdosed (AOR: 2.29, 95% Cl: 1.53, 3.42) independently predicted lifetime attempted suicide. Conclusions. Suicide prevention and intervention programs must address historical and lifetime trauma among Aboriginal young people who struggle with substance dependence.

Oral R; Bayman L; Assad A; Wibbenmeyer L; Buhrow J; Austin A et al. Illicit drug exposure in patients evaluated for alleged child abuse and neglect. Pediatric Emergency Care 27(6): 490-495, 2011. (32 refs.)

Background: Substantiation of drug exposure in cases with alleged maltreatment is important to provide proper treatment and services to these children and their families. A study performed at University of Iowa Hospitals and Clinics showed that 30% of pediatric patients with burn injuries, which were due to child maltreatment, were also exposed to illicit drugs. Objective: The children presenting to the University of Iowa Hospitals and Clinics with alleged maltreatment have been tested for illicit substances since 2004. The objective of this study was to analyze the presence of illicit drug exposure in the pediatric subpopulation admitted to pediatric inpatient and outpatient units for an evaluation for abuse/neglect. Design and Methods: The study design is a retrospective chart review. Using hospital databases, every pediatric chart with a child abuse/neglect allegation was retrieved. The association between risk factors and clinical presentation and illicit drug test result was assessed. Excel and SAS were used for statistical analysis. Institutional review board approval was obtained to conduct this study. Results: Six hundred sixty-five charts met study inclusion criteria for child abuse/neglect allegation. Of those, 232 cases were tested for illicit drugs between 2004 and 2008 per the testing protocol. Thirty-four cases (14.7%) tested positive on a drug test. Positive test rates based on clinical presentation were 28.6% (18/63) in neglect cases, 16.1% (5/31) in cases with soft tissue injuries, 14.3% (4/28) in burn injuries, 10.0% (2/20) in cases with sexual abuse, 7.1% (2/28) in cases with fractures, and 4.8% (3/62) in abusive head trauma cases. There were long-term abuse findings in 129 children (55.6%). Logistic regression analysis revealed that positive drug testing was most significantly associated with clinical symptoms suggesting physical abuse or neglect versus sexual abuse (odds ratio [OR] = 6.70; 95% confidence interval [CI], 1.26-35.49; P = 0.026), no or public health insurance versus those with private insurance (OR = 4.49; 95% CI, 1.47-13.66; P = 0.008), history of parental drug abuse versus those without parental history of drug abuse (OR = 3.42; 95% CI, 1.38-8.46; P = 0.008), and history of domestic violence versus those without a history of domestic violence (OR = 2.81; 95% CI, 1.08-7.30; P = 0.034). Conclusions: The results of this study showed that an illicit drug screening protocol used in the assessment of children evaluated for child abuse identified almost 15% of the population of allegedly abused and neglected children who were tested according to a protocol being exposed to illicit drugs. Thus, routine drug testing of at least children assessed for neglect and nonaccidental burn and soft tissue injuries, children with a history of either parental drug use or domestic violence is recommended.

Papadodima SA; Sakelliadis EI; Sergentanis TN; Giotakos O; Sergentanis IN; Spiliopoulou CA. Smoking in prison: A hierarchical approach at the crossroad of personality and childhood events. European Journal of Public Health 20(4): 470-474, 2010. (37 refs.)

Background: Smoking has long been considered part of prison culture and studies have shown a high prevalence of smoking within correctional facilities. Methods: A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. To assess current smoking habits, a hierarchical approach was adopted. The underlying conceptual framework included: (i) demographic parameters, (ii) adverse childhood history (physical abuse, parental neglect, parental divorce, alcoholism in the family, sexual abuse and psychiatric condition in the family), (iii) education, personality traits, such as impulsivity (Barrat Impulsivity Scale-11), aggression (BussPerry Aggression Questionnaire and Lifetime History of Aggression), and personal history of mental disease, (iv) prison-related features (duration of sentence, sentence already served and change in smoking habits during imprisonment). Results: Eighty percentage of the study sample reported current smoking; 43.4% disclosed deterioration in their smoking habits during imprisonment. The hierarchical approach pointed to: (i) adverse childhood events, i. e. alcoholism in the family [ adjusted odds ratio (OR) = 6.29, 95% confidence interval (CI): 2.44-16.25], psychiatric condition in the family (adjusted OR= 4.10, 95% CI: 1.31-12.84), physical abuse (adjusted OR = 2.90, 95% CI: 1.30-6.46), parental neglect (adjusted OR = 2.66, 95% CI: 1.19-5.95), parental divorce (adjusted OR= 2.14, 95% CI: 1.00-4.56), and (ii) impulsivity (adjusted OR= 2.26, 95% CI: 1.12-4.58) as independent risk factors. In addition, deterioration of smoking habits during imprisonment exerted an effect of borderline significance (adjusted OR = 2.02, 95% CI: 0.97-4.24). Conclusions: Heavy smoking in prison principally integrates two components: unfavourable childhood and current personality traits (impulsivity).

Reinert DF; Edwards CE. Childhood physical and verbal mistreatment, psychological symptoms, and substance use: Sex differences and the moderating role of attachment. Journal of Family Violence 24(8): 589-596, 2009. (30 refs.)

Sex differences in sequelae associated with levels of childhood physical mistreatment and verbal mistreatment were examined in a non-clinical sample of 272 university students. We predicted and found that both forms of mistreatment are related to attachment difficulties as well as various adverse psychological symptoms. We hypothesized, based on attachment theory, that the strength of a child's attachment to one parent would moderate adverse emotional sequelae of mistreatment by the other parent. This prediction was only partially supported. Strength of the mother-daughter attachment moderated several of the adverse psychological symptoms in response to mistreatment by fathers, but mother-son attachment did not so moderate. Strength of the father-son attachment also did not moderate the symptoms associated with mistreatment perpetrated by mothers, nor did the father-daughter attachment. These results suggest that, among other relevant factors, sex differences should also be taken into account in treatment and prevention efforts.

Rogosch FA; Oshri A; Cicchetti D. From child maltreatment to adolescent cannabis abuse and dependence: A developmental cascade model. Development and Psychopathology 22(4, special issue): 883-897, 2010. (94 refs.)

A developmental cascade model tested associations among child maltreatment, internalizing and externalizing psychopathology, social competence, and cannabis abuse and dependence symptoms in a longitudinal cohort (N = 415). Nested structural equation models evaluated continuity and cross-domain influences among broad multi-informant constructs across four developmental periods: age 7 to 9, 10 to 12, 13 to 15, and 15 to 18. Results indicated significant paths from child maltreatment to early externalizing and internalizing problems and social competence, as well as to cannabis abuse and dependence (CAD) symptoms in adolescence. Youth CAD symptoms were primarily related directly to child maltreatment and externalizing problems. Childhood internalizing symptoms contributed to later childhood decreases in social competence, which predicted increases in late adolescent externalizing problems. Using a developmental psychopathology framework, results are discussed in relation to cascade and transactional effects and the interplay between problem behaviors during childhood and development of CAD symptoms during early and late adolescence.

Romero V; Donohue B; Allen DN. Treatment of concurrent substance dependence, child neglect and domestic violence: A single case examination involving family behavior therapy. Journal of Family Violence 25(3): 287-295, 2010. (16 refs.)

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were "blind" to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.

Rothman EF; Bernstein J; Strunin L. Why might adverse childhood experiences lead to underage drinking among US youth? Findings from an emergency department-based qualitative pilot study. Substance Use & Misuse 45(13): 2281-2290, 2010. (29 refs.)

Research suggests that adverse childhood experiences (e.g., child abuse, interparental violence) predispose youth to early drinking initiation, but specifics about how and why adolescents progress from these exposures to alcohol use are not well understood. This National Institute on Alcohol Abuse and Alcoholism supported study presents data from semistructured interviews with 22 adolescents who reported both initiating drinking <= 18 years old and >= 2 adverse childhood experiences. Data were collected in 2007 as part of a formative research effort for an emergency department-based intervention to reduce adolescent drinking. Findings suggest that prevention initiatives for youth from challenging environments may need to do more than address conformity and social motivations for underage alcohol initiation. Study limitations are noted and future research is suggested.

Roy A. Characteristics of cocaine dependent patients who attempt suicide. Archives of Suicide Research 13(1): 46-51, 2009. (24 refs.)

There have been few studies examining risk factors for attempting suicide among cocaine dependent patients. Therefore, a large group of 406 abstinent cocaine dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. The results showed that 43.5% of the patients had attempted suicide. Attempters were younger; more were female; more reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and comorbidity with alcohol and opiate dependence. Logistic regression revealed that childhood physical abuse, childhood emotional negelect, comorbidity with alcohol dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. Thus these results suggest that attempting suicide is common among cocaine dependent patients and that both distal and proximal risk factors may play a role.

Sansone RA; Whitecar P; Wiederman MW. The prevalence of childhood trauma among those seeking buprenorphine treatment. Journal of Addictive Diseases 28(1): 64-67, 2009. (12 refs.)

In this study, the authors examined the prevalence of five types of childhood trauma among a sample of adult patients who were addicted to opioids and seeking treatment with buprenorphine. Using a survey methodology, the authors examined a consecutive sample of 113 participants and found that 20.4% reported having experienced sexual abuse, 39.8% reported having experienced physical abuse, 60.2% reported having experienced emotional abuse, 23.0% reported having experienced physical neglect, and 65.5% reported having witnessed violence. Only 19.5% of the sample denied having experienced any of the five forms of childhood trauma. Most respondents (60.2%) reported having experienced one, two, or three different forms of childhood trauma. A minority reported having experienced four (13.3%) or all five (7.1%) forms of childhood trauma. These data indicate that among individuals with opioid dependence who are seeking treatment with buprenorphine, the prevalence rates of various types of childhood trauma are quite high.

Schafer I; Langeland W; Hissbach J; Luedecke C; Ohlmeier MD; Chodzinski C et al. Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both: A multi-center study. Drug and Alcohol Dependence 109(1-3): 84-89, 2010. (40 refs.)

Background: The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse. Methods: Of the 459 participants (59.7% male) 182(39.7%) were alcohol-dependent (A), 154(33.6%) were drug-dependent (D), and 123(26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD. Results: Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9 +/- 8.8; group D: 12.9 +/- 11.7; group AD: 15.1 +/- 11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders. Conclusions: It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma.

Schiff M; Levit S; Cohen-Moreno R. Childhood sexual abuse, post-traumatic stress disorder, and use of heroin among female clients in Israeli methadone maintenance treatment programs (MMTPs). Social Work in Health Care 49(9): 799-813, 2010. (59 refs.)

This study investigated association between post-traumatic stress disorder (PTSD) and a 1-year follow-up heroin use among female clients in methadone clinics in Israel. Participants were 104 Israeli female clients from four methadone clinics (Mean age = 39.09, SD = 8.61) who reported victimization to childhood sexual abuse. We tested traces in urine of these female clients for heroin a year preceding and a year following the assessment of their PTSD. Results show that 54.2% reported symptoms that accedes the DSM-IV criteria for PTSD. We found that among childhood victimized women PTSD is associated with more frequent use of heroin at a 1-year follow-up even after controlling for duration of the stay at the clinic, background, other traumatic experiences and heroin use a year prior the assessment of their PTSD. This study shows the potential long-run negative consequences of childhood sexual abuse. Not only are these sexually abused women trapped into drug dependence and addiction, they cannot break the vicious cycle of continuing the use of illicit drugs even when treated for their addiction. One major practice implication is that treatment for PTSD proven efficacious will be provided in the methadone and other drug treatment services.

Scott KM; Smith DR; Ellis PM. Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry 67(7): 712-719, 2010. (37 refs.)

Context: Evidence for an association between child maltreatment and later psychopathology heavily relies on retrospective reports of maltreatment. The few studies using prospective ascertainment of child maltreatment show weaker associations, raising the possibility that it is not maltreatment, but rather the memory of maltreatment, that raises the risk of later mental disorders. Objectives: To estimate associations between prospectively ascertained child maltreatment and a wide range of subsequently measured DSM-IV mental disorders and to show the influence of retrospectively reported maltreatment in the comparison group on these associations. Design: Retrospective cohort study. Setting: Nationally representative New Zealand community. Participants: Respondents aged 16 to 27 years (n=2144) from a mental health survey, 221 of whom were identified as having records on a national child protection agency database. Main Outcome Measures: Twelve-month and lifetime prevalence of individual DSM-IV mood, anxiety, and substance use disorders, and disorder groups assessed with the World Health Organization Composite International Diagnostic Interview. Results: After adjusting for demographic and socioeconomic correlates, child protection agency history was associated with several individual mental disorders, mental disorder comorbidity, and all mental disorder groups, both 12-month and lifetime. Odds of 12-month posttraumatic stress disorder were 5.12 (95% confidence interval [CI], 2.42-10.83); of any 12-month mood disorder, 1.86 (95% CI, 1.12-3.08); of any anxiety disorder, 2.41 (95% CI, 1.47-3.97); and of any substance use disorder, 1.71 (95% CI, 1.01-2.88). These associations increased in magnitude when those who retrospectively reported child maltreatment were removed from the comparison group. Conclusions: Prospectively ascertained child maltreatment is significantly associated with a range of subsequent mood, anxiety, and substance use disorders, indicating that maltreatment, not just the memory of maltreatment, is associated with subsequent psychopathology. There is a need for both targeted mental health interventions with the present and past clients of child welfare agencies and for concerted population-level strategies to meet the needs of the many other children who experience maltreatment.

Senn TE; Carey MP; Vanable PA. The intersection of violence, substance use, depression, and STDs: Testing of a syndemic pattern among patients attending an urban STD clinic. Journal of the National Medical Association 102(7): 614-620, 2010. (67 refs.)

Objectives: High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic. Methods: Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis. Results: The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and. IPV predicted STD diagnosis. Conclusions: Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (ie, a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.

Shand FL; Degenhardt L; Slade T; Nelson EC. Sex differences amongst dependent heroin users: Histories, clinical characteristics and predictors of other substance dependence. Addictive Behaviors 36(1-2): 27-36, 2011. (88 refs.)

Introduction and aims To examine differences in the characteristics and histories of male and female dependent heroin users and in the clinical characteristics associated with multiple substance dependence diagnoses. Design and methods: 1513 heroin dependent participants underwent an interview covering substance use and dependence, psychiatric history, child maltreatment, family background, adult violence, and criminal history. Family background, demographic, and clinical characteristics were analysed by sex. Ordinal regression was used to test for a relationship between number of substance dependence diagnoses and other clinical variables. Results: Women were more likely to experience most forms of child maltreatment, to first use heroin with a boyfriend or partner, to experience ongoing adult violence at the hands of a partner, and to have a poorer psychiatric history than men. Males had more prevalent lifetime substance dependence diagnoses and criminal histories, and were more likely to meet the criteria for ASPD. Predictors of multiple substance dependence diagnoses for both sexes were mental health variables: antisocial behaviour, childhood sexual abuse, victim of adult violence, younger age at first cannabis use, and overdose. As the number of dependence diagnoses increased clinical and behavioural problems increased. Childhood emotional neglect was related to increasing dependence diagnoses for females, but not males, whereas PTSD was a significant predictor for males but not females. Discussion and conclusions: Mental health problems, other substance dependence, childhood and adult trauma were common in this sample with sex differences indicating different treatment needs and possible different pathways to heroin dependence for men and women.

Shelton KH; Taylor PJ; Bonner A; van den Bree M. Risk factors for homelessness: Evidence from a population-based study. Psychiatric Services 60(4): 465-472, 2009. (49 refs.)

Objective: This study examined factors associated with lifetime experience of homelessness among young adults. Methods: Data were analyzed for 14,888 young adults (mean +/-SD age 21.97+/-1.77; 7,037 men and 7,851 women) who participated in the National Longitudinal Study of Adolescent Health (Add Health), a U. S. nationally representative, population-based sample. Data were collected from young adults through computer-assisted interviews six years after they had enrolled in the study as adolescents. Variables that have been associated with lifetime homelessness in at least one service sample were mapped to Add Health survey items. Data were analyzed by logistic regression. Results: A total of 682 respondents (4.6%) were classified as ever being homeless. Several factors related to childhood experiences of poor family functioning, socioeconomic disadvantage, and separation from parents or caregivers were independently associated with ever being homeless. Other significant independent factors included current socioeconomic difficulty, mental health problems, and addiction problems. Indicators of involvement in crime and addiction problems with gambling and alcohol were not independently associated with homelessness. Conclusions: The findings underscore the relationship between specific indicators of adversity in childhood and risk of homelessness and point to the importance of early intervention efforts. Consistent with the extant research literature, mental health problems also appear to be associated with homelessness, highlighting the potentially complex service needs of this population.

Shin SH; Edwards EM; Heeren T. Child abuse and neglect: Relations to adolescent binge drinking in the National Longitudinal Study of Adolescent Health (AddHealth) Study. Addictive Behaviors 34(3): 277-280, 2009. (28 refs.)

The purpose of this study was to examine the relationship between child maltreatment and adolescent binge drinking. Given that many victimized children have been maltreated in multiple ways, we examine the effects of co-occurrence of multiple types of maltreatment on adolescent binge drinking. We used the National Longitudinal Study of Adolescent Health (AddHealth), which included a nationally representative sample of adolescents (n = 12,748). Adolescent binge drinking was defined as five or more drinks in a row at least 2-3 times per month in the past year. Among those reporting any maltreatment, 12.4% reported binge drinking compared to 9.9% among those reporting no maltreatment. Logistic regression models found that child maltreatment is a robust risk factor for adolescent binge drinking controlling for parental alcoholism. In particular, all types of or combinations of types of maltreatment were strongly associated with adolescent binge drinking, controlling for age, gender, race, parental alcoholism and monitoring. Research examining the effect of childhood maltreatment on later alcohol abuse needs to recognize the clustering effects of multiple types of childhood maltreatment on alcohol problems.

Shin SH; Edwards E; Heeren T; Amodeo M. Relationship between multiple forms of maltreatment by a parent or guardian and adolescent alcohol use. American Journal on Addictions 18(3): 226-234, 2009. (52 refs.)

This study examined the effect of the co-occurrence of multiple categories of maltreatment on adolescent alcohol use. Data were from the National Longitudinal Study of Adolescent Health which used a nationally representative sample of adolescents (n = 14,078). Among those reporting any maltreatment, over one-third had experienced more than one type of maltreatment. Logistic regression models found that all types or combinations of types of maltreatment except physical-abuse-only were strongly associated with adolescent alcohol use, controlling for age, gender, race, and parental alcoholism. These results add to accumulating evidence that child maltreatment has a deleterious impact on adolescent alcohol use.

Shin SH; Hong HG; Hazen AL. Childhood sexual abuse and adolescent substance use: A latent class analysis. Drug and Alcohol Dependence 109(1-3): 226-235, 2010. (117 refs.)

Children who have exposure to child sexual abuse (CSA) are at particular risk for developing substance abuse in adolescence, but the extent to which CSA may shape patterns of adolescent substance use remains uncertain. The aim of this paper is to characterize the variations in patterns of adolescent substance use and to examine the association between CSA and qualitatively distinct patterns of adolescent substance use. Latent class analyses identified homogenous groups of adolescents with similar patterns of substance use using a sample of 1019 adolescents (mean age: 15.9 years; range: 13-18) who were selected from five publicly funded service systems. Different patterns of latent class structures were identified in boys and girls (a 4-class solution for girls and a 3-class solution for boys). CSA was associated with an increased risk of being a heavy polysubstance user in girls, even after adjustment of age, race/ethnicity, parental substance use, sibling use, peer use, psychopathology and other forms of childhood maltreatment including physical abuse and neglect. Findings indicate that female victims of CSA who are involved with public service systems are at high risk for developing multiple-substance use in adolescence.

Shipman K; Taussig H. Mental health treatment of child abuse and neglect: The promise of evidence-based practice. Pediatric Clinics of North America 56(2): 417+, 2009. (61 refs.)

In 2006, 3.6 million children in the United States received a child protective services' investigation and 905,000 children (about one-quarter of those investigated) were found to have been abused or neglected. Children who have been maltreated are at risk for experiencing a host of mental health problems, including depression, posttraumatic stress, dissociation, reactive attachment, low self-esteem, social problems, suicidal behavior, aggression, conduct disorder, attention-deficit hyperactivity disorder (ADHD) and problem behaviors, including delinquency, risky sexual behavior and substance use. Given the high rate of mental health problems, it is not surprising that maltreated youth are in need of mental health services. Unfortunately, only a fraction of these children and adolescents receive services. Recently, several evidence-based practices have been rigorously tested and are demonstrating efficacy in reducing mental health problems associated with maltreatment. This article details these developments.

Silovsky JF; Bard D; Chaffin M; Hecht D; Burris L; Owora A et al. Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review 33(8, special issue): 1435-1444, 2011. (56 refs.)

Few studies have specifically examined prevention of child maltreatment among higher-risk populations in rural communities. The overarching goal of this study was to conduct a randomized clinical trial of SafeCare augmented for rural high-risk population (SC+) compared to standard home-based mental health services (SAU) to examine reductions in future child maltreatment reports, as well as risk factors and factors proximal to child maltreatment. Parents (N = 105) of young children (5 years or less) who had identifiable risk of depression, intimate partner violence, or substance abuse were randomized to SC+ or SAU. Participants randomized to SC+ were more likely to enroll (83% vs. 35% for SAU) and remain in services (35 h vs. 8 h for SAU). SC+ (for participants who successfully completed services) may have had limited impact on child welfare reports during service provision. Further, SC+ had fewer child welfare reports related to DV than SAU. Parent self-reports of parenting behaviors, risk factors, and protective factors did not demonstrate significant sustained program impact. Limitations include power constraints related to sample size. Promising next steps entail future trials with larger sample sizes examining service compliance and further augmentation of SafeCare to bolster service impact and address risk and protective factors.

Somaini L; Donnini C; Manfredini M; Raggi MA; Saracino MA; Gerra ML et al. Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents. (review). Neuroscience and Biobehavioral Reviews 35(8): 1771-1778, 2011. (104 refs.)

Epidemiological and clinical data show frequent associations between adverse childhood experiences (ACEs) and substance abuse susceptibility particularly in adolescents. A large body of evidences suggests that the possible dysregulation of neuroendocrine responses as well as neurotransmitters function induced by childhood traumatic experiences and emotional neglect could constitute one of the essential biological changes implementing substance abuse vulnerability. Moreover, genotype variables and its environment interactions have been associated with an increased risk for early onset substance abuse. In this paper we present several data that support the hypothesis of the involvement of hypothalamus-pituitary-adrenal (HPA) axis in mediating the combined effect of early adverse experiences and gene variants affecting neurotransmission. The presented data also confirm the relationship between basal plasma levels of cortisol and ACTH, on the one hand, and retrospective measures of neglect during childhood on the other hand: the higher the mother and father neglect (CECA-Q) scores are, the higher the plasma levels of the two HPA hormones are. Furthermore, such positive relationship has been proved to be particularly effective and important when associated with the "S" promoter polymorphism of the gene encoding the 5-HTT transporter, both in homozygote and heterozygote individuals.

Stone-Manista K. Protecting pregnant women: A guide to successfully challenging criminal child abuse prosecutions of pregnant drug addicts. Journal of Criminal Law and Criminology 99(3): 823-856, 2009. (19 refs.)

This Comment is intended to enable advocates for pregnant women to challenge the impermissible and unconstitutional prosecutions of pregnant drug users for criminal child abuse and endangerment. The Comment surveys the history of such prosecutions, and considers the policy justifications for them, before turning to an analysis of the frameworks that state appellate and supreme courts have applied in holding that these prosecutions may not proceed under various state laws. In summarizing the various challenges that may be brought to criminal prosecutions of pregnant drug addicts, this Comment illuminates the strategies that have been successful in previous cases, and offers various notes for those challenging future prosecutions.

Tikkanen R; Ducci F; Goldman D; Holi M; Lindberg N; Tiihonen J et al. MAOA alters the effects of heavy drinking and childhood physical abuse on risk for severe impulsive acts of violence among alcoholic violent offenders. Alcoholism: Clinical and Experimental Research 34(5): 853-860, 2010. (47 refs.)

Background: A polymorphism in the promoter region of the monoamine oxidase A gene (MAOA) has been shown to alter the effect of persistent drinking and childhood maltreatment on the risk for violent and antisocial behaviors. These findings indicate that MAOA could contribute to inter-individual differences in stress resiliency. Methods: Recidivism in severe violent crimes was assessed after 8 years of nonincarcerated follow-up in a male sample of 174 impulsive Finnish alcoholic violent offenders, the majority of whom exhibited antisocial (ASPD) or borderline personality disorder (BPD) or both. We examined whether MAOA genotype alters the effects of heavy drinking and childhood physical abuse (CPA) on the risk for committing impulsive recidivistic violent crimes. Results: Logistic regression analyses showed that both heavy drinking and CPA were significant independent predictors of recidivism in violent behavior (OR 5.2, p = 0.004 and OR 5.3, p = 0.003) among offenders having the high MAOA activity genotype (MAOA-H), but these predictors showed no effect among offenders carrying the low MAOA activity genotype (MAOA-L). Conclusion: Carriers of the MAOA-H allele have a high risk to commit severe recidivistic impulsive violent crimes after exposure to heavy drinking and CPA.

Topitzes J; Mersky JP; Reynolds AJ. Child maltreatment and adult cigarette smoking: A long-term developmental model. Journal of Pediatric Psychology 35(5): 484-498, 2010. (71 refs.)

Objective: To examine: (a) child maltreatment's association with young adult daily cigarette smoking, (b) variations in this association by gender, and (c) mediators of this association. Methods: For all study participants (N = 1,125, 94% African American), data from multiple sources (e.g., child welfare records) were collected prospectively at child, adolescent, and young adult time points. Authors enlisted multivariate probit regression for objectives a and b versus exploratory and confirmatory mediation strategies for objective c. Results: Maltreatment was significantly associated with daily cigarette smoking. Although not moderated by gender, this relation was fully mediated by adolescent indicators of family support/stability, social adjustment, and cognitive/school performance along with young adult indicators of educational attainment, life satisfaction, substance abuse, and criminality. Conclusions: Maltreatment places low-income, minority children at risk for daily cigarette smoking and other deleterious young adult health outcomes. Recommended treatment targets include family support/stability, emotion regulation, social skills, and cognitive/academic functioning.

Tucci AM; Kerr-Correa F; Souza-Formigoni MLO. Childhood trauma in substance use disorder and depression: An analysis by gender among a Brazilian clinical sample. Child Abuse & Neglect 34(2): 95-104, 2010. (53 refs.)

Objective: In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses. Methods: The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the "Childhood Trauma Questionnaire." Results: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men. Conclusion: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment.

Valtonen K; Padmore JC; Sogren M; Rock L. Lived experiences of vulnerability in the childhood of persons recovering from substance abuse. Journal of Social Work 9(1): 39-60, 2009. (41 refs.)

The aim of the study was to deepen understanding of the context of vulnerability which is associated with drug-taking behaviour and addiction. The researchers sought to identify recurring psychosocial and environmental factors in the childhood and early adulthood backgrounds of the participants. They further scrutinized the data for pairs or co-occurrences of such risk factors across the target groups. Qualitative methodology was employed, based on in-depth interviews. The participants were accessed in drug rehabilitation centres in Trinidad and in Barbados, bringing a cross-national dimension to the work. The Qualitative Comparative Analysis (QCA) method was used to analyse the data. Findings: It is significant that nearly half of the Trinidad group and two-thirds of the Barbados group reported experience of rejection or abandonment in childhood. A profile of stressful or traumatic experiences was compiled for each participant, from which it was possible to identify co-ocurring pairs of stressors, which suggest inter-relationships between the phenomena. Marked co-occurrence was found between domestic violence and alcoholism; domestic violence in the participants' family background and non-attainment of secondary School Certification; non-attainment of Secondary School Certification and rejection; poverty and rejection; domestic violence and rejection. Applications: Case management techniques can benefit from research-generated insights on interrelationships between critical risk-connected phenomena, especially in developing concerted approaches to problems of substance abuse using preventive techniques.

Vander Weg MW. Adverse childhood experiences and cigarette smoking: The 2009 Arkansas and Louisiana Behavioral Risk Factor Surveillance Systems. Nicotine & Tobacco Research 13(7): 616-622, 2011. (25 refs.)

Introduction: Adverse childhood experiences (ACEs) such as neglect, verbal, sexual, and physical abuse, household dysfunction, and other childhood stressors are associated with a range of negative health outcomes and risk behaviors. Although there is evidence that ACEs are related to an increased risk for cigarette smoking, additional studies in more diverse samples are needed. Methods: Adults taking part in the 2009 Arkansas (n = 3,125) and Louisiana (n = 7,152) Behavioral Risk Factor Surveillance Systems were surveyed regarding their smoking history and exposure to 11 ACEs. Multivariable logistic regression was used to examine independent associations between individual and total number of ACEs and both lifetime and current smoking adjusting for sociodemographic characteristics. Results: Exposure to each type of ACE was associated with a significantly increased risk for both lifetime (odds ratios [ORs]: 1.35-3.65) and current (ORs: 1.31-2.43) cigarette smoking among residents of both states. Total number of ACEs was also related to the odds of smoking in a generally graded fashion such that Arkansas residents reporting 5 or more ACEs were 3.97 (95% CI: 2.46-6.41) and 2.70 (95% CI: 1.64-4.43) times as likely as those reporting no ACEs to be lifetime and current smokers, respectively. Corresponding odds for those living in Louisiana were 3.06 (95% CI: 2.32-4.02) for lifetime smoking and 2.80 (95% CI: 2.07-3.77) for current smoking. Conclusions: ACEs are associated with an increased likelihood of cigarette smoking in adulthood among residents of Arkansas and Louisiana. Efforts to prevent abuse, neglect, and other ACE may include among their benefits reduced risk for later smoking-related illness.

Vaszari JM; Bradford S; O'Leary CC; Ben Abdallah A; Cottler LB. Risk factors for suicidal ideation in a population of community-recruited female cocaine users. Comprehensive Psychiatry 52(3): 238- 246, 2011. (53 refs.)

Introduction: Suicide, as the 11th leading cause of death in America, is a significant public health concern. Previous studies have shown that drug users are a population at especially high risk for suicidal ideation (SI). Although most people who think about killing themselves do not ultimately commit suicide, identifying those at risk for such thoughts is important. Methods: In this analysis, data from a sample of 462 cocaine-using women (87% African American) recruited using street outreach methods for a National Institute on Drug Abuse-funded study were examined to identify risk factors for lifetime SI. Sociodemographic factors, adverse childhood experiences, sexual behaviors, psychiatric comorbidities, and drug abuse and dependence were examined as potential risk factors using both bivariate and logistic regression analysis. Results: Fifty percent of the sample met at least one criterion for lifetime SI, and 32% of the sample reported a lifetime suicide attempt. In the final logistic regression model, childhood physical abuse, childhood sexual abuse, rape after the age of 15 years, posttraumatic stress disorder, and number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression criteria met emerged as significant independent predictors of lifetime SI. Conclusion: These findings identify important risk factors for SI among female substance abusers in community settings.

Walsh SM; Donaldson RE. Invited Commentary. National Safe Place: meeting the immediate needs of runaway and homeless youth. (editorial). Journal of Youth and Adolescence 39(5): 437-445, 2010. (23 refs.)

An estimated 1.6 million youth run away from home each year. While on the run, these youth are vulnerable to exploitation, victimization, increased dangers and perpetration of criminal behavior. Runaway and homeless youth are far more likely to engage in substance use and delinquent behavior, drop out of school and suffer from sexually transmitted diseases and mental illness at greater rates than the norm. Timely and direct intervention in runaway and throwaway cases is imperative to protect youth from the high risks of living on the streets. National Safe Place is an outreach and prevention program that is uniquely designed to provide immediate safety and access to services for any youth in need. In partnership with over 360 youth serving agencies and over 10,000 businesses and community organizations across the United States, the Safe Place program educates youth about alternatives to running away and homelessness and provides easily accessible links to service providers. Ongoing data collection indicates that National Safe Place has been successful in reaching endangered youth at risk of abuse, neglect or serious family problems but that expanded program models remain needed. The challenges and successes of current programming and the future of National Safe Place program expansion are discussed.

Walton G; Co SJ; Milloy MJ; Qi JZ; Kerr T; Wood E. High prevalence of childhood emotional, physical and sexual trauma among a Canadian cohort of HIV-seropositive illicit drug users. AIDS Care 23(6): 714- 721, 2011. (43 refs.)

Background. The psychosocial impacts of various types of childhood maltreatment on vulnerable illicit drug-using populations remain unclear. We examined the prevalence and correlates of antecedent emotional, physical and sexual abuse among a community-recruited cohort of adult HIV-seropositive illicit drug users. Methods. We estimated the prevalence of childhood abuse at baseline using data from the Childhood Trauma Questionnaire, a 28-item validated instrument used to retrospectively assess childhood maltreatment. Logistic regression was used to estimate relationships between sub-types of childhood maltreatment with various social-demographic, drug-using and clinical characteristics. Results. Overall, 233 HIV-positive injection drug users (IDU) were included in the analysis, including 83 (35.6%) women. Of these, moderate or severe emotional childhood abuse was reported by 51.9% of participants, emotional neglect by 36.9%, physical abuse by 51.1%, physical neglect by 46.8% and sexual abuse by 41.6%. In multivariate analyses, emotional, physical and sexual abuses were independently associated with greater odds of recent incarceration. Emotional abuse and neglect were independently associated with a score of >= 16 on the Centre for Epidemiology Studies Depression Scale. There was no association between any form of childhood maltreatment and clinical HIV variables, including viral load, CD4+ count and history of antiretroviral therapy use. Conclusion. These findings underscore the negative impact of childhood maltreatment on social functioning and mental health in later life. Given the substantial prevalence of childhood maltreatment among this population, there is a need for evidence-based resources to address the deleterious effect it has on the health and social functioning of HIV-positive IDU.

Wang Z; Du JA; Sun HM; Wu H; Xiao ZP; Zhao M. Patterns of childhood trauma and psychological distress among injecting heroin users in China. PLoS ONE 5(12): e-article 15882, 2010. (42 refs.)

Background: Childhood trauma has been reported as a possible cause of future substance abuse in some countries. This study reports the prevalence of childhood trauma and examines its association with psychological distress among injecting drug users from mainland China. Methodology: The study was conducted in three government-operated drug rehabilitation facilities in Shanghai, China in 2007. The Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to evaluate 4 types (general, emotional, physical and sexual) and severity of childhood trauma, and the Symptom Checklist-90-Revised (SCL-90-R) to evaluate psychological distress. Principal Findings: Among 341 injecting drug users who completed the study, about 80% reported one or more types of childhood trauma, specifically 53% general trauma, 56% physical abuse, 36% emotional abuse and 26% sexual abuse. Compared to female injecting drug users, males reported significantly higher scores of general trauma and physical abuse, but lower sexual abuse scores. Hierarchical linear regression analyses showed that greater physical and emotional abuse in childhood predict greater current psychopathological distress among these injecting drug users in China. Conclusions: The results reveal a high prevalence of childhood trauma among injecting drug users in China, and it is comparable to other similar studies in Western countries. It is important to consider the role of childhood trauma in the prevention and treatment of substance abuse.

Wilson DR. Health consequences of childhood sexual abuse. Perspectives in Psychiatric Care 46(1): 56-64, 2010. (54 refs.)

PURPOSE: This article provides a summary for advocacy, court testimony, assessment, treatment, prevention, and further research studies in the field of childhood sexual abuse. FINDINGS: A literature review identifies the psychiatric, social, and disease disorders to which this population is predisposed. Adult survivors experience more depression, obesity, autoimmune disorders (irritable bowel syndrome, asthma, fibromyalgia), eating disorders, and addictions. PRACTICE IMPLICATIONS: A holistic perspective allows understanding of health consequences for survivors. A model through which to consider these phenomena is presented. CONCLUSIONS: The long-term consequences of childhood sexual abuse must be assessed and addressed by healthcare professionals.

Wilson HW; Widom CS. Pathways from childhood abuse and neglect to HIV-risk sexual behavior in middle adulthood. Journal of Consulting and Clinical Psychology 79(2): 236-246, 2011. (51 refs.)

Objective: This study examines the relationship between childhood abuse and neglect and sexual risk behavior in middle adulthood and whether psychosocial factors (risky romantic relationships, affective symptoms. drug and alcohol use and delinquent and criminal behavior) mediate this relationship. Method: Children with documented cases of physical abuse, sexual abuse, and neglect (ages 0-11) processed during 1967-1971 were matched with nonmaltreated children and followed into middle adulthood (approximate age 41). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1.196). Past year HIV-risk sexual behavior was assessed via self-reports during 2003-2004 (N = 800). Logistic regression was used to examine differences in sexual risk behavior between the abuse and neglect and control groups, and latent variable structural equation modeling was used to test mediator models. Results: Child abuse and neglect was associated with increased likelihood of risky sexual behavior in middle adulthood, odds ratio = 2.84. 95% CI 11.74, 4.64], p <= 001. and this relationship was mediated by risky romantic relationships in young adulthood. Conclusions: Results of this study draw attention to the potential long-term consequences of child abuse and neglect for physical health, in particular sexual risk, and point to romantic relationships as an important focus of intervention and prevention efforts.

Wilson HW; Widom CS. Predictors of drug-use patterns in maltreated children and matched controls followed up into middle adulthood. Journal of Studies on Alcohol and Drugs 71(6): 801-809, 2010. (34 refs.)

Objective: This study examines whether child abuse; child neglect; demographic, family and social, behavioral, economic, and neighborhood risk; and protective factors predict different drug-use patterns into middle adulthood. Method: Using a prospective cohort design, individuals with documented cases of childhood physical and sexual abuse and neglect (processed during 1967-1971) and a matched control group were followed into middle adulthood. Participants completed in-person interviews in 1989-1995 (average age 29), 2000-2002 (average age 39.5), and 2003-2004 (average age 41). The sample for this study included 374 women and 332 men. Results: Four patterns of drug use were revealed: (a) abstinence and low use (34%), (b) adolescent and young adult limited use (31%), (c) chronic-persistent use (29%), and (d) late use (7%). The chronic-persistent pattern was associated with being male, parental substance-use problems, involvement in crime, and neighborhood problems. The late-use pattern was significantly associated with childhood neglect and being Black, when other risk factors were controlled; bivariate analyses also indicated associations with female gender, lower income, and greater neighborhood disadvantage. Conclusions: This study revealed two patterns of drug use involving substance use and substance-related problems in middle adulthood that are associated with different sets of risk factors. Further research is needed to understand the late-drug-use pattern, which appears to disproportionately involve low-income Black women with histories of childhood neglect. These individuals may be missed in efforts to prevent or reduce drug use among youths.

Yanos PT; Czaja SJ; Widom CS. A prospective examination of service use by abused and neglected children followed up into adulthood. Psychiatric Services 61(8): 796-802, 2010. (26 refs.)

Objective: This study sought to determine whether abused and neglected children are more likely than those without childhood maltreatment to use health and social services as adults and whether psychiatric status mediates or moderates the relationship. Methods: A prospective cohort design was used. Individuals with documented cases of physical and sexual abuse and neglect (ages 0-10) and nonvictimized children matched on age, sex, and race-ethnicity were interviewed in adulthood (mean age 41 years). Past-year service use (general medical, mental health, substance abuse, and social) was assessed during 2003-2004 interviews (maltreated group, N=458; control group, N=349). Psychiatric status (posttraumatic stress disorder [PTSD], drug abuse, and major depressive disorder) was assessed during 1989-1995 (mean age 29) by structured interview. Results: Individuals with histories of childhood abuse and neglect were significantly more likely than their control group counterparts to use mental health services (odds ratio [OR]=1.60, 95% confidence interval [CI]=1.04-2.45) and social services (OR=2.95, CI=2.19-3.97) in adulthood. Psychiatric status in young adulthood (PTSD and major depressive disorder) partially mediated the relationship between childhood maltreatment and use of mental health services, whereas major depression and drug abuse moderated the relationship between maltreatment and use of any services and general medical services. Conclusions: In adulthood, individuals with documented histories of childhood abuse and neglect are more likely than persons without such histories to use some types of services, and psychiatric status mediates and moderates these relationships. Findings have implications for the provision of services to persons with childhood abuse and neglect.

Yin S. Malicious use of pharmaceuticals in children. Journal of Pediatrics (5): 832-U180, 2010. (30 refs.)

Objective: To describe malicious administration of pharmaceutical agents to children. Study design: We performed a retrospective study of all pharmaceutical exposures involving children < 7 years old reported to the US National Poison Data System from 2000 to 2008 for which the reason for exposure was coded as "malicious.'' Results: A total of 1439 cases met inclusion criteria. The mean number of cases per year was 160 (range, 124 to 189) that showed an increase over time. The median (IQR) age was 2 (1.5) years. Outcome data were available for 1244 (86.4%) patients. Of these exposures, 172 resulted in moderate or major outcomes or death. 9.7% of cases involved > 1 exposed substance. The most common reported major pharmaceutical categories were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, and ethanol. In 51% of cases there was an exposure to at least one sedating agent. There were 18 (1.2%) deaths. Of these, 17 (94%) were exposed to sedating agents, including antihistamines (8 cases) and opioids (8 cases). Conclusions: Malicious administration of pharmaceuticals should be considered an important form of child abuse.

Young-Wolff KC; Kendler KS; Ericson ML; Prescott CA. Accounting for the association between childhood maltreatment and alcohol-use disorders in males: A twin study. Psychological Medicine 41(1): 59-70, 2011. (70 refs.)

Background. An association between childhood maltreatment and subsequent alcohol abuse and/or dependence (AAD) has been found in multiple studies of females. Less is known about the association between childhood maltreatment and AAD among males, and the mechanisms that underlie this association in either gender. One explanation is that childhood maltreatment increases risk for AAD. An alternative explanation is that the same genetic or environmental factors that increase a child's risk for being maltreated also contribute to risk for AAD in adulthood. Method. Lifetime diagnosis of AAD was assessed using structured clinical interviews in a sample of 3527 male participants aged 19-56 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. The sources of childhood maltreatment-AAD association were estimated using both a matched case-control analysis of twin pairs discordant for childhood maltreatment and bivariate twin modeling. Results. Approximately 9% of participants reported childhood maltreatment, defined as serious neglect, molestation, or physical abuse occurring before the age of 15 years. Those who experienced childhood maltreatment were 1.74 times as likely to meet AAD criteria compared with males who did not experience childhood maltreatment. The childhood maltreatment-AAD association largely reflected environmental factors in common to members of twin pairs. Additional exploratory analyses provided evidence that AAD risk associated with childhood maltreatment was significantly attenuated after adjusting for measured family-level risk factors. Conclusions. Males who experienced childhood maltreatment had an increased risk for AAD. Our results suggest that the childhood maltreatment-AAD association is attributable to broader environmental adversity shared between twins.