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CORK Bibliography: Child Abuse

61 citations. January 2007 to present

Prepared: September 2009

Afifi TO; Enns MW; Cox BJ; de Graaf R; ten Have M; Sareen J. Child abuse and health-related quality of life in adulthood. Journal of Nervous and Mental Disease 195(10): 797-804, 2007. (62 refs.)

Past research has indicated that child abuse is related to mental and physical health conditions and that mental and physical health conditions are related to decreased health-related quality of life (HRQOL). However, little is known about the independent relationship between child abuse and HRQOL. For the current analysis, data were from the nationally representative Netherlands Mental Health Survey and Incidence Study. Multiple linear regression analyses tested the relationships between child abuse and current HRQOL (SF-36) after adjusting for the effects of sociodemographic variables and numerous psychiatric disorders and physical health conditions. Neglect, psychological abuse, physical abuse, severe sexual abuse, and number of types of child abuse experienced were associated with reduced mental HRQOL. Psychological abuse, physical abuse, and number of types of child abuse experienced were associated with reduced physical HRQOL. Child abuse is an important determinant of HRQOL. The ability to successfully reduce the occurrence of child abuse or provide early intervention after child abuse occurs may help to improve HRQOL in the general population.

Back SE; Brady KT; Waldrop AE; Yeatts SD; Mcrae AL; Spratt E. Early life trauma and sensitivity to current life stressors in individuals with and without cocaine dependence. American Journal of Drug and Alcohol Abuse 34(4): 389-396, 2008. (22 refs.)

This study investigated the link between exposure to early life trauma, sensitivity to current daily stressors, and cocaine dependence. Individuals with (n = 105) or without (n = 53) cocaine dependence completed the Early Trauma Inventory and the Daily Hassles Scale. In comparison to controls, cocaine-dependent individuals reported almost twice as many daily hassles and perceived those hassles more negatively (p < .001). For participants with cocaine dependence, a significant relationship between exposure to early life trauma and negative perception of current daily hassles was observed (p < .01), whereas no such relationship was observed for participants without cocaine dependence. Adverse childhood events may lead to an altered view of the environment that contributes to increased irritability with daily life events among cocaine-dependent individuals.

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.

Blackstone M; Callahan J. An unsteady walk in the park. (editorial). Pediatric Emergency Care 24(3): 193-195, 2008. (11 refs.)

This is a case report of a 4 year old child playing in a park, who had ataxia, altered mental state, with eyes what were droopy, and who seemed "out of it," causing his care-giver to contact the police. He was transported to a hospital emergency room. Nystagmus was noted, but no signs of trauma. After three hours the ataxia had resolved. The differential diagnosis included a long list of possible causes. The rapid onset and rapid resolution suggested ingestion of a toxic substance. In futher discussion the child reported his mother giving him a cigarette to smoke, and reported this was not unusual, and it was given to help him "calm down." A laboratory test confirmed the presence of cannabinoids.

Burnette ML; Ilgen M; Frayne SM; Lucas E; Mayo J; Weitlauf JC. Violence perpetration and childhood abuse among men and women in substance abuse treatment. Journal of Substance Abuse Treatment 35(2): 217-222, 2008. (27 refs.)

Despite an association between violence perpetration and substance use, the characteristics associated with violence among patients in treatment for substance use disorders (SUDs) are not well documented. Data were gathered from a national sample of men (n = 4,459) and women (n = 1,774) entering SUD treatment on history of violence perpetration, exposure to childhood physical abuse (CPA) and childhood sexual abuse (CSA), and reasons for entering treatment. Rates of violence perpetration were high (72% of men, 50% of women), and violence was associated with being referred by family members, prior SUD treatment, CPA, and CSA. In multivariate analyses, CPA was a significant correlate of violence perpetration across gender; however, CSA was only significant among women. Findings highlight the need for increased screening and treatment of violence perpetration among patients with SUD and suggest that CSA may be an important correlate of violence perpetration among women.

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.

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.

Cuomo C; Sarchiapone M; Di Giannantonio M; Mancini M; Roy A. Aggression, impulsivity, personality traits, and childhood trauma of prisoners with substance abuse and addiction. American Journal of Drug and Alcohol Abuse 34(3): 339-345, 2008. (21 refs.)

Introduction: The aim of our study is then to analyze psychological and judicial features of a subgroup of inmates with substance abuse. Methods: Prisoners with substance abuse (n = 312) were compared to prisoners without substance abuse (n = 591). Recruited inmates completed a semistructured interview for collection of sociodemographic and judicial data and a battery of psychometric tests for assessement of aggression, impulsivity, depression, personality traits, hostility, resilience, and childhood trauma. Results: Substance abusers had on average multiple incarcerations (78.8%), more juvenile convictions (60.2%), more violent behaviors during detention (29.8%), and a history of one or more suicide attempts (20.8%). They also had higher scores on subscales for childhood trauma, higher scores for psychoticism and neuroticism, higher impulsivity levels, worse resilience, increased hostility, and prevalent suicidal ideation. Conclusion: Prisoners with substance abuse constitute a subgroup with increased judiciary and psychiatric issues, possibly due to early life history and psychological characteristics, such as high impulsivity and aggressiveness, poor resilience, and higher suicidal risk.

Dawe S; Harnett P. Reducing potential for child abuse among methadone-maintained parents: Results from a randomized controlled trial. Journal of Substance Abuse Treatment 32(4): 381-390, 2007. (55 refs.)

High rates of child abuse and neglect occur in many families in which either or both parents abuse illicit drugs. This study reports on the results of a randomized controlled trial with families having a parent on methadone maintenance (N = 64), in which an intensive, home-based intervention, the Parents Under Pressure (PUP) program, was compared to standard care. A second brief intervention control group of families received a two-session parenting education intervention. The PUP intervention draws from the ecological model of child development by targeting multiple domains of family functioning including the psychological functioning of individuals in the family, parent-child relationships, and social contextual factors. Mindfulness skills were included to address parental affect regulation, a significant problem for this group of parents. At 3- and 6-rnonth follow-up, PUP families showed significant reductions in problems across multiple domains of family functioning, including a reduction in child abuse potential, rigid parenting attitudes, and child behavior problems. Families in the brief intervention group showed a modest reduction in child abuse potential but no other changes in family function. There were no improvements found in the standard care group and some significant worsening was observed. Results are discussed in terms of their implications for improved treatment.

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.

Duggan A; Caldera D; Rodriguez K; Burrell L; Rohde C; Crowne SS. Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect 31(8): 801-827, 2007. (88 refs.)

Objectives: To assess the impact of a voluntary, paraprofessional home visiting program in preventing child maltreatment and reducing the multiple, malleable psychosocial risks for maltreatment for which families had been targeted. Methods: This collaborative, experimental study focused on 6 Healthy Families Alaska (HFAK) programs; 325 families were enrolled in 2000-2001, randomized to intervention and control groups, and interviewed to measure baseline attributes. Follow-up data were collected when children were 2 years old (85% follow-up rate). Outcomes included maltreatment reports, measures of potential maltreatment and parental risks, for example, poor mental health, substance use, and partner violence. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure perceived effectiveness and training adequacy. Results: Parental risks were common at baseline, and one-sixth of families had a substantiated child protective services report in the child's first 2 years of life. There was no overall program effect on maltreatment reports, and most measures of potential maltreatment. Home visited mothers reported using mild forms of physical discipline less often than control mothers. The groups were similar in their use of more severe forms of physical discipline. There was no program impact on parental risks. There was no impact on outcomes for families with a 'high dose' of home visiting. Home visitors often failed to address parental risks and seldom linked families with community resources. Contradictions in the model compromised effectiveness. Conclusions: The program did not prevent child maltreatment, nor reduce the parental risks that had made families eligible for service. Research is needed to develop and test strategies to improve the effectiveness of home visiting.

Duncan AE; Sartor CE; Scherrer JF; Grant JD; Heath AC; Nelson EC et al. The association between cannabis abuse and dependence and childhood physical and sexual abuse: Evidence from an offspring of twins design. Addiction 103(6): 990-997, 2008. (38 refs.)

Aim This study examines the association between childhood physical abuse (childhood physical abuse) and sexual abuse (CSA) and the development of cannabis abuse and dependence among adolescents and young adults while controlling for genetic and environmental risk factors. Design: To control for familial risk differences related to paternal drug dependence that might confound the relationship between childhood sexual abuse and childhood physical abuse and cannabis abuse/dependence, we created four groups based on father's and uncle's substance use dependence (SUD) status reflecting different degrees of genetic and environmental risks to offspring: (i) high genetic, high environmental risk; (ii) high genetic, low environmental risk; (iii) medium genetic, low environmental risk; and (iv) low genetic, low environmental risk. Participants Adolescent and young adult offspring of monozygotic and dizygotic US military veteran twin fathers (n = 819). Measurements: Data on childhood physical abuse and childhood sexual abuse, DSM-IV offspring cannabis abuse/dependence, other SUD and psychopathology and maternal and paternal SUD and psychopathology were collected via semi-structured telephone interview. Findings: Twenty-three per cent of the offspring sample met life-time criteria for cannabis abuse/dependence and 8.55% and 12.82% reported childhood sexual abuse and childhood physical abuse, respectively. Offspring exposed to childhood sexual abuse, but not childhood physical abuse, were at significantly greater risk of developing cannabis abuse/dependence compared to those who had not experienced childhood sexual abuse (hazard ratio = 2.16; 95% confidence interval = 1.48-3.16) after controlling for genetic and familial environmental risk and offspring gender, alcohol abuse and dependence and conduct disorder. Conclusions: These results indicate that there are effects of childhood sexual abuse on development of cannabis abuse/dependence in addition to the genetic and familial environmental risk imparted by having a drug-dependent father.

Erickson SJ; Tonigan J. Trauma and intravenous drug use among pregnant alcohol/other drug abusing women: Factors in predicting child abuse potential. Alcoholism Treatment Quarterly 26(3): 313-332, 2008

Because there is limited empirical literature addressing child abuse potential (CAP) in pregnant substance users, our study investigated associations between trauma, route of drug administration (IV use), and CAP in pregnant substance abusers. We explored this association using CAP as both a continuous and dichotomous measure, and with both narrow-band (i.e., PTSD) and broad-band (i.e., anxious arousal, depression, and anger/irritability) trauma symptoms. Participants were 44 ethnically diverse substance using pregnant women (61.4% Hispanic, 15.3% Native American, and 15.3% Caucasian women) who had completed a NIDA clinical trial. We found that women in our sample reported high CAP, with 43% reaching the conservative CAP cutoff, and the majority of women (56%) meeting the more liberal CAP cutoff. Trauma symptoms, both narrow and broad-band, as well as IV status, accounted for significant and unique CAP variance. Specifically, women with greater trauma symptomatology and women who were IV users reported significantly greater CAP. To a lesser extent, trauma exposure also accounted for significant CAP variance. Exploratory analyses revealed that "problems with others" drove the CAP difference between the IV status groups. Our results suggest that both trauma and IV use are significant predictors of child abuse potential. IV use was more highly associated with broad-band compared with narrow-band trauma symptoms, suggesting broader trauma spectrum problems in the form of affect dysregulation in this subsample. Overall, our findings were largely concordant when CAP was used as a continuous versus categorical variable. Regarding the level of trauma symptom specificity required to represent trauma in predicting CAP, our results suggest that narrow-band and broad-band trauma symptoms may be relatively equivalent, with clinical considerations determining which measure is employed in assessing trauma in this population. In addition, IV status is likely a proxy variable for "high-risk" status, and high-risk women, regardless of substance use, have been shown to evidence high levels of child abuse potential. The results from this community sample of low SES, ethnically diverse pregnant women suggest that because of the high levels of child abuse potential among this group, preventative interventions targeted toward child abuse potential are warranted for these women. Although there has been a burgeoning of substance abuse intervention services for this population, they have not addressed child abuse potential specifically (e.g., in the form of targeting parental expectations or discipline strategies), nor have they systematically evaluated outcomes. Secondly, the high level of trauma exposure and trauma symptoms in this group suggests that trauma-specific interventions are warranted. Although our study was unable to address questions of causality, and the relationship between trauma symptoms and IV use is likely bidirectional, identifying individual characteristics that predict IV use as a means of coping with trauma would be an important area for future research. Furthermore, to the extent that IV-using women report greater difficulties with others, this may exacerbate child abuse potential, as both substance use and low social support have been identified as child abuse potential risk factors in this population.

Faller-Marquardt M; Pollak S; Schmidt U. Cigarette burns in forensic medicine. Forensic Science International 176(2-3): 200-208, 2008. (50 refs.)

Skin lesions suspected to have been caused by a burning cigarette require thorough diagnostic evaluation as to the mode of infliction. Accidental cigarette bums must be differentiated from injuries due to self-infliction or maltreatment. The typical categories are presented on the basis of the literature and exemplary cases from the authors' own study material. An intentional infliction must be taken into consideration when a body region is involved which does not normally come into contact with a cigarette by chance. Full thickness bums from glowing cigarettes require an exposure time of more than 1 s. One should also keep in mind the possibility of confusion with local skin infections or thermal effects by traditional medical practices (e.g. moxibustion). In unclear cases, repeated inspection of the lesion is recommended in order to facilitate its classification as to causation and age. The courses of healing in first- to third-degree cigarette bums are demonstrated by means of continuous photographic documentation. The discussion deals with different kinds of accidental and intentional cigarette bums, e.g. in drug addicts, psychiatric patients, victims of child abuse, maltreatment and torture, but also in persons feigning a criminal offence.

Fergusson DM; Boden JM; Horwood LJ. Exposure to childhood sexual and physical abuse and adjustment in early adulthood. (editorial). Child Abuse & Neglect 32(6): 607-619, 2008. (49 refs.)

Objective: This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood. Method: The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25. Results: Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. it was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort. Conclusions: Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA. [NB. The role of alcohol and drug abuse 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.

Gibbs DA; Martin SL; Johnson RE; Rentz ED; Clinton-Sherrod M; Hardison J. Child maltreatment and substance abuse among U.S. Army soldiers. Child Maltreatment 13(3): 259-268, 2008. (49 refs.)

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U. S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.

Gratz KL; Bornovalova MA; Delany-Brumsey A; Nick B; Lejuez CW. A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy 38(3): 256-268, 2007. (84 refs.)

Despite the theorized centrality of experiential avoidance in abuse-related psychopathology, empirical examinations of the relationship between childhood abuse and experiential avoidance remain limited. The present study adds to the extant literature on this relationship, providing a laboratory-based investigation of the relationships between childhood sexual, physical, and emotional abuse, experiential avoidance (indexed as unwillingness to persist on 2 psychologically distressing laboratory tasks), and self-reported emotional nonacceptance among a sample of 76 inner-city treatment-seeking substance users. As hypothesized, results provide evidence for heightened experiential avoidance and emotional nonacceptance among individuals with moderate-severe sexual, physical, and emotional abuse (compared to individuals reporting none-low abuse). However, although emotional nonacceptance was associated with increased risk for experiential avoidance, it mediated the relationship between childhood abuse and experiential avoidance only for emotional abuse. As such, results suggest that one mechanism through which emotional abuse in particular leads to experiential avoidance is emotional nonacceptance. Findings suggest the utility of interventions aimed at decreasing experiential avoidance and promoting emotional acceptance among abused individuals.

Hamburger ME; Leeb RI; Swahn MH. Childhood maltreatment and early alcohol use among high-risk adolescents. Journal of Studies on Alcohol and Drugs 69(2): 291-295, 2008. (28 refs.)

Objective: Child maltreatment (CM) is prevalent among US. youth and has been associated with subsequent maladaptive behaviors, including substance use. The current study examines the associations between early child maltreatment and (1) preteen alcohol-use initiation and (2) heavy episodic drinking among students in a large study of adolescents. Method: The Youth Violence Survey is a cross-sectional survey of public school students enrolled in Grades 7, 9, 11, and 12 in a school district in a high-risk community. The analysis sample was limited to students who provided complete data on all relevant variables (N = 3,559). Fifty-two percent of the analysis sample was female. Early child maltreatment was defined as witnessing domestic violence and experiencing physical and/or sexual abuse before the age of 10 years. Outcome variables include ever drinking alcohol, preteen alcohol-use initiation, and heavy episodic drinking. Results: Witnessing domestic violence, experiencing physical abuse, and experiencing sexual abuse were significantly associated with preteen alcohol-use initiation (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI]: 1.26-1.91; AOR = 2.10, 95% CI: 1.69-2.63; AOR = 1.57, 95% CI: 1.16-2.14, respectively). Students who experienced one or more types of maltreatment were 1.5-3 times more likely to report preteen alcohol-use initiation. Heavy episodic drinking was associated only with childhood sexual abuse in boys (AOR = 2.62, 95% CI: 1.52-4.50). Conclusions: Prevention and treatment of the negative impact of early child maltreatment may delay and reduce alcohol use.

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.

Hughes TL; Johnson TP; Wisnack SC; Szalacha LA. Childhood risk factors for alcohol abuse and psychological distress among adult lesbians. Child Abuse and Neglect 31(7): 769-789, 2007. (51 refs.)

Objective: This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians. Methodology: Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians. Results: Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress. Conclusion: While the cross-sectional design precludes causal conclusions, study findings -- especially those related to CSA -- are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse.

Hurme T; Alanko S; Anttila P; Juven T; Svedstrom E. Risk factors for physical child abuse in infants and toddlers. European Journal of Pediatric Surgery 18(6): 387-391, 2008. (28 refs.)

Background: We examined the risk factors and injuries in physical child abuse between November 2003 and February 2007. Patients and Methods: The uptake area of the University Hospital of Turku, Finland, consists of about 700000 inhabitants. Forty-eight cases of physical child abuse were examined. The median age of the abused children was 2.2 years, for children with skull fractures it was 0.5 years. The incidence of child physical abuse increased during the study period; it was 0.6/month in 2004 and 1.7/month in 2006. Mortality in the study group was 2.7 %. Results: Depression, overactivity, crying and prematurity were risk factors in the physically abused children. Parental risk factors were alcohol and drug abuse. Most often the perpetrator was the fattier or stepfather; when the perpetrator was unknown, the children were mostly in their mothers' care. The average delay of 3 weeks until starting the investigation into abuse was mostly due to delays by health centers or homes. Radiographs were the cornerstones of the medical examination but magnetic resonance examinations were essential for the examination protocol. Conclusions: All levels of public health services, day care facilities and schools must be aware of possible physical child abuse and initiate an investigation as soon as possible by contacting the authorities. Physically abused children and their families must be followed up and supported for a sufficiently long period by social pediatric outpatient wards. The general information on child maltreatment provided to the public needs to be increased to prevent abuse. A child welfare report must be made to social workers in every maltreatment case examined in hospital, and in most cases the offence must also be reported to the police. Nevertheless, in certain cases even permanent custody of the child cannot be avoided.

Hyman SM; Paliwal P; Sinha R. Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults. Psychology of Addictive Behaviors 21(2): 233-238, 2007. (45 refs.)

The authors examined associations between a personal history of childhood maltreatment and the perceived stress and stress-coping styles of recently abstinent and treatment-engaged cocaine dependent adults. Fifty men and 41 women at an inpatient treatment and research facility were administered the short form of the Childhood Trauma Questionnaire (D. P. Bernstein & L. Fink, 1998; D. P. Bernstein et al., 2003), the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstem, 1983), and the COPE Questionnaire (C. S. Carver, M. R. Scheier, & J. K. Weintraub, 1989). Simple and multiple linear regression analyses were used to analyze relationships while adjusting for relevant covariates. Findings indicate that overall childhood maltreatment severity was significantly associated with greater perceived stress and greater use of avoidance stress-coping strategies. These findings suggest that having a history of childhood maltreatment may influence how recently abstinent cocaine dependent individuals experience and cope with stress. Stress and stress-coping focused interventions may be particularly indicated for cocaine dependent individuals with histories of childhood maltreatment.

Jaffee SR; Caspi A; Moffitt TE; Polo-Tomas M; Taylor A. Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model. Child Abuse & Neglect 31(3): 231-253, 2007. (82 refs.)

Objective: Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do children's individual strengths promote resilience even when children are exposed to multiple family and neighborhood stressors (cumulative stressors model)? Methods: Data were from the Environmental Risk Longitudinal Study which describes a nationally representative sample of 1, 116 twin pairs and their families. Families were home-visited when the twins were 5 and 7 years old, and teachers provided information about children's behavior at school. Interviewers rated the likelihood that children had been maltreated based on mothers' reports of harm to the child and child welfare involvement with the family. Results: Resilient children were those who engaged in normative levels of antisocial behavior despite having been maltreated. Boys (but not girls) who had above-average intelligence and whose parents had relatively few symptoms of antisocial personality were more likely to be resilient versus non-resilient to maltreatment. Children whose parents had substance use problems and who lived in relatively high crime neighborhoods that were low on social cohesion and informal social control were less likely to be resilient versus non-resilient to maltreatment. Consistent with a cumulative stressors model of children's adaptation, individual strengths distinguished resilient from non-resilient children under conditions of low, but not high, family and neighborhood stress. Conclusion: These findings suggest that for children residing in multi-problern families, personal resources may not be sufficient to promote their adaptive functioning.

Jun HJ; Rich-Edwards JW; Boynton-Jarrett R; Austin SB; Frazier AL; Wright RJ. Child abuse and smoking among young women: The importance of severity, accumulation, and timing. Journal of Adolescent Health 43(1): 55-63, 2008. (49 refs.)

Purpose: We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women. Methods: Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study 11 participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19. Results: A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7-2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8-2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8-2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1-2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1-1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without (p <.0001). Conclusions: A strong and graded association was observed between both severity and accumulation of abuse and the risk of early inifiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Kaufman J; Yang BZ; Douglas-Palumberi H; Crouse-Artus M; Lipschitz D; Krystal JH et al. Genetic and environmental predictors of early alcohol use. Biological Psychiatry 61(11): 1228-1234, 2007. (47 refs.)

Background: The goal of the current investigation was to examine genetic and environmental predictors of early alcohol use, a potent predictor of later alcohol dependence. Methods: This study represents an add-on project to an investigation examining the efficacy of an intervention for maltreated children entering out-of-home care. Predictors of early alcohol use include the following: maltreatment, family loading for alcohol or substance-use disorders, and serotonin transporter genotype (5-HTTLPR; locus SLC6A4). Participants included 127 subjects: 76 maltreated children and 51 demographically matched community controls. Results: At follow-up, 29% of the maltreated children reported alcohol use, a rate more than seven times the rate observed in controls. Maltreated children also drank alcohol, on average, more than 2 years earlier than controls (11.2 vs. 13.5 years). Early alcohol use was predicted by maltreatment, 5-HTTLPR, and a gene by environment interaction, with increased risk for early alcohol use associated with the s-allele. Psychopathology at baseline, severity of maltreatment, and poor mother-child relations also predicted early alcohol use. Conclusions: Maltreated children are at high risk for psychiatric, alcohol, and substance abuse problems. Examination of genetic and environmental risk and protective factors can help identify those who are most vulnerable and help guide prevention and intervention efforts.

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.

Kumpfer KL. Why are there no effective child abuse prevention parenting interventions? (editorial). Substance Use & Misuse 43(8/9): 1262-1265, 2008. (9 refs.)

Kurtz SP. Arrest histories of high-risk gay and bisexual men in Miami: Unexpected additional evidence for syndemic theory. Journal of Psychoactive Drugs 40(4): 513-521, 2008. (54 refs.)

Gay and bisexual men continue to suffer the highest burden of HIV/AIDS in the U.S. Since the beginning of the epidemic, substance abuse has been shown to be one of the strongest predictors of sexual risk behaviors and seroconversion among this population. Recent research has focused on additional aspects of health risk disparities among gay and bisexual men, including depression and other mental health problems, childhood sexual abuse, and adult victimization, suggesting that these men are impacted by a syndemic of health risks. The involvement of gay and bisexual men with the criminal justice system is largely absent from the literature. This article describes the nature, extent and predictors of the arrest histories of a sample of gay and bisexual substance users at very high risk for HIV infection and/or transmission. These histories are surprisingly extensive, and are strongly associated with poverty, severe mental distress, substance abuse and dependence, and victimization. The involvement of gay and bisexual men in the criminal justice system deserves a stronger research focus because of the unique challenges facing such men and also because arrests are yet another marker for a host of health risks among them.

Landsman MJ; Hartley CC. Attributing responsibility for child maltreatment when domestic violence is present. Child Abuse and Neglect 31(4): 445-461, 2007. (40 refs.)

Objective: The purpose of this study was to examine factors that influence how child welfare workers attribute responsibility for child maltreatment and child safety in cases involving domestic violence. Methods: The study used a factorial survey approach, combining elements of survey research with an experimental design. Case vignettes were constructed by randomly assigning characteristics to vignettes believed to be related to assessments about responsibility for child maltreatment. Public child welfare workers were systematically sampled and asked to rate vignettes on male and female caregivers' responsibility for child maltreatment and concerns for safety. Results: The presence of domestic violence significantly affected workers' assessments of the attribution of responsibility and concern for child safety, more so than variables related to child maltreatment. Responsibility for exposing a child to domestic violence differed for males and females, with more factors explaining female responsibility. Substance use by either caregiver was significant in attributing responsibility for physical harm, not watching the child closely enough, and concern for child safety, but not for exposure to domestic violence. Conclusions: Domestic violence appeared to heighten workers' assessments of responsibility for child maltreatment and concerns about child safety, taking precedence over the characteristics of the child maltreatment itself. Battering tends to work against the domestic violence victim in terms of the attribution of responsibility. A greater number of factors affect female responsibility for exposing a child to domestic violence than male responsibility, even though in every case the male was the designated domestic violence batterer.

Libby AM; Orton HD; Beals J; Buchwald D; Manson SM. Childhood abuse and later parenting outcomes in two American Indian tribes. Child Abuse & Neglect 32(2): 195-211, 2008. (53 refs.)

Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n = 3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. Results: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. Conclusions: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. Practice implications: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects of social support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence.

Linden M; Zehner A. The role of childhood sexual abuse (CSA) in adult cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy 35(4): 447-455, 2007. (38 refs.)

Sexual abuse in childhood is a pathogenetic factor for psychological disorders. The attention given to this phenomenon varies between therapists and therapeutic schools. The question is how often sexual abuse is recognized as a problem in cognitive behaviour therapy and how this is related to the present symptoms and therapeutic problems. 1223 case reports, written as application for reimbursement of routine cognitive behaviour therapy, were submitted to a content analysis in respect to childhood sexual abuse. Sexual abuse was mentioned in 10.3% of the cases; 59% of female and 50.0% of male victims were abused by relatives. Sexually abused patients showed significantly increased rates of inadequate care and negative life events during childhood. In comparison to controls, cases showed significantly increased rates of "eating disorders" (15 vs. 6; p <.05), "substance abuse/addiction" (16 vs. 6; p <.05). "suicide attempts" (15 vs. 3; p <.01), "strict refusal of sexual partners" (15 vs. 5; p <.05), "frequently changing partners" (21 vs. 3; p <.001), "problems in marriage/partnership" (95 vs. 77: p <.05) and "sexual problems" (51 vs. 24; p <.001). Childhood sexual abuse is a problem, frequently seen in behaviour therapy patients and therefore also warranting special attention in routine patient care. Sexual abuse is understood by cognitive behaviour therapists as an indicator for traumatizing conditions in general during childhood. It is associated with specific treatment problems and therapeutic needs in adulthood.

Lo CC; Cheng TC. The impact of childhood maltreatment on young adults' substance abuse. American Journal of Drug and Alcohol Abuse 33(1): 139-146, 2007. (13 refs.)

Designed to establish a causal relationship between childhood victimization and young adults' substance abuse, this study also examined depression's role as mediator in that causal relationship. The study employs child-abuse measures that weigh both the type (sexual, physical) and the persistence of abuse. The study took as its substance-abuse measures the DSM-IV criteria for current alcohol abuse, current marijuana abuse, and current drug abuse. Data from the first 5 waves of the National Youth Survey (NYS) was employed, along with data from its 7th wave, to establish the temporal order needed to determine causal relationship. Childhood physical abuse proved a strong predictor of young adults' current substance abuse, although sexual abuse did not. Depression was shown to mediate the relationship of physical abuse to current alcohol abuse and current drug abuse, but not to current marijuana abuse.

Lu W; Mueser KT; Rosenberg SD; Jankowski MK. Correlates of adverse childhood experiences among adults with severe mood disorders. Psychiatric Services 59(9): 1018-1026, 2008. (61 refs.)

Objectives: Adverse childhood experiences have been found to be associated with poor physical and poor mental health, impaired functioning, and increased substance abuse in the general adult population. The purpose of this study was to examine the clinical correlates of these experiences among adults with severe mood disorders. Methods: Adverse childhood experiences (including physical abuse, sexual abuse, parental mental illness, loss of parent, parental separation or divorce, witnessing domestic violence, and placement in foster or kinship care) were assessed retrospectively in a sample of 254 adults with major mood disorders. The relationships between cumulative exposure to these experiences and psychiatric problems, health, substance use disorders, community functioning, trauma exposure in adulthood, and high-risk behaviors were examined. Results: Increased exposure to childhood adverse experiences was related to high-risk behaviors, diagnosis of a substance use disorder, exposure to trauma in adulthood, psychiatric problems (younger age at first hospitalization, number of suicide attempts, and diagnosis of post-traumatic stress disorder), medical service utilization, and homelessness. Conclusions: The findings extend research in the general population by suggesting that adverse childhood experiences contribute to worse mental and physical health and functional outcomes among adults with severe mood disorders.

Mayer M; Lavergne C; Tourigny M; Wright J. Characteristics differentiating neglected children from other reported children. Journal of Family Violence 22(8): 721-732, 2007. (48 refs.)

The aims of this study were twofold: first, to identify the characteristics that distinguish neglected children from other children reported to youth protection services; and second, to assess the relative importance of each of these characteristics in the differentiation of such children. Researchers analyzed data from the Quebec Incidence Study (QIS), which documented all reports retained for in-depth assessment out of 4,774 reports filed with youth protection services over a 3-month period. Univariate and multivariate regression analyses examined variables on different levels to establish which of the factors linked to the phenomenon of neglect were most significant. Results indicate that neglected children tend to be younger than other reported children, and have a greater frequency of prior referrals and a greater number of learning and development problems; their parents have a greater tendency to have personal, economic, and social problems and childhood histories of maltreatment.

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.

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.

Pederson CL; Vanhorn DR; Wilson JF; Martorano LM; Venema JM; Kennedy SM. Childhood abuse related to nicotine, illicit and prescription drugs use by women: Pilot study. Psychological Reports 103(2): 459-466, 2008. (12 refs.)

A sample of 811 women ages 18 to 59 (M = 26.0, SD = 65) responded to an advertisement by telephone. Inquiries were made about childhood abuse status and adult use of alcohol, nicotine, and prescription and illicit drugs. Significant associations were noted for reported sexual, physical, and emotional childhood abuse with use of nicotine, marijuana, and antidepressants in adulthood. Reported childhood physical and emotional abuses were also significantly associated with use of cocaine and anxiolytics, and sexual abuse with antipsychotic use in adulthood. Only childhood emotional abuse was associated with the use of sleeping pills, number of types of abuse was significantly related with use of nicotine, marijuana, cocaine, antidepressants, antipsychotics, and anxiolytics. Alcohol use was not related to any type of abuse. The long-term effects of childhood emotional abuse may be just as severe as physical or sexual abuse.

Rogers-Adkinson DL; Stuart SK. Collaborative services: Children experiencing neglect and the side effects of prenatal alcohol exposure. Language, Speech and Hearing Services in Schools 38(2): 149-156, 2007. (62 refs.)

Purpose: The purpose of this article is to provide critical knowledge regarding children who are served by the child welfare system and how these children's specialized needs affect speech-language services. Specifically, the structure of social services system models is presented, with an emphasis on the cultural and systemic interactions between services providers and families. In addition, the role of special education for children who have experienced abuse, neglect, and prenatal drug or alcohol exposure is presented, with an emphasis on social services and special education legal issues. Method: This article provides a critical analysis of the research literature to date regarding effective tools for providing collaborative intervention to children who are experiencing fetal alcohol syndrome disorder or abuse and/or neglect. Clinical implications: This article provides suggestions about the collaborative roles that speech-language pathologists should integrate into treatment milieu when delivering therapy to children with histories of abuse, neglect, and prenatal drug or alcohol exposure.

Roxburgh A; Degenhardt L; Copeland J; Larance B. Drug dependence and associated risks among female street-based sex workers in the greater Sydney area, Australia. Substance Use & Misuse 43(8/9): 1202-1217, 2008. (44 refs.)

Background: This study examines drug use and dependence and associated risks among female street-based sex workers. Methods: Cross-sectional data collected from 72 women between April and August 2005 in Sydney, Australia, via face-to-face interviews. Sample: The average age was 34 years. Results: Risk factors associated with developing problematic drug use were prevalent. Child sexual abuse, leaving home before the age of 16, and exposure to multiple traumas was common. Depression and posttraumatic stress disorder were also prevalent. A substantial minority reported cocaine dependence which was associated with engaging in sex and injecting risk behaviors. Conclusions: More targeted interventions for this group are needed. Research on the value of extending existing outreach services to further reduce the harms associated with sex work and drug use is indicated. The study's limitations are noted.

Sacks JY; McKendrick K; Banks S. The impact of early trauma and abuse on residential substance abuse treatment outcomes for women. Journal of Substance Abuse Treatment 34(1): 90-100, 2008. (55 refs.)

This study examines the impact of early abuse on the functioning and the 12-month treatment outcomes of 146 homeless addicted women who entered residential substance abuse treatment. Sixty-nine percent of the women reported exposure to childhood physical, sexual, or emotional abuse; the majority reported multiple forms of abuse. Comparisons of abused and nonabused women revealed significant differences in childhood, adolescent, and adult functioning, indicative of the pervasive detrimental effects of early abuse. Female survivors of childhood abuse did not improve in treatment as much as their nonabused peers in psychological functioning (p <.001), substance abuse (p <.01), or continuing trauma exposure (p <.01) The findings suggest the importance of adapting models of residential substance abuse treatment to address concurrent issues related to trauma history. Additional research is needed to identify effective integrated treatment approaches for this population and to explore the independent and interconnected pathways linking trauma history and outcome.

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.

Sartor CE; Agrawal A; McCutcheon VV; Duncan AE; Lynskey MT. Disentangling the complex association between childhood sexual abuse and alcohol-related problems: A review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs 69(5): 718-727, 2008. (82 refs.)

This review describes and evaluates methodological approaches aimed at unraveling the association between childhood sexual abuse (CSA) and later misuse of alcohol, which is complicated by the significant overlap between factors that elevate risk for CSA exposure and those that increase risk for problem alcohol use. We critique methods used to distinguish direct effects of CSA events on alcohol-related outcomes from the effects of risk factors frequently present in families in which CSA exposure occurs (e.g., parental alcohol-related problems). These methods include measurement and adjustment for potentially confounding factors and the use of co-twin designs. The findings across methodological approaches provide support for a CSA-specific risk for alcohol misuse, despite the significant contribution of family background factors to overall risk, but much work remains to be done before a comprehensive model for this association can be proposed. Additional directions for research, including the incorporation of measured genes and the use of longitudinal designs, are proposed to further efforts to model the pathways from CSA to alcohol-related problems.

Scannapieco M; Connell-Carrick K. Assessment of families who have substance abuse issues: Those who maltreat their infants and toddlers and those who do not. Substance Use & Misuse 42(10): 1545-1553, 2007. (14 refs.)

Although an association exists among risk factors of age of child, substance use and child maltreatment, less is known about the differences between substance abusing families who maltreat their children and substance abusing families who do not maltreat their children. The relationship among substance use and maltreatment needs to be further explored to identify specific assessment techniques to discriminate between the two groups. The study findings, based upon case records analyzed in 2002, show there is a set of significant characteristics of families who have a history of substance use and who maltreat their infant and toddlers and those families who do not.

Self-Brown S; Whitaker DJ. Parent-focused child maltreatment prevention improving assessment, intervention, and dissemination with technology. (review). Child Maltreatment 13(4): 400-416, 2008. (108 refs.)

The goal of this article is to examine how technology has been and can be utilized to enhance parent-focused child maltreatment (CM) prevention efforts. The authors begin with a brief discussion of the current state of the CM prevention field. In the sections that follow, they review studies that have examined the use of technology across three facets of prevention: identification of CM, administration/augmentation of CM prevention programs, and broad dissemination and implementation of evidenced-based CM prevention programs. They conclude with a discussion of limitations and problems related to the use of technology as a tool to enhance CM prevention and future directions.

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 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; 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.

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.

Slep AMS; O'Leary SG. Multivariate models of mothers' and fathers' aggression toward their children. Journal of Consulting and Clinical Psychology 75(5): 739-751, 2007. (62 refs.)

Multivariate, biopsychosocial, explanatory models of mothers' and fathers' psychological and physical aggression toward their 3- to 7-year-old children were fitted and cross-validated in 453 representatively sampled families. Models explaining mothers' and fathers' aggression were substantially similar. Surprisingly, many variables identified as risk factors in the parental aggression and physical child abuse literatures, such as income, unrealistic expectations, and alcohol problems, although correlated with aggression bivariately, did not contribute uniquely to the models. In contrast, a small number of variables (i.e., child responsible attributions, overreactive discipline style, anger expression, and attitudes approving of aggression) appeared to be important pathways to parent aggression, mediating the effects of more distal risk factors. Models accounted for a moderate proportion of the variance in aggression.

Slesnick N; Kang MJ; Aukward E. Treatment attendance among homeless youth: The impact of childhood abuse and prior suicide attempts. Substance Abuse 29(2): 43-52, 2008

Treatment engagement and retention is a significant challenge for those who serve adolescent substance abusers. Homeless youth are considered especially challenging to engage and maintain in intervention efforts given their lack of residence and range of associated problems. This study examined predictors of treatment attendance and its impact on substance use outcome among a sample of substance abusing homeless youth (n = 133). Stepwise regression results indicated that a history of sexual abuse and suicide attempts were the two strongest predictors of the treatment attendance rate, higher attendance among those with these histories. Youths who attended greater than 6 treatment sessions showed a significant reduction in alcohol use at post-treatment, but attendance rates did not impact other substance use. Identifying predictors of treatment attendance among this subgroup of adolescents is vital given that much research suggests that treatment attendance alone is associated with better short and long term outcomes.

Smith CS. Coping strategies of female victims of child abuse in treatment for substance abuse relapse: Their advice to other women and healthcare professionals. Journal of Addictions Nursing 18(2): 75-80, 2007. (25 refs.)

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse. The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule. The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies. They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Smith MP. America's methamphetamine crisis: Solving one of America's leading drug problems through child abuse and nuisance laws. Catholic University Law Review 57(2): 605-636, 2008. (39 refs.)

Super labs engage in large scale production of the methamphetamine and produce a majority of the methamphetamine consumed in the United States. This legislation has addressed availability of precursor chemicals, heightened penalties for individuals convicted of methamphetamine related crimes, created penalties for environmental harms caused by production of the drug, and supported other policy-related efforts to address the drug's impact in communities. Addressing the Effects on Individuals Exposed to the Production of Methamphetamine Much of the state legislation passed to address methamphetamine has focused on the particular effects of the drug on children. As this Comment will argue, although child abuse laws are effective tools to combat methamphetamine, states should more aggressively employ nuisance laws in the war against methamphetamine production. Nuisance statutes can also support charges against methamphetamine producers when prosecutors have insufficient evidence to support a charge under the drug laws. This Comment explores the various methods employed to combat methamphetamine. First, it considers the federal and state efforts to combat methamphetamine production. Then, this Comment explores the growing trend of targeting methamphetamine production using child abuse laws. Next, this Comment considers the use of nuisance law in efforts to combat illicit drug use. Finally, this Comment analyzes the effectiveness of using child abuse law and considers the value of employing nuisance theory. This Comment argues that child abuse laws, although helpful, are insufficient to address the external harms associated with methamphetamine production. Nuisance law, on the other hand, presents an opportunity for local communities to address the harms associated with small methamphetamine labs and provides superior remedies as compared to those available under child abuse laws.

Stoltz JAM; Shannon K; Kerr T; Zhang R; Montaner JS; Wood E. Associations between childhood maltreatment and sex work in a cohort of drug-using youth. Social Science & Medicine 65(6): 1214-1221, 2007. (32 refs.)

Although research has examined the impacts of childhood maltreatment among various marginalized populations, few studies have explored the relationship between child abuse and subsequent involvement in sex work among drug-using street-involved youth. In the present study, the relationships between the level of childhood maltreatment and involvement in sex work were examined using the Childhood Trauma Questionnaire (CTQ) as part of an extensive interview protocol in an ongoing prospective cohort study of street-involved youth in Vancouver, Canada. Between September 2005 and June 2006, 361 youth were recruited using extensive outreach methods and snowball sampling. The prevalence rates for abuse in the sample were 73% for physical abuse; 32.4% for sexual abuse; 86.8% for emotional abuse; 84.5% for physical neglect; and 93% for emotional neglect. Univariate and logistic regression analyses demonstrated that not only was sexual abuse independently associated with sex work, but emotional abuse was as well. These findings have implications for early intervention efforts aimed at vulnerable, high-risk youth populations as well as intervention strategies for active sex trade workers.

Thombs BD; Lewis C; Bernstein DP; Medrano MA; Hatch JP. An evaluation of the measurement equivalence of the Childhood Trauma Questionnaire-Short Form across gender and race in a sample of drug-abusing adults. Journal of Psychosomatic Research 63(4): 391-398, 2007. (54 refs.)

Objective: A number of practice guidelines and recommendations call for an assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening instruments, however, has not been examined. High rates of childhood abuse history have been reported among adults who abuse substances. The objective of this study was to investigate the measurement invariance of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) across groups defined by gender and race in a sample of substance-abusing adults. Methods: This study performed a cross-sectional survey of 693 active intravenous drug abusers from San Antonio, TX. Structural equation modeling methods were used to evaluate the measurement invariance of the CTQ-SF between male and female subjects and between Black and Hispanic subjects. Results: Evidence was found for the invariance of the five-factor structure of the CTQ-SF across groups and for a partial invariance model at the item level. Consistent with study hypotheses, two items that referred to "abuse," using the actual word, were more likely to be endorsed by women than by men, even after controlling for responses on similar items. In addition, compared to Hispanics, Blacks tended to report having been "punished with hard objects" at higher rates than expected from their responses on other items related to physical abuse. Conclusion: The amount of bias from nonmeasurement invariance in the CTQ-SF across groups was minimal at the total scale score level. Clinically, however, individual questions that use broad labeling terms are more likely to identify women as having a history of abuse, and individual questions that blend the constructs of physical discipline and physical abuse may overidentify Black Americans as having a history of abuse.

Timko C; Sutkowi A; Pavao J; Kimerling R. Women's childhood and adult adverse experiences, mental health, and binge drinking: The California Women's Health Survey. Substance Abuse Treatment, Prevention and Policy 3: e-article 15, 2008. (60 refs.)

Background: This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California. Materials and methods: Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population- based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older. Results: The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood. Conclusion: Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.

Trent L; Stander V; Thomsen C; Merrill L. Alcohol abuse among U.S. Navy recruits who were maltreated in childhood. Alcohol and Alcoholism 42(4): 370-375, 2007. (23 refs.)

Aims: To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. Methods: An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical and sexual abuse. Results: Most of the recruits used alcohol, and a substantial proportion reported histories of childhood maltreatment. Recruits who had been victimized as children were more likely to use alcohol. Furthermore, among drinkers, those who had been abused were more likely to exhibit alcohol problems than were non-abused drinkers. Conclusion: Substanceantial numbers of personnel with alcohol-related problems may be using alcohol to self-medicate due to a history of childhood abuse. Attention to the association between alcohol abuse and childhood maltreatment might help improve the efficacy of military alcohol reduction programs.

Wall AE; Kohl PL. Substance use in maltreated youth: Findings from the National Survey of Child and Adolescent Well-Being. Child Maltreatment 12(1): 20-30, 2007. (47 refs.)

The purpose of this study was to describe the characteristics associated with different levels of substance use in a national probability sample of maltreated 11- to 15-year-olds (n = 1, 179). Bivariate (chi-square tests) and multivariate (logistic regression) analyses were used to examine the association of adolescent substance use with demographics, placement type, and youth and family characteristics. Seventy-one percent of youth reported no use, 20% reported low levels of substance use, and approximately 9% reported moderate to high levels of use. Youth substance use was similar across placement types. Conduct problems and low caregiver relatedness were more prevalent for youth reporting higher levels of substance use. High levels of conduct problems increased the odds of substance use, whereas high caregiver monitoring decreased the odds of substance use. Caregiver monitoring may be a key tactic in attempts to reduce the likelihood of substance use in maltreated youth, regardless of placement type.

Walsh CA; Jamieson E; MacMillan H; Boyle M. Child abuse and chronic pain in a community survey of women. Journal of Interpersonal Violence 22(12): 1536-1554, 2007. (88 refs.)

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship.

Widom CS; White HR; Czaja SJ; Marmorstein NR. Long-term effects of child abuse and neglect on alcohol use and excessive drinking in middle adulthood. Journal of Studies on Alcohol and Drugs 68(3): 317-326, 2007. (67 refs.)

Objective: The purpose of this study was to determine the long-term effects of child abuse and neglect on alcohol use in middle adulthood. Method: Individuals with documented cases of childhood physical and sexual abuse and/or neglect (n = 500) and matched controls (n = 396) from a metropolitan county in the Midwest were followed and interviewed in middle adulthood. Outcomes were Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses of alcohol abuse or dependence in young adulthood (age 29) and excessive drinking in middle adulthood (age 40). Results: Women with documented histories of child abuse or neglect reported higher past-year typical quantity (p less than.01) and past-month number of days drinking eight or more drinks (p less than.05) than nonabused/nonneglected women. Controlling for parental alcohol/drug problems, the effect of child maltreatment on excessive drinking in middle adulthood was not significant for women. For women, the final structural equation model revealed an indirect path through alcohol diagnosis in young adulthood (P less than.05) to excessive drinking in middle adulthood (p less than.001) but no direct path from child abuse and neglect to excessive drinking in middle adulthood. For men, there were no significant paths from child abuse and neglect to alcohol diagnosis in young adulthood or excessive drinking in middle adulthood. For men and women, parental alcohol/drug problems had a significant indirect effect on the offspring's drinking in middle adulthood (p less than.001) through young adult alcohol diagnosis (p <.001). Conclusions: Consequences of abuse and neglect persist into middle adulthood for women, through continuation of earlier alcohol problems, suggesting the need for interventions throughout the life course. The influence of parental alcohol and drug problems warrants further attention.

Xiao Q; Dong MX; Yao J; Li WX; Ye DQ. Parental alcoholism, adverse childhood experiences, and later risk of personal alcohol abuse among Chinese medical students. Biomedical and Environmental Sciences 21(5): 411-419, 2008. (21 refs.)

Objective: To determine the status of adverse childhood experiences (ACEs) and the association of multiple ACEs with both parental alcoholism and latter personal alcohol among Chinese medical students with a view of improving adolescent health and reducing alcohol abuse among them. Methods In this cross-sectional study, 2073 Chinese medical students completed a survey on ten categories of ACEs in Anhui province of China. The association of parental alcoholism with ACEs and personal alcohol abuse was assessed by logistic regression analyses. Results: The adjusted odds ratio (OR) for each category of ACEs in the subjects whose parents (either fathers or mothers or both) had alcohol abuse was 2 to 14 times higher than that in those with parental alcoholism (P<0.05). Subjects with bi-parental alcoholism had the highest likelihood of ACEs. Compared with the subjects without ACEs, the risk of personal alcohol abuse was increased by 2-4-folds in the subjects with ACEs, irrespective of parental alcoholism (P<0.05). The total number of ACEs (ACE score) had a graded relationship to 4 categories of personal alcohol abuse with or without parental alcoholism. The prevalence of personal alcohol abuse among the subjects with parental alcoholism was higher, which was independent of ACE scores. Conclusion: The prevalence of ACEs is generally serious in China. Efforts should be made to prevent and treat children with ACEs and subsequently to reduce alcohol abuse and later problems.

Yen CF; Yang MS; Chen CC; Yang MJ; Su YC; Wang MH et al. Effects of childhood physical abuse on depression, problem drinking and perceived poor health status in adolescents living in rural Taiwan. Psychiatry and Clinical Neurosciences 62(5): 575-583, 2008. (38 refs.)

Aims: The aim of the present study was to investigate the magnitude and independence of the effects of childhood physical abuse on adolescent depression, problem drinking and perceived poor mental health in Taiwanese indigenous and non-indigenous adolescents living in rural areas controlling for individual and familial characteristics. Methods: A sample of adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. The associations between childhood physical abuse and adolescent depression, problem drinking and perceived poor health status were examined on univariate and multivariate logistic regression. Results: Of the 1684 adolescents who completed the questionnaires, 374 (22.2%) reported that they had experienced physical abuse in childhood. Controlling for individual and familial factors, childhood physical abuse significantly increased the risk of depression, problem drinking and perceived poor health status in the present sample of adolescents on multivariate logistic regression. Conclusions: History of childhood physical abuse should be elicited from adolescents in treatment for depression, alcohol abuse or physical discomfort of unknown etiology. This finding may be of clinical benefit in terms of the design and implementation of intervention.