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CORK Bibliography: Child Abuse

99 citations. January 2003 to present

Prepared: September 2007

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.

Dickson-Gomez J; Bodnar G; Gueverra A; Rodriguez K; Gaborit M. Childhood sexual abuse and HIV risk among crack-using commercial sex workers in San Salvador, El Salvador: A qualitative analysis. Medical Anthropology Quarterly 20(4): 545-574, 2006. (69 refs.)

This article explores the relationship between childhood sexual abuse (CSA) and later HIV risk. It draws on qualitative, in-depth interviews with 40 women who either used crack or engaged in commercial sex work in the greater metropolitan area of San Salvador, El Salvador, 28 of whom experienced CSA. Although the relationship between CSA and later HIV risk has been clearly demonstrated, the processes that lead women who have experienced CSA to experience HIV risk are unclear. The theoretical model presented here incorporates the psychological effects of CSA, particularly stigmatization, as well as its social consequences and the larger context of poverty in which these women live. The meanings women draw from past abuse experiences and their rationale for choices made help explain the association between CSA and later risk as mediated through sex work and crack addiction. Self-report data gathered in this study indicate that HIV prevalence may be considerably higher in this high-risk population than Salvadoran national rates.

Donohue B; Romero V; Hill HH. Treatment of co-occurring child maltreatment and substance abuse. (review). Aggression and Violent Behavior 11(6): 626-640, 2006. (110 refs.)

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55-61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065-1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197-211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 2 7, 215-229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.

Evren C; Evren B. The relationship of suicide attempt history with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality in substance dependents. Nordic Journal of Psychiatry 60(4): 263-269, 2006. (40 AS refs.)

The aim of this study was to evaluate the prevalence of suicide in Turkish male substance dependents, and to investigate the relationship of suicide attempt history with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Participants were 154 consecutively admitted male substance dependents. Patients were investigated with the Childhood Abuse and Neglect Questionnaire, Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Among substance-dependent patients, 28.6% was considered a group with suicide attempt history (SAH). Current age was lower and rate of being single was higher in the group with SAH. There were no significant differences between groups in terms of employment, educational status and duration of education. Rates of physical, emotional abuse and neglect, self-mutilation and being alexithymic were higher and ages at first substance use and regular substance use were lower in the group with SAH. Mean scores of "difficulty in identifying feelings" (DIF) and "difficulty in describing feelings" (DDF) subscales of the TAS-20 were higher in the SAH group. Among temperament and character dimensions of the TCI, only "Self-directedness" and "Cooperativeness" were lower in SAH and there were no significant differences between groups in terms of other subscales. Age and Self-directedness score of TCI were determinants for suicide attempt. In particular, young drug users with low Self-directedness scores could be the target population in order to prevent suicidal behavior. This study also suggests that in substance-dependent patients, in the background of all suicidal behavior, childhood abuse and neglect must be evaluated.

Flaherty EG; Thompson R; Litrownik AJ; Theodore A; English DJ; Black MM et al. Effect of early childhood adversity on child health. Archives of Pediatrics & Adolescent Medicine 160(12): 1232-1238, 2006. (47 refs.)

Objective: To examine the effect of child abuse and other household dysfunction on child health outcomes. Design: Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old. Setting: Children in the South, East, Midwest, Northwest, and Southwest United States. Participants: One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting). Main Outcome Measures: (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention). Results: Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31). Conclusion: Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.

Hodson C; Newcomb MD; Locke TF; Goodyear RK. Childhood adversity, poly-substance use, and disordered eating in adolescent Latinas: Mediated and indirect paths in a community sample. Child Abuse and Neglect 30(9): 1017-1036, 2006. (62 refs.)

Objective: Although many studies have identified associations between childhood maltreatment and later substance use and disordered eating, few have examined causal or explanatory pathways, and whether victim characteristics predict the development of one versus the other of these outcomes remains uninvestigated. Furthermore, relatively little childhood maltreatment research has examined Latino samples. To address these gaps, this study examined among Latina adolescents the effects of sexual abuse, physical/emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. Method: Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. Results: Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. Conclusions: Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes.

Hussey JM; Chang JJ; Kotch JB. Child maltreatment in the United States: Prevalence, risk factors, and adolescent health consequences. Pediatrics 118(3): 933-942, 2006. (60 refs.)

OBJECTIVES. The purpose of this study was to estimate the prevalence of child maltreatment in the United States and examine its relationship to sociodemographic factors and major adolescent health risks. METHODS. The National Longitudinal Study of Adolescent Health is a prospective cohort study following a national sample of adolescents into adulthood. The wave III interview, completed by 15 197 young adults in 2001-2002 (77.4% response rate), included retrospective measures of child maltreatment. We used these measures to estimate the prevalence of self-reported supervision neglect, physical neglect, physical assault, and contact sexual abuse during childhood. Next, we investigated the relationship between sociodemographic characteristics and maltreatment. Finally, we examined the association between child maltreatment and adolescent self-rated health; overweight status; depression; cigarette, alcohol, marijuana, and inhalant use; and violent behavior. RESULTS. Having been left home alone as a child, indicating possible supervision neglect, was most prevalent (reported by 41.5% of respondents), followed by physical assault (28.4%), physical neglect (11.8%), and contact sexual abuse (4.5%). Each sociodemographic characteristic was associated with >= 1 type of maltreatment, and race/ethnicity was associated with all 4. Each type of maltreatment was associated with no fewer than 8 of the 10 adolescent health risks examined. CONCLUSIONS. Self-reported childhood maltreatment was common. The likelihood of maltreatment varied across many sociodemographic characteristics. Each type of maltreatment was associated with multiple adolescent health risks.

Hyman SM; Garcia M; Sinha R. Gender specific associations between types of childhood maltreatment and the onset, escalation and severity of substance use in cocaine dependent adults. American Journal of Drug and Alcohol Abuse 32(4): 655-664, 2006. (20 refs.)

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.

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.

Jones L. The prevalence and characteristics of substance abusers in a child protective service sample. Journal of Social Work Practice in the Addictions 4(2): 33-50, 2004. (31 refs.)

The purpose of this research was to identify characteristics of substance abusers in a child protective services caseload. The random sample of 443 children was drawn from an urban county from all children with a substantiated abuse case. Files of children were reviewed to derive data. Sixty-eight percent of the children had mothers who abused alcohol or drugs, and 37 percent of them had mothers who abused both. Substance abuse, service contacts, public assistance, homelessness, and household conditions in the service plan were all associated with child removal from the home. These findings suggest that the risks associated with substance abuse are not necessarily ameliorated with social work intervention.

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.

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.

Lynskey MT; Agrawal A; Bucholz KK; Nelson EC; Madden PAF; Todorov AA et al. Subtypes of illicit drug users: A latent class analysis of data from an Australian twin sample. Twin Research and Human Genetics 9(4): 523-530, 2006. (30 refs.)

This article applies methods of latent class analysis (LCA) to data on lifetime illicit drug use in order to determine whether qualitatively distinct classes of illicit drug users can be identified. Self-report data on lifetime illicit drug use (cannabis, stimulants, hallucinogens, sedatives, inhalants, cocaine, opioids and solvents) collected from a sample of 6265 Australian twins (average age 30 years) were analyzed using LCA. Rates of childhood sexual and physical abuse, lifetime alcohol and tobacco dependence, symptoms of illicit drug abuse/dependence and psychiatric comorbidity were compared across classes using multinomial logistic regression. LCA identified a 5-class model: Class 1 (68.5%) had low risks of the use of all drugs except cannabis; Class 2 (17.8%) had moderate risks of the use of all drugs; Class 3 (6.6%) had high rates of cocaine, other stimulant and hallucinogen use but lower risks for the use of sedatives or opioids. Conversely, Class 4 (3.0%) had relatively low risks of cocaine, other stimulant or hallucinogen use but high rates of sedative and opioid use. Finally, Class 5 (4.2%) had uniformly high probabilities for the use of all drugs. Rates of psychiatric comorbidity were highest in the polydrug class although the sedative/opioid class had elevated rates of depression/suicidal behaviors and exposure to childhood abuse. Aggregation of population-level data may obscure important subgroup differences in patterns of illicit drug use and psychiatric comorbidity. Further exploration of a 'self-medicating' subgroup is needed.

Messina N; Grella C. Childhood trauma and women's health outcomes in a California prison population. American Journal of Public Health 96(10): 1842-1848, 2006. (31 refs.)

Objectives. We sought to describe the prevalence of childhood traumatic events among incarcerated women in substance abuse treatment and to assess the relation between cumulative childhood traumatic events and adult physical and mental health problems. Methods. The study was modeled after the Adverse Childhood Events study's findings. In-depth baseline interview data for 500 women participating in the Female Offender Treatment and Employment Program evaluation were analyzed. Results. Hypotheses were supported, and regression results showed that the impact of childhood traumatic events on health outcomes is strong and cumulative (greater exposure to childhood traumatic events increased the likelihood of 12 of 18 health-related outcomes, ranging from a 15% increase in the odds of reporting fair/poor health to a 40% increase in the odds of mental health treatment in adulthood). Conclusions. Our findings suggest a need for early prevention and intervention, and appropriate trauma treatment, within correctional treatment settings.

Nicholas KB; Rasmussen EH. Childhood abusive and supportive experiences, inter-parental violence, and parental alcohol use: Prediction of young adult depressive symptoms and aggression. (review). Journal of Family Violence 21(1): 43-61, 2006. (124 refs.)

Issues in both the children of alcoholics and child abuse literatures were addressed in an attempt to disentangle the effects on young adults of growing up in alcoholic homes versus abusive homes. Using multiple regression, retrospective reports of parental abuse (emotional, physical, and sexual) and parental support (love/support, independence, and fairness), witnessing violence between parents, and parental alcohol use were used as predictor variables for outcomes noted by both literatures. When the effects of all other predictors were statistically controlled, parental alcohol use was not significantly related to depressive symptoms or aggression. Different abusive and supportive behaviors, depending on sex of parent and sex of participant, were significant predictors of both depression and aggression. Results underscore the importance of including and controlling for inter-parental violence and for different types of child abuse (especially emotional abuse) and parental supportive behaviors in investigations of outcomes related to abusive and alcoholic families. Implications for treatment of individuals from these families are discussed.

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.

Vaddiparti K; Bogetto J; Callahan C; Abdallah AB; Spitznagel EL; Cottler LB. The effects of childhood trauma on sex trading in substance using women. Archives of Sexual Behavior 35(4): 451-459, 2006. (63 refs.)

This article presents a model developed to understand the relationship between childhood victimization, perpetration of violence, and later cocaine dependence and adult sex trading among drug using women. A cohort of heavy drinking and drug using women (N=594) recruited for two on-going community based HIV prevention studies in St. Louis City was analyzed to evaluate this association using path analysis. The women were stratified into two groups: sex traders and non-sex traders. Sex traders were more likely than non-sex traders to report being forced to kiss or touch someone in a sexual way before age 15 (35% vs. 22%), being kissed or touched in a sexual way by others when they did not want to be (42% vs. 31%), and being forced to have sexual intercourse (30% vs. 21%). Sex traders were more likely than non-sex traders to use a weapon or threaten someone with a weapon (29% vs. 18%) and physically hurt others on purpose before age 15 (9% vs. 5%). Path analysis confirmed that childhood victimization had a significant and direct association with both adult cocaine dependence and sex trading. However, the association between childhood perpetration and adult sex trading was mediated by cocaine dependence. This analysis concludes that childhood victimization was the strongest predictor of cocaine dependence and sex trading in adulthood.

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.

Widom CS; Marmorstein NR; White HR. Childhood victimization and illicit drug use in middle adulthood. Psychology of Addictive Behaviors 20(4): 394-403, 2006. (91 refs.)

Using a prospective cohort design, the authors examined in this study whether childhood victimization increases the risk for illicit drug use and related problems in middle adulthood. Court-documented cases of childhood physical and sexual abuse and neglect and matched controls (N = 892) were first assessed as young adults (mean age = 29 years) during 1989-1995 and again in middle adulthood (mean age 40 years) during 2000-2002. In middle adulthood, abused and neglected individuals were about 1.5 times more likely than controls to report using any illicit drug (in particular, marijuana) during the past year and reported use of a greater number of illicit drugs and more substance-use-related problems compared with controls. The current results reveal the long-term impact of childhood victimization on drug use in middle adulthood. These new results reinforce the need for targeted interventions with abused and neglected children, adolescents, and adults, and particularly for women.

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 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, di agnoses 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 <.01) and past-month number of days drinking eight or more drinks (p <.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 <.05) to excessive drinking in middle adulthood (p <.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 <.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.

Yampolskaya S; Banks SM. An assessment of the extent of child maltreatment using administrative databases. Assessment 13(3): 342-355, 2006. (34 refs.)

This study examined the extent of violence toward children and factors associated with child maltreatment in Florida using a cohort of children (N = 499,330) who were adjudged to be victims of maltreatment between July 1, 1996, and June 30, 2003. To assess the extent of maltreatment, five indicators were proposed and examined. Multivariate analyses found that prior referral, having more than one type of maltreatment during an initial incident, and caregiver absence best predicted the recurrence of maltreatment. Caregivers' alcohol and substance use were strong predictors of neglect and threatened harm but not of abuse. Finally, multilevel analyses found that older, nonminority girls with histories of prior referrals were significantly (psuedo-zs > 2.00) more likely to experience high degrees of incident severity. Caregivers' substance use, excluding alcohol, also was significantly linked to incident severity. Implications of the findings are discussed.

Young SYN; Hansen CJ; Gibson RL; Ryan MAK. Risky alcohol use, age at onset of drinking, and adverse childhood experiences in young men entering the US Marine Corps. Archives of Pediatrics & Adolescent Medicine 160(12): 1207-1214, 2006. (42 refs.)

Objective: To examine how childhood experiences relate to risky underage drinking. Design: A survey study of men starting military training between June 11, 2002, and April 5, 2006. Multivariate logistic regression models compared risky drinkers with "all others" or with nonrisky drinkers; excluding nondrinkers. Setting: Marine Corps Recruit Depot, San Diego, Calif. Participants: Forty-one thousand four hundred eighty-two men aged 18 to 20 years. Main Exposures: Age at drinking onset; childhood emotional, physical, and sexual abuse; childhood emotional and physical neglect; and household alcohol abuse, mental illness, domestic violence, or divorce. Main Outcome Measures: Risky drinking identified by scoring responses to 3 questions about alcohol consumption. Results: Of 41 482 young men, 6128 (14.8%) were identified as risky drinkers, 18 693 (45.1%) as nonrisky drinkers, and 16 661 (40.2%) as nondrinkers. Among drinkers, early initiation of alcohol use was strongly associated with risky drinking, with a 5.5-fold risk if age at onset of drinking was 13 years or younger. Other associated factors included tobacco use, rural or small hometown, higher education, motivation to join the military for travel or adventure or to leave problems at home, numerous close friends and relatives, household alcohol abuse or mental illness, and childhood sexual or emotional abuse. When the comparison group included nondrinkers, additional associated factors included childhood physical abuse and domestic violence. Conclusions: These analyses confirm previous findings on risks for alcohol misuse in young adults and quantify these risks in new, large, multivariable models, adding unique perspective from a population of young Marines. Public health efforts to decrease alcohol misuse may be effectively targeted by prevention of underage alcohol use, tobacco use, and childhood abuse.

Zlotnick C; Johnson DM; Stout RL; Zywiak WH; Johnson JE; Schneider RJ. Childhood abuse and intake severity in alcohol disorder patients. Journal of Traumatic Stress 19(6): 949-959, 2006. (47 refs.)

In a sample of 336 patients with an alcohol use disorder this study examined, whether patients with histories of childhood sexual abuse (CSA) and childhood physical abuse (CPA) compared to those without such histories have a greater severity of alcohol and other clinical difficulties. Whether lifetime posttraumatic stress disorder (PTSD) mediates the relationship between childhood abuse and clinical outcomes was explored. Results were that CSA was associated with earlier age of onset for alcohol disorder, greater Axis I comorbidity as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), more social and psychiatric problems, but lower drinking frequency. Childhood physical abuse was related to greater drinking consequences, social and psychiatric dysfunction, and Axis I comorbidity, but also lower drinking frequency. Posttraumatic stress disorder partially mediated the effect of both CSA and CPA on severity of psychiatric problems.

Bailey JA; McCloskey LA. Pathways to adolescent substance use among sexually abused girls. Journal of Abnormal Child Psychology 33(1): 39-53, 2005. (54 refs.)

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls' childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.

Bissonnette M; Wall AM; Wekerle C. Childhood maltreatment, parental alcoholism, and beliefs about alcohol and violence among treatment seeking adults. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 144A-144A, 2004. (0 refs.)

Blackstock C; Trocme N; Bennett M. Child maltreatment investigations among aboriginal and non-aboriginal families in Canada. Violence Against Women 10(8): 901-916, 2004. (21 refs.)

This comparative analysis of Aboriginal and non-Aboriginal families uses a 1998 Canadian study of child maltreatment cases to identify important differences: Aboriginal families face worse socioeconomic conditions, are more often investigated because of neglect, less often reported for physical or sexual abuse, and report higher rates of substance abuse. At every decision point in the cases, Aboriginal children are overrepresented: investigations are more likely to be substantiated, cases are more likely to be kept open for ongoing services, and children are more likely to be placed in out-of-home care. Findings suggest the development of neglect intervention programs that include poverty reduction and substance misuse components.

Braitstein P; Li K; Tyndall M; Spittal P; O'Shaughnessy MV; Schilder A et al. Sexual violence among a cohort of injection drug users. Social Science & Medicine 57(3): 561-569, 2003. (40 refs.)

The objective of this study was to determine the prevalence of, and factors associated with, sexual violence in childhood, adolescence and adulthood, among injection drug using men and women. The Vancouver Injection Drug User Study is a prospective cohort of injection drug users (IDU) begun in 1996. The analysis included all individuals who completed the baseline questionnaire who responded to a question about sexual assault. Multivariate modeling was used to determine and to what extent a history of sexual violence at different ages is predictive of HIV risk and other health risk behaviors. HIV prevalence was calculated as the total current number of HIV-positive individuals in the cohort. Of the 1437 eligible individuals, 36% reported a lifetime history of sexual violence; 68% of women, and 19% of men (p < 0.001). After adjusting for fixed sociodemographics, these individuals were more likely to have ever been in the sex trade, to knowingly share needles/rigs with HIV-positive people, to have attempted suicide, to have ever accidentally overdosed, to binge on alcohol, and to have been diagnosed with a mental disorder/disability. The prevalence of child sexual abuse in this cohort is 21%; 33% for women, and 13% for men. The data show a dose-response relationship between age at first sexual violence and most risk behaviors examined. These relationships are further mediated by gender. The prevalence of HIV among individuals who ever experienced sexual violence was 25%, compared to 19% among those who never experienced sexual violence (p = 0.006). Sexual violence, and especially child sexual abuse, is highly prevalent among this cohort, particularly among women. Child sexual abuse has worse consequences for both genders than sexual violence later in life. Nevertheless, women and men are affected differently by sexual violence at different ages, and this has significant implications for health promotion programs, and specifically HIV prevention.

Brems C; Johnson ME; Neal D; Freemon M. Childhood abuse history and substance use among men and women receiving detoxification services. American Journal of Drug and Alcohol Abuse 30(4): 799-821, 2004. (28 refs.)

According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.

Caetano R; Field CA; Nelson S. Association between childhood physical abuse, exposure to parental violence, and alcohol problems in adulthood. Journal of Interpersonal Violence 18(3): 240-257, 2003. (47 refs.)

This article examines the association of exposure to parental violence during childhood and childhood physical abuse with the development of alcohol-related problems in adulthood among Whites, Blacks. and Hispanics. A multistage area household probability sample of While, Black, and Hispanic couples (married or cohabiting), 18 or older, in the U.S. household population was interviewed in 1995. Analyses show an association between childhood physical abuse and exposure to parental violence and alcohol problems among White, Black, and Hispanic females and Hispanic males and an association between parental violence and alcohol problems among Black males. In sum, childhood physical abuse and exposure to parental violence are associated with the development of alcohol-related problems in adulthood. However this association is ethnic and gender specific. Therefore, these violence-related experiences during childhood and adolescence have both immediate and long-term health consequences and should be addressed by health professionals in a variety of settings.

Cash SJ; Wilke DJ. An ecological model of maternal substance abuse and child neglect: Issues, analyses, and recommendations. American Journal of Orthopsychiatry 73(4): 392-404, 2003. (53 refs.)

This study examined an ecological model of maternal substance abuse and child neglect. Data are presented that identified an interplay among family history, interpersonal risk factors, current family functioning, and community networks in examinations of child neglect in a sample of substance-abusing women entering treatment.

Chester DL; Jose RM; Aldlyami E; King H; Moiemen NS. Non-accidental burns in children: Are we neglecting neglect? Burns 32(2): 222-228, 2006. (28 refs.)

Although many studies have described burn abuse in detail, burns that have occurred as a result of neglect have been studied to a much lesser degree. A retrospective study of 440 hospitalised paediatric burns patients during 2000-2002 inclusive was performed. A multi-disciplinary team investigation of suspicious cases was used. This included a home assessment. There were 41 cases of neglect (9.3%) and 395 cases of accidental burning (89.8%). Parental drug abuse, single parent families, delay to presentation and a lack of first aid were statistically more prevalent in the "neglect" group than in the "accidental" group. Children in the "neglect" group were also statistically more likely to have deeper burns and require skin grafting. 82.9% of children whose burns were deemed to be due to neglect had a previous entry on the child protection register. 48.8% were transferred into foster care. This study shows that burning by neglect is far more prevalent than abuse. We advocate a multidisciplinary investigation coupled with the use of home assessments to aid diagnosis. It may be possible to target preventative strategies on the children with the above risk factors.

Clark DB; De Bellis MD; Lynch KG; Cornelius JR; Martin CS. Physical and sexual abuse, depression and alcohol use disorders in adolescents: Onsets and outcomes. Drug and Alcohol Dependence 69(1): 51-60, 2003. (66 refs.)

Adolescents with alcohol use disorders (AUDs) often have major depressive disorder (MDD). While physical abuse and sexual abuse (PS Abuse) have been observed to be common in adolescents with AUDs, the influence of PS Abuse on comorbid MDD and AUD has not been determined. The effect of pre-existing PS Abuse on the young adulthood outcomes of adolescents with AUDs has also not been adequately explored. This study examined the relationships among PS Abuse, MDD, and AUD in adolescence, as well as related young adult outcomes. Adolescents (mean age: 16.4 years; range: 14-18 years) were recruited from clinical and community sources and classified into four groups: (1) AUD+PS Abuse (n = 154), (2) AUD only (n = 255), (3) PS Abuse only (n 74), and (4) Controls (n = 268). Subjects were longitudinally assessed through young adulthood (age 19 years or older). Measures included interview assessments of DSM-IV AUD and MDD, classified as "primary" or "secondary", and questionnaire measures of alcohol consumption and depression. Primary MDD preceded AUD whereas secondary MDD had a later onset than AUD. PS Abuse accelerated the onsets of primary MDD, secondary MDD and AUD. While affected adolescents had typically improved in both alcohol consumption and depression at the young adult assessment, the majority of those with adolescent AUD had AUDs in young adulthood, and MDD remained common in those with a history of PS Abuse. These results indicate that MDD among adolescents with AUD may be partly attributable to PS Abuse.

Compton MT; Furman AC; Kaslow NJ. Preliminary evidence of an association between childhood abuse and cannabis dependence among African American first-episode schizophrenia-spectrum disorder patients. (rapid communication). Drug and Alcohol Dependence 76(3): 311-316, 2004. (29 refs.)

Cannabis dependence is a prevalent comorbid substance use disorder among patients early in the course of a schizophrenia-spectrum disorder. Determining risk factors for substance abuse may be helpful in designing interventions to reduce the psychosocial morbidity associated with substance abuse among this population. This study aimed to determine whether or not African American, socially disadvantaged, first-episode schizophrenia-spectrum patients with cannabis dependence experienced greater levels of childhood abuse and neglect compared to similar patients without comorbid cannabis dependence. Among 29 eligible patients, 18 participated in this pilot study. First-episode patients with comorbid cannabis dependence (n = 8) reported significantly greater childhood physical and sexual abuse compared to those without comorbid cannabis dependence (n = 10). This represents preliminary evidence of an association between childhood maltreatment and cannabis dependence among this especially vulnerable population. Childhood physical and sexual abuse may be a risk factor for the initiation of cannabis dependence and other substance use disorders in the early course of schizophrenia.

Crowley TJ; Mikulich SK; Ehlers KM; Hall SK; Whitmore EA. Discriminative validity and clinical utility of an abuse-neglect interview for adolescents with conduct and substance use problems. American Journal of Psychiatry 160(8): 1461-1469, 2003. (53 refs.)

This study investigated the discriminative validity, clinical utility, and severity correlations of the Colorado Adolescent Rearing Inventory (CARI), a structured, 20-45-minute abuse-neglect interview in the assessment of adolescents with conduct and substance use problems. Ninety-eight adolescent patients with conduct and substance use problems and 102 comparison subjects (about 40% of the subjects in each group were female) completed the CARI, the Diagnostic Interview Schedule for Children, and the Composite International Diagnostic Interview-Substance Abuse Module. Although the subjects were advised that reports of abuse-neglect would be communicated to child welfare agencies, nearly two-thirds of the patients with conduct and substance use problems endorsed items indicating probable abuse-neglect, compared with about a third of the comparison subjects, a highly significant difference. Clinicians judged that 68%-80% of the cases of the patients and comparison subjects who endorsed such items warranted reporting to child welfare agencies. Scores on the CARI correlated significantly with severity of substance involvement, conduct disorder, and major depression. Compared to males, significantly more females reported sexual abuse. Patients were significantly more likely than comparison subjects to attribute adverse life effects to their reported abuse-neglect experiences. THE CARI scores revealed many cases of serious abuse-neglect, generated many reports to child welfare agencies, demonstrated discriminative validity, correlated with clinical measures, and reflected important gender differences. It is concluded that the CARI can contribute to clinical evaluation and research involving youths with conduct and substance use problems.

Davis JL; Combs-Lane AM; Smith DW. Victimization and health risk behaviors: Implications for prevention programs. IN: Kendall-Tackett KA, ed. Health Consequences of Abuse in the Family: A Clinical Guide for Evidence-Based Practice. Washington DC: American Psychological Association, 2004. pp. 179-195. (44 refs.)

Clinicians conducting prevention programs often find that the people who persist in risky behavior have had abuse experiences. Results from research studies have been striking. Research indicated that victims of trauma in general, and family violence in particular, report greater involvement in a number of health risk behaviors than nonvictims. This finding is consistent across different types of family violence (e.g., sexual abuse, physical abuse) and is particularly salient for victims who have experienced multiple incidents. Health risk behaviors that have been examined empirically include alcohol consumption, lack of exercise or inactivity, illicit drug use, tobacco use, eating disorders, sexual activity with numerous partners, sexual intercourse early in a relationship, failure to use contraceptives, and sexual activity while under the influence of alcohol or drugs. Research further suggests that unless these traumatic events are addressed, prevention and treatment efforts are likely to fail.

Dennis ML; Stevens SJ. Maltreatment issues and outcomes of adolescents enrolled in substance abuse treatment. Child Maltreatment 8(1): 3-6, 2003. (14 refs.)

Although they are mandated reporters and work regularly with youth who have experienced abuse and trauma, many substance abuse treatment programs do not systematically screen for or address child maltreatment issues. This special issue provides a collection of articles that consistently demonstrate the feasibility of systematically screening for victimization among adolescents entering these programs and documents that multiple co-occurring types of victimization are actually the norm. Other articles in the section examine how levels of abuse and traumatic victimization are associated with aspects of adolescent substance use disorders, traumatic distress symptoms, co-occurring somatic and health problems, HIV risk behaviors, and a victim-to-abuser spiral. Finally, the articles address how this might affect treatment matching across levels of care. This introduction provides an overview of the articles and then highlights some of the key implications of this collective body of work for practice, policy, and future research.

Dong MX; Anda RF; Felitti VJ; Williamson DF; Dube SR; Brown DW et al. Childhood residential mobility and multiple health risks during adolescence and adulthood: The hidden role of adverse childhood experiences. Archives of Pediatrics & Adolescent Medicine 159(12): 1104-1110, 2005. (49 refs.)

Background: Throughout US history, US society has been characterized by its high degree of residential mobility. Previous data suggest a relationship between mobility and increased health risk, but this relationship might be confounded by unmeasured adverse childhood experiences (ACEs). Objectives: To examine the relationship of childhood residential mobility to health problems during adolescence and adulthood and to determine how much these apparent relationships may result from underlying ACEs. Design, Setting, and Participants: Retrospective cohort study of 8116 adults who completed a survey that included childhood residential mobility, ACEs (childhood abuse, childhood neglect, and household dysfunction), and multiple health problems. Main Outcome Measures: Number of childhood residential moves and number of ACEs (ACE score) were assessed for relationships to depressed affect, attempted suicide, alcoholism, smoking, early sexual initiation, and teenaged pregnancy. Results: After adjustment for demographic variables, the risk of high residential mobility during childhood ( >= 8 moves) was 1.7- to 3.1-fold for each ACE, and increased with the number of ACEs. Compared with respondents who never moved, the odds of health risk for respondents with high mobility during childhood ranged from 1.3 (for smoking) to 2.5 (for suicide). However, when the number of ACEs was entered into multivariate models, the relationship between mobility and health problems was greatly reduced. Conclusions: Adverse childhood experiences are strongly associated with frequent residential mobility. Moreover, the apparent relationship between childhood mobility and various health risks is largely explained by ACEs. Thus, previous studies showing a relationship between residential mobility and negative outcomes were likely confounded by unmeasured ACEs.

Downs WR; Capshew T; Rindels B. Relationships between adult women's alcohol problems and their childhood experiences of parental violence and psychological aggression. Journal of Studies on Alcohol 65(3): 336-344, 2004. (26 refs.)

Objective: The objective of this study is to examine the associations between mother physical abuse, mother psychological aggression, father physical abuse and father psychological aggression and women's alcohol dependence while controlling for several demographic variables, childhood sexual abuse and mother and father alcohol problems. Method: Samples of women in treatment for substance use disorders (n = 225) and receiving services for domestic violence (n= 222) volunteered to be in the study. We used the Parent-Child Conflict Tactics Scales to assess retrospectively experiences of parental aggression during childhood and the Composite International Diagnostic Interview for a diagnosis of alcohol dependence based on International Classification of Diseases (ICD-10) criteria. Results: Logistic regression applied to the data showed that being in the substance use disorder treatment sample, being unemployed and not being black were significantly related to a higher likelihood of lifetime diagnosis of alcohol dependence. Mother psychological aggression was found to be significantly associated with alcohol dependence. Father psychological aggression was found to be significantly related to alcohol dependence for nonwhite women but not for white women. Mother and father physical abuse were both found to be significantly related to alcohol dependence, but Only for women who did not report childhood sexual abuse. Conclusions: Associations between experiences of childhood abuse and development of alcohol problems for women are complex. Experiences of mother and father abuse need to be examined separately with samples of women who are of different ethnicities and samples of women who are receiving services for different problems.

Dube SR; Felitti VJ; Dong M; Chapman DP; Giles WH; Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics 111(3): 564-572, 2003. (111 refs.)

Objective. Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed. Methods. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: less than or equal to14 years, 15 to 18 years, or as an adult (greater than or equal to19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use. Results. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with greater than or equal to5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use. Conclusions. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.

Duggan A; Fuddy L; Burrell L; Higman SM; McFarlane E; Windham A et al. Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse and Neglect 28(6): 623-643, 2004. (43 refs.)

Objectives: To assess the impact, of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. Methods: This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on Oahu, HI, USA. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Mothers in both groups were interviewed annually for 3 years (88% follow-up each year) to measure mental health, substance use, and partner violence. HSP records were reviewed to measure home visiting services provided. Home visitors were surveyed annually to measure their perceived competence. Results: Malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers' desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving greater than or equal to75% of visits called for in the model. Home visitors often failed to recognize parental risks and seldom linked families with community resources. HSP training programs were under-developed in preparing staff to address risks and to link families with community resources. Conclusions: Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service. Research is needed to develop and test strategies to improve home visiting effectiveness in reducing parental risks for child abuse.

Duncan A; Thomas JC; Miller C. Significance of family risk factors in development of childhood animal cruelty in adolescent boys with conduct problems. Journal of Family Violence 20(4): 235-239, 2005. (12 refs.)

The literature suggests that physical child abuse, sexual child abuse, paternal alcoholism, paternal unavailability, and domestic violence may be significant in development of childhood animal cruelty. Two groups of early- to late adolescent boys (CTA and N-CTA) in residential treatment for conduct disorder were compared in the current study on histories of these family risk factors. The adolescents in Group I were comprised of boys who had conduct problems with documented histories of animal cruelty (n = 50; CTA). Group 2 consisted of adolescent boys (n = 50; N-CTA) with conduct problems, but without documented histories of animal cruelty. Results showed that children in the CTA group had significantly greater histories of physical and/or sexual child abuse and domestic violence in comparison to children in the N-CTA group. These results suggest that physical and/or sexual abuse to a child, and exposure to domestic violence, may be significant in the development of childhood animal cruelty.

Duran B; Malcoe LH; Sanders M; Waitzkin H; Skipper B; Yager J. Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care. Child Abuse and Neglect 28(2): 131-145, 2004. (51 refs.)

Objective: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. Methods: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. Results: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] = 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI = 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4).Conclusion: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.

Evren C; Kural S; Erkiran M. Antisocial personality disorder in Turkish substance dependent patients and its relationship with anxiety, depression and a history of childhood abuse. Israel Journal of Psychiatry and Related Sciences 43(1): 40-46, 2006. (37 refs.)

The prevalence of antisocial personality disorder (ASPD) in treatment-seeking Turkish substance dependent patients and the relationship of ASPD with clinical characteristics were studied. Participants were 132 inpatients with substance dependence according to the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. The clinician applied a semi-structured socio-demographic form, SCID-I, SCID-II, Childhood Abuse and Neglect Questionnaire (CANQ), Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Among the 132 substance dependent patients, 31 (23.5%) had ASPD diagnosis and 56 (42.4%) had no personality disorder or personality traits. Rate of childhood physical abuse, childhood verbal abuse, childhood neglect, suicide attempt history, self-destructive behavior and lifetime major depression were higher among patients with ASPD. Also mean scores of BDI, BAI and MAST were higher among patients with ASPD. The high rate of ASPD found among Turkish substance dependent patients suggests that special attention must be paid to identify ASPD in this group. Findings in this study showed that there is an association between ASPD and childhood abuse, lifetime major depression and severity of substance use.

Evren C; Kural S; Cakmak D. Clinical correlates of childhood abuse and neglect in substance dependents. Addictive Behaviors 31(3): 475-485, 2006. (46 refs.)

The aim of this study was to evaluate the prevalence of childhood abuse and neglect (CAN) in Turkish substance dependents and to investigate the relationship between CAN with axis I disorders, personality disorders and severity of depression and anxiety symptoms. Among 132 substance dependents, 56.1% met dichotomous criteria for some form of CAN. Current age was lower, whereas rate of suicide attempt, self-destructive behavior, divorce of parents, major depression, posttraumatic stress disorder (PTSD), lifetime specific phobia and personality disorders were higher in patients with history of CAN. Severity of depression and anxiety symptoms were also higher in group with CAN and number of abuse type was correlated with depression and anxiety scores. Lifetime major depression, lifetime PTSD, suicide attempt, self-destructive behavior and divorce of parents predicted CAN. The high rate of CAN found among Turkish substance dependents suggests that special attention must be given to identify CAN in this group. Findings of this study showed that there is a relationship between history of CAN and some axis I disorders, personality disorders and severity of depression and anxiety symptoms.

Freisthler B. A spatial analysis of social disorganization, alcohol access, and rates of child maltreatment in neighborhoods. Children and Youth Services Review 26(9): 803-819, 2004. (49 refs.)

Parental substance abuse is a major contributing factor to increasing child welfare caseloads. Previous research on the role of substance abuse in child maltreatment has focused almost exclusively on the efficacy of substance abuse treatment programs for parents in reducing the reoccurrence of child abuse. Little attention has been given to the role of neighborhood characteristics or alcohol access on rates of child maltreatment. This study examines the relationship between alcohol access and neighborhood rates of child maltreatment. Using substantiated reports of child maltreatment for 940 census tracts in three counties in California, this study examines the role of neighborhood social disorganization and alcohol access on child abuse and neglect. Spatial regression models show that neighborhoods with higher percentages of poverty, female-headed households, Hispanic residents, population loss, and greater densities of bars have higher rates of child maltreatment. Neighborhoods provide an ideal mechanism for developing preventive interventions of child abuse and neglect because individual families or parents are not targeted for services. Instead, neighborhood characteristics that contribute to potentially harmful living situations for children can be identified and altered. These results suggest that efforts to prevent child maltreatment should focus on neighborhood disadvantage and alcohol outlet densities.

Freisthler B; Midanik LT; Gruenewald PJ. Alcohol outlets and child physical abuse and neglect: Applying routine activites theory to the study of child maltreatment. Journal of Studies on Alcohol 65(5): 586-592, 2004. (40 refs.)

Objective: The purpose of this study is to examine whether or not alcohol access in neighborhood areas is differentially related to substantiated reports of child physical abuse and neglect. Method: This cross-sectional ecological study uses spatial regression procedures to examine the relationship between the number of bars, restaurants and off-premise outlets per population and rates of child physical abuse and neglect in 940 census tracts in California, while controlling for levels of social disorganization, population density and county of residence. Results: The number of off-premise outlets per population was positively associated with rates of child physical abuse (b = 3.34, SE= 1.14), and the number of bars per population was positively related to rates of child neglect (b = 1.89, SE = 0.59). Conclusions: These results suggest that alcohol access is differentially related to type of child maltreatment, with higher densities of bars being related to higher rates of child neglect, and higher rates of off-premise outlets related to higher rates of child physical abuse. The findings suggest there is a spatial dynamic of neighborhoods that can result in child maltreatment and underscore the importance of examining the alcohol environment when developing programs to prevent child maltreatment.

Fuller TL; Wells SJ. Predicting maltreatment recurrence among CPS cases with alcohol and other drug involvement. Children and Youth Services Review 25(7): 553-569, 2003. (18 refs.)

The prevention of maltreatment recurrence is of utmost importance for Child Protective Services (CPS). Recent research has identified several factors that consistently predict maltreatment recurrence; however, these studies have assumed that the risks for recurrence are the same for all families who come to the attention of CPS. It seems likely, however, that the dynamics associated with certain family problems would elevate the risks associated with some factors and diminish the risk of others. Evidence suggests that the number of CPS cases involving families with alcohol and other drug (AOD) problems is increasing, which presents unique challenges to CPS workers who must be able to determine how a parent's substance use affects their child's safety. The current study examined the factors that are predictive of short-term (e.g. within 60 days) maltreatment recurrence among CPS cases with AOD involvement. Data was collected from 95 indicated investigations that involved caretaker AOD use as part of the maltreatment allegation. Analyses revealed that four factors were related to an increased risk of short-term maltreatment recurrence: 1) the safety assessment factor involving caretaker AOD use checked "yes;" 2) a high risk assessment rating for caretaker criminal behavior; 3) no police involvement during the investigation; and 4) families headed by single, African-American women. The implications of these findings for CPS practice are discussed in detail.

Garrison M. The State construction of families: Foster care, termination of parental rights, and adoption. Reforming child protection, a public health perspective. Virginia Journal of Social Policy & the Law 12: 590-634, 2005. (172 legal refs.)

A quarter of a century ago, researchers and reformers reported that the results achieved by the child protection system were far removed from its goals. ... In 1980, Congress adopted the Adoption Assistance and Child Welfare Act (AACWA), which required the states, as a condition of federal foster care funding, to make "reasonable [pre-placement] efforts" to solve the child maltreatment problem at home, provide periodic case review, and offer services to reunite children with their parents or ensure that they are placed in another permanent home. ... Despite accumulating evidence that child maltreatment is an urgent public health problem, the child protection system has failed to develop evidence-based treatments or even standardized diagnostic procedures. Section I describes the dimension of the problems. Section II explores the reasons for this record of failure. The author maintains that reformers relied on assumptions instead of evidence and thereby underestimated the gravity of harm associated with child maltreatment, the difficulty of cure, and the cost of treatment. In addition, the assumptions on which reformers relied derived from a simplistic, anti-authoritarian ideology that cast the state child welfare system as villain and the families served by that system as victims. Efforts failed to see this as a serious public health problem. Sections III and IV use a public health perspective to analyze the problem of child welfare reform and find that a major shift in law, practice, and funding is needed. The child protection system has failed to develop evidence-based treatments or even standardized diagnostic procedures. It has ignored the institutional context in which treatment is delivered, and it has woefully neglected prevention, the key to most successful public health campaigns. Most importantly, both federal law and local practice have relied on the wrong medical model: law and practice reflect an "acute care" treatment paradigm that aims at rapid cure and exit, while all the evidence suggests that child maltreatment - for both the maltreating parent and the victimized child - is a chronic condition which requires ongoing treatment and services. [Note: Within this discussion, the role of alcohol and other substance use is considered.]

Grella CE; Joshi V. Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreatment 8(1): 7-18, 2003. (41 refs.)

This study reports on the effects of having a history of physical and/or sexual abuse on treatment processes and posttreatment abstinence among 803 adolescents in a multisite study of drug treatment outcomes. A history of physical and/or sexual abuse was reported by 59% of the girls and 39% of the boys and was related to being White and having higher levels of comorbidity, exposure to other traumatic events, dependence on alcohol and marijuana, problem recognition, and negative peer or family influence. Abused adolescents had more service needs at treatment admission and there was some variation in treatment processes related to gender and abuse status. Youths with a history of physical abuse had a lower likelihood of posttreatment abstinence, except among those who had better rapport with their counselors. Attention to treatment processes and engagement strategies is crucial for treating youths in drug treatment who have a history of abuse.

Grella CE; Stein JA; Greenwell L. Associations among childhood trauma, adolescent problem behaviors, and adverse adult outcomes in substance-abusing women offenders. Psychology of Addictive Behaviors 19(1): 43-53, 2005. (71 refs.)

This article explores relationships among exposure to childhood abuse and traumatic events, adolescent conduct problems and substance abuse, and adult psychological distress and criminal behaviors in a sample of substance-abusing women offenders (N = 440). Latent variable structural equation models revealed direct relationships between several childhood traumatic events and greater adolescent conduct problems and substance abuse. Conduct problems predicted more adult criminal behavior, and adolescent substance abuse predicted higher levels of current psychological distress. There were direct relationships between several types of traumatic events and current psychological distress and between traumatic events and specific criminal behaviors. Ethnic differences were also found, suggesting different pathways to criminal behavior. The findings underscore the need to provide trauma-related services for substance-abusing women offenders.

Guterman NB; Lee Y. The role of fathers in risk for physical child abuse and neglect: Possible pathways and unanswered questions. Child Maltreatment 10(2): 136-149, 2005. (137 refs.)

Despite overrepresentation of fathers as perpetrators in cases of severe physical child abuse and neglect, the role they play in shaping risk for physical child abuse and neglect is not yet well understood. This article reviews the possible father pathways that may contribute to physical child abuse and neglect risk and their existing empirical support. The present empirical base implicates a set of sociodemographic factors in physical maltreatment risk, including fathers' absence, age, employment status, and income they provide to the family. As well, paternal psychosocial factors implicated in physical child maltreatment risk include fathers' abuse of substances, their own childhood experiences of maltreatment, the nature of fathers' relationships with mothers, and the direct care they provide to the child. However, the empirical base presently suffers from significant methodological limitations, preventing more definitive identification of risk factors or causal processes. Given this, the present article offers questions and recommendations for future research and prevention.

Haack M; Alemi F; Nemes S; Cohen JB. Experience with family drug courts in three cities. Substance Abuse 25(4): 17-25, 2005

The purpose of the study was to describe the following components of specialized Family Drug Courts: (1) children under court supervision; (2) parent(s) named in the petition; (3) services provided and court actions taken; and (4) relapse rates. Data were collected from the court records of 65 families in three courts in Florida, Kansas, and New York. Courts differed in type of clients, sanctions used, and length of time required between drug testing. Drug testing frequency varied depending on the parent's recovery and cooperation. Test results indicated a decline in drug use in the first four months and an increased risk for relapse between the 15th and 19th weeks. Specialized Family Drug Courts show promise for an improved way to address child abuse and neglect involving parental substance use. They can also provide a unique clinical training experience for health professionals.

Haack MR; Burda-Cohee C; Alemi F; Nemes S. Facilitating self-management of substance use disorders with online counseling: The intervention and study design. Journal of Addictions Nursing 16(1-2): 41-46, 2005. (12 refs.)

This paper describes a pilot study using online counseling for court-involved parents who have been charged with child abuse and neglect related to substance use. All families resided in the medically underserved area of Newark, New jersey and were recruited from halfway houses and the Family Court. The sample consisted of 30 participants randomly assigned to control (n = 15) and experimental (n = 15) groups. Of the participants, 83% were Black, 13% were White, and 3% were Hispanic. The control group had access to usual face-to-face treatment at a local treatment center where typical court-ordered offenders were referred. Usual face-to-face treatment often involved being wait-listed for periods of months even for a detox bed. The experimental group had immediate access to the online counseling intervention. The online counseling software and the live counseling components of the intervention were developed with a stages of change theoretical framework. Preliminary findings show promise for the feasibility of online interventions for underserved populations.

Haight W; Jacobsen T; Black J; Kingery L; Sheridan K; Mulder C. "In these bleak days": Parent methamphetamine abuse and child welfare in the rural Midwest. Children and Youth Services Review 27(8): 949-971, 2005. (49 refs.)

This report describes the impact of parent methamphetamine abuse on the development and wellbeing of school-aged children, and considers implications for culturally appropriate child welfare services. Thirty-five adult informants from several, adjacent rural Midwestern counties in the United States were interviewed as part of a larger ethnographic study. These child welfare workers, other community professionals (educators, counselors, law enforcement personnel, and substance abuse treatment providers), and foster caregivers described their experiences with families involved with methamphetamine. Overall, informants described that children are brought by their methamphetamine-abusing parents into a rural drug culture characterized by distinct, antisocial beliefs and practices. Children's experience of this culture includes environmental danger, chaos, neglect, abuse, loss, and isolation. Informants believed that children develop antisocial beliefs and practices such as lying, stealing, drug use, and violence through direct teaching by their parents and, indirectly, through observing parents' own antisocial behavior. Informants described children as displaying psychological, social, and educational disturbances. They also described individual variation in functioning across children that they attributed, in part, to individual (e.g., temperament, intelligence), familial (e.g., extended family), and community (e.g., school) characteristics. Informants noted a need for effective child mental health services in the area, and for ensuring a positive environment for children's future development through education of the children, foster parents and other community members.

Haller DL; Miles DR. Personality disturbances in drug-dependent women: Relationship to childhood abuse. American Journal of Drug and Alcohol Abuse 30(2): 269-286, 2004. (30 refs.)

This study examined associations between childhood abuse and personality disturbances in 228 drug-dependent women. Thirty-six percent denied abuse, 50% reported emotional, 42% physical, and 42% sexual abuse. Million Clinical Multiarial Inventory (MCMI-III) scores > 74 provided evidence of personality disturbance and scores on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales measuring somatic complaints, depression, anxiety and postraumatic stress disorder (PTSD) served as covariates. Emotional and physical abuse survivors were at increased risk for borderline, masochistic, and avoidant disturbances and decreased risk for narcissistic disturbances. Emotional abuse survivors were also less likely to be sadistic whereas physical abuse survivors were more likely to be paranoid. Sexual abuse survivors were twice as likely be antisocial; however, no association was found with borderline personality. Finally, an increased prevalence of severe personality disturbances was observed among those experiencing multiple types of abuse. Childhood trauma predisposes drug-dependent women to develop troublesome personality characteristics that are independent of drug addiction and other psychological problems associated with childhood trauma.

Haller DL; Miles DR. Victimization and perpetration among perinatal substance abusers. Journal of Interpersonal Violence 18(7): 760-780, 2003. (38 refs.)

This study examined associations between demographic, psychiatric, substance abuse, and childhood abuse variables and past 30-day victimization and perpetration among 77 perinatal substance abusers. Victimization rates were 70% emotional, 34% physical, 29% sexual, and 42% personal freedom violations. For perpetration, incidence was 71% emotional, 25% physical, 5% sexual, and 9% personal freedom violations. Through univariate regression, Addiction Severity Index (ASI) psychiatric and drug composite scores, childhood physical abuse, borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) were found to significantly predict victimization. In contrast, ASI psychiatric and drug composite scores, BPD, PTSD, and aggressive-sadistic and antisocial personality disorders were found to significantly predict perpetration. In multiple regression models, ASI drug and phychiatric composite scores accounted for the majority of the variance for both victimization and perpetration, suggesting that women with high ASI scores should be queried about their involvement in abusive acts at time of admission to drug treatment.

Hien DA; Miele GM. Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior. Psychology of Addictive Behaviors 17(1): 49-55, 2003. (40 refs.)

A great deal of data implicate parental drug use as a potential risk factor for child abuse, however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers, (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women.

Johansson A; Hermansson G; Ludvigsson J. When does exposure of children to tobacco smoke become child abuse? (letter). Lancet 361(9371): 1828-1828, 2003. (5 refs.)

Johnson RJ; Ross MW; Taylor WC; Williams ML; Carvajal R; Peters RJ. A history of drug use and childhood sexual abuse among incarcerated males in a county jail. Substance Use & Misuse 40(2): 211-229, 2005. (50 refs.)

This study explored the relationship between childhood sexual abuse and drug use among incarcerated males. A retrospective, self-reported survey was administered over an 8-week period (September and October 2001) to a random sample of 100 men who were incarcerated in a county jail. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors. Overall, 59% of this sample of male inmates reported some form of childhood sexual abuse, and all such instances occurred before or at the age of 13. Statistically significant relationships were found between drug use and childhood sexual abuse, with those who experienced childhood sexual abuse reporting drug use at percentages as much as 30% higher than those denying histories of childhood sexual abuse.

Kalichman SC; Gore-Felton C; Benotsch E; Cage M; Rompa D. Trauma symptoms, sexual behaviors, and substance abuse: Correlates of childhood sexual abuse and HIV risks among men who have sex with men. Journal of Child Sexual Abuse 13(1): 1-15, 2004. (27 refs.)

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N=647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.

Katerndahl D; Burge S; Kellogg N. Predictors of development of adult psychopathology in female victims of childhood sexual abuse. Journal of Nervous and Mental Disease 193(4): 258-264, 2005. (69 refs.)

The purpose of this study is to identify predictors of resilience and adult mental disorders in women with a history of childhood sexual abuse. This cross-sectional study was conducted in a family practice center using adult female (age 18-40) patients. Outcome measures assessed the prevalence of major depressive episode, panic disorder, agoraphobia, substance abuse, posttraumatic stress disorder, borderline personality disorder, bulimia, and suicidality. Seventy-six percent of the 90 women with sufficient data met criteria for at least one adult disorder. Mental health was related to high SES, lack of family alcohol abuse, lower frequency of first perpetrator abuse, and few perpetrators. Specifics of the abuse were associated with development of borderline personality disorder, substance abuse, major depressive episode, suicidality, bulimia, agoraphobia, and panic disorder. Maternal violence against the father, substance abuse within the household of origin, and maternal care and overprotection were also important. The specifics about the abuse and the family environment during childhood are important predictors of adult psychopathology.

Kerwin ME. Collaboration between child welfare and substance-abuse fields: Combined treatment programs for mothers. (review). Journal of Pediatric Psychology 30(7): 581-597, 2005. (125 refs.)

Objective: To review collaboration between child welfare and drug-abuse fields in providing treatment to mothers who abuse drugs and maltreat their children. Methods: Literature review of studies examining effects of maternal drug abuse on parenting skills and outcomes of interventions for both maternal drug abuse and parenting skills. Results: Parenting skills differ between mothers who do and do not abuse drugs, but these studies are primarily limited to mothers of infants and preschoolers. The evidence base for interventions to address both substance use and parenting in these mothers is growing, but more well-controlled studies are needed. Opportunities for improved collaboration between fields are presented. Conclusion: Progress has been made toward collaboration to address drug abuse and parenting skills of mothers who abuse drugs, but more integrated strategies are needed, especially for mothers who use drugs and maltreat their children.

Kim HS; Kim HS. Incestuous experience among Korean adolescents: Prevalence, family problems, perceived family dynamics, and psychological characteristics. Public Health Nursing 22(6): 472-482, 2005. (33 refs.)

Objectives: The present study aimed to identify the prevalence of incest among Korean adolescents and to determine the family problems, perceived family dynamics, and psychological consequences associated with incest in South Korea. Design: A cross-sectional study was performed, using an anonymous, self-reporting questionnaire. Data were analyzed by percentages, Chi-square, and t-test statistical analyses, using SAS software program. Sample: A total of 1,672 adolescents (1,053 student adolescents and 619 delinquent adolescents) were selected using proportional stratified random sampling method in this study. Results: The results showed a 3.7% prevalence of incest in the tested Korean population. Families in which incest occurred were characterized by higher levels of problems, such as psychotic disorders, depression, criminal acts, and alcoholism among family members. Adolescent incest victims showed significantly more dysfunctional and unhealthy in terms of family dynamics and expressed significantly higher maladaptive and problematic psychological patterns than nonvictimized adolescents. Conclusions: The present findings identified some of the family problems and dysfunctional family dynamics may associate with intrafamilial child sexual abuse in Korea. Therefore, when an allegation of intrafamilial sexual abuse is made, health professionals should carry out a comprehensive assessment of their family dynamics and an evaluation of the impact of the abuse on the child and family.

Lau JTF; Kim JH; Tsui HY; Cheung A; Lau M; Yu A. The relationship between physical maltreatment and substance use among adolescents: A survey of 95,788 adolescents in Hong Kong. Journal of Adolescent Health 37(2): 110-119, 2005. (40 refs.)

Purpose: To determine the prevalence of corporal punishment and the infliction of injuries from a beating occurring without provocation in the previous 6 months among secondary school children in Hong Kong, and to examine the associations between these two forms of physical maltreatment with substance-use-related behaviors and attitudes. Methods: Using secondary data, a cross-sectional, self-administered, anonymous survey of 95,788 secondary school students was conducted in Hong Kong. Results: The prevalence of physical maltreatment showed statistically significant associations with younger age, attendance in Chinese-speaking day schools, temporary housing, residence with only one parent, poorer parental relationship, greater peer influence, perceptions of excessive academic pressure, and feelings of being blamed for poor academic performance. Adolescents who had experienced corporal punishment were more likely to be current users of alcohol (OR = 1.11), tobacco (OR = 1.31), psychoactive substances (OR = 1.60). or heroin (OR = 1.90). Those who had been beaten to injury by a family member without provocation within the past 6 months also were more likely to be current users of alcohol (OR = 1.35), tobacco (OR = 1.65), psychoactive substances (OR = 2.39), and heroin (OR = 3.07). Additionally, students who experienced physical maltreatment were more likely to be acquainted with habitual substance users, have better access to psychoactive substances, to have engaged in sex after abusing drugs, have obtained money from illegal sources to purchase drugs, and believe that psychoactive substances are not harmful or addictive. Conclusions: Physical maltreatment showed strong associations with drug-related behaviors and attitudes, after adjusting for potential confounders. Further longitudinal studies are required to understand the causal direction of the relationship.

Liu HH; Longshore D; Williams JK; Rivkin I; Loeb T; Warda US et al. Substance abuse and medication adherence among HIV-positive women with histories of child sexual abuse. AIDs and Behavior 10(3): 279-286, 2006. (26 refs.)

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.

Locke TF; Newcomb MD. Child maltreatment, parent alcohol- and drug-related problems, polydrug problems, and parenting practices: A test of gender differences and four theoretical perspectives. Journal of Family Psychology 18(1): 120-134, 2004. (71 refs.)

The authors tested how adverse childhood experiences (child maltreatment and parent alcohol- and drug-related problems) and adult polydrug use (as a mediator) predict poor parenting in a community sample (237 mothers and 81 fathers). These relationships were framed within several theoretical perspectives, including observational learning, impaired functioning, self-medication, and parentification-pseudomaturity. Structural models revealed that child maltreatment predicted poor parenting practices among mothers. Parent alcohol- and drug-related problems had an indirect detrimental influence on mothers' parenting practices through self-drug problems. Among fathers, emotional neglect experienced as a child predicted lack of parental warmth and more parental neglect, and sexual abuse experienced as a child predicted a rejecting style of parenting.

Locke TF; Newcomb MD. Childhood maltreatment, parental alcohol/drug-related problems, and global parental dysfunction. Professional Psychology: Research and Practice 34(1): 73-79, 2003. (40 refs.)

How do different types of child maltreatment relate to parental drug/alcohol problems? A series of confirmatory factor models were tested with cross-sectional data from a community sample (N = 477). Findings suggest that childhood maltreatment and parental drug problems are two distinct conditions that co-occur about 30% of the time; they are not completely independent, nor are they always related to each other. When they co-occur, greater problems characterized by global parental dysfunction are suggested. Furthermore, several reported experiences differed by gender: Family abuse and parent drug problems were more strongly related for men.

Medrano MA; Hatch JP; Zule WA; Desmond DP. Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population. American Journal of Drug and Alcohol Abuse 29(2): 463-486, 2003. (52 refs.)

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to male addicts. Among male subjects, higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.

Medrano MA; Hatch JP. Childhood trauma, sexually transmitted diseases and the perceived risk of contracting HIV in a drug using population. American Journal of Drug and Alcohol Abuse 31(3): 403-416, 2005. (21 refs.)

This cross-sectional study explored the association among childhood trauma, sexually transmitted diseases histories, and perceived risk of contracting AIDS in 358 women and 338 male drug users in San Antonio, Texas. Women addicts were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Significant findings were that women with increasing severity of abuse (emotional, physical, and sexual) histories as measured by the Childhood Trauma Questionnaire had increasing numbers of sexually transmitted diseases and perceptions of contracting HIV. These findings have implications for future directions in HIV and sexually transmitted disease intervention programs.

Messman-Moore TL; Long PJ. The role of childhood sexual abuse sequelae in the sexual revictimization of women: An empirical review and theoretical reformulation. (review). Clinical Psychology Review 23(4): 537-571, 2003. (110 refs.)

There is now widespread empirical evidence that child sexual abuse (CSA) survivors are at greater risk for sexual revictimization in adulthood, but less is known of the mechanisms underlying this relationship. Despite the lack of a conceptual framework to guide research, there has been a recent influx of studies examining explanatory variables, with most focusing on the psychological sequelae of CSA: alcohol and drug use, sexual behavior, dissociation, posttraumatic symptomatology, poor risk recognition, and interpersonal difficulties. With the exception of sexual behavior, the studies reviewed here provide limited or mixed support for the role of intrapersonal factors in revictimization. Future research may benefit from a focus on the function of psychological distress that is expressed as psychological vulnerability, as opposed to individual forms of psychopathology or maladaptive behavior. An ecological framework may be useful as a guide to future investigations, as this model focuses on factors outside of the victim, including childhood factors such as family environment, contextual factors including the behavior of the perpetrator, and societal and cultural factors that impact revictimization. Future investigations should focus on the interaction between victim vulnerability and perpetrator behavior. Implications for prevention programming, clinical intervention, and future research are discussed.

Mirsal H; Kalyoncu A; Pektas O; Tan D; Beyazyurek M. Childhood trauma in alcoholics. Alcohol and Alcoholism 39(2): 126-129, 2004. (29 refs.)

Aims: Many studies have been conducted to evaluate the relationship between childhood trauma and alcoholism. In this study 80 alcoholics were chosen according to their hospitalization order. The control group consisted of 60 subjects, with no history of alcohol use, matched with the patient group in age and sex. Methods: A sociodemographic and clinical data form, a questionnaire focusing on traumatic life experiences in childhood and The Childhood Trauma Questionnaire, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were applied to both groups. Results: Significant differences were found between the two groups on traumatic life experiences in childhood. Results suggested that childhood trauma positively correlates with anxiety and affective symptoms among alcoholics. Conclusions: Further studies are needed concerning this issue.

Mullings JL; Hartley DJ; Marquart JW. Exploring the relationship between alcohol use, childhood maltreatment, and treatment needs among female prisoners. Substance Use & Misuse 39(2): 277-305, 2004. (82 refs.)

Objective. This study examined the relationship between child maltreatment and adult alcohol dependency among a sample of newly incarcerated female prisoners. Method. This secondary data analysis utilized information gathered through face-to-face interviews with female inmates at intake (N = 1198) within the Texas prison system from 1998 to 1999. Results. Using DSM-IV criteria we found that, among women who reported drinking at least 10 drinks in the last year, 40% scored as alcohol dependent. Bivariate findings revealed that women who were alcohol dependent were also more likely to have grown up in disorganized family situations, including parental drug and alcohol use-related problems, childhood neglect, and childhood physical and sexual abuse. As adults, these women were far more likely-to have utilized mental health services and substance user treatment programs. Supportive of Widom and colleagues (1995), multivariate analyses revealed that childhood neglect (not physical or sexual abuse) was a significant predictor of alcohol dependency. Finally, among the alcohol dependent group, 62% indicated a willingness to participate in substance user treatment programs. Conclusions. These findings emphasize that childhood neglect is related to long-term negative consequences in the form of alcohol use related problems in adulthood. Our findings strongly point to the need for improved screening, assessment procedures, and programming for women prisoners.

Nair P; Schuler ME; Blacka MM; Kettinger L; Harrington D. Cumulative environmental risk in substance abusing women: Early intervention, parenting stress, child abuse potential and child development. Child Abuse and Neglect 27(9): 997-1017, 2003. (76 refs.)

Objective: To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. Method: We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. Data analysis: Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time. Results: Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. Conclusion: Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.

Perkins DF; Jones KR. Risk behaviors and resiliency within physically abused adolescents. Child Abuse and Neglect 28(5): 547-563, 2004. (43 refs.)

Objective: This study examines the relationship between physical abuse and several risk behaviors, and thriving behaviors, and the relationship between potential protective factors and engagement in risk and thriving behaviors among victims of physical abuse. Three categories of potential protective factors were examined: (1) individual characteristics, (2) family processes, and (3) extra-familial factors. We expected that high levels of protective factors would reduce engagement in risk behaviors (i.e., alcohol use, tobacco use, drug use, sexual activity, antisocial behavior, attempted suicide, and purging) among abused adolescents. Results: Across all the risk behaviors, abused adolescents reported a higher frequency of engagement than non-abused adolescents. Several protective factors were identified for the seven risk behaviors. Peer group characteristics was a significant predictor in all seven of the logistic regressions, followed by positive school climate (six models), religiosity (five models), other adult support (five models), family support (four models), view of the future (two models), and involvement in extra-curricular activities (two models). The variance accounted for by the models ranged from 2% (risk behavior of purging) to 26% (risk behavior of alcohol use and antisocial behavior). Conclusions: The findings indicate that, with the exception of sexual activity, the majority of abused adolescents were not engaging in risk behaviors; however, significantly more abused adolescents were engaging in risk behaviors than their non-abused counterparts. In addition, that protective factors were found to exist at various levels of the adolescents' ecology has strong implications for practice.

Putnam FW. Ten-year research update review: Child sexual abuse. (review). Journal of the American Academy of Child and Adolescent Psychiatry 42(3): 269-278, 2003. (117 refs.)

Objective: To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. Method: Computer literature searches of Medline and PSYCInfo for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. Results: CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. Conclusions: CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.

Reese A; Burry CL. Evaluating Maryland's response to drug-exposed babies: SB 512 children in need of assistance: Drug-addicted babies. Psychology, Public Policy and Law 10(3): 343-369, 2004. (21 refs.)

The "crack epidemic" of the mid-1980s presented new challenges to the helping professions, along with the legal and policy fields. Concerns were raised about infants born with exposure to crack and other drugs. States began to react to these concerns with policy and legal changes. In Maryland, the General Assembly passed the Drug Addiction at Birth Act in 1997. This law is examined from several perspectives, including its stated purpose, its relationship to other parts of the Maryland Code regarding child abuse and neglect, its implementation in one major hospital, its congruence with informed consent statutes, its constitutionality, and its practical implications.

Reigstad B; Jorgensen K; Wichstrom L. Diagnosed and self-reported childhood abuse in national and regional samples of child and adolescent psychiatric patients: Prevalences and correlates. Nordic Journal of Psychiatry 60(1): 58-66, 2006. (48 refs.)

We investigated if rates of ICD-10 axis 5 abuse diagnoses in the total child psychiatric population in Norway were different from self-reported abuse at 12-18 years of age, and we investigated their respective correlates. Study 1: The official registers of the total child psychiatric population in Norway in the years 2000 and 2001 were analysed for rates and correlates of axis 5 diagnoses of sexual and physical abuse. Study 2: Self-reports of abuse and neglect in a representative clinical sample of 129 adolescents referred during the same period were analysed for rates and correlates Prevalence of diagnosed sexual abuse inside and outside the family was low (1.6% and 1.9%, respectively) in the total Norwegian clinical population, and physical abuse diagnoses were even lower (0.4%). Self-reports of abuse and neglect were much higher (60.2%). One-fourth (25.5%) of the adolescents reported more than one kind of abuse. Self-reports of abuse were associated with referral for depression, symptoms of depression and suicidal risk. Patients reporting physical abuse were more often intoxicated by alcohol, used solvents and cannabis, and scored higher on the Youth Self-Report externalizing syndrome. There is a large discrepancy between rates of ICD-10 axis 5 diagnoses of sexual and physical abuse and self-reports of such abuse. Childhood abuse needs more attention in clinical practice within child and adolescent psychiatry. Physical abuse needs to be addressed in particular.

Ricci L; Giantris A; Merriam P; Hodge S; Doyle T. Abusive head trauma in Maine infants: Medical, child protective, and law enforcement analysis. Child Abuse and Neglect 27(3): 271-283, 2003. (22 refs.)

This study collected and compared the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT). A retrospective chart review was conducted of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994. Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%) and attachment problems (32%). Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at symptom onset.

Rinehart DJ; Becker MA; Buckley PR; Dailey K; Reichardt CS; Graeber C et al. The relationship between mothers' child abuse potential and current mental health symptoms: Implications for screening and referral. Journal of Behavioral Health Services & Research 32(2): 155-166, 2005. (41 refs.)

This analysis examined data from mothers at 2 of the 9 sites participating in Substance Abuse and Mental Health Services Administration's (SAMHSAs) national Women Co-occurring Disorders and Violence Study (WCDVS). According to previous literature, it was hypothesized that women in the WCDVS would be at high risk of perpetrating child abuse. This research examined mothers' potential for physical child abuse and assessed the association between child. abuse potential, current mental health symptoms, alcohol and drug use severity, and trauma. Results revealed that participants had significant potential for child abuse. Hierarchical regression analyses revealed that current mental health symptoms were the strongest predictor of mothers' scores on the Child Abuse Potential (CAP) Inventory. This study highlights the important relationships between commonly used instruments across the mental health, substance, and child welfare fields and the potential dual use of these instruments. Implications for policy and practice are discussed.

Ryan JP; Marsh JC; Testa MF; Louderman R. Integrating substance abuse treatment and child welfare services: Findings from the Illinois alcohol and other drug abuse waiver demonstration. Social Work Research 30(2): 95-107, 2006. (32 refs.)

Alcohol and other drug abuse is a major problem for children and families involved with public child welfare. Substance abuse compromises appropriate parenting practices and increases the risk of child maltreatment. A substantial proportion of substantiated child abuse and neglect reports involve parental substance abuse. Once in the system, children of substance-abusing families experience significantly longer stays in foster care and significantly lower rates of reunification. To address these problems, child welfare systems are developing service integration models that incorporate both substance abuse and child welfare services. This study provides an initial examination of the effectiveness of one service integration model that emphasizes the provision of intensive case management to link substance abuse and child welfare services. The authors used an experimental design and focused particular attention on two outcomes: access to substance abuse services and family reunification. The findings indicate that the families assigned to the experimental group used substance abuse services at a significantly higher rate and were more likely to achieve family