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CORK Bibliography: Child Abuse

55 citations. January 2006 to present

Prepared: September 2008

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

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

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

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

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

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

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.

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.

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

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

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

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

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.

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.

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

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

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.

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

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

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

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

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

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

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.

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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.

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

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

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.

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.

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

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

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

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

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 reunification than were families in the control group.

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

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

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

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

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

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

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

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

Stephenson R; Sheikhattari P; Assasi N; Eftekhar H; Zamani Q; Maleki B et al. Child maltreatment among school children in the Kurdistan Province, Iran. Child Abuse and Neglect 30(3): 231-245, 2006. (40 refs.)

Objective: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes. and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. Methods: Data were collected from 1,370 school students, age 11-18. Separate logistic models are fitted for six binary outcomes examining self-reported experiences of physical maltreatment in the home or school, mental maltreatment in the home or school, and child neglect in the home or school. Results: Male children were more likely to report experiencing any kind of child maltreatment than girls. Residency in a rural area, poor parental relationships and the use of addictive substances by household members were associated with increased odds of reporting child maltreatment. Poor school performance was associated with the reporting of experiencing maltreatment at school. Conclusion: Each of the forms of child maltreatment is highly correlated with socioeconomic, demographic, and living condition factors. The results point to the strong influence that familial factors have in shaping a child's likelihood of reporting maltreatment. Characteristics of the mother were associated with maltreatment, but not characteristics of the father. The results highlight a number of mechanisms through which public health interventions may seek to reduce the prevalence of child maltreatment in Kurdistan; different approaches are needed to reduce child maltreatment in the home and school environments.

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

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

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

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

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

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

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.

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

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

Widom CS; 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 and Drugs 68(3): 317-326, 2007. (67 refs.)

Objective: The purpose of this study was to determine the long-term effects of child abuse and neglect on alcohol use in middle adulthood. Method: Individuals with documented cases of childhood physical and sexual abuse and/or neglect (n = 500) and matched controls (n = 396) from a metropolitan county in the Midwest were followed and interviewed in middle adulthood. Outcomes were Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, 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.