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CORK Bibliography: Sexual Abuse

75 citations. January 2005 to present

Prepared: March 2009

Al Mamun A; Alati R; O'Callaghan M; Hayatbakhsh MR; O'Callaghan FV; Najman JM et al. Does childhood sexual abuse have an effect on young adults' nicotine disorder (dependence or withdrawal)? Evidence from a birth cohort study. Addiction 102(4): 647-654, 2007. (40 refs.)

Aims To examine whether there is evidence of an independent association between childhood sexual abuse (CSA) and nicotine disorder in youth and to explore the mechanisms underlying this association in a prospective cohort study. Design Birth cohort study followed-up to 21 years. Setting One of two major obstetric hospitals in Brisbane, Australia. Participants The Mater-University of Queensland Study of Pregnancy involves a prospective birth cohort from a population-based sample involving 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of a subgroup of 2571 youth who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up. Measurements Nicotine disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria and measures of CSA, including retrospective self-reports of rape, were obtained at 21 years. Results Of 2571 young adults, 16.6% met the criteria for either dependence (12.8%) or withdrawal (8.5%). Non-penetrative sexual abuse was reported by 15.5% of respondents and 8.0% reported penetrative sexual abuse. For any types of sexual abuse including non-penetrative, penetrative and self-reported rape before age 16 years, young adults had significantly higher rates of nicotine disorder than young adults who did not experience CSA. This relationship was independent and appeared direct after adjustment for a range of potential confounding and mediating factors. Conclusions This study shows that CSA is associated with young adult nicotine disorder. The results extend the public health significance of findings in this area and highlight the importance of not only intensifying public health efforts to address substance use problems among those who have experienced CSA, but of early intervention, so that emerging risky behaviours may be targeted in the earliest stages.

Amos C; Peters RJ; Williams L; Johnson RJ; Martin Q; Yacoubian GS. The link between recent sexual abuse and drug use among African American male college students: It's not just a female problem in and around campus. Journal of Psychoactive Drugs 40(2): 161-166, 2008. (26 refs.)

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p <= 0.001) and past 30 day (OR = 5.0, p <= 0.001) drug use.

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.

Balousek S; Plane MB; Fleming M. Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain. Journal of General Internal Medicine 22(9): 1268-1273, 2007. (24 refs.)

Background: Interpersonal abuse is associated with clinical problems including chronic pain disorders. Objectives: The objective of this study is to describe 30-day and lifetime prevalence of emotional, physical, and sexual abuse found in men and women prescribed opioids for chronic pain. Design: Cross-sectional interview is the design of this study. Participants: Patients, 1,009, currently prescribed opioids for chronic noncancer pain. They were recruited from the practices of 235 Family Physicians and Internists in Wisconsin. The most common pain diagnoses were arthritis, low back pain, headache, and fibromyalgia/myofascial pain. Measurement: Data for this secondary analysis on rates of interpersonal abuse were based on 3 questions from the Addiction Severity Index (ASI) regarding 30-day and lifetime emotional, physical, and sexual abuse. Results: Forty-seven percent of women and 22% of men reported a history of lifetime physical abuse. Thirty -five percent of women and 10% of men reported lifetime sexual abuse. Binary logistic regression identified the following variables associated with lifetime physical abuse: female gender (RR 2.81, CI 2.01-3.94), age 31-50 (RR1.77, CI 1.30-2.41), Caucasian (RR1.67, CI 1.19-2.35), increased psychiatric symptoms as measured by the ASI (RR 2.14, CI 1.56-2.94), and lifetime suicide attempts (RR 3.98, CI 2.76-5.74). Conclusions: This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.

Baltieri DA; de Andrade AG. Drug consumption among sexual offenders against females. International Journal of Offender Therapy and Comparative Criminology 52(1): 62-80, 2008. (65 refs.)

This article aims to evaluate the role of drug consumption among sexual offenders against females. Three groups of participants (N = 133) comprising sexual offenders against girls, pubertal females, and women were examined with reference to history of drug and/or alcohol use, impulsivity level, sexual addiction, and recidivism risk. Sexual offenders against women were found to have significantly more difficulties with drug use, higher impulsivity level, and to be younger than the sexual offenders against girls and pubertal females. The combination of drug consumption and higher level of impulsivity may contribute to sexual aggression against adult females.

Bartholomew NG; Courtney K; Rowan-Szal GA; Simpson DD. Sexual abuse history and treatment outcomes among women undergoing methadone treatment. Journal of Substance Abuse Treatment 29(3): 231-235, 2005. (21 refs.)

Women entering drug abuse treatment programs who report a history of sexual abuse are also likely to report poorer psychosocial functioning, more drug-related problems, and more family-of-origin problems. This study investigates outcome differences at follow-up between women with and those without sexual abuse histories who were treated at an outpatient methadone treatment program. Follow-up interviews were conducted with 98 women, 40% of whom reported prior sexual abuse. Those with a history of sexual abuse who reported problems at intake with psychosocial functioning and family support continued to report such problems at follow-up as compared with the women without a history of sexual abuse. However, no difference was found at follow-up between women with and those without sexual abuse histories in terms of drug use, employment, criminality, or HIV-risky behaviors. The findings suggest that sexual abuse history alone cannot predict treatment outcomes for women in methadone treatment. The implications of these findings are discussed in terms of treatment process and services.

Belenko S; Lin J; O'Connor L; Sung HE; Lynch KG. Sexual and physical victimization as predictors of HIV risk among felony drug offenders. AIDS and Behavior 9(3): 311-323, 2005. (78 refs.)

Injection and other drug use and high-risk sexual behaviors put criminal offenders at increased risk for HIV infection. Studies in other populations, especially females, have found that a history of sexual or physical victimization increases engagement in HIV-risk behaviors, and drug-involved offenders have high rates of such prior victimization. However, there has been little research among male offenders. In a sample of 247 male felony drug offenders in New York City, prior sexual victimization was related to a higher number of sex partners and lower proportion of protected sex acts in the 30 days before arrest. Prior physical abuse was related to cocaine injection, but not heroin injection or high-risk sex behaviors. These results suggest a complex relationship between sexual and physical abuse and HIV risk among male offenders. Assessing for specific prior abuse histories of offenders and providing targeted interventions may be useful for developing more effective primary and secondary HIV prevention services for this high-risk population.

Branstetter SA; Bower EH; Kamien J; Amass L. A history of sexual, emotional, or physical abuse predicts adjustment during opioid maintenance treatment. Journal of Substance Abuse Treatment 34(2): 208-214, 2008. (37 refs.)

This study examined how having a history of sexual, physical, or emotional abuse is related to overall functioning as assessed by the Addiction Severity Index during short-term opioid maintenance treatment with either buprenorphine/naloxone or methadone. Furthermore, the relation between abuse history and overall functioning by sex was explored. Participants (N = 268) were opioid-dependent adults entering an outpatient randomized clinical trial with buprenorphine/naloxone and methadone. Latent growth modeling indicated that females with an abuse history entered treatment with more problems in the psychiatric and family domains as compared with females without an abuse history. Over the course of treatment, a history of abuse predicted problems in the psychiatric and alcohol domains. Furthermore, a history of abuse predicted slower recovery times and less recovery overall for females in some domains. Males with an abuse history entered treatment with more severe psychiatric and family problems as compared with males with no history of abuse. Victims of abuse may present to substance abuse treatment with weaknesses in the areas of family relations, psychiatric status, and alcohol use. The nature of these problems and their trajectory over time differed by sex.

Brown VB; Najavits LM; Cadiz S; Finkelstein N; Heckman JP; Rechberger E. Implementing an evidence-based practice: Seeking Safety group. Journal of Psychoactive Drugs 39(3): 231-240, 2007. (24 refs.)

This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.

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

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

Callaghan RC; Cull R; Vettese LC; Taylor L. A gendered analysis of Canadian aboriginal individuals admitted to inpatient substance abuse detoxification: A three-year medical chart review. (review). American Journal on Addictions 15(5): 380-386, 2006. (44 refs.)

This study examined gender differences within a sample of Canadian Aboriginal individuals admitted to an inpatient, hospital-based substance abuse detoxification program. Even though alcohol was the most frequent primary drug of detoxification for both genders, women received proportionately higher rates of cocaine or opiate detoxification diagnoses. In addition to a younger age, females reported higher rates of physical and sexual abuse. Women were also administered antidepressants, antibiotic medication protocols, and more medical evaluation tests. It appears that Canadian Aboriginal women have a diverse set of psychological and medical needs. This study demonstrates the need for detoxification programs to address the substantial rates of intravenous drug use and the associated risk of infectious disease (eg, Hepatitis C, HIV) among this treatment-seeking population.

Charney DA; Palacios-Boix J; Gill KJ. Sexual abuse and the outcome of addiction treatment. American Journal on Addictions 16(2): 93-100, 2007. (27 refs.)

The objective of this prospective follow-up study was to examine the effects of sexual abuse on substance use disorder patients' clinical presentation and course in treatment. Consecutive admissions to the MUHC's Addictions Unit were assessed at intake (N = 206) and six-month follow-up (n = 172). Assessments evaluated socio-demographic and psychiatric characteristics, addiction severity, and physical and/or sexual abuse histories. Upon entering treatment, 23% reported prior sexual abuse with or without physical abuse. Patients with a sexual abuse history had higher rates of psychological problems, stronger family histories of substance use disorders, and more impaired family relationships. At six months, there were no differences between patients with and without sexual abuse histories in their response to treatment, or their utilization of treatment services. The current study failed to show that prior sexual abuse compromised short-term treatment outcomes.

Christensen RC; Hodgkins CC; Garces LK; Estlund KL; Miller MD; Touchton R. Homeless, mentally ill and addicted: The need for abuse and trauma services. Journal of Health Care for the Poor and Underserved 16(4): 615-621, 2005. (17 refs.)

This paper examines an empirical investigation of the lifetime prevalence of trauma (defined as sexual and/or physical abuse) in a cohort of adults enrolled in a federally funded initiative that provides treatment for homeless persons suffering the effects of comorbid substance use and serious mental illness, and considers the impact of this information on clinical programming. Data collected from homeless individuals with co-occurring disorders admitted to the Seeking Treatment and Recovery (STAR) Program during a one year period (n=78) were analyzed for a history of trauma events. Of those individuals evaluated, 79.5% (62/78) acknowledged a history of either physical and/or sexual abuse at some time in their lifetimes. Of this population, 100% of the homeless women (27/27) with co-occurring disorders had experienced a life-altering traumatic event while 68.6% (35/51) of the homeless men also reported trauma histories. We describe the trauma-based interventions made in the STAR Program that have the potential for replication in other initiatives committed to serving homeless individuals with co-occurring disorders.

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.

Dube SR; Anda RF; Whitfield CL; Brown DW; Felitti V; Dong MX; Giles WH. Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine 28(5): 430-438, 2005. (55 refs.)

Background: Childhood sexual abuse (CSA) is a worldwide problem. Although most studies on the long-term consequences of CSA have focused on women, sexual abuse of both boys and girls is common. Thus, a comparison of the long-term effects of CSA by gender of the victim will provide perspective on the need for future research, prevention activities, and treatment of survivors. Methods: A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined. Results: Contact CSA was reported by 16% of males and 25% of females. Men reported female perpetration of CSA nearly 40% of the time, and women reported female perpetration of CSA 6% of the time. CSA significantly increased the risk of the outcomes. The magnitude of the increase was similar for men and women. For example, compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA (p < 0.05). Compared with those who did not report CSA, men and women exposed to CSA were at a 40% increased risk of marrying an alcoholic, and a 40% to 50% increased risk of reporting current problems with their marriage (p < 0.05). Conclusions: In this cohort of adult HMO members, experiencing CSA was common among both men and women. The long-term impact of CSA on multiple health and social problems was similar for both men and women. These findings strongly indicate that boys and girls are vulnerable to this form of childhood maltreatment; the similarity in the likelihood for multiple behavioral, mental, and social outcomes among men and women suggests the need to identify and treat all adults affected by CSA.

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.

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.

Eastwood EA; Birnbaum JM. Physical and sexual abuse and unstable housing among adolescents with HIV. AIDS and Behavior 11(6, Supplement S): S116-S127, 2007. (63 refs.)

Stable housing is a necessary component of treatment of adolescents with HIV. This study examines the housing status at two points in time of a sample of 224 adolescents with HIV seen at an adolescent medicine clinic in New York City. It addresses whether unstable housing is associated with several forms of abuse, and what factors predict continued instability. 38.6% (n = 86) had a prior history of unstable housing, reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting current and prior unstable housing revealed two variables related to both outcomes: physical abuse and referral from youth/social services entities. Continued unstable housing was associated with all abuse variables and adolescent history of arrest. When adolescents in abusive situations come to the attention of programs for youth, they have a positive impact on transitioning most adolescents to safer households, potentially improving adolescents' accessing of health care services.

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

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

Firestone P; Dixon KL; Nunes KL; Bradford JM. A comparison of incest offenders based on victim age. Journal of the American Academy of Psychiatry and the Law 33(2): 223-232, 2005. (45 refs.)

The purpose of the present study was to compare incest offenders (IOs) whose victims include infants or toddlers to IOs with adolescent victims on several variables commonly examined in the sexual offender literature. Participants were 48 men whose youngest victim was less than 6 years of age (younger-victim incest offenders; YVs); and 71 men whose youngest victim was 12 to 16 years of age (older-victim incest offenders (OVs). In general, YVs showed more emotional disturbance and pathology than OVs. Compared with OVs, YVs had a greater history of substance abuse and more current problems with alcohol. In addition, YVs reported significantly poorer sexual functioning and were significantly more psychiatrically disturbed. YVs were also more likely to have a male victim, to have victimized a nephew/niece or grandson/granddaughter, and to have denied their offense(s). It was evident that both the YVs and OVs demonstrated clinically significant difficulty with normal sexual functioning and exhibited deviant sexual arousal.

Gilchrist G; Gruer L; Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland (rapid communication). Addictive Behaviors 30(5): 1019-1023, 2005. (8 refs.)

Aims: To compare psychiatric morbidity between 176 female drug users with lifetime involvement in prostitution (prostitutes) and 89 female drug users with no involvement (non-prostitutes) in Glasgow, Scotland. Method: The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. Results: Prostitutes were more likely to report adult physical (OR 1.8) or sexual abuse (OR 2.4), to have attempted suicide (OR 1.7) and to meet criteria for current depressive ideas (OR 1.8) than non-prostitutes. Seventy-two percent of prostitutes and sixty-seven percent of non-prostitutes met criteria for a level of current neurotic symptoms likely to need treatment (CIS-R �18). Being in foster care (OR 8.9), being prescribed medication for emotional problems in the last 30 days (OR 7.7), adult sexual abuse (OR 4.5), poly drug use in the last 30 days (OR 3.6) and adult physical abuse (OR 2.6) were significantly associated with a CIS-R score of �18 for prostitutes using multiple logistic regression. Conclusions: Higher rates of adulthood abuse among prostitutes may explain the greater proportion of prostitutes than non-prostitutes meeting criteria for current depressive ideas and lifetime suicide attempts.

Henny KD; Kidder DP; Stall R; Wolitski RJ. Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior 11(6): 842-853, 2007. (51 refs.)

We examined the prevalence and risks associated with interpersonal (physical and sexual) abuse among HIV-seropositive homeless or unstably housed adults. Data were obtained from the Housing and Health Study of participants living in Baltimore, Chicago, and Los Angeles (n = 644). We used logistic regression to identify risks associated with abuse. About 77% of men and 86% of women reported ever experiencing abuse. Women were at greater risk than men for intimate partner physical abuse, childhood sexual abuse (CSA), and adulthood sexual abuse. Men and women experiencing intimate partner physical abuse reported increased risk of unprotected sex. Other risks associated with abuse include sex exchange; lifetime alcohol abuse; and depressive symptoms. Abuse prevalence among sample exceeds those found in other samples of general USA, HIV-seropositive, and homeless populations. Identifying persons at risk of abuse is needed to reduce risk among homeless or unstably housed persons living with HIV.

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.

Jun HJ; Rich-Edwards JW; Boynton-Jarrett R; Wright RJ. Intimate partner violence and cigarette smoking: Association between smoking risk and psychological abuse with and without co-occurrence of physical and sexual abuse. American Journal of Public Health 983(3): 527-535, 2008. (59 refs.)

Objectives. We examined the association between psychological abuse in a current relationship and current cigarette smoking among women, with and without the co-occurrence of physical or sexual abuse. Methods. Women's experience of psychological abuse, experience of physical or sexual abuse, and smoking status were ascertained through a survey of female nurses. A score of 20 or more on the Women's Experience With Battering scale defined psychological abuse. We used logistic regression to predict current smoking, adjusting for demographic and social covariates. Analyses included women in a current relationship (n = 54 200). Results. Adjusted analyses demonstrated that women experiencing only psychological abuse alone were 33% (95% confidence interval [CI] = 13%, 57%) more likely to smoke than nonabused women. Compared with nonabused women, psychologically abused women's risk of smoking was greater if they reported a single co-occurrence of physical or sexual abuse (odds ratio [OR] = 1.5; 95% CI = 1.3, 1.8) or multiple co-occurrences (OR = 1.9; 95% CI = 1.7, 2.3). Conclusions. Psychological abuse in a current relationship was associated with an increased risk of smoking in this cohort of largely White, well-educated, and employed women. The co-occurrence of physical or sexual abuse enhanced that risk. Further research is needed to see if these associations hold for other groups.

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.

Kaukinen C; DeMaris A. Age at first sexual assault and current substance use and depression. Journal of Interpersonal Violence 20(10): 1244-1270, 2005. (77 refs.)

This article explores how the association between sexual violence and substance use and mental health differs by race and life course stage. Analyses are based on data (n = 8,000) from the Violence and Threats of Violence against Women and Men in the United States Survey, 1994-1996 (NVAWS). Although sexual violence does not heighten the risk of problem drinking for White women, minority women victimized in adulthood are significantly more likely to engage in problem drinking and use illicit drugs. This suggests that for minority women the effects of recent victimization experiences result in immediate and potentially long-lasting consequences. The findings with respect to the association between sexual violence and depression are consistent with the child and adolescent development literature. It is Hispanic women who are more likely to suffer depression as a consequence of child sexual assault.

Kerr-Correa F; Igami TZ; Hiroce V; Tucci AM. Patterns of alcohol use between genders: A cross-cultural evaluation. (review). Journal of Affective Disorders 102(1-3): 265-275, 2007. (101 refs.)

Introduction: Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes. Method: A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books. Results and conclusions: Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders.

Kim HS; Kim HS. Aggression among Korean adolescents: A comparison between delinquents and nondelinquents. Social Behavior and Personality 35(4): 499-512, 2007. (31 refs.)

In this study family dynamics, personality, alcohol and drug abuse, coping strategies and sexual abuse in nondelinquent and delinquent adolescents were compared and a path model of aggression among Korean adolescents was constructed. Using a proportional stratified random sampling method, a sample of 2,100 Korean adolescents was assessed. Data were collected using a cross-sectional design, via anonymous, self-reporting questionnaires. Delinquent adolescents were found to have a higher incidence of dysfunctional family dynamics, greater incidence of antisocial personality, higher tendency to depression, and higher levels of aggressive impulsiveness than nondelinquent adolescents. Delinquent adolescents reported higher incidences of being sexually abused, and alcohol and drug abuse, and showed a greater tendency toward cognitive and behavioral avoidance coping strategies compared to nondelinquent adolescents. Person-related aggressive impulsiveness, antisocial personality tendency, and self-injurious aggressive impulsiveness had the largest significant total effects on aggressive behavior among Korean adolescents.

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.

King G; Guilbert P; Ward DG; Arwidson P; Noubary F. Correlates of sexual abuse and smoking among French adults. Child Abuse and Neglect 30(6): 709-723, 2006. (45 refs.)

OBJECTIVE: The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France. METHOD: A random sample size of 12,256 adults (18-75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status-for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted. RESULTS: Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons (p<.001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, p<.01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard=1.55; p<.0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12-2.99) more likely to quit smoking than people who began smoking after they were sexually abused. CONCLUSIONS: The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.

Kintz P; Villain M; Cheze M; Pepin G. Identification of alprazolam in hair in two cases of drug-facilitated incidents. Forensic Science International 153(2-3): 222-226, 2005. (9 refs.)

The use of a drug to modify a person's behaviour for criminal gain is not a recent phenomenon. However, the recent increase in reports of drug-facilitated crimes (sexual assault, robbery) has caused alarm by the general public. Among the drugs that can be used, alprazolam (Xanax), an anxiolytic benzodiazepine, has been seldom observed. To document two cases involving this drug, we have developed an approach based on hair testing by LC-MS/MS. After pH 8.4 buffer incubation and extraction with methylene chloride/diethyl ether (80/20, v/v), hair extracts were separated on a XTerra MS C18 column using a gradient of acetonitrile and formate buffer. Alprazolam and diazepam-d(5), used as internal standard, were detected by electospray tandem mass spectrometry. In the first criminal case, alprazolam tested positive in two consecutive 2 cm hair segments at 4.9 and 2.4 pg/mg, from a 12-year-old girl, assaulted by her father who had sedated her three or four times. In the other case, alprazolam was detected in four consecutive 1 cm hair segments at 3.1-0.4 pg/mg, obtained from an adolescent who had been forced to prostitute herself.

Klanecky AK; Harrington J; McChargue DE. Child sexual abuse, dissociation, and alcohol: Implications of chemical dissociation via blackouts among college women. American Journal of Drug and Alcohol Abuse 34(3): 277-284, 2008. (24 refs.)

The present study examined whether childhood sexual trauma moderated the relationships between dissociation and both problematic college drinking and alcohol-induced blackouts among a sample of college females (N = 156). Cross-sectional data were consistent with the moderation hypotheses. Simple effects showed that the relationship between dissociation and blackout frequency as well as problematic drinking only existed among those with sexual trauma histories (p < .035), but not among those reporting no sexual trauma exposure (p = .333). Findings implicate the use of alcohol as a possible maladaptive coping mechanism among college females with childhood sexual trauma.

Kolodziej ME; Griffin ML; Najavits LM; Otto MW; Greenfield SF; Weiss RD. Anxiety disorders among patients with co-occurring bipolar and substance use disorders. Drug and Alcohol Dependence 80(2): 251-257, 2005. (35 refs.)

Bipolar and substance use disorders are known to co-occur frequently, but limited attention has been paid to anxiety disorders that may accompany this dual diagnosis. Therefore, we examined the prevalence and nature of anxiety disorders among treatment-seeking patients diagnosed with current bipolar and substance use disorders, and investigated the association between anxiety disorders and substance use. Among 90 participants diagnosed with bipolar disorder I (it = 75, 78%) or 11 (n = 15, 22%), 43 (48%) had a lifetime anxiety disorder, with post-traumatic stress disorder (PTSD) occurring most frequently (it = 21, 23%). We found that those with PTSD, but not with the other anxiety disorders assessed, began using drugs at an earlier age and had more lifetime substance use disorders, particularly cocaine and amphetamine use disorders, than those without PTSD. Further examination revealed that (1) most participants with PTSD were women, (2) sexual abuse was the most frequently reported index trauma, and (3) the mean age of the earliest index trauma occurred before the mean age of initiation of drug use. Our findings point to the importance of further investigating the ramifications of a trauma history among those who are dually diagnosed with bipolar and substance use disorders.

Kueppenbender K; Herman J; Khantzian E; Albanese M. "Narcotics helped, I thought." Recurrent traumatization and recovery from drug dependence. Harvard Review of Psychiatry 16(5): 308-317, 2008. (45 refs.)

The article presents a case study of a 34-year-old woman with the history of sexual abuse in childhood and rape in adolescence. The patient is struggling with opioid dependence, alcohol abuse, and anxiety related to past and ongoing abuse. The patient was prescribed the opioid antagonist natrexone and engaged in outpatient treatment in the addiction service. Further, she has established a significant period of recovery with the buprenorphine/naloxone combination and group treatment.

Larson MJ; Miller L; Becker M; Richardson E; Kammerer N; Thom J; Gampel J et al. Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders. Journal of Behavioral Health Services & Research 32(2): 128-140, 2005. (40 refs.)

This article documents the physical health burdens of participants in a large, federally funded cross-site study of specialized services for women with histories of trauma (physical or sexual abuse) and co-occurring substance abuse and mental health disorders. Nearly half of the 2729 women in the study (48%) reported serious physical illnesses that frequently limited their daily life activities or required them to use special equipment. Nearly half (46%) rated their health status as only fair or poor. Given the prevalence of physical illnesses in this population, behavioral service providers should discuss with clients their overall health and how it might hinder their participation in treatment for trauma, substance abuse, and mental illness, and policymakers should consider this need when designing behavioral health requirements, setting reimbursement rates, and allocating funds.

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.

Littleton H; Breitkopf CR; Berenson A. Sexual and physical abuse history and adult sexual risk behaviors: Relationships among women and potential mediators. Child Abuse and Neglect 31(7): 757-768, 2007. (36 refs.)

Objective: While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors. Methods: A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior. Results: A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology. Conclusions: Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology.

Lloyd JJ; Ricketts EP; Havens JR; Cornelius LJ; Bishai D; Huettner S et al. The relationship between lifetime abuse and suicidal ideation in a sample of injection drug users. Journal of Psychoactive Drugs 39(2): 159-166, 2007. (34 refs.)

This study examined the relationship between lifetime abuse and suicidal ideation in a sample of 245 injection drug users (IDUs) who attended the Baltimore Needle Exchange Program and received a referral for opiate agonist therapy. Data were obtained from baseline interviews and HIV antibody tests. The sample mean age was 42.2 (SD = 8.1); 77% were African American; 69% were male. Overall, 27% reported thoughts of suicide in the last six months, and lifetime emotional, physical and sexual abuse was reported by 17%, 12% and 10%, respectively. In bivariate analyses, recent suicidal ideation was associated with emotional (odds ratio [OR] = 3.2; p = 0.001), physical (OR = 2.5; p = 0.026), and sexual abuse (OR = 5.0; p < 0.001). In multiple logistic regression models controlling for HIV status and Center for Epidemiological Studies Depression (CES-D) score, individuals who experienced emotional abuse were more than twice as likely to report recent suicidal ideation (adjusted odds ratio [AOR] = 2.6; p = 0.011); those who experienced sexual abuse were four times more likely to report suicidal ideation (AOR = 4.0; p = 0.004). These findings suggest that emotional and sexual abuse might be risk factors for suicidality among IDUs and also might suggest that suicide prevention should be an integral part of drug treatment for treatment-seeking IDUs.

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

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

Martin Q; Peters RJ; Amos CE; Yacoubian GS; Johnson RJ; Meshack A et al. The relationship between sexual abuse and drug use: A view of African-American college students in Texas. Journal of Ethnicity in Substance Abuse 4(1): 23-33, 2005. (26 refs.)

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were 4 times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.

McHugo GJ; Caspi Y; Kammerer N; Mazelis R; Jackson EW; Russell L et al. The assessment of trauma history in women with co-occurring substance abuse and mental disorders and a history of interpersonal violence. Journal of Behavioral Health Services & Research 32(2): 113-127, 2005. (19 refs.)

The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a large (N = 2729) multisite study of the effectiveness of integrated and trauma-informed services for women with substance use and mental health disorders and a history of interpersonal violence (physical or sexual abuse). Study participants' exposure to lifetime and current traumatic events was assessed at baseline and follow-up via in-person interviews. This article describes the choice of the Life Stress or Checklist-Revised (LSC-R) to assess trauma history to meet the WCDVS's research aims and to respond to consumer input. Quantitative data address the breadth and prevalence of potentially traumatic events in the past and current lives of study participants, the formation and properties of summary measures, and test-retest reliability. Qualitative data address tolerance of the instrument by interviewers and respondents and the generalizability of quantitative findings about trauma prevalence. Finally, recommendations are offered for improvements to the WCDVS version of the LSC-R for use in future research.

McKeganey N; Neale J; Robertson M. Physical and sexual abuse among drug users contacting drug treatment services in Scotland. Drugs: Education, Prevention and Policy 12(3): 223-2232, 2005. (18 refs.)

To date there has been no previous attempt to identify the extent of physical and sexual abuse among drug users in Scotland. Using data from a prospective study of the effectiveness of drug treatment agencies in Scotland this paper reports information on the extent of abuse among drug users coming forward for drug treatment. Overall nearly two thirds (61.9%) of female drug users contacting drug treatment services in Scotland report having been physically abused and over a third (35.5%) report having been sexually abused. Among male drug users contacting drug treatment services in Scotland just under a quarter (22.3%) report having been physically abused and 6.9% report having been sexually abused. On the basis of a multivariate analysis, past abuse was seen to be associated with a range of factors including: earlier age of onset of drug problems, having attempted suicide or self-harmed, having overdosed, and having paid or sold sex in the last 12 months. There is a clear need to ensure that drug treatment services within Scotland have access to staff trained in supporting those who have experienced abuse in the past and those who are currently within an abusive relationship.

McMillan GP; Hanson T; Bedrick EJ; Lapham SC. Using the bivariate dale model to jointly estimate predictors of frequency and quantity of alcohol use. Journal of Studies on Alcohol 66(5): 688-692, 2005. (19 refs.)

Objective: This study demonstrates the usefulness of the Bivariate Dale Model (BDM) as a method for estimating the relationship between risk factors and the quantity and frequency of alcohol use, as well as the degree of association between these highly correlated drinking measures. Method: The BDM is used to evaluate childhood sexual abuse, along with age and gender, as risk factors for the quantity and frequency of beer consumption in a sample of driving-while-intoxicated (DWI) offenders (N = 1,964; 1,612 men). The BDM allows one to estimate the relative odds of drinking up to each level of ordinal-scaled quantity and frequency of alcohol use, as well as model the degree of association between quantity and frequency of alcohol consumption as a function of covariates. Results: Individuals who experienced childhood sexual abuse have increased risks of higher quantity and frequency of beer consumption. History of childhood sexual abuse has a greater effect on women, causing them to drink higher quantities of beer per drinking occasion. Conclusions: The BDM is a useful method for evaluating predictors of the quantity-frequency of alcohol consumption. SAS macrocode for fitting the BDM model is provided.

Mehrabadi A; Paterson K; Pearce M; Patel S; Craib KJP; Moniruzzaman A et al. Gender differences in HIV and hepatitis C related vulnerabilities among aboriginal young people who use street drugs in two Canadian cities. Women & Health 48(3): 235-260, 2008. (47 refs.)

Objectives: Vulnerability to HIV and Hepatitis C virus (HCV) infection for indigenous populations worldwide must be contextualized in experiences of current and past trauma. Aboriginal women entrenched in poverty face further gender-specific harms which place them at increased risk for HIV infection. Methods: This study was cross-sectional and based on a community-based sample of Aboriginal young people (Metis, Aboriginal, First Nations, Inuit, and non-status Indians) between the ages of 14 and 30 years who used injection or non-injection non-cannabis illegal drugs (street drugs) in the previous month. Between October 2003 and July 2005, 543 participants living in either Vancouver or Prince George, Canada, were recruited by word of mouth, posters, and street outreach. Young people in the study completed a questionnaire administered by Aboriginal interviewers. Female participants (n = 262) were compared to male participants (n = 281) with respect to sociodemographics, trauma, sexual risk variables, and drug use patterns. Trained nurses drew blood samples for HIV and HCV antibodies and provided pre- and Post-test counseling. Results: Proportions positive for HIV and HCV were significantly higher among young women. HIV was 13.1% [9.5, 1.7.7] in women compared to 4.3% [2.5, 7.4] in men, and HCV was 43.6% [37.6, 49.8] in women as compared to 25.4% [20.5, 30.9] in men. When the analysis was restricted to young people who reported injection drug use, the proportions positive for HIV and HCV remained significantly higher among young women. Experiences of forced sex were reported by 70% of young women compared to 29% of young men, p < 0.001, while the median age of first forced sex was 6-years-old for both men and women. Discussion: The results of the final model indicated that HIV had been associated with residing in Vancouver, having injected for longer, and sexual abuse, but not being female. However, this gendered analysis demonstrated that a greater proportion of young women were experiencing sexual abuse, and sexual abuse was associated with HIV positive status. Harm reduction and drug treatment programs are urgently required that target women at a young age and address complex traumatic experiences associated with childhood sexual abuse.

Morrissey JP; Ellis AR; Gatz M; Amaro H; Reed BG; Savage A. Outcomes for women with co-occurring disorders and trauma: Program and person-level effects. Journal of Substance Abuse Treatment 28(2): 121-133, 2005. (35 refs.)

Six-month outcomes are evaluated from a 9-site quasi-experimental study of women with mental health and substance use disorders who have experienced physical or sexual abuse who enrolled in either comprehensive, integrated, trauma-informed, and consumer/survivor/recovering person-involved services (N= 1023) or usual care (N= 983). Mental health, post-traumatic stress symptoms, and substance use outcomes are assessed with multilevel regression models, controlling for program and personal characteristics. Person-level variables predict outcomes independent of intervention condition and, to a small extent, moderate intervention and program effects. In sites where the intervention condition provided more integrated counseling than the comparison condition, there are increased effects on mental health and substance use outcomes; these effects are partially mediated by person-level variables. These results encourage further research to identify the longer-term effects of integrated counseling for women with co-occurring disorders and trauma histories.

Nehls N; Sallmann J. Women living with a history of physical and/or sexual abuse, substance use, and mental health problems. Qualitative Health Research 15(3): 365-381, 2005. (70 refs.)

Most researchers have studied physical and/or sexual abuse, substance use, and mental health problems separately or as a dual diagnosis, and from a theory-driven, empirical perspective. In this study, the authors examined these three phenomena together and from a phenomenological perspective. Thirty women each participated in an individual interview about living with a history of physical and/or sexual abuse, substance use, and mental health problems. Using a hermeneutic approach, a team of researchers analyzed the transcribed interview texts. They identified three themes: (a) being thrown: the cycle of abuse; (b) living life fearfully: a restricted world; and (c) helping: hearing my story. The results are significant, in that they challenge current assumptions underlying health care for women with histories of physical and/or sexual abuse, substance use, and mental health problems.

Nelson EC; Heath AC; Lynskey MT; Bucholz KK; Madden PAF; Statham DJ et al. Childhood sexual abuse and risks for licit and illicit drug-related outcomes: A twin study. Psychological Medicine 36(10): 1473-1483, 2006. (45 refs.)

Background. This study examined the relationships between self-reported childhood sexual abuse (CSA) and drug-related outcomes in an Australian twin panel. Method. A semi-structured psychiatric interview was conducted in 1996-2000 by telephone with young adult Australian twins (mean age 29.9 years). Data reported here are from 6050 twins who responded to both CSA and drug-related items. Results. A history of CSA was associated with significant risk for subsequently occurring regular smoking and use of each illicit drug class. Further CSA-associated risk was found among regular users, for nicotine and alcohol dependence, and among illicit drug users, for abuse/dependence of most drug classes. In same-sex discordant pairs, significant risk for regular smoking and illicit drug use was found in twins with a history of CSA compared to their non-abused co-twins. Similar analyses for abuse/dependence found significant risk for opioids, any illicit drug, and any noncannabis illicit drug. CSA was associated with significantly earlier drug use. Despite the association of CSA with risk for early-onset cannabis use and regular smoking, risks for illicit drug outcomes associated with CSA and with either form of early-onset use combine in near-additive fashion. Conclusions. CSA is associated with risk for subsequently occurring regular smoking and illicit drug use and abuse/dependence. Risks for drug use are mildly attenuated with control for familial contributions; similar risks for abuse/dependence remain significant for opioids and for illicit drugs combined across classes. Although we found evidence of earlier onset drug use with CSA, risks associated with CSA and with early-onset use combine in a largely additive manner.

Nilsson KW; Sjoberg RL; Wargelius HL; Leppert J; Lindstrom L; Oreland L. The monoamine oxidase A (MAO-A) gene, family function and maltreatment as predictors of destructive behaviour during male adolescent alcohol consumption. Addiction 102(3): 389-398, 2007. (41 refs.)

Aim To investigate possible interactions between a polymorphism in the monoamine oxidase A (MAO-A) gene promoter, family relations and maltreatment/sexual abuse on adolescent alcohol-related problem behaviour among male adolescents. Design, setting and participants A cross-sectional study of a randomized sample of 66 male individuals from a total population of 16- and 19-year adolescents from a Swedish county. Boys, who volunteered to participate answering an alcohol-related problem/ behaviour questionnaire, were investigated with regard to interactions between such problems, family function, maltreatment and MAO-A genotype. Measurements MAO-A genotype, family relations history, history of being maltreated or abused and alcohol-related problem behaviour. Findings: Boys with the short (three-repeat) variant of the MAO-A gene, who had been maltreated/abused or came from families with poor relations, showed significantly higher scores of alcohol-related problems. We also found that maltreatment/ abuse independently showed the strongest relation to alcohol-related problems among boys in our model. Conclusions: The results suggest that both maltreatment and MAO-A genotype may be useful for the understanding of male adolescent alcohol-related problem behaviour.

O'Connell JM; Novins DK; Beals J; Whitesell N; Libby AM; Orton HD; AI-SUPERPFP Team. Childhood characteristics associated with stage of substance use of American Indians: Family background, traumatic experiences, and childhood behaviors. Addictive Behaviors 32(12): 3142-3152, 2007. (13 refs.)

The purpose of this analysis is to examine childhood characteristics associated with stage of substance use in adulthood in two American Indian (AI) populations. Data were drawn from an epidemiologic study of two AI reservation populations for persons age 18-44 years (n = 2070). We used descriptive and multivariate analysis to examine correlates of four mutually exclusive stages of substance use: lifetime abstinence (Stage 0), use of alcohol only (Stage 1A), use of marijuana/inhalants with or without alcohol (Stage 1B), and use of other illicit drugs with or without the previously listed substances (Stage 2). Problematic substance use by parents, younger age of first substance use, initiating substance use with a drug (with or without alcohol), and adolescent conduct problems were associated with higher stage substance use. Persons who experienced sexual abuse, witnessed family violence, or experienced other traumatic events before the age of 18 were more likely to be at Stage 1B than Stage 1A

Olley BO. Social and health behaviors in youth of the streets of Ibadan, Nigeria. Child Abuse and Neglect 30(3): 271-282, 2006. (31 refs.)

Objectives: This study documents the extent and impact of perceived patterns of behavior in a sample of youths of the streets of Ibadan, Nigeria, with the purpose of implementing a Life Skills Educational (LSE) intervention. Method: The study uses both qualitative and quantitative methods of data collection. Qualitatively, two Focus Group Discussions (FGD) and two in-depth interviews (IDI) with 20 boys and 2 community leaders were conducted on separate occasions for the purpose of eliciting commonly exhibited behaviors and patterns of street youth. Quantitatively, 169 youths (89.3% male) were consecutively interviewed from five subcultural areas in Ibadan, Nigeria. Street youths were accessed through a snowballing technique made possible by "Area boys" (AB, adults, who serve as a symbol of authority for street children). Results: The mean age of participants was 18.4 years. The majority was on the street for financial reasons, had been on the street for more than 1 year, and had not completed their primary schooling. While youths of the street were economically viable, 69% had a history of alcohol abuse, 14% of drug abuse, and 24% operated as drug couriers; 46% reported school refusal, 27% school suspension, and 47% school truancy. Forty-nine percent admitted to being sex workers and 11% had been raped and were, therefore, at risk of contacting sexually transmitted diseases (STD). One-third of youths had been arrested for various offenses, including street fighting and drug use. While females were in the minority, they were more likely to engage in antisocial behaviors compared with boys. Conclusions: Although many youths of the street display antisocial behaviors, they also are an economically viable group. Some of their antisocial behaviors may have been exhibited within the context of economic survival. Implementing a life skill program to address these antisocial behaviors may help to increase the well being of street youths in developing countries in Africa.

Ompad DC; Ikeda RM; Shah N; Fuller CM; Bailey S; Morse E; Collaborative Injection Drug User. Childhood sexual abuse and age at initiation of injection drug use. American Journal of Public Health 95(4): 703-709, 2005. (50 refs.)

Objectives. We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. Methods. We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. Results. The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. Conclusions. Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with post victimization services for children and adolescents.

Peirce JM; Kindbom KA; Waesche MC; Yuscavage ASE; Brooner RK. Posttraumatic stress disorder, gender, and problem profiles in substance dependent patients. Substance Use & Misuse 43(5): 596-611, 2008. (24 refs.)

Patients with a chronic and severe substance use disorder who also have a history of posttraumatic stress disorder (PTSD) are thought to have a unique set of problems. The present study assessed psychiatric disorders, psychosocial problems, and traumatic events with structured interviews in 747 men and 693 women enrolling in urban opioid substitution treatment programs from 1995 to 2001. Participants with versus without a history of PTSD were more likely to have a history of many other psychiatric disorders and demonstrated more current and historical medical, employment, family/social, and psychiatric problems. PTSD was generally unrelated to substance use disorder severity or diagnoses, with the exception of an increased risk of alcohol dependence. Women were more likely than men to have experienced sexual assault, and less likely to have been physically assaulted, although these events precipitated PTSD at equivalent rates across gender In contrast, witnessing or hearing about the death or injury of others was more likely to precipitate PTSD in women than men. Female gender exposure to combat, sexual assault, or physical assault, and a history of major mood or anxiety disorder were the best predictors of PTSD in this group. Study limitations are noted.

Pirard S; Sharon E; Kang SK; Angarita GA; Gastfriend DR. Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes. Drug and Alcohol Dependence 78(1): 57-64, 2005. (35 refs.)

More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. To achieve this goal, baseline characteristics, no-show for treatment status, post-treatment clinical outcomes, and treatment history were studied for subjects with lifetime history of abuse (47.3%) versus without. Abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index (ASI), and general level of functioning. The two groups endorsed different drugs as primary, with the abused group less frequently endorsing heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment.

Plant M; Plant M; Miller P. Childhood and adult sexual abuse: Relationships with 'addictive' or 'problem' behaviours and health. Journal of Addictive Diseases 24(1): 25-38, 2005. (37 refs.)

Questions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. In relation to women 12.5 % reported experiencing some form of sexual abuse before the age of 16 years. The corresponding figures for men in this category were 11.7 %. After the age of 16 the figure for women remained at this level. However the proportion of men reporting these traumatic experiences dropped to 3.2 %. Sexual abuse both pre and post age 16 was associated with 'addictive' or 'problem' behaviours such as those associated with eating too much (for women), sexual activity and Internet use (for men).

Plotzker RE; Metzger DS; Holmes WC. Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: A potential mediating pathway. American Journal on Addictions 16(6): 431-438, 2007. (43 refs.)

We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD=depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression.

Resnick H; Acierno R; Kilpatrick DG; Holmes M. Description of an early intervention to prevent substance abuse and psychopathology in recent rape victims. Behavior Modification 29(1): 156-188, 2005. (53 refs.)

Approximately 683,000 adult women are raped each year. Only one in seven of these victims report the assault to police and receive forensic exams and other professional services. For many rape victims, this may be the only professional contact with service providers; however these services are typically limited to evidence collection and prophylactic STD treatment. Yet this exam also presents a unique opportunity for a preventive intervention to help prepare women to cope with potential stress related to rape-exam procedures and to addresspotential post-rape psychopathology. This article reviews psychological interventions for trauma victims used in the acute post rape time frame and provides data from an ongoing clinical trial that evaluates delivery of a preventive intervention for victims presenting for forensic rape exams.

Rojas EY; Gretton HM. Background, offence characteristics, and criminal outcomes of aboriginal youth who sexually offend: A closer look at aboriginal youth intervention needs. Sexual Abuse 19(3): 257-283, 2007. (51 refs.)

Canada's Aboriginal peoples face a number of social and health issues. Research shows that Aboriginal youths are over-represented in the criminal justice system and youth forensic psychiatric programmes. Within the literature on sex offending youth, there appears to be no published data available to inform clinicians working with adjudicated Aboriginal youth. Therefore, the present study examines the background, offence characteristics, and criminal outcomes of Aboriginal (n = 102) and non-Aboriginal (n = 257) youths who engaged in sexual offending behaviour and were ordered to attend a sexual offender treatment programme in British Columbia between 1985 and 2004. Overall, Aboriginal youths were more likely than non-Aboriginal youths to have background histories of fetal alcohol spectrum disorders (FASD), substance abuse, childhood victimization, academic difficulties, and instability in the living environment. Both Aboriginal and non-Aboriginal youths had a tendency to target children under 12-years-old, females, and non-strangers. Aboriginal youths were more likely than non-Aboriginal youths to use substances at the time of their sexual index offence. Outcome data revealed that Aboriginal youths were more likely than their non-Aboriginal counterparts to recidivate sexually, violently, and non-violently during the 10-year follow-up period. Furthermore, the time between discharge and commission of all types of re-offences was significantly shorter for Aboriginal youths than for non-Aboriginal youths. Implications of these findings are discussed with regards to the needs of Aboriginal youth and intervention.

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

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

Sartor CE; Lynskey MT; Bucholz KK; McCutcheon VV; Nelson EC; Waldron M; Heath AC. Childhood sexual abuse and the course of alcohol dependence development: Findings from a female twin sample. Drug and Alcohol Dependence 89(2/3): 139-144, 2007. (50 refs.)

Childhood sexual abuse (CSA) has been associated with increased risk for alcohol dependence (AD), but the extent to which CSA history may impact transitions in the course of AD development remains unclear. The current study examined the role of CSA in initiation of alcohol use and rate of progression from first drink to AD using a sample of 3536 female twins (mean age = 21.6 years). Psychiatric diagnoses and alcohol use histories were obtained via telephone interviews using an adaptation of the SSAGA. The contribution of CSA to alcohol outcomes independent of familial influences was estimated by using co-twin AD status to adjust for familial liability to AD. CSA was associated with higher rates of both lifetime alcohol use and AD, but CSA-associated risk for consumption of first alcoholic drink was evident only at ages 12 and 13. Rate of transition from first alcohol use to AD did not differ by CSA status. Findings indicate that CSA and elevated risk for AD may be linked via early age at first drink and that progression from first drink to AD follows a similar course among women with and without histories of CSA.

Schneider R; Burnette M; Timko C. History of physical or sexual abuse and participation in 12-step self-help groups. American Journal of Drug and Alcohol Abuse 34(5): 617-625, 2008. (20 refs.)

Objectives: Although 12-step groups are an important resource for managing substance use problems, their efficacy for patients with a physical or sexual abuse history is unknown. Methods: In the present study, patients with a history of physical or sexual (n = 122) or no (n = 143) abuse were interviewed at entry to outpatient substance use treatment at the Veterans Administration. Results: After adjusting for baseline substance use, physical or sexual abuse was associated with more attendance at and involvement in 12-step groups. Participation in 12-step groups predicted abstinence at one year, regardless of abuse history. Conclusions: Limitations and implications are discussed.

Schneider R; Cronkite R; Timko C. Lifetime physical and sexual abuse and substance use treatment outcomes in men. Journal of Substance Abuse Treatment 35(4): 353-361, 2008. (38 refs.)

Although lifetime physical and Sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months post-intake. Men with it history of physical or sexual abuse had more severe drug, problems at intake, but by 6 months, there were no group differences in drug use. However, relative to men without an abuse history, men with a sexual abuse history had more severe psychiatric problems at all three time points and were more likely to report significant suicidality at intake and 6 months. Findings suggest that men with a history of sexual abuse benefit from SUD treatment, but additional intervention may be warranted to remedy persisting psychiatric distress.

Smith S; Wampler R; Jones J; Reifman A. Differences in self-report measures by adolescent sex offender risk group. International Journal of Offender Therapy and Comparative Criminology 49(1): 82-106, 2005. (85 refs.)

Differences in self-reports among three groups of juvenile sex offenders (N = 162) were examined. Risk was defined as the stun of the following static variables based on interviews with juveniles and others and from written records: type of offense (violent or predatory = 1, not = 0), prior sex offense (any = 1, none = 0), history of sexual abuse (self or family= 1, none = 0), history of substance abuse (self or family = 1, none = 0), history of behavior problems (yes = 1, no = 0), and unstable home life (yes = 1, stable = 0). Low-risk (0 to 2 risk factors), medium-risk (3factors), and high-risk (4 to 6factors) groups of offenders were formed. Univariate ANCOVAs indicated that the high-risk group reported less family cohesion, more aggression, lower self-esteem, more social discomfort, and more frequent and extreme sexual fantasies. The implications of these findings for differential identification of and interventions with adolescent sex offenders are discussed.

Steel JL; Herlitz CA. The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: A random sample of the general population of Sweden. Child Abuse and Neglect 29(10): 1141-1153, 2005. (37 refs.)

Objective: Several studies with small and "high risk" samples have demonstrated that a history of childhood or adolescent sexual abuse (CASA) is associated with sexual risk behaviors (SRBs). However, few studies with large random samples from the general population have specifically examined the relationship between CASA and SRBs with a comprehensive set of measures. Design: The study was a cross-sectional retrospective survey of past and current sexual health and behavior. Methods: A random sample of 4781 persons from the Swedish Post Address Register was obtained, which included 6,119,000 Swedish citizens in 1996. Of those persons, 28 10 participants agreed to participate in the study. Participants were interviewed as well as administered a questionnaire regarding their sexual health and behavior. Results: Using Mann-Whitney U tests, a history of CASA was found to be associated with younger age at first intercourse; younger age at diagnosis of first sexually transmitted infection (STI); greater frequency of unintended pregnancy; greater likelihood of participation in group sex; higher likelihood of not interrupting sexual intercourse despite the risk of pregnancy or risk of an STI; greater likelihood of exchanging sex for money or other necessities/drugs; more frequent substance use in the last 48 hours; and higher likelihood of adult sexual and physical assault. Conclusions: The findings of this study confirm previous research, which has reported an association between CASA and SRBs in smaller and high-risk samples. Clinicians working with adults with a history of CASA should be aware of the relationship between CASA and SRBs and be prepared to address such issues during therapy.

Sundaram V; Laursen B; Helweg-Larsen K. Is sexual victimization gender specific? - The prevalence of forced sexual activity among men and women in Denmark, and self-reported well-being among survivors. Journal of Interpersonal Violence 23(10): 1414-1440, 2008. (74 refs.)

The present study investigates the prevalence of sexual victimization and correlations between sexual victimization and indicators of poor health in two representative samples of men and women in Denmark. Specifically, the authors explore the prevalence of self-reported victimization among adolescents (N = 5,829) and adults (N = 3,932) and analyze differences in selfreported health outcomes between male and female victims and corresponding controls. Gender differences are found in the reported prevalence of sexual victimization. Significantly more females than males reported forced sexual experiences in both samples. Associations between sexual victimization and poor health outcomes are found for both genders. Comparable patterns of association for men and women are found on a number of variables, particularly those pertaining to risk behavior.

Thatcher DL; Cornelius JR; Clark DB. Adolescent alcohol use disorders predict adult borderline personality. Addictive Behaviors 30(9): 1709-1724, 2005. (50 refs.)

Background: This study investigated adolescent alcohol use disorders (AUDs) and other characteristics as predictors of adult borderline personality disorder (BPD) symptoms. Methods: Adolescents with AUDs (n=355) were recruited from clinical treatment sources and adolescents without AUDs (n=169) were recruited from the community. During an adolescent assessment (age 16 +/- 1.3), childhood physical and/or sexual abuse history, AUDs and associated psychiatric disorders were measured via semi-structured interviews. Symptoms of BPD were measured in a young adult follow-up assessment (age 22 +/- 2.4). Latent class analysis was utilized to classify individuals into four categories based upon BPD symptom profiles. Results: Multinomial regression models indicated that adolescent AUDs and other psychiatric disorders mediated the relationship between child physical and/or sexual abuse and adult BPD latent class. Conclusions: Results were consistent with a developmental conceptualization of BPD, with AUDs and other adolescent psychopathology antecedents representing developmentally relevant forms of dysregulation, and in their more severe forms culminating in borderline symptomatology.

Ullman SE; Filipas HH; Townsend SM; Starzynski LL. Correlates of comorbid PTSD and drinking problems among sexual assault survivors. Addictive Behaviors 31(1): 128-132, 2006. (18 refs.)

Numerous studies show that sexual assault victims are likely to develop PTSD and have a greater risk of drinking problems than nonvictims. However, little is known about what differentiates survivors with PTSD only from those with comorbid PTSD and drinking problems. In this study, a large, diverse sample of community-residing women who had experienced adult sexual assault was surveyed. Logistic regression analyses were conducted to identify pre-assault, assault, and post-assault factors differentiating survivors with PTSD only from those with PTSD and drinking problems. Results showed that survivors with less education, histories of other traumas, who blamed their character more for the assault, believed drinking could reduce distress, drank to cope with the assault's effects, and received negative social reactions were more likely to have comorbid PTSD and drinking problems than those with PTSD only. Implications for future research and treatment with sexual assault victims are discussed.

Ullman SE; Filipas HH; Townsend SM; Starzynski LL. Trauma exposure, posttraumatic stress disorder and problem drinking in sexual assault survivors. Journal of Studies on Alcohol 66(5): 610-619, 2005. (63 refs.)

Objective: Sexual assault history is associated with higher risk of problem drinking in women, yet little is known about mechanisms linking trauma histories to women's problem drinking. This study examined how trauma histories, alcohol-related cognitive mediators and posttraumatic stress disorder (PTSD) relate to past-year problem drinking in adult female sexual assault survivors. Method: Data from self-report questionnaires completed by a large, diverse sample (N = 865) of community-residing women who had experienced adult sexual assault were analyzed. Structural equation modeling was used to test a theoretical model examining the relationship between trauma exposure, alcohol-related cognitive mediators, PTSD symptoms and past-year problem drinking. Results: These analyses suggested that trauma exposure, drinking to cope with distress and tension-reduction expectancies are the most consistent factors associated with problem drinking, whereas PTSD symptoms are not. Drinking to cope and tension-reduction expectancies were both related to greater PTSD symptoms, consistent with self-medication theory. Conclusions: These results suggest that trauma histories, drinking to cope and tension reduction may be important risk factors distinguishing sexually assaulted women who develop problem drinking from those who do not. Screening women for trauma histories even within samples of victims and assessment of women's ways of coping and beliefs about alcohol's effects may help to identify those at greater risk for problem drinking.

Vera M; Aleger M; Pattatucci-Aragen AM; Peta M. Childhood sexual abuse and drug use among low-income urban Puerto Rican women. Journal of Social Work Practice in the Addictions 5(1/2): 45-68, 2005. (65 refs.)

This study examines the relationship between childhood sexual abuse and adult drug use among low-income urban Puerto Rican women. Interviews were conducted with 718 women, 408 involved in drug use and a comparison group of 310 non drug-users. Results demonstrate a strong association between childhood sexual abuse and adult drug use. The impact of childhood sexual abuse was greater for women reporting greater abuse severity, abuse by a family member, and increased abuse duration. Findings support a direct effects model of childhood sexual abuse on adult drug use. The increased rates of drug use among victims of childhood sexual abuse did not appear to be mediated by other childhood maltreatment or family background factors. Implications for practice and research are discussed.

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.

Wilsnack SC; Hughes TL; Johnson TP; Bostwick WB; Szalacha LA; Benson P et al. Drinking and drinking-related problems among heterosexual and sexual minority women. Journal of Studies on Alcohol and Drugs 69(1): 129-139, 2008. (60 refs.)

Objective: Studies of alcohol use among lesbians have typically used convenience samples with uncertain generalizability or general population samples with small numbers of lesbians. Here we compare rates of high-risk and problem drinking in a large sample of Chicago-area lesbians and a national sample of age- and education-matched urban heterosexual women. Method: Data came from comparable face-to-face interviews with 405 self-identified Chicago-area lesbians and with 548 urban women from a U.S. national sample. Rates of hazardous drinking (heavy episodic drinking, intoxication, drinking-related problems, alcohol-dependence symptoms) were compared for exclusively heterosexual, mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian subgroups. Results: Exclusively heterosexual women had lower rates than did all other women on all measures of hazardous drinking. Exclusively heterosexual women also reported less childhood sexual abuse, early alcohol use, and depression. Bisexual women reported more hazardous drinking indicators and depression than did exclusively or mostly lesbian women. Conclusions: These results indicate that sexual minority women are likely to have elevated risks of hazardous drinking. The differences between lesbian and bisexual women suggest that more attention is needed to subgroup differences among sexual minority women. Health care providers need to know the sexual identity of their patients and how their sexual identity may affect their risks for hazardous drinking. Higher rates of childhood sexual abuse, early drinking, and depression among sexual minority women suggest that these experiences may be important in assessing and treating problems related to their drinking, and in developing prevention and early intervention strategies.

Wyatt GE; Carmona JV; Loeb TB; Williams JK. HIV-positive black women with histories of childhood sexual abuse: Patterns of substance use and barriers to health care. Journal of Health Care for the Poor and Underserved 16(4, Supplement B): 9-23, 2005. (64 refs.)

A constellation of factors contributes to Black women's health including stressors and traumatic experiences. Their psychological adjustment and substance use can further affect their health status. The purpose of this study was to examine patterns of substance abuse and barriers to health care among HIV-positive Black women with histories of childhood sexual abuse (CSA). Baseline data on a community sample of 75 Black HIV-positive women were analyzed to assess and identify drug use, alcohol use, participation in an alcohol or drug treatment program, and communication skills with providers, all of which may act as barriers to health care. Findings indicate that substance use is a significant health problem, with 83% of the participants having used at least one substance regularly and 28% having engaged in regular injection drug use. Barriers to health care included confidentiality issues, poor financial resources, difficulty getting an appointment, excessive waiting to see a health care provider and obligation to care for others. Contrary to past research, poor communication between the participants and the providers did not seem to be a barrier to health care utilization for these women. Early traumatic experiences, including CSA, regardless of whether incidents involved penetration, may exacerbate the problems faced by HIV-positive Black women. Implications for future research and culturally relevant prevention and intervention programs are discussed.

Young A; Grey M; Abbey A; Boyd CJ; McCabe SE. Alcohol-related sexual assault victimization among adolescents: Prevalence, characteristics, and correlates. Journal of Studies on Alcohol and Drugs 69(1): 39-48, 2008. (53 refs.)

Objective: The purpose of this study was to document the prevalence and describe the characteristics of alcohol-related sexual assault among middle and high school students. Method: A Web-based, self-administered survey was used to collect data on 7th- through 12th-grade students (n = 1,037) in a large metropolitan area in the Midwest. A modified version of the Sexual Experiences Survey was used to ask students about their sexual victimization experiences so as to examine the involvement of alcohol within specific assault events. The sample was equally distributed by biological gender and ethnicity (white vs black) and was, on average (SD), 14 (2) years of age. Results: Findings from the study indicate that alcohol was involved in approximately 12%-20% of the assault cases, depending on age and gender of the respondent. For females, the presence of alcohol during assault differed significantly based on the location at which the assault occurred, ranging from 6% (at the survivor's home) to 29% (at parties or someone else's home). Furthermore, alcohol-related assault among females was more likely to involve physical force than non-alcohol-related assault. Conclusions: Results are discussed in light of the risk factors of alcohol-related assault among adolescents as well as the nature of social contexts that fosters alcohol-related sexual assault among both adolescents and college students.

Yuan NP; Koss MP; Polacca M; Goldman D. Risk factors for physical assault and rape among six native American tribes. Journal of Interpersonal Violence 21(12): 1566-1590, 2006. (50 refs.)

Prevalence and correlates of adult physical assault and rape in six Native American tribes are presented (N = 1,368). Among women, 45% reported being physically assaulted and 14% were raped since age 18 years. For men, figures were 36% and 2%, respectively. Demographic characteristics, adverse childhood experiences, adulthood alcohol dependence, and cultural and regional variables were assessed. Using logistic regression, predictors of physical assault among women were marital status, an alcoholic parent, childhood maltreatment, and lifetime alcohol dependence. Predictors of sexual assault among women were marital status, childhood maltreatment, and lifetime alcohol dependence. Among men, only childhood maltreatment and lifetime alcohol dependence predicted being physically assaulted. Tribal differences existed in rates of physical assault (both sexes) and rape (women only). The results underscore the problem of violence victimization among Native Americans and point to certain environmental features that increase risk of adulthood physical and sexual assault. Implications for tribe-specific interventions are discussed.

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.