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CORK Bibliography: Child Abuse

108 citations. January 2010 to present

Prepared: September 2012

Adams SM; Peden AR; Hall LA; Rayens MK; Staten RR; Leukefeld CG. Predictors of retention of women offenders in a community-based residential substance abuse treatment program. Journal of Addictions Nursing 22(3): 103-116, 2011. (86 refs.)

Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in the high recidivism rates of women offenders (50-70% within one year). Understanding factors that enhance and deter women from retention in substance abuse treatment will facilitate tailored interventions to improve treatment outcomes. This prospective study examined the relationship of substance use characteristics, childhood trauma, current trauma-related symptoms, motivation to treatment, and socio-demographic characteristics, in predicting the retention of women offenders in an urban, residential substance abuse program as they re-enter the community from incarceration. All women were interviewed within the first week of admission to the residential program using the following measures: the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), and the Trauma Symptom Inventory (TSI), and socio-demographic characteristics. Length of stay was tracked for all study participants (n = 105). Using multiple regression analysis, substance use characteristics did not predict retention. Age, current use of prescribed pain medication, sexual concerns, employment problems, and importance of drug treatment were significant predictors. Specifically, women remained in treatment longer if they were older, were not taking any prescription pain medication, reported concerns about employment, reported concerns about sexual problems, and reported lower importance of drug treatment, yet higher personal commitment to recovery. Higher scores for childhood emotional trauma, emotional neglect, and physical neglect were correlated with retention, but not statistically significant. These findings suggest the need to tailor individualized treatment to address the medical, employment, sexual and interpersonal relationships, and emotional trauma needs in this vulnerable population of women.

Copyright 2011, Informa Healthcare

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2011, Springer

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

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

Copyright 2011, Elsevier Science

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

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

Copyright 2010, Elsevier Science

Bornovalova MA; Tull MT; Gratz KL; Levy R; Lejuez CW. Extending models of deliberate self-harm and suicide attempts to substance users: Exploring the roles of childhood abuse, posttraumatic stress, and difficulties controlling impulsive behavior when distressed. Psychological Trauma: Theory, Research, Practice and Policy 3(4): 349-359, 2011. (122 refs.)

The current study examined models of risk for deliberate self-harm (DSH) and suicide attempts (SA) in a sample of 180 inner-city substance users. The factors of childhood physical, sexual, and emotional abuse, posttraumatic stress (PTS) symptoms, and difficulties controlling impulsive behaviors when distressed were examined, with path modeling used to explore the interrelationships between variables. Analyses examined the utility of a model wherein childhood abuse is associated with DSH and SA as a result of its relationship with PTS symptoms. Further, we examined whether difficulties controlling impulsive behaviors when distressed accounted for the relationship between PTS symptoms and DSH and SA. DSH and SA were both related to physical abuse and sexual abuse, PTS symptoms, and difficulties controlling impulsive behavior when distressed; only SA was associated with emotional abuse. Further, results demonstrated that the effect of childhood sexual abuse on DSH and SA was partially explained by PTS symptoms; however, difficulties controlling impulsive behaviors when distressed contributed little to either model. Findings suggest the importance of developing targeted interventions for PTS symptoms in order to reduce risk for SA and DSH.

Copyright 2011, American Psychological Association

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

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

Copyright 2010, American Psychological Association

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

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

Copyright 2011, Wiley-Blackwell

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

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

Copyright 2011, Wiley-Blackwell

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

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

Copyright 2011, Elsevier Science

Cheng HG; Anthony JC; Huang YQ; Lee S; Liu ZR; He YL. Childhood physical punishment and the onset of drinking problems: Evidence from metropolitan China. Drug and Alcohol Dependence 118(1): 31-39, 2011. (52 refs.)

Background: Evidence in support of a suspected causal association linking childhood physical punishment (CPP) and later alcoholic beverage-related disturbances has been found in metropolitan China. Here, the focus shifts to the CPP association with the estimated risk of starting to drink, having the first drinking problem, and transitioning from first drink to the first drinking problem. Methods: Data are from the World Mental Health Surveys-metropolitan China study, with representative samples of adult household residents living in two metropolitan cities, Beijing and Shanghai. Recalled information was available for early life experiences (including CPP, other childhood adversities, and parental alcohol and drug problems), as well as the onset age of drinking and drinking problems. Survival analyses were used to estimate the Hazard Ratio. A structural equation modeling approach was used to control for other inter-correlated childhood adversities. Results: Cox proportional hazards modeling discloses statistically robust associations linking CPP with drinking and drinking problems, as well as more rapid transitions from first drink to first drinking problem, even after accounting for other childhood adversities and parental drinking problems. These associations cannot be attributed to a more general noxious family environment. Conclusions: These results lay a foundation for future experimental studies on the possible causal relationship linking CPP with the onset of drinking problems and the transition from drinking to drinking problems.

Copyright 2011, Elsevier Science

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

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

Copyright 2011, Alcohol Research Documentation

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2010, Lippincott, Williams & Wilkins

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2010, Australasian Medical Publishing

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

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

Copyright 2010, Wiley-Blackwell

Diaz-Olavarrieta C; Garcia-Pina CA; Loredo-Abdala A; Paz F; Garcia SG; Schilmann A. Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study. Child Abuse & Neglect 35(11): 915-923, 2011. (50 refs.)

Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5, who suffered head trauma and were admitted to the National Pediatrics Institute in Mexico City, a tertiary care referral center. We reviewed medical records and extracted data on clinical and neurological signs and symptoms, fundus, radiological (long bones, thorax. CAT scan), and laboratory tests. We administered a standardized questionnaire assessing child abuse and neglect to the parents of the children included in the study. Results: One hundred and twenty children, under 5 presenting with head trauma, were recruited, 13 (11%) were considered abusive head trauma (AbHT) and 107 (89%) were diagnosed as accidental head injury (AcHl). The AbHT group comprised younger infants (mean age 8 months) and the AcHl group included toddlers about an average of 25 months. To account for this significant age difference, we performed a comparison of age matched cases. The children in the AbHT were more likely to be female, the result of the first unintended pregnancy and the children of younger mothers (17-19). Mothers in this group had attended fewer than 5 prenatal care visits and fathers had a history of alcohol abuse. Five (38%) of the 13 AbHT children did not survive their injuries and overall showed greater neurological and respiratory compromise, increased prothrombin time (PT), and lower hematocrit values. The most common intracranial injuries suffered by children in the AbHT group were subdural/epidural hematoma and parenchymal/subarachnoid hemorrhage. Retinal hemorrhage was the most frequent ocular injury. Conclusions: In a tertiary care children's hospital, 11% of the children presenting with head trauma, were considered of abusive origin. Unintended pregnancy among teen mothers and substance abuse in the father were associated with abusive head trauma in this descriptive study.

Copyright 2011, Elsevier Science

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

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

Copyright 2011, Elsevier Science

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

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

Copyright 2010, Elsevier Science

Feigelman S; Dubowitz H; Lane W; Grube L; Kim J. Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment. Academic Pediatrics 11(6): 474-480, 2011. (33 refs.)

OBJECTIVE: The objectives of this study were to determine whether 1) residents trained in the SEEK (A Safe Environment for Every Kid) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (parental depression, parental substance abuse, intimate partner violence, stress, corporal punishment, and food insecurity); 2) intervention residents would be more likely to screen for and assess those risk factors; and 3) families seen by intervention residents would report improved satisfaction with their child's doctor compared to families receiving standard care from control residents. METHODS: Pediatric residents in a university-based pediatrics continuity clinic were enrolled onto a randomized controlled trial of the SEEK model. The model included resident training about psychosocial risk factors, a Parent Screening Questionnaire, and a study social worker. Outcome measures included: 1) residents' baseline, 6-month, and 18-month post-training surveys, 2) medical record review, and 3) parents' satisfaction regarding doctor-parent interaction. RESULTS: Ninety-five residents participated. In 4 of 6 risk areas, intervention residents scored higher on the self-assessment compared to control subjects, with sustained improvement at 18 months. Intervention residents were more likely than control subjects to screen and assess parents for targeted risk factors. Parents seen by intervention residents responded favorably regarding interactions with their doctor. CONCLUSIONS: The SEEK model helped residents become more comfortable and competent in screening for and addressing psychosocial risk factors. The benefits were sustained. Parents viewed the intervention doctors favorably. The model shows promise as a way of helping address major psychosocial problems in pediatric primary care.

Copyright 2011, Elsevier Science

Fisher PA; Kim HK; Bruce J; Pears KC. Cumulative effects of prenatal substance exposure and early adversity on foster children's HPA-axis reactivity during a psychosocial stressor. International Journal of Behavioral Development 36(1): 29-35, 2012. (40 refs.)

Dysregulated hypothalamic-pituitary-adrenocortical (HPA) axis stress response has been reported among individuals with prenatal substance exposure and those with early adversity exposure. However, few researchers have examined the combined effects of these risk factors. Patterns of HPA reactivity among maltreated foster children with and without prenatal substance exposure (N = 53; ages 9-12 years) were examined using the Trier Social Stress Test for Children. Area under the curve with respect to increase (AUC(I)) analyses revealed that prenatal substance exposure or physical abuse significantly increased the likelihood of a negative AUC(I) (i.e., little or no HPA reactivity). Among children with prenatal substance exposure and physical abuse, 85% exhibited a negative AUC(I). The results underscore the importance of addressing this combined risk.

Copyright 2012, Sage Publications

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

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

Copyright 2010, John Wiley & Sons

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

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

Copyright 2011, Springer

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

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

Copyright 2010, American Psychological Association

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

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

Copyright 2010, Wiley-Liss

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

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

Copyright 2011, Elsevier Science

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

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

Copyright 2010, Elsevier Science

Gray CMK; Montgomery MJ. Links between alcohol and other drug problems and maltreatment among adolescent girls: Perceived discrimination, ethnic identity, and ethnic orientation as moderators. Child Abuse & Neglect 36(5): 449-460, 2012. (51 refs.)

Objectives: This study examined the links between maltreatment, posttraumatic stress symptoms, ethnicity-specific factors (i.e., perceived discrimination, ethnic identity, and ethnic orientation), and alcohol and/or other drug (AOD) problems among adolescent girls. Methods: These relations were examined using archived data from a community sample of 168 Black and Hispanic adolescent girls who participated in a school-based substance use intervention. Results: The results revealed that maltreatment was linked to AOD problems, but only through its relation with posttraumatic stress symptoms; maltreatment was positively related to posttraumatic stress symptoms, which were positively related to AOD problems. Both perceived discrimination and ethnic orientation were significant moderators. Specifically, greater perceived discrimination was associated with an increased effect of maltreatment on posttraumatic stress symptoms. Ethnic orientation demonstrated protective properties in the relation between maltreatment and AOD problem severity, such that the effect of maltreatment on AOD problem severity was less for girls with average to high ethnic orientation compared to girls with low ethnic orientation. Conclusions: The findings of this study underscore the importance of developing interventions for Black and Hispanic girls that target maltreatment and AOD use concurrently and address ethnicity-specific factors.

Copyright 2012, Elsevier Science

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

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

Copyright 2010, Cambridge University Press

Hart H; Rubia K. Neuroimaging of child abuse: A critical review. (review). Frontiers in Human Neuroscience 6: e-article 52, 2012. (188 refs.)

Childhood maltreatment is a stressor that can lead to the development of behavior problems and affect brain structure and function. This review summarizes the current evidence for the effects of childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, working memory, attention, response inhibition and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, gray and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum (CC). Diffusion tensor imaging (DTI) studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during response inhibition, working memory, and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavior and affect control. Future, large scale multimodal neuroimaging studies in medication-naive subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.

Copyright 2012, Frontiers Research Foundation

Herschl LC; Highland KB; McChargue DE. Prenatal exposure to testosterone interacts with lifetime physical abuse to predict anger rumination and cognitive flexibility among incarcerated methamphetamine users. American Journal on Addictions 21(4): 363-369, 2012. (56 refs.)

The present pilot study hypothesized that degree of exposure to prenatal testosterone interacts with a history of lifetime physical abuse (LPA) to predict the cognitive (anger rumination) and behavioral (intimate partner and interpersonal violence) components of aggression within incarcerated methamphetamine (MA) users. In addition, we hypothesized that the degree of exposure to prenatal testosterone interacts with LPA to predict cognitive flexibility (Stroop Color-Word performance). Male inmate MA users (N = 60) completed neuropsychological and paper/pencil tests. Hand photocopies were also obtained to index prenatal testosterone exposure. Five covariate-adjusted moderation models were tested using anger rumination, intimate partner violence (IPV) perpetration, interpersonal violence perpetration (before and while incarcerated), and Stroop Color-Word T-score as the criteria, prenatal testosterone exposure as the predictor, and LPA as the moderator. Results indicated that, in individuals with a history of LPA, exposure to higher levels of prenatal testosterone exposure predicted greater anger rumination, lower Stroop Color-Word test T-scores, and lower frequencies of IPV perpetration. Findings were not significant in individuals without a history of LPA. This research suggests that biochemical and psychosocial vulnerabilities influence anger rumination and cognitive flexibility, which may render incarcerated MA users at greater risk to relapse or recidivate upon release from prison.

Copyright 2012, Wiley-Blackwell

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

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

Copyright 2010, Elsevier Science

Huang MC; Schwandt ML; Ramchandani VA; George DT; Heilig M. Impact of multiple types of childhood trauma exposure on risk of psychiatric comorbidity among alcoholic inpatients. Alcoholism: Clinical and Experimental Research 36(6): 598-606, 2012. (52 refs.)

Background: This study examined the prevalence of single- and multiple-type childhood trauma exposure (CTE) among alcoholic patients undergoing inpatient detoxification and treatment. The relationships between various types of CTE and lifetime psychiatric comorbidities and suicide attempts were also explored. Methods: A total of 196 alcoholic inpatients were assessed by Structured Clinical Interview for DSM-IV Axis I Disorders and Childhood Trauma Questionnaire (CTQ) for CTE history. Results: The overall prevalence of CTE in the entire sample was high (55.1%). Specifically, the prevalence of emotional abuse was 21.4%, physical abuse 31.1%, sexual abuse 24.0%, emotional neglect 20.4%, and physical neglect 19.9%. Regarding multiple types of CTE, 31.7 and 18.9% reported at least 2 and at least 3 CTE types, respectively. Strikingly, among those with at least 1 positive CTQ category, more than half reported 2 or more CTE types. A history of emotional abuse increased the risk of mood disorder, in particular major depressive disorder, as well as posttraumatic stress disorder (PTSD). Physical abuse contributed to the prediction of suicide attempts, while sexual abuse was associated with a diagnosis of anxiety disorder, PTSD, and multiple comobidities (e.g., anxiety and mood disorder). The number of reported CTE types or the total score of the CTQ predicted an increased risk of having single or multiple psychiatric comorbidities as well as suicide attempts. Conclusions: We observed high rates of a broad range of CTE types and a trend for CTE-specific enhancement of risk for various psychiatric outcomes among alcoholic inpatients. Of note, a doseresponse relationship between number of CTE types and risk of psychiatric comorbidities as well as suicide attempts was found. We suggest a wide range of CTE should be included when exploring the effects of CTE or developing prevention and treatment strategies among alcoholic subjects.

Copyright 2012, Wiley-Blackwell

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

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

Copyright 2011, Elsevier Science

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

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

Copyright 2010, John Wiley & Sons

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

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

Copyright 2010, Taylor & Francis

Jonson-Reid M; Kohl PL; Drake B. Child and adult outcomes of chronic child maltreatment. Pediatrics 129(5): 839-845, 2012. (27 refs.)

Objective: To describe how child maltreatment chronicity is related to negative outcomes in later childhood and early adulthood. Methods: The study included 5994 low-income children from St Louis, including 3521 with child maltreatment reports, who were followed from 1993-1994 through 2009. Children were 1.5 to 11 years of age at sampling. Data include administrative and treatment records indicating substance abuse, mental health treatment, brain injury, sexually transmitted disease, suicide attempts, and violent delinquency before age 18 and child maltreatment perpetration, mental health treatment, or substance abuse in adulthood. Multivariate analysis controlled for potential confounders. Results: Child maltreatment chronicity predicted negative childhood outcomes in a linear fashion (eg, percentage with at least 1 negative outcome: no maltreatment = 29.7%, 1 report = 39.5%, 4 reports = 67.1%). Suicide attempts before age 18 showed the largest proportionate increase with repeated maltreatment (no report versus 4+ reports = +625%, P < .0001). The dose-response relationship was reduced once controls for other adverse child outcomes were added in multivariate models of child maltreatment perpetration and mental health issues. The relationship between adult substance abuse and maltreatment report history disappeared after controlling for adverse child outcomes. Conclusions: Child maltreatment chronicity as measured by official reports is a robust indicator of future negative outcomes across a range of systems, but this relationship may desist for certain adult outcomes once childhood adverse events are controlled. Although primary and secondary prevention remain important approaches, this study suggests that enhanced tertiary prevention may pay high dividends across a range of medical and behavioral domains.

Copyright 2012, American Academy of Pediatrics

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

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

Copyright 2010, Spinger

Kaestle CE. Selling and buying sex: A longitudinal study of risk and protective factors in adolescence. Prevention Science 13(3): 314-322, 2012. (60 refs.)

Engaging in trading sex is associated with many co-occurring problems, including elevated risk for sexually transmitted infections. Various dimensions of social support from parents, schools, and mentors may be protective against sex trading and may ameliorate the impact of risk factors. This study analyzes data from respondents to Waves I and III of the study who had not participated in sex trading for money or drugs in Wave I so that risk and protective factors for first initiations of selling or buying sex could be examined longitudinally. About 2% of the study sample began selling sex and about 2% began buying sex between Wave I and Wave III. The respondent's sex, race/ethnicity, history of sexual abuse, shoplifting, marijuana use, and experiences of homelessness or running away were significant predictors of trading sex ( < 0.05). Being happy at school was associated with lower selling of sex, and feeling part of school was associated with lower buying of sex even after controlling for demographics and risk factors ( < 0.05). Results indicate a need for early intervention for youth who experience sexual abuse or running away. Elements of school connectedness have a protective effect on selling and buying sex. Promoting school connectedness may advance public health goals.

Copyright 2012, Springer

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

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

Copyright 2011, Elsevier Science

Keller PS; Gilbert LR; Koss KJ; Cummings EM; Davies PT. Parental problem drinking, marital aggression, and child emotional insecurity: A longitudinal investigation. Journal of Studies on Alcohol and Drugs 72(5): 711-722, 2011. (49 refs.)

Objective: Marital aggression plays an important role in relations between parental problem drinking and child maladjustment. The purpose of the current study was to apply emotional security theory as a framework for understanding the role of marital aggression. Method: A community sample of 235 children in kindergarten participated once a year for 3 years. Parents completed measures of parental problem drinking and marital aggression, and children were interviewed about their emotional security reactions to marital conflict vignettes. Results: Greater parental problem drinking was directly associated with children's more negative emotional reactions to conflict. Maternal problem drinking predicted increased sad reactions and negative expectations for the future. Paternal problem drinking predicted increases in child anger reactions and negative expectations for the future. Parental problem drinking was also indirectly associated with child reactions via marital aggression. Conclusions: Results confirmed hypotheses that parental problem drinking would be related to child emotional insecurity and that associations would be indirect via greater marital conflict. Findings are interpreted in terms of emotional security theory as a framework for understanding the effects of parental problem drinking on marital aggression and child development.

Copyright 2011, Alcohol Research Documentation

Keyes KM; McLaughlin KA; Koenen KC; Goldmann E; Uddin M; Galea S. Child maltreatment increases sensitivity to adverse social contexts: Neighborhood physical disorder and incident binge drinking in Detroit. Drug and Alcohol Dependence 122(1-2): 77-85, 2012. (102 refs.)

Introduction: Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure. Methods: Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of >= 5 drinks (men) or >= 4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N = 1013). Results: Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (8 = 0.16, p = 0.02) and maximum number of past 30-day drinks (8 = 0.15, p = 0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment. Conclusion: The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.

Copyright 2012, Elsevier Science

King DC; Abram KM; Romero EG; Washburn JJ; Welty LJ; Teplin LA. Childhood maltreatment and psychiatric disorders among detained youths. Psychiatric Services 62(12): 1430-1438, 2011. (48 refs.)

Objective: This study examined the prevalence of childhood maltreatment and its relationship with current psychiatric disorders among detained youths. Methods: Clinical research interviewers assessed history of childhood maltreatment with the Child Maltreatment Assessment Profile and psychiatric diagnosis with the Diagnostic Interview Schedule for Children, version 2.3, in a stratified, random sample of 1, 829 youths detained at the Cook Country Juvenile Temporary Detention Center (final sample, N=1, 735). History of maltreatment was also ascertained from Cook County Court Child Protection Division records. Results: More than three-quarters of females and more than two-thirds of males had a history of physical abuse (moderate or severe). More than 40% of females and 10% of males had a history of sexual abuse. Females and non-Hispanic whites had the highest prevalence rates of childhood maltreatment. Among females, sexual abuse was associated with every type of psychiatric disorder. Females who experienced various types of abuse were 2.6 to 10.7 times as likely as females with no maltreatment to have any disorder. Among males, maltreatment was associated with every disorder except anxiety disorders (range of odds ratios, 1.9-7.9). Among youths who were sexually abused, abuse with force was associated with anxiety and affective disorders among females and attention-deficit hyperactivity or disruptive behavior disorders and substance use disorders among males. Conclusions: Childhood maltreatment is common among detained youths and is also highly associated with psychiatric disorders. The mental health, child welfare, and juvenile justice systems must collaborate to ensure that youths receive protection and care when they return to their communities.

Copyright 2011, American Psychiatric Association

Konings M; Stefanis N; Kuepper R; de Graaf R; ten Have M; van Os J et al. Replication in two independent population-based samples that childhood maltreatment and cannabis use synergistically impact on psychosis risk. Psychological Medicine 42(1): 149-159, 2012. (91 refs.)

Background. There may be biological plausibility to the notion that cannabis use and childhood trauma or maltreatment synergistically increase the risk for later development of psychotic symptoms. To replicate and further investigate this issue, prospective data from two independent population-based studies, the Greek National Perinatal Study (n=1636) and The Netherlands Mental Health Survey and Incidence Study (NEMESIS) (n=4842), were analyzed. Method. Two different data sets on cannabis use and childhood maltreatment were used. In a large Greek population-based cohort study, data on cannabis use at age 19 years and childhood maltreatment at 7 years were assessed. In addition, psychotic symptoms were assessed using the Community Assessment of Psychic Experiences (CAPE). In NEMESIS, the Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms at three different time points along with childhood maltreatment and lifetime cannabis use. Results. A significant adjusted interaction between childhood maltreatment and later cannabis use was evident in both samples, indicating that the psychosis-inducing effects of cannabis were stronger in individuals exposed to earlier sexual or physical mistreatment [Greek National Perinatal Study: test for interaction F(2, 1627)= 4.18, p=0.02; NEMESIS: test for interaction chi(2)(3)=8.08, p=0.04]. Conclusions. Cross-sensitivity between childhood maltreatment and cannabis use may exist in pathways that shape the risk for expression of positive psychotic symptoms.

Copyright 2012, Cambridge University Press

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

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

Copyright 2010, Sage Publications

Laslett AM; Ferris J; Dietze P; Room R. Social demography of alcohol-related harm to children in Australia. Addiction 107(6): 1082-1089, 2012. (33 refs.)

Aims: This study seeks to establish the prevalence alcohol-related harms to children (ARHC) that occur because of others' drinking in the general population and examine how this varies by who was reported to have harmed the child and socio-demographic factors. Design and setting: A randomly selected cross-sectional national population telephone survey undertaken in 2008 in Australia. Participants A total of 1142 adult respondents who indicated they lived with or had a parental/carer role for children. Measurements: Questions included whether children had been negatively affected in any way, left unsupervised or in an unsafe situation, verbally abused, physically hurt or exposed to serious family violence because of others' drinking in the past year. Findings: Twenty-two per cent of respondents reported children had been affected because of another's drinking in the past year; 3% reported substantial harm. Respondents most commonly reported that children were verbally abused because of others' drinking (9%). Participants in single-carer households were more likely to report ARHC than participants in households with two carers, and participants who drank weekly were more likely to report ARHC than those who did not drink. Conclusions: Almost a quarter of those with a caring role for children in Australia reported that a child or children with whom they lived or for whom they were responsible have been affected adversely by others' alcohol consumption in the past year. The problem extends across the social spectrum, but children in single-parent homes may be at higher risk.

Copyright 2012, Wiley-Blackwell

Lin DH; Li XM; Fan XH; Fang XY. Child sexual abuse and its relationship with health risk behaviors among rural children and adolescents in Hunan, China. Child Abuse & Neglect 35(9): 680-687, 2011. (40 refs.)

Objective: The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China. Methods: A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected. Results: A total of 123(18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors. Conclusion: More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents' awareness of CSA and ability of self-protection.

Copyright 2011, Elsevier Science

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

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

Copyright 2011, Wiley-Blackwell

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

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

Copyright 2010, Cambridge University Press

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

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

Copyright 2011, Cambridge University Press

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

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

Copyright 2010, Guilford Publications

Maniglio R. The role of child sexual abuse in the etiology of substance-related disorders. Journal of Addictive Diseases 30(3): 216-228, 2011. (99 refs.)

To elucidate the role of child sexual abuse in the etiology of substance-related disorders, a systematic review of the several articles on the childhood sexual abuse-related risk for developing substance problems in adolescence or adulthood is provided. Seven databases were searched, supplemented with hand-search of reference lists. Six reviews, including 200 studies, were included. Results indicate that child sexual abuse is a statistically significant, although general and nonspecific, risk factor for substance problems. Other biological and psychosocial variables contribute to substance-related disorders, with sexual abuse conferring additional risk, either as a distal, indirect cause or as a proximal, direct cause. Recommendations for future research are provided.

Copyright 2011, Taylor & Francis

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

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

Copyright 2011, Elsevier Science

McCabe I; Acree M; O'Mahony F; McCabe J; Kenny J; Twyford J et al. Male street prostitution in Dublin: A psychological analysis. Journal of Homosexuality 58(8): 998-1021, 2011. (48 refs.)

This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of self-esteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin.

Copyright 2011, Haworth Press

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

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

Copyright 2010, Elsevier Science

Miller EA; Green AE; Fettes DL; Aarons GA. Prevalence of maltreatment among youths in public sectors of care. Child Maltreatment 16(3): 196-204, 2011. (45 refs.)

Few studies have investigated the prevalence of maltreatment among youths in public sectors of care despite the critical public health concern and the burden of suffering on such youths. The current study examined the prevalence of multiple types of maltreatment across five public sectors of care. Youths aged 11-18 (n = 1,135) enrolled in one of five public sectors of care reported on their maltreatment history using the Childhood Trauma Questionnaire. Across all sectors, 78% of youth reported experiencing at least moderate levels of maltreatment with the majority (58%) reporting multiple types of maltreatment. The prevalence of maltreatment was highest for youths involved in the alcohol/drug (86%) and child welfare (85%) sectors, and lowest in the serious emotional disturbance sector (72%). Logistic regressions were conducted to examine differences in the likelihood of multiple types of maltreatment by sector affiliation, controlling for the effects of gender, race/ethnicity, and age. The results indicate that rates of maltreatment across sectors do not differ greatly from those in child welfare. The high incidence of maltreatment across all sectors, not solely child welfare, indicates that all youth in public sectors of care should be screened for a history of maltreatment when they enter into care.

Copyright 2011, Sage Publications

Mingione CJ; Heffner JL; Blom TJ; Anthenelli RM. Childhood adversity, serotonin transporter (5-HTTLPR) genotype, and risk for cigarette smoking and nicotine dependence in alcohol dependent adults. Drug and Alcohol Dependence 123(1-3): 201-206, 2012. (49 refs.)

Background: This study examined the extent to which cigarette smoking and nicotine dependence in adults with alcohol dependence (AD) are associated with adverse childhood experiences. Gender, social support, and an allelic variant in the gene encoding the serotonin transporter (5-HTTLPR) were examined as moderators of this relationship. Methods: The Semi-Structured Assessment for the Genetics of Alcoholism - Version II (SSAGA-II) was used to assess DSM-IV diagnoses and cigarette smoking characteristics as well as traumatic life events and social support during childhood in 256 AD men (n = 149) and women (n = 107). Results: An increase in number of adverse childhood events was associated with heightened risk of cigarette use and nicotine dependence. 5-HTTLPR genotype, gender, and social support did not significantly moderate the relationships among childhood adversity and ever-smoking or nicotine dependence. Conclusions: Results extend previous findings to suggest that childhood adversity is strongly related to risk for ever-smoking and nicotine dependence in AD individuals. Additional research is needed to examine other potential genetic and environmental moderators and mediators of the relationships among smoking, alcohol use, and childhood trauma.

Copyright 2012, Elsevier Science

Narvaez JCM; Magalhaes PVS; Trindade EK; Vieira DC; Kauer-Sant'Anna M; Gama CS et al. Childhood trauma, impulsivity, and executive functioning in crack cocaine users. Comprehensive Psychiatry 53(3): 238-244, 2012. (61 refs.)

Background: The use of crack cocaine is a major public health concern in Brazil and internationally. Recent data suggest that childhood trauma is associated with worse outcomes among cocaine users. This study had the objective of evaluating the relationship of childhood trauma with executive functioning and impulsivity in outpatients with crack cocaine use disorders. Methods: This is a cross-sectional study of 84 consecutive outpatients with a primary crack cocaine use disorder who sought treatment in Porto Alegre, Brazil. Childhood trauma was evaluated with the Childhood Trauma Questionnaire; executive functioning, with the Wisconsin Card Sorting Test; and impulsivity, with the Barratt Impulsivity Scale. Results: Childhood trauma was strongly associated with executive dysfunction and impulsivity, even when controlled for possible confounders. Conclusions: Childhood trauma may be associated with executive dysfunction and impulsivity in crack cocaine users. The full impact of trauma needs to be further investigated in longitudinal studies.

Copyright 2012, WB Saunders

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

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

Copyright 2011, Lippincott, Williams & Wilkins

Oshri A; Tubman JG; Burnette ML. Childhood maltreatment histories, alcohol and other drug use symptoms, and sexual risk behavior in a treatment sample of adolescents. American Journal of Public Health 102(supplement 2): S250-S257, 2012. (75 refs.)

Objectives. We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems. Methods. Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings. Results. Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse. Conclusions. Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment.

Copyright 2012, American Public Health Association

Oshri A; Tubman JG; Jaccard J. Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: Associations with self-reported child maltreatment and sexual risk behaviors. AIDS & Behavior 15(8): 1844-1856, 2011. (92 refs.)

Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

Copyright 2011, Springer Publishing

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

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

Copyright 2010, Oxford University Press

Peltan JR; Cellucci T. Childhood sexual abuse and substance abuse treatment utilization among substance-dependent incarcerated women. Journal of Substance Abuse Treatment 41(3): 215-224, 2011. (52 refs.)

Incarcerated women have high rates of substance abuse problems and trauma. A variety of variables may influence whether these women seek help or are referred for substance abuse problems. This study reports an exploratory project on service utilization among incarcerated substance-dependent women (N = 40) in southeastern Idaho. Using self-report and interview tools, most participants reported some substance abuse treatment history, although extent and types of treatment varied. Most of the women also reported some type of childhood abuse. Age, income, and consequences of alcohol and other drug use related positively to substance abuse treatment. However, severity of childhood sexual abuse and current trauma symptoms were negatively correlated with substance abuse treatment episodes. These women may use substances to cope with childhood trauma or may not perceive the substance abuse system as responsive to their co-occurring trauma symptoms.

Copyright 2011, Elsevier Science

Pence BW; Mugavero MJ; Carter TJ; Leserman J; Thielman NM; Raper JL et al. Childhood trauma and health outcomes in HIV-infected patients: An exploration of causal pathways. Journal of Acquired Immune Deficiency Syndromes 59(4): 409-416, 2012. (52 refs.)

Objective: Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. Methods: In 611 outpatient people living with HIV/AIDS, we tested whether trauma's influence on later health and behaviors was mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. Results: In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), past-trauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex [odds ratio (OR) = 1.17 per each additional type of trauma, 95% confidence interval = 1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to 1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22), and HIV disease progression (hazard ratio = 1.10, 0.98 to 1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (eg, OR for hospitalization changed from 1.12 to 1.07), whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (eg, OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. Conclusions: These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.

Copyright 2012, Lippincott, Williams & Wilkins

Rachamim E; Hodes D; Gilbert R; Jenkins S. Pattern of hospital referrals of children at risk of maltreatment. Emergency Medicine Journal 28(11): 952-954, 2011. (14 refs.)

Background Increasingly emergency departments (ED) and other acute services in the hospital provide first access care, especially out of hours and for poorer families. Studies of detection of child maltreatment in the hospital have focused on children presenting with injury, although maltreatment may be suspected when parents present to the hospital with problems related to violent behaviour, drug abuse or mental health problems. Methods A consecutive case series is described of patients referred for suspected child maltreatment from one inner-city general hospital after training was given to clinical staff and 2 years after the creation of a new post comprising a full-time, experienced child protection advisor (CPA) on-site to support clinicians with concerns about child maltreatment. Results There were 44 referrals to the CPA over 2 months in 2005, of whom just under half were initiated by clinicians caring for a parent. 15 referrals came from the ED (five followed a parent presenting to the ED), 14 from maternity obstetric services, and 15 from the neonatal or paediatric wards. Most families (38; 86%) were referred by nurses. One-quarter of referrals were already known to children's social care. Conclusions Clinicians need to be aware that half the vulnerable children in hospital are identified through one or other parent. It is hypothesised that the availability of an experienced child protection advisor on-site, combined with child protection training, makes it possible for clinicians caring for adults with problems related to violence, drug abuse or acute mental illness, to take action to address the potential vulnerability of their children.

Copyright 2011, BMJ Publishing Group

Robboy J; Anderson KG. Intergenerational child abuse and coping. Journal of Interpersonal Violence 26(17): 3526-3541, 2011. (53 refs.)

Many studies have investigated the consequences of child sexual abuse (CSA) but few have examined the intergenerational effects of poly-victimization and maladaptive coping. The purpose of this investigation was to examine patterns of maltreatment and maladaptive coping among second-generation CSA survivors. It is hypothesized that: (a) maternal CSA history would be associated with a higher incidence of poly-victimization and maladaptive coping and (b) experiencing more forms of abuse would mediate the relation between maternal CSA history and maladaptive coping behaviors. The method used was a chart review of 139 sexually abused females aged 12 to 17, examining maternal abuse history, maladaptive coping behaviors, and child maltreatment. The results showed that poly-victimization differed as a function of maternal CSA history but maladaptive coping did not. Experiencing more types of abuse was associated with both self-injurious behaviors and substance use. In conclusion, results support the hypothesis that second generation CSA survivors are more likely to experience poly-victimization. Future research should address how intergenerational patterns of abuse might affect presenting symptomatology and treatment outcome.

Copyright 2011, Sage Publications

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

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

Copyright 2010, Cambridge University Press

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

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

Copyright 2010, Springer

Rosenberg L. Addressing trauma in mental health and substance use treatment. Journal of Behavioral Health Services & Research 38(4): 428-431, 2011. (6 refs.)

Individuals with histories of violence, abuse, and neglect from childhood onward make up the majority of clients served by public mental health and substance abuse service systems. The greater the trauma, the greater the risk for alcoholism and alcohol abuse, depression, illicit drug use, suicide attempts, and other negative outcomes. Clearly, we cannot begin to address the totality of an individual's healthcare, or focus on promoting health and preventing disease, unless we address trauma. Trauma-informed care is now the expectation, not the exception, in behavioral health treatment systems.

Copyright 2011, Springer

Rosenkranz SE; Henderson JL; Muller RT; Goodman IR. Motivation and maltreatment history among youth entering substance abuse treatment. Psychology of Addictive Behaviors 26(1): 171-177, 2012. (38 refs.)

Research has established that maltreatment experiences are common in the life histories of youth with substance abuse problems, and efforts are now moving in the direction of enhancing our understanding of the unique clinical presentations and treatment needs of this population. The current study endeavored to contribute to this body of research by examining associations between experiences of maltreatment and levels of motivation among youth entering outpatient substance abuse treatment. Upon admission, 188 youth (131 males, 57 females) completed a package of self-report questionnaires including measures of motivation to change, motivation for treatment, and history of maltreatment experiences. Results indicated that youth with histories of all forms of maltreatment examined tended to be more aware of the problematic aspects of their substance use, more ready to engage in treatment, more motivated by feelings of shame, and more motivated by external influences. Emotional abuse was the form of maltreatment that predicted level of motivation most strongly. Emotional abuse was particularly strongly associated with the form of motivation reflecting shame regarding substance use, predicting this form of motivation over and above other factors previously reported to be associated with motivation, such as severity of substance abuse and age. While clinicians are increasingly attending to exposure to traumatic events among youth entering substance abuse treatment, these findings suggest that attending to experiences of emotional abuse is also important. Such experiences appear to be related to treatment motivation and may be important to treatment processes and outcomes for these vulnerable youth.

Copyright 2012, American Psychological Association

Rosenkranz SE; Muller RT; Henderson JL. Psychological maltreatment in relation to substance use problem severity among youth. Child Abuse & Neglect 36(5): 438-448, 2012. (85 refs.)

Objectives: Research has demonstrated that experiences of childhood maltreatment are prevalent in the life histories of youth with substance use problems; however, most of this research has focused on sexual or physical abuse. The purpose of the current study was to extend the scope of previous investigations to include psychological maltreatment experiences, examining the extent to which emotional abuse and emotional neglect predict substance use problem severity among youth. The current study also sought to examine whether a cumulative model fit the data, in which the experience of multiple forms of maltreatment would be related most strongly to severity of substance use problems, or whether there was a distinct effect of psychological maltreatment. Methods: Data were collected through self-report questionnaires from 216 youth (144 males, 72 females) entering an outpatient treatment program for youth with substance use concerns. Results: Results indicated that, when considering all forms of abuse together, only emotional abuse and emotional neglect emerged as significant predictors of substance use problem severity. Furthermore, the association between psychological maltreatment and substance use problem severity was unaltered by the consideration of concurrent experiences of interpersonal violence. Conclusions: The results of the current study are consistent with those of a body of research describing the detrimental effects of psychological maltreatment. The findings have potential implications for the development and provision of trauma-informed youth substance use treatment services. The findings suggest that attending to the sequelae of psychological maltreatment may be important in assisting these youth in achieving successful treatment outcomes.

Copyright 2012, Elsevier Science

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

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

Copyright 2010, Taylor & Francis

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2010, Taylor & Francis

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

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

Copyright 2010, American Medical Association

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

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

Copyright 2010, National Medical Association

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

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

Copyright 2011, Elsevier Science

Sharp SF; Peck BM; Hartsfield J. Childhood adversity and substance use of women prisoners: A General Strain Theory approach. Journal of Criminal Justice 40(3, special issue): 202-211, 2012. (67 refs.)

The current paper seeks to add to the literature on General Strain Theory (GST) in two ways. First, it tests the efficacy of the theory in a sample of incarcerated women, adding to our knowledge of the generality of the theory. Second, it examines whether specific individual measures of strain or an index of cumulative strain provide more information about the relationship between strain and deviance. To explore this issue, we examine the effects of individual strains versus the cumulative impact of strain on daily drug and alcohol use prior to incarceration using data from the 2008 and 2009 Oklahoma Study of Incarcerated Women and Their Children. Our measures of strain are drawn from the Adverse Childhood Experiences Study. The analyses indicate that certain tenets of GST do predict daily drug use in this sample, thus suggesting the theory is has applicability to an offending population. The analyses further suggest that the explanatory power is similar, whether the individual or cumulative measures of strain are employed. However, a few key stressors appear to account for most of the explanatory power of the index, and there are some variations in which strains are related to the type of substance used.

Copyright 2012, Elsevier Science

Shin SH; Hong HG; Wills TA. An examination of pathways from childhood maltreatment to adolescent binge drinking. American Journal on Addictions 21(3): 202-209, 2012. (65 refs.)

Considerable clinical and empirical evidence has accumulated over the past decades indicating that there is a strong association between childhood maltreatment and heavy episodic drinking in adolescence, but there is a paucity of empirically based knowledge about the processes linking the association. The aim of this paper is to examine mechanisms that might account for the association between childhood maltreatment and heavy episodic drinking in adolescence. Using a nationally representative sample of adolescents (ages ranging 1221; N = 6,337), this study examined the role of individual self-regulatory processes in the associations, controlling for age, gender, race/ethnicity, peer substance use, parental alcoholism, and parent child conflict. Factor analyses were used to test the measurement structure of self-regulatory processes. Findings confirmed the association between childhood maltreatment and heavy episodic drinking in adolescence. Structural modeling analyses indicated indirect effects for childhood maltreatment primarily through poor self-regulatory processes and peer substance use. Implications for future research are discussed.

Copyright 2012, Wiley-Blackwell

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2011, Elsevier Science

Sinanan AN. The impact of child, family, and child protective services factors on reports of child sexual abuse recurrence. Journal of Child Sexual Abuse 20(6, special issue): 657-676, 2011. (74 refs.)

This study identified selected child factors (e. g., age, gender, race/ethnicity, disabilities, prior victimization, and relationship to perpetrator of abuse), family risk factors (e. g., substance abuse, domestic violence, inadequate housing, and financial problems), and services provided by child protective services that likely increased reports of child sexual abuse recurrence by type of reporter. Survival analysis was conducted using the National Child Abuse and Neglect Data System data set of 2002-2004. Child disability, being a prior victim, having a perpetrator as a caregiver, family financial problems, and receiving family supportive services increased the likelihood for reports of child sexual abuse by mandated reporters. Being Hispanic, having a disability, having a perpetrator as a caregiver, financial problems, and receiving family preservation services statistically decreased the likelihood for reports of child sexual abuse recurrence.

Copyright 2011, Taylor & Francis

Small E; Kohl PL. African American caregivers and substance abuse in child welfare: Identification of multiple risk profiles. Journal of Family Violence 27(5): 415-426, 2012. (96 refs.)

Despite the strong correlation between caregiver substance abuse and child maltreatment, little information exists to understand the typology of African American caregivers with substance abuse problems in the child welfare system. Research shows African American caregivers contend with multiple problems stemming from substance abuse. Unfortunately, we do not yet know how to best tailor resources to be responsive to varying groups of African American caregivers. Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this investigation tested for distinct multivariate profiles among a subset of African American caregivers with substance abuse problems (n = 258). Latent Class Analysis (LCA) was used to classify caregivers, and five classes were identified among this high risk sample-each with distinct risk profiles. Based on these findings, we discuss implications for tailored practices to enhance the safety and stability of children involved with child welfare.

Copyright 2012, Springer Publishing

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

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

Copyright 2011, Elsevier Science

Strine TW; Dube SR; Edwards VJ; Prehn AW; Rasmussen S; Wagenfeld M et al. Associations between adverse childhood experiences, psychological distress, and adult alcohol problems. American Journal of Health Behavior 36(3): 408-423, 2012. (84 refs.)

Objective: To examine the mediating role of psychological distress on the relationship between adverse childhood experiences and adult alcohol problems by gender. Methods: Linear and logistic regression analyses were conducted on 7279 Kaiser-Permanente members, aged >18 years. Results: Psychological distress mediated significant proportions of alcohol problems associated with childhood emotional abuse and neglect, physical abuse and neglect, mental illness in the household, parental separation or divorce, sexual abuse, and household drug use among women and mental illness in the household, emotional neglect, physical abuse, household drug use, and sexual abuse among men. Conclusion: It may be important to identify early childhood trauma and adult psychological distress in programs that focus on reducing alcohol abuse.

Copyright 2012, PNG

Sunday S; Kline M; Labruna V; Pelcovitz D; Salzinger S; Kaplan S. The role of adolescent physical abuse in adult intimate partner violence. Journal of Interpersonal Violence 26(18): 3773-3789, 2011. (29 refs.)

This study's primary aims were to examine whether a sample of young adults, aged 23 to 31, who had been documented as physically abused by their parent(s) during adolescence would be more likely to aggress, both physically and verbally, against their intimate partners compared with nonabused young adults and whether abuse history was (along with other risk factors) a significant predictor of intimate partner physical and emotional violence perpetration or victimization. In this longitudinal study, 67 abused and 78 nonabused adults (of an original sample of 198 adolescents) completed the Modified Conflict Tactics Scale and the Jealousy and Emotional Control Scales. Nonabused comparison adolescents were matched for age, gender, and community income. As adults, participants with abuse histories had significantly higher rates of intimate partner physical violence and verbal aggression than did comparison participants. Multivariate logistic regressions indicated that adults with histories of physical abuse were more than twice as likely to be physically violent and almost six times more likely to be verbally aggressive to their intimate partners than were comparison participants. Having had an alcohol use disorder, being married to or living with a partner, and perceiving one's partner as controlling were also significantly associated with physical violence. Jealousy and feeling controlled by one's partner were also significant predictors of verbal aggression. These findings underscore the importance of preventing adolescent abuse as a means of decreasing the incidence of intimate partner physical violence in adulthood.

Copyright 2011, Sage Publications

Swahn MH; Ali B; Bossarte RM; Van Dulmen M; Crosby A; Jones AC et al. Self-harm and suicide attempts among high-risk, urban youth in the U.S.: Shared and unique risk and protective factors. International Journal of Environmental Research and Public Health 9(1): 178-191, 2012. (55 refs.)

The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the "linkages study" (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring) associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.

Copyright 2012, MDPI AG

Swogger MT; Conner KR; Walsh Z; Maisto SA. Childhood abuse and harmful substance use among criminal offenders. Addictive Behaviors 36(12): 1205-1212, 2011. (53 refs.)

Childhood abuse is a serious problem that has been linked to harmful alcohol and drug use in non-offender samples. In a sample of 219 criminal offenders, we examined the associations between childhood physical and sexual abuse and three indices of harmful substance use. Results indicate that physical abuse was associated with symptoms of alcohol use disorder and sexual abuse was associated with symptoms of drug use disorder among offenders. Both forms of childhood abuse were associated with substance use consequences, even after taking into account substance type and frequency of use. No gender by childhood abuse interactions were found. Symptoms of depression and generalized anxiety partially mediated relationships between childhood abuse and substance use consequences. Findings underscore the importance of assessing childhood abuse and treating anxiety and depression among offenders who exhibit harmful substance use.

Copyright 2011, Elsevier Science

Tanaka M; Wekerle C; Schmuck ML; Paglia-Boak A. The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents. Child Abuse & Neglect 35(10): 887-898, 2011. (80 refs.)

Objectives: Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion - a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process. Methods: The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire (Bernstein at al., 1994, 2003). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16-20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment. Results: Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gentler, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion. Conclusion: Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services.

Copyright 2011, Elsevier Science

Taplin S; Mattick R. Child Protection and Mothers in Substance Abuse Treatment. NDARC Technical Report No. 320. Sydney: National Drug and Alcohol Research Centre (Australia), 2011

This report presents the major findings from the Child Protection and Mothers in Substance Abuse Treatment study, a three-year study funded by NSW Community Services, Department of Family and Community Services, and the University of New South Wales. Parental substance use has received particular attention as a child protection concern in recent years, but it is an area in which there has been little research and in which a number of research questions remain unanswered. Evidence has shown that parental substance misuse is associated with high rates of child maltreatment, but substance use by a parent does not necessarily mean that they are abusing or neglecting their children. Research from overseas has also found that families in which alcohol or other drug use is present are more likely to come to the attention of child protection services, more likely to be re-reported, more likely to have children removed from their care, and more likely to have them remain in out-of-home care (OOHC) for long periods of time, than are families with the same characteristics but no substance use. A small number of overseas studies have also found that, among substance-using mothers, factors other than the severity of substance use are associated with child protection involvement. The applicability of these overseas studies to the child protection system in Australia is, however, unknown. This study provides an enhanced understanding of parenting issues and child protection involvement among women with a history of illicit drug use in Australia. Methods: Women with at least one child aged under 16 years were recruited through nine public and private opioid treatment clinics across Sydney. One hundred and seventy-one women were interviewed between May 2009 and May 2010. Their drug treatment and child protection records were also used as a source of information where they consented. Major findings: Just over one-third of the women were involved with child protection services at the time of interview, with one-third of their children (n = 99) in OOHC. Women who were involved with child protection were compared with those who were not to determine the factors associated with child protection involvement. Logistic regression analysis revealed that those variables which significantly increased the likelihood of being involved with child protection (while controlling for the other variables) were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with their own parents. Although women who had a more extensive substance use history were more likely to be involved with child protection (when no other factors were taken into account), this association was no longer significant in the logistic regression model. Discussion: The results of this study are important for the child protection field. They show that, rather than severity of substance use being associated with mothers' involvement with the child protection system, other factors are of greater importance. Of particular interest was the finding that having greater social support, particularly from parents, significantly reduced the likelihood of being involved with the child protection system. Women made great improvements while on their treatment program, particularly in relation to reduced substance use. In terms of policy and practice implications, this study supports the call by overseas researchers to intervene earlier with girls who have been abused themselves prior to the escalation of problems associated with abuse, such as mental health problems and substance misuse, and prior to them becoming mothers. The provision of targeted women-only services is essential for girls in such circumstances, and for most women in opioid pharmacological treatment, in order to help them deal with their mental health problems and to enhance parenting, coping skills and social supports. It is important that such services are provided if we are to reduce the high rates of intergenerational abuse, trauma and disadvantage among these women and their children.

Public Domain

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

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

Copyright 2010, Research Society on Alcoholism

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

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

Copyright 2010, Oxford University Press

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2011, Oxford University Press

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

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

Copyright 2011, W B Saunders

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

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

Copyright 2010, Springer

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

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

Copyright 2011, Routledge

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

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

Copyright 2010, Public Library of Science

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

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

Copyright 2010, Wiley-Blackwell Publishing

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

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

Copyright 2011, American Psychological Association

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

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

Copyright 2010, Alcohol Research Documentation Center

Wood JN; Pecker LH; Russo ME; Henretig F; Christian CW. Evaluation and referral for child maltreatment in pediatric poisoning victims. Child Abuse & Neglect 36(4): 362-369, 2012. (17 refs.)

Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS. Methods: Retrospective study of poisoning victims <6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning). Results: Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and <= 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p < 0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p < 0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning. Conclusions: Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.

Copyright 2012, Elsevier Science

Xie PX; Kranzler HR; Zhang HP; Oslin D; Anton RF; Farrer LA et al. Childhood adversity increases risk for nicotine dependence and interacts with alpha 5 nicotinic acetylcholine receptor genotype specifically in males. Neuropsychopharmacology 37(3): 669-676, 2012. (45 refs.)

The relative importance of specific genetic and environmental factors in regulating nicotine dependence (ND) risk, including the effects on specific forms of childhood adversity on smoking risk, have been understudied. Genome-wide association studies and rodent models have demonstrated that the alpha 5 nicotinic acetylcholine receptor gene (CHRNA5) is important in regulating nicotine intake. Childhood adversity increases the methylation level of the CHRNA5 promoter region in European Americans (EAs), an effect that was observed only in males (Zhang et al, submitted for publication). In view of this potential sex difference in the effects of early life experience on smoking, we investigated the presence of a sex-specific gene-by-environment effect of this marker on ND risk. A nonsynonymous SNP in CHRNA5 previously associated to ND and several related traits, rs16969968, was genotyped in 2206 EAs (1301 men and 905 women). The main and interactive effects of childhood adversity and rs16969968 genotype on diagnosis of ND and ND defined by dichotomized Fagerstrom test for ND (FTND) scores were explored. Men and women were analyzed separately to test for sex differences. Childhood adversity significantly increased ND risk in both sexes, and the effect in women was twice than that in men. Significant interactive effects of childhood adversity and rs16969968 genotype were observed in men (ND: OR = 1.80, 95% CI = 1.18-2.73, P = 0.0044; FTND: OR = 1.79, 95% CI = 1.11-2.88, P = 0.012). No interaction was found in women. This study provides evidence of a sex-specific gene x environment effect of CHRNA5 and childhood adversity on the risk for ND.

Copyright 2012, Nature Publishing Group

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

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

Copyright 2010, American Psychiatric Association

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

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

Copyright 2010, Elsevier Science

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

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

Copyright 2011, Cambridge University Press

Young-Wolff KC; Kendler KS; Prescott CA. Interactive effects of childhood maltreatment and recent stressful life events on alcohol consumption in adulthood. Journal of Studies on Alcohol and Drugs 73(4): 559-569, 2012. (65 refs.)

Objective: Childhood maltreatment is associated with early alcohol use initiation, alcohol-related problem behaviors, and alcohol use disorders in adulthood. Heavy drinking risk among individuals exposed to childhood maltreatment could be partly attributable to stress sensitization, whereby early adversity leads to psychobiological changes that heighten sensitivity to subsequent stressors and increase risk for stress-related drinking. We addressed this issue by examining whether the association between past-year stressful life events and past-year drinking density, a weighted quantity frequency measure of alcohol consumption, was stronger among adults exposed to childhood maltreatment. Method: Drinking density, stressful life events, and childhood maltreatment were assessed using structured clinical interviews in a sample of 4,038 male and female participants ages 20-58 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Stress sensitization was examined using hierarchical multiple regression analyses to test whether stressful events moderated the association between maltreatment and drinking density. Analyses were stratified by sex and whether the impact was different for independent stressful events or dependent stressful events as related to a participant's actions. Results: Independent stressful events were associated with heavier drinking density among women exposed to maltreatment. In contrast, drinking density was roughly the same across independent stressful life events exposure among women not exposed to maltreatment. There was little evidence for Maltreatment x Independent Stressor interactions in men or Maltreatment x Dependent Stressor interactions in either gender. Conclusions: Early maltreatment may have direct effects on vulnerability to stress-related drinking among women, particularly in association with stressors that are out of one's control.

Copyright 2012, Alcohol Research Documentation