The sexual abuse of Afro-American and white-American women in childhood

Adverse childhood experiences and smoking status in five states

OBJECTIVE

Our objective was to examine the associations between adverse childhood experiences (ACEs) and smoking behavior among a random sample of adults living in five U.S. states.

METHODS

We used data from 25,809 participants of the 2009 Behavioral Risk Factor Surveillance System to assess the relationship of each of the 8 adverse childhood experiences and the adverse childhood experience score to smoking status.

RESULTS AND CONCLUSIONS

Some 59.4% of men and women reported at least one adverse childhood experience. Each of the eight adverse childhood experiences measures was significantly associated with smoking status after adjustment for demographic variables. The prevalence ratios for current and ever smoking increased in a positive graded fashion as the adverse childhood experience score increased. Among adults who reported no adverse childhood experiences, 13.0% were currently smoking and 38.3% had ever smoked. Compared to participants with an adverse childhood experience score of 0, those with an adverse childhood experience score of 5 or more were more likely to be a current smoker (adjusted prevalence ratio (aPR): 2.22, 95% confidence interval [CI]: 1.92-2.57) and to have ever smoked (aPR: 1.80, 95% CI: 1.67-1.93). Further research is warranted to determine whether the prevention of and interventions for adverse childhood experiences might reduce the burden of smoking-related illness in the general population.

The Protective Effect of Family Strengths in Childhood against Adolescent Pregnancy and Its Long-Term Psychosocial Consequences

BACKGROUND

Few reports have addressed associations between family strengths during childhood and adolescent pregnancy and its consequences. We examined relationships among a number of childhood family strengths and adolescent pregnancy, risk behavior, and psychosocial consequences after adolescent pregnancy.

METHODS

Our retrospective cohort of 4648 women older than 18 years (mean age, 56 years) received primary care in San Diego, CA. Outcomes included adolescent pregnancy and psychosocial consequences compared with number of the following childhood family strengths: family closeness, support, loyalty, protection, love, importance, and responsiveness to health needs.

RESULTS

Of the cohort, 3082 participants (66%) reported 6 or 7 categories of childhood family strengths. Teen pregnancy occurred in 39%, 33%, 30%, 25%, 24%, 21%, and 19% of those with 0 or 1, 2, 3, 4, 5, 6, and 7 childhood family strengths, respectively (p for trend < 0.00001). When childhood abuse and household dysfunction were present, adjusted odds ratios (ORs) for adolescent pregnancy demonstrated an increasingly protective effect as numbers of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (1.0 to 0.80), (1.0 to 0.80, 0.60, and 0.54, respectively). These findings were partly explained by progressive delays in initiation of sexual activity as the number of childhood family strengths increased. Adjusted ORs for psychosocial problem occurring decades later decreased as the number of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (job problems, 1.0, 0.8, 0.6, 0.4; family problems, 1.0, 1.1, 0.7, 0.6; financial problems, 1.0, 0.9, 0.9, 0.6; high stress, 1.0, 1.1, 0.9, 0.8; uncontrollable anger, 1.0, 0.7, 0.7, 0.4).

CONCLUSIONS

Childhood family strengths are strongly protective against adolescent pregnancy, early initiation of sexual activity, and long-term psychosocial consequences.

Changes in the prevalence of child sexual abuse, its risk factors, and their associations as a function of age cohort in a Finnish population sample

OBJECTIVE

We examined (1) the prevalence of childhood sexual abuse (CSA) experiences as a function of cohort and gender, (2) the prevalence of factors associated with CSA as a function of cohort and whether the association of these factors with CSA remained the same irrespective of cohort, and (3) whether any cohort differences could be explainable by cohort differences in reporting bias.

METHOD

We used the responses of 4,561 men (M=29, SD=7 years) and 8,361 female (M=29, SD=7 years) Finnish participants who responded to the Childhood Trauma Questionnaire-Short Form as well as questions regarding family structure.

RESULTS

The prevalence of CSA experiences varied between 0.7-4.6% for men and 1.8-7.5% for women depending on the item. Younger cohorts reported less CSA as well as less of the risk factors (physical neglect and abuse, emotional neglect and abuse, parental substances abuse, not growing up with both biological parents) that were positively associated with the likelihood of CSA. The effects of these risk factors did not vary as a function of the cohort. Also, the declining trend was not explainable by social desirability being higher in the younger cohorts.

CONCLUSIONS

The results suggest that there is a real decline in the prevalence of CSA and it is associated with a simultaneous decline in factors associated with CSA.

Childhood sexual abuse severity reconsidered: a factor structure of CSA characteristics

To address the lack of empirically grounded measures of childhood sexual abuse severity, a survey of self-report items was developed following a thorough review of the childhood sexual abuse literature. An exploratory factor analysis was conducted using data collected from a convenience sample of college students that included 275 females and males with a history of childhood sexual abuse. The solution produced seven factors interpreted as the following: (a) less intrusive forms of childhood sexual abuse (e.g., sexual invitations, kissing), (b) more intrusive forms of childhood sexual abuse (e.g., oral sex, intercourse), (c) humiliation/fear, (d) childhood sexual abuse involving photography, (e) familiarity with the perpetrator, (f) physical force/rape, and (g) active digital penetration. Correlations among these factors further suggested the existence of two relatively independent second-order factors, one based on the levels of physical intrusiveness and the other composed of the psychological/emotional factors. While arguably the most common measurement of severity, physical intrusiveness had little association with critical factors such as humiliation, fear, and association with the perpetrator. Consequently, physical intrusiveness appears to be an inadequate stand-alone measure of childhood sexual abuse severity. These results are proposed to lay the groundwork for an improved, more comprehensive measure of childhood sexual abuse severity.

Childhood adversity and personality disorders: results from a nationally representative population-based study

BACKGROUND

Although, a large population-based literature exists on the relationship between childhood adversity and Axis I mental disorders, research on the link between childhood adversity and Axis II personality disorders (PDs) relies mainly on clinical samples. The purpose of the current study was to examine the relationship between a range of childhood adversities and PDs in a nationally representative sample while adjusting for Axis I mental disorders.

METHODS

Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n=34,653; data collection 2004-2005); a nationally representative sample of the United States population aged 20 years and older.

RESULTS

The results indicated that many types of childhood adversity were highly prevalent among individuals with PDs in the general population and childhood adversity was most consistently associated with schizotypal, antisocial, borderline, and narcissistic PDs. The most robust childhood adversity findings were for child abuse and neglect with cluster A and cluster B PDs after adjusting for all other types of childhood adversity, mood disorders, anxiety disorders, substance use disorders, other PD clusters, and sociodemographic variables (Odd Ratios ranging from 1.22 to 1.63). In these models, mood disorders, anxiety disorders, and substance use disorders also remained significantly associated with PD clusters (Odds Ratios ranging from 1.26 to 2.38).

CONCLUSIONS

Further research is necessary to understand whether such exposure has a causal role in the association with PDs. In addition to preventing child maltreatment, it is important to determine ways to prevent impairment among those exposed to adversity, as this may reduce the development of PDs.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Adulthood stressors, history of childhood adversity, and risk of perpetration of intimate partner violence

BACKGROUND

More than half a million U.S. women and more than 100,000 men are treated for injuries from intimate partner violence (IPV) annually, making IPV perpetration a major public health problem. However, little is known about causes of perpetration across the life course.

PURPOSE

This paper examines the role of "stress sensitization," whereby adult stressors increase risk for IPV perpetration most strongly in people with a history of childhood adversity.

METHODS

The study investigated a possible interaction effect between adulthood stressors and childhood adversities in risk of IPV perpetration, specifically, whether the difference in risk of IPV perpetration associated with past-year stressors varied by history of exposure to childhood adversity. Analyses were conducted in 2010 using de-identified data from 34,653 U.S. adults from the 2004-2005 follow-up wave of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

There was a significant stress sensitization effect. For men with high-level childhood adversity, past-year stressors were associated with an 8.8 percentage point (pp) increased risk of perpetrating compared to a 2.3 pp increased risk among men with low-level adversity. Women with high-level childhood adversity had a 14.3 pp increased risk compared with a 2.5 pp increased risk in the low-level adversity group.

CONCLUSIONS

Individuals with recent stressors and histories of childhood adversity are at particularly elevated risk of IPV perpetration; therefore, prevention efforts should target this population. Treatment programs for IPV perpetrators, which have not been effective in reducing risk of perpetrating, may benefit from further investigating the role of stress and stress reactivity in perpetration.

Witness of intimate partner violence in childhood and perpetration of intimate partner violence in adulthood

BACKGROUND

At least half a million women are victims of intimate partner violence in the United States annually, resulting in substantial harm. However, the etiology of violence to intimate partners is not well understood. Witnessing such violence in childhood has been proposed as a principal cause of adulthood perpetration, yet it remains unknown whether the association between witnessing intimate partner violence and adulthood perpetration is causal.

METHOD

We conducted a propensity-score analysis of intimate partner violence perpetration to determine whether childhood witnessing is associated with perpetration in adulthood, independent of a wide range of potential confounding variables, and therefore might be a causal factor. We used data from 14,564 U.S. men ages 20 and older from the 2004-2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

Nearly 4% of men reported violent behavior toward an intimate partner in the past year. In unadjusted models, we found a strong association between childhood witnessing of intimate partner violence and adulthood perpetration (for witnessing any intimate partner violence, risk ratio [RR] = 2.6 [95% confidence interval = 2.1-3.2]; for witnessing frequent or serious violence, 3.0 [2.3-3.9]). In propensity-score models, the association was substantially attenuated (for witnessing any intimate partner violence, adjusted RR = 1.6 [1.2-2.0]; for witnessing frequent or serious violence, 1.6 [1.2-2.3]).

CONCLUSIONS

Men who witness intimate partner violence in childhood are more likely to commit such acts in adulthood, compared with men who are otherwise similar with respect to a large range of potential confounders. Etiological models of intimate partner violence perpetration should consider a constellation of childhood factors.

Patterns of childhood trauma and psychological distress among injecting heroin users in China

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.

Sexual victimization and hazardous drinking among heterosexual and sexual minority women

AIMS

Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because the rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women.

METHOD

Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking.

RESULTS

Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian.

CONCLUSIONS

This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women's heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization.

Pregnancy complications in women with childhood sexual abuse experiences

OBJECTIVE

Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA.

METHODS

The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation.

RESULTS

Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59).

CONCLUSION

Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.

Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults

BACKGROUND

Childhood adversity (CA) is associated with adult mental disorders, but the mechanisms underlying this association remain inadequately understood. Stress sensitization, whereby CA increases vulnerability to mental disorders following adult stressful life events, has been proposed as a potential mechanism. We provide a test of the stress sensitization hypothesis in a national sample.

METHOD

We investigated whether the association between past-year stressful life events and the 12-month prevalence of major depression, post-traumatic stress disorder (PTSD), other anxiety disorders, and perceived stress varies according to exposure to CA. We used data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=34 653).

RESULTS

Past-year stressful life events were associated with an increased risk of major depression, PTSD, anxiety disorders, and perceived stress. However, the magnitude of the increased risk varied according to respondents' history of CA. For example, past-year major stressors were associated with a 27.3% increase in the 12-month risk of depression among individuals with 3 CAs and a 14.8% increased risk among individuals without CAs. Stress sensitization effects were present for depression, PTSD, and other anxiety disorders in women and men, although gender differences were found in the threshold of past-year stress needed to trigger such effects. Stress sensitization was most evident among individuals with 3 CAs.

CONCLUSIONS

CA is associated with increased vulnerability to the deleterious mental health effects of adult stressors in both men and women. High levels of CA may represent a general diathesis for multiple types of psychopathology that persists throughout the life course.

Prevalence of child and adult sexual abuse and risk taking practices among HIV serodiscordant African-American couples

This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIV-negative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.

Do adverse childhood experiences increase the risk of postdeployment posttraumatic stress disorder in US Marines?

BACKGROUND

Posttraumatic stress disorder (PTSD) has been associated with combat intensity, lack of social support, and adverse childhood factors among military personnel in previous studies. It has not been well established if adverse childhood experiences reported predeployment are independently associated with postdeployment PTSD.

METHODS

Data were evaluated from 8,391 male responders of the Recruit Assessment Program survey at Marine Corps Recruit Depot in San Diego who were deployed in support of military conflicts between September 2001 and June 2004. Using patient medical records to determine PTSD diagnoses, Cox proportional hazard modeling was performed to examine if adverse childhood experiences were independently associated with postdeployment PTSD.

RESULTS

After adjustment, those who reported adverse childhood experiences in more than one category were significantly more likely to be diagnosed with postdeployment PTSD. Specifically, childhood physical neglect was mostly strongly associated with postdeployment PTSD.

CONCLUSIONS

Findings suggest that Marines who experience multiple types of adverse childhood experiences may be at increased risk for postdeployment PTSD. It is possible, however, that these results indicate that men willing to report childhood adverse experiences are also more willing to seek care for PTSD.

The relation between an adverse psychological and social environment in childhood and the development of adult obesity: a systematic literature review

The prevalence of obesity is on a global-wide increase, but still the aetiology of adult obesity is poorly understood. It has been shown that overweight children suffer from adverse psychological events, but less is known about the potential effects of adverse psychological factors among normal weight children for later development of obesity. The purpose of this study was to systematically review current literature on associations between psychological factors in childhood and development of obesity in adulthood. A systematic search was conducted in three electronic databases MEDLINE (silverplatter 1977-2008), PsycINFO (1972-2008) and PsycINFO Weekly (week 1 January 2007-week 3 July 2008) to identify studies of interest. Six prospective and two retrospective studies were identified. Psychosocial factors related to adult obesity were lack of childhood care, abuse and childhood anxiety disorders. In addition, depression in adolescence tended to be related to adult obesity but among young girls only. Learning difficulties and scholastic proficiencies below average were also risk factors. The current literature suggests that specific psychosocial factors in childhood may act as determinants for developing obesity in adulthood.

Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study

Background

Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood.

Methods

Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index.

Results

The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000^-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000^-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs.

Conclusions

Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.

Childhood sexual abuse severity and disclosure predict posttraumatic stress symptoms and biomarkers in ethnic minority women

OBJECTIVE

Adult posttraumatic stress symptoms and a biomarker index of current health risk in childhood sexual abuse (CSA) survivors were investigated in relation to CSA severity, disclosure, and other peri- and post-trauma factors.

METHOD

A community sample of 94 African American and Latina female CSA survivors was assessed.

RESULTS

Severe CSA predicted posttraumatic stress symptoms overall, avoidance/numbing symptoms, and greater biomarker risk and was not mediated by post-trauma variables. Moderate CSA severity was mediated by post-trauma disclosure, predicted reexperiencing symptoms, but was unrelated to biomarker risk. No overall ethnic differences were found.

CONCLUSION

Results suggest targets for interventions to improve the well-being of minority women CSA survivors.

Sexual violence and its association with health self-perception among pregnant women

OBJECTIVE

To estimate the prevalence of sexual violence history among pregnant women and its association with the self-perception of health status.

METHODS

Cross-sectional study including a total of 179 pregnant women older than 14 years old at gestation week 14 to 28 attending public health services in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. Data collection instruments included: questionnaire on sexual violence; questionnaire on sociodemographic data; and an assessment of health-related quality of life using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12(R)). Age, skin color, education, occupational and marital status, and self-perception of physical and mental health were compared between women with and without a lifetime history of sexual violence. Sexual violence was categorized as penetrative and non-penetrative sex.

RESULTS

Among all women interviewed, the prevalence of sexual violence was 39.1%, of which 20% were of penetrative type by known perpetrators. In 57% of cases, the first episode of violence was before the age of 14. There were no sociodemographic differences between women with and without history of sexual violence. Mean scores of self-perception of physical health among women with history of sexual violence were lower (42.2; SD= 8.3) compared to those without history of sexual violence (51.0; SD= 7.5) (p<0.001). Mean scores of self-perception of mental health were 37.4 (SD= 11.2) and 48.1 (SD= 10.2) (p<0.001), respectively.

CONCLUSIONS

There was found high prevalence of sexual violence among pregnant women studied. Women with history of sexual violence showed poorer self-perception of health status compared to those without history of sexual violence.

Sexual Dysfunctions Among Women Clients Who Were Sexually Abused in Childhood

In a series of 51 previously sexually abused women who entered therapy 94% were found to be sexually dysfunctional. It is proposed that these dysfunctions may stem from certain mood disturbances, interpersonal problems, and sexual stresses, that are associated with the earlier traumatic experience of sexual abuse and its surrounding circumstances.

Factores del abuso sexual en la niñez y la adolescencia en estudiantes de Morelos, México

OBJETIVO: Estimar la prevalencia y los factores asociados al abuso sexual en niñez y adolescencia. MÉTODOS: Estudio realizado en una muestra de estudiantes del estado de Morelos, México, en 2004-2005. Los participantes (n=1730) pertenecen a una cohorte de 13.293 estudiantes de 12 a 24 años. Los datos fueron colectados mediante la aplicación de un cuestionario conteniendo secciones de escalas validadas. Las variables analizadas fueron: factores sociodemográficos (sexo, zona de habitación, nivel socioeconómico); familiares (educación de los padres, adicciones de los padres, violencia entre padres); psicológicos individuales (autoestima - Inventario de Autoestima de Coopersmith, depresión, consumo de alcohol); violencia intrafamiliar (Escala de Strauss); y abuso sexual. Mediante regresión logística múltiple se evaluaron los factores asociados. Se obtuvieron Razones de Momios (RM) con intervalos de confianza al 95%. RESULTADOS: El 4.7% (n=80) de los (as) estudiantes presentaron intento de abuso y el 2.9% (n=50) fueron víctimas de abuso sexual consumado. Las mujeres tuvieron mayor prevalencia de intento (6.1%). El 3.6% de las mujeres y el 1.9% de los hombres fueron abusados sexualmente. Principal agresor en mujeres fue el novio y en hombres una persona desconocida. Edad promedio de 12.02 años en mujeres y 11.71 en hombres. Factores asociados al abuso: mayor consumo de alcohol padres (RM = 3.37; IC 95% 1.40;8.07); violencia hacia madre (RM=4.49; IC 95%1.54;13.10); ser mujer (RM = 2.47; IC 95%1.17;5.24); ser víctima de violencia intrafamiliar alta (RM=3.58; IC 95%1.32;9.67). Autoestima alta fue un factor protector (RM=0.27; IC 95% 0.09;0.75). CONCLUSIONES: En promedio el abuso sexual se presenta a los 12 años de edad en ambos sexos, siendo más frecuente en el sexo femenino. La mayoría de víctimas no lo denuncia.

The international epidemiology of child sexual abuse: a continuation of Finkelhor (1994)

OBJECTIVE

The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse.

METHODS

Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse.

RESULTS

Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men.

CONCLUSIONS

Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women.

PRACTICE IMPLICATIONS

Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining to North America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.

The relationship of adverse childhood experiences to a history of premature death of family members

BACKGROUND

To assess the association between adverse childhood experiences (ACEs), including childhood abuse and neglect, and serious household dysfunction, and premature death of a family member. Because ACEs increase the risk for many of the leading causes of death in adults and tend to be familial and intergenerational, we hypothesized that persons who report having more ACEs would be more likely to have family members at risk of premature death.

METHODS

We used data from 17,337 adult health plan members who completed a survey about 10 types of ACEs and whether a family member died before age 65. The prevalence of family member premature death and its association with ACEs were assessed.

RESULTS

Family members of respondents who experienced any type of ACEs were more likely to have elevated prevalence for premature death relative to those of respondents without such experience (p < 0.01). The highest risk occurred among those who reported having been physically neglected and living with substance abusing or criminal family members during childhood. A powerful graded relationship between the number of ACEs and premature mortality in the family was observed for all age groups, and comparison between groups reporting 0 ACE and >or= 4 ACEs yielded an OR of 1.8 (95%CI, 1.6-2.0).

CONCLUSION

Adverse childhood experiences may be an indicator of a chaotic family environment that results in an increased risk of premature death among family members.

The prevalence of child sexual abuse in community and student samples: a meta-analysis

BACKGROUND

Studies conducted internationally confirm that child sexual abuse is a much more widespread problem than previously thought, with even the lowest prevalence rates including a large number of victims that need to be taken into account.

OBJECTIVE

To carry out a meta-analysis of the prevalence of child sexual abuse in order to establish an overall international figure.

METHODS

Studies were retrieved from various electronic databases. The measure of interest was the prevalence of abuse reported in each article, these values being combined via a random effects model. A detailed analysis was conducted of the effects of various moderator variables.

RESULTS

Sixty-five articles covering 22 countries were included. The analysis showed that 7.9% of men (7.4% without outliers) and 19.7% of women (19.2% without outliers) had suffered some form of sexual abuse prior to the age of eighteen.

CONCLUSIONS

The results of the present meta-analysis indicate that child sexual abuse is a serious problem in the countries analysed.

Cumulative childhood stress and autoimmune diseases in adults

OBJECTIVE

To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.

METHODS

Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia).

RESULTS

Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05). Compared with persons with no ACEs, persons with >or=2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p < .05).

CONCLUSIONS

Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.

Covariation in the Use of Physical and Sexual Intimate Partner Aggression Among Adolescent and College-Age Men

A longitudinal examination of male perpetration of physical aggression toward a romantic partner and its covariation with sexual aggression reveals a decline from adolescence through 4 years of college. Witnessing domestic violence and experiencing parental physical punishment increased the likelihood of physical aggression in adolescence, but not thereafter. Prior perpetration best predicted subsequent perpetration. Although adolescence was the time of greatest risk, the 2nd year in college was an additional time of increased risk. Furthermore, physical and sexual aggression covaried with each other in the sample at rates significantly greater than chance, indicating that covariation may be a unique form of perpetration. Witnessing domestic violence and experiencing parental physical punishment were associated with an increased likelihood of men committing both forms of intimate partner aggression in adolescence.

Sibling agreement on retrospective reports of parental alcoholism and other childhood events

Studies have used siblings to verify subject reports of retrospective data and examined variables influencing subject-sibling agreement, but questions remain. From 1998 to 2000, we examined a community sample of women (N = 143) in a metropolitan area, aged 21-60, balanced by race, parental alcoholism, and social class, as well as their siblings, using standardized, self-administered questionnaires and an interview.

RESEARCH QUESTIONS

Do subject and sibling reports agree? Do reports vary by subject characteristics, or the type of childhood experience? Descriptive statistics showed that agreement was strong for measures of parental alcoholism and psychiatric problems, weaker for family environment, and varied little by subject characteristics. Study limitations and implications are noted, and future research suggested.

Sexual and physical abuse: a comparison between lesbians and their heterosexual sisters

The purpose of this study was to investigate similarities and differences in the incidence and patterns of abuse experienced by lesbians and their heterosexual sisters. In a matched sample of 324 lesbian/heterosexual sister pairs, the lesbians reported a greater incidence than their sisters of childhood physical and sexual abuse, as well as adult sexual abuse. Both groups identified male relatives as the most common perpetrator of both childhood physical and sexual abuse. Male relatives were most commonly identified as perpetrators of adult physical abuse and male strangers were most commonly identified as adult sexual abusers. Our results demonstrate that both sexual and physical abuse are common experiences for lesbian and heterosexual women; however, since the context of these experiences is different, each group will have special needs for services and treatment.

Associations of Sexual Victimization, Depression, and Sexual Assertiveness with Unprotected Sex: A Test of the Multifaceted Model of HIV Risk Across Gender

This study examined whether the Multifaceted Model of HIV Risk (MMOHR) would predict unprotected sex based on predictors including gender, childhood sexual abuse (CSA), sexual victimization (SV), depression, and sexual assertiveness for condom use. A community-based sample of 473 heterosexually active men and women, aged 18-46 years completed survey measures of model variables. Gender predicted several variables significantly. A separate model for women demonstrated excellent fit, while the model for men demonstrated reasonable fit. Multiple sample model testing supported the use of MMOHR in both men and women, while simultaneously highlighting areas of gender difference. Prevention interventions should focus on sexual assertiveness, especially for CSA and SV survivors, as well as targeting depression, especially among men.

Parental alcoholism, adverse childhood experiences, and later risk of personal alcohol abuse among Chinese medical students

OBJECTIVE

To determine the status of adverse childhood experiences (ACEs) and the association of multiple ACEs with both parental alcoholism and later personal alcohol abuse among Chinese medical students with a view of improving adolescent health and reducing alcohol abuse among them.

METHODS

In this cross-sectional study, 2073 Chinese medical students completed a survey on ten categories of ACEs in Anhui province of China. The association of parental alcoholism with ACEs and personal alcohol abuse was assessed by logistic regression analyses.

RESULTS

The adjusted odds ratio (OR) for each category of ACEs in the subjects whose parents (either fathers or mothers or both) had alcohol abuse was 2 to 14 times higher than that in those with parental alcoholism (P<0.05). Subjects with bi-parental alcoholism had the highest likelihood of ACEs. Compared with the subjects without ACEs, therisk of personal alcohol abuse was increased by 2-4-folds in the subjects with ACEs, irrespective of parental alcoholism (P<0.05). The total number of ACEs (ACE score) had a graded relationship to 4 categories of personal alcohol abuse with or without parental alcoholism. The prevalence of personal alcohol abuse among the subjects with parental alcoholism was higher, which was independent of ACE scores.

CONCLUSION

The prevalence of ACEs is generally serious in China. Efforts should be made to prevent and treat children with ACEs and subsequently to reduce alcohol abuse and later problems.

Family trauma through generations: incest and domestic violence in rural Sweden in the nineteenth century

Two generations of a family who lived in mid-nineteenth rural Sweden are described. Domestic violence was a common feature in the first generation family. The salient feature there was undoubtedly the incestuous father-daughter relationships. The way incest appeared in Sweden about 150 years ago, the role of local authorities, and the serious consequences to those victimized is analyzed with reference to both the cultural context of that time and to modern theories of incest. Seemingly puzzling violence committed by a second generation family member is related to the domestic violence in the previous generation. Due to the extraordinary character of the incest cases and the specific church council sessions in which the incest case was treated, aspects of family life normally hidden behind curtains of conventions were made public. Reaction patterns drawn from this case indicate a patriarchal system of oppression and badly-directed considerations.

Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men

OBJECTIVE

Mediators of childhood sexual abuse (CSA) and HIV risk behavior were examined for men-who-have-sex-with-men (MSM).

METHOD

Data from a dual frame survey of urban MSM (N=1078) provided prevalence estimates of CSA, and a test of two latent variable models (defined by partner type) of CSA-risk behavior mediators.

RESULTS

A 20% prevalence of CSA was reported. For MSM in secondary sexual relationships, our modeling work identified two over-arching but inter-related pathways (e.g., both pathways include effects on interpersonal skills) linking CSA and high-risk behavior: (1) CSA-Motivation-Scripts-Skills-Risk Behavior; and (2) CSA-Motivation-Coping-Risk Appraisal-Skills-Risk Behavior. For men in primary relationships, there was one over-arching pathway including CSA-Motivation-Coping-Risk Appraisal-Risk Behavior processes. Exploratory analyses indicated that men with a history of CSA in only primary relationships versus only secondary relationships had, for example, fewer motivational problems, and better coping and interpersonal skills.

CONCLUSIONS

CSA contributes to the ongoing HIV epidemic among MSM by distorting or undermining critical motivational, coping, and interpersonal factors that, in turn, influence adult sexual risk behavior. Further, the type of adult relationships men engage in serve as markers for adult CSA-related problems. The findings are discussed in the context of current theory and HIV prevention strategies.

PRACTICE IMPLICATIONS

Direct extrapolation from our findings to practice is limited. However, there are general implications that may be drawn. First, the complex challenges faced by men with severe CSA experiences may limit the effectiveness of typical short-term HIV risk reduction programs; more intensive treatment maybe needed. Secondly, Clinical Psychologists and Psychiatrists with MSM patients with CSA histories should, if not already, routinely consider issues of sexual health; patterns and types of sexual partners may be useful markers for identifying more problematic cases. Lastly, public service messages directed at destigmatizing CSA for MSM may increase use of health and mental health services.

Risk reduction for HIV-positive African American and Latino men with histories of childhood sexual abuse

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men's Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an "intent to treat" analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time.

Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients

Background

Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce.

Method

We used the ACE Score (an integer count of 8 different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and assessed mediation of this relationship by documented ACE-related health and social problems.

Results

Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend < 0.0001). Compared to persons with an ACE Score of 0, persons with a Score ≥ 5 had rates increased by 40%; graded relationships were seen for all age groups (18–44, 45–64, and 65–89 years) (p for trend < 0.01). Graded relationships were observed for the risk of being in the upper decile of number of classes of drugs used; persons with scores of ≥ 5 had this risk increased 2-fold. Adjustment for ACE-related health problems reduced the strength of the associations by more than 60%.

Conclusion

ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.

Adverse childhood experiences and chronic obstructive pulmonary disease in adults

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality in the U.S. However, little is known about the influence of childhood stressors on its occurrence.

METHODS

Data were from 15,472 adult HMO members enrolled in the Adverse Childhood Experiences (ACE) Study from 1995 to 1997 and eligible for the prospective phase. Eight ACEs were assessed: abuse (emotional, physical, sexual); witnessing domestic violence; growing up with substance-abusing, mentally ill, or criminal household members; and parental separation or divorce. The number of ACEs (ACE Score) was used to examine the relationship of childhood stressors to the risk of COPD. Three methods of case ascertainment were used to define COPD: baseline reports of prevalent COPD, incident hospitalizations with COPD as a discharge diagnosis, and rates of prescription medications to treat COPD during follow-up. Follow-up data were available through 2004.

RESULTS

The ACE Score had a graded relationship to each of three measures of the occurrence of COPD. Compared to people with an ACE Score of 0, those with an ACE Score of > or =5 had 2.6 times the risk of prevalent COPD, 2.0 times the risk of incident hospitalizations, and 1.6 times the rates of prescriptions (p<0.01 for all comparisons). These associations were only modestly reduced by adjustment for smoking. The mean age at hospitalization decreased as the ACE Score increased (p<0.01).

CONCLUSIONS

Decades after they occur, adverse childhood experiences increase the risk of COPD. Because this increased risk is only partially mediated by cigarette smoking, other mechanisms by which ACEs may contribute to the occurrence of COPD merit consideration.

Health-related quality of life among adults who experienced maltreatment during childhood

OBJECTIVES

We sought to assess the difference in a preference-based measure of health among adults reporting maltreatment as a child versus those reporting no maltreatment.

METHODS

Using data from a study of adults who reported adverse childhood experiences and current health status, we matched adults who reported childhood maltreatment (n = 2812) to those who reported no childhood maltreatment (n = 3356). Propensity score methods were used to compare the 2 groups. Health-related quality-of-life data (or "utilities") were imputed from the Medical Outcomes Study 36-Item Short Form Health Survey using the Short Form-6D preference-based scoring algorithm.

RESULTS

The combined strata-level effects of maltreatment on Short Form-6D utility was a reduction of 0.028 per year (95% confidence interval=0.022, 0.034; P<.001). All utility losses for the childhood-maltreatment versus no-childhood-maltreatment groups by age group were significantly different: 18-39 years, 0.042; 40-49 years, 0.038; 50-59 years, 0.023; 60-69 years, 0.016; 70 or more years, 0.025.

CONCLUSIONS

Persons who experienced childhood maltreatment had significant and sustained losses in health-related quality of life in adulthood relative to persons who did not experience maltreatment. These data are useful for assessing the cost-effectiveness of interventions designed to prevent child maltreatment in terms of cost per quality-adjusted life years saved.

African-American sexuality and HIV/AIDS: recommendations for future research

HIV/AIDS continues to create a significant health crisis in African-American communities and health disparities within the United States. Understanding African-American sexuality within a culturally congruent and ethnocentric approach is critical to decreasing the HIV infection and transmission rates for African Americans. This brief discusses two major factors: 1) confusion about race-based stereotypes; and 2) historical health disparities and mistrust, which have influenced our understanding of African-American sexuality despite that fact that very little research has been conducted in this area. This paper discusses the limitations of what is known and makes recommendations for research surrounding sexuality and HIV/AIDS. Research trainings for new and established investigators and collaborations among health, community, religious, political organizations, and historically black colleges and universities are needed to disseminate relevant HIV prevention messages. Conducting research to better understand African-American sexuality will facilitate the development of behavioral interventions that address health, HIV and mental health risk reduction within the context of African-American life.

The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample

This study presents test-retest reliability statistics and information on internal consistency for new diagnostic modules and risk factors for alcohol, drug, and psychiatric disorders from the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV). Test-retest statistics were derived from a random sample of 1899 adults selected from 34,653 respondents who participated in the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Internal consistency of continuous scales was assessed using the entire Wave 2 NESARC. Both test and retest interviews were conducted face-to-face. Test-retest and internal consistency results for diagnoses and symptom scales associated with posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and borderline, narcissistic, and schizotypal personality disorders were predominantly good (kappa>0.63; ICC>0.69; alpha>0.75) and reliability for risk factor measures fell within the good to excellent range (intraclass correlations=0.50-0.94; alpha=0.64-0.90). The high degree of reliability found in this study suggests that new AUDADIS-IV diagnostic measures can be useful tools in research settings. The availability of highly reliable measures of risk factors for alcohol, drug, and psychiatric disorders will contribute to the validity of conclusions drawn from future research in the domains of substance use disorder and psychiatric epidemiology.

Sexual abuse in childhood and physical and mental health in adulthood: an Australian population study

Although childhood sexual abuse (CSA) is associated with a wide range of health problems later in life, there is also evidence of substantial individual differences. This study describes the mental and physical health of a population sample of Australians, randomly selected from the Commonwealth electoral roll, who have reported their CSA histories. Some 58% of those located from the electoral roll agreed to a telephone interview (n=1,784). Health status was measured using the Short Form 36 questionnaire. Men who had experienced non-penetrative and penetrative sexual abuse in childhood had 2.25 (95% CI=1.32-3.82) and 5.93 (95% CI=2.72-12.95) times respectively the rate of impaired mental health, but no higher rates of impaired physical health. Women who had experienced non-penetrative and penetrative sexual abuse in childhood had 1.87 (95% CI=1.19-2.95) and 3.15 (95% CI=1.87-5.33) times respectively the rate of impaired mental health and 1.87 (95% CI=1.19-2.92) and 2.31 (95% CI=1.34-3.97) times respectively the rate of impaired physical health. However, participants who had experienced CSA were no less likely than those who had not experienced CSA to be in optimum physical and mental health. None of the possible confounding or moderating variables tested appeared to mitigate the impact of CSA on health outcomes. Those with the highest levels of mental and physical health appear to be unaffected by the experience of CSA.

Adverse childhood experiences and childhood autobiographical memory disturbance

OBJECTIVE

To examine relationships between childhood autobiographical memory disturbance (CAMD) and adverse childhood experiences (ACEs) which are defined as common forms of child maltreatment and related traumatic stressors.

METHODS

We use the ACE score (an integer count of eight different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. In a cross sectional analysis we assess the relationship of the ACE score to the prevalence of CAMD in a sample of 9,460 relatively healthy adults evaluated for wellness care at a southern California health maintenance organization between August 1995 and March 1996. In addition, we examined possible secular influences by examining association among each of four birth cohorts. Logistic regression was used to obtain the adjusted relative odds of CAMD associated with increasing ACE score.

RESULTS

Overall, the age-standardized prevalence of CAMD was 18% (men: 15%; women: 19%). As the ACE score increased, the prevalence of CAMD increased in a graded fashion for both men and women (p for trend <.0001). After adjustment for age, sex, race/ethnicity, and education, adults with an ACE score >or=6 were 5.9 (95% CI, 4.4-7.9) times more likely to have CAMD compared to adults with an ACE score of 0. The prevalence of CAMD increased with each successive birth cohort, and graded relationships between the ACE score and CAMD were observed among each of the four birth cohorts though no statistical difference in the association was found across birth cohorts.

CONCLUSIONS

The accumulation of ACEs across several domains is associated CAMD among men and women and in each of four birth cohorts. Further research is needed that describes the prevalence of CAMD in population-based samples and that examines whether impaired memory is a marker for persons neurobiologically affected by multiple forms of child maltreatment and related traumatic stressors.

Effect of Childhood Sexual Abuse on Gynecologic Care as an Adult

The study sought to evaluate whether childhood sexual abuse (CSA) experiences significantly affect the gynecologic care received as an adult. A self-administered questionnaire including eight questions on CSA was completed by 85 women exposed to CSA and 170 matched-control women. Women exposed to CSA experienced gynecologic examinations as anxiety-provoking significantly more often and sought more treatment for acute gynecologic problems; 43.5% of these women experienced memories of the original abuse situation during gynecologic consultations. Gynecologic care is particularly distressing for women exposed to CSA.

Does childhood sexual abuse predict young adult's BMI? A birth cohort study

OBJECTIVE

The objective was to identify the extent to which childhood sexual abuse (CSA) is associated with BMI and overweight status in young adulthood and to examine whether any associations differ by gender.

RESEARCH METHODS AND PROCEDURES

The Mater-University of Queensland Study of Pregnancy is a prospective birth cohort from a population-based sample involving 7223 singletons whose mothers were enrolled in the 1980s at the first antenatal visit. The present cohort consisted of a subgroup of 2461 young adults who had both self-reported CSA data and measured BMI at 21 years.

RESULTS

Of 1273 men, 10.5% reported non-penetrative and 7.5% reported penetrative CSA before age 16 years. Of 1305 women, 20.6% reported non-penetrative and 7.9% reported penetrative CSA by age 16 years. We found young women's BMI and the prevalence of overweight at age 21 were greater in those who experienced penetrative CSA. This association was robust to adjustment for a variety of potential confounders. However, there was no association between non-penetrative CSA and BMI in women and no association between either category of CSA and BMI in men. There was statistical evidence for a gender difference in the association of CSA with mean BMI at age 21 (p value for statistical interaction <0.01 in all models).

DISCUSSION

These findings suggest that among women, penetrative CSA is associated with greater BMI and increased odds of being overweight in later life, whereas in men, this association does not hold. This gender difference may reflect differences between women and men in the relationship between psychological trauma and body image or may be a chance subgroup finding.

Childhood risk factors for alcohol abuse and psychological distress among adult lesbians

OBJECTIVE

This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians.

METHODOLOGY

Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians.

RESULTS

Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress.

CONCLUSION

While the cross-sectional design precludes causal conclusions, study findings--especially those related to CSA--are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse.

Manipulation and force as sexual coercion tactics: conceptual and empirical differences

This study examines the relationship between perpetrator characteristics, situational characteristics, and type of sexual coercion tactics used to obtain sexual contact (including sexual intercourse) with an unwilling partner. Men who used manipulation or force were compared to each other and to men who engaged in only consensual sex. Participants were college men drawn from the first wave of a 5-year longitudinal study. Stepwise discriminant function analyses, univariate analyses of variance (ANOVA), and chi(2) analyses tested group differences. As predicted, men who used force reported more childhood sexual abuse, witnessed more domestic violence, were more accepting of male violence, and were less likely to endorse love as a motive for sex than men in both the manipulation and consent groups. Men in the force group were also more likely to have had a casual relationship with the woman, and to be drinking and also intoxicated during the coercive incident than men in the manipulation group. Hypothesized differences between men who used force and manipulation regarding parental physical punishment, traditional gender role attitudes, delinquency, hedonistic and dominance motives for sex, prior sexual contact, and the length of the relationship were not supported. The results suggest that types of tactic used in sexual assaults can be distinguished on the basis of person and situational variables and that knowledge of these differences can facilitate future research, as well as rape deterrent and intervention programs.

Adverse childhood experiences and prescribed psychotropic medications in adults

BACKGROUND

Prescription drugs are one of the fastest growing healthcare costs in the United States. However, the long-term influence of child abuse and related traumatic stressors on prescriptions for psychotropic medications in adults has not been described. This study assessed the relationship of eight adverse childhood experiences (ACEs) to rates of prescriptions for psychotropic medications throughout adulthood. These ACEs included: abuse (emotional, physical, or sexual), witnessing domestic violence, growing up with substance abusing, mentally ill, or criminal household members, and parental separation/divorce.

METHODS

Data about ACEs were collected between 1995 and 1997 from adult health maintenance organization patients; prescription data were available from 1997 to 2004. The number of ACEs (ACE Score: maximum 8) was used as a measure of cumulative traumatic stress during childhood. The relationship of the score to rates of prescribed psychotropic drugs was prospectively assessed among 15,033 adult patients eligible for the follow-up phase of the study (mean follow-up: 6.1 years). Data were analyzed in 2006. Multivariate models were adjusted for age, race, gender, and education.

RESULTS

Prescription rates increased yearly during the follow-up and in a graded fashion as the ACE Score increased (p for trend <0.001). After adjusting compared with persons with an ACE Score of 0, persons with a score of equal to or more than 5 had a nearly threefold increase in rates of psychotropic prescriptions. Graded relationships were observed between the score and prescription rates for antidepressant, anxiolytic, antipsychotic, and mood-stabilizing/bipolar medications; rates for persons with a score of equal to or more than 5 for these classes of drugs increased 3-, 2-, 10-, and 17-fold, respectively.

CONCLUSIONS

The strong relationship of the ACE Score to increased utilization of psychotropic medications underscores the contribution of childhood experience to the burden of adult mental illness. Moreover, the huge economic costs associated with the use of psychotropic medications provide additional incentive to address the high prevalence and consequences of childhood traumatic stressors.

Consequences of childhood sexual abuse experiences on dental care

OBJECTIVE

Around 20% of female patients seeking dental care may have experienced childhood sexual abuse (CSA). Several similarities between abuse situations and dental treatment lead to dental fear. Since dental fear hampers oral health, the long-term effects of CSA on dental care and the specific factors that lead to increased stress during dental treatment have been investigated in women exposed to CSA.

METHODS

A self-administered questionnaire, which was developed to investigate the objectives of the study, was distributed to 111 women recruited from support centers for women with CSA experiences. CSA was explored with a modified version of the questionnaire developed by Wyatt. Data from 85 women with CSA experiences were used for comparison to the data of 170 matching control women recruited, who were mothers of children attending kindergarten.

RESULTS

Compared to controls, women exposed to CSA exhibited several long-term effects on dental care in terms of major psychological strain during dental treatment (36.5%/18.8%; P<.005), a lower number of prophylactic controls (72.9%/89.4%; P<.005), and preference for a female dentist to a male dentist (29.4%/8.2%; P<.0001). Women with CSA experiences considered four of five defined stressors associated with dental treatment as more intense. Of these women, 28% suffered from memories of their original abuse situations during dental treatment, and 29.4% believed that the dentist should have known about their history of abuse.

CONCLUSION

CSA experiences may increase psychological strain during dental treatment. To improve dental care for women exposed to CSA, dentists should adjust their treatment plans to the specific needs of these patients.