Does childhood sexual abuse have an effect on young adults' nicotine disorder (dependence or withdrawal)? Evidence from a birth cohort study

Adverse childhood experiences and risky behaviors in Oman: A cross-sectional study

Objective

Adverse childhood experiences (ACEs), which refer to potentially traumatic events occurring during childhood, have been consistently linked to detrimental effects on high-risk behaviors through various studies. Nonetheless, such an association has rarely been examined in the context of Arab culture. This study aimed to investigate the association between ACE levels and high-risk behaviors (e.g., smoking, alcohol consumption, drug use, high-risk sexual behavior, and physical inactivity) among Omani adults.

Methods

This was a cross-sectional study with convenience sampling. The participants were recruited from a university-affiliated medical facility in Oman. Data were collected in 2022. They were asked to complete the Adverse Childhood Experience International Questionnaire (ACE-IQ).

Results

The study included 1648 Omani adults. Analyses revealed that the adjusted odds ratios (ORs) for engaging in some of the identified high-risk behaviors increased as the level of ACEs increased. Specifically, individuals with an ACE level of 4 exhibited higher odds of smoking (OR: 2.6), alcohol consumption (OR: 2.9), and risky sexual behavior (OR: 32) than those without ACEs.

Conclusion

The findings of this study underscore a notable association between ACEs and high-risk behaviors among Omani adults. Consequently, there is a pressing need for intensified efforts to prevent ACEs when possible and to alleviate their adverse effects, emphasizing the importance of public health initiatives and interventions in Oman.

Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study

The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience of 22 adverse outcomes in seven domains (physical, mental, sexual, interpersonal, economic, antisocial, multi-domain) from young adulthood to midlife (26 to 45y). Analyses controlled for sex, socioeconomic status, prospectively reported child harm and household dysfunction adverse childhood experiences, and adult sexual assault, and considered different definitions of CSA. After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.

Parental divorce and nicotine addiction in Lebanese adolescents: the mediating role of child abuse and bullying victimization

BACKGROUND

Lebanon ranks first amongst Middle-Eastern countries in terms of cigarette and waterpipe smoking. Understanding the mediating factors for nicotine addiction in adolescents who have experienced parental divorce is vital to take effective measures that will help in lowering its prevalence in our community. The objective of this study was to investigate the association between the increasingly concerning parental divorce and nicotine addiction in Lebanese adolescents while taking into consideration the plausible mediating effect of abuse and bullying victimization.

METHODS

This was a cross-sectional survey-based study that was conducted between January and May 2019. A total of 1810 adolescents aged between 14 and 17 years was enrolled from 16 Lebanese schools. Linear regressions taking the cigarette and waterpipe dependence scores as dependent variables were conducted respectively, using the SPSS software. PROCESS v3.4 model 4 was used for mediation analysis.

RESULTS

A total of 11.9% of the enrolled participants had divorced parents. Higher cigarette and waterpipe dependence were found in adolescents whose parents were divorced compared to those living together. More child psychological abuse, having divorced parents vs living together, and more child physical abuse were significantly associated with higher cigarette dependence. More child psychological and physical, and having divorced parents vs living together were significantly associated with more waterpipe dependence. In addition, all forms of abuse (except neglect) and bullying victimization had a partially mediating effect in the associations between parental divorce and nicotine dependence (cigarette and waterpipe) in adolescents.

CONCLUSION

This study results may serve as a first step towards enrolling separated parents and their children in special prevention programs to help them create a protective and supportive environment.

Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review

AIM

Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment.

METHOD

This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school.

RESULTS

In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature.

CONCLUSION

Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.

Associations of Adverse Childhood Experiences to Smoking and Nicotine Dependence Among Adolescent Psychiatric Inpatients

Our aim was to examine whether ACEs associate to regular smoking and nicotine dependence (ND) among 508 psychiatric inpatients aged 13-17 years. Adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children and the European Addiction Severity Index -instruments. ND was measured with the modified Fagerström Tolerance Questionnaire. In girls, all violent ACEs (domestic violence, physical abuse at home, sexual abuse) were related to regular smoking and some family-related ACEs (parental divorce and substance use problems) both to regular smoking and ND. After controlling for covariates, girls with parental substance use had an increased likelihood for being a regular smoker and having ND. Greater number of ACEs in girls indicated higher level of ND. Corresponding associations were not observed in boys. Our findings suggest that girls after experiencing ACEs are more prone to becoming smokers and developing ND already in adolescence compared to boys.

Associations between child maltreatment, cigarette smoking, and nicotine dependence in young adults with a history of regular smoking

PURPOSE

The purpose of this study was to evaluate whether childhood maltreatment is associated with smoking behaviors and lifetime nicotine dependence and if associations are moderated by sex. We examined these associations among individuals who ever reported being regular smokers.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined relationships between retrospectively self-reported child maltreatment (parent/caregiver-perpetrated emotional, physical, sexual abuse, and neglect; and non-parent/caregiver-perpetrated sexual abuse) and self-reported smoking behaviors among individuals with a history of regular smoking. Outcomes were any current smoking in early adulthood (mean age = 28 years), current smoking in adolescent study waves only, adulthood only, and adolescence and adulthood (n = 3581); and lifetime history of nicotine dependence (n = 3594) per the Fagerstrom scale.

RESULTS

Poly-maltreatment (aRR for 2+ vs. 0 exposures = 1.20, 95% CI: 1.08, 1.34) was associated with lifetime nicotine dependence; associations between nicotine dependence and neglect and non-parent/caregiver sexual abuse by force were only present in women. Neglect and non-parent/caregiver sexual abuse by nonphysical threat were associated with continued smoking, and an association between non-parent/caregiver sexual abuse by physical force and continued smoking was also noted in women only. Women who experienced poly-maltreatment were less likely to report current smoking in adolescence but not adulthood.

CONCLUSIONS

These data suggest in a nationally representative sample of ever regular smokers, child maltreatment is associated with outcomes that suggest an inability to quit smoking and some associations may vary by sex.

Are Gender Differences in DSM-5 PTSD Symptomatology Explained by Sexual Trauma?

Although many studies have assessed gender differences in posttraumatic stress disorder (PTSD) prevalence, few examine individual PTSD symptoms (PTSSs). Hypothesizing that trauma differences explain many gender differences in symptomatology, this is the first known study to adjust PTSSs for trauma type, and to compare gender differences in those with sexual traumas. Using a cross-sectional survey methodology in a sample of adult outpatients (n = 775), we examined gender, trauma type, PTSSs, suicide, alcohol, and tobacco. Among those with trauma (n = 483), women generally had more severe symptoms than men, but after adjusting for trauma type, only physical reactivity (p = .0002), excessive startle (p = .0005), external avoidance (p = .0007), internal avoidance (p = .0008), psychological reactivity (p = .0009), and suicide attempts (p = .001) remained significantly worse among women, whereas men more commonly reported alcohol problems (p = .007). Among those with PTSD (n = 164), there were no significant PTSS gender differences. Those with sexual trauma had worse symptoms (particularly amnesia) compared with non-sexual trauma (p < .0001 for PTSD diagnosis and total severity), including within each gender. Among those with sexual trauma (n = 157), men had worse recklessness (p = .004) and more commonly reported tobacco (p = .02), whereas women more commonly attempted suicide (p = .02) and had worse avoidance (p = .04). However, when isolating the effects of sexual trauma beyond other traumas, there were no significant symptom difference-in-differences between genders. Our findings suggest that, while women have higher PTSD rates, men with PTSD present similarly. In addition, while women have higher sexual trauma rates, men may have similarly severe responses. Most gender differences in PTSD presentation appear to be explained by trauma type, particularly women having higher rates of sexual trauma. We discuss potential biopsychosocial explanations.

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.

Should community health workers offer support healthcare services to survivors of sexual violence? a systematic review

Background

Sexual violence is widespread, yet relatively few survivors receive healthcare or complete treatment. In low and middle-income countries, community health workers (CHWs) have the potential to provide support services to large numbers of survivors. The aim of this review was to document the role of CHWs in sexual violence services. We aimed to: 1) describe existing models of CHWs services including characteristics of CHWs, services delivered and populations served; 2) explore acceptability of CHWs’ services to survivors and feasibility of delivering such services; and 3) document the benefits and challenges of CHW-provided sexual violence services.

Methods

Quantitative and qualitative studies reporting on CHWs and other community-level paraprofessional volunteer services for sexual violence were eligible for inclusion. CHWs and sexual violence were defined according to WHO criteria. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Quality of included studies was assessed using two quality assessment tools for quantitative, and, the methodology checklist by the National Institute for Health and Clinical Excellence for qualitative studies. Data were extracted and analysed separately for quantitative and qualitative studies and results integrated using a framework approach.

Results

Seven studies conducted in six countries (Democratic Republic of Congo, Rwanda, Burma, United States of America, Scotland, Israel) met the inclusion criteria. Different models of care had diverse CHWs roles including awareness creation, identifying, educating and building relationships with survivors, psychosocial support and follow up. Although sociocultural factors may influence CHWs’ performance and willingness of survivors to use their services, studies often did not report on CHWs characteristics. Few studies assessed acceptability of CHWs’ to survivors or feasibility of delivery of services. However, participants mentioned a range of benefits including decreased incidence of violence, CHWs being trusted, approachable, non-judgmental and compassionate. Challenges identified were high workload, confidentiality issues and community norms influencing performance.

Conclusions

There is a dearth of research on CHWs services for sexual violence. Findings suggest that involving CHWs may be beneficial, but potential challenges and harms related to CHW-provided services exist. No different models of CHW-provided care have been robustly evaluated for effects on patient outcomes. Further research to establish survivors’ views on these services, and, their effectiveness is desperately needed.

Electronic supplementary material

The online version of this article (10.1186/s12914-017-0137-z) contains supplementary material, which is available to authorized users.

Resilience and biomarkers of health risk in Black smokers and nonsmokers

OBJECTIVES

Blacks are disproportionately affected by tobacco-related illnesses as well as traumatic events associated with psychiatric conditions and smoking. We examined the potential protective nature of resilience within this context, hypothesizing resilience differentially moderates the associations of traumatic experiences to depressive symptoms and to biomarkers of health risk among Black ever versus never smokers.

METHOD

Measures of resilience, traumatic experiences, depressive symptoms, and biomarkers (interleukin-6 [IL-6], C-reactive protein [CRP], allostatic load) were obtained among 852 Blacks recruited from Grady Memorial Hospital in Atlanta.

RESULTS

Ever smokers experienced more trauma (p < .001) and depressive symptoms (p = .01). Structural equation modeling indicated that, in ever smokers, childhood trauma was positively associated with depressive symptoms (p < .001); resilience was negatively associated with depressive symptoms (p = .01). Depressive symptoms were positively associated with IL-6 (p = .03), which was positively associated with allostatic load (p = .01). Adulthood trauma was associated with higher CRP levels (p = .03). In never smokers, childhood (p < .001) and adulthood trauma (p = .01) were associated with more depressive symptoms. Adulthood trauma was also associated with higher CRP levels (p < .001), which was positively associated with allostatic load (p < .001). Never smokers with higher resilience had a negative association between childhood trauma and depressive symptoms whereas those with lower resilience had a positive association between childhood trauma and depressive symptoms. Resilience was negatively associated with CRP levels (p < .001).

CONCLUSIONS

Interventions targeting resilience may prevent smoking and adverse health outcomes. (PsycINFO Database Record

Early Childhood Adversity and Pregnancy Outcomes

OBJECTIVES

To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits.

METHODS

Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators.

RESULTS

Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age.

CONCLUSIONS

ACEs have an enduring effect on maternal reproductive health, as manifested by mothers' delivery of offspring that were of reduced birth weight and shorter gestational age.

The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review

The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.

Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women

OBJECTIVE

The aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women.

METHODS

Data were drawn from a same-sex female twin study of substance use (n=3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure).

RESULTS

After adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR)=1.43, 95% confidence intervals (CI): 1.26-1.62) and with smoking initiation ≤16 in African Americans (HR=1.70, CI: 1.26-2.29). CSA was associated with regular smoking onset ≤15 in European Americans (HR=1.63, CI: 1.21-2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR=3.30, CI: 1.23-8.89 to HR=1.16, CI: 0.71-1.92 for regular smoking ≤15).

CONCLUSIONS

CSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.

Risk Factors for Smoking in Rural Women: The Role of Gender-Based Sexual and Intimate Partner Violence

BACKGROUND

Women living in Ohio Appalachia experience cervical cancer at disproportionately high rates. Intimate partner and sexual gender-based violence (GBV) and smoking are independent risk factors for cervical cancer and interact to heighten risk. Appalachian women smoke at higher rates than other Ohio women, but little is known about GBV exposure in the region. The purpose of this study was to establish prevalence of women's exposure to GBV in Ohio Appalachia and examine the association between GBV and smoking among women in the region.

METHODS

A two-phase address-based random sampling approach was used in three purposefully selected Ohio Appalachian counties to identify women to complete an interviewer administered cross-sectional survey (n = 398). The primary exposure variable was GBV Index Score, a 4 level indices representing increasing exposure to eight abuse types. Correlation analysis and logistic regression were used to examine smoking correlations and risk.

RESULTS

Almost 57% of women in the three selected Ohio Appalachian counties experienced GBV, with rate increasing to 77.5% among current smokers. The distribution of the GBV Exposure Index Score was significantly different across smoking status (p < = 0.0001), with exposure of GBV increasing when moving from never, to former, to current smokers. When controlling for depression, age, and adult socioeconomic position, GBV Exposure Index was significantly associated with current smoking behavior (OR:1.62, 95% CI [1.21-2.17]).

DISCUSSION

Professionals working to reduce disparate disease burden among women in Ohio Appalachia should consider the role GBV plays in health behavior and behavioral change interventions, including smoking and smoking cessation.

PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse). Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment.

Burden attributable to child maltreatment in Australia

Child maltreatment is a complex phenomenon, with four main types (childhood sexual abuse, physical abuse, emotional abuse, and neglect) highly interrelated. All types of maltreatment have been linked to adverse health consequences and exposure to multiple forms of maltreatment increases risk. In Australia to date, only burden attributable to childhood sexual abuse has been estimated. This study synthesized the national evidence and quantified the burden attributable to the four main types of child maltreatment. Meta-analyses, based on quality-effects models, generated pooled prevalence estimates for each maltreatment type. Exposure to child maltreatment was examined as a risk factor for depressive disorders, anxiety disorders and intentional self-harm using counterfactual estimation and comparative risk assessment methods. Adjustments were made for co-occurrence of multiple forms of child maltreatment. Overall, an estimated 23.5% of self-harm, 20.9% of anxiety disorders and 15.7% of depressive disorders burden in males; and 33.0% of self-harm, 30.6% of anxiety disorders and 22.8% of depressive disorders burden in females was attributable to child maltreatment. Child maltreatment was estimated to cause 1.4% (95% uncertainty interval 0.4-2.3%) of all disability-adjusted life years (DALYs) in males, and 2.4% (0.7-4.1%) of all DALYs in females in Australia in 2010. Child maltreatment contributes to a substantial proportion of burden from depressive and anxiety disorders and intentional self-harm in Australia. This study demonstrates the importance of including all forms of child maltreatment as risk factors in future burden of disease studies.

The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment

BACKGROUND AND AIMS

Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study.

DESIGN

Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities.

SETTING

National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

PARTICIPANTS

NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence (n = 1172) and nicotine dependence (n = 4017).

MEASUREMENTS

Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce).

FINDINGS

Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio (AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence (AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence (AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence (AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk (AOR = 1.19-1.36; 95% CI = 1.11-1.56).

CONCLUSIONS

A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence.

Early smoking onset and risk for subsequent nicotine dependence: a monozygotic co-twin control study

OBJECTIVE

Early onset of regular smoking is associated with an elevated risk for later nicotine dependence. Whether or not this association is causal is unknown and has substantial public policy implications.

METHOD

The authors used a monozygotic co-twin control study design. Pairs were selected from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders for discordance in age at onset of regular smoking. Nicotine dependence was measured by the Fagerström test for nicotine dependence and level of craving.

RESULTS

The authors identified 175 male-male and 69 female-female monozygotic twin pairs who differed by at least 2 years in age at onset of regular smoking. During their period of heaviest smoking, the twin who began smoking earlier had significantly higher Fagerström test scores in both the male-male (Cohen's d=0.20) and female-female twin pairs (d=0.26). Craving for cigarettes when unable to smoke was also higher in the early-onset member in both groups (male pairs, d=0.38; female pairs, d=0.25). The early-onset smoking twin did not differ from the later-onset twin in symptoms of alcohol or cannabis abuse or dependence, current alcohol use, or maximal level of cannabis, sedative, stimulant, or cocaine use.

CONCLUSIONS

Controlling for genetic and familial-environmental effects, age at onset of regular smoking predicted level of nicotine dependence. Consistent with the animal literature, these findings suggest that in humans, early nicotine exposure directly increases level of later nicotine dependence. These results should be interpreted in the context of the methodological strengths and limitations of the monozygotic co-twin design.

The childhood sexual abuse among youth in three Asian cities: Taipei, Shanghai, and Hanoi

The article describes the prevalence and risk factors of childhood sexual abuse (CSA) among youth in Hanoi, Shanghai, and Taipei. Data used in this study are from the Three-City Asian Study of Adolescents and Youth, 2006-2007. Descriptive analysis and logistic regression models were used. The self-reported lifetime prevalence of CSA was 5.2% in Taipei, 1.3% in Shanghai, and 0.5% in Hanoi. The overall prevalence was 2.2% for females and 1.7% for males. The average age of first CSA was 10.5 years. Household instability, migration before age 14, and low maternal warmth were found to be positively associated with CSA, whereas discussing problems with father and being close to mother were negatively associated with CSA, after adjusting for sociodemographic characteristics. Our findings suggested the importance of prevention programs for preteen aged children, public education to raise awareness, and further prospective studies to identify various risk markers for CSA in Asia.

Childhood maltreatment and substance use disorders among men and women in a nationally representative sample

OBJECTIVE

To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample.

METHOD

Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders.

RESULTS

All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect.

CONCLUSIONS

This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.

The link between childhood sexual abuse and myocardial infarction in a population-based study

OBJECTIVES

This study examined the relationship between childhood sexual abuse (CSA) and myocardial infarction in men and women, while controlling for social determinants (i.e., socioeconomic status, social support, mental health) and traditional cardiovascular risk factors (i.e., age, race, obesity, smoking, physical inactivity, diabetes mellitus).

METHODS

Population-based data were obtained from the 2010 Behavioral Risk Factor Surveillance System. Myocardial infarction was ascertained by self-report of a health-professional diagnosis. CSA was defined as forced sex with someone at least 5 years older before the age of 18. The final sample included 5,095 men and 7,768 women.

RESULTS

After adjustment for 15 factors, abused males had nearly 3 times the odds of heart attack compared to non-abused males (OR=2.96; 95% CI=1.12, 7.85). Among women, CSA was not associated with heart attack in the age-race adjusted (OR=1.20; 95% CI=0.39, 3.68) or fully-adjusted (OR=0.88; 95% CI=0.28, 2.75) analyses.

CONCLUSIONS

CSA was associated with heart attack in men, even when controlling for traditional risk factors; however, no association was found among women. Future research is needed to replicate the study's unique findings.

Review of risk and protective factors of substance use and problem use in emerging adulthood

This review examines the evidence for longitudinal predictors of substance use and abuse in emerging adulthood. Nationally representative data from the 2007 National Survey on Drug use and Health suggest that many substance use problems reach their peak prevalence during emerging adulthood (usually defined as the period from age 18 to age 26). This stage of development is characterized by rapid transitions into new social contexts that involve greater freedom and less social control than experienced during adolescence. Concurrent with this newfound independence is an increase in rates of substance use and abuse. Understanding the risk and protective factors associated with emerging adult substance use problems is an important step in developing interventions targeting those problems. While multiple reviews have examined risk and protective factors for substance use during adolescence, and many of these earlier predictors may predict emerging adult substance use, few studies have focused primarily on the emerging adult outcomes examining predictors from both adolescence and emerging adulthood. This review used the databases PubMed and PsycInfo to identify articles pertaining to longitudinal predictors of substance use problems in emerging adulthood, building from the conceptual framework presented in a review on risk and protective factors for adolescent substance abuse by Hawkins and colleagues (Hawkins, Catalano, & Miller, 1992). Predictors identified as predictors of substance use in adolescence, sometimes decreased in strength and in one case reversed direction. Unique predictors in emerging adulthood were also identified. Implications for prevention science during adolescence and emerging adulthood are discussed as well as suggestions for future research.

Association between childhood sexual abuse and adverse psychological outcomes among youth in Taipei

PURPOSE

The objective of this study was to examine the relationship between a history of childhood sexual abuse (CSA) and negative psychological consequences in adulthood, controlling for family environments and Confucian values.

METHODS

The data used in this study were collected from Taipei. The final analysis sample comprised 4,084 participants aged 15-24 years. Three sets of logistic regression models were fitted to verify the association between CSA and negative psychological outcomes. Sociodemographic variables, household instability, and parenting variables, as well as Confucian value variables were controlled in models step by step. The overall prevalence of CSA in our analysis sample was 5.2%.

RESULTS

The overall prevalence of depression, anxiety, and suicidal ideation among Taipei respondents was 11.8%, 16.4%, and 16.7%, respectively, but young people who experienced CSA had significantly higher rates of all three than young adults who had not experienced CSA. After controlling for other covariates, the odds ratios of depression, anxiety, and suicidal ideation associated with a history of CSA were 1.78 (95% confidence intervals [CI]: 1.25-2.54), 1.77 (95% CI: 1.28-2.44), and 2.56 (95% CI: 1.56-4.29), respectively.

CONCLUSIONS

Our findings suggested that CSA was an independent predictor of negative psychological consequences in adulthood. In our analysis, we controlled for household, parenting, and Confucian culture factors, which provides a better understanding of how they work together to affect adult psychological status.

The relationship of childhood trauma to nicotine dependence in pregnant smokers

Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement, and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.

Posttraumatic stress disorder and alcohol dependence in young women

OBJECTIVE

The aim of the current study is to characterize the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) in women, distinguishing PTSD-specific influences on AD from the contribution of co-occurring psychiatric conditions and from the influences of trauma more generally.

METHOD

Trauma histories and DSM-IV lifetime diagnoses, including PTSD and AD, were obtained via telephone interview from 3,768 female twins. Based on PTSD status and trauma history, participants were categorized as no trauma (43.7%), trauma without PTSD (52.6%), or trauma with PTSD (3.7%). Cox proportional hazards regression analyses were conducted using trauma/PTSD status to predict AD, first adjusting only for ethnicity and parental problem drinking, then including conduct disorder, major depressive disorder, regular smoking, and cannabis abuse.

RESULTS

Before accounting for psychiatric covariates, elevated rates of AD were evident in both trauma-exposed groups, but those with PTSD were at significantly greater risk for AD than those without PTSD. This distinction was no longer statistically significant when psychiatric covariates were included in the model, but both trauma-exposed groups continued to show elevated odds of developing AD compared with the no trauma group.

CONCLUSIONS

The elevated rates of AD in women who have experienced trauma are not accounted for in full by psychiatric conditions that commonly co-occur with AD and trauma exposure. The greater likelihood of developing AD in the subset of trauma-exposed individuals who develop PTSD may reflect higher levels of distress and/ or higher rates of psychopathology associated with traumas that lead to PTSD rather than PTSD-specific influences.

Predictors of young adults' amphetamine use and disorders: a prospective study

INTRODUCTION AND AIMS

Understanding the risk factors that predict amphetamine use and development of amphetamine abuse or dependence (disorder) may help guide preventive interventions. This study aimed to investigate the correlates and predictors of young adults' amphetamine use and use disorders.

DESIGN AND METHODS

Prospective cohort, population-based study which started in Brisbane, South East Queensland (Australia) in 1981. The study participants were a cohort of 2042 young adults, followed up from birth to young adulthood. At the 21-year follow-up, amphetamine use was assessed via a self-report questionnaire, and amphetamine use disorder (AUD) was assessed using the Composite International Diagnostic Interview (CIDI-Auto). Potential predictors (15 risk factors) were assessed between baseline (antenatal visit) and the 21-year follow-up. These included participant's gender, mother's age and education, maternal marital status and quality of marital relationship, maternal tobacco and alcohol consumption, mother-child communication, child mental health and problem behaviours, child smoking and alcohol consumption and child school performance.

RESULTS

Young adult amphetamine users were more likely to have concurrent symptoms of mental illness and problem behaviours and to use or abuse cigarettes, cannabis, or other illicit drugs. In multivariate analyses, young adults' amphetamine use and disorder were disproportionately more common among males and those who have prospectively reported aggression/delinquency or smoking at 14 years, or who have experienced childhood sexual abuse.

CONCLUSIONS

Our findings suggest that problem behaviours, smoking and childhood sexual abuse are predictors of initiation to use of amphetamines and development of amphetamine abuse and dependence.

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.

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

Risky health behaviors among mothers-to-be: the impact of adverse childhood experiences

OBJECTIVES

Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors.

METHODS

A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy.

RESULTS

Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without.

CONCLUSIONS

ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

Onanism and child sexual abuse: a comparative study of two hypotheses

For some decades now in the West, there has been a growing social anxiety with regard to a phenomenon which has become known as child sexual abuse (CSA). This anxiety is fed by scientific theories whose cornerstone is the assessment of these experiences as necessarily harmful, due to their presumed serious consequences for the present and future lives of the minors involved in them. This principle, widely held by experts and laypersons alike, was also part and parcel of the danger presumably posed by Onanism, a phenomenon which occupied a similar position in society and medical science in the West during the eighteenth through twentieth centuries. The present work is a comparative review of these two hypotheses and the central objective was to compare the evolution and fundamental elements of the two hypotheses in light of what history tells us about Onanism theory. This comparative analysis will allow a critical look at the assumptions of the CSA hypothesis in order to make evident the similarities to the conceptual model that enabled the Onanism hypothesis in the past.

Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up

BACKGROUND

The contribution of gestational weight gain (GWG) to the development of obesity may have important implications for mothers in their later lives. However, whether GWG is a strong predictor of body mass index (BMI) 2 decades after the index pregnancy is unknown.

OBJECTIVE

We examined the long-term effect of GWG by using a community-based birth cohort study.

DESIGN

We followed a subsample of 2055 women from an original cohort of 7223 women who gave birth in Brisbane, Australia, between 1981 and 1983. Multivariable regression and multinomial regression were used to examine the independent associations of GWG per gestational week and Institute of Medicine (IOM) categories of combined prepregnancy BMI and GWG with BMI and its categories 21 y after the index pregnancy.

RESULTS

In analyses using GWG per week as a continuous exposure variable, maternal BMI (in kg/m(2)) increased, on average, by 0.52 (95% CI: 0.31, 0.73) for a 0.1-kg/wk greater GWG. This association became stronger when adjusted for maternal prepregnancy BMI. Analyses with IOM categories showed a greater postnatal increase in BMI for women defined as having excessive GWG (3.72, on average; 95% CI: 3.12, 4.31) than for women with adequate GWG. The women who gained excess weight during pregnancy had increased odds of being overweight [odds ratio (OR): 2.15; 95% CI: 1.64, 2.82] or obese (OR: 4.49; 95% CI; 3.42, 5.89) 21 y after the index pregnancy. These associations were independent of other potential factors.

CONCLUSION

Weight gain during pregnancy independently predicts the long-term weight gain and obesity of women.

Relationship between child abuse and adult smoking

OBJECTIVE

A strong association between a history of child abuse and subsequent psychiatric disorders including substance use has been demonstrated. However, few studies have examined the relationship between child abuse and cigarette smoking in individuals without co-occurring psychiatric disorders. In this study, the relationship between severe childhood abuse and smoking were examined in a group of adults without significant psychopathology.

METHODS

Participants (N = 57) represent the control group of a larger study of substance dependence. Participants were without major DSM-IV psychopathology, including substance use disorders, major depression, or posttraumatic stress disorder. The Early Trauma Inventory [20] assessed history of exposure to traumatic events prior to age 18.

RESULTS

The majority of individuals with, as compared to without, a history of severe child abuse (79% vs. 47%, p = .02) were current cigarette smokers. The odds of smoking was four times as high in participants with versus without a severe childhood abuse history (OR = 4.0, p = 0.04).

CONCLUSIONS

Although preliminary, the findings demonstrate a strong link between early childhood trauma and later adult cigarette smoking among individuals without significant substance use or other psychopathology.

Cumulative violence exposure and self-rated health: longitudinal study of adolescents in the United States

OBJECTIVE

The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents.

METHODS

The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997-2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health.

RESULTS

At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported >or=5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors.

CONCLUSIONS

In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood.

The association between cannabis abuse and dependence and childhood physical and sexual abuse: evidence from an offspring of twins design

AIM

This study examines the association between childhood physical abuse (CPA) and sexual abuse (CSA) and the development of cannabis abuse and dependence among adolescents and young adults while controlling for genetic and environmental risk factors.

DESIGN

To control for familial risk differences related to paternal drug dependence that might confound the relationship between CSA and CPA and cannabis abuse/dependence, we created four groups based on father's and uncle's substance use dependence (SUD) status reflecting different degrees of genetic and environmental risks to offspring: (i) high genetic, high environmental risk; (ii) high genetic, low environmental risk; (iii) medium genetic, low environmental risk; and (iv) low genetic, low environmental risk.

PARTICIPANTS

Adolescent and young adult offspring of monozygotic and dizygotic US military veteran twin fathers (n = 819).

MEASUREMENTS

Data on CPA and CSA, DSM-IV offspring cannabis abuse/dependence, other SUD and psychopathology and maternal and paternal SUD and psychopathology were collected via semi-structured telephone interview.

FINDINGS

Twenty-three per cent of the offspring sample met life-time criteria for cannabis abuse/dependence and 8.55% and 12.82% reported CSA and CPA, respectively. Offspring exposed to CSA, but not CPA, were at significantly greater risk of developing cannabis abuse/dependence compared to those who had not experienced CSA (hazard ratio = 2.16; 95% confidence interval = 1.48-3.16) after controlling for genetic and familial environmental risk and offspring gender, alcohol abuse and dependence and conduct disorder.

CONCLUSIONS

These results indicate that there are effects of CSA on development of cannabis abuse/dependence in addition to the genetic and familial environmental risk imparted by having a drug-dependent father.

Association between trauma exposure and smoking in a population-based sample of young adults

PURPOSE

To evaluate the relation between smoking and trauma exposure in a population-based, longitudinal sample. Contrary to current smoking trends in the general population, recent findings indicate continued high smoking rates in trauma-exposed samples.

METHODS

A nationally representative sample of 15,197 adolescents was followed from 1995 (mean age, 15.6 years) to 2002 (mean age, 22 years) as part of three waves of The National Longitudinal Study of Adolescent Health (Add Health). We examined the relation between self-reported trauma exposure and smoking behaviors (lifetime regular, current regular), nicotine dependence based on the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, and age of onset of regular smoking.

RESULTS

Controlling for demographics and depressive symptoms, exposure to traumatic events yielded a significant increase in the odds of lifetime regular smoking. Nicotine dependence and cigarettes smoked per day was also significantly related to exposure to childhood physical and sexual abuse. Decreased age of regular smoking onset was seen for those reporting childhood physical abuse and childhood sexual abuse.

CONCLUSIONS

Exposure to traumatic life events during childhood and young adulthood increases the risk of smoking, highlighting the need to prevent and treat tobacco use in this vulnerable population.