The relations between family environment and violence exposure among youth: findings from the national survey of adolescents

Treatment Engagement Among Children Exposed to Violence: A Systems Perspective

Childhood exposure to violence is a major public health issue. Effective treatment can reduce the impact of violence exposure on child outcomes. However, disparities in treatment engagement can interfere with effective treatment. This study reviews data collected from 2,546 children referred to community-based mental health services from 2001 to 2015 after exposure to violence. Children were categorized into three groups: those who attended intake but never started treatment, referred to as the Nonengager group; those who started but discontinued treatment prior to meeting treatment goals, referred to as the Attriter group; and those who completed treatment as rated by the treating therapist, referred to as the Completer group. The three groups were analyzed for differences in behavioral and emotional problems, racial identity, child social support, household income, number of people living in the home, parent stress, parent social support, community violence exposure, and neighborhood-level child opportunity. Analyses demonstrated that the Completer group were more likely to: live in neighborhoods with higher levels of childhood opportunity, identify as White, have an annual household income of $40,000 or greater, have significantly fewer people living in the home, report lower levels of parental stress, report higher levels of parental social support, report higher levels of child social support, and have significantly lower scores of emotional and behavioral problems after treatment. Overall, our study supports the importance of considering multiple ecological levels when targeting treatment engagement for children after exposure to violence. Results indicate that children from more advantaged environments are more likely to complete treatment, which leads to better outcomes. This can exacerbate existing disparities. Findings highlight the need for systems change and advocacy for children in less advantaged environments and meeting families in their specific context, to combat treatment disparities.

Exploring Family Backgrounds of Chinese Adolescents Who Are Vulnerable to Victimization and Repeated Victimization

There is abundant evidence in the literature to show that victimization has a series of adverse consequences on child victims' physical and mental health. However, some studies detailed whether the family correlates of repeat victims differ from those who are victimized only once. This study fills this gap by describing the probabilities that children who fit certain profiles will be repeat victims and implies that it is possible to identify and screen individual and family factors who are at high risk of repeated victimization. Using the 2009-2010 Child Victimization Survey, we analyzed data from 14,564 Chinese adolescents aged 14-18 years from five major cities in China. We employed a multinomial logit regression model, using child victimization as the dependent variable and demographic factors as independent variables. We identified the top 1% of the most vulnerable cases and summarized their demographic characteristics. Our analysis revealed that older boys with siblings in the same household whose mothers' education was below average were the most vulnerable to one-time victimization. Further, boys with siblings whose parents were less-educated than average, unemployed, and unmarried were the most vulnerable to repeated victimization. This study has vast practical implications, including different ways to confront the problem of repeated child victimization (both practically and in the literature), develop a quick screening tool, and apply cost-effective prevention and interventions in China.

Self-harming behavior in relation to exposure to inter-personal violence among youth and young adults in Colombia

The effects of violence exposure on the risk of self-harming behaviors of youth in low- and middle-income countries is not well-understood. Using household survey data from one nationally representative sample and one sample from conflict-affected areas, we examined violence exposure and self-harm among Colombian youth aged 13-24. Survey-weighted prevalence ratios comparing self-harming behaviors by exposure to violence were estimated with Poisson log-linear models, controlling for age, sex, education and food insecurity. Compared to unexposed youth, those exposed to violence in both home and community settings were 7.97 (95% confidence interval [CI]:2.72-23.36) times more likely in the conflict-affected sample, and 21.05 (95% CI: 8.80-50.34) times more likely in the national sample to report having attempted suicide. Among Colombian youth, exposure to violence as either witness or victim was associated with greater prevalence of self-harming behaviors. Youth suicide prevention programs can address exposures to violence as a risk factor for self-harm.

Traumatic Brain Injury-Related Emergency Department Visits Among American Indian and Alaska Native Persons-National Patient Information Reporting System, 2005-2014

OBJECTIVE

The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility.

METHODS

Using the IHS National Patient Information Reporting System, we assessed the incidence of TBI-related emergency department visits among AI/AN children and adults seen in IHS or tribally managed facilities over a 10-year period (2005-2014).

RESULTS

There were 44 918 TBI-related emergency department visits during the study period. Males and persons aged 18 to 34 years and 75 years and older had the highest rates of TBI-related emergency department visits. Unintentional falls and assaults contributed to the highest number and proportion of TBI-related emergency department visits. The number and age-adjusted rate of emergency department visits for TBI were highest among persons living in the Southwest and Northern Plains when compared with other IHS regions.

CONCLUSION

Thousands of AI/AN children and adults are seen each year in emergency departments for TBI and the numbers increased over the 10-year period examined. Evidence-based interventions to prevent TBI-related emergency department visits, such as programs to reduce the risk for older adult falls and assault, are warranted.

Physical Punishment and Child Externalizing Behavior: Comparing American Indian, White, and African American Children

This study examined if, compared to White and African American children, maternal spanking of American Indian children was associated with child externalizing behavior problems. Using a community-based sample of 3,632 children (1,183 White, 2,183 African American, 266 American Indian), multiple-group autoregressive cross-lagged models examined the associations between maternal spanking and child externalizing behavior across the first 5 years of life. Rates of spanking for American Indian and White children were similar at all three time points (age 1, age 3, and age 5). When comparing White and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (White: β = .10, p < .001; American Indian: β = .08, p < .01), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (White: β = .09, p < .05; American Indian: β = .08, p < .01). When comparing African American and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (African American: β = .08, p < .01; American Indian: β = .06, p < .001), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (African American: β = .08, p < .001; American Indian: β = .07, p < .001). Structural invariance tests suggested that the associations observed among American Indian children were not distinguishable from those observed among White and African American children. Results of this study can be interpreted in light of the recent American Academy of Pediatrics statement that encourages pediatricians to counsel parents against the use of physical punishment. Similar to White and African American families, American Indian families may benefit from reducing or eliminating the use of physical punishment.

Moderators of the Association Between Exposure to Violence in Community, Family, and Dating Contexts and Substance Use Disorder Risk Among North American Indigenous Adolescents

Exposure to violence and substance abuse are salient public health concerns among Indigenous people (i.e., American Indian and Canadian First Nations). Despite this, little research has examined the association between the two among community-based reservation/reserve samples, or factors within the broader social environment that may moderate this association. As such, the purpose of the study is to examine ecological moderators of the association between direct (i.e., dating violence victimization) and indirect (i.e., current perceptions of community violence and prospective caretaker-reported victimization exposure) exposure to violence and meeting diagnostic criteria for a substance use disorder among a large longitudinal sample of Indigenous youth and their caretakers in the upper-Midwest of the United States and Canada (N = 521). Data come from the last two waves of the study, when the adolescents were between the ages of 16 and 19 years. The results show relatively high rates of direct and indirect violence exposure by late adolescence. Logistic regression models with added interaction terms were examined to test moderating effects. Per capita family income and remote location both amplified the positive association between current community violence exposure and substance use disorder risk. Family warmth and support buffered the association between caretaker victimization exposure and substance use disorder risk, whereas dating violence victimization exposure amplified this association. The findings are contextualized for Indigenous communities, and substance abuse prevention and intervention implications are discussed.

Parent Cultural Stress and Internalizing Problems in Latinx Preschoolers: Moderation by Maternal Involvement and Positive Verbalizations

Parent cultural stress has a pervasive and significant impact on family functioning and increases risk for socioemotional problems among Latinx children. Identifying factors that can protect against the negative influence of cultural stressors and enhance the developmental trajectories of Latinx children early in life is key as these children experience disproportionate risk for psychosocial adversity and internalizing mental health problems. The present study evaluated the effect of maternal cultural stress on young children´s internalizing problems, and the moderating role of maternal parenting behaviors. Participants were 65 Latinx children (3 to 5 years old, 50% female) and their mothers (21 to 47 years old, 68% immigrants) recruited from three Head Start Centers in the Chicagoland Area. Mother-reported cultural stress predicted young children's internalizing problems. In addition, maternal self-reported involvement and observed maternal positive verbalizations during one-on-one interactions with the child moderated the effect of cultural stress on child internalizing symptoms. Findings are discussed in the context of efforts to promote family and child resilience and implications for culturally sensitive measurement and intervention.

Association Between State-Level Criminal Justice-Focused Prenatal Substance Use Policies in the US and Substance Use-Related Foster Care Admissions and Family Reunification

Importance

States have enacted criminal justice-related substance use policies to address prenatal substance use and protect infants from adverse health effects of parental substance use. However, little is known about the consequences of these policies for permanency outcomes among infants in the foster care system in the United States.

Objectives

To evaluate the consequences of criminal justice-related prenatal substance use policies for family reunification and to examine differences in parental reunification by racial/ethnic group.

Design, Setting, and Participants

In this cohort study using data from the 2005 to 2017 Adoption and Foster Care Analysis and Reporting System, 13 cohorts of infants who entered the foster care system were followed up. States with criminal justice-related prenatal substance use policies were compared with states without such policies before and after their enactment using a discrete-time hazard model adjusted for individual covariates, state, and cohort fixed effects. The sample consisted of 350 604 infants 1 year or younger who had been removed from their home because of parental drug or alcohol use.

Main Outcomes and Measures

Length of time from entering the child welfare system to first reunification with a parent and hazard rates (HRs).

Results

Of the 350 604 infants 1 year or younger, 182 314 (52%) were boys, 251 572 (72%) were non-Hispanic white children, and 160 927 (46%) lived in US states with a criminal justice-focused prenatal substance use policy. Among those who were reunified, 36% of the reunifications occurred during the first year and 45% in the second year. Foster care infants who were removed from their homes because of parental substance use who live in states that have adopted criminal justice-oriented policies had a lower chance of reunification with a parent compared with states that have not adopted those policies (HR, 0.95; 95% CI, 0.94-0.96). Specifically, non-Hispanic black children who live in a state that has adopted criminal justice-oriented policies had a lower chance of reunification with a parent than non-Hispanic black children who live in a state that has not adopted those policies (HR, 0.87; 95% CI, 0.81-0.94).

Conclusions and Relevance

Given the child welfare system's legal mandate to make every effort toward parental reunification, a more comprehensive treatment and supportive policy approach toward parental substance use might be warranted.

Child Victimization in the Context of Family Violence

Child victimization refers to all possible forms of violence experienced by a child. This issue examines multiple types of victimization through a comprehensive approach. To understand child victimization fully, it should be investigated within the context of family violence. The studies in this issue provide evidence of the prevalence of various types of child victimization. As well as child maltreatment and bullying, the emerging form of cyberbullying is examined in several studies. The family has always been the main focus around child victimization, with parenting style as one prominent example. Studies show that some parenting styles are associated with child maltreatment and therefore have suggested that parenting programs may be effective in reducing child victimization. This issue provides up-to-date studies from different regions around the world. It makes a significant contribution to the current debate in child victimization.

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.

Violence exposure in an urban city: A GxE interaction with aggressive and impulsive behaviors

BACKGROUND

Previous research has demonstrated a reciprocal relationship between community violence exposure and disruptive behavior problems among youth. No study to date, however, has explored the potential interaction between violence exposure in early adolescence and genetics.

METHODS

We explore the gene x environment interaction's impact on teacher-rated aggressive and impulsive behaviors. Violence exposure during the middle school years was assessed using self-report. Genetic data collection occurred in emerging adulthood. A polygenic score was created using findings from a conduct disorder symptomatology genome-wide association study.

RESULTS

Three longitudinal classes of teacher reported aggressive and impulsive behavior were identified. We found a significant relationship between violence exposure and class membership. There was a significant GxE interaction, such that those with below average levels of the polygenic score and who were exposed to violence were more likely to be in the moderately high aggressive and impulsive class as compared to the no to low class.

CONCLUSIONS

These findings highlight the influence of genetic risk together with violence exposure on adolescent problem behavior. Although youth may have little control over the environments in which they live, interventions can and should focus on helping all youth.

Victimization and traumatic stress: Pathways to depressive symptoms among low-income, African-American girls

Socioeconomic disadvantage is associated with increased exposure to victimization and traumatic stress. The present study evaluates longitudinal pathways linking victimization and trauma to depressive symptoms in a socioeconomically disadvantaged sample of African-American adolescent girls seeking mental health services (N = 177, 12-16 years old at baseline). Girls completed four assessments over the course of three years (T1-T4). Depressive symptoms were assessed at T1-T3 using clinical interviews and questionnaires. At T4, lifetime history of victimization and traumatic stressors was evaluated with in-person interviews. Separate structural equation models tested longitudinal pathways from stressor frequency, severity, and duration to depressive symptoms. In all three models, higher levels of victimization and traumatic stressors were associated with significantly higher levels of depressive symptoms. More frequent stressors prior to T1 directly predicted depressive symptoms at T1 and indirectly predicted depressive symptoms at T2, which, in turn, predicted depressive symptoms at T3. A similar pattern emerged in the stressor severity and duration models. Findings support the idea that victimization and traumatic stressors are associated with higher levels of depressive symptoms and that, among treatment-seeking low-income adolescent girls, these effects occur through both direct and indirect paths. Implications of these findings are discussed in the context of the stress-generation and stress proliferation models of psychopathology.

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial

BACKGROUND

Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence.

METHODS

Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators.

RESULTS

Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change.

CONCLUSIONS

The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate.

The Interrelationship between Family Violence, Adolescent Violence, and Adolescent Violent Victimization: An Application and Extension of the Cultural Spillover Theory in China

The current study is the first study to emphasize family systems, violent norms, and violent peer association as three domains of the social environment that influence both adolescent violent offending and victimization among Chinese adolescents using a longitudinal sample. Under the framework of cultural spillover theory, the purpose of the current study was to explore how these three factors influenced adolescent violent offending and victimization. A total of 1192 middle and high school students were randomly selected from one of the largest cities in Southwest China. Structural equation model analysis was applied to investigate the direct and indirect effect of violence in the family system on violent offending and victimization. The results indicated that violent offending and victimization overlapped among Chinese adolescents. Violent peer association and acceptance of the violence norm fully mediated the effect of violence in the family system on violent offending, and partially mediated the effect of violence in the family system on violent victimization. In conclusion, adolescents who had experienced violence in their family system were more likely to be exposed to violent peer influences and to accept violent norms, which increased the likelihood of violence perpetration and victimization later in their life.

Differences in childhood physical abuse reporting and the association between CPA and alcohol use disorder in European American and African American women

The goal of the current study was to examine whether the magnitude of the association between childhood physical abuse (CPA) and alcohol use disorder (AUD) varies by type of CPA assessment and race of the respondents. Data are from the Missouri adolescent female twins study and the Missouri family study (N = 4508) where 21.2% identified as African American (AA) and 78.8% as European American (EA); mean age = 23.8. Data were collected using a structured comprehensive interview which assessed CPA experiences using behavioral questions about specific abusive behaviors and trauma checklist items. Cox proportional hazards regression analyses were conducted, adjusting for additional risk factors associated with AUD, including co-occurring psychiatric disorders (defined as time-varying) and parental alcohol misuse. Overall, CPA reporting patterns were highly correlated (tetrachoric ρ = 0.73); although, only 25.8% of women who endorsed behaviorally defined CPA also endorsed checklist items whereas 72.2% of women who endorsed checklist items also endorsed behavioral questions. Racial disparities were evident, with behaviorally defined CPA increasing the hazard for AUD in EA but not AA women. Additional racial disparities in the risk for AUD were observed: increased hazard for AUD were associated with major depressive disorder in AA, and cannabis dependence and paternal alcohol problems in EA, women. Results demonstrate the relevance of the type of CPA measure in assessing CPA in studies of alcohol-related problems-behavioral items may be more inclusive of CPA exposure and more predictive of AUD- and highlight racial distinctions of AUD etiology in women. (PsycINFO Database Record

Experiences of Domestic and School Violence Among Child and Adolescent Psychiatric Outpatients

The experience of cumulative childhood adversities, such as exposure to domestic violence or abuse by caregivers, has been described as risk factor for poor mental health outcomes in adolescence and adulthood. We performed an investigation of experience of violence in all patients aged 6 to 20 years who had consulted the Department of Child and Adolescent Psychiatry, Medical University of Vienna, as outpatients during the period of one year. We were using the Childhood Trauma Interview (CTI) in order to obtain information on the kind of violence. Seventy-five percent of all patients had reported experiences of violence. These youth were significantly more often involved in acts of school violence, thus a significant correlation between experience of domestic violence and violence at school could be revealed. The results of our study emphasize the need for interventions preventing violence both in domestic and in school environments.

Conditional and indirect effects of age of first exposure on PTSD symptoms

Childhood violence exposure (CVE) in formative developmental years may have potent effects on severity and complexity of post-traumatic stress symptoms (PTSS) in adulthood, yet little research has examined the role of age of first exposure in the context of polyvictimization or gone beyond an examination of direct effects. The current study examines the specific associations between age of first exposure, total CVE, and posttraumatic stress symptoms in adulthood. Further, the conditional and indirect effects of age of first exposure on posttraumatic stress symptoms were examined. We hypothesized that age of first exposure to violence would be associated with higher total violence exposure across childhood, thereby predicting current posttraumatic stress symptom severity (i.e., indirect effect). We also postulated that age of first exposure would affect the relationship between total violence exposure and posttraumatic stress symptoms such that earlier exposure would exacerbate the effects of violence exposure (i.e., conditional effect). Participants included 269 violence-exposed adults recruited through MTurk; the mean age of first CVE was 6 years (SD=3.29). Conditional process models indicated that age of first exposure was significantly associated with higher total childhood violence exposure, which in turn, was significantly associated with current posttraumatic stress symptoms in all domains. Further, a conditional effect of age of first exposure was present such that the relationship between total exposure to violence and symptoms of hyperarousal was stronger for those first exposed at earlier ages. Findings provide support suggesting the particular potency of early trauma on regulatory response systems.

Attachment as a mediator between community violence and posttraumatic stress symptoms among adolescents with a history of maltreatment

Experiences that are detrimental to the attachment relationship, such as childhood maltreatment, may reduce feelings of safety among survivors and exacerbate the effects of exposure to subsequent violence, such as witnessing community violence. Though attachment style has been examined in regard to posttraumatic stress in adults who have a history of exposure to violence in childhood, less is known about the influence of attachment on the relationship between exposure to violence and posttraumatic stress symptoms in children and adolescents. The current study aimed to explore the role of attachment in the link between exposure to community violence and posttraumatic stress symptoms in adolescents with a history of childhood abuse. Participants included adolescents (aged 15-18 years) who had a history of maltreatment (N=75) and a matched sample without a childhood abuse history (N=78) from the National Data Archive on Child Abuse and Neglect (Salzinger, Feldman, & Ng-Mak, 2008). A conditional process model using bootstrapping to estimate indirect effects showed a significant indirect effect of insecure attachment on the relationship between exposure to community violence and posttraumatic stress symptoms for adolescents with a history of childhood physical abuse, but not for adolescents without this history. Implications for a cumulative risk model for post-trauma pathology starting in adolescence are discussed.

Loss Due to Death and its Association with Mental Disorders in Juvenile Detainees

This study investigated the prevalence of loss due to death and its association with mental disorders in a random sample of 898 newly detained adolescents in Chicago, Illinois. Nearly 90% of youth experienced the loss of an important person; most had also experienced a "high-risk" loss (e.g., loss due to violence, sudden loss). Minority youth were at particular risk. Youth with any loss or multiple losses were more likely to have mood disorders and ADHD/behavioral disorders, respectively, than youth who had no such losses. Interventions focusing on modifiable protective factors following loss may increase positive outcomes in this vulnerable population.

Age, sex, and racial differences in harsh physical punishment: results from a nationally representative United States sample

The purpose of this research was to examine age, sex, and racial differences in the prevalence of harsh physical punishment in childhood in a nationally representative sample of the United States. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) collected in 2004 and 2005 (n=34,653). Logistic regression analyses were conducted to examine age, sex, and racial differences in the prevalence of harsh physical punishment. Results suggest that the prevalence of harsh physical punishment has been decreasing among more recently born age groups; however, there appear to be sex and racial differences in this trend over time. The magnitude of the decrease appears to be stronger for males than for females. By race, the decrease in harsh physical punishment over time is only apparent among Whites; Black participants demonstrate little change over time, and harsh physical punishment seems to be increasing over time among Hispanics. Prevention and intervention efforts that educate about the links of physical punishment to negative outcomes and alternative non-physical discipline strategies may be particularly useful in reducing the prevalence of harsh physical punishment over time.

Perceived neighborhood safety, recovery capital, and successful outcomes among mothers 10 years after substance abuse treatment

This study examines perceived neighborhood characteristics associated with successful outcome among mothers 10 years after being treated for substance use disorders. Data were obtained from 713 mothers first studied at admission to drug treatment in California in 2000-2002 and followed up in 2009-2011. At follow-up, 53.6% of mothers had a successful outcome (i.e., no use of illicit drugs and not involved with the criminal justice system). Perceived neighborhood safety almost doubled the odds of success. Perceived neighborhood safety interacted with social involvement, decreasing the odds of success among mothers who reported more versus less neighborhood social involvement. Perceived neighborhood climate is associated with long-term outcomes among mothers with substance use disorders independent of individual-level characteristics, underscoring the need for further efforts to understand its interaction with recovery capital in ways that promote and impede health.

Emotional risks to respondents in survey research

Some survey research has documented distress in respondents with pre-existing emotional vulnerabilities, suggesting the possibility of harm. In this study, respondents were interviewed about a personally distressing event; mood, stress, and emotional reactions were assessed. Two days later, respondents participated in interventions to either enhance or alleviate the effects of the initial interview. Results indicated that distressing interviews increased stress and negative mood, although no adverse events occurred. Between the interviews, moods returned to baseline. Respondents who again discussed a distressing event reported moods more negative than those who discussed a neutral or a positive event. This study provides evidence that, among nonvulnerable survey respondents, interviews on distressing topics can result in negative moods and stress, but they do not harm respondents.

Children of treated substance-abusing mothers: a 10-year prospective study

This study examined children of substance-abusing mothers approximately 10 years after mothers' admission to drug abuse treatment, and identified maternal characteristics that may be risk factors for child behavior problems on the Child Behavior Checklist. Data were obtained from 396 mothers who were included in a sample consecutively admitted to 44 treatment programs in 13 California counties during 2000-2002. The Addiction Severity Index was administered at both intake and follow-up. Each mother reported on one child 6-17 years of age. All of the children had been exposed to drugs, either in utero or postnatally. At follow-up about 22% of the children demonstrated borderline or clinical range problem behaviors. Child behavior problems were related significantly to the mothers' ethnicity (lower among Hispanics relative to white), and problem severity in family/social relationship and mental health, marginally related to her prior medical/health problem, and not related to severity of alcohol, drug, legal and employment problems. Assisting mothers to address their family/social relationship and psychological problems may have an added value to prevent or reduce behavioral problems of their children.

Family and partner interpersonal violence among American Indians/Alaska Natives

Family and partner interpersonal violence are common among American Indian/Alaska Native (AI/AN) populations. AI/AN women have the second highest prevalence of violence against women among all racial/ethnic groups in the United States, and child abuse prevalence rates in AI/AN populations are among the highest. Elder abuse in AI/AN is also an important concern, although data on this are sparse. This review describes the epidemiology of child abuse, violence against women, and elder abuse among AI/AN, including prevalence and associated risk factors. The authors discuss potential reasons for the high burden of interpersonal violence among AI/AN, including common risk factors. Important limitations in existing literature are also highlighted, along with recommendations for future research on this topic.

Correlates of sexual abuse in a sample of adolescent girls admitted to psychiatric inpatient care

We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children-Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent's home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.

The evaluation of children in the primary care setting when sexual abuse is suspected

This clinical report updates a 2005 report from the American Academy of Pediatrics on the evaluation of sexual abuse in children. The medical assessment of suspected child sexual abuse should include obtaining a history, performing a physical examination, and obtaining appropriate laboratory tests. The role of the physician includes determining the need to report suspected sexual abuse; assessing the physical, emotional, and behavioral consequences of sexual abuse; providing information to parents about how to support their child; and coordinating with other professionals to provide comprehensive treatment and follow-up of children exposed to child sexual abuse.

Explaining long-term outcomes among drug dependent mothers treated in women-only versus mixed-gender programs

Specialized substance abuse treatment for parenting women is thought to improve outcomes, but long-term impacts and how they occur are poorly understood. Utilizing a sample of 789 California mothers followed for 10 years after admission to women-only (WO) or mixed-gender (MG) drug treatment, we examine the relationship between WO treatment and outcomes and whether it is mediated by post-treatment exposures to criminal justice and health services systems. At follow-up, 48% of mothers had a successful outcome (i.e., no use of illicit drugs, not involved with the criminal justice system, alive). Controlling for patient characteristics, WO (vs. MG) treatment increased the odds of successful outcome by 44%. In the structural equation model WO treatment was associated with fewer post-treatment arrests, which was associated with better outcomes. Women-only substance abuse treatment has long-term benefits for drug-dependent mothers, a relationship that may be partially explained by post-treatment exposure to the criminal justice system. Findings underscore additional leverage points for relapse prevention and recovery-supportive efforts for drug-dependent mothers.

Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design

We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing and externalizing symptoms were all correlated, the discordant twin analyses and biometric modeling showed little to no evidence that was consistent with a causal effect of childhood abuse on BPD traits. Instead, our results indicate that the association between childhood abuse and BPD traits stems from common genetic influences that, in some cases, also overlap with internalizing and externalizing disorders. These findings are inconsistent with the widely held assumption that childhood abuse causes BPD, and they suggest that BPD traits in adulthood are better accounted for by heritable vulnerabilities to internalizing and externalizing disorders.

Sexual Victimization and Family Violence Among Urban African American Adolescent Women

Guided by an intersectional feminist perspective, we examined sexual victimization, witnessing intimate partner violence (IPV) in the family, and familial physical abuse among a sample of 180 urban African American adolescent women. We used cluster analysis to better understand the profiles of cumulative victimization, and the relationships between profiles and IPV victimization and personal exposure to the sex trade. Just under one third of the sample reported sexual victimization, with cooccurrence with both forms of family violence common. The cluster profile with high levels of severe family violence was associated with the highest rate of IPV victimization and sex trade exposure.

Development and preliminary validation of an indirect screener for drug use in the perinatal period

AIMS

This study sought to develop and begin validation of an indirect screener for identification of drug use during pregnancy, without reliance on direct disclosure.

DESIGN

Women were recruited from their hospital rooms after giving birth. Participation involved (i) completing a computerized assessment battery containing three types of items: direct (asking directly about drug use), semi-indirect (asking only about drug use prior to pregnancy) and indirect (with no mention of drug use), and (ii) providing urine and hair samples. An optimal subset of indirect items was developed and cross-validated based on ability to predict urine/hair test results.

SETTING

Obstetric unit of a university-affiliated hospital in Detroit.

PARTICIPANTS

Four hundred low-income, African American, post-partum women (300 in the developmental sample and 100 in the cross-validation sample); all available women were recruited without consideration of substance abuse risk or other characteristics.

MEASUREMENTS

Women first completed the series of direct and indirect items using a Tablet PC; they were then asked for separate consent to obtain urine and hair samples that were tested for evidence of illicit drug use.

FINDINGS

In the cross-validation sample, the brief screener consisting of six indirect items predicted toxicology results more accurately than direct questions about drug use (area under the ROC curve = 0.74, P < 0.001). Traditional direct screening questions were highly specific, but identified only a small minority of women who used drugs during the last trimester of pregnancy.

CONCLUSIONS

Indirect screening may increase the accuracy of mothers' self-reports of prenatal drug use.

Family Closeness and Domestic Abuse Among Caribbean and South American Women in South Florida

This paper focuses on the importance of family member closeness as a protective factor against domestic abuse. We explore the link between long-lasting relations within the family and intra-familial violence perpetrated against women in Latino households in South Florida. We use data from an Inter-generational Transmission of Drug Use between Latina Mothers and Daughters (ITDMD) study. The study includes data on family relations and domestic abuse. We estimate a series of multivariate regressions to obtain the probability of abuse against women, the types of abuse inflicted and the relationship with the abusers. Our results indicate that among abused women, the effects of long-lasting relations within the family differ depending on the type of relationship between the abuser and the victim and the degree of closeness the victim feels towards other family members. Given these findings, there is a need to further study family relations and abuse in Latino households.

Examining the moderating role of family cohesion on the relationship between witnessed community violence and delinquency in a national sample of adolescents

Witnessed community violence has been linked to a number of internalizing and externalizing problems in adolescents. Guided by Cicchetti and Lynch's (1993) ecological-transactional model, this study aimed to examine the impact that family-level factors had on negative outcomes associated with witnessed community violence. Using a nationally representative sample, we explored the moderational role of family cohesion in the relationship between witnessing community violence and delinquent behavior while taking demographic variables into account. Results from the investigation suggested that low levels of family cohesion were predictive of delinquency after controlling for race, gender, past delinquency, and direct trauma. In addition, the findings suggested that family cohesion moderated the impact of witnessed community violence on future delinquent behavior. Future directions for research and implications for practice were also discussed.

Exposure to violence in incarcerated youth from the city of São Paulo

OBJECTIVE

This study aimed to determine the extent of exposure to community violence among delinquent Brazilian youth in the 12-month period prior to their incarceration and to identify factors associated with this exposure.

METHOD

With an oversampling of girls, a cross-section of youth under 18 years of age from juvenile detention units in the city of São Paulo, Brazil completed a structured interview. Key items related to exposure to violence (witnessed and experienced) were drawn from the Social and Health Assessment questionnaire to cover the 12-month period prior to incarceration.

RESULTS

Participants (n = 325, 89% boys) reported high rates of exposure to violence with largely similar levels for boys and girls. Being threatened with physical harm, being beaten or mugged and/or shot at were the most common forms of violence experienced. After controlling for demographic and family variables, the fact of having peers involved in risk behavior, easy access to guns and previous involvement with the justice system were associated with witnessed violence; whereas having slept on the street was the only variable associated with experienced violence.

CONCLUSION

This group of youth was exposed to high levels of violence and other adverse experiences. Future research should examine the effectiveness of strategies aimed at reducing the exposure to violence of high-risk youth.

The impact of violence exposure on aggressive behavior through social information processing in adolescents

The purpose of this study was to determine whether exposure to violence (EV) in several contexts predicts aggressive behavior through social information processing (SIP) in adolescents. Six hundred and fifty adolescents between the ages of 12 and 17 participated in a 3-wave longitudinal study. The participants completed measures of proactive and reactive aggression at all waves, SIP measures at Time 1 and Time 2, and violence exposure at Time 1. It was expected that SIP would mediate the predictive relationship between EV and aggressive behavior. We found that total Time 1 EV predicted Time 3 reactive aggression. The influence of EV on proactive aggression was direct. Slight differences emerged, however, for victimization and witnessing violence. Witnessing was associated with reactive aggression via both hostile attribution and response selection, whereas victimization predicted reactive aggression via hostile attribution only. Results also suggested that the types of exposure that are most relevant for the development of aggressive behavior are community and school violence. Finally, male adolescents experienced more EV than female adolescents in all contexts except in the home. The findings indicate that intervention in social-cognitive mechanisms is important to reduce aggressive behavior in adolescents who have been exposed to violence.

Witnessed violence and youth behavior problems: a multi-informant study

Witnessed violence has significant negative consequences for youth behavior and mental health. However, many findings on the impact of witnessed violence have been based on a single informant. There is a general lack of consistency between caregiver and youth reports on both witnessed violence and behavioral problems. This study included data from both caregivers and youth and incorporated a multisource analytic approach to simultaneously examine the association between youth witnessed violence and externalizing and internalizing behavior problems. Data from 875 caregivers and 812 youth were collected as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Findings showed that youth reported more witnessed violence than did their caregivers, and caregivers reported more externalizing and internalizing behavior problems than did youth. Further, the source of information had a significant impact on the association between witnessed violence and internalizing behaviors. These findings highlight the need to incorporate multiple sources and multi-informant analytic techniques to eliminate methodological limitations to understanding the effect of witnessed violence on youth behavioral problems.

Ethnic/racial differences in the prevalence of injurious spanking and other child physical abuse in a National Survey of Adolescents

Limited research has examined whether similar patterns in injurious spanking and other forms of child physical abuse (CPA) exist across specific ethnic/racial groups. The authors examined and compared differences in the lifetime prevalence of injurious spanking and CPA in two national samples of adolescents across ethnic/racial groups and over time. Participants were 4,023 youth (12-17 years) and 3,614 youth (12-17 years) who participated in the 1995 National Survey of Adolescents (NSA) and 2005 National Survey of Adolescents-Replication (NSA-R), respectively. Adolescents, who were identified through random digit dial procedures, completed a telephone interview assessment. Results indicated significant ethnic/racial variation across groups in reports of injurious spanking in the NSA and the NSA-R samples; however, significant differences were not observed within groups between the two samples over time. Ethnic/racial differences also were found between groups in reports of CPA in the NSA-R sample. Limitations and future directions of this research are discussed.

Child mental health problems as risk factors for victimization

The current study examines the effects of child internalizing and externalizing symptoms on increases in victimization over a 1-year period. Using longitudinal data from the Developmental Victimization Survey (DVS), analyses are based on a national probability sample of 1,467 children aged 2-17. Results indicate that children with high levels of co-occurring internalizing and externalizing symptoms were particularly likely to experience increased exposure to several forms of victimization, including peer victimization, maltreatment, and sexual victimization, controlling for earlier victimization and adversity. The relationship of symptoms to victimization exposure differed across developmental stage. Elementary school-age children with high levels of symptoms were especially vulnerable to victimization by peers, whereas distressed youth in early adolescence were particularly vulnerable to sexual victimization. Mental health problems in childhood and adolescence appear to represent important risk factors for increased victimization. Future interventions might consider targeting youth with co-occurring internalizing and externalizing symptoms during especially vulnerable developmental stages.

Toward a stress process model of children's exposure to physical family and community violence

Theoretically informed models are required to further the comprehensive understanding of children's ETV. We draw on the stress process paradigm to forward an overall conceptual model of ETV (ETV) in childhood and adolescence. Around this conceptual model, we synthesize research in four dominant areas of the literature which are detailed but often disconnected including: (1) exposure to three forms of physical violence (e.g., child physical maltreatment, interparental violence, and community ETV); (2) the multilevel correlates and causes of ETV (e.g., neighborhood characteristics including concentrated disadvantage; family characteristics including socio-economic status and family stressors); (3) a range of consequences of ETV (e.g., internalizing and externalizing mental health problems, role transitions, and academic outcomes); and (4) multilevel and cross domain mediators and moderators of ETV influences (e.g., school and community factors, family social support, and individual coping resources). We highlight the range of interconnected processes through which violence exposures may influence children and suggest opportunities for prevention and intervention. We further identify needed future research on children's ETV including coping resources as well as research on cumulative contributions of violence exposure, violence exposure modifications, curvilinearity, and timing of exposure.

Posttraumatic stress symptoms in children and adolescents referred for child welfare investigation. A national sample of in-home and out-of-home care

This study examines the prevalence and correlates of heightened posttraumatic stress (PTS) symptoms in a nationally representative sample of 1,848 children and adolescents (ages 8-14) who were referred to child welfare for investigation of abuse or neglect based on the National Survey of Child and Adolescent Well-Being. The severity of current PTS symptoms was assessed using the PTS subscale of the Trauma Symptom Checklist for Children, a standardized child-report scale evaluating common symptoms associated with trauma. The overall prevalence of clinically significant PTS symptoms was 11.7% (overall mean T score = 49.5). The prevalence was higher for cases that were placed in out-of-home care (19.2%) than those maintained at home (10.7%). Multivariate hierarchical regression identified four contributors to heightened PTS symptoms: younger child age, abuse by a nonbiological parent, violence in the home, and child depression. The authors discuss the modest but still lower than expected prevalence of self-reported, clinically significant PTS symptoms and the variables associated with greater risk for heightened PTS symptoms found among cases referred to child welfare services.

Childhood maltreatment, intervening variables, and adult psychological difficulties in women: an overview

This article reviews the complex relationship between child maltreatment and later psychosocial difficulties among adult women. Specifically addressed are (a) the various forms of childhood maltreatment, (b) the range of potential long-term psychological outcomes, and (c) important contextual variables that mediate or add to these maltreatment-symptom relationships. Among the latter are characteristics of the abuse and/or neglect; effects of impaired parental functioning; premaltreatment and postmaltreatment psychobiology; qualities of the parent-child attachment; abuse and/or neglect-related affect dysregulation that may lead to further symptomatology; the extent to which the child responds with significant emotional or behavioral avoidance; and whether later traumas are also present. Also relevant are sociocultural contributors to both child maltreatment and maltreatment effects, especially poverty and marginalization. Clinical and research implications are considered.

Lifetime assessment of poly-victimization in a national sample of children and youth

OBJECTIVE

To use a lifetime assessment of victimization experiences to identify children and youth with high cumulative levels of victimization (poly-victims). Also to compare such children to other victims and non-victims, and assess the contribution of cumulative victimization to levels of psychological distress.

DESIGN

A national sample of 1,467 children aged 2-17 recruited through random digit dialing and assessed via telephone interviews (with caretakers and youth themselves) about a comprehensive range of 33 types of victimization experiences in the previous year and at any time in their lives.

RESULTS

Nearly 80% of the children and youth reported at least one lifetime victimization. The mean number of lifetime victimizations was 3.7 and the median 2.6. The total number of different lifetime victimizations was highly predictive of symptoms of current distress. The best linear prediction of distress on the basis of cumulative victimization entailed weighting child maltreatment and sexual assault by factors of 4 and 3 respectively compared to other victimizations. We proposed classifying poly-victims as those 10% of children and youth with the highest victimization scores, and calculating different thresholds for children at different ages. Poly-victims designated in this way had significantly more distress, more non-victimization adversities than other youth and were less likely to come from an intact family.

CONCLUSION

Lifetime assessment of victimization has value as a means of identifying groups of highly victimized children and youth.

PRACTICE IMPLICATIONS

This paper describes a procedure under which practitioners can assess for a group of children, termed "poly-victims," who have a very high burden of lifetime victimization. These children merit identification because they have high levels of psychological distress, some of the most serious victimization profiles, and a presumed vulnerability for further victimization.

Exposure to community violence and adolescents' internalizing behaviors among African American and asian American adolescents

Exposure to community violence can seriously threaten healthy adolescent development. This longitudinal study examines the relationship between exposure to violence in the community and the internalizing behaviors of Asian American and African American adolescents. Data analyzed was from 901 adolescents (57.9% female and 42.1% male, and 84.7% African American and 15.3% Asian American) who had participated in both Wave I and II interviews of the National Longitudinal Survey of Adolescent Health conducted between 1994 and 1996. Being female, having prior internalizing behaviors at baseline, and being exposed to violence significantly predicted African American adolescents' subsequent report of internalizing behaviors and their symptoms. Being female and having prior internalizing behaviors also predicted Asian American adolescents' subsequent internalizing behaviors and their symptoms. However, exposure to violence was not associated with Asian American adolescents' internalizing behaviors. Findings suggested a need to conceptualize mental health risk in a more nuanced context of cultural diversity.

Delinquent histories of adolescents adjudicated for criminal sexual conduct

A content analysis of closed case records from family court examined personal and family history variables for adolescents with sexually abusive behaviors who had been adjudicated for criminal sexual conduct and compared subgroups of adolescents with ( n = 72) and without (n = 80) prior other delinquent behavior. The study's findings indicate that adolescents with and without prior delinquent behaviors differed on a majority of the variables measured in this study. Adolescents with sexual offending behaviors who also had prior delinquent behaviors were older and had higher rates of documented childhood maltreatment, and drug and alcohol use. These adolescents had caregivers with more substance use and abuse problems and more extensive criminal histories. These findings have a number of practice implications when working with adolescents with sexually abusive behaviors. The findings also suggest that comparisons between adolescents with sexually abusive behaviors and other delinquents may be misleading if these subgroups of adolescents with sexually abusive behaviors are not distinguished.