Nonsexual Abuse Research Articles

Interpersonal Violence Victimization and Sexual Harassment: A Prospective Study of Revictimization

This study examined associations between past interpersonal victimization (including both child and adult victimization) and sexual harassment (SH); and it examined intervening and moderating variables of the association of past victimization with SH, including posttraumatic stress symptoms (PTSS) and job-gender context. In addition, we examined an alternative hypothesis for revictimization that abuse survivors are hyper-sensitive to perceptions of sexual harassment. Employed women residing in Kentucky (U.S.) who had received an order of protection from a male partner and who were followed-up 12 months later (n = 445, 78 % White, mean age = 31.98, SD = 8.60) were selected for this analysis. SH experienced between baseline and follow-up interviews was associated with baseline assessments of child nonsexual assault experiences (r = 0.24, p < 0.001) and intimate partner violence victimization (r = 0.20, p < 0.000), demonstrating a revictimization effect. PTSS mediated the relationship between child sexual assault, child nonsexual assault and subsequent SH. Further, working in a job with a male supervisor or in a male-dominated workgroup increased associations between child nonsexual abuse and subsequent SH. No support was found for the hyper-sensitivity hypothesis. Findings are consistent with prior research that identifies sexual harassment as a form of interpersonal violence that mental health and victim service providers and researchers should include in their assessment and treatment strategies. Employers should also understand that working in male-dominated work environments compound the risk of sexual harassment for those with prior abuse histories and should be vigilant to reducing these risks.

Measuring the incidence and reporting of violence against women and girls in liberia using the 'neighborhood method'

BackgroundThis paper reports on the use of a “neighborhood method” to measure the nature and incidence of violence against women and girls in post-conflict Liberia.MethodsThe study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent’s household, and those of her four closest neighbors to make up the full sample.FindingsHouseholds in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners.ConclusionsViolence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.

Maternal history of child abuse moderates the association between daily stress and diurnal cortisol in pregnancy: a pilot study

Previous research on the association between maternal daily stress and cortisol in pregnancy has yielded inconsistent findings. However, past studies have not considered whether stressful experiences in childhood impact maternal cortisol regulation in pregnancy. In this pilot study, we aimed to examine whether the association between maternal daily stress and cortisol differed according to maternal history of child abuse. Forty-one women provided salivary cortisol samples at wake-up, 30 min after wake-up, and bedtime for 3 days at three times over second and third trimesters of pregnancy. On each day of cortisol collection women reported their daily stress. Women reported child abuse experiences prior to age 18 years by completing 15 items from the Adverse Childhood Experiences Scale. Twenty-one percent (N = 9) of women reported a history of child sexual abuse (CSA), 44% (N = 18) reported a history of non-sexual child abuse and 34% (N = 14) reported no history of child abuse. Hierarchical Linear Modeling (HLM) analyses revealed that stress in the day prior was associated with increases in morning cortisol in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Increases in evening cortisol were associated with increases in daily stress in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Results reveal a dynamic association between daily stress and cortisol in pregnancy and suggest that patterns differ according to maternal child abuse history.

Homosexual Orientation—From Nature, Not Abuse: A Critique of Roberts, Glymour, and Koenen (2013)

Roberts, Glymour, and Koenen (2013), using instrumental variable models, argued that child abuse causes homosexual orientation, defined in part as any same-sex attractions. Their instruments were various negative family environment factors. In their analyses, they found that child sexual abuse (CSA) was more strongly related to homosexual orientation than non-sexual maltreatment was, especially among males. The present commentary therefore focused on male CSA. It is argued that Roberts et al.'s "abuse model" is incorrect and an alternative is presented. Male homosexual behavior is common in primates and has been common in many human societies, such that an evolved human male homosexual potential, with individual variation, can be assumed. Cultural variation has been strongly influenced by cultural norms. In our society, homosexual expression is rare because it is counternormative. The "counternormativity model" offered here holds that negative family environment weakens normative controls and increases counternormative thinking and behavior, which, in combination with sufficient homosexual potential and relevant, reinforcing experiences, can produce a homosexual orientation. This is a benign or positive model (innate potential plus release and reinforcement), in contrast to Roberts et al.'s negative model (abuse plus emotional compensation or cognitive distortion). The abuse model is criticized for being based on the sexual victimological paradigm, which developed to describe the female experience in rape and incest. This poorly fits the gay male experience, as demonstrated in a brief non-clinical literature review. Validly understanding male homosexuality, it is argued, requires the broad perspective, as employed here.

Review: childhood non-sexual maltreatment is associated with poor mental and sexual health outcomes

Review: childhood non-sexual maltreatment is associated with poor mental and sexual health outcomes

Does Maltreatment in Childhood Affect Sexual Orientation in Adulthood?

Epidemiological studies find a positive association between physical and sexual abuse, neglect, and witnessing violence in childhood and same-sex sexuality in adulthood, but studies directly assessing the association between these diverse types of maltreatment and sexuality cannot disentangle the causal direction because the sequencing of maltreatment and emerging sexuality is difficult to ascertain. Nascent same-sex orientation may increase risk of maltreatment; alternatively, maltreatment may shape sexual orientation. Our study used instrumental variable models based on family characteristics that predict maltreatment but are not plausibly influenced by sexual orientation (e.g., having a stepparent) as natural experiments to investigate whether maltreatment might increase the likelihood of same-sex sexuality in a nationally representative sample (n=34,653). In instrumental variable models, history of sexual abuse predicted increased prevalence of same-sex attraction by 2.0 percentage points [95% confidence interval (CI)=1.4-2.5], any same-sex partners by 1.4 percentage points (95% CI=1.0-1.9), and same-sex identity by 0.7 percentage points (95% CI=0.4-0.9). Effects of sexual abuse on men's sexual orientation were substantially larger than on women's. Effects of non-sexual maltreatment were significant only for men and women's sexual identity and women's same-sex partners. While point estimates suggest much of the association between maltreatment and sexual orientation may be due to the effects of maltreatment on sexual orientation, confidence intervals were wide. Our results suggest that causal relationships driving the association between sexual orientation and childhood abuse may be bidirectional, may differ by type of abuse, and may differ by sex. Better understanding of this potentially complex causal structure is critical to developing targeted strategies to reduce sexual orientation disparities in exposure to abuse.

Child physical and sexual abuse in Dammam, Saudi Arabia: A descriptive case-series analysis study

BackgroundChild abuse, including sexual abuse, is a problem in all societies regardless of cultural and/or religious backgrounds. Until 2007, the law referred victims of sexual crimes to gynecologists for forensic examination in Saudi Arabia. Since then, the Forensic Department has taken over responsibility for the examination of such cases; a special forensic clinic was established at that time. ObjectiveTo describe the socio-medical and forensic characteristics of reported cases of living child abuse in the maternity and children hospital (MCH) and the forensic and legal center (FLC) in Dammam, Saudi Arabia. Research design and methodsThis research uses a descriptive case-series analysis that targets all reported physical and sexual assaults on victims less than 18years old in the MCH from 2008 till the end of 2010 and FLC from 2006 to 2010. ResultsOut of 87 reported cases, 85% of the assaults were sexual, 12.6% of the assaults were non-sexual and 2.3% were combined (both sexual and non-sexual abuse). Cases of sexual abuse were significantly higher in the older age group in comparison to the non-sexually assaulted group, which occurred more often at younger ages (P<0.001). The mean age was (11.04+5.07). Most victims were females (56.3%) and Saudi (90.8%). ConclusionThere is an increasing pattern of reports over recent years. Therefore, there is a need for more collaboration and advertising about the forensic clinic in order to improve the handling of sexual abuse cases.

Childhood sexual abuse is associated with cortisol awakening response over pregnancy: Preliminary findings

Childhood sexual abuse (CSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in non-pregnant samples. However, it is not yet known whether CSA is associated with HPA dysregulation over pregnancy. In the present study we assessed whether maternal cortisol levels across pregnancy differed in women with CSA histories compared to women with histories of non-sexual child abuse (CA) and no abuse (NA). 135 pregnant mothers (CSA=30, CA=58, NA=47) provided salivary cortisol samples at wakeup, wake +30 min, and bedtime for 3 consecutive days at 1-3 time points over second and third trimester. Cortisol awakening responses and slopes were computed. Women with CSA histories displayed increasing cortisol awakening response over pregnancy compared to women with CA and NA histories. Group differences were not observed for slope. This is the first study to show that cortisol awakening responses increase over pregnancy in women with CSA histories compared to women with CA and NA histories.

Are the Predictors of Sexual Violence the Same as Those of Nonsexual Violence? A Gender Analysis

Violence manifests itself in such multifarious ways as sexual, physical, and psychological abuse. What has hitherto eluded the medical community, however, is whether sexual and nonsexual abuse share the same predictors. Drawing upon a representative sample of married men and women in the Iranian capital, Tehran, we aimed to determine: (i) the overlap between sexual abuse and physical and psychological violence, and (ii) the predictors that sexual violence victimization share with physical and psychological violence victimization. Victimization through any type of sexual coercion by the husband in the context of the current marital relationship, as determined via the conflict tactic scales-revised (CTS-2). In a cross-sectional survey in Tehran in 2007, 460 married Iranian men and women were selected via a multicluster sampling method from four different randomized regions. Independent variables comprised sociodemographic characteristics, subscores of psychological, and personality characteristics known to be allied with intimate abuse (personal and relationship profile), and dichotomus data on victimization history through all types of violence by the spouse including psychological aggression, physical assault, and sexual coercion (CTS-2). In both genders, the experience of physical or psychological violence increased the likelihood of sexual violence victimization. In both genders, higher conflict was a predictor of sexual and psychological violence victimization. In addition, the common predictors of sexual and physical violence victimization were low self-control and high violent socialization in the men and women, respectively. Sexual violence victimization shares some factors with the victimization of nonsexual types of marital abuse, but this seems to be partially gender dependent.

A Pooled Analysis of Gender and Trauma-Type Effects on Responsiveness to Treatment of PTSD With Venlafaxine Extended Release or Placebo

To examine effects of gender and trauma type on response to treatment with venlafaxine extended release (ER) or placebo in patients with posttraumatic stress disorder (PTSD). Data were pooled from 2 flexible-dose, parallel-group, randomized, double-blind, placebo-controlled trials: a 12-week trial conducted in the United States (March 2001 to December 2002) and a 24-week trial conducted in 12 countries outside the United States (October 2001 to December 2003). Six hundred eighty-seven outpatients with DSM-IV-diagnosed PTSD and a 17-item Clinician-Administered PTSD Scale abbreviated 1-week Symptom Status version (CAPS-SX-17) score > or = 60 were randomly assigned to treatment with venlafaxine ER (37.5 mg/day-300 mg/day, N = 340) or placebo (N = 347). The primary efficacy end point was the CAPS-SX-17 total score at week 12. Secondary end points included CAPS-SX-17 cluster scores for reexperiencing, avoidance/numbing, and hyperarousal and scores on the Connor-Davidson Resilience Scale (CD-RISC), Clinical Global Impressions-Severity of Illness scale, Sheehan Disability Scale (SDS), and 17-item Hamilton Rating Scale for Depression (HAM-D-17). Analysis-of-covariance models were used to test for differences by gender and trauma type (accidental injury, combat, nonsexual abuse, adult sexual abuse, childhood sexual abuse, unexpected death, and other), treatment (venlafaxine ER vs. placebo), and the treatment-by-trauma-type interaction. Using last-observation-carried-forward analysis, significant effects of treatment with venlafaxine ER were found on the CAPS-SX-17 total score and on all CAPS-SX-17 cluster scores and most other secondary measures. No significant treatment-by-gender interactions were observed. Trauma type significantly affected treatment responsiveness on symptom-related disability (SDS, p = .0057) and resilience (CD-RISC, p = .0012), with a nearly significant effect on depression (HAM-D-17, p = .0625). Overall, there does not appear to be a significant effect of gender on the efficacy of venlafaxine ER in the treatment of PTSD. Trauma type may affect treatment outcome but seems to affect domains such as disability and resilience more than core PTSD symptoms.

The Sexual Well-Being of Women Who Have Experienced Child Sexual Abuse

The present study examined the association between child sexual abuse (CSA) and a range of positive and negative aspects of women's sexual well-being. We also investigated the extent to which women's cognitive-affective sexual appraisals mediated these relationships. Participants were 272 female community college and university students. CSA involving fondling only was generally not associated with adverse sexual outcomes. However, the women who had experienced CSA involving sexual penetration or attempted sexual penetration were (a) more likely to be sexually revictimized in adulthood; (b) more likely to have engaged in casual sex, unprotected sex, and voluntary sexual abstinence; and (c) reported fewer sexual rewards, more sexual costs, and lower sexual self-esteem. These findings held over and above the effects of nonsexual abuse in childhood, and as predicted, sexual self-esteem partially or fully mediated most of these relationships. Nonsexual abuse in childhood and adult sexual victimization were also uniquely associated with a number of adverse sexual outcomes. However, outcomes were not worse for women who had experienced CSA involving actual or attempted sexual penetration and sexual assault in adulthood. The results highlight the fact that CSA is a serious and widespread problem with significant implications for adult women's sexual functioning.

Relation of Childhood Sexual Abuse and Other Forms of Maltreatment to 12-Month Postoperative Outcomes in Extremely Obese Gastric Bypass Patients

The prognostic significance of sexual abuse for extremely obese patients who undergo bariatric surgery is uncertain. This study examined self-reported childhood sexual abuse and other forms of childhood maltreatment in relation to preoperative presentation and to 12-month postoperative outcomes in gastric bypass patients. 137 extremely obese patients undergoing gastric bypass surgery completed a questionnaire battery before surgery and again 12 months after surgery. Weight loss was determined with measured weight and height, childhood maltreatment was assessed with the Childhood Trauma Questionnaire, and associated eating disorder and psychological functioning were assessed with established measures. 32% of patients self-reported childhood sexual abuse, 37% reported some form of non-sexual childhood abuse or neglect, and 31% reported no form of childhood maltreatment. Significant and clinically robust improvements in weight and in all measures of eating and psychological functioning were observed at 12 months after surgery. Patients who reported histories of childhood sexual abuse and other forms of childhood maltreatment differed little from patients who reported no childhood maltreatment in body mass index, eating disorder features, and psychological functioning both pre- and postoperatively at 12-month follow-up. Patients who reported childhood sexual abuse had statistically significantly higher levels of depression at 12 months after surgery, although the depression levels represented significant reductions from pre-surgery and fell within the non-depressed range. Extremely obese patients who seek gastric bypass surgery report higher rates of childhood maltreatment than normative community samples. A history of childhood maltreatment, including reports of sexual abuse, does not appear to be a negative prognostic indicator for gastric bypass surgery.

Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa

Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N=272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N=119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.

Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s☆

Objective: Although reports of child maltreatment have increased yearly since national data were first collected in 1976, little information is available about changes in the characteristics of children reported. Therefore, to examine changes over time in recognition and reporting in a medical setting, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s. Design: Retrospective, cross-sectional review of medical records and logs of the hospital’s child abuse committee. Settings: Ambulatory, emergency, and inpatient services at Yale-New Haven Hospital. Patients: Medical records were reviewed for 101 of the 165 children referred to the child abuse committee in 1968–1969 (early group) and 107 of the 843 children referred in 1990–1991 (late group). Cases of sexual abuse were excluded. Results: Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late group was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with private insurance (31% vs. 12%, p < .05). The late group also had more female-headed households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all classified as “at-risk,” the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and “at-risk” (16% vs. 35%). Although the types of injuries were similar: superficial injuries (20% vs. 16%), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05). Conclusions: A substantial change has occurred in referrals to the hospital’s child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families.

Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

Context: Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known. Objective: To estimate the risk of self-reported adult HIV-risk behaviors and heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to determine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse. Design: A population-based telephone survey, the 1997 Washington State Behavioral Risk Factor Surveillance System (BRFSS), asked a representative sample of adults whether they had ever been physically or sexually abused in childhood, and if so, the age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 years, about HIV-risk behaviors. Participants: Three thousand four hundred seventy-three English-speaking non-institutionalized civilian adults in Washington State. Main Outcome Measures: Self-reported HIV-risk behaviors in the past year and heavy drinking in the past month. Results: We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with more than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% confidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a 5-fold increase in these risk behaviors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and physical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16.9). Physical abuse alone was not associated with either health-risk behavior for women. For men, any sexual abuse was associated with an 8-fold increase in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alone was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of the men who were asked about HIV-risk behaviors reported any history of childhood abuse, these accounted for 51% and 50% of those reporting HIV-risk behaviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively. Conclusions: Efforts to prevent or remediate adult health-risk behaviors should consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a general-population survey also reported childhood abuse.

Forgetting child abuse: Feldman-Summers and Pope's (1994) study replicated among Dutch psychologists

In a replication of Feldman-Summers and Pope's (1994) national survey of American Psychologists on ‘forgetting’ childhood abuse, a Dutch sample of 500 members of the Netherlands Institute of Psychologists (NIP), were asked if they had been abused as children, and, if so, whether they had ever forgotten some or all of the abuse for some significant period of time. As compared to the 23.9% in the original study, 13.3% reported childhood abuse. Of that subgroup, 39% (as compared to 40% in the original study) reported a period of forgetting some or all of the abuse for a period of time. Both sexual and non-sexual physical abuse were subject to forgetting which in 70% of cases was reversed while being in therapy. Almost 70% of those who reported forgetting also reported corroboration of the abuse. The forgetting was not related to gender or age, but was associated with the reported early abuse onset. These results were remarkably similar to the results of Feldman- Summers and Pope's original study. Copyright © 2000 John Wiley & Sons, Ltd.

Domestic violence and sexually transmitted diseases: the experience of prenatal care parents

The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services.

Self-reported abuse history and adolescent problem behaviors. II. alcohol and drug use

Purpose: We examined the associations of self-reported abuse and sexual molestation with self-reported alcohol and drug use in a general population of adolescents. Methods: We used a stratified cluster sampling procedure with replacement to sample 4790 students in Washington State public schools in Grades 8, 10, and 12. Students were asked whether they had ever been abused by an adult and whether they had ever been sexually molested. They were also asked about their levels of alcohol and drug use and about early initiation of substance use. We conducted polytomous logistic regressions, controlling for gender and grade, using Software for the Statistical Analysis of Correlated Data (SUDAAN). Results: We identified associations between reported abuse history and alcohol and drug use in adolescence and early initiation of substance use. The associations between reported abuse history and alcohol use were stronger at younger ages. The strongest association was between combined abuse and molestation, and relatively severe (heavy) drinking by eighth graders (odds ratio, 7.9; 95% confidence interval, 2.6–17.4). For drug use, the associations with reported abuse history were slightly stronger at higher levels of severity and for combined abuse and molestation compared to nonsexual abuse. For early initiation, the associations with abuse history were stronger for combined abuse and molestation than for nonsexual abuse or molestation alone, and stronger for marijuana use/regular drinking than for alcohol/cigarette experimentation. For example, adjusted odds ratios and 95% confidence intervals (in parentheses) for combined abuse and molestation were 3.5 (2.8–4.5) for alcohol/cigarette experimentation and 12.2 (6.3–23.6) for marijuana use/regular drinking by age 10. For abuse alone, these figures were 2.5 (2.0–3.1) and 4.7 (3.0–7.3), respectively. Conclusion: Efforts to reduce substance use and abuse in adolescence, particularly heavy use and use early in adolescence, should consider the possible role of a history of maltreatment.

Self-reported abuse history and adolescent problem behaviors. I. antisocial and suicidal behaviors

Purpose: To examine the associations of self-reported abuse and sexual molestation with self-reported antisocial behavior and suicidal ideation/behavior in a general population of adolescents. Methods: We used a stratified cluster sampling procedure with replacement to sample 4790 students in Washington State public schools in Grades 8, 10, and 12. Students were asked in a self-administered questionnaire whether they had ever been abused by an adult and whether they had ever been sexually molested. They were also asked about antisocial behavior and suicidal ideation and behavior in the past year. We conducted polytomous logistic regressions, controlling for gender and grade, using Software for the Statistical Analysis of Correlated Data (SUDAAN). Results: Reported abuse history was associated with antisocial behavior and with suicidal ideation and behavior. The associations were stronger for abuse and molestation than for nonsexual abuse or molestation alone, and stronger at higher levels of severity (e.g., suicide attempts vs. suicidal thoughts). For example, adjusted odds ratios and 95% confidence intervals (in parentheses) for abuse and molestation were 4.4 (3.1–6.2) for suicidal thoughts, 6.8 (4.4–10.4) for suicide plan, 12.0 (7.9–18.4) for noninjurious suicide attempt, and 47.1 (23.3–95.3) for injurious suicide attempt. For abuse alone, these figures were 2.3 (1.7–3.2), 3.1 (2.1–4.6), 5.1 (3.3–7.8), and 11.8 (4.4–31.9), respectively. Conclusions: Efforts to reduce antisocial behavior and suicidal ideation/behavior in adolescence, particularly early or severe manifestations of the behaviors, should consider the possible role of a history of maltreatment, especially the possibility of sexual abuse.

Sexually and physically abused foster care children and posttraumatic stress disorder.

Considerable debate exists regarding the possible relationship between child abuse and posttraumatic stress disorder (PTSD). In this study, 3 groups of foster care children were compared. The groups included 50 sexually abused, 50 physically abused, and 50 nonabused foster care children. Participants completed the Child Post-Traumatic Stress Reaction Index, the Childhood PTSD Interview, and the Modified Stroop Procedure (MSP), which included sexual abuse and nonsexual abuse stimuli. The MSP has not been previously used in child abuse research. Results indicated that sexually and physically abused children demonstrated PTSD at a high level. The MSP discriminated between the sexually abused children with PTSD and those without PTSD. Responses to the MSP sexual abuse stimuli resulted in significantly longer color-naming times than responses to nonsexual abuse stimuli. Preadolescents demonstrated more severe PTSD than early adolescent children.