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.

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.

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.

The impact of marital status and quality on family functioning in maternal chronic illness.

Married individuals tend to enjoy greater health and well-being than nonmarried. However, investigators disagree about whether this is related to the quality of the marriage or to participation in the socially accepted role of marriage. In the present study, we examined the roles of marital quality and marital status as predictors of the family's adjustment processes in the context of maternal chronic illness. We found that the family functioning of single women and unhappily married women was similar and that happily married women enjoyed higher levels of family functioning and family coping. Unhappily married women reported more illness demands, particularly on their time and energy, than did happily married or single women. We suggest it is the quality of the marital interaction, and not the role benefits of marriage, that facilitates family adjustment under conditions of maternal chronic illness.

Parenting behavior of adolescent children of alcoholics.

We compared the parenting behavior of children of alcoholics (COAs) and non-COAs within a sample of adolescent mothers. COAs and their children showed dyadic behaviors that were less problematic than those of their peers on mother-child teaching interactions at 1 year of age, mother-child interactions during structured play at pre-school age and child attachment behavior at pre-school age. COAs reported feeling relatively more rejection as compared to love from the alcoholic parent, but this was not related to their own parenting scores. Similar to other research, COAs reported more historical life stress, more family disruption and more drug use compared to non-COAs, but these measures also were not related to parenting scores. These results suggest that, although adolescent mothers are at risk for parenting difficulties compared to adult mothers, adolescent COAs do not necessarily encounter more problems in parenting their own children compared to other adolescent mothers.

Construct validity evidence for the interpretation of drinking restraint as a response conflict.

A style of control over alcohol consumption, termed restrained drinking, has been identified as an important predictor of drinking behavior and a possible risk factor for more serious alcohol problems. This control style is hypothesized to involve a cyclical pattern of drinking in which the specific phase (restraint or binging) depends on the balance between opposing response tendencies. A survey study of 429 college students supported the important predictions that restrained drinkers experience more response conflict, as evidenced by stronger impulses to drink (cravings and preoccupation with alcohol) as well as stronger inhibitions against drinking (social commitment to drinking goals, self-esteem threat of excessive consumption, and negative expectancies) compared to unrestrained drinkers. Restrained drinkers additionally reported more cyclical and extreme patterns of drinking, more reduction of alcohol consumption below preferred levels, and more costs of drinking reduction compared to unrestrained drinkers. This pattern of results occurred after controlling for habitual levels of alcohol consumption. These findings support important theoretical predictions concerning a restrained drinking style and provide further evidence of its importance in the early identification of the development of alcohol problems.

The role of drinking restraint success in subsequent alcohol consumption.

Intentional self-restraint may play an important role in the control of potentially addictive behavior. Unfortunately, for some individuals, efforts to reduce substance use may prove not only temporary but to increase the likelihood of a later "binge." An experimental study examined the relationship between prior self-restraint efforts and drinking. Results indicated that successfully restrained drinkers (i.e., those individuals who reported exerting considerable effort toward drinking self-control, and who were normatively successful, that is, light drinkers) responded to the sudden availability of alcohol with increased levels of consumption, relative to unrestrained drinkers at a similar level of habitual drinking. There was no such effect among unsuccessfully restraining (i.e., heavy) drinkers. These results suggest that a period of successful drinking restraint which is initiated by the individual, may lead to heightened subsequent alcohol consumption.

The family's functioning with chronic illness in the mother: the spouse's perspective.

While previous research has studied the impact of chronic illness on the patient or spouse, the impact on the marriage, the child, the parent-child relationship, and the family's functioning have been relatively ignored. To date ther is no known study of the impact of a mother's chronic illness on the family. The purpose of the current exploratory study was to test a set of interrelated hypotheses about family functioning with the mother's chronic illness from the spouse's perspective based on a family systems perspective. Data were obtained from standardized questionnaires from 48 fathers with young school-age children whose wife had either breast cancer, diabetes, or fibrocystic breast disease. Results of a path analysis revealed that the number of illness demands the father experienced was a significant predictor of his level of depression. More demands resulted in higher depression scores. Marital adjustment was significantly affected by both the father's level of depression as well as by his wife's type of disease. Spouses of women with breast cancer had significantly higher levels of marital adjustment than did partners of the other women. More depressed spouses had lower levels of marital adjustment. Both illness demands and level of marital adjustment significantly predicted the type of coping behavior the family used. More frequent illness demands and higher levels of marital adjustment were associated with familial introspection, that is, coping behavior characterized by frequent feedback, reflection, and discussion in the family. The quality of the father-child relationship was significantly affected by this type of coping behavior. Families characterized as introspective had fathers who reported more frequent interchange with their children.(ABSTRACT TRUNCATED AT 250 WORDS)