Child sexual abuse consequences in community samples of Latino and European American adolescents.

OBJECTIVE: Research investigating the impact of child sexual abuse (CSA) in community samples of adolescents has been limited. This study aims to identify sexual abuse among ethnically diverse high school adolescents of both genders and evaluate their psycho-emotional consequences. METHOD: Through the use of self-report instruments, a sample of 223 Latino and European American 16-19-year-old high school students were identified as either victims of CSA or as nonabused. The emotional impact of sexual abuse was also investigated among these ethnically diverse adolescent males and females. RESULTS: Initial findings revealed that those adolescents who gave inconsistent responses to CSA assessments questions were much more similar in patterns of psychological distress to CSA victims compared to nonabused teenagers. Prevalence analyses revealed that females (45%) were nearly two times more likely to report CSA than males (24%). Latinos (44%) were significantly more likely to experience CSA compared to European Americans (27%), and Latinas (54%) had the highest prevalence overall. Other findings indicated substantial differences in type of perpetrator. While female victims of CSA identified male perpetrators in 91.9% of cases, male victims of CSA identified female perpetrators in 52.9% of cases. Consistent with past research, sexually abused adolescents reported significantly greater psychological distress than their nonabused peers, regardless of gender or ethnic group. Gender differences emerged with females reporting greater psychological symptoms, but these differences were substantially reduced when CSA was controlled. European Americans reported greater anxious arousal symptoms compared to Latinos. CONCLUSIONS: Our findings suggest that the prevalence of CSA among adolescents is higher than existing research has noted for both males and females and particularly higher for Latinos compared to European Americans. Perpetration by females upon males may also be higher than research has noted. Our findings also revealed many ethnic and gender similarities and fewer differences in the psychological impact and circumstances of sexual abuse in this diverse sample of adolescents. PRACTICE IMPLICATIONS: The high prevalence of CSA among adolescent males and particularly Latinas emphasize the need to intervene on a community level and with parents for both prevention and intervention regarding issues of sexual victimization. The numbers of female perpetrators, especially when boys are the targets of abuse, may be higher than previously imagined and thus must be assessed tactfully and thoroughly. This study found that adolescents who reported CSA inconsistently had similar symptoms as those with confirmed CSA and therefore warrant greater attention and more persistent intervention. When treating victims of CSA, the Trauma Symptom Inventory (TSI) is effective in identifying specific areas of emotional distress to treat in sexually abused ethnically diverse male and female adolescents. Culturally relevant prevention efforts are needed for ethnically diverse children of both genders.

Correlates and predictors of HIV risk among inner-city African American female teenagers.

OBJECTIVE DESIGN: For human immunodeficiency virus (HIV)-related prevention initiatives to be most effective, they should be broad-based and incorporate multiple domains of influence. This study tested how several ecodevelopmental domains influenced HIV-risk related attitudes and behaviors in a community sample of African American female teens (N = 242). MAIN OUTCOME MEASURES: Outcome measures were number of partners, frequency of intercourse, number of pregnancies, abstinence/condom use, HIV/AIDS-related attitudes and behaviors, and HIV testing. RESULTS: Structural Equation Modeling revealed many direct paths from ecodvelopmental domains to risky sexual behaviors. The findings include having more partners was associated with parental alcohol-related problems, more drug use, and a younger age at first intercourse. More frequent intercourse was associated with less cultural pride and more drug use. More pregnancies were related to a younger age at first intercourse and parental alcohol problems. HIV testing was associated with having experienced sexual abuse, an older age at first intercourse, and stronger self-efficacy. CONCLUSIONS: Prevention programs that focus on risk reduction could expand their focus beyond sexual behavior to include a broad-range of psychosocial domains that are associated with HIV-risk. The effectiveness of prevention programs should be monitored carefully for appropriateness in different ethnic groups.

Suicidality, depression, and alcohol use among adolescents: a review of empirical findings.

Suicide is a serious health problem as it is currently the third leading cause of death for teenagers between the ages of 15 and 24 years. Depression, which is also a serious problem for adolescents, is the most significant biological and psychological risk factor for teen suicide. Alcohol use remains extremely widespread among today's teenagers and is related to both suicidality and depression. Suicidality refers to the occurrence of suicidal thoughts or suicidal behavior. The consensus in empirical research is that mental disorders and substance abuse are the most important risk factors in both attempted and completed adolescent suicide. Therefore, it is incumbent upon researchers to identify the factors that can lead to their prevention among today's youth. This review compiles the existing literature on suicidality, depression, and alcohol use among adolescents spanning over the past 15 years. Both Problem Behavior Theory and Stress-coping Theory can explain the relationships among suicidality, depression and alcohol use. The prevention of suicidality is critical, especially during the early school years, when it is associated with depression and alcohol use. Suicidality, depression and alcohol use are three phenomenon that noticeably increase in adolescence marking this time period as an ideal opportunity for prevention efforts to commence. Future empirical work is needed that will further assess the impact of adolescent depression and alcohol use on suicidality. In sum, this review of empirical research highlights critical results and limitations, as well as indicates a need for continued efforts in preventing suicidality, depression, and alcohol use among adolescents.

Childhood adversity, poly-substance use, and disordered eating in adolescent Latinas: mediated and indirect paths in a community sample.

OBJECTIVE: Although many studies have identified associations between childhood maltreatment and later substance use and disordered eating, few have examined causal or explanatory pathways, and whether victim characteristics predict the development of one versus the other of these outcomes remains uninvestigated. Furthermore, relatively little childhood maltreatment research has examined Latino samples. To address these gaps, this study examined among Latina adolescents the effects of sexual abuse, physical/emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. METHOD: Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. RESULTS: Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. CONCLUSIONS: Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes.

Childhood adversity and poor mothering: consequences of polydrug abuse use as a moderator.

Drug abuse consequences have been typically examined as a direct or main effect on various later outcomes. Drug abuse may also serve as a consequence that alters (moderates) critical developmental trajectories. This study examined the relationship between childhood adversity factors (parent alcohol and drug-related problems, childhood maltreatment) and future parenting practices through an analysis of the moderating effects of polydrug problems. Data from a community sample of mothers was divided into two groups based on the median split level of polydrug problems (alcohol, marijuana, cocaine) that they reported (low, N=123; high, N=114). Confirmatory factor models (CFAs) were developed for the two groups and compared with multiple group analyses (MGAs). Results revealed that mothers who had parents with alcohol or drug-related problems were more likely to become poor parents, if they themselves used drugs and had problems related to drug use.

The motivation, skills, and decision-making model of "drug abuse" prevention.

This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behavior prevention.

Adolescent predictors of young adult and adult alcohol involvement and dysphoria in a prospective community sample of women.

The adolescent predictors of later alcohol involvement (AI), dysphoria (D), and their shared association (AD) among women have not been adequately established. Three waves of data from an ethnically diverse community sample of women, assessed over 16 years are used to study how various psychosocial factors in adolescence influenced later drinking, depression, and their shared association. Structural equation models revealed that several adolescent ecodevelopmental and social development model variables influenced their later outcome in young adulthood and adulthood. The strongest relation was between adolescent Social Conformity and adult AD (beta = -.46) over a 16-year period, emphasizing the impact of this construct. Numerous other relations were revealed. For instance, less satisfaction with school during adolescence predicted adult AI. Having a good bond to the family in adolescence predicted a lower quantity of alcohol consumed during adulthood. Lower satisfaction with "what you want to be" during adolescence predicted young adult D. Higher levels of adolescent relationship satisfaction and school satisfaction predicted less suicidal ideation as an adult. Prevention interventions focusing on increasing socially conforming attitudes and on strengthening relationships both in and out of the home during adolescence are likely to be effective in reducing aspects of AI, D, and AD for women in the general community.

Adult trauma and HIV status among Latinas: effects upon psychological adjustment and substance use.

Latinas have unique cultural factors that can contribute to their health, including recent immigration, documentation status, and language barriers. Additional stressors and experiencing traumatic events can further compromise their psychological adjustment and substance use. This study tests the differential contribution of adult trauma and other life stressors to psychological adjustment and substance use among Latinas who differ in their HIV status and level of acculturation. Baseline and 1-year follow-up data on a community sample of 113 (79 HIV-positive and 34 HIV-negative) 1 to 50 year old Latinas were examined with path analyses to estimate the influence of acculturation, HIV status, and adult trauma, including intimate partner violence (IPV) and sexual assault, on subsequent changes in psychological adjustment (depression) and substance use 1 year later. Age, education, and relationship status were controlled and further analyses examined the interactive influence of HIV status and acculturation and trauma on the outcomes. Findings indicate that both acculturation and HIV status were related to the outcome variables, but did not influence these over time, emphasizing the developmental stability of these processes. Education was the most prominent variable in protecting these women from HIV, depression, and intimate partner violence (IPV), but placed them at greater risk for illicit drug use. The primary predictors of change in the outcome variables were domestic and sexual trauma were exacerbated by HIV positive status. Implications for future research and culturally relevant prevention and intervention programs are discussed.

Childhood experiences and psychosocial influences on HIV risk among adolescent Latinas in southern California.

This study determined how adverse childhood experiences influenced risky sexual behavior in a community sample of Latina adolescents in Los Angeles (N = 904) within a modified ecodevelopmental perspective. Psychosocial, sociocultural, and environmental mediators of the relations between childhood experiences and risky sexual behavior were tested. Many direct and mediated paths were revealed using structural equation modeling. Childhood maltreatment was associated with risk sexual practices, including more partners, less condom use, more frequent intercourse, and less HIV testing. Drug use and general self-efficacy mediated several relationships. Reducing childhood maltreatment reduced HIV risk and improved psychosocial functioning. Many factors tested did not influence HIV risk. Much of what is known about HIV risk among other populations may not apply to young Latina women.

Psychosocial outcomes of alcohol involvement and dysphoria in women: a 16-year prospective community study.

OBJECTIVE: Alcohol involvement, dysphoria, and their combined effects, may have long-term psychosocial consequences. However, because of weaknesses in existing literature, the exact relationships are unclear, as are the relative contributions of either construct or their combined effects to later psychosocial outcomes. This study tests the relationships between these conditions during late adolescence andyoung adulthood as predictors of adult marital, relational and job satisfaction; divorce; perceived opportunity; and job stability. We also test the influence of a change (increase or decrease) in alcohol involvement, dysphoria, or their combined association, on adult psychosocial functioning. METHOD: This study used three waves of data from an ethnically diverse, longitudinal community sample (N = 305 women) assessed over a 16-year span. The measures used have established validity and reliability. RESULTS: Structural equation models revealed that a second-order factor reflecting alcohol involvement and dysphoria during young adulthood was a stronger predictor of psychosocial maladjusument in adulthood than either alcohol involvement or dysphoria alone, predicting decreased satisfaction in multiple psychosocial domains (marriage, relationships and employment). An increase in the shared association between alcohol involvement and dysphoria from late adolescence to young adulthood reduced adult perceived opportunity. CONCLUSIONS: Early intervention is crucial. Clinicians should emphasize the screening for and treatment of alcohol involvement, dysphoria, and their combined effects, in late adolescence and young adulthood. Psychoeducational and treatment efforts to raise awareness of long-term consequences of these conditions are critical.

Development and validation of a brief screening version of the Childhood Trauma Questionnaire.

OBJECTIVE: The goal of this study was to develop and validate a short form of the Childhood Trauma Questionnaire (the CTQ-SF) as a screening measure for maltreatment histories in both clinical and nonreferred groups. METHOD: Exploratory and confirmatory factor analyses of the 70 original CTQ items were used to create a 28-item version of the scale (25 clinical items and three validity items) and test the measurement invariance of the 25 clinical items across four samples: 378 adult substance abusing patients from New York City, 396 adolescent psychiatric inpatients, 625 substance abusing individuals from southwest Texas, and 579 individuals from a normative community sample (combined N=1978). RESULTS: Results showed that the CTQ-SF's items held essentially the same meaning across all four samples (i.e., measurement invariance). Moreover, the scale demonstrated good criterion-related validity in a subsample of adolescents on whom corroborative data were available. CONCLUSIONS: These findings support the viability of the CTQ-SF across diverse clinical and nonreferred populations.

Measuring public opinion on alcohol policy: a factor analytic study of a US probability sample.

Public opinion has been one factor affecting change in policies designed to reduce underage alcohol use. Extant research, however, has been criticized for using single survey items of unknown reliability to define adult attitudes on alcohol policy issues. The present investigation addresses a critical gap in the literature by deriving scales on public attitudes, knowledge, and concerns pertinent to alcohol policies designed to reduce underage drinking using a US probability sample survey of 7021 adults. Five attitudinal scales were derived from exploratory and confirmatory factor analyses addressing policies to: (1) regulate alcohol marketing, (2) regulate alcohol consumption in public places, (3) regulate alcohol distribution, (4) increase alcohol taxes, and (5) regulate youth access. The scales exhibited acceptable psychometric properties and were largely consistent with a rational framework which guided the survey construction.

Development of the Waldron/Varni pediatric pain coping inventory.

The standardized assessment of pediatric pain coping strategies may substantively contribute to the conceptual understanding of individual differences in pediatric pain perception and report. The Waldron/Varni Pediatric Pain Coping Inventory (PPCI) was developed to be a standardized questionnaire to assess systematically children's pain coping strategies. The PPCI was administered to 187 children and adolescents experiencing musculoskeletal pain associated with rheumatologic diseases. A principal components analysis revealed a five-factor solution for the PPCI: (1) cognitive self-instruction, (2) seek social support, (3) strive to rest and be alone, (4) cognitive refocusing, and (5) problem-solving self-efficacy. The results of this research provide initial evidence that the PPCI is a conceptually valid and internally reliable measure for assessing pediatric pain coping strategies.

Modeling the Etiology of Adolescent Substance Use: A Test of the Social Development Model.

The social development model is a general theory of human behavior that seeks to explain antisocial behaviors through specification of predictive developmental relationships. It incorporates the effects of empirical predictors ("risk factors" and "protective factors") for antisocial behavior and attempts to synthesize the most strongly supported propositions of control theory, social learning theory, and differential association theory. This article examines the power of social development model constructs measured at ages 9 to 10 and 13 to 14 to predict drug use at ages 17 to 18. The sample of 590 is from the longitudinal panel of the Seattle Social Development Project, which in 1985 sampled fifth grade students from high crime neighborhoods in Seattle, Washington. Structural equation modeling techniques were used to examine the fit of the model to the data. Although all but one path coefficient were significant and in the expected direction, the model did not fit the data as well as expected (CFI=.87). We next specified second-order factors for each path to capture the substantial common variance in the constructs' opportunities, involvement, and rewards. This model fit the data well (CFI=.90). We conclude that the social development model provides an acceptable fit to predict drug use at ages 17 to 18. Implications for the temporal nature of key constructs and for prevention are discussed.