Helen W. Wilson

Pathways from Childhood Abuse and Neglect to HIV-Risk Sexual Behavior in Middle Adulthood.

OBJECTIVE This study examines the relationship between childhood abuse and neglect and sexual risk behavior in middle adulthood and whether psychosocial factors (risky romantic relationships, affective symptoms, drug and alcohol use, and delinquent and criminal behavior) mediate this relationship. METHOD Children with documented cases of physical abuse, sexual abuse, and neglect (ages 0-11) processed during 1967-1971 were matched with nonmaltreated children and followed into middle adulthood (approximate age 41). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1,196). Past year HIV-risk sexual behavior was assessed via self-reports during 2003-2004 (N = 800). Logistic regression was used to examine differences in sexual risk behavior between the abuse and neglect and control groups, and latent variable structural equation modeling was used to test mediator models. RESULTS Child abuse and neglect was associated with increased likelihood of risky sexual behavior in middle adulthood, odds ratio = 2.84, 95% CI [1.74, 4.64], p ≤ .001, and this relationship was mediated by risky romantic relationships in young adulthood. CONCLUSIONS Results of this study draw attention to the potential long-term consequences of child abuse and neglect for physical health, in particular sexual risk, and point to romantic relationships as an important focus of intervention and prevention efforts.

Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study.

OBJECTIVES We examined associations between childhood abuse and neglect and the risk in adulthood for sexually transmitted diseases. METHODS In a prospective cohort design, we matched children aged 0 to 11 years with documented cases of abuse or neglect during 1967 to 1971 with a control group of children who had not been maltreated (754 participants in all) and followed them into adulthood. Information about lifetime history of sexually transmitted diseases was collected as part of a medical status examination when participants were approximately 41 years old. RESULTS Childhood sexual abuse increased risk for any sexually transmitted disease (odds ratio [OR] = 1.94; 95% confidence interval [CI] = 1.00, 3.77; P = .05) and more than 1 type of sexually transmitted disease (OR = 3.33; 95% CI = 1.33, 8.22; P = .01). Physical abuse increased risk for more than 1 type of sexually transmitted disease (OR = 3.61; 95% CI = 1.39, 9.38; P = .009). CONCLUSIONS Our results provided the first prospective evidence that child physical and sexual abuse increases risk for sexually transmitted diseases. Early screening and interventions are needed to identify and prevent sexually transmitted diseases among child abuse victims.

Intergenerational Transmission of Violence

In this chapter, we first describe a number of prominent and frequently cited theories describing how victimized children may grow up to become violent offenders, including social learning, attachment, social information processing, neurophysiological, and behavioral genetics. The second part of this chapter reviews the empirical evidence on the “cycle of violence”, and the final section describes a variety of interventions that might be implemented to “break” the cycle of violence. We provide a vignette to illustrate possible points of intervention in the life of one maltreated child. Finally, we conclude with a brief comment on recommendations for research and practice.

Do the Long-Term Consequences of Neglect Differ for Children of Different Races and Ethnic Backgrounds?

Scant research has examined how children of different races or ethnic backgrounds manifest consequences of neglect. We examined multiple domains of functioning (academic/intellectual, social/behavioral, and psychiatric), three theories (racial invariance, double jeopardy, and resilience), and potential confounding variables. Children with documented cases of neglect (ages 0–11) and matched controls without such histories were followed up and interviewed in adulthood (N = 1,039). The sample was 47.3% female, 62.4% White, 34.3% Black, and 3.4% Hispanic. Black and White neglected children showed negative consequences for IQ, reading ability, and occupational status compared to controls. Compared to same race and ethnic group controls, neglected White children showed extensive mental health consequences, Black children showed more anxiety and dysthymia, and Hispanic children showed increased risk for alcohol problems. Black and White neglected children differed in risk for violence compared to same race controls: Neglected Black children were arrested for violence two times more often than Black controls, whereas neglected White children were more likely than White controls to report engaging in violence. Findings provide some support for each theory (racial invariance, double jeopardy, and resilience). Understanding the factors that account for similarities and differences in consequences requires further investigation. Implications for research and policy are discussed.

Trauma History and PTSD Symptoms in Juvenile Offenders on Probation

Abstract Detained and incarcerated juveniles are found to have heightened rates of trauma and post-traumatic stress disorder (PTSD). Less is known about probation youth, who represent the majority of juveniles in the criminal justice system. This study examined trauma history and PTSD and associations with behavioral health problems among 13- to 17-year-old juveniles on probation (N = 61). Most (93%) reported at least one traumatic event, and 12% met diagnostic criteria for PTSD. Trauma exposure and PTSD symptoms were associated with mental health problems but not substance use or risky sexual behavior. Findings underscore the importance of addressing trauma history in probation youth.

Family environment, coping, and mental health in adolescents attending therapeutic day schools.

OBJECTIVE This study examined associations among family environment, coping, and emotional and conduct problems in adolescents attending therapeutic day schools due to mental health problems. METHODS Adolescents (N = 417; 30.2% female) ages 13-20 (M = 15.25) reported on their family environment (affective involvement and functioning), coping (emotion-focused support-seeking, cognitive restructuring, avoidant actions), and emotional and conduct problems. RESULTS Poorer family environment was associated with less emotion-focused support-seeking and cognitive restructuring, and more emotional and conduct problems. Emotional problems were negatively associated with cognitive restructuring, and conduct problems were negatively associated with all coping strategies. Cognitive restructuring accounted for the relationship between family environment and emotional problems. Cognitive restructuring and emotion-focused support-seeking each partially accounted for the relationship between family functioning and conduct problems, but not the relationship between family affective involvement and conduct problems. CONCLUSIONS Findings implicate the role of coping in the relationship between family environment and adolescent mental health.

History of Sexual Abuse and Development of Sexual Risk Behavior in Low-Income, Urban African American Girls Seeking Mental Health Treatment

Objective: This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment. Method: Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2–T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates. Results: Sexual abuse was significantly associated with T2 sexual experience, T2–T4 number of partners, T3 inconsistent condom use, and T2–T3 having a risky partner. These relationships decreased when mental health symptoms were controlled. Conclusions: This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.

Exposure to Violence and Sexual Risk among Early Adolescents in Urban Middle Schools.

This article examines the relationship between exposure to violence, fear of exposure to violence, and sexual risk among a sample of urban middle school youth. The sample included 911 seventh-grade students who completed self-report surveys. Approximately 20% of the sample reported at least one direct threat or injury with a weapon in the past 3 months, and 52% reported ever seeing someone seriously injured or killed. Experiencing a direct threat was significantly associated with greater intentions to engage in vaginal intercourse and sexual touching behaviors; witnessing violence was significantly associated with sexual touching. Fearing exposure to violence was not associated with increased sexual risk. Most associations did not differ by gender. These data highlight the potential influence of exposure to violence on sexual risk among early adolescents, and underscore the potential of addressing exposure to violence in sexuality education programs and sexual health services for enhanced impact.

Trajectories of psychopathology and risky behaviors associated with childhood abuse and neglect in low-income urban African American girls

The current study examined patterns of psychopathology, drug and alcohol use, and sexual behavior associated with childhood abuse and neglect in a high-risk sample of low-income African American girls seeking mental health treatment. Participants (N=177) were African American girls recruited from mental health clinics serving low-income communities in Chicago, IL and followed over six waves of data collection (T1-T6) reflecting early (mean age 14) to late (mean age 17) adolescence. Child abuse and neglect history was determined from adolescent and caregiver reports. Latent curve modeling examined patterns of internalizing and externalizing psychopathology, drug and alcohol use, sexual experience, and risky sexual behavior reported by girls and associations with reported child abuse and neglect. Overall, these trajectories indicated a decrease in internalizing and externalizing symptoms, stability of drug and alcohol use, and an increase in sexual experience and risky sexual behaviors over time. Child abuse and neglect was associated with increased internalizing symptoms and sexual experience at baseline and with externalizing symptoms and risky sexual behavior both at baseline and the final point. Child abuse and neglect was not significantly associated with alcohol or drug use. This study adds to the literature on the long-term consequences of child abuse and neglect by demonstrating patterns of psychopathology and risky behavior that persist over time in a high-risk group of girls with self or parent reported histories of abuse and neglect. Interventions that address externalizing problems and health risk behaviors may be of particular importance for this population.

Dyadic Confirmatory Factor Analysis of the Inflammatory Bowel Disease Family Responsibility Questionnaire

OBJECTIVES Evaluate the factor structure of youth and maternal involvement ratings on the Inflammatory Bowel Disease Family Responsibility Questionnaire, a measure of family allocation of condition management responsibilities in pediatric inflammatory bowel disease. METHODS Participants included 251 youth aged 11-18 years with inflammatory bowel disease and their mothers. Item-level descriptive analyses, subscale internal consistency estimates, and confirmatory factor analyses of youth and maternal involvement were conducted using a dyadic data-analytic approach. RESULTS Results supported the validity of 4 conceptually derived subscales including general health maintenance, social aspects, condition management tasks, and nutrition domains. Additionally, results indicated adequate support for the factor structure of a 21-item youth involvement measure and strong support for a 16-item maternal involvement measure. CONCLUSIONS Additional empirical support for the validity of the Inflammatory Bowel Disease Family Responsibility Questionnaire was provided. Future research to replicate current findings and to examine the measures clinical utility is warranted.