Lillian Bensley

Childhood Family Violence History and Women's Risk for Intimate Partner Violence and Poor Health

BACKGROUND There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and womens health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. METHODS A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month. RESULTS The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured. CONCLUSIONS These findings underscore the role of childhood experiences of abuse and of witnessing family violence in womens current risk for IPV, poor physical health, and frequent mental distress.

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.

Video games and real-life aggression: review of the literature

Concern about violent video games has been widely expressed [1–3]. A professor of military science has asserted that some games are “very definitely enabling violence” in a way analogous to training programs used by the military and police agencies [4, p. 315]. Also, violent video games have been suggested as a contributing factor in recent school shootings by adolescent males who played violent games [5]. However, population-level evidence suggests that between 1991 and 1997, there was a linear decrease in adolescent weapon-carrying and physical fighting [6], and this downward trend continued in 1999 [7]. Also, between 1993 and 1998 (the most recent year available), national homicide rates dropped from 2.5 to 1.5 per 100,000 for 10to 14-year-olds and from 20.5 to 11.7 per 100,000 for 15to 19-year-olds. During this period, video games were ubiquitous, and most games contained violence [8,9], calling into question the notion that video games have a largescale harmful effect on youth violence. We reviewed the scientific literature to determine whether the evidence supports a public health concern that violent video games contribute to real-life aggression. Youth violence and delinquency have been consistently associated with family factors such as child abuse and neglect, parental rejection of the child, and parental criminality and alcoholism [10]. Individual factors such as poor performance in school and on standardized tests, truancy, gang membership, and attention–deficit-hyperactivity and conduct disorders are also consistent predictors of youth violence and delinquency, although these factors may be early manifestations or “markers” rather than causes of later problem behavior. Violent video games may be considered in the context of war play and other forms of aggressive play by youth. Societal attitudes toward aggressive play differ among adults [11]. Aggressive play differs from real aggression by the fact that it does not include an attempt to injure someone. Although opponents of aggressive play argue that such play fosters real-life violence, proponents argue that it is a natural, even inevitable, aspect of boys’ play and provides an opportunity to try to come to terms with war, violence, and death [11]. Several psychological theories are relevant to the possible role of video game violence in youth aggression. J. L. Sherry [personal communication, October 25, 1999] identified six theories used to predict either increased or decreased aggression after violent video game play. First, social learning theory [12,13] suggests that at least some aggression is learned by observing, and then by imitating, a model who acts aggressively. Aggressive video game characters might serve as models for aggressive behavior. Further, rewards such as higher points and longer playing times within the game and increased status From the Office of Epidemiology, Washington State Department of Health, Olympia, Washington. Address correspondence and reprint requests to: Lillian Bensley, Ph.D., Non-Infectious Conditions Epidemiology, Washington State Department of Health, P.O. Box 47812, Olympia, Washington 98504-7812. E-mail: Lillian.Bensley@doh.wa.gov. Manuscript accepted March 1, 2001. JOURNAL OF ADOLESCENT HEALTH 2001;29:244–257

Sexual abuse as a factor in child maltreatment by adolescent mothers of preschool aged children

We examined the role of a history of sexual abuse as a predictor of child maltreatment by adolescent mothers in a prospective study of 104 mother-child dyads. Mothers were interviewed about any experienced abuse, and the mother-child dyads were observed in a teaching interaction and in the Strange Situation when the children were 1 year old. Three and a half years later, the mothers were interviewed about their Child Protective Service (CPS) contacts since the birth of their children. The percentage of mothers reporting CPS contacts for their own children was 15.4%, 38.5%, and 83.3%, respectively, for those mothers with no history of sexual abuse, a history of a single incident or brief duration of sexual abuse, and those mothers with a history of chronic sexual abuse (median 24 months duration; test of increasing trend significant at p

Community Responses and Perceived Barriers to Responding to Child Maltreatment

Although child maltreatment has important effects on physical and psychological health, even serious cases often go unreported. Little is known about actions that individuals take when they know of an abused child, factors influencing whether they take action, or general population beliefs about how best to prevent maltreatment. A random-digit-dialed telephone survey of 504 Washington State civilian, English-speaking adults living in households with telephones was conducted in 2002. Respondents were asked whether they had ever known an abused child and if so, how they responded and any barriers they experienced to responding. Regardless of whether they had known an abused child, they were asked how they would respond in a hypothetical situation and hypothetical barriers. They were also asked what they believed to be effective in preventing maltreatment. Half (49% ± 5%) of the respondents indicated that they had known a child they believed to be abused and of these, four-fifths (84% ± 5%) indicated that they took some action, most frequently reporting the abuse to Child Protective Services, talking to the parents about the abuse or how to parent, or calling the police or other law enforcement. The most frequently reported barriers were fear of retaliation by the abusive parent, being afraid of making the childs situation worse, and not wanting to intrude on family privacy. About nine-tenths of respondents believed that mental health services and drug and alcohol treatment, support services such as food banks and crisis nurseries, and parenting education classes were effective in preventing abuse. These results provide evidence that most people are willing to intervene to help an abused child. However, barriers to intervening (particularly fear of retaliation) exist and may account for some of the failures to report abuse.

Comparison of examination-based and self-reported risk factors for cardiovascular disease, Washington State, 2006-2007.

Introduction Obesity, hypertension, and high cholesterol are risk factors for cardiovascular disease, which accounts for approximately 20% of deaths in Washington State. For most states, self-reports from the Behavioral Risk Factor Surveillance System (BRFSS) provide the primary source of information on these risk factors. The objective of this study was to compare prevalence estimates of self-reported obesity, hypertension, and high cholesterol with examination-based measures of obesity, hypertension, and high-risk lipid profiles. Methods During 2006–2007, the Washington Adult Health Survey (WAHS) included self-reported and examination-based measures of a random sample of 672 Washington State residents aged 25 years or older. We compared WAHS examination-based measures with self-reported measures from WAHS and the 2007 Washington BRFSS (WA-BRFSS). Results The estimated prevalence of obesity from WA-BRFSS (27.1%; 95% confidence interval [CI], 26.3%–27.8%) was lower than estimates derived from WAHS physical measurements (39.2%; 95% CI, 33.6%–45.1%) (P < .001). Prevalence estimates of hypertension based on self-reports from WA-BRFSS (28.1%; 95% CI, 27.4%–28.8%) and WAHS (33.4%; 95% CI, 29.4%–37.7%) were similar to the examination-based estimate (29.4%; 95% CI, 25.8%–33.4%). Prevalence estimates of high cholesterol based on self-reports from WA-BRFSS (38.3%; 95% CI, 37.5%–39.2%) and WAHS (41.8%; 95% CI, 35.8%–48.1%) were similar; both were lower than the examination-based WAHS estimate of high-risk lipid profiles (59.2%; 95% CI, 54.2%–64.2%) (P < .001). Conclusion Self-reported heights and weights underestimate the prevalence of obesity. The prevalence of self-reported high cholesterol is significantly lower than the prevalence of high-risk lipid profiles. Periodic examination-based measurement provides perspective on routinely collected self-reports.

Limited Percentages of Adults in Washington State Meet the Dietary Guidelines for Americans Recommended Intakes of Fruits and Vegetables

Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption.