Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults

Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, but little research has been done on the effect of ACEs on the health and well-being of adults in South Carolina (SC). This study analyzed a sample of 9744 respondents who participated in the 2014 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship among childhood experiences of physical, sexual, and emotional abuse, as well as witnessing household violence, on mental and physical health outcomes in adulthood among SC residents. Twenty-two percent of survey respondents reported poor general health (22.1%), and a smaller proportion reported high frequent mental distress in the past month (13.1%). Each category of childhood experiences was associated with an increase in the risk of poor general health. Individuals reporting three or more types of experiences were more likely to report poor health (aOR 2.89; 95% CI 2.86–2.92) than adults without such experiences. Respondents reporting three or more types of childhood adverse experiences were more likely to report frequent mental distress (aOR 3.29; 95% CI 3.26–3.33) compared to adults who did not report three or more types of adversity. Findings from the SC BRFSS highlight a connection between ACEs and negative health outcomes later in life. Given that results of this study also demonstrated that increased exposure to ACEs was associated with greater odds of negative health in adulthood, preventing adverse events such as experiencing abuse or witnessing domestic violence in childhood will have significant effects on later adult health.     

The veridicality of punitive childhood experiences reported by adolescents and young adults

OBJECTIVE: The primary goal of the present research was to determine whether retrospective reports of childhood disciplinary experiences and perceptions of that discipline correspond to actual childhood events and whether the accuracy of that report was influenced by the affective state of the respondent. METHOD: Eighty-three adolescent and young adult males completed a retrospective measure of physical child maltreatment, Assessing Environments (AEIII), and the Brief Symptom Inventory (BSI). As children the participants had been observed naturalistically in their homes interacting with their parents an average of 10 years earlier. RESULTS: Analyses were consistent with the hypothesis that both current mood and actual observations of parent-child interactions during childhood predict self-reported recollections of childhood maltreatment by one's parents. Further the veridicality of such recollections appears to depend upon the objective specificity versus the perceptive nature of the questions used to elicit the recollections. CONCLUSIONS: The findings suggest that assessment instruments suitable for obtaining information regarding earlier childhood victimization must utilize behaviorally specific items. Thus, items that are either global or intimate a normative comparison should be avoided.     

Childhood victimization and lifetime revictimization

OBJECTIVE: To examine the fundamental hypothesis that childhood victimization leads to increased vulnerability for subsequent (re)victimization in adolescence and adulthood and, if so, whether there are differences in rates of experiencing traumas and victimizations by gender, race/ethnicity, and type of childhood abuse and/or neglect. METHODS: Using a prospective cohort design, participants are individuals with documented cases of childhood physical and sexual abuse and neglect from the years 1967 through 1971 and a matched control group. Both groups were interviewed in-person (mean age 39.5 years) in 2000-2002 using a new instrument to assess lifetime trauma and victimization history. RESULTS: Abused and neglected individuals reported a higher number of traumas and victimization experiences than controls and all types of childhood victimization (physical abuse, sexual abuse, and neglect) were associated with increased risk for lifetime revictimization. Significant group (abuse/neglect vs. control) by gender and group by race/ethnicity interactions were found. Childhood victimization increased risk for physical and sexual assault/abuse, kidnapping/stalking, and having a family friend murdered or commit suicide, but not for general traumas, witnessing trauma, or crime victimization. CONCLUSIONS: These findings provide strong support for the need for early intervention with abused and neglected children and their families to prevent subsequent exposure to traumas and victimization experiences.     

Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.     

Parental abusive versus supportive behaviors and their relation to hostility and aggression in young adults

The relation of parental support to abuse has rarely been considered in research on the sequelae of childhood abuse in adulthood. In this study, using the Exposure to Abusive and Supportive Environments Parenting Inventory (EASE-PI), young adults who reported higher emotionally abusive parenting (EA) consistently reported significantly lower love and support from both parents. The relation between physically abusive parenting (PA) and love/support depended upon gender of parent and child. EA was significantly related to higher hostility and higher aggression, as measured by the Buss-Durkee Hostility Inventory, for both men and women, and to reports of physical fights within the family, for women only. PA was significantly related to higher aggression but not higher hostility. Lower support by fathers, but not by mothers, was significantly related to higher hostility. However, lower support of daughters by mothers was significantly related to increased physical fights in the family. Results indicate that less severe abusive behaviors, especially EA, may have detrimental outcomes of hostility and aggression and that supportive behaviors by both mothers and fathers may be important factors in the outcome.     

Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires,Argentina

This study sought to describe childhood sexual experiences with older partners (CSEOP) among men who have sex with men (MSM) in Buenos Aires, Argentina. MSM were recruited through respondent driven sampling. They responded to a computer administered self-interview with questions on CSEOP, operationalized as manual, oral, genital, or anal contact prior to age 13 with a partner at least 4 years older. Of the 500 respondents, only 25% identified as gay. Eighteen percent of the respondents reported CSEOP, the majority of whom did not feel they were hurt by the experience and did not consider it to be childhood sexual abuse (CSA). Over two-thirds of MSM who reported CSEOP said that their older partner was a female. Only 4% of those with a female partner felt their experience was CSA compared to 44% of those who had a male partner. Among all men reporting CSEOP, those who felt sexually abused were more likely to have been physically forced or threatened, physically hurt, and emotionally hurt than those who did not feel sexually abused. Having CSEOP, being hurt by the experiences, and perceiving the experiences as sexual abuse were not associated with current HIV sexual risk or substance use behavior. In this sample of MSM in Argentina, a substantial minority reported CSEOP. Those who felt they had been sexually abused were much more likely to have had an older male partner than an older female partner, and were more likely to report having been physically forced and threatened by their older partner.     

Childhood sexual experiences among substance-using non-gay identified Black men who have sex with men and women

This study explored potential variations in childhood sexual abuse (CSA) by examining qualitative accounts of first sexual experiences among non-disclosing, non-gay identified Black men who have sex with men and women (MSMW). We analyzed data from semi-structured qualitative interviews with 33 MSMW who described first sexual experiences with male and female partners. Thematic analysis revealed four patterns of first sexual experiences including: unwanted sexual experiences with a male or female consistent with definitions of childhood sexual abuse; consensual sex with an older male or female; bodily exploration with another male or female child; and consensual sex with a peer-age female. Most of the experiences described by participants as consensual with an older male or female, however, met criteria for childhood sexual abuse found in the extant literature. Several men discussed childhood sexual experiences (CSE) relative to their experiences with alcohol, drugs, and same-sex behavior as adults. Findings suggest that the relationship between CSE and risk-taking behavior may be shaped by whether men perceive their experiences as abusive or consensual, and have implications for researchers, treatment providers and counselors.     

Comparing disciplinary methods used by mothers in Palestine and Qatar

This paper explores child disciplinary methods used by parents in Qatar and Palestine. In this study ICAST-P, an internationally recognized tool, was used with mothers reporting on one of their children up to their 12th birthday. It questions about disciplinary methods: nonviolent; physical: moderate and severe; and psychological methods that had been used in the previous year on the index child in the family. A comparative national cross-sectional household survey of mothers aged 25–50 years old was conducted in both Qatar and Palestine, both Arabic Muslim states, but with very different socio-economic and political contexts that place Qataris in a much more advantageous position. Our results show that the 1299 Palestinian mothers interviewed were younger, had more children and less education compared to the 1018 Qatari mothers. Fewer mothers from Palestine were working. The index child in Palestine tended to be younger with 60% being under 5 years, while 73.7% of Qatari children were over 5 years of age. Severe physical disciplinary methods were reported significantly more often, in Palestine, e.g. Kicking the child (P value < 0.001), using hand or pillow to prevent breathing (P value < 0.001) and hitting child with object or fist (P value < 0001). Moderate as well as psychological disciplinary methods were also significantly higher among Palestinian mothers (P value < 0.001). Our results suggest that challenging circumstances that Palestinian mothers experience, as compared to their Qatari peers, are associated with greater prevalence of the harsher forms of discipline. Our findings have policy implications and preventative strategies for child maltreatment in both countries.     

Tailoring health-related messages for young adults with adverse childhood experiences (ACEs)

The goal was to identify factors that might affect likelihood of seeking health-related interventions for young adults with adverse childhood experiences (ACEs). We tested whether ACEs were associated with (1) regulatory focus (tendency toward promoting good outcomes versus preventing bad outcomes), and (2) patient activation (the intention to take active charge of one’s health). We further tested whether promotion and prevention and patient activation were associated with each other and with health. Students at a public university (N = 321) completed online questionnaires assessing ACEs, regulatory focus, patient activation, and health. Greater childhood adversity showed small but significant associations with being a less activated patient and being less focused on promoting good outcomes. In contrast, greater childhood adversity had a much stronger association with focusing on preventing negative outcomes. Students with a more significant mental health history were more likely to have been exposed to childhood adversity, to be less activated patients, and to focus more on prevention. Results suggest that using a prevention focus may be effective in health messages aimed to reach individuals with high levels of ACEs. Furthermore, individuals with high levels of ACEs may benefit from interventions aimed at increasing patient activation.     

The whole picture: Child maltreatment experiences of youths who were physically abused

The purpose of the current study was to describe the maltreatment experiences of a sample of urban youths identified as physically abused using the Maltreatment Case Record Abstraction Instrument (MCRAI). The sample (n = 303) of 9–12 year old youths was recruited from active child protective services (CPS) cases in 2002–2005, and five years of child protective service records were reviewed. The demographic and maltreatment experiences of MCRAI-identified youths with physical abuse were compared to maltreated youths who were not physically abused and youths who were identified as physically abused by CPS when they entered this longitudinal study. T-tests and chi-square tests were used to compare the demographics and maltreatment experiences of the sample MCRAI-identified physically abused to the sample MCRAI-identified as nonphysically abused maltreated by gender. Of the total sample, 156 (51%) were identified by MCRAI as physically abused and 96.8% of these youth also experienced other types of maltreatment. Whereas youth with the initial CPS identification of physical abuse showed little co-occurrence (37.7%) with other forms of maltreatment. The MCRAI-identified physically abused youths had a significantly higher mean number of CPS reports and higher mean number of incidents of maltreatment than MCRAI-identified nonphysically maltreated youths. Lifeline plots of case record history from the time of first report to CPS to entry into the study found substantial individual variability in maltreatment experiences for both boys and girls. Thus, obtaining maltreatment information from a single report vastly underestimates the prevalence of physical abuse and the co-occurrence of other maltreatment types.     

Listening to Young People with Physical Disabilities' Experiences of Education

There is a general acceptance that inclusion is morally and ethically the most appropriate form of education. However, more research needs to focus on how best to accommodate and support the educational needs of all students, including those with physical disabilities. Listening to young people with physical disabilities talk about their educational experiences is one way to do this. The aim of this research was to investigate the life stories of a small number of young people with physical disabilities, in particular focusing on their educational experiences. Nine young people, between the ages of 10 and 13 years, who used a manual or powered wheelchair and had the cognitive ability to participate in a series of biographical interviews, were recruited. They collaborated in the writing of their life stories. One theme identified in the analysis of these life stories was their educational experiences. The results highlight that the participants held mixed views about their education. The four who attended a segregated special school were generally positive about their experiences. Participants who had attended a mainstream school talked about positive and negative experiences. Individual and differing perspectives on friendships and the ethos of their school were noted. It is suggested that young people with physical disabilities need to be considered as individuals and that if schools are to achieve the goal of inclusion they need to develop ways to accommodate each individual's needs.     

Childhood abuse,adult interpersonal abuse,and depression in individuals with extreme obesity

This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p < .001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p = .01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p < .001 and p = .002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.     

Self-reported disciplinary practices among women in the child welfare system: association with domestic violence victimization

OBJECTIVE: To examine the association between physical domestic violence victimization (both recent and more than a year in past measured by self-report) and self-reported disciplinary practices among female parents/caregivers in a national sample of families referred to child welfare. METHODS: Cross-sectional survey of more than 3,000 female caregivers in the National Survey of Child and Adolescent Well-being (NSCAW) study, a nationally representative sample of children and their families referred to child welfare agencies for investigation of abuse and neglect. Women reported physical domestic violence victimization and their disciplinary practices for their child on different versions of the Conflict Tactics Scales. RESULTS: Four hundred and forty-three women reported prior year domestic violence, 1,161 reported domestic violence but not in the past 12 months, and 2,025 reported no domestic violence exposure. Any prior domestic violence exposure was associated with higher rates of self-reported psychological aggression, physical aggression and neglectful disciplinary behaviors as compared to those with no domestic violence victimization in bivariate comparisons. After controlling for child behavior, demographic factors, and maternal characteristics, those with remote and recent domestic violence victimization employed more self-reported psychological aggression, while only caregivers with recent DV reported more physical aggression or neglectful behaviors. CONCLUSIONS: In a national child welfare sample, self-reported aggressive and neglectful parenting behaviors were common. In this sample, domestic violence victimization is associated with more self-reported aggressive and neglectful disciplinary behaviors among female caregivers. The mechanism for these associations is not clear. PRACTICE IMPLICATIONS: Rates of aggressive and neglectful disciplinary practices are especially high among female parents/caregivers exposed to domestic violence. Child welfare agencies should plan routine and structured assessments for domestic violence among parents/caregivers and implement parenting interventions to reduce harmful disciplinary practices for those families identified.     

School-based bullying experiences as reflected by adults with visual impairments

The purpose of this study was to describe the reflections of adults with visual impairments regarding bullying experiences during their school-based education. An interpretative phenomenological analysis research approach was used and 11 participants (aged 20–35 years; seven women, four men) participated in this study. The sources of data were semi-structured audiotaped telephone interviews and reflective field notes. Thematic development was undertaken utilizing a three-step analytical process guided by the research approach. Based on the data analysis, three interrelated themes were constructed: (a) “It would be when they knew there weren't teachers watching”: bullying experiences in unowned and unstructured spaces; (b) “Going through the motions”: feelings about verbal, social, and physical victimization; and (c) “They had their own insecurities”: understanding the bullies and bystanders. The emerged themes provide a unique insight into the way in which those with visual impairments experienced bullying in schools and the meaning they ascribed to those experiences.     

Childhood maltreatment experiences and problematic sexual outcomes in adult males who have sexually offended: Further evidence of the potency of male caregiver psychological abuse

BackgroundAlthough research on the developmental antecedents of sexual offending has tended to focus on sexual abuse, recent research in juveniles and adults who have sexually offended suggests that psychological abuse perpetrated by a male caregiver may be a particularly important factor in the development of problematic sexual interests and behaviors.ObjectiveThis study aimed to extend previous findings by investigating the association between psychological abuse by a male caregiver and problematic sexual outcomes in a sample of adult males who had sexually offended.ParticipantsParticipants were 529 adult males incarcerated for sexual offenses, 21% of whom were civilly committed.MethodsChildhood maltreatment and problematic sexual outcomes were assessed using the Multidimensional Assessment of Sex and Aggression, a contingency-based inventory that assesses domains related to sexual aggression. Hierarchical regressions were calculated examining the association between childhood abuse types and sexual outcomes.ResultsChildhood sexual abuse was associated with child sexual (β = .247, p < .001) and other paraphilic interests (β = .189, p < .001). Male caregiver psychological abuse also emerged as marginally associated with child sexual interest (β = .100, p = .059), even after controlling for other abuse types.ConclusionsThese results partially replicate recent findings in a juvenile sample and challenge conventional developmental theories of sexual offending, by suggesting that male caregiver psychological abuse may play a role in the etiology of child sexual interest among males who have sexually offended. This study also suggests a possible gender symmetry effect moderating the developmental consequences of abuse.     

Childhood maltreatment and the persistence of smoking: A longitudinal study among adults in the US

The current study examined the relationship between childhood maltreatment—emotional, physical, and severe physical maltreatment—and the initiation and persistence of smoking. Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves 1 and 2. Frequency of childhood emotional, physical, and severe physical maltreatment (never, rare, intermittent, frequent) reported at Wave 1 was examined in relation to ever smoking, smoking daily, and persistent daily smoking at Waves 1 and 2. Logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals), which were then adjusted for potential confounders. Childhood emotional, physical, and severe physical maltreatment were associated with increased odds of ever smoking, smoking daily, and persistent smoking at Waves 1 and 2. The majority of these associations remained significant after adjusting for confounding variables. These results suggest a history of trauma may play a prominent role in recalcitrant cigarette smoking and suggest that the success rates of treatments for smoking cessation may be improved by integrating trauma treatment where appropriate.     

Inter-rater reliability of physical abuse determinations in young children with fractures

As there is no “gold standard” in determining whether a fracture is caused by accident or abuse, agreement among medical providers is paramount. Using abstracted medical record data from 551 children <36 months of age presenting to a pediatric emergency department, we examined the extent of agreement between specialists who evaluate children with fractures for suspected abuse. To simulate clinical scenarios, two pediatric orthopaedists and two child abuse pediatricians (CAPs) reviewed the full abstraction and imaging, whereas the two pediatric radiologists reviewed a brief history and imaging. Each physician independently rated each case using a 7-point ordinal scale designed to distinguish accidental from abusive injuries. For any discrepancy in independent ratings, the two specialists discussed the case and came to a joint rating. We analyzed 3 types of agreement: (1) within specialties using independent ratings, (2) between specialties using joint ratings, and (3) between clinicians (orthopaedists and CAPs) with more versus less experience. Agreement between pairs of raters was assessed using Cohen's weighted kappa. Orthopaedists (κ = 0.78) and CAPs (κ = 0.67) had substantial within-specialty agreement, while radiologists (κ = 0.53) had moderate agreement. Orthopaedists and CAPs had almost perfect between-specialty agreement (κ = 0.81), while agreement was much lower for orthopaedists and radiologists (κ = 0.37) and CAPs and radiologists (κ = 0.42). More-experienced clinicians had substantial between-specialty agreement (κ = 0.80) versus less-experienced clinicians who had moderate agreement (κ = 0.60). These findings suggest the level of clinical detail a physician receives and his/her experience in the field has an impact on the level of agreement when evaluating fractures in young children.     

Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing

The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.     

Maternal experiences of childhood abuse and intimate partner violence: Psychopathology and functional impairment in clinical children and adolescents

Objectives

The current study examined the independent effects of mothers’ childhood abuse (CA) and intimate partner violence (IPV) on psychopathology and functional impairment in children; and the potential moderating and mediating role of individual and family factors in these relationships. Additionally, this study explored the potential cumulative effects of both maternal CA and IPV on children's outcomes.

Method

The sample included 547 Spanish children and adolescents aged between 8 and 17 years, and their parents, who had accessed mental health services. The assessment was based on structured interviews with the children and their parents. Statistical analyses were carried out through hierarchical multiple, negative-binomial and logistic regressions, and Structural Equation Models.

Results

Children whose mothers experienced CA and those whose mothers suffered physical IPV showed increased DSM-IV disruptive disorders and externalizing behavior problems, respectively. Children who directly observed physical IPV and also suffered physical punishment by parents showed increased internalizing problems. IPV had effects, either direct or indirect by physical punishment, on children's externalizing problems. Cumulative effect analyses indicated that the prevalence of disruptive disorders was highest in children whose mothers had suffered both CA and IPV.

Conclusion

Spanish children whose mothers have suffered CA, IPV or both, are at high risk of serious conduct problems, whereas children exposed to IPV and who were also physically abused are at greater risk of internalizing problems. Physical punishment of children contributes in part to explain externalizing problems of IPV-exposed children. These findings indicate potential targets of assessment and intervention for families seeking help in mental health services.     

Children's experiences of companion animal maltreatment in households characterized by intimate partner violence

Cruelty toward companion animals is a well-documented, coercive tactic used by abusive partners to intimidate and control their intimate partners. Experiences of co-occurring violence are common for children living in families with intimate partner violence (IPV) and surveys show that more than half are also exposed to abuse of their pets. Given children's relationships with their pets, witnessing such abuse may be traumatic for them. Yet little is known about the prevalence and significance of this issue for children. The present study examines the experiences of children in families with co-occurring pet abuse and IPV. Using qualitative methods, 58 children ages 7–12 who were exposed to IPV were asked to describe their experiences of threats to and harm of their companion animals. Following the interviews, template analysis was employed to systematically develop codes and themes. Coding reliability was assessed using Randolph's free-marginal multirater kappa (k_free = .90). Five themes emerged from the qualitative data, the most common being children's exposure to pet abuse as a power and control tactic against their mother in the context of IPV. Other themes were animal maltreatment to discipline or punish the pet, animal cruelty by a sibling, children intervening to prevent pet abuse, and children intervening to protect the pet during a violent episode. Results indicate that children's experiences of pet abuse are multifaceted, potentially traumatic, and may involve multiple family members with diverse motives.