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Abstract
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We surveyed 342 pregnant adolescents 17 years old and younger for a history of physical or sexual assault and substance use to investigate whether victims of childhood violence are at increased risk of smoking and using alcohol or drugs. A total of 95% of new patients who attended the university's teen pregnancy clinic between May 8, 1989, and December 8, 1990, were interviewed. Substance use was reported seven times more often in those with a history of combined physical and sexual assault, five times more frequently by those who had been sexually assaulted, and three times more often in those who had been physically assaulted than adolescents without a history of assault. Violence was associated with substance use in all ethnic groups although this relationship was modified by ethnicity. Among Hispanics, an association was observed between physical assault and tobacco use. Sexual and combined physical and sexual assault were strongly associated with use of alcohol among blacks. All categories of violence were associated with drug use among all ethnic groups. When use of each substance was analyzed by the adolescent's relationship to the perpetrator, drug use was most strongly associated with assault by a mate, whereas tobacco or alcohol use was more often associated with assault by a member of the victim's family of origin.
VioLit summary:
OBJECTIVE:
The objective of this research by Berenson et al. was to examine the relationship between violence and substance use in cases of adolescent pregnancy.
METHODOLOGY:
The authors employed a quasi-experimental cross-sectional design with a non-probability sample of 342 pregnant adolescents aged 17 or younger. Subjects included 95% of new patients who presented for their first prenatal examination to the University of Texas teen pregnancy clinic, between May 8, 1989 and December 8, 1990. Measures were obtained via structured survey interviews, using open-ended questions, and included information about history of physical and sexual abuse and the use of tobacco, alcohol or illegal drugs during the previous year. Demographic information was obtained from clinic and hospital records, and no patient refused to participate. Analysis included examination of frequencies and development of odds ratios.
FINDINGS/DISCUSSION:
The authors divided the subjects into four groups: those who had been physically assaulted without sexual assault, those who were sexually assaulted without other physical assault, subjects who were both physically and sexually assaulted, and those who had experienced neither physical nor sexual assault. Of the 342 subjects, 45% were white, 34% were black, 21% were Hispanic and one was Asian. 83% were single, and 94% were unemployed. Of the total sample, 25% reported having experienced some form of personal violence: 9% had been physically but not sexually assaulted, 8% had a history of sexual but not physical assault, and 8% had experienced both physical and sexual assaults. 28% of the subjects reported use of at least one substance, with 47% of whites, 16% of Hispanics and 7% of blacks using tobacco, alcohol or an illegal substance. Whites and Hispanics each had 10% of subjects using illegal drugs, whilst only 3% of blacks used some form of illegal substance. Of the 25 subjects reporting use of an illegal substance, 17 used only marijuana. Associations between type of assault and type of substance use by ethnic group was also examined. A relationship was found between tobacco use and physical assault was found only for Hispanics, and an association was found between alcohol use and physical assault only for blacks. Sexual assault and the combination of physical and sexual assault were found to be strongly related to alcohol use for black subjects, and less strongly related for whites. All types of violence were found to be related to drug use for all of the ethnic groups. When combining all the ethnic groups together, the authors found that, for each substance, the odds ratio increased from physical assault to sexual assault to the combined physical and sexual assault group. Tobacco and alcohol were each individually related to assault, with subjects in the combined physical and sexual assault group being at the highest risk for use of either substance, followed by those who reported only sexual assault, then those with only physical assault in their histories. Compared with subjects who had not experienced any form of attack, tobacco use was twice as common for those who had been physically abused, 2.7 times as frequent in the group that had experienced sexual assault, and 4.3 times more frequent for the individuals who had experienced both physical and sexual attacks. The results for tobacco use were found to be similar - use was 2.8 times as frequent in those reporting physical abuse, 4.3 times as common for victims of sexual assault, and 5.7 times more frequent in the group of subjects who had reported both physical and sexual victimization. Stronger relationships were found between a history of violence and alcohol or tobacco use if the attacker was a member of the victim's family of origin, rather than if he was a partner of the subject. Use of illegal drugs, however, was most strongly related to abuse by a partner. The authors concluded that victims of assault as children are at a greater risk of substance use than are those who were spared from such victimization in their youth, possibly due to the long-term psychological effects of such traumatic experiences.
AUTHORS' RECOMMENDATIONS:
The authors suggested that adolescents who enter a prenatal care facility should provide clinicians with information about prior and continuing assault. People who report such experiences in their lives should subsequently be screened for substance use and the self-destructive behavior that might accompany the abused adolescent.
EVALUATION:
The authors present a valuable addition to research in the filed of the abused adolescent. The good sample size allows for confidence in external validity, although internal validity cannot be determined - no discussion is provided about the measures and definitions of the various categories of assault and levels of substance use. The use of self-report data suggests that the results might actually be underestimating the amount of abuse and substance use that occurs. An examination of the differences between those who were heavy users of drugs and those who were not, as well as between those who were victims of long-term abuse and those who experienced a single attack, could prove to be very interesting. The discussion about implications of the findings could provide valuable information for policy and intervention planners, and the study as a whole should be seen as a foundation upon which to build further research and policy implementation studies. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - Texas
KW - Juvenile Female
KW - Juvenile Victim
KW - Juvenile Substance Use
KW - Juvenile Pregnancy
KW - Female Substance Use
KW - Female Victim
KW - Alcohol Use Causes
KW - Drug Use Causes
KW - Substance Use Causes
KW - Child Abuse Effects
KW - Child Abuse-Substance Use Link
KW - Child Abuse Victim
KW - Child Physical Abuse Effects
KW - Child Physical Abuse Victim
KW - Child Sexual Abuse Effects
KW - Child Sexual Abuse Victim
KW - Child Female
KW - Child Victim
KW - Childhood Victimization
KW - Childhood Experience
KW - Sexual Assault Effects
KW - Sexual Assault Victim
KW - Domestic Violence Effects
KW - Domestic Violence Victim
KW - Juvenile Dating Violence
KW - Dating Violence Effects
KW - Dating Violence Victim
KW - Partner Violence
KW - Violence Against Women
Language: en |