Childhood Maltreatment and Health Risk Factors in Adolescent Girls Involved in Child Welfare

Background and Purpose: Histories of childhood maltreatment have been linked to poor mental health and health outcomes in adulthood. The Adverse Childhood Events Study (ACES) has provided strong evidence that childhood abuse is significantly associated with poor health behaviors and poor health outcomes, such as diabetes, heart disease, cancer, and HIV/STD’s in adulthood. Most of the research in this area has examined adults who retrospectively reported childhood abuse, yet little is known about adverse childhood events and health risk factors among adolescents who have substantiated histories of childhood abuse. To better understand this problem, we investigated the relationship between child maltreatment and four health risk factors in adolescent girls who are involved in child welfare. The following question was explored: What is the association of child maltreatment types (emotional abuse, physical abuse, and sexual abuse) with current health risk factors, such as poor eating, risky sexual behaviors, substance use, and depression among adolescent girls involved in child welfare, controlling for service use, medication use, and demographics? 

Methods: The study utilized baseline data from a trauma-focused CBT study that included 235 adolescent girls, ages 12-19 years (mean = 14.9, SD=1.6). Participants were youths of color (74%, most were African American), and White (26%). The girls lived with biological parents, relatives, or adopted parents (60%), foster homes (27%), and group homes (13%). Structured interviews included the following health risk factors: poor eating (3 items), sexual risk behaviors (6 items), substance use (8 items), and depression (Kovacs, 2003). Independent variables included: 1) emotional abuse (EA), physical abuse (PA), and sexual abuse (SA) (Bernstein & Fink’s Childhood Trauma Questionnaire); 2) demographics (age, race, living situation), and 3) service and medication use. Data analyses included descriptive statistics, simple correlations, MANCOVA, and post-hoc multiple regression analyses for each of the dependent variables.  

Results: Results indicated that 78% of the girls endorsed poor eating behaviors; 40% endorsed at least one sexual risk behavior, 56% used 1 or more substance; and 21% experienced depressive symptoms at or above the clinical cut-off score. EA was associated with poor eating, substance use, and depressive symptoms (p<.01). PA was associated with substance use and depression (p<.05). SA was associated with all health risk behaviors (p<.05), and depression (p<.001). Results of the MANCOVAS indicated that EA (Wilk’s λ=0.86, p<.001) and SA (Wilk’s λ=0.95, p<.05) were associated with the combined health risk dependent variables, but not PA. The post-hoc multiple regression models for each health risk behavior indicated that EA remained a significant predictor of poor eating, substance use, and depression. SA remained a significant predictor only for depression controlling for the other variables in the model.

Conclusions: Findings suggest that exposure to EA is linked to multiple health risks in adolescent girls that increase their chances of morbidity as adults.  Experiencing SA increases depressive symptoms which may lead to obesity and diabetes. Knowledge of the types of abuse that may lead to poor health behaviors among adolescents can be utilized to inform disease prevention and health promotion programs for child welfare populations.