Pick Your Poison: Gender, Race, and the Relations Among Child Maltreatment, Body Mass Index, and Substance Use Disorder

Background and Purpose: Child maltreatment may lead to coping with unhealthy use of food and substances, contributing to elevated body mass index (BMI) and substance use disorder (SUD). Despite their common connection to adversity, however, little research has jointly considered SUD and BMI as sequelae of child maltreatment. This study addressed two research questions: 1) what are the relations among child maltreatment types at various developmental periods and SUD and BMI at 18 years? 2) To what extent do these relations vary by gender and race?

Methods: The study sample included 1,149 youths (52% female, 80% living in poverty) participating in the Longitudinal Studies of Child Abuse and Neglect. Race group analysis included a subset of 923 Black (n = 639, 69%) and White (n = 284, 31%) youths. BMI was calculated based on interviewer measurements of height and weight at 18 years. Diagnostic criteria for SUD were determined by the National Institute of Mental Health Diagnostic Interview Schedule for Children-Youth IV at 18 years. Lifetime child protective services records were grouped by maltreatment type (physical and sexual abuse, emotional maltreatment, failure to protect and supervisory neglect) and child age (0-4, 4-12, and 12-18 years); number of different maltreatment types from age 0-18 (range: 0-5) was also included. Following univariate and bivariate analyses, BMI and SUD were regressed on child maltreatment and control variables in the overall sample, and in multi- gender and race group analysis.

Results: Female (M = 26.2) and Black (M = 26.4) youths had higher BMIs than male (M = 25.2) and White (M = 24.6) youths, respectively, and less SUD (female: 11%, male: 19%, Black: 11%. White: 19%).

Sexual abuse from 12-18 was positively associated with BMI in the overall sample (β =.10, SE = .04, p = .029) and among females (β =.16, SE = .07, p = .014), and White youths (β = .19, SE = .09, p = .040). Failure to protect neglect from 0-4 was associated with BMI in White youths (β = .20, SE = .07, p = .002). Sexual abuse from 0-4 was associated with BMI in males (β = .09, SE = .04, p = .017). Poverty, not child maltreatment, was related to BMI in Black youths (β = .10, SE = .05, p = .045).

Physical abuse from 12-18 was associated with SUD overall (B = .16, SE = .07, p = .021) and among males (B = .51, SE = .14, p < .001). Sexual abuse from 12-18 was associated with SUD among female (β = 2.18, SE = .90, p = .015) and Black youths (B = .51, SE = .25, p = .039).

Conclusions and Implications: Findings suggest race and gender differences in the sequelae of child maltreatment. The type and timing of child maltreatment predicting BMI and SUD varied by gender. Child maltreatment predicted BMI in White youths and SUD in Black youths. Intervention should encompass multiple possible stress responses. Future research should further consider intersections of race and gender and sociocultural context.