Building Trauma Informed Practice: Appreciating the Impact of Trauma in the Lives of Women with Substance Abuse and Mental Health Problems

ABSTRACT

This paper examines the lifetime interpersonal abuse experienced by a substance abuse treatment sample of 1,955 women with co-occurring disorders. Substantial rates of intimate and community-based interpersonal abuse and other life stressors are documented. Regression analysis shows that while trauma severity is significantly related to trauma distress, its impact on psychological symptom distress and drug severity is quite modest. The implementation of a trauma informed approach featuring trauma-specific treatment, service integration and consumer empowerment is described as a promising practice model for assisting women seeking help in substance abuse treatment programs.     

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse

ABSTRACT

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents’ trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent’s relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.     

Ethnicity and Health Service Use in a Women's Prison

ABSTRACT

This paper highlights the findings in relation to health need, ethnicity, and health service use among a sample of women in prison. Medical records review for 129 women and interviews with 15 women were conducted to determine factors associated with differential service use. Statistical analyses reveal that ethnicity and an interaction between ethnicity and whether one is on medication at prison admission (a health need variable) significantly predict extent of service use. Women of color use fewer services overall, with the exception of those on medication. Qualitative analyses reveal that women of color view the quality of medical care and the ways they are treated less positively than White women. Implications for equitable service provision are explored.     

Relationships Between Social-Emotional Intelligence and Sexual Risk Behaviors in Adolescent Girls

Social-emotional intelligence (SEI) has been linked with a number of health behaviors in adolescent populations. However, little is known about the influence of SEI on sexual behavior. This study examined associations between three indicators of SEI (intrapersonal skills, interpersonal skills, stress management skills) and adolescent girls’ sexual risk behaviors. Data come from a cross-sectional sample of sexually active adolescent girls (ages 13 to 17 years) at high risk for pregnancy (N = 253), recruited from health care clinics in a Midwest metropolitan area during 2007 and 2008. Results of multivariable regression models controlling for participants’ age and race/ethnicity indicated that each aspect of SEI was related to distinct sexual risk behaviors. Specifically, girls with greater intrapersonal skills had significantly fewer male sex partners in the past six months (b = ?0.16). Participants with greater interpersonal skills reported earlier communication with their sexual partner about sexual risk (b = 0.14), and those with a better ability to manage stress reported more consistent condom use (b = 0.31). Study findings suggest that SEI may provide a protective buffer against sexual risk behaviors. Building adolescent girls’ social and emotional skills may be an effective strategy for reducing their risk for early pregnancy and sexually transmitted infections.     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

Parent and Stepparent Support and Psychological Control in Remarried Families and Adolescent Empathic Concern

Abstract

Using a symbolic interaction perspective, this study examined the extent to which (a) perceptions of parent/stepparent support were positively related to adolescent empathic concern and (b) perceptions of parent/stepparent psychological control mediated this relationship. Participants were a convenience sample of 72 ninth and tenth grade adolescents residing in remarried family households who completed self-report questionnaires. Results showed that adolescent girls in remarried family households who perceived their residential parent as more supportive reported greater empathic concern and that the relationship was mediated by perceptions of parent psychological control.     

A Pilot Investigation of Media Multitasking and Trauma Symptoms Among Adolescents

Effective prevention and intervention for trauma symptoms are still needed, particularly for adolescents, in whom high-risk behavior is common. This pilot study examines how media multitasking may be related to trauma symptoms in a sample of adolescent college students (N = 55). Results indicate that higher media multitasking is uniquely and independently associated with higher trauma symptoms. These results hold even after controlling for alcohol intoxication, which is commonly associated with trauma symptoms. Adolescents may be more forthcoming in revealing information about media multitasking than other behaviors commonly associated with trauma symptoms, such as alcohol and drug use. The present study provides the first evidence that media multitasking could be an additional tool for clinicians treating adolescents with trauma symptoms.     

Adolescents in residential treatment: The prevalence of ACEs,substance use and justice involvement

Abstract

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.     

Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis

Abstract

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N ? 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjuction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Internal and External Stress Factors Associated with the Identity Development of Transgendered Youth

Abstract

The goal of this paper is to present an alternative to a traditionally-held view that transgendered youth suffer from some sort of disorder, and instead shed light on the internal and external stress factors that may lead the young person to seek help. Social service professionals need to be aware of such factors in order to make a full assessment of what a potential transgendered adolescent client's issues are, and in order to work at changing some of these external pressures societally so that more transgendered youth can attain peaceful identity integration.     

Factors contributing to eviction from permanent supportive housing: Lessons from HUD-VASH

IntroductionEviction from housing is associated with several negative outcomes, further exacerbated among high-need populations requiring financial and supportive services to maintain housing stability. This study investigated risk and protective factors—both characteristics and precipitating events of tenant eviction—informing permanent supportive housing (PSH) programs’ efforts to identify tenants at risk and intervene.MethodsUsing administrative data for a cohort of 20,146 Veterans participating in PSH, this study assessed differences in Veterans who exited the program due to eviction and Veterans who exited because they accomplished their goals. A series of logistic regressions identified patterns of health services use that may signal imminent eviction.ResultsVeterans with a drug use disorder and those who received inpatient, emergency, or outpatient care related to mental/behavioral health and substance use conditions proximal to program exit had greater risk for eviction. Receipt of outpatient primary medical care and supportive services was generally protective against eviction. The likelihood of eviction was greatest for Veterans with acute care use within 30 days of exit.DiscussionPSH providers may use these correlates of eviction to identify Veterans in need of an intervention to prevent eviction. Future work should focus on operationalizing these findings and identifying appropriate interventions.     

Sex Differences Among College Students in Awareness of the Human Papillomavirus Vaccine and Vaccine Options

Abstract

Objectives: To explore awareness of human papillomavirus (HPV) and use of HPV vaccines (Gardasil and Cervarix) by college students. Participants: The sample was composed of 817 undergraduates at 2 northeastern US universities; they participated between February and May 2010. Methods: Students were provided with a link to an anonymous, self-administered, Web-based survey comprised of 76 questions. The survey included questions about health behaviors, awareness, and knowledge of HPV and the 2 HPV vaccines, and vaccine uptake. Results: Results indicate high levels of awareness of HPV as well as marked sex differences related to vaccine awareness and uptake. Both sexes are largely unaware of Cervarix and the differences between Cervarix and Gardasil. Conclusion: The study affirms the importance of a clinician's recommendation for HPV vaccination. Public health messaging should become more inclusive of adolescent and young adult males. College students’ awareness of HPV vaccine options mirrors Gardasil's market dominance in the United States.     

Mindfulness moderates the relation between trauma and anxiety symptoms in college students

Objective: To explore the relations between trauma exposure and anxiety and depression among college students, and to determine whether trait mindfulness may moderate these relations. Participants: Self-report survey data from 2,336 college sophomores were drawn from a larger university-wide study (“Spit for Science”). Methods: We constructed multiple linear regression models using past-year trauma exposure, trait mindfulness, and their multiplicative interaction to predict current anxiety and depressive symptom severity, while controlling for covariates. Results: Mindfulness was associated with lower levels of depression and anxiety symptom severity. Trauma was a significant predictor of anxiety, but not depression, and high levels of mindfulness attenuated the association between trauma exposure and higher anxiety symptom severity. Conclusions: These results have implications for the treatment and prevention of anxiety among trauma-exposed college students and provide a basis for further research into the mechanisms through which mindfulness may facilitate positive mental health.     

Prevalence and predictors of sexual assault among a college sample

Objective: This study examined the prevalence and correlates of precollege, college-onset, and repeat sexual assault (SA) within a representative student sample. Participants: A representative sample of 7,603 students. Methods: Incoming first-year students completed a survey about their exposure to broad SA prior to college, prior trauma, personality, relationships, and mental health. Broad SA was then reassessed each spring semester while enrolled. Results: Nearly 20% of the sample reported experiencing broad SA, with women endorsing significantly higher rates compared with males. Prior victimization before coming to college was related to a greater risk of victimization in college, and there was no statistically significant difference between males and females who reported revictimization. Correlates of college-onset broad SA were found and are discussed. Conclusions: Given the need for SA intervention and prevention on college campuses, identification of factors potentially contributing to exposure within this population is essential.     

Feeling unloved is the most robust sign of adolescent depression linking to family communication patterns

Using network analysis, this study investigated how family communication patterns (Conversation and Conformity) were related to and predictive of adolescent overall depression severity and specific symptoms. A community sample of adolescents (10–17 years, n = 1327) completed the Children's Depression Inventory and the Revised Family Communication Pattern Instrument. Depressive symptoms were also re-assessed 6 months later. Results showed that Conversation orientation protected against, whereas Conformity orientation increased the risk of adolescent depression. Family communication particularly influenced the child's feeling of being unloved, and feeling unloved was the only symptom prospectively predicted by two communication orientations at baseline. These findings revealed the path linking family factors to adolescent depression and may have implications for future family-based interventions.     

Adolescent Psychological Functioning and Membership in Latent Adolescent–Parent Communication Dual Trajectory Classes

The primary goal of this study was to examine the relationship between adolescents’ psychological functioning (as indicated by depressive symptoms) and substance use (alcohol and drug use) and membership in adolescent–parent communication trajectory subgroups in a large, diverse community sample of adolescents from the United States (n = 1,057; 53% female; 51% Caucasian; Age: M = 16.15, SD = .75). Adolescents completed questionnaires at three annual assessments. Fit indices from parallel process growth mixture models suggested three dual trajectory classes: (1) Average communication with both parents (Average‐Both); (2) Good adolescent–mother and poor adolescent–father communication (Good‐Mom/Poor‐Dad); and (3) Poor adolescent–mother and good adolescent–father communication (Poor‐Mom/Good‐Dad). The trajectory classes differed by gender. In addition, psychological functioning and substance use were differentially related to the trajectory classes.     

Exploring Gender and Racial/Ethnic Differences in the Effects of Child Sexual Abuse

Child sexual abuse (CSA) has been linked to a number of adverse effects including hypersexuality (HYP), substance use (SUB), suicidality (SUI), and depression (DEP). Despite a plethora of research on CSA, little is known about how it affects adolescents and the cultural factors that influence their coping styles. This study was founded on social-cultural coping theory and the model of traumagenic dynamics of sexual abuse, suggesting that CSA consequences lead to maladaptive coping mechanisms influenced by sociocultural factors. Using archival data, loglinear analysis was conducted to examine gender differences within racial/ethnic groups in HYP, SUI, DEP, and SUB among adolescent survivors of CSA in a National sample of 13,583 male and female high school students. The purpose of the study was to identify differences in the effects of CSA as manifested by variations of maladaptive coping across racial/ethnic groups and gender. Boys were significantly more likely to use substances, while girls were more likely to experience depressive symptoms and suicidality. Notably, this study did not reveal any significant racial/ethnic differences in adolescent coping. These findings can inform treatment planning and interventions for adolescents who may present with DEP, SUI, SUB, or risky sexual behaviors, but may have underlying trauma from CSA. This study contributes to the knowledge base about the processes that take place within adolescent CSA survivors, shedding light on cultural nuances among adolescent coping and informing culturally competent practice.     

Mental Health Among College Students: Do Those Who Need Services Know About and Use Them?

Objective: The objective of this study was to examine connections between university students' mental health and their knowledge and use of campus mental health services. Participants and Methods: In March 2001, a sample of undergraduate students (N = 266) completed a Web-based questionnaire, providing information related to their mental health, knowledge of mental health services, and use of those services. Results: Students who were mentally distressed were more likely to know about and use services; however, some students who reported to be mentally distressed either did not know about services or knew about services but did not use them. Living off campus, identifying as male, and having fewer years in college were related to less knowledge of campus mental health services. In addition, female sex and number of years in college were predictive of higher service use. Conclusions: With the high prevalence rates and severity of mental health problems, university mental health providers must continue to make strategic efforts to disseminate knowledge about mental health services to all students.     

Traumatic Responding in Children Exposed to Domestic Violence

Abstract

The present cross-cultural study summarizes the traumatic responses of Mexican, Mexican American, and non-Mexican American children who were residents of three shelters for battered women in Monterrey Mexico, McAllen Texas, and Ft. Worth Texas. Sixty-eight mothers reported on their children's (n = 90) individual and total traumatic symptoms. Findings revealed very slight differences in individual responses with no overall trauma symptom differences. Multiple regression analyses revealed that mothers' experiences of physical, and sexual abuse predicted greater trauma responses in children. Implications for practice with children and mothers in shelters for battered women are highlighted.     

Predicting Korean Adolescents' Sexual Behavior

Abstract

Using data from 370 adolescent males and 390 adolescent females, this study investigates factors associated with Korean adolescents' sexual behavior. The data showed that sixteen percent of the sample reported some type of intimate sexual behavior. The results from regression analyses indicate that alcohol use, dating mood, love for partner, similarity of sexual attitude between partners, and interaction between respondents' attitude on sex and alcohol use were significant predictors of Korean adolescents' sexual behavior with adjusted R² of .61. The factors significant for adolescents' sexual behavior differed by gender. The factors significant for adolescent males and adolescent females accounted for 65% and 61% of the explained variance for adolescent males' and adolescent females' sexual behavior, respectively. In both cases, dating mood was a strong predictor of adolescents' sexual behavior. Contrary to expectations specified, neither parental factors nor sibling influence was significant.