Elsevier

Women's Health Issues

Volume 23, Issue 2, March–April 2013, Pages e95-e102
Women's Health Issues

Original article
The Influence of Childhood Physical Abuse on Adult Health Status in Sexual Minority Women: The Mediating Role of Smoking

https://doi.org/10.1016/j.whi.2012.11.007Get rights and content

Abstract

Background

Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking—an important health risk behavior—would mediate the relationship between CPA and current health status.

Methods

Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW.

Results

More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between “fair” and “good.” When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status.

Implications for Practice and/or Policy

These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.

Section snippets

CPA and Physical Health Outcomes

Experiences of CPA have long been known to negatively impact the mental health of adults in the general population (for reviews, see Fergusson & Mullen, 1999; Finkelhor & Hashima, 2001; Holmes & Slap, 1998). More recently, researchers have described associations between adverse childhood experiences and adult physical health (Anda et al., 1999; Dube, Cook & Edwards, 2010; Walker et al., 1999; Dembo, Dertke, Borders, Washburn, & Schmeidler, 1988; Thompson, Potter, Sanderson, & Maibach, 1997).

Participants

A volunteer sample was recruited for the CHLEW study using sampling methods designed to minimize the limitations and maximize the strengths of convenience sampling strategies. Clusters of social networks (e.g., formal community-based organizations and informal community social groups) and individual social networks, including those of women who participated in the study, were used. The study was advertised in local newspapers and on flyers posted in churches and bookstores, and distributed to

Sample Characteristics

As shown in Table 1, the average age of the women at baseline was 37.4 years. More than half of the women (55.5%) identified as non-Hispanic White; 25.6% were Black non-Hispanic, and 18.9% were Latina. Comparisons of respondents' race/ethnicity with 2000 census data indicated that the sample closely reflected the distribution of the population in Cook County, Illinois, where the large majority of CHLEW participants lived (Chicago Fact Finder, 2005). Unlike the general Cook County population,

Discussion

Consistent with the extant literature, the prevalence of CPA in the current study was higher than observed among women in the general population. The long-term health consequences associated with adverse childhood experiences among SMW is one of several unanswered questions in the literature. Previous research among women in the general population has demonstrated a link between childhood abuse and adult health outcomes (Anda et al.,1999; Dube et al., 2010). The self-perceived health

Conclusion

Research aimed at understanding the individual and contextual determinants of poor health outcomes among vulnerable populations is vitally important (U.S. Department of Health and Human Services, 2011). Our study results provide a unique contribution to the literature by identifying an important pathway by which CPA negatively impacts of the health of SMW. The results from this study have direct implications for both research and practice. Additional research is needed to examine factors that

Acknowledgments

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health. The authors thank the women of Chicago who participated in the CHLEW study.

Alicia K. Matthews, PhD, is Associate Professor, College of Nursing, University of Illinois at Chicago. Research interests include identification of sociocultural predictors of poor health, and the use of culturally targeted interventions to improve the physical health of underserved minority populations.

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    Alicia K. Matthews, PhD, is Associate Professor, College of Nursing, University of Illinois at Chicago. Research interests include identification of sociocultural predictors of poor health, and the use of culturally targeted interventions to improve the physical health of underserved minority populations.

    Young Ik Cho, PhD, is Associate Professor, Zilber School of Public Health, University of Wisconsin-Milwaukee. Research interests are: substance abuse behaviors and treatment, substance abuse risk factors among minority populations, and evaluation of substance abuse intervention and treatment programs.

    Tonda L. Hughes, PhD, is Professor, Department Head, Health Systems Sciences, College of Nursing, University of Illinois at Chicago. Research expertise is in sexual minority women's health, alcohol use, and mental health.

    Timothy P. Johnson, PhD, is Professor and Director, Survey Research Laboratory, University of Illinois at Chicago, Chicago. Research interests include cultural disparities in survey measurement and health behaviors among disadvantaged populations.

    Lisa Alvy, MA, is a Doctoral student, Department of Psychology, University of Illinois at Chicago. Research interests include lesbian, gay, bisexual, and transgender (LGBT) health, body image and obesity, and sexual health and HIV prevention.

    Supported by National Institute on Alcohol Abuse and Alcoholism grants K01 AA00266 and R01 AA13328 (to Tonda L. Hughes).

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