Child maltreatment and age of alcohol and marijuana initiation in high-risk youth. (December 2017) - Proctor, Laura J.
Abstract: Introduction: Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation. Materials and methods: Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children. Results: Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance. Conclusions: Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems. Highlights: Longitudinal data were used to assess the impact of child maltreatment, and internalizing and externalizing behavior problems, on the initiation of alcohol and marijuana use among high-risk youth. Externalizing problems at age 8 mediated the link between child maltreatment and both alcohol and marijuana use initiation. There was a direct effect of physical abuse on alcohol use initiation, and mediated effects from sexual abuse and neglect through externalizing behaviors for alcohol and marijuana use. Externalizing behaviors are one mechanistic pathway from early childhood to age of substance use initiation among maltreated youth.