Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

Context: Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known. Objective: To estimate the risk of self-reported adult HIV-risk behaviors a nd heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to d etermine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse. Design: A population-based telephone survey, the 1997 Washington State Beha vioral Risk Factor Surveillance System (BRFSS), asked a representative samp le of adults whether they had ever been physically or sexually abused in ch ildhood, and if so, die age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 y ears, about HIV-risk behaviors. Participants: Three thousand four hundred seventy-three English-speaking no n-institutionalized civilian adults in Washington State. Main Outcome Measures: Self-reported HIV-risk behaviors in the past rear an d heavy drinking in the past month. Results: We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with mor e than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% c onfidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a ti-fold increase in these risk behavi ors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and phy sical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16. 9). Physical abuse alone was not associated with either health-risk behavio r for women. For men, any sexual abuse was associated with an 8-fold increa se in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alo ne was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of th e men who were asked about HIV-risk behaviors reported any history of child hood abuse, these accounted for 51% and 50% of those reporting HIV-risk beh aviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively. Conclusions: Efforts to prevent or remediate adult health-risk behaviors sh ould consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a g eneral-population survey also reported childhood abuse. (C) 2000 American J ournal of Preventive Medicine.