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The Relationship between Interviewer Characteristics and Physical and Sexual Abuse Disclosures among Substance Users: A Multilevel Analysis
Ren M. Dailey and Ronald E. Claus Journal of Drug Issues 2001 31: 867 DOI: 10.1177/002204260103100404 The online version of this article can be found at: http://jod.sagepub.com/content/31/4/867

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Florida State University College of Criminology and Criminal Justice

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JOURNAL OF DRUG ISSUES31(4), 867-888

T HE R ELATIONSHIP B ETWEEN I NTERVIEWER CHARACTERISTICS AND PHYSICAL AND SEXUAL ABUSE D ISCLOSURES AMONG S UBSTANCE U SERS : A MULTILEVEL ANALYSIS
REN M. DAILEY, RONALD E. CLAUS
Data were collected at assessment for substance abuse treatment from 22 interviewers and 8,276 clients to assess the relationship between interviewer characteristics and disclosure of physical and sexual abuse. Characteristics examined were client and interviewer gender, race/ethnicity, and age. Multilevel regressions that adjusted for the clustering of clients within interviewers were compared to unadjusted logistic regressions to determine the effect of response similarity within clusters. Clustering accounted for only 2 5% of the unexplained variance; however, ignoring the clustering effect generated several misleading results. Adjusted models indicated that clients were more likely to disclose physical abuse to Caucasian interviewers than to African American interviewers and more likely to disclose sexual abuse to female interviewers than to male interviewers. Matching clients and interviewers on gender, race, and age did not increase disclosures of either physical or sexual abuse.

Accurate assessments of symptomatology and correlates of substance abuse are essential in order to best diagnose and treat clients. One recurrent correlate of substance abuse is a history of physical and sexual abuse (Browne & Finkelhor, 1986; Malinosky-Rummell & Hansen, 1993; Polusny & Follette, 1995; Windle,
__________ Rene M. Daily was Senior Research Specialist at the Missouri Institute of Mental Health until August 2000. Ronald E. Claus is a Research Scientist at the Missouri Institute of Mental Health, School of Medicine, University of Missouri, Columbia. Direct corresondence to Ronald Claus at clausr@mimh.ed.

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Windle, Scheidt, & Miller, 1995). However, this background information has not been routinely gathered during in-take interviews (Bryer, Nelson, Miller, & Krol, 1987; Hart, Mader, Griffith, & deMendonca, 1989; Jacobson & Richardson, 1987). Moreover, abuse history is not freely offered by the client due to the sensitive nature of this information (Simpson, Westerberg, Little, & Trujillo, 1994). Though it is difficult to establish a direct causal relationship between physical and sexual abuse and substance abuse, previous literature suggests that those with a history of childhood abuse often have more severe psychological problems (Briere & Runtz, 1988; Bryer et al., 1987; Gil-Rivas, Fiorentine, Anglin, & Taylor, 1997; Mullen, Martin, Anderson, Romans, & Herbison, 1993; Sedney & Brooks, 1984; Simpson et al., 1994; Windle et al., 1995) and are more susceptible to relapse (Root, 1989; Wadsworth, Spampneto, & Halbrook, 1995). Several researchers have also suggested that those with physical and sexual abuse histories use drugs and alcohol to dissociate themselves from the posttraumatic symptoms of the abuse (Briere & Runtz, 1993; Rohsenow, Corbett, & Devine, 1988; Root, 1989). Thus, obtaining accurate assessments of physical and sexual abuse may be vital to addiction recovery; without addressing the psychological problems related to this victimization, substance abuse may reoccur. Accurate assessments are, however, often elusive. Instruments used to obtain physical and sexual abuse histories generally have high sensitivity (true positives) yet lower specificity (true negatives) (Dill, Chu, Grob, & Eisen, 1991; Leserman, Drossman, & Li, 1995; Najavits et al., 1998). In other words, respondents positive endorsements of childhood abuse are quite accurate; however, respondents negative endorsements cannot always be assumed to be negative. Some respondents with a history of childhood abuse therefore withhold this information during interviews. Multiple reasons exist for individuals not revealing a history of physical or sexual abuse. One potential source of this response editing is interviewer characteristics. Research encompassing topics such as political issues, gender equality, culture, drug use, and mental health suggests visible interviewer characteristics such as gender, race, or age mitigate the amount and accuracy of information respondents disclose (Fendrich, Johnson, Shaligram, & Wislar, 1999; Huddy et al., 1997; Johnson & Parsons, 1994; Pollner, 1998; Thompson, Worthington, & Atkinson, 1994; Webster, 1996). Two models have been proposed to explicate these interviewer effects: Social Attribution and Conditional Social Attribution (Fendrich et al., 1999). These models characterize response editing as a result of respondents biases (positive or negative) about the interviewers characteristics, rather than the result of interviewers abilities to elicit responses. The Social Attribution model explains direct effects whereby respondents edit their responses as a function of interviewers characteristics. Support for the Social Attribution model would be evidenced by, for example, respondents disclosing
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abuse more often to female interviewers than to male interviewers or disclosing abuse more often to older interviewers than to younger interviewers. The Conditional Social Attribution model differs in that responses may be a function (or interaction) of both respondent and interviewer characteristics. The Conditional Social Attribution model is supported by matching effects: higher rates of disclosure when respondents are either paired with interviewers of the same characteristics or paired with interviewers of dissimilar characteristics. For example, matching effects would be present if female respondents were more likely to disclose to female interviewers and male respondents were more likely to disclose to male interviewers. Thus, the Conditional Social Attribution model describes disclosures that vary by both respondent and interviewer characteristics. Interviewer effects are especially evident when asking questions related to interviewers visible characteristics. Respondents modify or omit their responses to questions related to their interviewers characteristics in order to project a certain impression or avoid offending the interviewer. This has been found when a respondent is paired with an interviewer of the opposite sex (Huddy et al., 1997; Kane & Macaulay, 1993) or of a different ethnicity (Reese, Danielson, Shoemaker, Chang, & Hsu, 1986; Schaeffer, 1980; Webster, 1996; Weeks & Moore, 1981). Respondents may perceive abuse histories as related, at least indirectly, to interviewers characteristics. For example, if respondents are paired with an interviewer of their perpetrators gender, they may be less likely to reveal experiences of abuse because of a general mistrust of that gender. Respondents may therefore edit their responses to avoid discomfort and protect themselves as well as to manage impressions if they perceive a connection between the abuse questions and their interviewers characteristics. This relationship between question content and interviewer characteristics has not been carefully examined in regard to physical and sexual abuse disclosure among persons seeking substance abuse treatment. Though numerous studies on general interviewer effects exist, few pertain specifically to the disclosure of physical and sexual abuse. Among the relevant studies, Kaplan, Becker, and Tenke (1991) asked adolescent males who had been charged with a sexual crime which characteristics they preferred in an interviewer when discussing sexual experiences. Those with a physical or sexual abuse history were more likely to prefer a female interviewer, and those who had been abused by males showed a higher rate of preference for a female interviewer. Thus, both the occurrence of abuse and the sex of the perpetrator may affect the interviewer characteristics preferred by the client. Results thus supported the Social Attribution model for interviewer gender effects, although interviewer race effects were not observed. Fry, Rozenwicz, and Crisp (1996) found no significant effect for interviewer gender when detecting sexual abuse histories among female gynecological patients. While no support for the Social Attribution model was found,
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the authors noted a positive correlation between the length of interview and degree of rapport established. Dill et al. (1991) observed no significant gender of interviewer effect when comparing written survey and interviewing methods eliciting abuse histories among female psychiatric inpatients. Again the Social Attribution model was not supported, as physical or sexual abuse disclosures did not vary by interviewer characteristics. Currie and MacLean (1997) examined abuse history response rates of female respondents obtained by male and female interviewers in the London Islington Crime Survey. Females reported more domestic assault and sexual abuse to male interviewers than to female interviewers (no statistical analyses were performed, however, on the disclosure rate). Interviews in this study were comprehensive and purposefully designed to avoid inflicting any discomfort on the respondent. Hence, this suggests that when interviews are constructed to reduce participants anxiety and increase trust and rapport, male interviewers may elicit more disclosure than females. The impact of interviewer characteristics on abuse disclosure has not been widely studied among substance abuse clients, and limitations in studies of other populations hinder a full understanding of the way that client and interviewer characteristics relate to abuse disclosures. First, these studies were unable to analyze the interaction of both client and interviewer characteristics (i.e. the Conditional Social Attribution model); none included clients of both genders, and three of the four did not examine multiple client or interviewer races or ages. Second, it is difficult to determine if the differences (or lack of differences) noted were due to interviewers visible characteristics rather than interviewing skills when as few as two interviewers were employed (Fry et al., 1996) or when no information on interviewers was provided (Dill et al., 1991). Previous research has also largely ignored the hierarchical nature of data in interviewer effects research. Inherent in all interviewer effects research is the nesting (or clustering) of respondents within interviewers. Respondents assessed by the same interviewer may respond similarly as a result of the interviewers personality or interviewing skills. This similarity of responses violates the statistical assumption of independence of responses: responses in clustered data are considered interdependent. Without accounting for this similarity, the possibility of interviewer differences generating the evidenced effects could not be ruled out. The purpose of the present study was to determine the impact of interviewer characteristics as well as the matching of client and interviewer characteristics on rates of physical and sexual abuse disclosures among substance users. Characteristics included both client and interviewer gender, race, and age. In addition, the statistical effects of clustering were explored. Multilevel analyses that accounted for the interdependence of responses within interviewers were compared to logistic regression analyses that assumed independent responses. Results are discussed in terms of support for the Social Attribution or Conditional Social Attribution models.
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Data from the St. Louis Target Cities Project were utilized to assess the impact of client and interviewer characteristics and clustering effects. Adults seeking publicly funded substance abuse treatment in the metropolitan St. Louis area were assessed at a Central Intake Unit (CIU) and subsequently referred to an area treatment provider. Analysis of these data afforded several advantages over previous studies. First, the Target Cities data has a large sample of both clients and interviewers. Second, several client and interviewer characteristics could be examined simultaneously: gender, race, and age. Third, the Target Cities data allowed an examination of physical and sexual abuse disclosures among substance users, a population likely to have higher prevalence rates of abuse histories than non-using populations. Physical and sexual abuse histories of this Target Cities sample have been previously examined; prevalence of abuse was generally comparable to other substance abuse samples (Claus & Dailey, 2000).
METHOD SAMPLE

Data were gathered on 8,276 clients and 22 interviewers. Clients completed an assessment at the CIU between February 1995 and December 1997. If a client was assessed on more than one occasion, only data from the first assessment were included in this study. Clients were predominately male (77.0%), African American (67.9%), and averaged 33.2 (SD = 9.2) years of age and had 11.5 (SD = 1.9) years of education. Over half of the clients (51.9%) indicated that they had problems with both alcohol and drugs, 33.2% indicated drugs only, and 14.9% indicated alcohol only. The interviewers were predominantly female (81.6%), Caucasian (73.2%), and averaged 42.7 (SD = 9.3) years of age. Seven (31.8%) interviewers were clinical psychologists and 15 (71.4%) were state-certified substance abuse counselors; two interviewers had both a masters degree and substance abuse certification. Interviewers conducted an average of 386 interviews (ranging from 60 to 1351).
INSTRUMENTATION

At the CIU, each client provided demographic information and completed a series of assessments. Assessments were collected using the Initial Standardized Assessment Protocol (ISAP), an automated assessment system utilizing both clientcompleted instruments and computer-assisted interviews conducted by staff (Hile, Callier, Schmoock, Adkins, & Cho, 1998). Data for the present study were individual items from the Addiction Severity Index (ASI). The ASI, a structured interview generally 45 minutes in length, is used widely in addiction treatment and research that explores seven domains: medical status, employment/support status, drug use, alcohol use, legal status, family/social relationships, and psychiatric status (McLellan et al., 1992). The Family/Social section contains items about physical and sexual
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abuse experienced during ones lifetime. These questions do not distinguish between childhood and adult victimization, but inquire about times when the participant was abused physically (cause you physical harm) or sexually (force sexual advances or sexual acts). This section also includes items denoting the presence of alcohol abuse, drug abuse, and psychological problems for each clients father and mother. At the start of the project, interviewers received McLellans two-day ASI training. Interviewers entering the project later were trained by the existing interviewers and were allowed to observe several administrations of the ASI before conducting interviews themselves.
ANALYSIS

Separate analyses were conducted for physical and sexual abuse. Bivariate results on the impact of client and interviewer characteristics on abuse disclosures are presented first. Cluster-adjusted and unadjusted regressions are then compared to examine the effect of response similarity within interviewers. Based on these results, the best-fitting and most parsimonious models explaining physical and sexual abuse disclosures are determined. The final models are discussed in terms of the Social Attribution and Conditional Social Attribution models. The binomial (yes/no) responses to the ASI questions eliciting experiences of physical and sexual abuse in clients lifetime were used as dependent variables throughout the analyses. Because family environment is often associated with experiences of physical and sexual abuse (Briere, 1988; Rind, Tromovitch, & Bauserman, 1998), the family history items of parental alcohol, drug, and psychological problems were used as covariates in all regression analyses. The uncertain and no responses for these variables were grouped together to yield a categorical variable coded as yes or no. Because of the non-linear relationship between client age and disclosure of abuse, a categorical variable was created based on the difference in age between client and interviewer. This combination of both client and interviewer age into one variable also facilitated the analysis of age-matching on disclosures of abuse. If both client age and interviewer age had been divided into several categories ranging from younger to older, a valid analysis of age-matching would not have been possible. Client age ranged from 16 to 82 whereas interviewer age ranged from 29 to 62. Thus, the large differences in age between pairings of young clients and young interviewers and older clients and older interviewers could not be considered matching. Younger clients may have viewed their young interviewers as relatively old and older clients may have viewed their older interviewers as relatively young. In other words, generational differences may have still occurred in these types of age pairings. Client and interviewer age were therefore categorized into one of four dummy variables according to age differences rather than actual
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age: (1) clients who were five or more years older than their interviewer; (2) clients who were less than five years older or younger than their interviewer; (3) clients who were five to 20 years younger than their interviewer; and (4) clients who were 20 years or more younger than their interviewer. The number of interviews included in each analysis varied slightly due to small amounts of missing data in client age and the family history variables. Additionally, for analyses involving race, clients who identified one of seven racial/ethnic backgrounds other than African-American and Caucasian (1.9%, n = 157) were excluded due to the relatively small size of this group. Interviews conducted by the sole Asian/Pacific Islander interviewer (2.1%, n = 173) were also excluded as multiple interviewers for each group are necessary in order to rule out the possibility of personality characteristics influencing any evidenced effects. Cluster-adjusted and unadjusted regressions included the same number of interviews within each type of abuse to ensure fair comparisons. Logistic regressions were employed to control for other predictor variables as well as family history of substance abuse and psychological problems. Regression analyses included multilevel models to control for the similarity of responses within interviewers. (For an explanation of multilevel modeling or random effect regression, see Bryk and Raudenbush (1992) and Kreft and deLeeuw (1998).) Because the data involved almost 8,000 clients nested within 21 interviewers, clients responses were not assumed to be completely independent. The clients assessed by the same interviewer may have responded similarly as compared to the total sample due to interviewer personality or interviewing skills. This interdependence (similarity) of responses within clusters can under-estimate the standard errors, thereby increasing the Type I error rate. In other words, significant findings may be indicated where none actually exist. Multilevel model analyses adjust for the similarity of responses within each interviewer. This similarity is represented by the intraclass correlation (ICC), which denotes the proportion of variance accounted for by the clustering. For example, an ICC of 0.10 would indicate that 10% of the unexplained variance is due to the similarity of responses within interviewers. An ICC also indicates the degree to which any two randomly drawn cases within a cluster are correlated. Thus, an ICC greater than zero would indicate that the clients with the same interviewer responded similarly to some degree and that responses could not be considered independent. In contrast, an ICC of zero would indicate that clients responses within interviewers are not similar and could therefore be considered independent. In such cases, multilevel models are not necessary. In the present study, multilevel analysis adjusts for the dependence of responses within interviewers in order to isolate clients response editing. Multilevel regressions were conducted using the MIXNO program developed by Hedeker (1999). Results of both clusteradjusted and unadjusted logistic regressions are compared and discussed.
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Overall, three models are presented for each type of abuse. Each model includes a comparison of an unadjusted logistic regression and a cluster-adjusted logistic regression in order to determine the effect of clustering. The three models build on each other; subsequent models are compared to previous models in order to determine the unique effects of the parameters added as well as improvement in overall fit. Model 1 contains client gender and race as well as the Social Attribution parameters interviewer gender and race. In addition to these four variables, Model 2 includes the dummy-coded age difference variables. These are considered Conditional Social Attribution parameters as they incorporate both client and interviewer age. Model 3 adds two more Conditional Social Attribution parameters: the interactions between client and interviewer gender and client and interviewer race. The likelihood-ratio chi-square test was used to determine the best models explaining disclosure of physical and sexual abuse. A significant reduction in the minus twice the log likelihood (-2LL) with the addition of predictor variables indicates improvement in model fit. A reduction is considered significant if the difference in 2LL is greater than the critical value for the chi-square distribution and corresponding degrees of freedom lost (or number of parameters added). This test can be used to determine if models are improved with the inclusion of additional parameters. Moreover, this test can be used to compare the unadjusted and clusteradjusted regressions within each model; the random effects regressions in this study differ from the unadjusted regressions only in the addition of one random parameter. Individual significant predictors of physical and sexual abuse disclosures were determined by the Wald test.
RESULTS

Almost 22% of participants reported experiencing physical or sexual abuse in their lifetime. Physical abuse was reported by 18.3% of the sample and sexual abuse was reported by 11.1%; nearly eight percent reported both types of abuse. Table 1 summarizes rates of physical and sexual abuse disclosures by client and interviewer characteristics. Overall, physical and sexual abuse were more prevalent among females than males. Physical and sexual abuse were also more prevalent among Caucasians than African Americans. Clients who were between 30 and 39 years of age reported both physical and sexual abuse more often than groups of younger or older clients. Female interviewers elicited more reports of physical and sexual abuse as did Caucasian interviewers. Interviewers between the ages of 50 and 62 were less likely to elicit reports of both physical and sexual abuse as compared to all groups of younger interviewers. Table 2 relates the variation of client abuse disclosures by interviewer characteristics. Results for physical and sexual abuse were similar. Female clients disclosed both physical and sexual abuse more often to female interviewers than to
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TABLE 1
PHYSICAL AND SEXUAL ABUSE DISCLOSURE RATES BY CLIENT AND INTERVIEWER GENDER, RACE, AND AGE

male interviewers. Male clients disclosed experiences of physical abuse, and to a lesser extent sexual abuse, more often to female interviewers than to male interviewers. Both African American and Caucasian clients were more likely to disclose to Caucasian interviewers. In addition, clients were least likely to disclose physical and sexual abuse if interviewers were 20 or more years older, and most likely to disclose when within five years of their interviewers. Results of the logistic regression analyses for physical and sexual abuse are described in Tables 3 and 4. All zero-order correlations between independent variables were less than 0.20 indicating multicollinearity was inconsequential. Family history items denoting parental substance abuse or psychological problems were used as covariates in all regressions; however, these variables are not included in the tables or description of results. A preliminary examination showed interviewer education level did not influence disclosures of physical and sexual abuse and was thus excluded from further analyses.
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TABLE 2
COMPARISON OF PHYSICAL AND SEXUAL ABUSE DISCLOSURE WITHIN INTERVIEWER CHARACTERISTICS

PHYSICAL ABUSE

Model 1. This model compared a logistic regression and a cluster-adjusted logistic regression using client gender and race as well as the Social Attribution variables interviewer gender and race to predict disclosure of physical abuse. The unadjusted regression showed that all four predictors were significant. Specifically, female and Caucasian clients were more likely to disclose physical abuse, and female and Caucasian interviewers were more likely to elicit abuse disclosures. However, after adjusting for the similarity of responses within interviewers, denoted by the ICC of 0.058, the impact of interviewer race was reduced and the significant interviewer gender effect disappeared. Though clustering only accounts for 6% of the unexplained variance, this similarity of client responses within interviewers explains the effect found for interviewer gender and partially explains the effect for interviewer race. Model 2. The age difference variables were added to both the unadjusted and cluster-adjusted regressions in Model 2 to determine the unique impact of age difference on abuse disclosures. In addition to the significant main effects of client and interviewer gender and race found in Model 1, the unadjusted model indicated that clients paired with interviewers of similar ages (within five years) were more likely to disclose physical abuse than clients paired with interviewers who were 20
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COMPARISON OF CLUSTER-ADJUSTED AND UNADJUSTED MODELS PREDICTING PHYSICAL ABUSE (N=7812)

TABLE 3

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years their senior. The cluster-adjusted model did not indicate this significant age difference after adjusting for the ICC of 0.049. In addition to significant client gender and race main effects, the cluster-adjusted regression revealed main effects for interviewer gender and race but not for age. However, it should be noted that the inclusion of age differences in Model 2 increased the impact of interviewer gender and interviewer race (as compared to the Adjusted Model 1) even though none of the age difference variables were significant. Age difference is therefore a suppressor variable and may be important to control when examining disclosures of abuse within interviewers. Model 3. In the third model, interactions between client and interviewer gender and client and interviewer race were added. Results greatly differed when comparing the unadjusted and adjusted models. The unadjusted model revealed significant main effects as well as matching effects. Female and Caucasian clients were more likely to disclose physical abuse, and female and Caucasian interviewers were more likely to elicit physical abuse. Disclosure was also more likely when client and interviewer ages differed by five years or less as compared to clients paired with interviewers 20 years their senior. In addition, a post hoc analysis of the significant gender interaction showed that both male and female clients were more likely to report abuse to female interviewers; yet, female clients were much more likely to report abuse to female interviewers (OR = 2.5) than male clients (OR = 1.6). However, after adjusting for the similarity of responses within interviewers, none of the above interviewer effects were present. In fact, only client gender and client race were significant in the adjusted model; disclosures did not vary by any interviewer characteristic. Thus, the small clustering effect (4% of the variance) explains many of the significant effects found in the unadjusted regression. To determine the best model explaining reports of physical abuse, the presence of cluster effects and improvement in model fit were considered. Because all three ICCs were greater than zero, the assumption of independent responses in the unadjusted regressions was violated. Moreover, all three models were significantly improved with the addition of the random parameter as indicated by the large reductions in 2LL. Thus, the adjusted regressions were considered stronger and the unadjusted models were excluded from further analysis. When comparing the adjusted models, the 2LL was not significantly reduced with the addition of the age difference variables, and the log likelihood actually increased with the addition of the gender and race interaction terms. In addition to the analyses presented in Table 3, a cluster-adjusted regression adding the gender and race interactions to Model 1 without the age difference variables was conducted but failed to converge. Thus, based on model fit, Adjusted Model 1 best and most parsimoniously explains disclosure of physical abuse. This model shows that in addition to female clients being six times more likely and Caucasian clients being almost twice as likely to
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disclose physical abuse, Caucasian interviewers were almost twice as likely to elicit reports of physical abuse than African American interviewers.
SEXUAL ABUSE

Model 1. The unadjusted analysis for disclosure of sexual abuse showed that all four main effects were significant. Female and Caucasian clients were more likely to disclose sexual abuse and female and Caucasian interviewers were more likely to elicit reports of abuse. However, after adjusting for the ICC of 0.034, the effects of client race and interviewer gender were reduced and interviewer race was nonsignificant. Again, the similarity of client responses within interviewers explains, or partially explains, several of the significant effects found in the unadjusted analysis. Model 2. Client and interviewer gender and race were all significant in the unadjusted regression. In addition, clients paired with interviewers 20 years their senior were less likely to disclose sexual abuse than clients in all other age pairings. The adjusted analysis yielded substantially different results. The impact of client race and interviewer gender diminished, interviewer race was no longer significant, and none of the age difference variables were significant. Though the similarity of clients responses was minimal (clustering only accounted for 2.6% of the variance), this similarity greatly affected the findings. Model 3. In the unadjusted analysis, female and Caucasian clients disclosed more sexual abuse and female and Caucasian interviewers elicited more reports of sexual abuse. Additionally, clients 20 or more years younger than their interviewers were less likely to disclose sexual abuse than clients in all other age pairings. In contrast, the adjusted model showed only one significant predictor: client gender. As would be expected, female clients were more likely to report sexual abuse. The added gender and race interactions were not significant in either the unadjusted or adjusted regressions. Moreover, their inclusion reduced or eliminated the significance of other predictor variables in both regressions as compared to Model 2. As with physical abuse, the best model to explain sexual abuse disclosure was determined by the presence of cluster effects and improvement in model fit. The ICCs in all three models denoted that responses could not be assumed independent. Furthermore, all models were significantly improved with the addition of the random parameter. The adjusted regressions were thus considered stronger and unadjusted models were excluded from further analysis. When comparing the three adjusted models, neither the addition of the age difference terms nor the addition of the gender and race interactions significantly reduced the 2LL. In addition to the analyses presented in Table 4, a cluster-adjusted regression adding the gender and race interactions to Model 1 without the age difference variables was conducted;
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COMPARISON OF CLUSTER-ADJUSTED AND UNADJUSTED MODELS PREDICTING SEXUAL ABUSE (N = 7818)

TABLE 4

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however, the addition of these variables did not improve the model. Thus, similar to the analysis of physical abuse, Adjusted Model 1 best and most parsimoniously explains the relationship between interviewer characteristics and disclosure of sexual abuse. This model shows that in addition to female clients being 10 times more likely and Caucasian clients being almost twice as likely to disclose sexual abuse, female interviewers were twice as likely to elicit reports of sexual abuse than male interviewers. It is important to highlight that results would have greatly differed if adjusted analyses had not been applied. Unadjusted Model 3 would have been selected as the model best explaining disclosures of physical abuse and Model 2 would have been selected for disclosures of sexual abuse (based on the significant 2LL reductions with the additional variables). These models erroneously suggest a gender-matching effect for physical abuse disclosures and age-matching effects for both physical and sexual abuse disclosures. Clearly, these findings contradict those of the adjusted analysis accounting for the interdependence of responses within clusters.
DISCUSSION

Accurate accounts of physical and sexual abuse history are vital to the treatment of substance abusers. Abuse victims may use substances to anesthetize themselves from the psychological symptoms associated with this victimization (Briere & Runtz, 1993; Rohsenow et al., 1988; Root, 1989). Without treating the psychological trauma associated with physical and sexual abuse, substance abuse may continue or reoccur. In order to obtain accurate assessments of physical and sexual abuse, it is necessary to determine the relationship between interviewer characteristics and abuse disclosures. This study examined the impact of interviewer characteristics as well as the matching of client and interviewer characteristics on the disclosure of physical and sexual abuse among substance users. Additionally, because clients were nested within interviewers, the effect of clustering was explored by comparing the results of cluster-adjusted logistic regressions and unadjusted logistic regressions. Findings are discussed in terms of support for the Social Attribution and Conditional Social Attribution models (Fendrich et al., 1999).
CLUSTERING EFFECTS

This comparison of cluster-adjusted and unadjusted models provides a clear example of how the similarity of responses within clusters can generate misleading results. The unadjusted models suggested considerably different conclusions regarding interviewer effects. In comparison to the adjusted models, the unadjusted models indicated stronger main effects for interviewer gender and race for both physical and sexual abuse, an age-matching effect for both physical and sexual
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abuse, and a gender-matching effect for physical abuse. These findings would have unnecessarily suggested treatment providers and researchers match clients and interviewers based on gender and age when evaluating histories of abuse. Though the ICCs were quite small (clustering accounted for only 2 6% of the unexplained variance), the interdependence of responses made a substantial impact. This similarity of client responses within interviewers explained, or partially explained, many of the significant results found in the unadjusted regressions. Thus, it is necessary to account for such similarity when analyzing nested data even if the clustering effect is minimal.
RELATIONSHIP BETWEEN CLIENT AND INTERVIEWER CHARACTERISTICS AND ABUSE DISCLOSURES

The cluster-adjusted regression analyses revealed only client and interviewer effects; no matching effects were found. Female clients were more likely to disclose physical and sexual abuse, which is consistent with the previous literature on abuse prevalence (Dhaliwal, Gauzas, Antonowicz, & Ross, 1996; Gil-Rivas et al., 1997; Gutierres & Todd, 1997, Rind & Tromovitch, 1997). In contrast to previous literature which found similar prevalence rates of physical and sexual abuse among different race and ethnicity groups (Dansky et al., 1996; Roosa, Reinholtz, & Angelini, 1999; Wyatt, 1985), Caucasian clients in this study were more likely to disclose both physical and sexual abuse than African American clients. In addition to these client differences, interviewer race was related to physical abuse disclosures and interviewer gender was related to sexual abuse disclosures. However, disclosures were neither more likely nor less likely when client and interviewer gender, race, or age were matched. Thus, overall, results support the Social Attribution Model when explaining disclosures of physical and sexual abuse. Disclosures did not vary by the combination of client and interviewer characteristics, yet clients in general had biases toward interviewer gender and race. These findings are important to treatment providers and researchers assessing histories of physical and sexual abuse. Matching clients and interviewers with similar (or dissimilar) characteristics is not necessary to obtain accurate assessments of abuse. However, clients may feel more comfortable disclosing sexual abuse to female interviewers. This is substantiated by Jonker, De Jong, de Weert-van Oene, and Gijss (2000) recent finding that two-thirds of addicted patients preferred a female counselor. In this study, females were generally regarded as better listeners and more sympathetic; therefore, clients with a sexual abuse history may be more likely to entrust this personal information with a female interviewer. Additionally, clients may feel more comfortable disclosing physical abuse to Caucasian interviewers. However, research has not previously indicated race of interviewer effects and conclusions regarding this finding are cautioned. Though few effects were found regarding interviewer characteristics, assessors need to be aware of these and other potential biases clients possess in order to reduce their impact on abuse disclosures.
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Increased rapport between client and interviewer may reduce client bias towards visible interviewer characteristics. Fry et al. (1991) posited that their differing rates of disclosure in two different interviews was due to length of interview; abuse may have been disclosed more often in the first interview because respondents and interviewers had more time to establish trust and rapport. Additionally, Currie and MacLean (1997) constructed an interview tailored to the needs of abuse victims and found, contrary to the common conception that female interviewers elicit more information, respondents were slightly more likely to disclose abuse to male interviewers. Clients in the present study averaged only 45 minutes with their interviewer during the administration of the ASI. Perhaps, if the clients had had more time to establish trust and rapport with their interviewer, the few interviewer effects evidenced in this analysis would have disappeared. However, actual level of perceived rapport was not assessed in this study and support for this could not be determined. Future research should therefore explicitly examine the relationship between degree of rapport and response editing. The results of the sexual abuse disclosure analysis lends support to the relationship between question content and visible interviewer characteristics. Kaplan et al. (1991) found that male adolescents preferred a female interviewer when discussing sexual experiences, especially when their perpetrators had been male. Similarly, clients in the present study may have perceived the sexual abuse question as related to interviewer gender. Most of the previous literature on sexual abuse has found that the majority of sexual abuse perpetrators are male (see Dhaliwal et al. (1996) for a summary). If a majority of clients perpetrators were male in this study as well, clients may have consciously or unconsciously concealed experiences of physical and sexual abuse from male interviewers due to a general mistrust of males stemming from the abuse. The present analysis was unable to examine the specific impact of perpetrator characteristics because information such as perpetrator gender was not collected. Therefore, the impact of question content and its relation to interviewer characteristics needs to be explored further in analyses measuring disclosures of abuse. In any analysis involving multiple interviewers, variation in interviewing skill is a confounding variable. Preliminary analyses showed that interviewer education did not influence reports of physical or sexual abuse. However, education may not the best indicator of verbal or interviewing skill; other measures such as years of experience or interviewees perceptions of their interviewers may be better constructs of skill. It may prove useful to explicate the relationship between interviewing skill and abuse disclosures; more experienced or more skilled interviewers may be better able to elicit disclosures of abuse as well as other personal information. It is also important to examine the impact of client and interviewer age on disclosure of abuse. Though the age difference variables did not predict abuse disclosures, the addition of these variables strengthened the effect of the other
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physical abuse predictors. Hence, it may be important to control client and interviewer age, or their age difference, when analyzing abuse disclosures. It may be that this analysis was unable to fully capture an existing effect of client and interviewer age.
LIMITATIONS

This study has many strengths such as sample size of clients and interviewers and an analysis of several characteristics simultaneously, but certain limitations should be noted. First, only two questions were used to assess a history of physical and sexual abuseone question for each type of abuse. Researchers have noted the benefits of in-depth questioning when eliciting reports of abuse (Rohsenow et al., 1988; Simpson et al., 1994; Wyatt & Peters, 1986). Clients may have experienced physical or sexual abuse in a legal sense, yet do not perceive their experience as abuse. Further questioning about specific acts clients may have experienced elicits more accurate assessments. Interviewers in the Target Cities project likely defined physical and sexual abuse in their own terms and explored further if clients appeared uncertain in their answers; however, extensive measures were not taken to elicit this information since the focus of the intake assessment was not physical and sexual abuse history. It should be noted that the data from this assessment is representative of typical substance abuse intake assessments. Positive reports of abuse in these interviews were assumed to be accurate in this study. It is unknown if these disclosures are indeed truthful; however, previous research suggests positive reports of abuse are accurate (Dill et al., 1991; Leserman et al., 1995; Najavits et al., 1998). Also, distributions of client and interviewer characteristics were skewed. More than half the total number of interviews were between a male client and a female interviewer and only five percent were between a female client and a male interviewer. This led to relatively low cell sizes in some analyses, which may have tempered the power of analyses conducted. However, this was partially compensated for by the large sample size. Additionally, distribution is unrelated to the presence of clustering effects within individual interviewers. In order improve the balance of client and interviewer characteristics, future studies should include analyses with equal numbers of male and female interviewers as well as equal numbers of interviewers of different ethnicities. Generalization of results is cautioned. These findings are specific to substance users in the context of a brief interview. In addition, only Caucasians and African American clients and interviewers were included in the analysis. Results may differ for clients and interviewers of other ethnic descent. Nonetheless, this analysis demonstrated that the similarity of responses within interviewers can produce spurious results and controlling for this interdependence is necessary. Additionally, results indicated that Caucasian interviewers elicited more physical abuse disclosures and female interviewers elicited more sexual abuse disclosures. However, results
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did not suggest that disclosures increased or decreased when client and interviewer gender, race, or age were matched.
ACKNOWLEDGMENTS

This work was supported by Grant U95 T100662 from the Center for Substance Abuse Treatment (CSAT). The opinions expressed here are those of the authors and not necessarily those of CSAT.
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