The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child sexual abuse as: "The

employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or The rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children"2

Objectives: 1. examine child abuse as correlate to adult health. 2. examine the cummulative effect of abuse on health and healthcare utilization.

obtained a representative sample population of 9953 participants over the age of 15 multiple questionnaires to assess adverse childhood experiences logistic regression models were used; bivariate, adusted, and cumulative effect

risk of adult health problems increased with each adverse event, suggesting a cumulative effect on the body from abuse CSA and physical abuse had a stronger influence on negative health effects than other adverse events

retrospective nature of the study - there was likely a certain amount of recall bias and misinformation. broad categories - it is difficult to understand the actual effects of the abuse at a physiological level.

Objective: examine the relationship between CSA and illness burden/Bodily Pain.

163 female participants with primary mood disorder diagnosis Self reports were used in collecting CSA and BP data Illness burden was based on chart review functioning based on ADLs and IADLs scales Linear and logistic regression was used to look at the effects of CSA on adult health

Findings were that CSA had a major impact on adult health burden in psychiatric patients respiratory system and the musculoskeletal/integument systems were found to be the most highly associated systems for health problems related to CSA adding 20 years to the participants age

small sample size Non random sample Retrospective nature of CSA assessment

Objective: To assess the impact of adverse childhood events on health outcomes

a 2002 Behavioral risk factor phone survey 5,378 people surveyed, 4 groups were created:

no childhood abuse or household

dysfunction childhood abuse only household dysfunction only both childhood abuse and household dysfunction

adverse childhood events scale (ACEs) divided into seven sections:

psychological abuse physical abuse sexual abuse substance abuse

mental illness
mother or stepmother treated violently criminal behavior in the household

3 health behavior outcomes were assessed:

Smoking Obesity self-reported general health

grouped by age, race/ethnicity, sex, education level, annual household income, and employment status.

27% of participants had experienced some form of child abuse 37% had experienced some form of dysfunction in the home ACEs did NOT vary by race/ethnicity or sex for any of the 4 categories rates were lower for college graduates, at 13%, than non-graduates higher annual incomes reported lower amounts of abuse and dysfunction

32% of those who experienced abuse and dysfunction smoked

those who experienced both, there was a 90% increased likelihood of smoking

prevalence of obesity was also higher in those who experienced abuse and dysfunction

a 50% increase in the likelihood of obesity

reliance on self report non-random sampling method of phone interviewing

Addiction Eating Disorders- obesity, bulimia Diabetes Mellitus Coronary Artery Disease Auto-immune disorders

Smoking - many studies show correlation between smoking and CSA

Alcoholism especially in women, tends to be due to CSA

Obesity CSA increases chances of obesity beyond 50%

Bulimia Using food as a way to avoid emotion leads to obesity or mouth, throat, and stomach problems.

Obesity Genetics Poor food choices Sedentary lifestyle

Obesity Smoking Genetics Sedentary lifestyle

Obesity Inflammation Chronic Fatigue Syndrome Multiple Sclerosis Lupus Rheumatoid Arthritis

All behavior , as well as physical illness, has multiple under lying physiological mechanisms.

CRH receptor 1 gene this gene and sex of victim help moderate the effects of CSA 4 SNPs(single nucleotide polymorphisms) of FKBP5 interact with environment to produce PTSD symptoms

Sensitization of anterior pituitary -> counter regulation of adrenal cortex -> hypersensitivity to CRF -> down regulation of adenohypophyseal CRF receptors -> depression and anxiety Over or under production of Cortisol leading to depression or anxiety

Changes in brain size and density in different areas depending on length and type of abuse Severely effects dopamine, epinephrine, norepinephrine, corticotrophin releasing factor,

Focused on specific interactions between biology and environment Larger and more generalizable studies Focus on verifiable abuse/separate verifiable from unverifiable

Further research may lead to biological tests that can help identify those at risk Help diagnose psychological conditions with verifiable evidence

More abuse prevention programs focused on empirical data rather than fear Better interventions in cases of abuse or suspected abuse

References Binder, E.B., Bradley, R.G., Liu, W., Epstein, M.P., Deveau, T.C., Mercer, K.B., Tang, Y., Gillespie, C.F., Heim, C., Nemeroff, C.B., Schwartz, A.C., Cubells, J.F., Ressler, K.J. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in Adults. JAMA , 299, 1291-1305. Chartier, M.J., Walker, J.R., Naimark,. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse and Neglect , 34, 454-464. Dube, S. R, Cook M.L., Edwards, V.J., (2009). Health Related Outcomes of Adverse Childhood Experiences in Texas, 2002. Preventing Chronic Disease , 7(3).http://www.cdc.gov/pcd/issues/2010/may/09_0158.htm. Accessed 11/20/2010 Greenfield, E.A., Marks, N.F. (2009). Profiles of physical and psychological violence in childhood as a risk factor for poorer adult health: evidence from the 1995-2005 national survey of midlife in the United States. Journal of Aging and Health , 21, 943-966. Heim, C., Bradley, B., Mletzko, T.C., Deveau, T.C., Musselman, D.L., Neveroff, C.B., Ressler, K.J., Binder, E.B. (2009). Effect of childhood trauma on adult depression and neuroendocrine function: sex-specific moderation by CRH receptor 1 gene. Fronteirs in Behavioral Neuroscience ,3, 1-9.

Heim, C., Newport, D.J., Bonsall, R., Miller, A.H., Nemeroff, C.B. (2001). Altered Pituitary-Adrenal Axis Responses to Provocative Challenge tests in adult surviors of childhood abuse. American Journal of Psychiatry , 158:4, 579-581.
Talbot, N.L., Chapman, B., Conwell, Y., McCollumn, K., Franus, N., Cotescu, S., Duberstein, P.R. (2009). Childhood Sexual Abuse is Associated with Physical Ilness Burden and Functioning in Psychiatric Patients 50 years of age and older. Psychosomatic Medicine , 71, 417-422. http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.cfm