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ORIGINAL RESEARCH |
From the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and Department of Preventive Medicine, Southern California Permanente Medical Group (Kaiser-Permanente), San Diego, California.
Address reprint requests to: Daniel P. Chapman, PhD, Centers for Disease Control and Prevention, Mailstop K-45, 4770 Buford Hwy NE, Atlanta, GA 30341; E-mail: dpc2{at}cdc.gov.
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ABSTRACT |
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 ABSTRACT MATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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METHODS: We conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man’s own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education.
RESULTS: At least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P < .001) between the number of adverse childhood experiences and the risk of involvement in a teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64–100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences.
CONCLUSION: Adverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four successive birth cohorts dating back to 1900–1929, suggesting that the effects of adverse childhood experiences transcend changing sexual mores and contraceptive methods. Efforts to prevent teen pregnancy will likely benefit from preventing adverse childhood experiences and their associated effects on male behaviors that might mediate the increased risk of teen pregnancy.
Efforts to prevent teenage pregnancies1,2 seldom focus on the male role.3 Because reducing the number of teen pregnancies is a national priority,4 the scarcity of information about the male role presents an opportunity to investigate new avenues of prevention. In a retrospective study of adolescent mothers, Taylor et al5 identified demographic characteristics of adult men who impregnated a teenager. While providing an important description, that study did not examine life experiences that potentially increase the risk of male involvement in teen pregnancy. Moreover, they identified risk factors distinguishing only men aged 20 years or older at the time of the pregnancy, who were responsible for slightly less than half of the births of teenage mothers in their sample.5
The effects of childhood abuse can provide insight into behavioral pathways that lead to teen pregnancies. Relative to their peers, adolescents who have been physically or sexually abused or exposed to domestic violence have more sexual partners and earlier ages at first intercourse,6–15 are less likely to use contraception,16 more likely to use alcohol or drugs,6,17 and to consume alcohol before sex.9 Each of these behaviors could increase a male’s risk of impregnating a teenage girl. Notably, adolescent males involved in a teen pregnancy report having more sexual partners, using condoms inconsistently or not at all, and higher rates of drug use and sexually transmitted diseases (STDs).18 In previous investigations, we found that the risks of alcoholism, drug abuse, sexual promiscuity, STDs, and unintended pregnancies increase as the number of adverse childhood experiences increases19,20 and that adverse childhood experiences usually occur in clusters19–21 and thus should be studied as a set of experiences rather than individually.22
This investigation estimates the strength of the association between the following eight adverse childhood experiences and the risk of male involvement in a teen pregnancy: emotional, physical, and sexual abuse; having a battered mother; parental separation or divorce; and growing up with a substance abusing, mentally ill, or criminal household member. We chose these experiences because they are common and have deleterious effects on child development.19,20,23–27 We assessed the relationship between adverse childhood experiences and impregnating a teenager among four birth cohorts of men to determine whether our findings apply to the experiences of both younger and older males. In addition, we examined the effect of sexual behaviors and substance abuse on the adverse childhood experience–teen pregnancy relationship. To better assess the impact of adverse childhood experiences on a male’s risk of impregnating a teenager during both adolescence and adulthood,28–30 we report results separately for both males who were teenagers versus those who were more than 20 years old at the time of their involvement in a teen pregnancy.
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MATERIALS AND METHODS |
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The adverse childhood experience survey was conducted in two waves. Survey wave I included 13,494 Kaiser members who consecutively completed standardized medical evaluations at the clinic between August 1995 and March 1996; 70% (9508 of 13,494) responded by completing a mailed Adverse Childhood Experience Study questionnaire and became the study population (wave I) discussed in the initial adverse childhood experience publications.19–21 Survey wave II included 13,330 persons who completed examinations between June and October of 1997; 65% (8667 of 13,330) responded. Thus, the final study cohort includes 18,175 persons with a response rate of 68% (18,175 of 26,824). Of these persons, 8037 were men and thus included in this analysis.
In addition to completing the Adverse Childhood Experience Study questionnaire, the standard medical evaluation and histories from the clinic were abstracted for every study participant and included in the Adverse Childhood Experience Study database. Because the Adverse Childhood Experience Study questionnaire was lengthy and contained questions about sensitive topics, we compared respondents with nonrespondents to assess possible bias in the study due to nonresponse. Specifically, we abstracted data from the standardized medical evaluations for both respondents and nonrespondents to the wave I Adverse Childhood Experience Study questionnaire. We found no differences between respondents and nonrespondents in their health risk behaviors (eg, smoking, alcohol, or drug abuse) or disease histories (eg, diabetes, hypertension, lung disease, cardiovascular diseases, or cancer).31
Male Involvement in Teen Pregnancy
Participants were asked, "Have you ever gotten someone pregnant?" If the answer was "yes," they were then asked, "What was the age of the youngest woman you ever got pregnant?" and "How old were you then?" Any man who reported an age of 19 or less for the youngest woman he ever got pregnant was defined as having been involved in a teen pregnancy, regardless of his age at the time.
Definitions of Adverse Childhood Experiences
Questions about adverse childhood experiences specified that the experiences had to have occurred during the respondent’s first 18 years of life. The questions for the verbal and physical abuse and a battered mother categories were adapted from the Conflict Tactics Scale for which potential responses were never, once or twice, sometimes, often, or very often.32 Questions about contact sexual abuse were adapted from Wyatt.33
The questions for the eight categories of adverse childhood experiences and the responses considered positive for an adverse childhood experience were as follows:
Verbal Abuse: 1) "How often did a parent, stepparent, or adult living in your home swear at you, insult you, or put you down? and 2) How often did a parent, stepparent, or adult living in your home threaten to hit you or throw something at you, but didn’t do it?" Responses of "often" or "very often" to either question defined verbal abuse during childhood.
Physical Abuse: "Sometimes parents or other adults hurt children. While you were growing up, that is, in your first 18 years of life, how often did a parent, stepparent, or adult living in your home: 1) push, grab, slap, or throw something at you? or 2) hit you so hard that you had marks or were injured?" A response of "often" or "very often" to the first question or "sometimes," "often," or "very often" to the second defined childhood physical abuse.
Sexual Abuse: "Some people, during their first 18 years of life, had a sexual experience with an adult or someone at least 5 years older than themselves. These experiences may have involved a relative, family friend, or stranger. During the first 18 years of life, did an adult, relative, family friend, or stranger ever 1) touch or fondle your body in a sexual way, 2) have you touch their body in a sexual way, 3) attempt to have any type of sexual intercourse with you (oral, anal, or vaginal), or 4) actually have any type of sexual intercourse with you (oral, anal, or vaginal)?" A "yes" response to any of the four questions was defined as contact sexual abuse during childhood.
Battered Mother: "Sometimes physical blows occur between parents. While you were growing up in your first 18 years of life, how often did your father (or stepfather) or mother’s boyfriend do any of these things to your mother (or stepmother): 1) push, grab, slap, or throw something at her; 2) kick, bite, hit her with a fist, or hit her with something hard; 3) repeatedly hit her over at least a few minutes; or 4) threaten her with a knife or gun, or use a knife or gun to hurt her?" A response of "sometimes," "often," or "very often" to at least one of the first two questions or any response other than "never" to at least one of the third and fourth questions was defined as having had a battered mother.
Household Substance Abuse: This category consisted of two questions that asked whether the respondent had grown up in a household with a problem drinker or alcoholic27 or anyone who used street drugs. A "yes" response to either question defined childhood exposure to household substance abuse.
Mental Illness in Household: A respondent who said that during his or her childhood, anyone was depressed or mentally ill or that anyone in the household had attempted suicide was defined as having grown up with mental illness in the household.
Parental Separation or Divorce: This was defined as a "yes" response to the question "Were your parents ever separated or divorced?"
Criminal Household Members: Having a household member go to prison while growing up was defined as having childhood exposure to a household member who was a criminal.
The Adverse Childhood Experience Score
We summed the total number of individual adverse childhood experiences to create an adverse childhood experience score. The purpose of this score was to assess the cumulative effect of multiple adverse childhood experiences that have been shown to be highly interrelated.19,21 The adverse childhood experience score repeatedly has been shown to have a strong, graded relationship to numerous health and social problems.19–21,34,35
Exclusions
Of the 8037 men who responded, we excluded 86 (1.1%) whose race was unstated and 22 (0.3%) whose educational attainment was not reported. We excluded 341 (4.3%) men who did not answer the questions about impregnating a female or did not provide the age of the youngest female they had impregnated, 162 (2.0%) who had impregnated a female and provided her age but not their own age at the time, and 27 (0.3%) who met our definition of sexual abuse but whose age at first abuse was older than their age at the time of the teen pregnancy. Thus, the final study sample included 92% of the men who responded to the surveys (7399 of 8037).
Data Analysis
We assessed both the relationship of each adverse childhood experience and the adverse childhood experience score (sum of the number of individual adverse childhood experiences; range 0–8) to the risk of involvement in a teen pregnancy and to the presence of variables that could be intermediate factors in the relationship between adverse childhood experiences and such involvement, including age at first intercourse, lifetime number of sexual partners, history of an STD, and alcohol or illicit drug abuse. We used logistic regression36 to adjust for age, race, and educational attainment. To test for the significance of the graded relationship between the adverse childhood experience score and the risk of paternity in teen pregnancy, we entered the adverse childhood experience score as a single ordinal variable (range 0–8) into logistic models, with adjustment for demographic covariates. The coefficient for this ordinal adverse childhood experience score variable and its P value provide a statistical measure of the significance of any apparent graded relationships between the adverse childhood experience score and risk of involvement in teen pregnancy.
To determine whether changing social mores, methods of contraception, or other factors that have changed with time influenced the relationship between adverse childhood experiences and male involvement in teen pregnancies, we assessed the relationship between the adverse childhood experience score and involvement in a teen pregnancy for the following four birth cohorts: persons born between 1900–1929, 1930–1945, 1946–1959, or 1960–1977.
Assessment of Intermediate Effects of Known Risk Factors
Finally, we assessed the potential intermediate role of known male risk factors6–15,17,18 in the relationship between the adverse childhood experience score and involvement in teen pregnancy. We did this by comparing the strength of the relationships between the adverse childhood experience score and involvement in teen pregnancy in logistic models with and without controlling for the potential intermediate variables (sexual behaviors and substance abuse). For this investigation, we defined potential intermediate variables as those that might be part of a causal pathway that may have been initiated by adverse childhood experiences. We use the term "intermediate" because we know of no universally accepted term, as some researchers prefer the term "mediation." We consider these terms to have the same meaning and to be interchangeable. According to Roth-man,37 a confounding variable cannot be an intermediate step in the causal path between the exposure and the disease, as this assumption requires information outside the data. Rather, if the causal mechanism that might follow from exposure to disease would include the potentially confounding factor as an intermediate step, the variable is not a confounder.37 Our proposed causal pathway between adverse childhood experiences and male involvement in teen pregnancy includes published factors for male involvement,6–15,17,18 which have also been shown to be strongly associated with adverse childhood experiences. Thus, our logistic models that enter the known risk factors simultaneously with the adverse childhood experience score (full model) treat these risk factors as potential intermediate variables, as recommended by Rothman.37
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RESULTS |
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).
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). Nearly 63% reported at least one adverse childhood experience, and more than one third reported two or more.
Prevalence of Involvement in a Teen Pregnancy
Nineteen percent of the men reported impregnating a teenage girl. Mean male age at the time of the pregnancy was 20.6 years (SD 3.7 years; median 20 years); 58% were at least 20 years old when the pregnancy occurred. More than half of all reported teen pregnancies were definitely extramarital, as 53% reported their age at first marriage to be greater than their age when the teen pregnancy occurred, and 4% had never married. Forty percent of the men were married at the same age or younger than when the teen pregnancy occurred; however, 3% provided incomplete marital histories. The age of the teenage girls who were involved in these pregnancies ranged from 12 to 19 years (mean 17.7 years, SD 1.8 years; median, 18 years). Fifteen percent of the girls were aged 12–16 years; 17%, 17 years; 32%, 18 years; and 36%, 19 years.
Adverse Childhood Experiences and the Risk of Involvement in a Teen Pregnancy
Each adverse childhood experience was significantly associated with involvement in a teen pregnancy in the study cohort (Table 2). The odds ratios ranged from 1.2 for sexual abuse (95% confidence inverval [CI] 1.1, 1.4) to 1.8 for growing up with a criminal in the home (95% CI 1.4, 2.3).
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).
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). Each adverse childhood experience was also associated with an increased risk of ever having an STD, problems with alcohol abuse, or using illicit drugs. A positive, graded relationship was seen between the adverse childhood experience score and each of those three behaviors (Table 4). For each birth cohort, we found a positive, graded relationship between the adverse childhood experience score and each of the five potential intermediate variables (P < .001) (data not shown). In addition, each of the five potential intermediate variables was strongly associated with involvement in a teen pregnancy (P < .001; data not shown).
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). When we adjusted for the potential intermediate variables, including age at first intercourse, number of sexual partners, history of STD, alcohol abuse, and use of illicit drugs (model 2), we found that the risks (odds ratio) of involvement in a teen pregnancy were substantially reduced from model 1 for all adverse childhood experience scores (Table 5). The addition of the potential intermediate variables to model 2 significantly increased the log likelihood ratio (
2 = 154, 8 degrees of freedom; P < .001). This indicates that the five potential intermediate variables account for significantly more variance in teen pregnancy involvement than was seen in model 1.
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19 years) or adults (
20 years) when they were involved in a teen pregnancy, we found positive, graded relationships between adverse childhood experiences and involvement. Associations in the adolescent group were slightly stronger. Similarly, adverse childhood experiences were more strongly associated with the risk of involvement in a pregnancy with younger teenage girls (age 17 years) than with older teenagers (age 18–19 years) (data not shown). |
DISCUSSION |
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Because the behaviors we studied did not completely account for the relationship between adverse childhood experiences and the risk of paternity in teen pregnancy, there could be a direct effect of adverse childhood experiences as well as the presence of other intermediate variables not examined here, including characteristics of female partners, that increase the risk of pregnancy.20,38–42 Our results are consistent with those reported in other studies that have related these potential intermediate variables to male involvement in teen pregnancy.5–17,43–46 The prior studies, however, did not report data about possible antecedents to these behavioral risk factors for teen paternity. The results of this investigation suggest that previously reported risk factors for involvement in teen pregnancy may be sequelae of exposure to childhood abuse, domestic violence, impaired parents, or other forms of household dysfunction.19
Although adverse childhood experiences were significantly associated with increased risk of paternity in teen pregnancy among males of all ages, they were more strongly linked among adolescent males and those who impregnated a younger teenage girl. This finding is consistent with the results of previous research documenting the effects of childhood abuse as a precipitant of premature sexual involvement10,47 and failure to use contraception.16
Because our survey was retrospective, we could not assess some potentially important pathways, including attitudes toward paternity and contraception48,49 and the characteristics of the teenage girls who became pregnant.38–42 Some men may have been unaware of teen pregnancies they caused, and others may not have admitted to them or misstated the age of the girl. Sexual abuse in this study was likely higher than reported because several studies of documented sexual abuse have found substantial underreporting.50,51 Although older men may have had poorer recall of these life events, the relationship between the adverse childhood experience score and involvement in a teen pregnancy was stronger in the oldest birth cohort than in the subsequent two birth cohorts. Moreover, if both the outcome (causing a teen pregnancy) and exposure (adverse childhood experiences) were underreported in our study, we have underestimated, not overestimated, the strength of their association.
Population-based studies have found levels of exposures nearly identical to ours. Specifically, we found that 16% of the men met the case definition for sexual abuse. In a recent nationally representative study of adults, 15% of men reported childhood sexual abuse.26 In our study, 31% of the men had been physically abused as boys; the same percentage was found in a recent population-based study of Ontario men that used questions from the same scales.25 These similarities suggest that our findings are likely to be generalizable.
Notably, males who were involved in teen pregnancies had a higher prevalence of adverse childhood experiences, which our results indicate are associated with alcohol or illicit drug abuse, STDs, increased prevalence of smoking, attempted suicide, and depression, as we previously reported.19,20 Furthermore, youth with a history of exposure to abuse and domestic violence are more likely to perpetrate violence or display antisocial behavior,52–56 and childhood experiences of sexual abuse or witnessing domestic violence have been linked to the perpetration of sexual violence during adolescence.57 Thus, children born from these teen pregnancies are more likely to face adverse childhood experiences themselves, which would increase their own risk of subsequent teenage pregnancy. Consequently, adverse childhood experiences likely contribute to an intergenerational cycle of these exposures58,59 and teen pregnancy.
In conclusion, throughout the 20th century boyhood exposure to adverse childhood experiences has been associated with involvement in teen pregnancies. This has been evident despite changing sexual mores, advances in contraceptive practices,60 and the availability of elective abortion.4 One possible explanation for the persistence of this effect is that adverse childhood experiences are stressors whose biologic sequelae61 are not bound by societal norms but rather by effects on the developing child that lead to common emotional and behavioral outcomes.62 Regardless of the locus of this effect, interventions to prevent teen pregnancy are likely to be improved by prevention of adverse childhood experiences, additional research about male risk factors,3 and interruption of the intermediate pathways by which these experiences lead to an increased risk of paternity in teen pregnancy.
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Footnotes |
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The Adverse Childhood Experiences Study is currently funded by a grant from the Garfield Memorial Fund.
Received December 11, 2001. Received in revised form March 1, 2002. Accepted March 21, 2002.
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REFERENCES |
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2. Kahn JG, Brindis CD, Glei DA. Pregnancies averted among U.S. teenagers by the use of contraceptives. Fam Plann Perspect 1999;31:29–34.[Medline]
3. Meyer VF. A critique of adolescent pregnancy prevention research: The invisible white male. Adolescence 1991;26: 217–22.[Medline]
4. Spitz AM, Velabil P, Koonin LM, Strauss LT, Goodman KA, Wingo P, et al. Pregnancy, abortion, and birth rates among US adolescents—1980, 1985, and 1990. JAMA 1996;275:989–94.[Abstract]
5. Taylor D, Chavez G, Chabra A, Boggess J. Risk factors for adult paternity in births to adolescents. Obstet Gynecol 1997;89:199–205.[Abstract]
6. Nagy S, Adcock AG, Nagy MC. A comparison of risky health behaviors of sexually active, sexually abused, and abstaining adolescents. Pediatrics 1994;93:570–5.
7. Cunningham RM, Stiffman AR, Dore P. The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: Implications for public health. Child Abuse Negl 1994;18:233–45.[Medline]
8. Nelson DE, Higginson GK, Grant-Worley JA. Physical abuse among high school students. Prevalence and correlation with other health behaviors. Arch Pediatr Adoles Med 1995;149:1254–8.[Abstract]
9. Hernandez JT, Lodico M, DiClemente RJ. The effects of child abuse and race on risk-taking in male adolescents. J Natl Med Assoc 1993;85:593–7.[Medline]
10. Riggs S, Alario AJ, McHorney C. Health risk behaviors and attempted suicide in adolescents who report prior maltreatment. J Pediatr 1990;116:815–21.[Medline]
11. Cavaiola A, Schiff M. Behavioral sequelae of physical and/or sexual abuse in adolescents. Child Abuse Negl 1988;12:181–8.[Medline]
12. Polit DF, White CM, Morton TD. Child sexual abuse and premarital intercourse among high-risk adolescents. J Adoles Health Care 1990;11:231–4.[Medline]
13. Friedrich WN, Grambsch P, Damon L, Hewitt SK, Koverola C, Lang RA, et al. Child sexual behavior inventory: Normative and clinical comparisons. Psychologic Assess 1992;4:303–11.
14. Runtz M, Briere J. Adolescent "acting-out" and childhood history of sexual abuse. J Interpersonal Violence 1986;1: 326–34.
15. Friedrich WN, Beilke RL, Urquiza AJ. Behavior problems in young sexually abused boys: A comparison study. J Interpersonal Violence 1988;3:21–8.
16. Mason WA, Zimmerman L, Evans W. Sexual and physical abuse among incarcerated youth: Implications for sexual behavior, contraceptive use, and teenage pregnancy. Child Abuse Negl 1998;22:987–95.[Medline]
17. Dembo R, Williams L, Wotke W, Schmeidler J, Brown CH. The role of family factors, physical abuse, and sexual victimization experiences in high-risk youth’s alcohol and other drug use and delinquency: A longitudinal model. Violence Victims 1992;7:245–66.[Medline]
18. Guagliardo MF, Huang X, D’Angelo LJ. Fathering pregnancies: Marking health risk behaviors in urban adolescents. J Adolesc School Health 1999;24:10–5.
19. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. The relationship of adult health status to childhood abuse and household dysfunction. Am J Prev Med 1998;14:245–58.[Medline]
20. Dietz PM, Spitz AM, Anda RF, Williamson DF, McMahon PM, Santelli JS, et al. Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA 1999;282:1359–64.
21. Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, Williamson DF, et al. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA 1999; 282:1652–8.
22. Finkelhor D. Improving research, policy, and practice to understand child sexual abuse (editorial). JAMA 1998; 280:1864–5.
23. Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278:823–32.[Abstract]
24. Lykken DT. Incompetent parenting: Its causes and consequences. Child Psychiatr Hum Dev 1997;27:129–37.[Medline]
25. MacMillan HL, Fleming JE, Trocme N, Boyle MH, Wong M, Racine YA, et al. Prevalence of child physical and sexual abuse in the community: Results from the Ontario Health Supplement. JAMA 1997;278:131–5.[Abstract]
26. Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse Negl 1990; 14:19–28.[Medline]
27. Schoenborn CA. Exposure to alcoholism in the family: United States, 1988. Advance data from the Vital Health Statistics, no. 204. DHHS publication no. (PHS) 95–1880. Hyattsville, MD: National Center for Health Statistics, 1995.
28. Landry DJ, Forrest JD. How old are U.S. fathers? Fam Plann Perspect 1995;27:159–65.[Medline]
29. Males M. School-age pregnancy: Why hasn’t prevention worked? J School Health 1993;63:429–32.[Medline]
30. Duberstein L, Sonenstein FL, Ku L, Martinez G. Age differences between minors who give birth and their adult partners. Fam Plann Perspect 1997;29:61–6.[Medline]
31. Edwards VJ, Anda RF, Nordenberg DF, Felitti VL, Williamson DF, Wright JA. Factors affecting probability of response to a survey about child abuse. Child Abuse Negl 2001;25:307–12.[Medline]
32. Straus M, Gelles RJ. Physical violence in American families: Risk factors and adaptations to violence in 8,145 families. New Brunswick, NJ: Transaction Press, 1990.
33. Wyatt GE. The sexual abuse of Afro-American and White-American women in childhood. Child Abuse Negl 1985;9:507–19.[Medline]
34. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span. JAMA 2001;286:3089–96.
35. Hillis SD, Anda RF, Felitti VJ, Nordenberg D, Marchbanks P. Adverse childhood experiences and sexually transmitted diseases in men and women: A retrospective study. Pediatrics 2000;106:E11.
36. SAS Institute. SAS Procedures Guide. Version 6, 3rd ed, Cary, NC: SAS Institute, 1990.
37. Rothman KJ. Modern epidemiology. Boston: Little Brown, 1986.
38. Santelli JS, Beilenson P. Risk factors for adolescent sexual behavior, fertility, and sexually transmitted diseases. J School Health 1992;62:271–9.[Medline]
39. Rickert VI, Wiemann CM, Berenson AB. Health risk behaviors among pregnant adolescents with older partners. Arch Pediatr Adolesc Med 1997;151:276–80.[Abstract]
40. Luster T, Small SA. Sexual abuse history and number of sex partners among female adolescents. Fam Plann Perspect 1997;29:204–11.[Medline]
41. Thompson, S. Going all the way. Teenage girls’ tales of sex, romance, and pregnancy. New York: Hill and Wang, 1995.
42. Lamb ME, Elster A, Tavare J. Behavioral profiles of mothers and partners with varying intracouple age differences. J Adolesc Res 1996;1:399–408.
43. Dearden KA, Hale CB, Woolley T. The antecedents of teen fatherhood: A retrospective case-control study of Great Britain youth. Am J Public Health 1995;85:551–4.
44. Dearden K, Hale C, Alvarez J. The educational antecedents of teen fatherhood. Br J Educ Psychol 1992:62: 139–47.
45. Elster AB, Lamb ME, Peteres L, Kahn J, Tavare J. Judicial involvement and conduct problems of fathers of infants born to adolescent mothers. Pediatrics 1987;79:230–4.
46. Spingarn RW, DuRant RH. Male adolescents involved in pregnancy: Associated health risk and problem behaviors. Pediatrics 1996;98:262–8.
47. Nagy S, DiClemente R, Adcock AG. Adverse factors associated with forced sex among southern adolescent girls. Pediatrics 1995;96:944–6.
48. Marsiglio W. Adolescent males’ orientation toward paternity and contraception. Fam Plann Perspect 1993;25: 22–31.[Medline]
49. Visser AP, van Bilsen P. Effectiveness of sex education provided to adolescents. Patient Educ Counsel 1995;23: 147–60.
50. Della Femina D, Yeager CA, Lewis DO. Child abuse: Adolescent records vs adult recall. Child Abuse Negl 1990; 14:227–31.[Medline]
51. Williams LM. Recovered memories of abuse in women with documented child sexual victimization histories. J Trauma Stress 1995;8:649–73.[Medline]
52. Spaccarelli S, Coatsworth JD, Bowden BS. Exposure to family violence among incarcerated boys: Its association with violent offending and potential mediating variables. Violence Victims 1995;10;163–82.[Medline]
53. Widom CP, Ames MA. Criminal consequences of childhood sexual victimization. Child Abuse Negl 1994;18: 303–7.[Medline]
54. Rivera B, Widom CS. Childhood victimization and violent offending. Violence Victims 1990;5:519–35.
55. Dodge KA, Bates JE, Pettit GS. Mechanisms in the cycle of violence. Science 1990;250:1678–83.
56. Luntz BK, Widom SC. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry 1994;151:670–4.
57. Borowsky IW, Hogan M, Ireland M. Adolescent sexual aggression: Risk and protective factors. Pediatrics 1997; 100:1–8.
58. Oliver JE. Intergenerational transmission of child abuse: Rates, research, and clinical implications. Am J Psychiatry 1993;150:1315–24.
59. Kaufman J, Zigler E. Do abused children become abusive parents? Am J Orthopsychiatry 1987;57:186–92.[Medline]
60. Kaufman RB, Spitz AM, Strauss LT, Morris L, Santelli JS, Koonin LM, et al. The decline in US pregnancy rates, 1990–1995. Pediatrics 1998;102:1141–7.
61. Perry BD, Pollard R. Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma. Child Adoles Psychiatr Clin N Am 1998;7:33–51.
62. Weiss JS, Wagner SH. What explains the negative consequences of adverse childhood experiences on adult health? Insights from cognitive and neuroscience research (editorial). Am J Prev Med 1998;14:356–60.[Medline]
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M. Dong, R. F. Anda, V. J. Felitti, D. F. Williamson, S. R. Dube, D. W. Brown, and W. H. Giles Childhood Residential Mobility and Multiple Health Risks During Adolescence and Adulthood: The Hidden Role of Adverse Childhood Experiences Arch Pediatr Adolesc Med, December 1, 2005; 159(12): 1104 - 1110. [Abstract] [Full Text] [PDF]
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 U.S. Preventive Services Task Force* Screening for Family and Intimate Partner Violence: Recommendation Statement Ann Intern Med, March 2, 2004; 140(5): 382 - 386. [Abstract] [Full Text] [PDF]
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H. D. Nelson, P. Nygren, Y. McInerney, and J. Klein Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, March 2, 2004; 140(5): 387 - 396. [Abstract] [Full Text] [PDF]
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 U.S. Preventive Services Task Force Screening for Family and Intimate Partner Violence: Recommendation Statement Ann. Fam. Med, March 1, 2004; 2(2): 156 - 160. [Full Text] [PDF]
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P. Nygren, H. D. Nelson, and J. Klein Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force Ann. Fam. Med, March 1, 2004; 2(2): 161 - 169. [Abstract] [Full Text] [PDF]
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