Adverse childhood exposures and alcohol dependence among seven Native American tribes
Adverse childhood exposures and alcohol dependence among seven Native American tribes
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DOI：
10.1016/s0749-3797(03)00195-8
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发表时间：
2003-10-01
影响因子：
5.5
通讯作者：
Goldman, D
中科院分区：
文献类型：
--
作者：
Koss, MP;Yuan, NP;Goldman, D
背景：酗酒和酗酒是美洲原住民死亡的主要原因。关于儿童时期的不良接触，包括父母酗酒、童年虐待和离家安置，对这一人群中酒精依赖的终生DSM-IV(精神疾病诊断和统计手册，第4版)诊断的风险，人们知之甚少。方法：从1998年到2001年，对来自7个美洲原住民部落的1660人进行了面对面的访谈。用Logistic回归估计不同类型和不同不良童年经历对酒精依赖的影响。结果：不同部落的酒精依赖率和几种不良童年时期的接触情况有显著差异。酒精依赖的终生流行率在所有部落中都很高(男性：21%-56%，女性：17%-30%)，但只有一个部落(男性：1%，女性：2%)。一种或多种不良童年经历的患病率很高(男性：74%-100%；女性：83%-93%)。对于男性来说，身体虐待和性虐待的结合显著增加了随后酒精依赖的可能性(优势比[OR]=1.58；95%可信区间[CI]，1.10-2.27)。对于女性来说，性虐待(OR=1.79；95%CI，1.21-2.66)和寄宿学校出勤率增加了酒精依赖的几率(OR=1.57；95%CI，1.03-2.40)。观察到男性和女性的两种不同的剂量-反应关系模式。在考虑了部落特定的文化因素和地理区域后，部落间的酒精依赖率仍然存在显著差异。结论：童年暴露对高危行为的影响强调在医疗环境中筛查暴力行为，并为居住在部落保留地及其附近的父母和儿童制定社会和教育计划。
Background: Alcohol abuse and alcoholism are leading causes of death among Native Americans. Little is known about the impact of negative childhood exposures, including parental alcoholism, childhood maltreatment, and out-of-home placement, on risk of lifetime DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis of alcohol dependence in this population.Methods: Face-to-face interviews were conducted with 1660 individuals from seven Native American tribes from 1998 to 2001. Logistic regression was used to estimate the impact of specific types and number of different adverse childhood experiences on alcohol dependence. Relationships between tribe-specific cultural characteristics and alcohol dependence were also examined.Results: There were significant tribal differences in rates of alcohol dependence and several adverse childhood exposures. Lifetime prevalence of alcohol dependence was high among all tribes (men: 21%-56%, women: 17%-30%), but one (men: 1%, women: 2%). High prevalence rates were documented for one or more types of adverse childhood experiences (men: 74%-100%; women: 83%-93%). For men, combined physical and sexual abuse significantly increased the likelihood of subsequent alcohol dependence (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.10-2.27). For women, sexual abuse (OR=1.79; 95% CI, 1.21-2.66) and boarding school attendance increased the odds of alcohol dependence (OR=1.57; 95% CI, 1.03-2.40). Two separate patterns of dose-response relationships were observed for men and women. Significant inter-tribal differences in rates of alcohol dependence remained after accounting for tribe-specific cultural factors and geographic region.Conclusions: Effects of childhood exposures on high-risk behaviors emphasize screening for violence in medical settings and development of social and educational programs for parents and children living on and near tribal reservations.