College students and emerging adults have been found to be at risk for smoking cigarettes, drinking to excess, using illicit drugs, driving dangerously, and engaging in risky sexual and delinquent behaviour. Psychosocial correlates (Sensation Seeking, peer behaviour, parent behaviour, and peer and parent anti-substance use messages) from three domains of influence (personality, parent, and peer) were examined together to provide a greater context for the occurrence of such health-risk behaviours. The strongest predictor(s) of each behaviour were identified to better inform intervention practices. Three groups were compared— 1) those who never tried substances, 2) those who tried substances in the past, and 3) those who continue to use substances at present, in a population of emerging adults. Self-report data was gathered from 203 Collèges d'Enseignement Général Et Professionnel (CEGEP) students in the Montreal region. Measures included: Reckless Behaviour Questionnaire, Reckless Driving Measure, Health Behaviour Survey, Sensation Seeking Scale—Form V, and the Marlowe-Crowne Social Desirability Scale. Results revealed that peer behaviour was the most significant predictor of substance use in emerging adults, whereas parent behaviour was only a significant predictor of reckless driving. Sensation Seeking, specifically Disinhibition, was found to predict more global reckless behaviours, including illegal activities, such as stealing or using marijuana (p < .01). Neither peer nor parent anti-substance messages were significantly related to any of the health-risk behaviours measured in this study. It would appear that health-risk behaviours tend to be related to the same underlying factors but to varying degrees. Intervention implications are discussed.

Women with histories of interpersonal trauma (physical, sexual, or psychological abuse experienced during childhood, adolescence, and adulthood) are more likely to experience posttraumatic stress symptoms (PTSS) and to develop physical health problems than women without trauma histories. In fact, PTSS and posttraumatic stress disorder (PTSD) have been established in the literature as mediators of the relation between interpersonal trauma and physical health outcomes (e.g., Resnick et al., 1997; Schnurr & Green, 2004). What remains to be determined is a clear understanding of the various mechanisms explaining why individuals with trauma histories, and subsequently PTS symptoms, go on to develop physical health problems. The purpose of this study was to examine the role of health risk behaviours, specifically sexual risk taking and substance use, as possible mechanisms through which interpersonal trauma and PTSS might influence physical health. These relations were examined, through structural equation modelling, in a sample of 475 women currently attending university. Models were tested separately for sexual traumas (childhood sexual abuse and sexual assault experienced during adolescence and adulthood) and nonsexual interpersonal traumas (physical and psychological maltreatment by parents in childhood, witnessing violence between parents, and intimate partner violence in their own relationships). Results indicated that PTSS severity partially mediated pathways from both types of interpersonal trauma, sexual and nonsexual, to adverse health outcomes, contributing to the existing theory that one’s psychological response to a trauma may be more important in determining physical health outcomes than the trauma itself. Furthermore, a significant indirect pathway was found to link nonsexual trauma to risky sexual behaviours through PTSS severity. In addition, PTSS severity fully mediated the relation between nonsexual trauma and substance use behaviours. These latter findings suggest that the likelihood of engaging in substance use and/or risky sexual behaviours may be greater in trauma survivors who are suffering from posttraumatic stress symptoms. Contrary to hypotheses, no significant pathways were found from risky sexual behaviours or substance use to physical health outcomes in the context of trauma variables and PTSS severity. Consequently, these health risk behaviours were not found to operate as mechanisms explaining the link from PTSS severity to physical health outcomes. Limitations and alternative hypotheses are presented. Implications for clinical interventions and recommendations for future research are discussed. / Graduate / 0621 / 0622 / 0384

Child maltreatment is not a new issue. It has existed in various forms in every society since the early days in history. However, it is only in the past four decades that abuse and neglect of children has attracted widespread interest among health professionals and the general public. There is now a large body of evidence that identifies four main maltreatment forms: physical, sexual, emotional maltreatment and neglect. Child maltreatment is a substantial public health problem, as it is associated with immediate and long-term health problems. Most research into child maltreatment has been conducted in English-speaking, developed countries. Although there has been a small but steady increase in the number of studies from less developed countries over the past decade, there remains a relative dearth of research in these populations, especially in Asia. Over the years, most research projects around the world tend to be focused on only one type of child maltreatment (usually either child sexual abuse or child physical maltreatment), and many studies do not examine risk factors in depth, or address the possible outcomes of various forms of maltreatment. Children have always held a very important place in the culture and traditions in Vietnam. In 1989, Vietnam was the first Asian country and the second country in the world to sign and ratify the United Nations Convention on the Rights of the Child. Since then Vietnam has adopted various measures to promote children's rights and particularly children's rights to be protected from abuse and exploitation. Despite strong political support for the rights of children, there is little formal research into child maltreatment. From the small amount of available evidence and media reports, it appears that children in Vietnam are vulnerable to maltreatment, just as they are all over the world. It is clear that information about the extent and health consequences of different forms of child maltreatment from scientifically sound studies is still far from sufficient. Thus, more research is essential to ensure effective and culturally appropriate responses to protect children from maltreatment. The primary aim of this research was to examine the nature and co-occurrence of four forms of child maltreatment including sexual, physical, emotional maltreatment and neglect among Vietnamese secondary and high school adolescents in both urban and rural settings, and determine the extent to which such adverse experiences impact on self-reported health risk behaviours and physical and mental health. A mixed methods design including qualitative interviews and focus group discussions, and a cross-sectional survey was employed in this study. Incorporation of qualitative inquiry added a cultural dimension on child maltreatment and informed to develop appropriate quantitative measures. Following 8 focus group discussions and 16 in-depth interviews as well as a pilot study of 299 adolescents in Vietnamese schools, a cross-sectional survey of 2,591 adolescents randomly selected from eight secondary and high schools in one urban district and one rural district was undertaken between 2004 and 2005. Data were collected by self-administered questionnaires in class rooms. Key information included demographics, family characteristics and environment, and four scales measuring sexual abuse, emotional and physical maltreatment and neglect as well as standard brief assessments of health related risk behaviours, mental and general physical health. The study clearly revealed that experiences of different forms and co-occurrence of child maltreatment among school adolescents were prevalent in Vietnam. The prevalence estimates of at least one type of physical and emotional maltreatment, neglect and sexual abuse were 47.5%, 39.5%, 29.3% and 19.7% respectively. A significant proportion of respondents (41.6%) was exposed to more than one form of child maltreatment, of which 14.5% and 6.3% experienced three or four maltreatment forms. Results from multivariate logistic regression analyses showed that the prevalence of child physical and emotional maltreatment and neglect among adolescents was not statistically different between urban and rural districts. However, children from rural schools were more likely to report unwanted sexual experiences than their counterparts in urban schools. There was no significant gender difference in reports of adverse sexual experiences. In contrast, girls were more likely to report emotional maltreatment and neglect whereas boys were more likely to experience physical maltreatment. Furthermore, family environment assessed by parental quarrelling, fighting, perceived quality of parental relationship and emotional support appeared to be the most consistent factors significantly predicting each form of child maltreatment. After controlling for a wide range of potential confounding factors, many significant correlates between each type of maltreatment, each level of maltreatment co-occurrence and each health risk behaviour were found. In general, the pattern of correlations between child maltreatment and health risk behaviours was similar for females and males. Emotional maltreatment significantly correlated with most behaviours examined. Physical maltreatment seems more likely to be associated with involvement in physical fights and being threatened. Sexual abuse was significantly related to smoking, drinking, being drunk, and involvement in fighting. Statistically significant associations between neglect and self-harm such as involvement in fighting, feeling sad and hopeless, suicidal thoughts and attempts were found. Clearly, co-occurrence of child maltreatment was significantly associated with almost all examined health risk behaviours and a dose-response relationship was observed in most of the dependent variables. Regarding continuous measures of mental and physical health, multivariate regression analyses revealed that presence of four types of child maltreatment explained a small but significant proportion of variance (from 5% to 9%), controlling for a wide range of background variables. Additionally, while each form of child maltreatment had independent effects on depression, anxiety problems, low self-esteem and poor physical health emotional maltreatment appeared to be the strongest influence on mental and physical health of both female and male adolescents. Analysis of variance also clearly suggested that exposure to increasing numbers of maltreatment forms significantly increased the risk of mental and physical health problems in a dose-response fashion. The present study extends a small body of previous research examining poly-victimization in developed nations to an Asian country. The data contribute new knowledge on cross-cultural child maltreatment problems. Considerable commonalities as well as some differences in the findings in Vietnam compared with earlier research were found. One important conclusion concerns the significant independent associations between various types of child maltreatment, as well as the cumulative effects of poly-victimization on a wide range of health risk behaviours, depression, anxiety, self-esteem, and general physical health. This pioneering research in Vietnam provides timely and substantial evidence that can be used to raise public awareness of the nature of child maltreatment and the harmful effects of not only sexual and physical abuse but also other forms of emotional maltreatment and neglect which have not received attention before. These results from a community-based sample have demonstrated the urgent need for prevention programs. The current study provides an impetus for more comprehensive research in this sensitive area in the near future so that culturally and politically relevant evidence-based responses to child maltreatment can be developed in Vietnam.