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A total of 70.5% (9,508) of eligible participants returned questionnaires. Nonrespondents did not differ from respondents by gender, education or history of childhood sexual abuse (as indicated in the women’s medical records). Compared with nonrespondents, respondents were slightly older (57 vs. 49) and were more likely to be white (84% vs. 75%). For the purposes of this article, in which we evaluate the association between adverse childhood experiences and at-risk sexual behaviors, we included all female respondents for whom we had complete information on race and education.
All questions about adverse childhood experiences pertained to experiences during the respondent’s first 18 years of life. Each category of abuse and household dysfunction (having been abused verbally; having been abused physically; having been abused sexually; reporting that their mother had been treated violently; having lived with household members who were substance abusers; having lived with household members who were mentally ill or suicidal; or having lived with household members who had ever been imprisoned) has been described in detail. 15 A number of questions were taken from the Conflict Tactics Scale; the response categories for these questions included never, once or twice, sometimes, often or very often.
• Verbal abuse. Verbal abuse was determined from answers to the following questions from the Conflict Tactics Scale: “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 item defined verbal abuse during childhood.
• Physical abuse. Two questions from the Conflict Tactics Scale were used to describe physical abuse during childhood. These were: “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?” Respondents were defined as experiencing physical abuse if they answered “often” or “very often” to the first question or “sometimes,” “often” or “very often” to the second one.
• Sexual abuse. Four questions used in previous work 16 were adapted to create the following question on contact sexual abuse during childhood: “Some people, while they are growing up in their first 18 years of life, had a sexual experience with an adult or someone at least five years older than themselves. These experiences may have involved a relative, family friend or stranger. During the first 18 years of [your] 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” reply to any of these four questions defined a participant as having experienced sexual abuse during childhood.
• Battered mother. Four questions were used from the Conflict Tactics Scale to define childhood exposure to a battered mother. The questions were as follows: “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 defined a respondent as having had a battered mother.
• Household substance abuse. Two questions adapted from the National Health Interview Survey 17 addressed whether the respondent, during her or his childhood, lived with a substance user. The questions were: “During your first 18 years of life, did you live with anyone who was a problem drinker or alcoholic?” and “During the first 18 years of life, did you live with anyone who used street drugs?” An affirmative response to either question indicated childhood exposure to substance abuse in the household.
• Mental illness in the household. A respondent who reported that during his or her childhood anyone was mentally ill or depressed or that anyone in the household had attempted suicide was considered exposed to mental illness. The questions used to measure such exposure were: “During your first 18 years of life, was anyone in your household depressed or mentally ill?” and “During your first 18 years of life, did anyone in your household attempt to commit suicide?”
• Incarcerated household member. If anyone in the household had gone to prison during the respondent’s childhood, this was defined as childhood exposure to an incarcerated household member. The question was: “During your first 18 years of life, did anyone in your household go to prison?”
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