Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06516, USA.
Addiction. 2013 May;108(5):993-1000. doi: 10.1111/add.12115. Epub 2013 Mar 1.
To assess the extent to which the association between childhood sexual abuse (CSA) and early use of alcohol, cigarettes and cannabis in adolescent girls is mediated by risk factors that tend to cluster in families where CSA occurs.
An abridged version of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) was administered by telephone.
A total of 3761 female twins aged 18-29 (14.6% African American, 85.4% European American).
CSA experiences and history of substance use were queried in the SSAGA-based interviews.
After controlling for familial influences on early substance use by including co-twin early use status in models, separate Cox proportional hazards regression analyses predicting onset of alcohol, cigarette and cannabis use revealed a significant association with CSA. The effect was observed to age 19 years for cigarettes and to age 21 years for cannabis, but was limited to age 14 years or younger for alcohol, with the most pronounced risk before age 10 [hazard ratio (HR) = 4.59; confidence interval (CI): 1.96-10.74]. CSA-associated risk for initiation of cigarette and cannabis use was also highest in the youngest age range, but the decline with age was much more gradual and the hazard ratios significantly lower (HR: 1.70; CI: 1.13-2.56 for cigarettes and HR: 2.34, CI: 1.57-3.48 for cannabis).
Childhood sexual abuse history is a distinct risk factor for use of cigarettes and cannabis, and a very strong predictor of early age at first drink.
评估儿童期性虐待（CSA）与青少年时期早期饮酒、吸烟和使用大麻之间的关联在多大程度上受到倾向于聚集在发生 CSA 的家庭中的风险因素的影响。
通过电话进行了简化版半结构式酒精遗传学评估（SSAGA）。
共有 3761 名年龄在 18-29 岁的女性双胞胎（14.6%为非裔美国人，85.4%为欧裔美国人）。
在基于 SSAGA 的访谈中询问 CSA 经历和物质使用史。
通过在模型中包含同卵双胞胎早期使用状况来控制早期物质使用的家族影响后，分别对预测酒精、香烟和大麻使用起始的 Cox 比例风险回归分析显示与 CSA 存在显著关联。这种影响在 19 岁时对香烟可见，在 21 岁时对大麻可见，但仅限于 14 岁或以下的酒精，在 10 岁之前风险最大[危险比（HR）=4.59；置信区间（CI）：1.96-10.74]。CSA 与开始吸烟和使用大麻的关联风险在最小年龄范围内最高，但随着年龄的增长，风险下降得更为缓慢，且危险比显著降低（HR：1.70；CI：1.13-2.56 用于香烟和 HR：2.34，CI：1.57-3.48 用于大麻）。
儿童期性虐待史是使用香烟和大麻的一个独特风险因素，也是首次饮酒年龄较早的一个非常强的预测因素。
