CWRU researchers trace inner-city women's health issues to childhood traumas

(Press-News.org) Researchers at Case Western Reserve University have traced chronic health problems of adult inner-city women to traumas from childhood abuse and neglect.

The latest findings, reported in the journal Child Abuse & Neglect, complement prior studies of other socioeconomic groups and provide further evidence linking childhood mistreatment to serious health issues as adults, said Meeyoung O. Min, assistant professor of social work at Case Western Reserve's Jack, Joseph and Morton Mandel School of Applied Social Sciences.

The National Institute on Drug Abuse funded the study.

Min's research team set out to understand specific factors that link childhood trauma to major health problems that surface as adults. The research focused on inner-city women who participated in a series of studies examining the development of children with prenatal exposure to cocaine.

After ruling out such factors as age, education and race, the researchers found that childhood trauma affects physical health in adulthood through lifetime drug dependence, smoking, more adverse life events and greater psychological distress.

The study also found that emotional struggles and life strains—such as financial and family-related issues—and being re-victimized as adults, resulted in health problems among relatively young urban women with a history of substance use.

By identifying the specific cause in this link, Min said, interventions may be developed to help women avoid behaviors that lead to dependence on tobacco and illegal substances, additional trauma and other mental health issues.

Also, Min said, health care providers should be aware of childhood maltreatment as a potential contributor to health problems, especially among women in urban, low-income communities. Min urged providers to use the findings to design more personalized treatment.

Given their role in fostering the emotional and cognitive development of their children, women with childhood trauma potentially place their children at risk by exposing them to a range of adverse life events and poor capacity for parenting.

"The cycle can repeat itself," she said.

The study's participants

The study examined data from 279 women who gave birth at a large, urban publicly subsidized, teaching hospital in Cleveland between 1994 and 1996. These women were among 404 mothers with newborns recruited for a series of studies on the effects of prenatal cocaine exposure on their children's development.

About eight in 10 were African-American; about half used cocaine during pregnancy. One-fourth were married, 98 percent were of low socioeconomic status and about half were unemployed when they gave birth. They ranged in age from 31 to 54 (with an average age of 40) when their physical health was assessed, and more than a fourth had lost child custody.

Seven in 10 reported one or more childhood maltreatment: sexual abuse (32 percent), physical abuse (45 percent), emotional abuse (37 percent), emotional neglect (30 percent), and physical neglect (45 percent).

About half also reported a chronic medical condition, mainly hypertension, pulmonary diseases and pain syndromes.

The Assessment

The women provided information about their lives and children in five-hour research sessions when their children were 4, 6, 11 and 12 years old.

Information provided over time by the women included their personal accounts of the childhood trauma; responses from health surveys; diagnostic examination of addiction to alcohol, cocaine or marijuana; the kinds of everyday life stresses experienced; and psychological distress and the toll they took on their lives.

Min said the women were quite young to have such chronic health problems. The study raises concerns for their health and quality of life as they age, she said.

### Case Western Reserve researchers Sonia Minnes, assistant professor of social work, Lynn Singer, deputy provost and professor of pediatric medicine, and HyunSoo Kim, a doctoral social work student, contributed to the study.