***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This study examined the prevalence and psychological sequelae of childhood sexual and physical abuse in adults from the general population . METHOD A national sampling service generated a geographically stratified , r and om sample of 1,442 subjects from the United States . Subjects were mailed a question naire that included the Traumatic Events Survey ( TES ) [ Traumatic Events Survey , Unpublished Psychological Test , Harbor-UCLA Medical Center , Los Angeles ] and the  Trauma Symptom Inventory ( TSI )  [ Trauma Symptom Inventory Professional Manual , Psychological Assessment Re sources , Odessa , FL ] . Of all potential subjects , 935 ( 64.8 % ) returned substantially completed surveys . RESULTS Sixty-six men and 152 women ( 14.2 % and 32.3 % , respectively ) reported childhood experiences that satisfied criteria for sexual abuse , and 103 males and 92 females ( 22.2 % and 19.5 % , respectively ) met criteria for physical abuse . Twenty-one percent of subjects with one type of abuse also had experienced the other type , and both types were associated with subsequent adult victimization . After controlling for demographics , adult history of interpersonal violence , and other child abuse , childhood sexual abuse was associated with all 10 scales of the TSI , and physical abuse was related to all TSI scales except those tapping sexual issues . Sexual abuse predicted more symptom variance than did physical abuse or adult interpersonal victimization . Various aspects of both physical and sexual abuse experiences were predictive of TSI scores . Abuser sex , however , both alone and in interaction with victim sex , was not associated with additional TSI symptomatology . CONCLUSIONS Childhood sexual and physical abuse is relatively common in the general population , and is associated with a wide variety of psychological symptoms . These relationships remain even after controlling for relevant background variables OBJECTIVE To examine the long-term effects of an intervention combining teacher training , parent education , and social competence training for children during the elementary grade s on adolescent health-risk behaviors at age 18 years . DESIGN Nonr and omized controlled trial with follow-up 6 years after intervention . SETTING Public elementary schools serving high-crime areas in Seattle , Wash. PARTICIPANTS Of the fifth- grade students enrolled in participating schools , 643 ( 76 % ) were given written parental consent for the longitudinal study and 598 ( 93 % ) were followed up and interviewed at age 18 years . INTERVENTIONS A full intervention provided in grade s 1 through 6 of 5 days of in-service training for teachers each intervention year , developmentally appropriate parenting classes offered to parents when children were in grade s 1 through 3 and 5 through 6 , and developmentally adjusted social competence training for children in grade s 1 and 6 . A late intervention , provided in grade s 5 and 6 only , paralleled the full intervention at these grade s. MAIN OUTCOME MEASURES Self-reported violent and nonviolent crime , substance use , sexual activity , pregnancy , bonding to school , school achievement , grade repetition and school dropout , suspension and /or expulsion , and school misbehavior ; delinquency charges from court records ; grade point average ; California Achievement Test scores : and disciplinary action reports from school records . RESULTS Fewer students receiving full intervention than control students reported violent delinquent acts ( 48.3 % vs 59.7 % ; P=.04 ) , heavy drinking ( 15.4 % vs 25.6 % ; P=.04 ) , sexual intercourse ( 72.1 % vs 83.0 % ; P=.02 ) , having multiple sex partners ( 49.7 % vs 61.5 % ; P=.04 ) , and pregnancy or causing pregnancy ( 17.1 % vs 26.4 % ; P=.06 ) by age 18 years . The full intervention student group reported more commitment ( P=.03 ) and attachment ( P=.006 ) to school , better academic achievement ( P=.01 ) , and less school misbehavior ( P=.02 ) than control students . Late intervention in grade s 5 and 6 only did not significantly affect health-risk behaviors in adolescence . CONCLUSIONS A package of interventions with teachers , parents , and children provided throughout the elementary grade s can have enduring effects in reducing violent behavior , heavy drinking , and sexual intercourse by age 18 years among multiethnic urban children . Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods This study examined whether childhood victimization increases risk for drug abuse  using prospect i ve and retrospective victimization information . Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender , age , race , and approximate social class with nonabused/nonneglected children and followed prospect ively into young adulthood . Between 1989 and 1995 , 1,196 participants ( 676 abused/neglected and 520 control ) were administered a 2-hr interview , including measures of self-reported childhood victimization and drug use/abuse ( the National Institute of Mental Health Diagnostic Interview Schedule -- Version III -- Revised ) . Prospect ively , abused/neglected individuals were not at increased risk for drug abuse . In contrast , retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse . The relationship between childhood victimization and subsequent drug problems is more complex than originally anticipated OBJECTIVE This study examines whether  child abuse ; child neglect ; demographic , family and social , behavioral , economic , and neighborhood risk ; and protective factors predict different drug-use patterns into middle adulthood . METHOD Using a prospect i ve cohort design , individuals with documented cases of childhood physical and sexual abuse and neglect ( processed during 1967 - 1971 ) and a matched control group were followed into middle adulthood . Participants completed in-person interviews in 1989 - 1995 ( average age 29 ) , 2000 - 2002 ( average age 39.5 ) , and 2003 - 2004 ( average age 41 ) . The sample for this study included 374 women and 332 men . RESULTS Four patterns of drug use were revealed : ( a ) abstinence and low use ( 34 % ) , ( b ) adolescent and young adult limited use ( 31 % ) , ( c ) chronic-persistent use ( 29 % ) , and ( d ) late use ( 7 % ) . The chronic-persistent pattern was associated with being male , parental substance-use problems , involvement in crime , and neighborhood problems . The late-use pattern was significantly associated with childhood neglect and being Black , when other risk factors were controlled ; bivariate analyses also indicated associations with female gender , lower income , and greater neighborhood disadvantage . CONCLUSIONS This study revealed two patterns of drug use involving substance use and substance-related problems in middle adulthood that are associated with different sets of risk factors . Further research is needed to underst and the late-drug-use pattern , which appears to disproportionately involve low-income Black women with histories of childhood neglect . These individuals may be missed in efforts to prevent or reduce drug use among youths OBJECTIVE To determine whether  child physical maltreatment early in life has long-term effects on psychological , behavioral , and academic problems independent of other characteristics associated with maltreatment . DESIGN Prospect i ve longitudinal study with data collected annually from 1987 through 1999 . SETTING AND PARTICIPANTS R and omly selected , community-based sample s of 585 children from the ongoing Child Development Project were recruited the summer before children entered kindergarten in 3 geographic sites . Seventy-nine percent continued to participate in grade 11 . The initial in-home interviews revealed that 69 children ( 11.8 % ) had experienced physical maltreatment prior to kindergarten matriculation . MAIN OUTCOME MEASURES Adolescent assessment of school grade s , st and ardized test scores , absences , suspensions , aggression , anxiety/depression , other psychological problems , drug use , trouble with police , pregnancy , running away , gang membership , and educational aspirations . RESULTS Adolescents maltreated early in life were absent from school more than 1.5 as many days , were less likely to anticipate attending college compared with nonmaltreated adolescents , and had levels of aggression , anxiety/depression , dissociation , posttraumatic stress disorder symptoms , social problems , thought problems , and social withdrawal that were on average more than three quarters of an SD higher than those of their nonmaltreated counterparts . The findings held after controlling for family and child characteristics correlated with maltreatment . CONCLUSIONS Early physical maltreatment predicts adolescent psychological and behavioral problems , beyond the effects of other factors associated with maltreatment . Undetected early physical maltreatment in community population s represents a major problem worthy of prevention Prospect i ve longitudinal data from 585 families were used to examine  parents ’ reports of child physical abuse in the first 5 years of life as a predictor of substance use at ages 12 , 16 , and 24 . Path analyses revealed that physical abuse in the first 5 years of life predicted subsequent substance use for females but not males . We found a direct effect of early physical abuse on girls ’ substance use at age 12 and indirect effects on substance use at age 16 and age 24 through substance use at age 12 . For boys , age 12 substance use predicted age 16 substance use , and age 16 substance use predicted age 24 substance use , but physical abuse in the first 5 years of life was unrelated to subsequent substance use . These findings suggest that for females , a mechanism of influence of early physical abuse on substance use into early adulthood appears to be through precocious initiation of substance use in early adolescence AIMS The purpose of this study was to examine differences in the clinical presentation and treatment outcomes of older adults with a diagnosis of alcohol dependence compared to middle-aged adults . DESIGN The study is a prospect i ve naturalistic study . Participants included 1358 patients admitted to a residential rehabilitation program for alcohol dependence . RESULTS Older adults entering an alcohol rehabilitation program  are less impaired on a number measures of psychiatric distress and addiction severity but more impaired in somatic health . While there were no significantly different outcomes in abstinence rates at 1 month , older adults engaged in formal post-discharge aftercare less than middle-aged adults . CONCLUSIONS These results confirm impressions that older adults seeking alcohol treatment may have a lower severity of alcohol dependence compared to those at younger ages . However , results suggest that traditional outpatient substance abuse care is not accepted at the same rates as middle-aged adults . The low rates of engagement suggest the need for age appropriate treatment options and are potentially of concern if treatment is necessary to maintain short-term success Background Adverse childhood experiences ( ACEs ) have been consistently linked to psychiatric difficulties  in children and adults . However , the long-term effects of ACEs on mental health during the early adult years have been understudied . In addition , many studies are method ologically limited by use of non-representative sample s , and few studies have investigated gender and racial differences . The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes –depressive symptoms , drug abuse , and antisocial behavior – two years later during the transition to adulthood . Methods The study has a two-wave , prospect i ve design . A systematic probability sample of high school seniors ( N = 1093 ) was taken from communities of diverse socioeconomic status . They were interviewed in person in 1998 and over the telephone two years later . Gender and racial differences in ACE prevalence were tested with chi-square tests . Each mental health outcome was regressed on one ACE , controlling for gender , race/ethnicity , and SES to obtain partially st and ardized regression coefficients . Results Most ACEs were strongly associated with all three outcomes . The cumulative effect of ACEs was significant and of similar magnitude for all three outcomes . Except for sex abuse/assault , significant gender differences in the effects of single ACEs on depression and drug use were not observed . However , boys who experienced ACEs were more likely to engage in antisocial behavior early in young adulthood than girls who experienced similar ACEs . Where racial/ethnic differences existed , the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics . Conclusion Our sample of young adults from urban , socio-economically disadvantaged communities reported high rates of adverse childhood experiences . The public health impact of childhood adversity is evident in the very strong association between childhood adversity and depressive symptoms , antisocial behavior , and drug use during the early transition to adulthood . These findings , coupled with evidence that the impact of major childhood adversities persists well into adulthood , indicate the critical need for prevention and intervention strategies targeting early adverse experiences and their mental health consequences OBJECTIVE To examine : ( a )  child maltreatment 's association with young adult daily cigarette smoking , ( b ) variations in this association by gender , and ( c ) mediators of this association . METHODS For all study participants ( N = 1,125 , 94 % African American ) , data from multiple sources ( e.g. , child welfare records ) were collected prospect ively at child , adolescent , and young adult time points . Authors enlisted multivariate probit regression for objectives a and b versus exploratory and confirmatory mediation strategies for objective c. RESULTS Maltreatment was significantly associated with daily cigarette smoking . Although not moderated by gender , this relation was fully mediated by adolescent indicators of family support/stability , social adjustment , and cognitive/school performance along with 
    Output:
    
When studies that found no gender effects were compared with studies that did identify gender effects , differences in measurement , sample composition , and developmental timing of outcomes were identified .