Adolescent female vomiters and alcohol abuse: differences on violence measures.Abstract: Numerous studies on adolescent risk behaviors have defined bulimic bu·li·mi·a n. 1. An eating disorder, common especially among young women of normal or nearly normal weight, that is characterized by episodic binge eating and followed by feelings of guilt, depression, and self-condemnation. behavior by examining responses to paper-and-pencil measures on vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body. behaviors. Alcohol abuse among adolescent populations is a common practice and can be a factor in vomiting behaviors. Few studies have differentiated between groups that abuse alcohol and also display vomiting behavior. The purpose of this study was to compare vomiting and alcohol abuse female groups (N = 1170) on violence measures using data from the 1998 version of the Alabama Adolescent Survey. Results indicate a relationship between the incidence of violence with both vomiting behavior and alcohol abuse. ********** Eating disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. are relatively common in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . Conservative estimates indicate that 5-10% of women have an eating disorder eat·ing disorder n. Any of several patterns of severely disturbed eating behavior, especially anorexia nervosa and bulimia, seen mainly in female teenagers and young women. of some kind (Eating Disorder Awareness and Prevention, 2000). While most of the attention has focused on college women, 0.5-1% of adolescent girls also have an issue with eating disorders (K-Seidenfeld & Ricket, 2001). A co-morbid risk factor associated with eating disorders is substance abuse. This may be due to personality characteristics that may be complicated by anxiety and impulsivity (Grau & Orter, 1999; Loxton & Dawe, 2001; Vitousek & Manke, 1994). The need to control is common to both substance abuse and disordered eating Disordered Eating is a term that is used by some people to describe a wide variety of irregularities in eating behavior that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa. behavior and if one examines the characteristics of women being clinically treated for eating disorders, more than 50% displayed alcohol abuse (Watts & Ellis, 1992). Substance abusing women with eating disorders seem to follow the same course of addiction as those abusers without eating disorders (Specker, Westermeyer, & Thuras, 2000). However, women with both afflictions tend to be younger, more often single, and more likely to be living with family or friends (Specker, Westermeyer, & Thuras, 2000). Cooley and Toray (2001) found that bulimic symptoms increased as alcohol use increased. Other studies have shown that female adult children of alcoholics Adult Children of Alcoholics (ACAs) refers to individuals who have grown up in a dysfunctional household as a result of their caretakers's alcoholism. ACAs find they often have common characteristics into adulthood as the result of their childhood and upbringing, often are at risk for eating disorders, interpersonal problems, and sexual abuse (Ackerman & Gondolf, 1991; Berkowitz & Perkins, 1988; Bulik, 1987; Cooley & Toray, 2000). These individuals also showed prevalence of a childhood environment of violence (Stout & Mintz, 1996). Some researchers have concluded that both disordered eating behavior and substance abuse are used as a coping mechanism coping mechanism Psychiatry Any conscious or unconscious mechanism of adjusting to environmental stress without altering personal goals or purposes for girls dealing with depression and difficult family and peer relationships (Watts & Ellis, 1992). Potential triggers of disordered eating include anxiety associated with the threat of emotional and physical violence or other traumatic experiences (Lyubomirsky, Casper, & Sousa, 2001). One traumatic experience that has been frequently implicated im·pli·cate tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates 1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot. 2. as a potential trigger is sexual abuse. A number of studies suggest that childhood sexual abuse is a general risk factor for bulimia nervosa bulimia nervosa Eating disorder, mostly in women, in which excessive concern with weight and body shape leads to binge eating followed by compensatory behaviour such as self-induced vomiting or the excessive use of laxatives or diuretics. (Perkins & Luster, 1999; Romans, Gendall, Martin, et al, 2001; Wonderlich, Crosby, Mitchel, et al, 2001; Wonderlich, Brewerton, Jocic et al, 1997; Wonderlich & Donaldson, 1996). As much as 25% of bulimic behaviors have been attributed to childhood sexual abuse (Thompson et al., 2001; Wonderlich, Wilsnack, Wilsnack, et al, 1996). Very few studies have utilized childhood or adolescent populations to examine both bulimia bulimia: see eating disorders. and sexual abuse issues. Furthermore, few studies have examined vomiting as a dietary practice and how it is complicated by alcohol abuse (Loxton & Dawe, 2001; Rafiroiu, Sargent, Parra-Medina, Drane, & Valois, 2003). The purpose of this study was to examine vomiting behaviors and alcohol abuse among a group of rural southern adolescent females. Of particular interest were the associations between violence measures, vomiting and alcohol abuse status. METHOD INSTRUMENT This study utilized data from the 1998 Alabama Adolescent Survey (AAS). The AAS was previously administered in 1988, 1990, and 1993 (Adcock & Nagy, 1994; Nagy & Adcock, 1991, 1992). In its current form, the 109-item AAS has core questions that have test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument exceeding .80 (Nagy & Adcock, 1994). SAMPLING A voluntary sample of adolescents was drawn from 16 school districts in Alabama This is a list of school districts in Alabama, USA.
PARTICIPANTS The University of Alabama The University of Alabama (also known as Alabama, UA or colloquially as 'Bama) is a public coeducational university located in Tuscaloosa, Alabama, USA. Founded in 1831, UA is the flagship campus of the University of Alabama System. Institutional Review Board approved instrumentation and recruitment procedures. Participants included 9th and 10th grade students (N = 2272) present on days when data were collected. In smaller rural districts, all students participated. In semi-rural and urban districts, classes were selected at random from the participating schools. Surveys were completed in settings determined by school administrators. After listening to instructions about anonymity and voluntary participation, students completed the inventory and then deposited their completed answer sheets in a large enclosed collection box. A review of Alabama Health Department data on morbidity and mortality Morbidity and Mortality can refer to:
MEASURES Group Measures: Responses to items on vomiting and binge-drinking behaviors were used to separate respondents into four groups. The vomiting measure asked students to indicate how many times they had thrown up on purpose to lose weight during the past month. A yes response at any frequency categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat a student as practicing vomiting behaviors. The binge-drinking measure asked students whether they had consumed five or more alcoholic drinks at one sitting during the past two weeks. A yes response on this measure categorized the student as alcohol abusing. Using these two measures four groups were established: No Vomiting and No Binge- drinking (NV-NBd), Vomiting Only (V), Binge-drinking Only (Bd), and both Vomiting and Binge-drinking (VBd). Violence Measures: Seven items examined issues of assault and coercion. Coercion items asked: * How many times over the past 12 months did someone take something from you by using force or by threatening to hurt you? * How many times did someone threaten to hurt you but not actually hurt you? * How many times did a girl attack you in a way that you were left with a bruise bruise or contusion Visible bluish or purplish mark beneath the surface of unbroken skin, indicating burst blood vessels in deeper tissue layers. Bruises are usually caused by a blow or pressure, but they may occur spontaneously in elderly persons. or a scar? * How many times did a boy attack you in a way that you were left with a bruise or a scar? * Have you ever been forced to have sex or forced to do sexual things that you really didn't want to do? * Have you ever been forced to have intercourse Verb 1. have intercourse - have sexual intercourse with; "This student sleeps with everyone in her dorm"; "Adam knew Eve"; "Were you ever intimate with this man?" (sex)? One measure addressed assault and consisted of an item asking "How many times did you take something from someone by using force or by threatening to hurt them?" The violence measures also were categorized into yes or no responses. ANALYSIS Data from the survey were entered into the Statistical Package for the Social Sciences (statistics, tool) Statistical Package for the Social Sciences - (SPSS) The flagship program of SPSS, Inc., written in the late 1960s. ["SPSS X User's Guide", SPSS, Inc. 1986]. (SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. Version 12.0.1). Univariate analyses, including the use of frequencies, were conducted for each demographic variable and responses to the dependent and independent measures. Chi-square tests chi-square test: see statistics. were used to test for differences between groups on each measure, using a p value of <.05 to determine statistically significant differences. RESULTS A total of 1277 adolescent females took part in the AAS. Only responses from Caucasian (56%) and African American students (44%) were included in the current analyses due to few students from other ethnic groups. The final sample consisted of 1,170 young women. On average, the young women were 15.5 years of age with a median age of 15 years. Within this group, 53% lived with both their mother and father, 28% lived with one parent only, 4% lived with their grandparents grandparents npl → abuelos mpl grandparents grand npl → grands-parents mpl grandparents grand npl , and 15% reported other living arrangements. Demographic information for this sample is presented in Table 1. When asked about vomiting behavior, 12% of the sample reported making themselves vomit vomit /vom·it/ (vom´it) 1. to eject stomach contents through the mouth. 2. matter expelled from the stomach by the mouth. to lose weight during the past month. In addition, 29% reported having at least one 5-drink occasion in the past month. A review of the four groups revealed that the No Vomiting and No Binge-drinking-group (NV-NBd) comprised the largest number of students (n = 743) followed by the Binge-drinking Only group (Bd; n = 285), the Vomit Only Group (V;n = 83), and the both Vomiting and Binge-drinking-group (VBd; n = 59). With respect to the violence measures, young women most frequently reported being threatened, but not actually hurt (44%), followed by being attacked by a boy (24%). The young women in this sample were least likely to report being forced to have sex (8%). Table 2 shows the proportion of young women indicating that they had experienced each violence measure at least once by vomiting and binge-drinking groups. The four groups were then compared on each of the violence measures using Chi-square analysis. Two-by-two post hoc post hoc adv. & adj. In or of the form of an argument in which one event is asserted to be the cause of a later event simply by virtue of having happened earlier: comparisons (p=.05) identified specific groups that were different on each violence measure. Table 3 identifies the direction of significant differences between the groups. The analysis utilized seven independent measures compared across six groups, resulting in forty-two comparisons. Nineteen significant group differences resulted across the seven violence measures. A review of the group comparisons focused on establishing patterns among the various groups. Given the existing literature, it was hypothesized that group differences would be greatest between the NV-NBd group and the other three groups (V, Bd, VBd), with the VBd group portraying the most negative profile. A review of the six columns in Table 3 provides support for this hypothesis. Thirteen of the nineteen significant comparisons included the NV-NBd group. A review of percentages for this group in Table 2 confirms lower rates for this group on each of the violence measures. Ten significant comparisons involved the VBd group and all pointed in the anticipated direction of VBd being the group at highest risk of experiencing violence. An examination of established patterns was most striking for the sexual abuse measures. There were significant differences across the majority of group comparisons. Again, the lowest risk of sexual abuse was for the NV-NBd group and the highest risk was for the VBd group. Individuals in the V group had the second highest risk for sexual abuse revealing a statistically significant relationship between sexual violence and vomiting to lose weight, regardless of an individual's binge-drinking status. DISCUSSION The purpose of this investigation was to explore possible relationships between violence measures, vomiting with the intention of losing weight, and alcohol abuse status in rural southern adolescent females. Vomiting group members were defined as those individuals who reported having vomited at least once in the past month for the purpose of losing weight. Binge-drinkers, or alcohol abusers, were those students who reported drinking five or more alcoholic drinks at one sitting during the past two weeks. Definite patterns arose giving an overall picture of each group's risk. Significant differences existed between the Vomiting Only group when compared with the No-Vomiting No-Binge-drinking group. Although neither of these groups abused alcohol, the Vomiting Only group was more likely to report encountering violence than the group participating in neither risky behavior. The most similar groups, the Vomiting Only and Binge-Drinking Only groups, showed only two significant differences. These differences revealed that the females who vomited only were more likely than the binge-drinking only females to have been threatened and to have been forced to have sex. Clearly, there is a relationship between vomiting to lose weight and experiencing violence that is independent of alcohol abuse. The two groups who reported vomiting showed significant differences only when examining violent sexual activity, with those abusing alcohol and vomiting at higher risk of forced sexual activity. The only differences seen between the two drinking groups, the Binge-drinking Only group and the Vomiting and Binge-drinking group, occurred when analyzing the forced sexual activity measures. Those who abused alcohol and vomited experienced forced sexual activity at higher rates. Students participating in both drinking and vomiting behaviors were consistently the most at risk for participating in or experiencing violence. Correspondingly, the females who do not binge-drink and do not display vomiting behaviors were the least likely to be involved in or be victims of violence. These findings suggest that there is a relationship between the incidence of violence in this sample with both vomiting behavior and high alcohol consumption. Most importantly Adv. 1. most importantly - above and beyond all other consideration; "above all, you must be independent" above all, most especially , binge drinking binge drinking An early phase of chronic alcoholism, characterized by episodic 'flirtation' with the bottle by binges of drinking to the point of stupor, followed by periods of abstinence; BD is accompanied by alcoholic ketoacidosis–accelerated lipolysis and further complicates the risk for violence in individuals who vomit to lose weight. Although the results of this study offer new information about the relationships between these variables, these findings should be viewed with caution. First, causality causality, in philosophy, the relationship between cause and effect. A distinction is often made between a cause that produces something new (e.g., a moth from a caterpillar) and one that produces a change in an existing substance (e.g. of eating disorders and alcohol abuse cannot be inferred from these results. Those individuals placed into the vomiting categories were done so based on their answers to a self-report questionnaire and not based on the diagnosis of an eating disorder by a health professional. As mentioned, the data is composed of self-report answers that may underestimate the actual occurrence of vomiting behaviors, binge-drinking, and violent events. Another issue is that participants who did not respond to the survey honestly were removed from the considered sample. It is possible that these individuals had a higher risk of experiencing sexual abuse. Additionally, each student in the sample was a volunteer from a rural southern school system. Therefore, the results were not from a randomly selected sample and may not apply universally. Findings from this study support previous research linking substance abuse and traumatic experiences with disordered eating (Thompson, Wonderlich, Crosby, et al, 2001; Williams & Ricciardelli, 2003). Most importantly, this research looks at several measures of substance abuse, vomiting, and violence at the same time within a nonclinical sample. The results support the hypotheses that all these factors can be occurring at the same time. Vomiting to lose weight and violence are related independent of the effect of alcohol. Individuals with both the vomiting and substance abusing traits are at the highest risk for violence. This risk profile is particularly strong when considering sexual violence. IMPLICATIONS School counselors A school counselor is a counselor and educator who works in schools, and have historically been referred to as "guidance counselors" or "educational counselors," although "Professional School Counselor" is now the preferred term. should be aware that these behaviors (vomiting to lose weight and binge drinking) and violent events are clustered, and may occur alone or in combination with other risk factors. This knowledge can assist professionals in identifying individuals suffering from violence and direct them in meeting the needs of those individuals. This is of particular importance when creating a school-based intervention or education program. School health education professionals should collaborate with other educators and health workers, such as pediatricians and mental health professionals, to create inclusive programs addressing eating disorders, substance abuse, and violence collectively. These programs should focus on healthy ways to relieve stress, cope with the experiences of life, and have a sense of control over one's life without vomiting or abusing alcohol. Additionally, persons who binge-drink and vomit to lose weight share characteristics of a risk taking personality. Therefore, programs should address healthy ways to have fun and take positive risks in life. An awareness of the co-occurrence of the factors in this study can help prevent the perpetuation of the cycle of eating disorders, substance abuse, and violence. Future research should examine the patterns of substance abuse and violence with adolescent females who skip meals more often than vomit to lose weight. Also, this study could be replicated examining the abuse of substances other than alcohol to explore whether these substances are equivocally e·quiv·o·cal adj. 1. Open to two or more interpretations and often intended to mislead; ambiguous. See Synonyms at ambiguous. 2. Of uncertain significance. 3. Of a doubtful or uncertain nature. related to eating disorders and violence, or if these other substances have a more substantial influence on vomiting behavior and the presence of violence in the population. REFERENCES Ackerman, R.J., & Gondolf, E.W. (1991). Adult children of alcoholics: The effects of background and treatment on ACOA ACOA Adult Children Of Alcoholics ACOA Atlantic Canada Opportunities Agency ACOA American Committee on Africa ACOA Association Canadienne des Orthophonistes et Audiologistes (Canadian Association of Speech-Language Pathologists and Audiologists) symptoms. International Journal of the Addictions, 26, 1159-1172. Adcock, A.G., Jacobs, D.P., & Nagy, S. (1999). Health risk behaviors among Alabama adolescents, 1988-1998. ASAHPERD Journal, 21(1). Berkowitz, A., & Perkins, H. (1988). Personality characteristics of children of alcoholics. Journal of Consulting and Clinical Psychology The Journal of Consulting and Clinical Psychology (JCCP) is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad , 56, 206-209. Bulik, C.M. (1987). Drug and alcohol abuse by bulimic women and their families. American Journal of Psychiatry The American Journal of Psychiatry (AJP) is the most widely read psychiatric journal in the world. It covers topics on biological psychiatry, treatment innovations, forensic, ethical, economic, and social issues. , 144, 1604-1606. Cooley, E., & Toray, T. (2001). Disordered eating in college freshman women: A prospective study. Journal of American College American College is the name of:
Eating Disorders Awareness and Prevention, Inc. (2001). Eating disorders and their precursors. Retrieved on August 31, 2000, from http://www.eadp.org/edinfo/stats2.html Grau, E., & Orter, G. (1999). Personality traits and alcohol consumption in a sample of non-alcoholic women. Personality and Individual Differences, 27, 1057-1066. Hoek, H.W. (1995). The distribution of eating disorders. In K.D. Brownell and C.G. Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp. 207-211). New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Guilford Press. K-Seidenfeld, M., & Rickert, V.I. (2001). Impact of anorexia anorexia /an·orex·ia/ (-rek´se-ah) lack or loss of appetite for food. anorexia nervo´sa , bulimia and obesity on the gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology. health of adolescents. American Family Physician The American Family Physician is a medical journal of the American Academy of Family Physicians. See also
Loxton, N.J., & Dawe, S. (2001). Alcohol abuse and dysfunctional eating in adolescent girls: The influence of individual differences in sensitivity to reward and punishment. International Journal of Eating Disorders, 29, 455-462. Lyubomirsky, S., Casper, R.C., & Sousa, L. (2001). What triggers abnormal eating in bulimic and nonbulimic women? The role of dissociative dissociative /dis·so·ci·a·tive/ (-so´se-a´tiv) pertaining to or tending to produce dissociation. experiences, negative affect, and psychopathology psychopathology /psy·cho·pa·thol·o·gy/ (-pah-thol´ah-je) 1. the branch of medicine dealing with the causes and processes of mental disorders. 2. abnormal, maladaptive behavior or mental activity. . Psychology of Women Quarterly, 25, 223-232. Nagy, S., & Adcock, A.G. (1991). The 1990 Alabama Adolescent Health Survey. ASAHPERD Journal, 14, 18-20. Nagy, S., & Adcock, A.G. (1992). Summary report II, the Alabama Adolescent Health Survey: Health knowledge and behaviors. ERIC Resources in Education, 338, 608. Nagy, S., Adcock, A.G., & Nagy, M.C. (1994). A comparison of risky health behaviors of sexually active, sexually abused and abstaining adolescents. Pediatrics, 93(4), 570-575. Perkins, D.F., & Luster, T. (1999). The relationship between sexual abuse and purging: Findings from community-wide surveys of female adolescents. Child Abuse and Neglect, 23(4), 371-382. Rafirouiu, A.C., Sargent, R.G., Parra-Medina, D., Drane, W.J., & Valois, R.F. (2003). Covariations of adolescent weight-control, health-risk and health-promoting behaviors. American Journal of Health Behavior, 27(1), 3-14. Romans, S.E., Gendall, K.A., Martin, J.L., & Mullen, Paul E. (2001). Child sexual abuse Child sexual abuse is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. and later disordered eating: A New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. epidemiological study An Epidemiological study is a statistical study on human populations, which attempts to link human health effects to a specified cause. . International Journal of Eating Disorders, 9, 380-392. Specker, S., Westermeyer, J., & Thuras, P. (2000). Course and severity of substance abusing patients with comorbid eating disorders. Substance Abuse, 21(3), 137-147. Stout, M.L., & Mintz, L.B. (1996). Differences among nonclinical college women with alcoholic mothers, alcoholic fathers, and nonalcoholic non·al·co·hol·ic adj. A beverage usually containing less than 0.5 percent alcohol by volume. parents. Journal of Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. , 43(4), 466-472. Thompson, K., Wonderlich, S.A., Crosby R., et al. (2001). Sexual violence and weight control techniques among adolescent girls. International Journal of Eating Disorders, 29, 166-176. Vitousek, K., & Manke, F. (1994). Personality variables and disorders in anorexia nervosa anorexia nervosa: see eating disorders. anorexia nervosa Eating disorder, mostly in young women, characterized by a failure to maintain body weight at a normal level because of an intense desire to be thin, a fear of gaining weight, or a disturbance and bulimia nervosa. Journal of Abnormal Psychology Journal of Abnormal Psychology is a scientific journal published by the American Psychological Association. It has previously been entitled Journal of Abnormal & Social Psychology • , 103, 137-147. Watts, D.W., & Ellis, A.M. (1992). Drug abuse and eating disorders: Prevention implications. Journal of Drug Education, 22(3), 223-240. Williams, R.J., & Ricciardelli, L.A. (2003). Negative perceptions about self-control and identification with gender-role stereotypes related to binge eating Binge eating A pattern of eating marked by episodes of rapid consumption of large amounts of food; usually food that is high in calories. Mentioned in: Anorexia Nervosa , problem drinking, and to comorbidity among adolescents. Journal of Adolescent Health, 32, 66-72. Wonderlich, S.A., Brewerton, T.D., Jocic, Z., et al. (1997). Relationship of childhood sexual abuse and eating disorders. Journal of the American Academy The American Academy in Berlin is a non-partisan academic institution in Berlin. It was founded in September 1994 by a group of prominent Americans and Germans, among them Richard Holbrooke, Henry Kissinger, Richard von Weizsäcker, Fritz Stern and Otto Graf Lambsdorff and opened in of Child and Adolescent Psychiatry A branch of psychiatry that specialises in work with children, teenagers, and their families. History An important antecedent to the specialty of child psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with , 36(8), 1107-1115. Wonderlich, S., Crosby, R., Mitchel, J., Thompson, K., Redlin, J., Demuth, G. et al. (2001). Pathways mediating sexual abuse and eating disturbance in children. International Journal of Eating Disorders, 29, 270-279. Wonderlich, S., & Donaldson, M.A. (1996). Eating disturbance and incest incest, sexual relations between persons to whom marriage is prohibited by custom or law because of their close kinship. Ideas of kinship, however, vary widely from group to group, hence the definition of incest also varies. . Journal of Interpersonal Violence, 11(2), 195-207. Wonderlich, S.A., Wilsnack, R.W., Wilsnack, S.C., & Harris, T.R. (1996). Childhood sexual abuse and bulimic behavior in a nationally representative sample. American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. , 86(8, Pt.1), 1082-1086. CHES AREAS Responsibility I Competency A: Obtain health related data about social and cultural environments, growth and development factors, needs, and interests. Sub-competencies 1: Select valid sources of information about health needs and interests. Sub-competencies 2: Utilize computerized sources of health-related information. Sub-competencies 3: Employ or develop appropriate data-gathering instruments. Sub-competencies 4: Apply survey techniques to acquire health data. Sub-competencies 5: Conduct health-related needs assessment in communities. Competency B: Distinguish between behaviors that foster and those that hinder well-being. Sub-competencies 1: Investigate physical, social, emotional, and intellectual factors influencing health behavior. Sub-competencies 2: Identify behaviors that tend to promote or compromise health. Sub-competencies 3: Recognize the role of learning and affective experiences in shaping patterns of health behavior. Sub-competencies 4: Analyze social, cultural, economic, and political factors that influence health. Competency C: Infer needs for health education on the basis of obtained data. Sub-competencies 1: Analyze needs assessment data. Sub-competencies 2: Determine priority areas of need for health education. Lea G. Yerby, MS, CHES is affiliated with the Department of Health Science at The Unviersity of Alabama. M. Christine Nagy Christine Nagy is most notable for her career as a radio broadcaster. She is a morning radio personality at WLTW-FM (106.7 Lite FM), which is New York City's highest rated radio station. She is also an actress. , PhD and Stephen Nagy, PhD are affiliated with Western Kentucky University Student Body Profile WKU had a total enrollment in the Fall Semester of 2002 (the latest published figures) of 17,818 students. Out of this total, 73% were full-time and 85% were undergraduates. Ethnic and racial minority enrollment was just under 13% at 2,097. . Address all correspondence to Lea G. Yerby, MS, Doctoral Student, The University of Alabama, Department of Health Science, 209 East Annex, Box 870311, Tuscaloosa, AL 35487-0311; PHONE: 205-348-8371; FAX: 205-3487568; E-MAIL e-mail: see electronic mail. in full electronic mail Messages and other data exchanged between individuals using computers in a network. : yerby002@bama.ua.edu.
Table 1. Demographic Information of Sample (N = 1,170)
Characteristic %
Age
13 or younger 9
14 41
15 41
16 9
17 or older
Ethnicity
Caucasian 56
African American 44
Living Arrangement
Mother & Father 53
Mother Only 25
Father Only 3
Mother & Others 9
Father & Others 2
Grandparents 4
Other 4
Table 2. Proportion of Responses on Each Violence Measure by Group.
V VBd Bd NV-NBd
n = 83 n = 59 n = 285 n = 743
Measure % % % %
Something taken from you 21 32 22 17
Threatened, but not actually hurt 58 53 45 41
Attacked by a girl 11 20 12 8
Attacked by a boy 31 37 30 20
You threaten someone 18 25 21 13
Forced to do sexual things 25 48 29 20
Forced to have sex 12 22 11 5
* Note: V = Vomit Only; VBd = Binge-Drink and Vomit; Bd = Binge-Drink
Only; NVNBd = No Vomit, No Binge-Drink
Table 3. Direction of Data
Column 1 2 3
Measure I vs II I vs III I vs IV
Something taken from you
Threatened, but not
actually hurt II > III * I > IV **
Attacked by a girl
Attacked by a boy I > IV *
You threaten someone
Forced to do sexual things I < II **
Forced to have sex I < II ** I > III * I > IV *
Column 4 5 6
Measure II vs III II vs IV III vs IV
Something taken from you II > IV **
Threatened, but not
actually hurt
Attacked by a girl II > IV **
Attacked by a boy II > IV ** III > IV ***
You threaten someone II > IV ** III > IV ***
Forced to do sexual
things II > III ** II > IV *** III > IV **
Forced to have sex II > III * II > IV *** III > IV ***
Note: * = p < .05, ** = p [less than or equal to] .01,
*** = p [less than or equal to] .001
I = Vomiting Only, II = Vomiting and Binge-drinking, III =
Binge-drinking Only, N = No Vomiting and No Binge-drinking.
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