Associations of childhood poly-adversity with alcohol problems among undergraduates: adolescent alcohol use trajectories and drinker self-schema.

OBJECTIVE: Undergraduate drinking is associated with childhood adversity, early alcohol experience, and drinker self-schema. However, the pathway linking childhood adversity to undergraduate drinking problems remains undefined. This study aimed to identify the effects of childhood poly-adversity on the sequelae of adolescent alcohol-use trajectory, drinker self-schema, and alcohol problems among undergraduates. We also examined whether adolescent alcohol-use trajectory and drinker self-schema mediated the effects of childhood poly-adversity on undergraduate alcohol problems. METHODS: Baseline data from an ongoing prospective study, which included 851 first- and second-year full-time college students in Taiwan, were used. An anonymous online questionnaire was administered. RESULTS: The results showed that low poly-adversity and high poly-adversity were associated with the mean of initial alcohol use frequency during adolescence and further alcohol problems at college than those with no adversity. High poly-adversity was also associated with the increase in alcohol use frequency during adolescence. Both initial and increase in alcohol use frequency were associated with higher drinker self-schema scores and further alcohol problems. The indirect effects of high poly-adversity on undergraduate alcohol problems were mediated through adolescent alcohol-use trajectories and drinker self-schema. CONCLUSION: Findings suggest that early identification of childhood poly-adversity and interventions to decrease adolescent drinking may prevent the formation of drinker self-schema and reduce undergraduate drinking problems.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis.

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

Peer Victimization Trajectory and Psychosocial Maladjustment in Early Taiwanese Adolescents: A Longitudinal Study.

This study examined the peer victimization trajectory and maladjustment outcomes among early Taiwanese adolescents. Data were extracted from a large-scale longitudinal study with a national representative sample. A total of 1691 school students in 4th, 6th, and 8th grade were analyzed. Using latent profile analysis, students were classified into four trajectories, chronic victims, late onset victims, desisters, and non-victims, based on their self-reported physical and verbal victimization at three time points. Maladjustment, including psychological distress, reduced school attachment, internet addiction, and suicidal ideation in 8th grade, were assessed. The results showed significant differences in adjustment among students in the four trajectories. Chronic victims had the poorest outcomes on most variables, followed by late onset victims and desisters, while non-victims had the least maladjustment. The findings highlight the need for future interventions that would consider students' victim status over time and pay particular attention to those who suffer constant bullying and abuse.

The structure, function, task, and effectiveness of hospital-based child protection teams in Taiwan.

BACKGROUND: Child protection teams (CPTs) are established in many countries with an intent to safeguard children at risk for maltreatment. However, the tasks and effectiveness of CPTs in Taiwan and many countries remain unclear. OBJECTIVE: A two-step, descriptive correlational study aimed to explore the implementation status and needs concerning the structure, functions, tasks, and effectiveness of hospital-based CPTs using a self-developed evaluation tool in Taiwan. PARTICIPANTS AND SETTING: Five experts and 10 CPT members were evaluated the psychometric properties of the evaluation tool. The main study participants comprised 153 CPT members in Taiwan in 2020. METHODS: Content validity, factor analysis, test-retest reliability, and internal consistency were used to evaluate the psychometric properties of the instrument. Descriptive and correlational statistics were to describe the implementation status and needs of the structure, functions, tasks, and effectiveness of hospital-based CPTs and their relationships. RESULTS: The psychometric properties of the tool were acceptable and satisfactory. The mean scores for each dimension of CPT implementation status were 2.77-2.93 (potential range 0-4) with the lowest for collaboration (mean = 1.97) and incentive (mean = 1.93). The average need scores for each dimension ranged 7.96-8.12 (potential range 0-10), indicating high needs for each dimension, particularly in support, cohesion, and incentive. The implementation status was significantly, weakly correlated with the needs. CONCLUSIONS: There is a need to further strengthen the structure and function of the CPTs and to improve its implementation in Taiwan. It is important to improve inter-agency collaboration and to establish an incentive mechanism for hospital CPTs. Working closely with community agencies is also needed to provide a good quality of care to the maltreated child and the family.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study.

BACKGROUND: Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan. OBJECTIVE: To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan. PARTICIPANTS AND SETTING: A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed. METHODS: Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference. RESULTS: Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time. CONCLUSIONS: This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.

Time-dependent effects of storage at -80 °C on the stability of butyrylcholinesterase activity in human serum.

Objectives: Butyrylcholinesterase (BChE) is an important biomarker in serum, and aberrant BChE activity indicates onset and progression of human diseases. The duration of serum storage at -80 °C may introduce variability into and compromise the reproducibility of BChE activity measurements. Design and Methods: We collected serum samples from eight healthy volunteers and determined serum BChE activity in these samples using a sensitive fluorescence assay at various time points during a six-month storage period at -80 °C. Changes in averaged BChE activity over storage time were assessed by repeated measures analysis of variance (ANOVA). Sidak multiple comparisons test was also used to perform post-hoc analysis. Results: Almost all determined BChE activity values lay within the normal physiological range of BChE activity. However, repeated measures ANOVA using mean BChE activity vs. storage time showed that BChE activity values from two time points were significantly different. Analysis by Sidak multiple comparisons test provided no substantial change of BChE activity during the first 90 days of storage, but BChE activity noticeably decreased after 90 days. Conclusions: Serum samples stored in -80 °C for up to 90 days can be exploited to accurately determine BChE activity.

Hospital-Based Case Management Model for Child Protection Teams in Taiwan: An Action Research Approach.

BACKGROUND: Hospital-based child protection teams play an important role in the multidisciplinary assessment, treatment, care, and rehabilitation of abused children and their families. However, the process by which these teams are built and promoted has not been explored adequately in the literature. PURPOSE: This study was developed to examine the process used to promote child protection team case management and to evaluate the related results. METHODS: An action research model was adopted in this study. The participants and the investigator were members of a child protection team at a medical center in southern Taiwan. Qualitative and quantitative assessments were used to identify problems related to organizational structure, intervention procedures, and evaluation effectiveness. Thereafter, the study program was implemented, and the results were evaluated. Content analysis of the qualitative data, including transcribed interviews with external benchmark members and members of the hospital's team and text entries from the investigator's reflective journal, was conducted. Quantitative data, including monitoring indicators for team case management, were analyzed using descriptive statistics. RESULTS: Three important concepts emerged related to changes in the promotion of case management by hospital child protection teams. These included formulation of a team operation model through visits to benchmark hospitals, establishment of the case management and monitoring mechanism based on team consensus, and expansion of collaboration with external agencies through the establishment of a child and adolescent protection medical regional integration center. The results of the promotion process were affected by factors that included member willingness, teamwork, hospital support, and national policy. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Use of the hospital child protection team case management model developed in this study was shown to facilitate the provision of consultation services, integrate the opinions and resources of experts from various fields, and allow the timely provision of acute care, follow-up family environment support, and social resources required by children and their family members. These measures help prevent the reoccurrence of child abuse and enable children to grow up healthily and free from violence.

Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study.

BACKGROUND: Abusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited. OBJECTIVE: To estimate health services utilization and costs attributable to AHT among children aged 0-4 years in Taiwan. PARTICIPANTS AND SETTING: Sixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator). METHODS: Health services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models. RESULTS: AHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64-17.27 times, 1.25-5.22 times, and 1.77-2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors. CONCLUSIONS: Children with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative.

Appraisal and evaluation of the instruments measuring the nursing work environment: A systematic review.

AIMS: To appraise the current instruments available for measuring the nursing work environment and re-examine the definition and construct of the nursing work environment. BACKGROUND: A psychometrically sound instrument is fundamental to understanding and improving the nursing work environment. The nursing work environment is a complex construct, and its definition remains inconclusive. None of the instruments available is considered as the gold standard. EVALUATION: A comprehensive searching was undertaken in August 2021 in six databases according to PRISMA. The COSMIN and modified GRADE were applied to assess the methodological quality and measurement properties of the instruments. Instruments were categorized into three levels. The definition and construct of nursing work environment were revisited. KEY ISSUES: Forty-one studies (19 instruments) were included. One, fourteen, and four instruments are respectively appraised as A-, B- and C-level recommendation. Definition and eight labels of nursing work environment are identified. CONCLUSION: This paper provides recommendations for selecting a proper instrument for the nursing work environment. IMPLICATIONS FOR NURSING MANAGEMENT: This study helps nurse managers to select instruments and understand the construct of the nursing work environment. The eight labels can be used as a reference for tailoring policy aimed at creating a favourable nursing work environment.

Screening Tools for Child Abuse Used by Healthcare Providers: A Systematic Review.

BACKGROUND: The early detection of child abuse is essential for children at risk. Healthcare professionals working at hospitals and in the community are often the first to encounter suspected cases of child abuse. Therefore, an accurate identification of child abuse is critical for intervention. However, there is no consensus on the best method to screen for child abuse. PURPOSE: This systematic review was designed to evaluate the relevant psychometric properties and critically appraise the methodological quality of child abuse screening tools used by healthcare providers with children less than 18 years old. METHODS: We searched the Cochrane Library, MEDLINE, Embase, CINAHL, Education Resources Information Center, PubMed, Airiti Library, and OpenGray databases for studies on screening tools used to identify abuse in children published through October 2019 in English or Chinese. Information regarding populations, assessment methods, and accuracy parameters were extracted. Study quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Grading of Recommendation, Assessment, Development, and Evaluation criteria. RESULTS: Nine hundred thirty-nine abstracts and 23 full-text articles were reviewed for eligibility, and 15 screening tools for child abuse used by healthcare providers were identified. Screening tools often assess the presence of more than one form of abuse, but no single tool covered all forms. Of these, 10 tools screened for a single, discrete type of abuse, including nine physical abuse screening tools (three abusive head trauma tools) and one sexual abuse tool. Eighty percent (n = 12) of the screening tools had a moderate-to-high quality of evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation criteria. However, none of these screening tools achieved an adequate level of evidence based on the COnsensus-based Standards for the selection of health Measurement INstruments checklist. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified, of which nine screened for physical abuse. Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive. Therefore, future research should focus on the use of screening tools in the healthcare system to identify effective screening interventions that may help healthcare providers identify child abuse cases as early as possible.

From childhood victimization to internalizing and externalizing behavior problems through self-esteem in adolescence.

In this study, we aimed to determine whether forms of victimization influence internalizing and externalizing behavior problems differently and whether these relationships are mediated by self-esteem. This study included 2321 Taiwanese adolescents aged 11-21 from a previous case-control study. Six forms of victimization, self-esteem, and seven behaviors were measured. Gender, age, group (justice-involved vs. high-school adolescents), and family dysfunction were covariates in generalized linear models and path analysis. Different forms of childhood victimization were associated with different internalizing and externalizing behavior problems. Additionally, psychological abuse and psychological neglect were negatively associated with self-esteem, which itself was associated with all internalizing and externalizing behavior problems. Significant indirect effects of psychological abuse and psychological neglect on all internalizing and externalizing behavior problems (mediated by self-esteem) were also identified. Due to the limitation of measurement, the interpretation about the influence of victimization patterns could not be made. Findings suggest that different forms of childhood victimization may lead to different mechanisms for internalizing and externalizing behavior problems in adolescents. Further research is needed to identify the mechanisms underlying different forms of childhood victimization and to clarify the effects of victimization patterns to develop effective interventions.

Ecological Predictors and Trajectory of Internet Addiction from Childhood through Adolescence: A Nationally Representative Longitudinal Study.

We examined multidimensional factors within four systems (individual, family, school, and community) that influence internet addiction across time among children through adolescence in Taiwan. We hypothesize that internet addiction increases from childhood to adolescence and that resilience, child neglect, positive school experiences, and community violence are significant predictors at baseline and of the rate of change across time. Based on stratified random sampling, a valid sample size of 6233 Taiwanese children participated in our study, which we began in 2014 and then followed this sample in 2016 and 2018 using repeated measures. We used hierarchical linear modeling to model changes in internet addiction across time (with equal two-year intervals between assessments) and the associations between the predictors and internet addiction over time. The results show that internet addiction increases from childhood to adolescence. After controlling for gender, we found that resilience and positive school experiences predict less internet addiction, whereas neglect and community violence predict greater internet addiction. Over time, greater resilience predicts a decreasing trajectory of internet addiction, whereas greater neglect and community violence predict a slower increasing trajectory and positive school experiences predict a faster-increasing trajectory. A holistic approach can help children cope with internet addiction.

[Implementation of Trauma-Informed Healthcare].

Trauma that is rooted in extremely stressful events is an important factor affecting human health. Patients who have experienced trauma may present in a variety of different ways in healthcare settings. One of these ways is the exhibiting of strong emotional or behavioral reactions triggered by traumatic memories. Caring for patients affected by known or unknown trauma is a significant challenge for healthcare providers. The core of trauma-informed care includes understanding trauma; respecting, empathizing and responding to the needs and reactions of patients with trauma; and providing care in a manner that prevents re-traumatization. In this article, the impact of trauma on overall health is introduced followed by a presentation of trauma triggers in the healthcare context, underscoring the importance of prioritizing care for patients with a history of trauma. Lastly, the concept and principles of trauma-informed care are incorporated into healthcare practice, providing specific, practical application strategies for healthcare providers to use in clinical settings. Trauma-informed healthcare practice relies on healthcare providers and organizations working together. The principles include the self-awareness and self-care of healthcare providers, awareness of the patient's trauma reaction, ensuring patient safety, building trust and transparency in care, working collaboratively with the patient and the healthcare team, and providing choices and empowerment during the care process. This article provides a reference to healthcare providers for providing friendly and high-quality care to patients with trauma.

Exploring teachers' risk perception, self-efficacy and disease prevention measures during the outbreak of 2019 novel coronavirus disease in Taiwan.

BACKGROUND: The 2019 novel coronavirus disease pandemic (COVID-19) is one of the most serious health risks facing the global population. Teachers' responses are important in the management of the outbreak in schools. The purpose of this study is to examine teachers' risk perception, self-efficacy, response efficacy, and approach to disease prevention during the COVID-19 outbreak in Taiwan. METHODS: A descriptive, cross-sectional online survey was completed by 344 teachers across four levels of education. Pearson correlations between major variables were calculated. General linear model with a posthoc test was used to estimate the least squares means for each level of the independent variables and test the mean differences between the response scores. RESULTS: The teachers with a higher risk perception showed a stronger adoption of disease prevention measures, but they also showed lower self-efficacy. In addition, teachers with higher self-efficacy had higher response efficiency. Female teachers had relatively stronger adoption of disease prevention measures than their male colleagues, and age was associated with a 0.040 point increase in adoption scores. Elementary school teachers were significantly stronger in this regard than teachers at junior high schools, high schools and universities in terms of behavior scores. CONCLUSIONS: High implementation rate of Taiwanese teachers' disease prevention measures came from their higher risk perceptions. Among them, older female teachers, especially those who teach at elementary schools, are key to implementing disease prevention measures.

Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study.

OBJECTIVES: To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS: From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS: This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.

The impacts of maternal childhood adversity, stress, and mental health on child development at 6 months in Taiwan: A follow-up study.

Exposure to adverse childhood experiences (ACEs) is not only associated with one's adverse health outcomes in adulthood but also increases the risk of child developmental problems in offspring. However, the mechanisms involved in the transmission of the effects of maternal ACEs to the offspring largely remain unexplored. This study sought to identify possible psychosocial pathways of intergenerational effects of maternal ACEs on child development at 6 months. Data from a longitudinal study on maternal childhood adversity and maternal psychosocial risk during pregnancy as well as maternal mental health problems and child development at 6 months postnatal were used. Structural equation modeling with bootstrapping was used to estimate the indirect effects of maternal ACEs on child development at 6 months. The model showed that maternal ACEs indirectly influenced offspring's development via maternal stressful events during pregnancy and pre- and postnatal mental health problems. This finding highlights the possible interventions at the prenatal and postnatal periods. Early identification of women who have ACEs or who are at psychosocial risk during pre- and postnatal periods is critical to provide interventions to buffer those negative effects on offspring's development. Future studies are needed to longitudinally assess the effects of maternal ACEs on child development over time.

Impacts of childhood adversity forms and drinker self-schema on undergraduate drinking behaviors and depression.

PURPOSE: Drinking behaviors and depression are common and highly correlated behaviors in undergraduates. Child adversity and drinker self-schemas have been recognized as significant risk factors of drinking behaviors and depression. However, how the various child adversity forms differentially influence the formation of drinker self-schema and behaviors is underexplored. We aimed to determine whether drinker self-schema serves as a mechanism underlying the influence of child adversity forms on drinking frequency, drinking problems, and depressive symptoms. METHODS: A cross-sectional, correlational study design with an anonymous, internet-based survey was conducted. Participants were 330 first- and second-year undergraduates enrolled in a four-year college/university as full-time students in Taiwan. Path analysis was performed to examine the direct and indirect effects (through drinker self-schema) of child adversity forms on drinking frequency, drinking problems, and depressive symptoms. Gender and friend's alcohol use were the covariates. RESULTS: Psychological abuse, psychological neglect, physical neglect, and household substance use were associated with drinker self-schema, which was associated with drinking frequency, drinking problems, and depressive symptoms. Physical abuse was associated with drinking frequency. Household substance use and parent(s) treated violently were associated with drinking problems. Psychological neglect and household mental illness were associated with depressive symptoms. Moreover, psychological abuse and psychological neglect had indirect effects on drinking frequency and drinking problems through drinker self-schema. CONCLUSIONS: Different forms of childhood adversity are differently associated with drinker self-schema, drinking behaviors, and depression. Drinker self-schema serves as an underlying mechanism linking psychological maltreatments to drinking behaviors.

A psychometric analysis of a short form of the Chinese version of the ISPCAN child abuse screening tools - Children's home version (SC-ICAST-CH) using multidimensional item response theory.

BACKGROUND: The development of measures of child maltreatment for the Chinese population were limited until the Chinese version of the ISPCAN Child Abuse Screening Tools - Children's Home version (ICAST-CH-C) was proposed. Although the ICAST-CH-C was found to be effective in assessing the scope and prevalence of child maltreatment, it has several potential drawbacks. The time that is required to complete the ICAST-CH-C scale is longer than usual for a 36-item scale, because many of its items have one or more follow-up questions. Moreover, each item requires child victims to recall unpleasant experiences. Both phenomena can cause increases in invalid responses and in turn damage the data quality. OBJECTIVE: The goal of this study was to propose a short form of the ICAST-CH-C (called the SC-ICAST-CH) to reduce the test length and response time in order to improve the measurement quality. PARTICIPANTS AND SETTING: A dataset from a national survey of 5236 adolescents in Taiwan was used. METHODS: A multidimensional version of the rating scale model (MRSM) was fitted to the data. The model parameters were estimated with the ConQuest software. RESULTS: The results indicated the reliability of the SC-ICAST-CH was fairly good, with only 61 % of the original test length. Disordered thresholds were found in all five subscales; the underlying reasons for this phenomenon need further investigation. Specific cultural differences related to item retention/removal decisions were also discussed. CONCLUSION: The efficient, shorter SC-ICAST-CH was shown to be a valid and reliable instrument for assessing the prevalence of child maltreatment.

Alcohol-related cognitive mechanisms underlying adolescent alcohol use and alcohol problems: Outcome expectancy, self-schema, and self-efficacy.

PURPOSE: The objective of this study was to empirically test a theoretical model to determine the cognitive mechanisms that are associated with adolescent alcohol use and alcohol problems. We posited that alcohol outcome expectancies would affect alcohol-refusal self-efficacy through the drinker self-schema. We also posited that alcohol outcome expectancies and the drinker self-schema would affect alcohol use and problems through alcohol-refusal self-efficacy. METHODS: A survey was administered to 225 adolescents in a public junior high school in Taiwan at two-time points, six months apart. Path analysis was used to determine the mechanisms underlying the alcohol-related cognitive constructs on the alcohol use and alcohol problems separately, controlling for appropriate alcohol-related personal and environmental factors. Indirect effects were estimated using the bootstrapping method. RESULTS: Higher positive alcohol outcome expectancies and lower negative alcohol outcome expectancies predicted higher drinker self-schema scores. Higher positive alcohol outcome expectancies and drinker self-schema scores predicted lower alcohol-refusal self-efficacy. Lower alcohol-refusal self-efficacy was associated with a history of drinking and alcohol problems in the past six months. Effects of alcohol outcome expectancies on alcohol use and alcohol problems were partially mediated through the drinker self-schema and alcohol-refusal self-efficacy. CONCLUSIONS: Findings support the proposed theoretical cognitive mechanisms underlying alcohol use and alcohol problems in a sample of Taiwanese adolescents. Given that alcohol-related cognitive constructs are modifiable, the findings also provide a foundation to suggest that interventions to reduce positive alcohol outcome expectations and prevent the formation of a drinker self-schema may facilitate alcohol-refusal self-efficacy and mitigate drinking behaviors in this adolescent population.

Effects of academic performance on the relationship between child maltreatment and deviant behavior: A national study in Taiwan.

BACKGROUND: Child maltreatment has been found to significantly increase the risk of deviant behavior. Academic performance has been shown to have an indirect effect on the relationship between child maltreatment and deviant behavior. However, not all adolescents who have been maltreated engage in deviant behavior, so the relationship between child maltreatment and deviant behavior has remained unclear. OBJECTIVE: The aim of this research was to examine the potential mediating and/or moderating effects of academic performance on the relationship between child maltreatment and deviant behavior. PARTICIPANTS AND SETTING: The data in this study were from a nationwide study examining the consequences of childhood maltreatment in Taiwan. The database consisted of data from 2321 adolescents. METHODS: A secondary data analysis was conducted. Self-report data were obtained on childhood maltreatment experiences, academic performance, and deviant behaviors. Path analyses and a generalized linear model were used to examine the effects of academic performance on the relationship between child maltreatment and deviant behavior. RESULTS: Most participants were male (61.4%), with a mean age of 15.9 years. The mean scores of self-rated academic performance and deviant behavior were 2.86 and 8.2, respectively. A total of 83% participants reported having experienced childhood maltreatment. In this study, academic performance was found to have a moderating rather than a mediating effect on the relationship between child maltreatment and deviant behavior. Among adolescents who had been maltreated during childhood, those who self-rated poorer academic performance were more likely to have a higher deviant behavior score than those who self-rated better academic performance. CONCLUSIONS: Good academic performance can be a buffer that reduces the risk of deviant behavior among individuals with a history of childhood maltreatment. Healthcare professionals and educators can tailor early prevention and intervention educational programs targeted toward adolescents with experience of childhood abuse or poor academic performance to prevent the incidence of deviant behavior and thus break the cycle of violence.