An evaluation of the measurement equivalence of the Childhood Trauma Questionnaire--Short Form across gender and race in a sample of drug-abusing adults.

OBJECTIVE: A number of practice guidelines and recommendations call for an assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening instruments, however, has not been examined. High rates of childhood abuse history have been reported among adults who abuse substances. The objective of this study was to investigate the measurement invariance of the Childhood Trauma Questionnaire--Short Form (CTQ-SF) across groups defined by gender and race in a sample of substance-abusing adults. METHODS: This study performed a cross-sectional survey of 693 active intravenous drug abusers from San Antonio, TX. Structural equation modeling methods were used to evaluate the measurement invariance of the CTQ-SF between male and female subjects and between Black and Hispanic subjects. RESULTS: Evidence was found for the invariance of the five-factor structure of the CTQ-SF across groups and for a partial invariance model at the item level. Consistent with study hypotheses, two items that referred to "abuse," using the actual word, were more likely to be endorsed by women than by men, even after controlling for responses on similar items. In addition, compared to Hispanics, Blacks tended to report having been "punished with hard objects" at higher rates than expected from their responses on other items related to physical abuse. CONCLUSION: The amount of bias from nonmeasurement invariance in the CTQ-SF across groups was minimal at the total scale score level. Clinically, however, individual questions that use broad labeling terms are more likely to identify women as having a history of abuse, and individual questions that blend the constructs of physical discipline and physical abuse may overidentify Black Americans as having a history of abuse.

Self-assessment of cultural and linguistic competence in an ambulatory health system.

The University Health System (UHS) leaders organized a comprehensive planning process of its ambulatory care system. As part of this planning process, UHS assessed the cultural and linguistic competence of its outpatient environment. This assessment was conducted within the context of standards outlined in the U.S. Department of Health & Human Services (2001) Standards for Cultural and Linguistically Appropriate Services, using a multimethod approach. This multimethod approach included (1) a review of the organizational profile, (2) a review of organizational documents, (3) a review of policies and procedures, (4) clinic site visits, (5) a staff survey, (6) patient and provider focus groups, and (7) interviews with key stakeholders in the community. Generally, the UHS was found to have several strengths that enable it to continue meeting the medical needs of its target populations. To develop greater capacity in the areas of cultural and linguistic competencies, the UHS should continue to promote respect for diversity by focusing on attitudes; beliefs; behaviors; practices; and communication patterns associated with race, ethnicity, religion, socioeconomic status, historical and social context, physical or mental ability, age, gender, sexual orientation, generational status, and acculturation level. Recommendations for achieving a more culturally competent healthcare organization are provided.

Childhood abuse and neglect histories in low-income women: prevalence in a menopausal population.

OBJECTIVES: To examine the prevalence of self-reported childhood abuse and neglect in a primary care population of menopausal women. DESIGN: A cross-sectional questionnaire-based study. RESULTS: Three of four women (119/160, 74%) reported histories of childhood abuse and neglect. The prevalence of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect were 43%, 35%, 33%, 49%, and 44%, respectively. Eleven percent of the sample reported maltreatment in all five categories of trauma. Fifteen percent of women studied met criteria for severe-extreme levels of maltreatment, usually in more than one category. CONCLUSIONS: A high prevalence of self-reported childhood trauma was detected in our low-income population of menopausal women attending primary care clinics. Because of the potential impact of childhood trauma on physical and mental health, clinicians need to inquire about childhood maltreatment in women of menopausal age and appropriately refer women to mental health intervention and treatment.

Redes En Acción. Increasing Hispanic participation in cancer research, training, and awareness.

Hispanics are affected by many health care disparities. The National Cancer Institute (NCI), through its Special Populations Branch, is supporting networking and capacity-building activities designed to increase Hispanic participation and leadership in cancer research. Redes En Acción established a national network of cancer research centers, community-based organizations, and federal partners to facilitate opportunities for junior Hispanic scientists to participate in training and research projects on cancer control. Since 2000, Redes En Acción has established a network of more than 1800 Hispanic leaders involved in cancer research and education. The project has sustained 131 training positions and submitted 29 pilot projects to NCI for review, with 16 awards for a total of $800,000, plus an additional $8.8 million in competing grant funding based on pilot study results to date. Independent research has leveraged an additional $32 million in non-Redes funding, and together the national and regional network sites have participated in more than 1400 community and professional awareness events. In addition, the program conducted extensive national survey research that provided the basis for the Redes En Acción Latino Cancer Report, a national agenda on Hispanic cancer issues. Redes En Acción has increased participation in cancer control research, training, and awareness among Hispanic scientists and within Hispanic communities. Cancer 2006. (c) 2006 American Cancer Society.

Childhood trauma, sexually transmitted diseases and the perceived risk of contracting HIV in a drug using population.

This cross-sectional study explored the association among childhood trauma, sexually transmitted diseases histories, and perceived risk of contracting AIDS in 358 women and 338 male drug users in San Antonio, Texas. Women addicts were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Significant findings were that women with increasing severity of abuse (emotional, physical, and sexual) histories as measured by the Childhood Trauma Questionnaire had increasing numbers of sexually transmitted diseases and perceptions of contracting HIV. These findings have implications for future directions in HIV and sexually transmitted disease intervention programs.

A national agenda for Latino cancer prevention and control.

Although cancer is a leading cause of morbidity and premature death among Latinos, there is limited knowledge of cancer-related issues and priorities of greatest significance to the Latino population, the largest minority group in the nation. This information is vital in helping to guide Latino cancer research, training, and awareness efforts at national, regional, and local levels. To help identify cancer issues of greatest relevance to Latinos, Redes En Accion, The National Hispanic/Latino Cancer Network, a major network among the National Cancer Institute's Special Populations Networks, conducted a survey of 624 key opinion leaders from around the country. Respondents were asked to rank the three cancer sites most important to Latinos in their region and the five issues of greatest significance for this population's cancer prevention and control. Recommendations were prioritized for three specific areas: 1) research, 2) training and/or professional education, and 3) awareness and/or public education. Among cancers, breast carcinoma was ranked number one, followed in order by cervical and lung carcinomas. The issues of greatest significance to Latinos were 1) access to cancer screening and care, 2) tobacco use, 3) patient-doctor communication, 4) nutrition, and 5) risk communication. This survey solicited information from scientists, health care professionals, leaders of government agencies, professional and community-based organizations, and other stakeholders in Latino health. The results laid the foundation for a national Redes En Accion Latino cancer agenda, thus providing a useful tool for individuals and organizations engaged in cancer prevention and control efforts among the Hispanic-Latino population.

Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population.

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects,higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.

Psychological distress in childhood trauma survivors who abuse drugs.

The relationships between the level of childhood maltreatment and current psychological distress were examined in a community sample of 676 substance abusing men and women using a validated self-report instrument (the Childhood Trauma Questionnaire) designed to measure physical, emotional, and sexual abuse and physical and emotional neglect. Current levels of self-reported psychological distress/symptoms were measured using a 53-item Brief Symptom Inventory. Prevalence of early trauma ranged from 44% for emotional neglect to 65% for sexual abuse. The severity of all forms of childhood maltreatment were directly associated with current psychological distress.