Pathways From Childhood Maltreatment to Emerging Adulthood

Abstract

Longitudinal survey data were used to examine the relationship between two types of childhood maltreatment, abuse/neglect and exposure to intimate partner violence (IPV), and two outcomes, substance use and dating violence, within the past year. Participants were youth (N = 158, aged 16–19 at Time 3) involved with child protective services (CPS). A parallel multiple mediator model was used to test the hypothesis that trauma symptoms would mediate the relationship between both types of maltreatment and dating violence, marijuana, and alcohol use outcomes. Although both types of maltreatment were not directly associated with dating violence and substance use outcomes, the indirect effects of anxiety, anger, and dissociation on the relationship between maltreatment and substance use/dating violence were significant. Direct effects of both types of maltreatment on past year use of dating violence + alcohol use and dating violence + marijuana use were not significant, but results demonstrated a significant indirect effect for anger on the relationship between exposure to IPV and past year dating violence + marijuana use. No other indirect effects were significant. Findings highlight the negative effects of exposure to IPV and have implications for the development of prevention programming for youth transitioning out of CPS.

Keywords

child maltreatment domestic/intimate partner violence substance abuse adolescents youth

Emerging adulthood is a stage of unique developmental challenge marked by greater independence and exploration as well as feelings of instability and uncertainty (Arnett, 2004). In addition, the transition into emerging adulthood represents a period of vulnerability for the development of a number of maladaptive behaviors, including increased risk for substance use and substance-related problems (Arnett, 2005; Tucker, Ellickson, Orlando, Martino, & Klein, 2005) as well as for becoming either a perpetrator or a victim of dating violence (Centres for Disease Control [CDC], 2010a; Statistics Canada, 2011); rates of dating violence as well as heavy alcohol use are highest among adolescents and emerging adults. Arnett (2005) suggested that substance use may constitute an aspect of identity development as young adults “try on” diverse experiences before settling into adulthood and that emerging adults may use substances to self-medicate when struggling with emotions related to instability. Youth who come in contact with personal, social, and environmental obstacles to identity development during or prior to emerging adulthood may also struggle with mature intimacy and may engage in behaviors disruptive to the development of positive relationships (Montgomery, 2005).

Childhood maltreatment may be one such obstacle. There is a large body of research establishing childhood maltreatment as a risk factor for multiple negative outcomes in both adolescence and adulthood, including interpersonal difficulties (Jaffee & Gallop, 2007; Wolfe, Scott, Wekerle, & Pittman, 2001); aggression, violence, and criminal behaviors (Casiano, Mota, Afifi, Enns, & Sareen, 2009; Gilbert et al., 2009; Ou & Reynolds, 2010); physical and mental health problems (MacMillan et al., 2001; Scott, Smith, & Ellis, 2010); and the development of substance abuse and dependence (Simpson & Miller, 2002; Tonmyr, Thornton, Draca, & Wekerle, 2010). Young people involved with the child protective services (CPS) system may be a particularly vulnerable group, given that, in addition to significant histories of child maltreatment, they often experience multiple transitions, interrupted relationships, and a lack of continuity or consistency in activities, learning environments, friendships, and caregiver relationships (Fong, Schwab, & Armour, 2006; Healy & Fischer, 2011). Furthermore, the transition out of CPS, typically occurring during emerging adulthood, is likely to be fraught with multiple challenges for youth (Courtney & Dworsky, 2006; Keller, Cusick, & Courtney, 2007), further heightening their vulnerability for involvement in a variety of risk behaviors that are common among emerging adults within the general population. In light of numerous overlapping risk factors experienced by emerging adults with maltreatment histories and CPS involvement, research examining the mechanisms of risk-related outcomes among these youth is needed.

The purpose of this study was to address gaps in the existing literature by examining outcomes associated with two dynamically related risk behaviors—alcohol/marijuana use and the perpetration of dating violence—among CPS-involved adolescents and emerging adults. It was hypothesized that experiences of abuse and neglect as well as exposure to domestic violence among caregivers would predict later likelihood of engaging in both alcohol and marijuana use and perpetration of dating violence in late adolescence and emerging adulthood; furthermore, it was expected that trauma symptoms would mediate these relationships.

Intimate Partner and Dating Violence

In the United States, one in four women and one in seven men have experienced severe physical violence by an intimate partner (CDC, 2010a). In a recent survey of 19,000 Canadians, 6.4% of women reported that they were victims of physical violence at the hands of a partner or ex-partner within the previous 5 years (Statistics Canada, 2011). Victims of intimate partner violence (IPV; acts of physical aggression, psychological abuse, sexual coercion, or controlling or isolating behaviors toward one’s romantic partner or expartner) often suffer from serious and long-term health consequences, disruptions in employment, impaired psychosocial functioning, depression, self-harm, and even death (Afifi et al., 2009; Garcia, Soria, & Hurwitz, 2007; Swanberg, Logan, & Macke, 2005). Although rates of IPV are high among adults, prevalence is highest during adolescence and emerging adulthood. Individuals between the ages of 15 and 24 are both the most likely victims and perpetrators of IPV (CDC, 2010a; Statistics Canada, 2011)—or, more aptly, dating violence—with rates ranging from 10% using conservative definitions (i.e., physical or sexual violence; CDC, 2012) to up to 50% using less restrictive definitions (i.e., psychological and verbal abuse; Malik, Sorenson, & Aneshensel, 1997).

Youth (i.e., adolescent and emerging adult) profiles of dating violence may differ in important ways from adult IPV. In contrast to the broad consensus that men perpetrate more severe violence and cause greater injury toward their partners than women (Archer, 2002; Statistics Canada, 2011), research supports a more equal gender distribution for both victimization and perpetration of mild, moderate, and severe dating violence within youth couples (Foshee, 1996; Schnurr, Lohman, & Kaura, 2010; Windle & Mrug, 2009). Dating relationships also differ from adult relationships in terms of gendered power dynamics, experience and social skill development, and peer influence (Shorey, Cornelius, & Bell, 2008). During early experiences with romantic relationships, youth are largely unfamiliar with normative expectations and boundaries and may not immediately regard dating violence as problematic (Wekerle & Wolfe, 1999). Importantly, dating violence in adolescence and emerging adulthood is a risk factor for continued perpetration in later adulthood, particularly among youth already at risk (Capaldi, Shortt, & Crosby, 2003; Gomez, 2011). Wolfe and his colleagues (Wolfe et al., 2003) suggest that these early patterns of abusive behavior may be more experimental or less rigidly established and thus argue that adolescence represents an important opportunity to intervene with potential IPV perpetrators and to teach more adaptive, nonviolent relationship skills. Establishing more clearly the risk factors and underlying mechanisms of teen dating violence perpetration is essential to improving preventative and intervention efforts.

Substance Use and Dating Violence

Alcohol and drug use is a risk factor for the perpetration of IPV that is particularly relevant to young populations. As with the typical age of initiation of dating relationships, initiation of alcohol use usually takes place during adolescence (Adlaf & Paglia-Boak, 2009; Health Canada, 2010) and escalates into emerging adulthood, with the highest rates of alcohol use and heavy drinking among individuals aged 15 to 25 (Health Canada, 2010; Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). Although the relationship between alcohol use and perpetration of IPV is well documented in adult and college student samples (see Stuart et al., 2009), less is known about this relationship among adolescents and other samples of emerging adults. Furthermore, although marijuana is the most widely used illicit drug in both Canada and the United States, particularly among youth (Health Canada, 2010; SAMHSA, 2012), and has received attention as a potential risk factor for perpetration of IPV (e.g., Moore & Stuart, 2005), very little research has been directed at examining the relationship between marijuana and perpetration of dating violence among youth.

Much of the research examining the relationship between substance use and IPV perpetration has assumed a causal link as a result of intoxication-related aggression; however, these behaviors may also be related in more distal ways. Especially within the context of the experimentation and identity confusion of emerging adulthood, in which relationship patterns begin to emerge, substance misuse and dating violence may together create dynamic risk for increased engagement in each as well as for the potential that dating violence behaviors begin to occur within the specific context of intoxication. As research suggests that violence occurring while intoxicated is more severe than violence occurring while sober (Testa, Quigley, & Leonard, 2003), understanding the precursors to a more direct link is an important endeavor.

Childhood Maltreatment, Substance Use, and Dating Violence

A history of childhood maltreatment has also been linked to later perpetration of dating violence (Wekerle & Wolfe, 2003; Wekerle et al., 2009b; Wolfe et al., 2003) as well as to increased adolescent alcohol use and alcohol problems (see Tonmyr et al., 2010 for review), and marijuana use and dependence (Rogosch, Oshri, & Cicchetti, 2010; Wekerle, Leung, Goldstein, Thornton, & Tonmyr, 2009a). Although the link between childhood maltreatment and a variety of negative outcomes in adolescence and young adulthood is well established, the existing literature on this topic is primarily focused on the impact of physical and sexual abuse and, with the exception of a few studies, has not adequately addressed the effects of exposure to IPV among caregivers; this is true for research examining both substance use and IPV outcomes (e.g., Gomez, 2011; Moran, Vuchinich, & Hall, 2004; Widom, Czaja, & Dutton, 2013; Wekerle et al., 2009b; see Tonmyr et al., 2010). Recent research has identified exposure to IPV as having a significant role in the etiology of problem behaviors including substance misuse (Hamburger, Leeb, & Swahn, 2008; Kilpatrick et al., 2000; Tonmyr et al., 2010) and perpetration of dating violence (Gover, Park, Tomsich, & Jennings, 2011; Roberts, Gilman, Fitzmaurice, Decker, & Koenen, 2010). Older youth who are involved with CPS may be at particular risk due to the overlapping transition into emerging adulthood and out of CPS (Fong et al., 2006; Healy & Fischer, 2011). During this transition, critical support is lost, particularly for youth whose guardianship is provided by the state (i.e., Crown Wards in Canada).

Little research has examined the dynamic role of maltreatment in creating risk for the interrelated problem behaviors of both substance use and dating violence. In one of the few studies examining the relationship between these variables cross-sectionally, Barnett and Fagan (1993) found that male perpetrators of IPV used more alcohol than their nonabusive counterparts and had also experienced more maltreatment and observed significantly more IPV between caregivers during their childhoods than nonabusive men. In addition, researchers have found evidence to support a causal pathway from a history of physical maltreatment in childhood to an increased likelihood of drinking problems and, in turn, to higher rates of IPV perpetration in adulthood (Schafer, Caetano, & Cunradi, 2004; White & Widom, 2003). Research efforts examining the association between marijuana use and perpetration of IPV are in much earlier stages, and we are not aware of any other investigations of the contribution of maltreatment history to dating violence perpetration that have also assessed the role of marijuana use.

Trauma symptoms as a shared mechanism

The trauma literature has much to contribute to the investigation of these complex relationships. Research has supported trauma symptomology as one pathway through which childhood maltreatment may lead to the development of both substance use problems (Goldstein et al., 2011; White & Widom, 2008) and dating violence (Wekerle et al., 2009b; Wolfe, Wekerle, Straatman, & Grasley, 2004). DeBellis’ (2001) developmental traumatology theory argues that childhood maltreatment impacts a number of psychobiological systems, resulting in, among other things, compromised arousal control, behavioral regulation, and executive functioning which might underlie harm to self or others and contribute to negative emotions, which may increase risk for “self-medicating” with alcohol or other drugs (DeBellis, 2001, 2002).

In one study, researchers found that trauma symptoms fully mediated the effects of trauma exposure on both physical and psychological dating violence in college students and that higher levels of posttraumatic stress disorder (PTSD) were related to greater use of dating aggression (Taft, Schumm, Orazem, Meis, & Pinto, 2010). Using a sample of CPS-recruited youth from the Maltreatment and Adolescent Pathways (MAP) study, Wekerle and colleagues (Wekerle et al., 2009b) found that emotional abuse predicted trauma symptoms even after controlling for covariates and other types of childhood maltreatment; moreover, for males, the number of trauma symptoms mediated the relationship between emotional maltreatment and perpetration of dating violence. Researchers have also demonstrated that PTSD plays a mediating role between the experience of maltreatment and illicit drug use in adulthood (Plotzker, Metzger, & Holmes, 2007; White & Widom, 2008). Using another subset from the MAP, Goldstein and colleagues (2011) found that trauma symptoms (specifically, anger and dissociation) were a significant predictor of alcohol and illicit drug use and associated problems, even after controlling for age, sex, CPS status, and childhood maltreatment. Similarly, in an earlier study with the MAP sample, researchers found that trauma symptoms predicted past year marijuana use for female adolescents, over and above childhood maltreatment (Wekerle et al., 2009a).

In sum, little is yet known about the nature of the relationships between childhood maltreatment, substance use, and dating violence among youth, particularly those who are at risk for substance use and dating violence behaviors based on their maltreatment histories and age (e.g., older youth making the transition out of child welfare and into emerging adulthood). Furthermore, a consideration of the role of exposure to IPV in predicting dating violence and substance use is lacking from the existing literature. Understanding the complex dynamics of these vulnerabilities and risk behaviors within both adolescent and emerging adult populations has important implications for the development of more adequate prevention, intervention, and education efforts for youth involved with CPS. Using data from a longitudinal survey, we examined the temporal nature of these relationships among CPS-involved youth in adolescence and early emerging adulthood, and investigated the mediating role of trauma symptoms on the relationship between childhood maltreatment, including exposure to IPV, and the occurrence of both alcohol and/or marijuana use and perpetration of dating violence over the past year.

Method

Participants and Procedure

Participants were adolescents and emerging adults involved in the MAP longitudinal study. The MAP examined multiple outcomes among youth (N = 561, aged 14–17 at initial assessment), randomly selected from CPS caseloads (i.e., case management, resource linkages, out-of-home care, etc.) within a large urban catchment area in Ontario. Rolling recruitment occurred over 6 years, with all initial data collection occurring between 2003 and 2009. Data for each participant were then collected at 6-month intervals over 3 years, following developmental trajectories from adolescence into emerging adulthood. Ethics approval for the MAP was provided by both CPS and respective universities. Additional recruitment, consent, and procedural information may be found in Wekerle et al. (2009b).

This study involved examining the relationship between childhood maltreatment assessed at the initial session (Time 1), trauma symptoms assessed at the 1.5-year follow-up (Time 2), and alcohol and marijuana use as well as perpetration of dating violence assessed 6 months later at the 2-year follow-up (Time 3). These particular time points were selected to capture the chronological relationship between child maltreatment, trauma symptoms, and the past year occurrence of both substance use and dating violence and to follow these trajectories from adolescence through emerging adulthood. Due to the transitional circumstances of many of the youth initially recruited for this study, in particular as a result of their aging out of the CPS system, the initial MAP sample of 561 participants was subject to significant attrition over its longitudinal course (for a more detailed discussion of these issues, see Wekerle et al., 2011). As a result, at the 1.5-year follow-up time point (Time 2), a total of 269 participants (59% female; 64% Crown Ward) were tested, a retention rate of 47% from baseline. At the 2-year follow-up time point (Time 3), a total of 218 youth (61% female; 63% Crown Ward) were tested, a retention rate of 81% from the previous time point. The current results are based on data from the 158 participants (62.7% female; 58.9% Crown Ward) remaining in the study at Time 3 who indicated that they had initiated dating.

Participants ranged in age from 16 to 19 (M = 17.89, SD = 0.98) at Time 3. Half (47.5%) of the participants were living with foster parents at the time of initial assessment, 19.6% were living in group homes, 8.9% with a single parent, and the remainder were living with one biological and one stepparent (5.1%), on their own or with roommates (5.1%), with two biological parents (3.2%), with other relatives (1.9%), or in some alternative living arrangement (3.8%). The majority (58.9%) of participants were Crown wards; in Ontario, a Crown ward is a child or youth for whom the government has assumed parental responsibility, given that parental rights have been terminated. Participants indicated that they had been involved with CPS for between 6 months and 17 years (M = 5.6 years, SD = 4.2). The majority of youth self-identified as Caucasian (25.8%), African or Caribbean Canadian (26.5%), or mixed race (30.3%), with the remainder identifying as Hispanic, Chinese, Aboriginal, South Asian, and West or South East Indian. Approximately three quarters (79.7%) of participants identified as heterosexual, 4.4% identified as bisexual, and 2.5% as Gay or Lesbian. The remaining 13.3% (n = 21) of participants indicated that they did not know their sexual orientation or declined to answer. On average, participants had begun dating at the age of 14 (SD = 2.48).

Analyses were conducted to examine the possibility of systematic loss of participants between initial assessment (N = 561) and Time 3. Chi-square analyses revealed that, compared to male youth, a greater proportion of female youth remained in the study from the initial assessment to Time 3, χ²(1, N = 556) = 6.19, p < .05. In addition, a disproportionate number of Crown ward youth remained in the study compared to youth classified under other CPS statuses, χ²(1, N = 556) = 9.37, p < .05. Independent sample t-tests revealed that youth who remained in the study did not differ in age, total childhood maltreatment, or age of initiation of binge drinking, alcohol use, or marijuana use from those who left the study. Because many youth had not initiated dating until Time 3, comparisons for dating violence were not possible.

Measures

Childhood maltreatment

History of childhood abuse and neglect were assessed with the 28-item Childhood Trauma Questionnaire–Short Form (CTQ-SF; Bernstein et al., 2003). The CTQ-SF includes 25 clinical items measuring the frequency of physical, sexual, and emotional abuse and physical and emotional neglect using a 5-point Likert-type scale (1 = Never true, 2 = Rarely true, 3 = Sometimes true, 4 = Often true, and 5 = Very often true) as well as 3 items testing validity. A subscale score was generated for each type of maltreatment and cutoff scores were calculated for establishing the prevalence of moderate to severe maltreatment experiences (Bernstein & Fink, 1998). Cronbach’s αs for the CTQ subscales in this study ranged from α = .86 to α = .94, with the exception of the physical neglect scale (α = .69). A total score was calculated based on the sum of all CTQ abuse and neglect items (Total abuse/neglect).

Two items from the Childhood Experiences of Victimization Questionnaire (CEVQ; Walsh, MacMillan, Trocme, Jamieson, & Boyle, 2008) were used to assess witnessing IPV. Participants indicated on a 5-point Likert-type scale how often they had been exposed to aggression between caregivers in the home (0 = Never, 1 = 1 to 2 times, 2 = 3 to 5 times, 3 = 6 to 10 times, 4 = More than 10 times). The CEVQ items were summed for a total score (total witnessing IPV).

Trauma symptoms

The Trauma Symptom Checklist for Children (TSCC; Briere, 1996) was used to assess six areas of trauma-related functioning, namely anxiety, depression, posttraumatic stress (PTS), dissociation, anger, and sexual concerns. Participants rated how frequently they experienced specific events, “things that youth sometimes think, feel, or do,” on a 4-point Likert-type scale, ranging from 0 (Never) to 3 (Almost all of the time). For example, “going away in my mind, trying not to think” or “wanting to yell or break things.” Cronbach’s αs for TSCC scales in the current sample ranged from α = .84 to α = .91.

Alcohol and marijuana use and problems

Past 30-day frequency (0 = 0 times, 1 = 1–2 times, 2 = 3–7 times, 3 = 7 or more times) of binge drinking (i.e., consuming five or more alcoholic drinks on a single occasion) and past 30-day marijuana use were assessed using items from the 2009 National Youth Risk Behavior Survey (CDC, 2010b). The 23-item Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989) was used to assess the frequency of alcohol problems in the past year. Response options range from 0 (Never) to 4 (More than 10 times); items were summed to create a total RAPI score. The RAPI possesses good internal consistency, adequate test–retest reliability, and correlates moderately well with other problem drinking markers (White & Labouvie, 1989). Cronbach’s α for the current sample was α = .92. No measure of problem marijuana use was included in this study.

Dating violence

Perpetration of dating violence was assessed with a 35-item subset of the Conflict in Adolescent Dating Relationships Inventory (CADRI; Wolfe et al., 2001), which assesses the frequency with which various behaviors are used during a conflict or argument between dating partners over the past year. The CADRI is specifically geared toward the dynamics of adolescent relationships. Items are rated on a 4-point Likert-type scale, 0 = Never; 1 = Seldom (1–2 times); 2 = Sometimes (3–5 times); and 3 = Often (6 or more times). For example, “I kicked, hit, or punched [him/her]”; “I kissed [him/her] when [he/she] didn’t want me to”; and “I said things just to make [him/her] angry.” Five types of dating violence are assessed including physical abuse, sexual abuse, verbal/emotional abuse, relational abuse, controlling behaviors, and threatening behaviors. In this study, analyses focused on physical, sexual, threatening, and verbal/emotional abuse only. The CADRI has demonstrated strong internal consistency and 2-week test–retest reliability (Wolfe et al., 2001) as well as acceptable partner agreement (Wolfe et al., 2003). Cronbach’s αs in the current sample were α = .84 for physical dating violence, α = .63 for sexual dating violence, α = .88 for verbal/emotional dating violence, and α = .76 for threatening dating violence. CADRI subscale scores were summed to create a total dating violence variable.

Dating violence + substance use

To capture past year temporal overlap of dating violence and substance use, three dichotomous variables were first created, (a) problem drinking, (b) current marijuana use, and (c) moderate to severe dating violence. An individual received a score of 1 on the Problem Drinking variable if they reported binge drinking at least once in the past 30 days (38.6%, n = 61) or obtained a score of 15 or higher on the RAPI (10.1%, n = 16; see Thombs & Beck, 1994). Current Marijuana Use was defined as marijuana use one or more times in the past 30 days (45.6%, n = 72). Cutoff scores to capture perpetration of at least Moderate Dating Violence were established based on previous research (Roudsari, Leahy, & Walters, 2009; Wolfe et al., 2001). For physical, sexual, and threatening dating violence, perpetration of any act was considered moderate dating violence. For verbal/emotional abuse, perpetration 3–5 times or more in the past year of any subscale item was considered moderate dating violence. A positive score on one or more subtype constituted Moderate Dating Violence (80.4%, n = 127), capturing moderate to severe dating violence perpetration. Past year occurrence of both dating violence and substance use was operationalized as having perpetrated any Moderate Dating Violence as well as having engaged in (a) problem alcohol use (Dating Violence + Problem Drinking) or (b) marijuana use (Dating Violence + Marijuana Use).

Statistical Analysis

Prior to conducting primary analyses, the distributions of all variables were examined for deviations from normality. Due to positive skewness, drinking problems (RAPI) and dating violence (CADRI) scores were log transformed. Bivariate correlations were examined to identify significant relationships between the independent and the dependent variables as well as potential mediators. Tests of mediation were conducted using the PROCESS macro (Hayes, 2013), which integrates multiple mediation functions in SPSS Regression Models.

We hypothesized that all trauma symptom subtypes could mediate the relationship between child maltreatment and the substance use/dating violence outcomes. As a result, we used a parallel multiple mediator model (Hayes, 2013) wherein all trauma symptom subscales were included as mediators. Analyses were structured in such a way that the temporal nature of the hypothesized relationships could be tested with predictors assessed at Time 1, mediators assessed at Time 2, and outcomes assessed at Time 3. Specifically, we tested whether trauma symptoms mediated the relationships between two predictor variables (child abuse/neglect [total CTQ scores] and witnessing IPV [total CEVQ scores]) and five outcome variables (dating violence, problem drinking, marijuana use, Dating Violence + Problem Drinking, and Dating Violence + Marijuana Use). This resulted in 10 separate multiple mediation models. A general outline of the mediation model is illustrated in Figure 1. For each model, we tested: (1) the direct effects of the predictor on the outcome variable; (2) the total effect of the predictor on the outcome; (3) the direct effects of the predictor on the mediators; (4) the direct effect of the mediators on the outcome; and (5) the indirect effect of the predictor on the outcome via each mediator. To test for mediation, bootstrap confidence intervals were estimated using bias-corrected bootstrap confidence intervals for all indirect effects (95% confidence intervals, z = 1,000 bootstrap samples); when zero is outside of the 95% confidence interval, this indicates a significant indirect effect. Finally, gender was included as a covariate in all models due to significant gender differences in some dating violence variables (physical and verbal/emotional, with female youth reporting greater perpetration; p < .01) and binge drinking (with male youth reporting more binge drinking; p < .05). Although we examined correlations with age, we did not include age as a covariate as it was not significantly related to any of the dependent variables.

Figure 1.

Parallel multiple mediator model depicting trauma symptoms as mediators of the relationship between child maltreatment and substance use/dating violence outcomes. Note. T1 = Time 1; T2 = Time 2; T3 = Time 3. PTS = posttraumatic stress. All models include gender as a covariate.

Results

With respect to maltreatment histories, when responses were limited to at least moderate experiences of abuse (as defined by Bernstein & Fink, 1998), 48.1% (n = 76) of participants reported emotional neglect, 44.9% (n = 71) physical abuse, 43.7% (n = 69) physical neglect, 41.8% (n = 66) emotional abuse, and 21.5% (n = 34) sexual abuse. In addition, 60.8% (n = 96) of participants witnessed verbal IPV among caregivers and 38.6% (n = 61) witnessed physical IPV. Multiple traumatization was common; whereas 16.5% (n = 26) of participants reported experiencing moderate to severe maltreatment of only one type, 64.6% (n = 102) reported experiencing two or more types. The remaining 19% (n = 30) reported no experiences of moderate to severe maltreatment. Among subtypes of dating violence perpetration (dichotomized as defined earlier), verbal/emotional dating violence was the most commonly reported at 77.2% (n = 122); 36.7% threatened violence (n = 58), 32.9% (n = 52) used physical violence, and 11.4% (n = 18) used sexual violence. Over one third of the sample (38.6%, n = 61) reported at least one incident of binge drinking in the last 30 days and almost half (45.6%, n = 72) had used marijuana at least once in the last 30 days. On average, scores on the RAPI were 4.93 (SD = 8.83), and 10.1% (n = 16) of individuals met the cutoff for problem drinking. In terms of past year occurrence of both dating violence and substance use, 37.3% (n = 59) of participants fell into the Dating Violence + Problem Drinking category and 38.6% (n = 61) into the Dating Violence + Marijuana Use category.

Bivariate Relationships

Table 1 shows correlations between childhood maltreatment, trauma symptom, substance use, and dating violence variables. Both maltreatment variables were correlated with all trauma symptoms. All trauma variables were correlated with problem drinking, while only anger was correlated with binge drinking; no trauma symptoms were correlated with marijuana use. Only PTS, depression, and anger were correlated with total dating violence. Among substance use variables, only problem drinking was correlated with total witnessing IPV. Similarly, total dating violence was correlated only with total witnessing IPV. Finally, total witnessing IPV was significantly correlated with Dating Violence + Marijuana Use. Dating Violence + Problem Drinking was not significantly correlated with any maltreatment variable.

Table 1.

Bivariate Correlations Between Maltreatment, Trauma Symptoms as well as Substance Use, Dating Violence, and their Combination.

	Range	M (SD)	%	Gender	1	2	3	4	5	6	7	8	9	10	11	12	13
Maltreatment
1 Total abuse/neglect	25–117	53.90 (20.69)		−.24
2 Total witnessing IPV	0–8	2.31 (2.51)		−.07	.40
Trauma symptoms
3 PTS	0–30	6.20 (6.48)		−.20	.41	.33
4 Anxiety	0–27	4.13 (5.15)		−.29	.43	.30	.86
5 Depression	0–27	4.92 (5.23)		−.28	.32	.24	.84	.81
6 Anger	0–27	5.49 (5.75)		−.22	.25	.32	.65	.63	.69
7 Dissociation	0–30	6.27 (6.04)		−.18	.31	.30	.84	.84	.79	.62
8 Sexual concerns	0–30	4.41 (4.86)		−.06	.19	.29	.57	.55	.62	.55	.60
Substance use
9 Past 30-day binge	0–3	0.61 (0.85)		.15	.02	.08	.11	.08	.09	.24	.16	.13
10 Problem drinking	0–92	4.93 (8.83)		.11	.07	.30	.32	.26	.31	.37	.35	.29	.59
11 Past 30-day marijuana use	0–3	0.97 (1.26)		.14	−.05	.13	.13	.05	.07	.12	.16	.14	.47	.45
Dating violence perpetration
12 Total dating violence	0–52	11.10 (10.36)		−.25	.07	.28	.20	.13	.21	.32	.15	.17	.14	.26	.26
Dating violence + substance use
13 Dating violence + problem drinking	0–1		37.3	.11	−.04	.06	.21	.11	.25	.26	.22	.25	.79	.64	.45	.19
14 Dating violence + marijuana use	0–1		38.6	.02	−.02	.19	.21	.12	.18	.27	.22	.25	.54	.51	.76	.34	.61

Note. Boldface values represent significant correlation coefficients (p < .05). IPV = intimate partner violence; RAPI = Rutgers Alcohol Problem Index; PTS = Posttraumatic Stress; Gender: female = 0, male = 1.

Multiple Mediation Models

Total and direct effects

Total and direct effects of the two maltreatment variables on all five outcomes are listed in Table 2. Controlling for gender, there were only two significant total effects for maltreatment on the dating violence/substance use outcomes. Specifically, the total effects of witnessing IPV on both dating violence and problem drinking were significant. All other total effects were nonsignificant. In addition, there was no significant direct effect (c’) of child abuse/neglect on perpetration of dating violence, alcohol problems, or marijuana use. The direct effects of witnessing IPV on dating violence, alcohol problems, and marijuana use were also nonsignificant.

Table 2.

Total and Direct Effects of Child Abuse/Neglect and Witnessing IPV on Dating Violence, Problem Drinking, Marijuana Use, Dating Violence + Problem Drinking, and Dating Violence + Marijuana Use.

Outcome (Y)	Total Effect (c)			Direct Effect (c')
	Coefficient	SE	p	Coefficient	SE	p
	Child Abuse/Neglect (X)
Dating violence	.0003	.0023	.908	−.0010	.0025	.692
Problem drinking	.0027	.0024	.254	−.0001	.0024	.983
Marijuana use	−.0091	.0093	.329	−.0183	.0111	.099
Dating violence + problem drinking	−.0014	.0096	.881	−.0090	.0016	.441
Dating violence + marijuana use	−.0073	.0095	.443	−.0181	.0017	.120
	Witnessing IPV (X)
Dating violence	.0471	.0172	.007	.0353	.0185	.059
Problem drinking	.0539	.0176	.003	.0261	.0182	.155
Marijuana use	.0967	.0718	.178	.0117	.0813	.886
Dating violence + problem drinking	.0471	.0729	.518	−.0439	.0874	.616
Dating violence + marijuana use	.1077	.0721	.134	.0164	.0825	.842

Note. IPV = intimate partner violence; SE = standard error. Boldface values represent significant effects (p < .01). All models include gender as a covariate.

Predicting trauma symptoms

Direct effects of the two child maltreatment variables on the trauma symptom mediators are listed in Table 3. With the exception of the relationship between child abuse/neglect and sexual concerns, all of the direct effects were significant, indicating that both child abuse/neglect and witnessing IPV were directly associated with each of the trauma symptoms when controlling for gender.

Table 3.

Direct Effects of Child Abuse/Neglect and Witnessing IPV on Trauma Symptoms.

Independent Variable	Mediator	Direct Effect (a _i)
Independent Variable	Mediator	Coefficient	SE	p
Child abuse/neglect	PTS	.122	.028	<.001
	Anxiety	.096	.021	<.001
	Depression	.071	.023	.002
	Anger	.057	.026	.029
	Dissociation	.083	.027	.002
	Sexual concerns	.039	.022	.082
Witnessing IPV	PTS	.830	.216	<.001
	Anxiety	.579	.170	<.001
	Depression	.481	.177	.007
	Anger	.727	.191	<.001
	Dissociation	.722	.204	<.001
	Sexual concerns	.595	.166	<.001

Note. IPV = intimate partner violence; PTS = posttraumatic stress; SE = standard error. All models include gender as a covariate. Boldface values represent significant effects (p < .05). a _i = direct effects of the independent variable on the mediator (X → M).

Predicting dating violence and substance use via trauma symptoms

Table 4 lists results of the multiple mediation analyses for perpetration of dating violence and substance use, controlling for gender. Few direct effects of trauma symptoms on the substance use and dating violence outcomes emerged; only the direct effect of anger was significant, for both perpetration of dating violence and problem drinking. For indirect effects, the relationship between child abuse/neglect and perpetration of dating violence and between witnessing IPV and perpetration of dating violence was indirect via anger. In addition, there was a significant indirect effect of child abuse/neglect on problem drinking and of witnessing IPV on problem drinking via anger. There was also a significant negative indirect effect via anxiety on the relationship between witnessing IPV and dating violence and between witnessing IPV and marijuana use. Finally, there was a significant indirect effect of witnessing IPV on marijuana use via dissociation.

Table 4.

Results of Multiple Mediation Analyses Examining Direct and Indirect Effects of Child Maltreatment on Dating Violence and Substance Use Outcomes Through Posttraumatic Stress Symptomatology.

Independent Variable	Mediator	Direct Effect (b _i)			Indirect Effect (a _ib_i )
Independent Variable	Mediator	Coefficient	SE	p	Coefficient	Boot SE	Lower	Upper
		Dating violence (Y)
Child abuse/neglect	PTS	.021	.016	.216	.0028	.0023	−.0006	.0094
	Anxiety	−.028	.020	.157	−.0029	.0024	−.0099	.0004
	Depression	−.002	.018	.925	−.0001	.0014	−.0029	.0031
	Anger	.024	.010	.019	.0017	.0012	.0001	.0049
	Dissociation	−.004	.015	.796	−.0004	.0017	−.0047	.0026
	Sexual concerns	.003	.011	.763	.0002	.0006	−.0007	.0021
Witnessing IPV	PTS	.015	.016	.361	.0122	.0144	−.0072	.0502
	Anxiety	−.032	.019	.091	−.0173	.0126	−.0519	−.0005
	Depression	.007	.017	.677	.0031	.0086	−.0092	.0319
	Anger	.021	.010	.039	.0154	.0098	.0018	.0422
	Dissociation	−.003	.015	.830	−.0022	.0125	−.0279	.0259
	Sexual concerns	.001	.011	.943	.0005	.0072	−.0136	.0159
		Problem drinking (Y)
Child abuse/neglect	PTS	.004	.016	.822	.0004	.0021	−.0033	.0052
	Anxiety	−.014	.019	.474	−.0013	.0020	−.0055	.0022
	Depression	.006	.017	.733	.0004	.0013	−.0017	.0037
	Anger	.025	.011	.018	.0014	.0011	.0001	.0046
	Dissociation	.020	.015	.175	.0017	.0015	−.0007	.0056
	Sexual concerns	.003	.012	.832	.0001	.0007	−.0011	.0018
Witnessing IPV	PTS	.001	.015	.945	.0009	.0145	−.0262	.0326
	Anxiety	−.016	.019	.386	−.0094	.0126	−.0390	.0116
	Depression	.011	.017	.527	.0005	.0087	−.0091	.0285
	Anger	.023	.011	.034	.0166	.0111	.0013	.0469
	Dissociation	.020	.015	.175	.0145	.0129	−.0065	.0481
	Sexual concerns	.001	.012	.988	.0001	.0087	−.0186	.0177
		Marijuana use (Y)
Child abuse/neglect	PTS	.054	.040	.180	.0062	.0055	−.0018	.0209
	Anxiety	−.065	.050	.201	−.0061	.0049	−.0179	.0020
	Depression	−.048	.044	.285	−.0031	.0031	−.0124	.0013
	Anger	.028	.028	.325	.0015	.0018	−.0011	.0068
	Dissociation	.051	.038	.189	.0040	.0034	−.0007	.0136
	Sexual concerns	.021	.030	.500	.0008	.0015	−.0010	.0054
Witnessing IPV	PTS	.051	.040	.202	.0402	.0373	−.0101	.1482
	Anxiety	−.088	.049	.074	−.0493	.0328	−.1348	−.0026
	Depression	−.046	.045	.307	−.0209	.0209	−.0756	.0111
	Anger	.032	.028	.260	.0216	.0208	−.0105	.0748
	Dissociation	.061	.038	.107	.0414	.0292	.0014	.1229
	Sexual concerns	.025	.030	.407	.0137	.0164	−.0103	.0577

Note. IPV = intimate partner violence; PTS = posttraumatic stress; SE = standard error. Boldface values represent significant effects (p < .05). All models include gender as a covariate. b _i = direct effects of the mediator on the dependent variable (M → Y); a _i b _i = indirect effects of the independent variable on the dependent variable via the mediator (X → M → Y).

Predicting past year occurrence of both dating violence and problem drinking/marijuana use

Table 5 lists the results of the multiple mediation models for Dating Violence + Problem Drinking and Dating Violence + Marijuana Use outcomes. Controlling for gender, there was a significant indirect effect of exposure to IPV on past year Dating Violence + Marijuana Use via anger; no other indirect effects were significant.

Table 5.

Results of Multiple Mediation Analyses Examining Direct and Indirect Effects of Child Maltreatment on Dating Violence and Substance Use Outcomes Through Posttraumatic Stress Symptomatology.

Independent Variable	Mediator	Direct Effect (b _i)			Indirect Effect (a _i b _i)
Independent Variable	Mediator	Coefficient	SE	p	Coefficient	Boot SE	Lower	Upper
		Dating violence + problem drinking (Y)
Child abuse/neglect	PTS	.026	.072	.715	.0032	.0104	−.0171	.0262
	Anxiety	−.162	.099	.103	−.0154	.0133	−.0468	.0039
	Depression	.120	.081	.138	.0083	.0080	−.0018	.0298
	Anger	.081	.051	.110	.0047	.0052	−.0010	.0198
	Dissociation	.060	.073	.412	.0050	.0077	−.0069	.0228
	Sexual concerns	.030	.055	.591	.0013	.0034	−.0041	.0099
Witnessing IPV	PTS	.023	.072	.751	.0183	.0681	−.1003	.1714
	Anxiety	−.179	.097	.064	−.1001	.0795	−.2790	.0018
	Depression	.122	.082	.137	.0567	.0610	−.0136	.2360
	Anger	.086	.052	.100	.0584	.0566	−.0129	.2225
	Dissociation	.066	.072	.554	.0457	.0609	−.0598	.1874
	Sexual concerns	.033	.056	.616	.0180	.0378	−.0499	.1040
		Dating violence + marijuana use (Y)
Child abuse/neglect	PTS	.088	.073	.228	.0537	.0524	−.0351	.0397
	Anxiety	−.132	.100	.186	−.0633	.0564	−.1945	.0054
	Depression	−.058	.082	.477	−.0202	.0316	−.0986	.0080
	Anger	.097	.051	.056	.0282	.0237	−.0013	.0202
	Dissociation	.071	.072	.323	.0299	.0367	−.0225	.0192
	Sexual concerns	.066	.055	.228	.0149	.0189	−.0063	.0146
Witnessing IPV	PTS	.065	.071	.361	.0526	.0728	−.0551	.2667
	Anxiety	−.161	.095	.090	−.0903	.0688	−.2626	.0118
	Depression	−.040	.081	.620	−.0186	.0416	−.1257	.0457
	Anger	.094	.051	.064	.0642	.0473	.0017	.2014
	Dissociation	.083	.071	.239	.0575	.0559	−.0212	.2035
	Sexual concerns	.063	.055	.250	.0346	.0375	−.0173	.1345

Discussion

This study sought to extend previous research on the relationship between substance use and perpetration of dating violence in adolescence and emerging adulthood and to further elucidate the contribution of child abuse and neglect, exposure to IPV among caregivers, and trauma symptoms, to dynamic risk for these behaviors by examining their past year occurrence within a sample of youth involved in CPS. In terms of the role of trauma symptoms as potential mediators of the relationship between childhood maltreatment and substance use and dating violence outcomes, only anger, dissociation, and anxiety emerged as significant.

Although child abuse and neglect were not directly associated with any of the dating violence and substance use outcomes (i.e., independent of trauma symptoms), experiences of child abuse and neglect predicted more frequent perpetration of dating violence and greater alcohol problems, indirectly via anger. Similarly, despite the lack of a direct relationship between exposure to caregiver IPV and dating violence or substance use outcomes, the total effects of exposure to IPV on both dating violence and problem drinking were significant. Furthermore, exposure to caregiver IPV was associated with dating violence indirectly via anxiety and anger, with problem drinking indirectly via anger, and with marijuana use indirectly via anxiety and dissociation. Finally, exposure to caregiver IPV was associated with past year occurrence of both marijuana use and dating violence indirectly via anger. It should be noted that a significant direct or total effect is not a requirement for testing specific indirect effects (Hayes, 2009). In the current study, the effects of maltreatment on substance use and dating violence are most apparent when one considers the specific emotional impacts of maltreatment, assessed here as trauma symptoms. In addition, the pattern of indirect effects of trauma symptoms on the relationships between substance use and dating violence outcomes involved mechanisms working in opposite directions (e.g., the negative effect of anxiety along with the positive effect of anger); when considered in combination, some indirect effects may have canceled each other out, resulting in a nonsignificant total effect. These findings highlight the importance of assessing specific trauma symptoms and not relying solely on clinical cutoffs or categorical diagnoses for identifying risk for problematic behaviors.

The finding that anger most consistently emerged as a mediator of the relationship between childhood maltreatment and the later perpetration of dating violence is consistent with past studies examining the link between PTSD and perpetration of dating violence (Taft et al., 2010). These findings support the intergenerational transmission of abusive behaviors via feelings of anger that may originate with caregivers and become directed at other targets, including dating partners. Furthermore, the finding that anger acted as a mediator between both types of maltreatment and later problem drinking, as well as between exposure to IPV and past year occurrence of both dating violence and marijuana use, is consistent with research documenting the relationship between elevated impulsivity, a personality construct that has consistently been linked to substance abuse (see Morris, Stewart, & Ham, 2004), and high trait anger (e.g., Shorey, Brasfeild, Febres, & Stuart, 2011). In addition, the use of alcohol or marijuana to manage or calm feelings of intense anger is in line with coping models of substance use (Wills & Hirky, 1996). A number of other studies have reported elevated levels of trait or expressed anger among individuals with substance use problems (e.g., Eftekhari, Turner, & Larimer, 2004), and increased symptoms of anger were also associated with increased levels of alcohol and drug problems in a study examining an earlier time point of the current sample (Goldstein et al., 2011).

The finding that witnessing IPV was significantly predictive of marijuana use indirectly via dissociation is somewhat consistent with an earlier study using data from the MAP sample in which dissociation was associated with illicit drug and problem alcohol use as well as drug problems, over and above background variables, maltreatment history, and other trauma symptoms (Goldstein et al., 2011). Dissociation may be a particularly challenging trauma experience for individuals transitioning through late adolescence and emerging adulthood and may reflect a fragmented sense of self or a lack of identity coherence (MacFie, Cichetti, & Toth, 2001), resulting in greater use of marijuana to cope. Alternatively, exposure to caregiver IPV may result in greater use of marijuana by adolescents and emerging adults using to facilitate dissociative experiences (i.e., emotional numbing), which may reflect a pattern of avoidance stemming from early experiences with avoiding high conflict situations consistent with exposure to IPV.

The finding that anxiety acted as an inverse mediator of the relationship between exposure to IPV and marijuana use is somewhat counterintuitive, as it is at odds with coping models of substance use; research finds that both alcohol and marijuana are commonly used to manage anxiety (Buckner, Heimberg, Ecker, & Vinci, 2013; Johnson, Mullin, Marshall, Bonn-Miller, & Zvolensky, 2010; Pihl & Peterson, 1995). One possible explanation for these findings is that adolescents high in anxiety may avoid social situations in which substance use is likely to occur; research has demonstrated that social anxiety may be protective against substance abuse among adolescents (Myers, Aarons, Tomlinson, & Stein, 2003). Similarly, the finding that anxiety acted as an inverse mediator of the relationship between witnessing IPV and dating violence perpetration may reflect an avoidance of conflict in dating relationships by individuals who are high in anxiety as a result of conflict experienced in their childhood homes. Youth who have significant exposure to violence or abuse between their primary caregivers growing up may develop a “flight” rather than “fight” response to signals of threat in their dating relationships. As outlined by Pynoos, Steinberg and Piacentini (1999), the neurobiological mechanisms of danger and threat appraisal mature over childhood and adolescence, and are likely to be particularly strengthened among those who have experienced or been exposed to violence during this critical developmental period. Future studies should further explore the complex relationships between childhood IPV exposure and anxiety on substance use and dating violence perpetration.

Taken together, the current findings highlight the contribution of exposure to IPV in the development of substance use and dating violence behaviors over time and during the transition from adolescence to emerging adulthood, as well as the mediating role of trauma symptoms including anger, anxiety, and dissociation. These results are consistent with past research indicating that IPV exposure contributes to substance use over and above other forms of maltreatment (Hamburger et al., 2008; Kilpatrick et al., 2000) as well as being an independent predictor of youth perpetration of dating violence (Gover et al., 2011; Roberts et al., 2010). In addition, the current findings support the contribution of exposure to IPV specifically to risk for the occurrence within a relatively brief time span (i.e., past year) of both marijuana use and at least moderate dating violence behaviors in early emerging adults.

Limitations and Future Directions

Although this study contributed several noteworthy results, it suffers from some limitations that should be addressed in future research. First, there was no measure of marijuana dependence or problem use. Because experimental marijuana use is fairly common among youth, problem use may distinguish individuals for whom marijuana acts as a risk factor or correlate of engagement in dating violence behavior and measures of marijuana problems should be included in future work. Second, the majority of the sample was Crown wards. Non-Crown wards who left the study may face more challenges, including more serious substance problems, due to a lack of monitoring and system support. Indeed, rates of substance use and trauma symptoms were low in comparison to what has been found in prior research. Relatedly, it is possible that youth outcomes were positively impacted by involvement in mental health services provided or facilitated by CPS, although this was not assessed in this study.

Third, the sample size for this analysis was small due to high attrition. This reflects the nature of the sample (i.e., youth experiencing significant transitions and instability), but it is also important to note that, at the time of the study, youth who exited CPS at age 16 were unable to reconnect to services. In 2013, several changes were made to further support youth leaving care in Ontario, including continued support for youth whose formal care was terminated at 16 or 17 and greater support for emerging adults in care through the Continued Care and Support for Youth policy (Ministry of Children and Youth Services, 2013). Fourth, due to the timing of the assessments and the nature of the trauma symptom items, we cannot conclude with certainty that histories of maltreatment were the sole factor contributing to trauma symptoms. Participants may have experienced traumatic events in the intervening months between testing sessions. Furthermore, TSCC items are not trauma specific; there is no specific reference to experiencing anger or anxiety, for example, as a result of traumatic experiences.

Finally, although the construct of past year combined occurrence utilized in this study is useful in establishing a relatively close temporal relationship between substance use and dating violence perpetration, this does not imply that they are causally related. We cannot conclude on the basis of the results reported here that marijuana use at Time 3 was facilitative of dating violence behaviors occurring either proximally or distally at the same time point, nor can we conclude the opposite. Future research investigating the role of child abuse and witnessing IPV in the risk for substance-related dating violence should more specifically assess violence that occurs while under the influence of alcohol or marijuana.

Clinical Implications

Despite these limitations, the present findings contribute important information to our understanding of maltreatment-related risk for substance use and dating violence in adolescence and early emerging adulthood. In particular, our findings suggest that one form of child maltreatment that is often excluded from existing definitions, witnessing IPV, may have overlooked negative effects on youth. MacMillan and colleagues have addressed issues of child safety associated with current models of intervention with parental victims of IPV and have called for a general emphasis within educational programs on the unacceptability of all types of abuse (MacMillan, Wathen, & Varcoe, 2013). The present findings indicate that greater attention to the negative influence of witnessing verbally and physically abusive behaviors among caregivers is warranted. Intervention efforts with youth already involved with CPS might be expanded to address the detrimental effects of exposure to IPV, including feelings of anger and the tendency toward dissociation that may emerge from these experiences.

As results further support a relationship between both child abuse/neglect and witnessing IPV and both substance use and abusive behaviors within adolescent relationships, CPS programming should focus efforts on substance use dating violence education and prevention, including among youth with known exposure to IPV. Furthermore, anger or emotion management programming should be available to CPS-involved youth to help address the greater risk that youth with anger problems may have for both substance use issues and perpetration of dating violence. For example, both Dialectical Behavior Therapy (DBT) and mindfulness-based interventions have been utilized effectively to address emotion regulation difficulties with both youth populations and traumatized individuals. Shorey and colleagues (2012) noted that DBT and mindfulness interventions may be effective additions to dating violence prevention efforts in youth.

Footnotes

Acknowledgment

We would like to acknowledge the contributions of the MAP Research Team in the development of the MAP study.

Authors’ Note

The MAP Research Team includes Michael Boyle, Eman Leung, Harriet MacMillan, Nico Trocmé, Randy Waechter, Deborah Goodman, Bruce Leslie, Brenda Moody, and Anne-Marie Wall (deceased).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MAP project is funded by: The Canadian Institutes of Health Research (CIHR), Community Action Health Research and the Institute of Gender and Health; The Children’s Hospital of Eastern Ontario (CHEO) Centre of Excellence in Child & Youth Mental Health; The Ministry of Children & Youth Services Ontario; The Ontario Mental Health Foundation; CIHR/Ontario Women’s Health Council Mid-Career Award (to Christine Wekerle); The Public Health Agency of Canada; The Centre for Excellence in Research in Child Welfare. Funding for this study also came from a Connaught Start-Up Award (Abby Goldstein) and from a Joseph-Armand Bombardier Doctoral Canada Graduate Scholarship from the Social Sciences and Humanities Research Council of Canada (Breanne Faulkner).

References

Adlaf

E. M.

Paglia-Boak

(2009). Drug use among Ontario students, 1977–2007: Detailed OSDUHS findings. Ontario, Canada: Centre for Addiction and Mental Health.

Afifi

T. O.

MacMillan

Cox

B. J.

Asmundson

G. J. G.

Stein

M. B.

Sareen

(2009). Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. Journal of Interpersonal Violence, 24, 1398–1417.

Archer

(2002). Sex differences in physically aggressive acts between heterosexual partners: A meta-analytic review. Aggressive and Violent Behavior, 7, 313–351.

Arnett

J. J.

(2004). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press.

Arnett

J. J.

(2005). The developmental context of substance use in emerging adulthood. Journal of Drug Issues, 35, 235–254.

Barnett

Fagan

(1993). Alcohol use in male spouse abusers and their female partners. Journal of Family Violence, 8, 1–25.

Bernstein

D. P.

Fink

(1998). Childhood trauma questionnaire: A retrospective self-report manual. San Antonio, TX: Psychological.

Bernstein

D. P.

Stein

J. A.

Newcomb

M. D.

Walker

Pogge

Ahluvalia

… Zule

(2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27, 169–190.

Briere

(1996). Trauma Symptom Checklist for Children (TSCC): Professional manual. Odessa, FL: Psychological Assessment Resources.

10.

Buckner

J. D.

Heimberg

R. G.

Ecker

A. H.

Vinci

(2013). A biopsychosocial model of social anxiety and substance use. Depression and Anxiety, 30, 276–284.

11.

Capaldi

D. M.

Shortt

J. W.

Crosby

(2003). Physical and psychological aggression in at-risk young couples: Stability and change in young adulthood. Merrill-Palmer Quarterly, 49, 1–27.

12.

Casiano

Mota

Afifi

T. O.

Enns

M. W.

Sareen

(2009). Childhood adversity and threats made with weapons in a nationally representative sample. The Journal of Nervous and Mental Disease, 197, 856–861.

13.

Centres for Disease Control. (2010a). The National intimate partner and sexual violence survey. Retrieved July 31, 2013, from, http://www.cdc.gov/violenceprevention/nisvs/2010_report.html

14.

Centres for Disease Control. (2010b). Youth risk behavior surveillance: United States, 2009. Surveillance Summaries, 59, 1–142.

15.

Centres for Disease Control. (2012). Youth risk behavior surveillance: United States, 2011. Surveillance Summaries, 61, 1–168.

16.

Courtney

M. E.

Dworsky

(2006). Early outcomes for young adults transitioning from out-of-home care in the USA. Child & Family Social Work, 11, 209–219.

17.

DeBellis

M. D.

(2001). Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13, 537–561.

18.

DeBellis

M. D.

(2002). Developmental traumatology: A contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27, 155–170.

19.

Eftekhari

Turner

A. P.

Larimer

M. E.

(2004). Anger expression, coping, and substance use in adolescent offenders. Addictive Behaviors, 29, 1001–1008.

20.

Fong

Schwab

Armour

(2006). Continuity of activities and child well-being of foster care youth. Child and Youth Services Review, 28, 1359–1374.

21.

Foshee

V. A.

(1996). Gender differences in adolescent dating abuse prevalence, types and injuries. Health Education Research: Theory and Practice, 11, 275–286.

22.

Garcia

Soria

Hurwitz

E. L.

(2007). Homicides and intimate partner violence: A literature review. Trauma, Violence, & Abuse, 8, 370–383.

23.

Gilbert

Widom

C. S.

Browne

Fergusson

Webb

Janson

(2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373, 68–81.

24.

Goldstein

Wekerle

Tonmyr

Thornton

Waechter

Pereira

Chung

(2011). The Relationship between post-traumatic stress symptoms and substance use among adolescents involved with child welfare: Implications for emerging adulthood. International Journal of Mental Health and Addiction, 9, 507–524.

25.

Gomez

A. M.

(2011). Testing the cycle of violence hypothesis: Child abuse and adolescent dating violence as predictors of intimate partner violence in young adulthood. Youth and Society, 43, 171–192.

26.

Gover

A. R.

Park

Tomsich

E. A.

Jennings

W. G.

(2011). Dating violence perpetration and victimization among South Korean college students: A focus on gender and childhood maltreatment. Journal of Interpersonal Violence, 26, 1232–1263.

27.

Hamburger

M. E.

Leeb

R. T.

Swahn

M. H.

(2008). Childhood maltreatment and early alcohol use among high-risk adolescents. Journal of Studies on Alcohol and Drugs, 3, 291–295.

28.

Hayes

A. F.

(2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408–420.

29.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.

30.

Health Canada. (2010). Canadian Drug Use Monitoring Survey. Retrieved August 5, 2011, from http://www.hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2010/summary-sommaire-eng.php

31.

Healy

C. V.

Fischer

P. A.

(2011). Young children in foster care and the development of favorable outcomes. Children and Youth Services Review, 33, 1822–1830.

32.

Jaffee

S. R.

Gallop

(2007). Social, emotional, and academic competence among children who have had contact with child protective services: Prevalence and stability estimates. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 757–765.

33.

Johnson

K. A.

Mullin

J. L.

Marshall

E. C.

Bonn-Miller

M. O.

Zvolensky

M. J.

(2010). Exploring the meditational role of coping motives for marijuana use in terms of the relation between anxiety sensitivity and marijuana dependence. American Journal on Addictions, 19, 277–282.

34.

Keller

T. E.

Cusick

G. R.

Courtney

M. E.

(2007). Approaching the transition to adulthood: Distinctive profiles of adolescents aging out of the child welfare system. Social Services Review, 81, 453–484.

35.

Kilpatrick

D. G.

Acierno

Sanders

Resnick

H. S.

Best

C. L.

Schnurr

P. P.

(2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68, 19–30.

36.

MacFie

Cicchetti

Toth

S. L.

(2001). The development of dissociation in maltreated preschool-aged children. Development and Psychopathology, 13, 233–254.

37.

MacMillan

H. L.

Fleming

J. E.

Streiner

D. L.

Lin

Boyle

M. H.

Jamieson

Beadslee

W. R.

(2001). Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry, 158, 1878–1883.

38.

MacMillan

H. L.

Wathen

C. N.

Varcoe

C. M.

(2013). Intimate partner violence in the family: Considerations for children’s safety. Child Abuse & Neglect, 37, 1186–1191.

39.

Malik

Sorenson

S. B.

Aneshensel

C. S.

(1997). Community and dating violence among adolescents: Perpetration and victimization. Journal of Adolescent Health, 21, 291–302.

40.

Ministry of Children and Youth Services. (2013, October). Youth leaving care update: Policy development and program design. Retrieved from http://provincialadvocate.on.ca/documents/en/Update_Youth_Leaving_Car_Initiatives.pdf

41.

Montgomery

M. J.

(2005). Psychosocial intimacy and identity: From early adolescence to emerging adulthood. Journal of Adolescent Research, 20, 346–374.

42.

Moore

T. M.

Stuart

G. L.

(2005). A review of the literature on marijuana and interpersonal violence. Aggression and Violent Behavior, 10, 171–192.

43.

Moran

P. B.

Vuchinich

Hall

N. K.

(2004). Associations between types of maltreatment and substance use during adolescence. Child Abuse & Neglect, 28, 565–574.

44.

Morris

E. P.

Stewart

A. H.

Ham

L. S.

(2004). The relationship between social anxiety disorder and alcohol use disorders: A critical review. Anxiety and Stress Vulnerability and Substance Problems: Theory, Empirical Evidence, and Directions for Future Research, 25, 734–760.

45.

Myers

M. G.

Aarons

G. A.

Tomlinson

Stein

M. B.

(2003). Social anxiety, negative affectivity and substance use among high school students. Psychology of Addictive Behaviors, 17, 277–283.

46.

S. R.

Reynolds

A. J.

(2010). Childhood predictors of young adult male crime. Children and Youth Services Review, 32, 1097–1107.

47.

Preacher

K. J.

Curran

P. J.

Bauer

D. J.

(2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437–448.

48.

Pihl

R. O.

Peterson

J. B.

(1995). Alcoholism: The role of different motivational systems. Journal of Psychiatry and Neuroscience, 20, 372–396.

49.

Plotzker

R. E.

Metzger

D. S.

Holmes

W. C.

(2007). Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: A potential mediating pathway. The American Journal on Addictions, 16, 431–438.

50.

Pynoos

R. S.

Steinberg

A. M.

Piacentini

J. C.

(1999). A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biological Psychiatry, 46, 1542–1554.

51.

Roberts

A. L.

Gilman

S. E.

Fitzmaurice

Decker

M. R.

Koenena

K. C.

(2010). Witness of intimate partner violence in childhood and perpetration of intimate partner violence in adulthood. Epidemiology, 21, 809–818.

52.

Rogosch

F. A.

Oshri

Cicchetti

(2010). From child maltreatment to adolescent cannabis abuse and dependence: A developmental cascade model. Development and Psychopathology, 22, 883–897.

53.

Roudsari

B. S.

Leahy

M. M.

Walters

S. T.

(2009). Correlates of dating violence among male and female heavy-drinking college students. Journal of Interpersonal Violence, 24, 1892–2905.

54.

Schafer

Caetano

Cunradi

C. B.

(2004). A path model of risk factors for intimate partner violence among couples in the United States. Journal of Interpersonal Violence, 19, 127–142.

55.

Schnurr

M. P.

Lohman

B. J.

Kaura

S. A.

(2010). Variation in late adolescents’ reports of dating violence perpetration: A dyadic analysis. Violence and Victims, 25, 84–100.

56.

Scott

K. M.

Smith

D. R.

Ellis

P. M.

(2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry, 67, 712–719.

57.

Shorey

R. C.

Brasfeild

Febres

Stuart

G. L.

(2011). The association between impulsivity, trait anger, and the association between intimate partner and general violence among women arrested for domestic violence. Journal of Interpersonal Violence, 26, 2681–2697.

58.

Shorey

R. C.

Cornelius

T. L.

Bell

K. M.

(2008). Critical review of theoretical frameworks for dating violence: Comparing the dating and marital fields. Aggression and Violent Behavior: A Review Journal, 13, 185–194.

59.

Shorey

R. C.

Zucosky

Brasfield

Febres

Cornelius

T. L.

Sage

Stuart

C. L.

(2012). Dating violence prevention programming: Directions for future interventions. Aggression and Violent Behavior, 17, 289–296.

60.

Simpson

T. L.

Miller

W. R.

(2002). Concomitance between childhood sexual and physical abuse and substance use problems: A review. Clinical Psychology Review, 22, 27–77.

61.

Statistics Canada. (2011). Family violence in Canada: A statistical profile. Ontario, Canada: Author.

62.

Stuart

G. L.

O’Farrell

T. J.

Leonard

Moore

T. M.

Temple

J. R.

Ramsey

S. E.

(2009). Examining the interface between substance misuse and intimate partner violence. Substance Abuse: Research and Treatment, 3, 25–29.

63.

Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of National findings. NSDUH Series H-44, HHS, Publication No. (SMA) 12-4713. Rockville, MD: Author

64.

Swanberg

J. E.

Logan

T. K.

Macke

(2005). Intimate partner violence, employment, and the workplace: Consequences and future directions. Trauma, Violence, & Abuse, 6, 286–312.

65.

Taft

C. T.

Schumm

Oraem

R. J.

Meis

Pinto

L. A.

(2010). Examining the link between posttraumatic stress disorder and symptoms and dating violence perpetration. Violence and Victims, 25, 456–469.

66.

Testa

Quigley

B. M.

Leonard

K. E.

(2003). Does alcohol make a difference? Within-participants comparisons of incidents of partner violence. Journal of Interpersonal Violence 18, 735–743.

67.

Thombs

D. L.

Beck

K. H.

(1994). The social context of four adolescent drinking patterns. Health Education Research Theory and Practice, 9, 13–22.

68.

Tonmyr

Thornton

Draca

Wekerle

(2010). A review of childhood maltreatment and adolescent substance use relationship. Current Psychiatry Reviews, 6, 223–234.

69.

Tucker

J. S.

Ellickson

P. L.

Orlando

Martino

S. C.

Klein

D. J.

(2005). Adulthood: A comparison of smoking, binge drinking, and marijuana use. Journal of Drug Issue, 35, 307–322.

70.

Walsh

MacMillan

H. L.

Trocme

Jamieson

Boyle

M. H.

(2008). Measurement of victimization in adolescence: Development and validation of the Childhood Experiences of Violence Questionnaire. Child Abuse & Neglect, 32, 1037–1057.

71.

Wekerle

Leung

Goldstein

A. L.

Thornton

Tonmyr

(2009a). Substance use among adolescents in child welfare versus adolescents in the general population: A comparison of the maltreatment and adolescent pathways (MAP) longitudinal study and Ontario student drug use survey (OSDUS) datasets. Ottawa, Canada: Report prepared for Health Canada.

72.

Wekerle

Leung

Wall

A.-M.

MacMillan

Boyle

Trocme

Waechter

(2009b). The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth. Child Abuse & Neglect, 33, 45–58.

73.

Wekerle

Waechter

Chen

Leung

Wall

A.-M.

Nassar

… Moody

(2011). The Maltreatment and Adolescent Pathways (MAP) Project feasibility study: Are youth involved with child protection services a feasible sub-population for study? In Léveillé

Trocmé

Brown

Chamberland

(Eds.), Research-community partnerships in child welfare (pp. 59–90). Toronto, Canada: Centre of Excellence for Child Welfare.

74.

Wekerle

Wolfe

D. A.

(1999). Dating violence in mid-adolescence: Theory, significance, and emerging prevention initiatives. Clinical Psychology Review, 19, 435–456.

75.

Wekerle

Wolfe

D. A.

(2003). Child maltreatment. In Mash

E. J.

Barkley

R. A.

(Eds.), Child psychopathology (2nd ed., pp. 632–684). New York, NY: Guilford Press.

76.

White

H. R.

Labouvie

E. W.

(1989). Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol, 50, 30–37.

77.

White

H. R.

Widom

C. S.

(2003). Partner violence among abused and neglected children in young adulthood; The mediating effect of early aggression, antisocial personality, hostility and alcohol problems. Aggressive Behavior, 29, 332–345.

78.

White

H. R.

Widom

C. S.

(2008). Three potential mediators of the effects of child abuse and neglect on adulthood substance use among women. Journal of Studies on Alcohol and Drugs, 69, 337–347.

79.

Widom

C. S.

Czaja

Dutton

M. A.

(2013). Child abuse and neglect and intimate partner violence victimization and perpetration: A prospective investigation. Child Abuse & Neglect, 13, 343–348.

80.

Wills

T. A.

Hirky

A. E.

(1996). Coping and substance abuse. In Zeidner

Endler

N. S.

(Eds.), Handbook of coping (pp. 279–302). New York, NY: Wiley.

81.

Windle

Mrug

(2009). Cross-gender violence perpetration and victimization among early adolescents and associations with attitudes toward dating conflict. Journal of Youth & Adolescence, 38, 429–439.

82.

Wolfe

D. A.

Scott

Reitzel-Jaffe

Wekerle

Grasley

Straatman

(2001). Development and validation of the conflict in adolescent dating relationships inventory. Psychological Assessment, 13, 277–293.

83.

Wolfe

D. A.

Scott

Wekerle

Pittman

(2001). Child maltreatment: Risk of adjustment problems and dating violence in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 282–298.

84.

Wolfe

D. A.

Wekerle

Scott

Straatman

Grasley

Reitzel-Jaffe

(2003). Dating violence prevention with at-risk youth: A controlled outcome study. Journal of Clinical and Consulting Psychology, 71, 279–291.

85.

Wolfe

D. A.

Wekerle

Straatman

Grasley

(2004). Predicting abuse in adolescent dating relationships over 1 year: The role of child maltreatment and trauma. Journal of Abnormal Psychology, 113, 406–415.