Interpersonal violent victimization precedes substance abuse among women on welfare: A longitudinal study

Background: Temporary Assistance to Needy Families (TANF) welfare reform laws emphasize economic independence to combat welfare reliance. This study examines the extent to which interpersonal violence, including domestic violence, rape, physical assault, and child abuse, predicts substance abuse over the course of the study. The combination of violence and substance abuse may inhibit women's ability to function and thereby achieve independence.

Methods: Applicants (N=1235 women) for TANF and local General Assistance (GA) were surveyed in a northern California county during 2002 as part of the Welfare Client Longitudinal Study. Those granted benefits were re-interviewed each year for 4 more years. Interpersonal violent victimization, demographic, work, and health factors were assessed.

Results: Adult violence was reported by 44.8% of women during the five year study. Cumulative partner violence and severe violence (rape or severe physical assault) during the five years was reported by 37.9% and 27.2% respectively. Physical or sexual child abuse was reported by 36.5%. In longitudinal analyses, women reporting severe violence were more likely to report substance use in each subsequent year. Substance abuse was predicted by moderate (OR=1.7; 95% CI 1.0-2.8) and severe child abuse (OR=2.4; 95% CI 1.5-3.8) and severe adult violence (OR=1.8, 95% CI 1.2-2.6). In multivariate analyses child abuse, young age and psychological distress predicted later substance abuse. Discussion: A reported history of violence was associated with subsequent substance abuse. Some of the relationship between adult violence and substance abuse may be accounted for by the strong association between child abuse and substance abuse.