Child Abuse & Neglect 34 (2010) 576–584

Contents lists available at ScienceDirect

Child Abuse & Neglect

Family violence and risk of substance use among Mexican adolescents夽

Miguel Ángel Caballero ∗ , Luciana Ramos, Catalina González, María Teresa Saltijeral
Instituto Nacional de Psiquiatría Ramón de la Fuente (National Institute of Psychiatry Ramón de la Fuente), Mexico City, Mexico

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Determine the relationship between psychological and physical violence,
Received 3 June 2006 exerted by fathers and/or mothers, and inter- or extra-familiar sexual violence with risk for
Received in revised form 8 December 2009
consuming tobacco, alcohol and drugs among adolescents.
Accepted 7 February 2010
Method: A cross-sectional study was carried out with students in two secondary schools
Available online 11 June 2010
in Mexico City. A total of 936 students participated: 54.3% males and 45.7% females, rang-
ing between 12 and 16 years of age. A self-administered questionnaire was applied. This
Keywords:
included Straus’ Parent–Child Conflict Tactics Scales, as well as instruments to evaluate
Family violence
Adolescents sexual violence and substance use, among other components.
Tobacco Results: Over half of the adolescents reported psychological or physical violence exerted
Alcohol by their parents, and 1 in 10, sexual violence. The proportion of use of the 3 substances
Drugs was similar in both sexes. Logistic regression analysis for males showed that psychological
violence, exerted by either parent, implied twice the risk for the victims to use tobacco.
For males, having suffered sexual violence increased the risk of consuming drugs various
times. For females, being a victim of multiple forms of violence within the family increased
the risk of consuming tobacco, alcohol and drugs notably, in comparison to non-victims.
Conclusions: Treatment programs for young people who have suffered family violence
should consider adolescence not only as a stage of vulnerability for substance use but also
as a critical time to implement preventive measures. For these measures, a joint strategy
for both parents and adolescents should be considered, not only to stop the violence but
also warn the parents about the serious consequences of the same.
© 2010 Elsevier Ltd. All rights reserved.

Introduction

It is known that the various types of violence occurring within the familiar environment may have mental health repercus-
sions on its victims. In the particular case of children and adolescents, suffering violence in the family has been associated
with problems such as depression (Pelcovitz, Kaplan, DeRosa, Mandel, & Salzinger, 2000; Turner, Finkelhor, & Ormrod,
2006), post-traumatic stress disorder (Pelcovitz et al., 2000), eating disorders, suicidal behavior (Krug, Dahlberg, Mercy, Zwi,
& Lozano, 2002), and social isolation (Elliott, Cunningham, Linder, Colangelo, & Gross, 2005) as well as high-risk behavior,
such as the consumption of alcohol and drugs (Heise, Pitanguy, & Germain, 1994; Krug et al., 2002). Nevertheless, further
studies that allow for the identification of variations and specificities to help understand family violence and its conse-
quences are needed, given that these are complex phenomena. To this end, we were interested in studying the relationship

夽 The authors thank the Consejo Nacional de Ciencia y Tecnología (Mexican National Science and Technology Council) for support offered to Project
25902H: “Suicide Attempt and Family Violence: Cultural Elements, Prevalence, Associated Factors and Subjective Perception Among Adolescents”.
∗ Corresponding author address: Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente,
Calzada México-Xochimilco # 101, Col. San Lorenzo Huipulco, Tlalpan, 14370 México, D.F., Mexico.

0145-2134/$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2010.02.001
 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584 577

that exists between suffering certain types of violence within the family, specifying the perpetrator, with substance use in
adolescents.
The above is important because it has been documented that having experienced violence is a factor which has a strong
relationship with contact and use of drugs (Vermeiren, Schwab-Stone, Deboutte, Leckman, & Ruchkin, 2003), particularly
when the violence occurred during childhood or adolescence (Bensley, Spieker, Van Eenwyk, & Schoder, 1999; Dube et al.,
2003; Freeman, Collier, & Parillo, 2002; Krug et al., 2002; Ramos, Saldívar, Medina-Mora, Rojas, & Villatoro, 1998; Ramos,
Saltijeral, Romero, Caballero, & Martínez, 2001), and which is also related to younger age at first consumption (Kilpatrick et
al., 2000). The literature also indicates that the severity of exposure to violence may be directly associated to substance use
(Clark, Lesnick, & Hegedus, 1997; Dube et al., 2003; Freeman et al., 2002).
In Mexico, the first studies on family violence focused on violence exerted toward children, and centered on the doc-
umentation of extreme cases such as violent physical shaking and its consequences (Loredo et al., 1986; Loredo, Carbajal,
Reynés, & Rodríguez, 1993). In addition, sexual abuse in childhood and the survival of this type of abuse have been studied,
making evident that family members perpetrate this type of violence to an important degree (González, 1995; Ramos et
al., 1998). At the same time, spousal violence against women has been researched (Alvarado, Salvador, Estrada, & Terrones,
1998; Ramírez & Patiño, 1997; Saltijeral, Ramos, & Caballero, 1998; Valdez & Juárez, 1998), including sexual violence (Ramos
et al., 2001) and the severity of resulting injuries, according to emergency room reports (Híjar, Flores, Valdez, & Blanco, 2003;
Ramos, Borges, Cherpitel, Medina-Mora, & Mondragón, 2002). Nevertheless, little research has studied the problem of family
violence within the adolescent population (Caballero, Ramos, González, & Saltijeral, 2002) and particularly its relationship
to mental health problems (Caballero & Ramos, 2004).
Although previous studies exist, principally at the international level, on family violence and its probable link to substance
use, certain considerations need to be taken into account. For example, it has been pointed out that the bulk of studies have
focused on the adult female population (MacMillan & Munn, 2001; Widom & Hiller-Sturmhofel, 2001); and have highlighted
the need of carrying out further research in populations other than those in legal and clinical environments. Results of
research with solely these samples, which concentrate the most serious cases possibly generating an important bias, cannot
be applied to the wider population (Bensley et al., 1999).
At the same time, research is often intended to investigate the effects of only one dimension of violence, be it physical,
sexual, or psychological, and not necessarily the combined effects. In other words, little research has been carried out on
what happens when one is a victim of multiple forms of family violence and particularly, if this could increase the risk
of substance use in adolescents. The above is important given that studies such as that of Perez (2000) have found that
although physical and sexual violence are by themselves strong predictors for the use of illegal drugs by adolescents, the
probability of consuming drugs, and doing so at an earlier age, is increased considerably when these two types of violence
are reported concurrently. This occurs independently of control factors such as academic level, family structure and low-
income levels. In this same vein, Moran, Vuchinich, and Hall (2004) found that if physical and sexual violence are reported,
the risk of consuming tobacco, alcohol and illegal drugs increases various times in adolescents, compared to those reporting
only one form of violence. It is interesting to observe that although this study includes emotional mistreatment, which has
been associated principally with the use of tobacco and alcohol by adolescents, it does not include a combined measure of
violence to understand the joint effects, along with the other forms of violence.
In addition, in the above-mentioned studies, although they distinguish between the types of violence suffered and add
a combined measure of violence (physical and sexual), they did not include who had been the perpetrator of the violence.
In fact, in research on family violence and substance use, it is more common to differentiate the sex of the victims but
not necessarily that of the perpetrator, due to which its probable implications are unknown. Harrier, Lambert, and Ramos
(2001), in their study of physical and sexual abuse suffered by adolescents, did not set apart who had been the perpetrator
of this violence, although they did distinguish, interestingly enough, the role and influence that substance use by the father
or mother played. Their results showed that physical abuse, sexual abuse, family violence and parental history of alcohol or
drug use predicted substance use by adolescents. Perhaps it is in this sense that Howells and Rosenbaum (2008) observed
that there is little research directed toward understanding if the sex of the perpetrator, in addition to that of the child,
has some relationship on the negative effects of physical abuse in childhood, although their study associated depressive
symptomatology and aggression. For example, they found that young people who reported physical abuse in childhood
by both parents or only the mother presented higher levels of aggressive conduct, and if females had been victimized
by both parents or only the father, they presented more depressive symptoms. The above reflects on the convenience of
differentiating the perpetrator of the violence as well as the sex of the victim, given that the effects differ according to the
specificity of the case.
Considering the above, the need to examine the role that family violence may play in adolescents’ substance use is evident,
particularly if data from the last Mexican National Survey on Drugs are taken into account. This survey reported noteworthy
increases in at least once-in-a-lifetime consumption of illicit drugs, principally marijuana, cocaine and inhalants, the drugs
most used among adolescents 12–17 years of age (Medina-Mora et al., 2003). In the particular case of Mexico City, according
to surveys among secondary and high school students, drug use has increased and levels of consumption between males
and females are increasingly comparable, especially for alcohol and tobacco (Villatoro et al., 2005).
As such, the objective of the present study was to attempt to determine the relationship between family violence—be it
psychological or physical, exerted by the father or mother, or inter- or extra-familiar sexual violence—with tobacco, alcohol
and drug use, in a sample of adolescent students. On one hand, analysis was carried out to evaluate if differences in risk of
578 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584

substance use by adolescents was influenced by type of violence according to perpetrator and on the other, if the number
of reported types of violence increased the risk of consuming the mentioned substances.

Method

Sample and subjects

A cross-sectional, ex post facto, and non-probabilistic study was carried out. The sample was obtained in 2 public sec-
ondary (grades 7–9) schools (n = 1,040 students) located in downtown Mexico City. A total of 936 students (school A: n = 385;
school B: n = 551) offered complete information for the study, practically 90% of the total eligible students. Of these, 508
(54.27%) were males and 428 (45.73%) were females. Ages ranged from 12 to 16 and the mean was 13.7 years. The majority
of adolescents (69.76%) reported living with both parents; 18.80% reported living only with his/her mother and 1.82% only
with his/her father; the rest (9.62%) lived with some other person such as grandparents, aunts and uncles and so forth. All
students pertained to a low socioeconomic stratum.

Instrument

A self-administered instrument, including original questionnaires on study topics and previously existing scales, was
compiled. The entire instrument was piloted previously with secondary school students from the same geographic zone
and socioeconomic status; in this way, it was possible to verify the functioning of each scale (González, Ramos, Caballero, &
Saltijeral, 2000). In particular, the evaluation of physical or psychological violence was carried out through the Parent–Child
Conflict Tactics Scales (Straus, Hamby, Finkelhor, Moore, & Runyan, 1998). This scale was translated and adapted for
application, respecting the original structure and content. Results obtained during the pilot and present studies were
consistent.
Straus’ Parent–Child Conflict Tactics Scales measure the presence and degree of maltreatment of children by their parents,
more than assessing injuries. This distinction avoids confusion with the term “abuse,” associated more closely with injury. The
22-item scale, answered by participants for the father and the mother, includes the sub-scales nonviolent discipline—which
was not used in this study,—psychological aggression and physical assault. This last category includes three levels of sever-
ity: minor and severe corporal punishment, severe physical assault and very severe physical assault, exerted by the father or
mother. Below we present a description of the sub-scales, including the reliability values obtained through Cronbach’s
alpha.
In turn, the psychological aggression sub-scale includes 5 items, measuring symbolic and verbal acts against chil-
dren by their parents with the intention of provoking fear or psychological pain; for example, Has your mother ever
said she would send you away or kick you out of the house? This sub-scale obtained an acceptable reliability both in
the case of fathers (˛ = 0.73) and mothers (˛ = 0.72). At the same time, physical assault involved 3 categories. The first,
minor and severe corporal punishment, includes 5 items such as spanking or shaking; for example, Your father spanked
you (father: ˛ = 0.71; mother: ˛ = 0.76). The following 2 categories were severe physical assault (father: ˛ = 0.79, mother:
˛ = 0.62) and very severe physical assault (father: ˛ = 0.50, mother: ˛ = 0.45). Each was composed of 4 items and inves-
tigated behaviors of severe mistreatment such as beatings or purposeful burning. For aims of the present article, all
physical assault was grouped into 1 category, total physical violence (father: ˛ = 0.85; mother: ˛ = 0.83), which obtained good
reliability.
Sexual violence was evaluated through an 8-item questionnaire that had been applied in previous studies (Ramos et
al., 1998). Nevertheless, after the pilot study with the target population, the principal question was modified slightly to
specify if the act in question had been committed by a family member or some one else. The adapted question was as
follows: Has any one—a family member or someone else—ever touched or caressed a part of your body that you did not want
them to? Did they force or pressure you to engage in sexual contact? In addition to the occurrence of sexual violence, it
explored the age at which and the number of times violence was present, as well as the identity of the aggressor and if
the victim had told anyone. As in the cases of psychological and physical violence, here we were interested in detecting
the presence of sexual conduct exerted by others against the will of a young person in a vulnerable situation, be it due
to the aggressors’ age or their relationship with the adolescent, and did not focus on the evaluation of probable conse-
quences. For this article, cases of sexual violence were grouped by relationship to aggressor: family member (i.e., father,
brother, grandfather, cousin, stepfather, uncle) or someone outside the family (i.e., boyfriend, friend, acquaintance, authority,
neighbor).
In addition, an 11-item questionnaire queried tobacco, alcohol, and 9 types of drug use: marijuana or hash, inhalants,
tranquilizers, amphetamines, sedatives, hallucinogens, cocaine, crack and heroin. Two characteristics of consumption were
evaluated—type of substance and frequency—through similar questions that varied according to substance. For example, in
the case of alcohol consumption, we asked: How many times have you drunk a complete glass of any alcoholic beverage such
as beer, wine, brandy, rum, tequila, or a cocktail prepared with these types of alcohol such as piña colada or daiquiri? There were
4 possible responses: never, once, 2–5 times, and more than 5 times. However, in the present paper the rate of frequency
was not used, rather only if a certain substance had been consumed or not. At the same time, drugs were grouped into a sole
category that included the 9 types of substances mentioned.
 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584 579

Procedures

The survey was applied in the selected schools with the previous authorization and consent of school authorities. Like-
wise, the schools advised parents or guardians of the study and secured consent in a meeting. Before initiating the study’s
application, the young people were also asked for their consent, guaranteeing them absolute anonymity and confidential
data management. The instrument application was carried out during normal class hours and participation was voluntary.
This project was also approved by the Instituto Nacional de Psiquiatría Ramón de la Fuente’s Research Ethics Committee.

Analysis

During data analysis using the Straus et al. (1998) scale for the present study, we did not consider the severity of physical
violence. As such, we grouped the three forms of physical violence into one category. Nevertheless, in the Results section,
the percentages obtained in each physical violence sub-scale are listed with the aim of offering the proportions reported
by young people in this study. Moreover, drug use was also classified into one category, given that reported use of distinct
types of substances was relatively low. Types of violence were the independent variables while substance use comprised
the dependent variables. All variables were dichotomous, except the variable on relationship with the perpetrator of sexual
violence, containing three mutually exclusive values: no sexual violence, violence exerted by a family member or exerted
by a non-family member. The first step was to carry out bi-variate analysis to obtain contrasts between the victims of each
type of violence with non-victims, considering males and females separately. This was done for each type of violence against
the three categories of substances: tobacco, alcohol and drugs. When carrying out preliminary stratified analysis (Rothman
& Greenland, 1988) among the various forms of violence and the three types of substance use, we found that sex acted as
an effect modifier in the association between types of violence and substance use. As such, the decision was made to carry
out separate analysis for males and females. All violence and substance use variables were prepared as dummy variables
with the aim of carrying out multiple logistic regression analysis (Hosmer & Lemeshow, 1989). Here, we developed two
types of models; in the first model, our interest was to understand which type of violence, distinguishing the perpetrator,
had greater weight for substance use risk, while in the second, we created a variable that totaled the number of different
types of violence suffered by the subjects to identify if the risk of substance use increased in function of having been a
victim of distinct types of violence. For example, if a young person reported physical violence exerted by the father and the
mother, this event was counted as two distinct forms of violence and not merely one, given that our interest was not solely
in the nature of the violence but also who exerted it. For this last model, the maximum number of types of violence suffered
was five, not six, given the previously mentioned conditions about the sexual violence perpetrator item. All models were
simultaneously adjusted by age, school and family structure with the aim of avoiding the probable confounding effect of
these variables. The Stata program, version 8 (2003), was used for all statistical analysis.

Results

Magnitude of family violence and substance use

[Data not shown but available.] In general, psychological violence was reported by between 5 and 6 of every 10 cases,
exerted either by the father (males: 60.24%, and females: 59.81%) or the mother (males: 54.13%, and females: 64.25%).
Regarding physical violence by the father, male adolescents mentioned having experienced it in 58.66% of the cases (mod-
erate: 31.10%; severe: 15.55%; very severe: 12.01) and females reported it in 54.67% (moderate: 29.91%; severe: 16.12%;
very severe: 8.64%). In the case of physical violence exerted by the mother, the proportion was 61.61% for males (moderate:
32.87%; severe: 16.73%; very severe: 12.01) and 65.89% for females (moderate: 34.11%; severe: 18.93%; very severe: 12.85).
Sexual violence was measured at 11.32% or 1 in 10 adolescents. Of these, 43% reported that a family member and 57% that
someone outside the family had exercised this violence. For females, sexual violence represented 14.95%, while in males it
represented 8.27%. Additionally, half of the males (52.56%) and females (50.70%) reported tobacco use, and almost 6 in 10
adolescents had drunk at least 1 complete glass of alcohol (males: 58.66% and females: 57.94%). Finally, the use of drugs
represented 15.94% for males and 16.36% for females.

Multiple logistic regression analysis according to types of violence

To understand the risk that having been a victim of some type of violence implied for substance use, multiple logistic
regression models were carried out, controlled simultaneously for age, school, and family structure. The following results
were obtained.

Males

Table 1 shows the estimations for risk of substance use in males according to various types of violence. First, it can be
observed that the risk of tobacco use is higher for adolescent males who had experienced psychological violence, exerted
580 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584

Table 1
Estimated risk of substance use, according to various types of violence in males.

Tobacco Alcohol Drugs

OR CI 95% P OR CI 95% P OR CI 95% P

No violence 1 1 1

Psychological violence
Exerted by father 1.70 1.02–2.83 0.039 1.27 0.77–2.09 0.345 0.73 0.36–1.46 0.383
Exerted by mother 1.76 1.10–2.83 0.018 1.15 0.72–1.84 0.550 1.22 0.63–2.36 0.549

Physical violence
Exerted by father 0.68 0.40–1.15 0.153 1.08 0.65–1.80 0.756 2.00 0.97–4.14 0.060
Exerted by mother 1.03 0.62–1.69 0.905 0.88 0.53–1.44 0.616 0.94 0.47–1.90 0.878

Sexual violence
Family member 2.28 0.56–9.29 0.248 3.62 0.74–17.76 0.112 5.31 1.48–18.96 0.010
Non-family member 0.57 0.23–1.38 0.217 1.12 0.46–2.73 0.790 4.73 1.95–11.50 0.001

Note. Models adjusted by age, school and family structure. OR: odds ratio; CI: confidence interval; P: probability.

by the father (OR = 1.70, CI 95% = 1.02–2.83) or mother (OR = 1.76, CI 95% = 1.10–2.83). Although relatively low, having been
a victim of this type of violence represented almost twice the risk for tobacco use.
In turn, the alcohol consumption model did not show sufficient evidence between this type of consumption and violence,
as no variable demonstrated a significant probability. Even though sexual violence exerted by a family member (OR = 3.62,
CI 95% = 0.74–17.76) represented a 3-fold higher risk of consuming alcohol, it was not statistically significant.
The type of violence that best explained drug use in males is that of sexual violence. If this violence was perpetrated by
a family member (OR = 5.31, CI 95% = 1.48–18.96), it represented more than a 5-fold higher risk for drug use. Likewise, if it
was exerted by a non-family member (OR = 4.73, CI 95% = 1.95–11.50), it resulted in a 4-fold higher risk.

Females

In the risk of tobacco use and types of violence model (Table 2), it can be observed that females who reported psychological
violence by their mothers (OR = 2.38, CI 95% = 1.37–4.13) and those who reported physical violence by their fathers (OR = 2.37,
CI 95% = 1.41–3.99) had a little more than twice the risk of presenting tobacco use. For the other types of violence, there was
not an evident association between being a victim and consuming tobacco.
In the case of the alcohol consumption model, the types of violence that best predicted a risk include psychological
violence exerted by the mother (OR = 2.27, CI 95% = 1.32–3.91), that represents more than twice the risk for this type of
consumption, and sexual violence exerted by a family member (OR = 5.48, CI 95% = 1.56–19.21), that represents a more than
5-fold higher risk for alcohol use in victims. The drug use risk model according to types of violence did not contribute
sufficient evidence to predict this type of consumption.
Upon reviewing the bi-variate analysis [data not shown but available] together with the logistical regression models, it
was possible to note that, for males, the relationship between the various types of violence and substance use is maintained,
despite established controls. This is not the case for females, given that there was a decrease in the number of previous
significant associations between the distinct variables once controls were placed. The above suggests that, for the females
in this sample, probably age, and not only violence, is a significant variable that could explain part of substance use.

Table 2
Estimated risk of substance use, according to various types of violence in females.

Tobacco Alcohol Drugs

OR CI 95% P OR CI 95% P OR CI 95% P

No violence 1 1 1

Psychological violence
Exerted by father 0.81 0.47–1.40 0.465 1.39 0.82–2.37 0.215 1.52 0.74–3.10 0.244
Exerted by mother 2.38 1.37–4.13 0.002 2.27 1.32–3.91 0.003 1.08 0.52–2.24 0.820

Physical violence
Exerted by father 2.37 1.41–3.99 0.001 1.41 0.84–2.38 0.184 1.47 0.74–2.91 0.261
Exerted by mother 0.69 0.40–1.19 0.189 0.72 0.42–1.24 0.241 1.18 0.57–2.41 0.649

Sexual violence
Family member 1.93 0.78–4.73 0.149 5.48 1.56–19.21 0.008 1.95 0.81–4.69 0.134
Non-family member 1.53 0.69–3.39 0.292 0.84 0.38–1.84 0.677 0.59 0.19–1.81 0.365

Note. Models adjusted by age, school and family structure. OR: odds ratio; CI: confidence interval; P: probability.
 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584 581

Table 3
Estimated risk of substance use, considering the number of distinct types of violence suffered in males.

Tobacco Alcohol Drugs

OR CI 95% P OR CI 95% P OR CI 95% P

0 (n = 97) 1 1 1
1 (n = 55) 0.79 0.39–1.58 0.515 0.78 0.39–1.55 0.488 0.68 0.22–2.04 0.495
2 (n = 92) 1.21 0.67–2.17 0.519 1.02 0.56–1.84 0.937 0.85 0.36–2.02 0.721
3 (n = 82) 1.25 0.68–2.30 0.454 1.10 0.59–2.02 0.756 1.06 0.45–2.50 0.881
4 (n = 168) 1.92 1.14–3.24 0.013 1.35 0.80–2.27 0.256 1.75 0.87–3.52 0.115
5 (n = 14) 1.97 0.60–6.41 0.260 1.83 0.55–6.07 0.323 4.19 1.18–14.87 0.026

Note. Models adjusted by age, school and family structure. OR: odds ratio; CI: confidence interval; P: probability.

Table 4
Estimated risk of substance use, considering the number of distinct types of violence suffered in females.

Tobacco Alcohol Drugs

OR CI 95% P OR CI 95% P OR CI 95% P

0 (n = 62) 1 1 1
1 (n = 49) 2.06 0.89–4.79 0.091 2.17 0.96–4.89 0.060 1.69 0.49–5.80 0.401
2 (n = 86) 3.12 1.49–6.55 0.003 3.06 1.49–6.27 0.002 1.58 0.51–4.89 0.424
3 (n = 67) 2.76 1.27–6.00 0.010 4.14 1.92–8.89 0.000 1.65 0.51–5.33 0.396
4 (n = 132) 4.39 2.19–8.78 0.000 4.41 2.25–8.62 0.000 2.91 1.05–8.01 0.039
5 (n = 32) 7.23 2.69–19.42 0.000 7.11 2.62–19.23 0.000 4.87 1.46–16.21 0.010

Note. Models adjusted by age, school and family structure. OR: odds ratio; CI: confidence interval; P: probability.

Multiple logistic regression analysis according to number of types of violence suffered

To respond to one of the initial questions—where we hypothesized about the high likelihood of adolescents suffering
several types of violence in the family environment, which could entail differences in the risk of consuming the various
substances—we used a second multivariate analysis model, through which the following results were obtained (see Table 3).

Males

Upon viewing the results in Table 3, a very slight increase in the risk of tobacco use can be noted as the types of violence
suffered increase, in such a way that having suffered 4 distinct types of violence (OR = 1.92, CI 95% = 1.14–3.24) represents
practically twice the risk for using tobacco in males.
In the alcohol consumption model, it can be observed that the increase in risk for this type of consumption is very small as
the types of violence suffered increase, without offering a significant probability. Given this, the model does not contribute
sufficient evidence for this relationship.
In turn, in the drug use model, a moderate increase can be detected that results in a 4-fold higher risk for drug use in
young men reporting 5 types of violence (OR = 4.19, CI 95% = 1.18–14.87).

Females

In the results obtained for females using the same type of analysis (Table 4), it can be observed that a tendency toward
a higher risk for tobacco use exists as the types of violence suffered increase. In this model, having experienced 1 type
of violence (OR = 2.06, CI 95% = 0.89–4.79) represents twice the risk for tobacco use, and this progressively increases until
reaching a 7-fold higher risk (OR = 7.23, CI 95% = 2.69–19.42) when 5 types of violence have been suffered.
Similar results appear in the model of alcohol use, where having suffered 1 type of violence (OR = 2.17, CI 95% = 0.96–4.89)
represents twice the risk for alcohol consumption, and the risk increases gradually until reaching a 7-fold risk for those who
have suffered 5 types of violence (OR = 7.11, CI 95% = 2.62–19.23).
Lastly, for the drug consumption model, the tendency toward a higher risk is maintained, although moderate. The risk
for drug use in females that report 4 (OR = 2.91, CI 95% = 1.05–8.01) and 5 types of violence (OR = 4.87, CI 95% = 1.46–16.21)
is practically 3 and 5 times higher with respect to those who have not suffered any type of violence.

Discussion

The magnitude of physical and psychological violence reported in our sample is high, given that nearly 6 in 10 adolescents
reported being a victim. It is worth underlining that these types of violence are exerted, in similar proportions, by both parents
toward their children. Part of the explanation of these results could be connected to prevailing socio-cultural traditions in
Mexico, where family education and discipline standards still contain violent components. Punishment and insults, but also
spanking and slapping, are still part of families’ disciplinary dynamics and are not necessarily viewed as violent expressions
582 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584

(Caballero et al., 2005). All the same, this propensity is not limited to Mexican society, given that studies in other countries,
using the same measurement scale, also report elevated family violence rates (Kim et al., 2000; Pelcovitz et al., 2000). In
Latin America, there are generalized reports of physical punishment against girls and boys in rural and urban areas (Krug et
al., 2002), which is related to the idea that when children suffer, they learn their lesson (UNICEF, 2006).
Concomitantly, sexual violence is a problem that was present in 1 of every 10 cases, affecting females for the most part,
which coincides generally with the 9.4% prevalence reported in Mexico in the National Survey of Psychiatric Epidemiology
(Medina-Mora et al., 2005). Yet, this type of violence represents an important risk factor for substance use in both sexes,
predominantly drugs for males and alcohol for females. Indeed, it was observed that having been a victim of sexual violence
represented the highest substance consumption risk in the models for both sexes. In this vein, in a study with female
adolescents, Csoboth, Birkas, and Purebl (2003) found that females who had suffered sexual abuse presented twice the
risk of using tobacco and had more probability of consuming higher quantities of alcohol than women who had not been
victimized. Part of the explanation given for this relationship is that the consumption of alcohol and drugs by women could
be a coping response to sexual abuse (Filipas & Ullman, 2006). This association has been established more accurately for
women than men (Widom & Hiller-Sturmhofel, 2001). In this sense, it is difficult to provide an overarching explanation
about the probable mechanisms that underlie this link in males, more so when we consider that in Mexico specific studies
to examine the effects of sexual violence associated with adolescent substance use have not been developed. Although it is
worth questioning if drug consumption could have a palliative role against the negative effects of sexual violence for males
as well. In light of the above, the results on sexual violence obtained in the present study are important, given the inclusion
of both male and female adolescents, in contrast to most of the other studies on sexual violence and its consequences,
which focus solely on adult females (MacMillan & Munn, 2001). However, this work also presents limitations that should be
recognized. One of these is that sexual violence variables need to be adjusted to register aggressors as independent items to
allow for more precise data analysis.
The percentage of youth who reported having used tobacco, alcohol, and drugs at least once in a life time in our sample
coincides with the prevalence reported in a Mexico City survey of secondary and high schools (Villatoro et al., 2005). However,
it is noteworthy that the use of alcohol in males was not associated significantly with any type of violence while there was
only a slight relationship between violence and drug use in females. A preliminary hypothesis could be that many young
people experiment with substances, particularly with illegal drugs, for the first time during adolescence, and so it is not yet
possible to appreciate the probable relationship between family violence and substance use. In this sense, Medina-Mora,
Peña, Cravioto, Villatoro, and Kuri (2002) reported that the average age for the first consumption of drugs, including tobacco
and alcohol, is between 15 and 19 years in Mexico. This reinforces our above hypothesis, as the study’s sample ranged from
12 to 16 years of age.
Our justification for distinguishing violence exerted by the father or mother was the fact that it is not possible to sustain
that both manifestations of violence operate as just one, although they are of the same nature (psychological, physical,
or sexual), given that both the father and mother are distinct significant figures in a young person’s life. The above is
demonstrated in the models of multiple violence since the risk of consumption increases in accordance with the number of
types of violence suffered. But, at the same time, this distinction complicates the discussion since it is difficult to establish an
explanation on the mechanisms that underlie these associations. In this sense, our study provides a modest contribution on
the existence of specific effects that depend not only on the nature of the violence but also on who perpetrated it, the father
or the mother, and in the case of sexual violence, if the perpetrator was a family member or not. Howells and Rosenbaum
(2008) offer information on an element that could be involved, based on childhood development theory. They examine if
being a victim of physical violence exerted by the mother, compared to being a victim of physical violence exerted by the
father, could generate increased depressive symptoms and aggressive conduct, given higher dependence on mothers during
childhood and adolescence. Although their hypothesis was not completely sustained, they did find variations between being
a victim of violence exerted by the father or mother, which indicates the pertinence of making this distinction.
Although in our approach, we speculated that adolescent victims of some type of violence would report in general higher
use of tobacco, alcohol and drugs than their peers who had not suffered violence, this did not occur necessarily in all cases.
The above indicates that consumption, at least for this sample, might be attributed to other circumstances beyond the scope
of this study, as to which additional influences related to consumption that have been reported in the literature, such as
substance use by parents (Harrier et al., 2001; Ritter, Stewart, Bernet, Coe, & Brown, 2002), opportunity and substance
availability (Benjet et al., 2007; Wagner & Anthony, 2002) and adolescent social interaction, should be considered. This last
variable plays a central role, given that tobacco and alcohol use often forms part of group dynamics among friends. These
substances are easy to access in Mexico, despite legal restrictions on selling them to minors. At the same time, if social
interaction between young people is important for the development of inter-personal and social skills, it can also influence
other areas of a young person’s life. For example, Getz and Bray (2005) found that consumption by friends was the strongest
predictor for severe alcohol use among youth. Furthermore, Medina-Mora et al. (2003) also report that having friends who
use substances was a risk factor for personal use.
It is worth highlighting the fact of being a victim of various forms of violence within the family, given that the probabilities
of substance use risk increase markedly as the number of distinct types of violence suffered increases. In the case of females,
a clear tendency can be observed according to which as the number of types of violence suffered increases, so does the risk for
consuming tobacco, alcohol, or drugs. To the contrary, for males, the tendency in the models of experiencing multiple types of
violence and risk for consuming substances is less evident, particularly for alcohol. Given the above, it is interesting to observe
 M.A. Caballero et al. / Child Abuse & Neglect 34 (2010) 576–584 583

that the studies have not necessarily found a direct relationship between violence in childhood and alcohol consumption. For
example, Widom, White, Czaja, and Marmorstein (2007) report that men with documented childhood violence compared to
those without violence did not present statistically significant results of excessive alcohol consumption in adulthood. To the
contrary, Lo and Cheng (2007) report that, in young adults, physical abuse in childhood resulted to be a strong predictor for
substance abuse (alcohol, marijuana, and other drugs) although sexual abuse did not present significant levels within their
models. Despite differences in research, the violence experienced and its probable link to the various types of substance use
should not be underestimated. In fact, our results speak to the gravity of the same and underscore the importance of studying
exposure to multiple forms of family violence and not just one manifestation of the same. More so when other studies on
the same topics (Moran et al., 2004; Perez, 2000) document that the co-occurrence of physical and sexual violence is related
to high levels of illicit drug use, as well as earlier age of first consumption, including tobacco and alcohol.
It should be emphasized that both family violence and substance use are complex problems by themselves, and there
is not necessarily a causal relationship between the two. For the same, the idea that family violence is just one important
element, among many others, that encourages substance use during this stage cannot be disregarded. In addition, another
limitation of our study, related to the evaluation instrument for substance use, must be pointed out. In light of the results
obtained, substance use variables must be adjusted and questions that establish the pattern of consumption must be added,
with the goal of strengthening the data. For example, the data could capture a precise consumption pattern, including
frequency and quantity, and separate occasional from habitual use (Borges, Cherpitel, Medina-Mora, & Mondragón, 2004).
Establishing this distinction could be of great use to improve analysis and provide more elements for discussion.
The study’s importance stems from its contribution of precise information on a complex area that is seldom studied, family
violence among adolescents, where we established a distinction between psychological and physical violence, violence
committed by the father or mother, and sexual violence perpetrated by someone inside or outside of the family in addition
to including cases of those who have suffered distinct types of violence. However, the categorization of various types of
violence is relative, given that they are not independent phenomenon. For example, a father hitting a son or daughter
implies, in addition to a physical component, a psychological element as well. This is particularly true since all of these types
of violence take place in the familiar environment where adolescents are taught fundamental values.
Last, the results of this work suggest that treatment programs for young people who have been victims of family violence
should consider this age to be a stage of vulnerability for substance use as well as a critical moment to implement preventive
measures. For these measures, strategies that consider both parents and adolescents should be promoted, when possible,
not only to detain the violence but also advert parents about the serious consequences of the same.

Acknowledgements

The authors thank the participating school authorities, parents, teachers and, particularly, the students for their coopera-
tion. At the same time, we would like to thank Ricardo Orozco, Guilherme Borges, Liliana Mondragón, and Joaquín Zambrano
for their assistance during data analysis. We also thank Jennifer Paine for her translation and Mario Aranda for copy-editing
the final text.

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