Health care use, access, and economic welfare of adults with histories of childhood sexual abuse

University Of Southern California, Los Angeles CA

Investigators

Abstract

Project Summary Sexual abuse is a public health crisis that affects people across the life cycle. In preliminary analysis of US data, 11% of adults reported sexual abuse before age 18. The primary consequences of childhood sexual abuse have been studied: survivors experience higher rates of anxiety, depression, and suicide attempt. But, consequences of childhood sexual abuse may extend beyond poorer mental health. Scientists have described neurobiological mechanisms explaining effects of chronic childhood stress on physiological systems, behavior, and cognitive development. Social scientists have found that adult survivors of childhood abuse had higher rates of chronic physical conditions such as diabetes and hypertension as well as higher rates of engagement in adverse health behaviors. Yet, the literature has largely overlooked the potential consequences of childhood abuse on cognitive development, productivity, and later-life economic wellbeing. If childhood sexual abuse leads to poorer labor market outcomes, then adults with histories of childhood sexual abuse may have not only a greater health burden but also less ability to pay for needed health care. Thus, in the proposed dissertation, nationally representative data? the National Longitudinal Study of Adolescent to Adult Health?will be used to: (1) examine health of adult survivors of childhood sexual abuse, (2) assess their access to health care, and (3) measure the impact of childhood sexual abuse on adult economic wellbeing. All regression models will account for demographics, childhood socioeconomic status, and include school fixed effects to remove unobserved factors such as neighborhood and school quality from the estimate of the effect of childhood sexual abuse. Health will be studied by examining all recent prescription medication use. Health care access will be studied through uninsured status and reports of unmet medical needs. Economic wellbeing will be measured as earnings level. For (2) and (3), whether the effect of childhood sexual abuse is plausibly causal will be examined by using information on the predictive power of the observed factors listed above to calculate how large the relative magnitude of the effect of unobserved factors would have to be to reduce the effect of sexual abuse to zero. Findings of differential use of certain medication classes may motivate targeted screenings for the related health conditions in patients with histories of trauma. Measuring a plausibly causal link between childhood sexual abuse and reduced economic welfare may motivate quality improvements to therapy practices to address potential consequences of trauma on cognitive development and productivity. This research will be conducted with mentorship from experts in health economics, health policy, econometrics, pediatric medicine, and social welfare.