Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children

Abstract

Aim: Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males.

Methods: A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex.

Results: Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused.

Conclusion: Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.

Keywords: Physical abuse; adolescents; juvenile justice; opioid misuse; sexual abuse.

Figure 1.

Conceptual diagram adopted from the stress process model hypothesizing that sex will moderate the individual and cumulative effects of physical and sexual abuse on opioid misuse.

Figure 2.

Consort diagram of FLDJJ data depicting past 30 day (P30D) opioid misuse (OM).

Figure 3.

The moderation effects of sex on the individual and combined effects of physical abuse and sexual abuse on past 30-day opioid misuse (estimating predictive margins with confident intervals plotted in vertical dotted lines).