Violence and its relationship to substance use in adolescent pregnancy.

We surveyed 342 pregnant adolescents 17 years old and younger for a history of physical or sexual assault and substance use to investigate whether victims of childhood violence are at increased risk of smoking and using alcohol or drugs. A total of 95% of new patients who attended the university's teen pregnancy clinic between May 8, 1989, and December 8, 1990, were interviewed. Substance use was reported seven times more often in those with a history of combined physical and sexual assault, five times more frequently by those who had been sexually assaulted, and three times more often in those who had been physically assaulted than adolescents without a history of assault. Violence was associated with substance use in all ethnic groups although this relationship was modified by ethnicity. Among Hispanics, an association was observed between physical assault and tobacco use. Sexual and combined physical and sexual assault were strongly associated with use of alcohol among blacks. All categories of violence were associated with drug use among all ethnic groups. When use of each substance was analyzed by the adolescent's relationship to the perpetrator, drug use was most strongly associated with assault by a mate, whereas tobacco or alcohol use was more often associated with assault by a member of the victim's family of origin.