Date of Award

Spring 5-17-2019

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Katherine E. Masyn, PhD

Second Advisor

Monica H. Swahn, PhD

Third Advisor

Shannon Self-Brown, PhD


Child maltreatment is a global public health and human rights issue, with severe lifelong consequences. Previous research has linked experiences of child maltreatment with suicidality, sexual risk behaviors, and polysubstance use. However, little is known about these associations with child maltreatment longitudinally, collectively, and in specific regions of the world. Few studies have examined suicidality among youth in sub-Saharan Africa, and youth living in the slums of Kampala, Uganda are a vulnerable population that is drastically understudied and at risk for suicidal ideation. Additionally, research in the U.S. has been conducted on child maltreatment, sexual risk behaviors, and polysubstance use; however, few studies have examined these associations longitudinally across adolescence into adulthood. These studies seek to expand on previous research on the associations between child maltreatment and 1) suicidality, 2) polysubstance use, and 3) sexual behaviors. Using data from Kampala, Uganda, the impact of child maltreatment on suicidal ideation was examined in the context of current and problematic alcohol use as well as negative future expectations using structural equation mixture modeling. Child maltreatment had a direct effect on suicidal ideation, after accounting for negative future expectations and alcohol use. Using data from the U.S., the association between child maltreatment and polysubstance use was examined using both latent class and latent transition analyses. Lastly, the association between child maltreatment and sexual behaviors was examined a similar analytic approach. The second and third studies aimed to determine if changes between substance use profiles and sexual behaviors differed by child maltreatment patterns. Child maltreatment impacted profiles of substance use and sexual behaviors at specific time points, and previous substance use and sexual behavior profiles influenced profiles at later waves. While there was no interaction between maltreatment and previous profiles of substance use and sexual behaviors, there was an indirect effect of maltreatment on subsequent profiles through the elevated uniform impact of maltreatment in previous waves. Future studies should incorporate additional types of child maltreatment and contextual information on timing, severity, and perpetration.