title: The prevalence of physical, sexual and mental abuse among adolescents and the association with BMI status.
abstract: BACKGROUND
  Studies among adults show an association between abuse and Body Mass Index (BMI) status. When an aberrant BMI status as a consequence of abuse is already prevalent in adolescence, early detection and treatment of abuse might prevent these adolescents from developing serious weight problems and other long-term social, emotional and physical problems in adulthood. Therefore, this study investigated the prevalence of physical, sexual and mental abuse among adolescents and examined the association of these abuse subtypes with BMI status.
  
  
  METHODS
  In total, data of 51,856 secondary school students aged 13-16 who had completed a questionnaire on health, well-being and lifestyle were used. BMI was classified into four categories, underweight, normal weight, overweight and obesity. Adolescents reported if they had ever been physically, sexually or mentally abused. Crude and adjusted General Estimation Equation (GEE) analyses were performed to investigate the association between abuse subtypes and BMI status. Analyses were adjusted for ethnicity and parental communication, and stratified for gender and educational level.
  
  
  RESULTS
  Eighteen percent of the adolescents reported mental abuse, 7% reported sexual abuse, and 6% reported physical abuse. For underweight, overweight and obese adolescents these percentages were 17%, 25%, and 44%; 7%, 8%, and 16%; and 6%, 8%, 18% respectively. For the entire population, all these subtypes of abuse were associated with being overweight and obese (OR=3.67, 1.79 and 1.50) and all but sexual abuse were associated with underweight (OR=1.21 and 1.12). Stratified analyses showed that physical and sexual abuse were significantly associated with obesity among boys (OR=1.77 and 2.49) and among vocational school students (OR=1.60 and 1.69), and with underweight among girls (OR=1.26 and 0.83).
  
  
  CONCLUSIONS
  Mental abuse was reported by almost half of the obese adolescents and associated with underweight, overweight and obesity. Longitudinal analyses are recommended to explore the causality of and the mechanisms explaining this association between abuse and overweight.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands. jorien.veldwijk@rivm.nl
authors.forename: Jorien
authors.initials: J
authors.lastname: Veldwijk
authors.forename: Karin I
authors.initials: KI
authors.lastname: Proper
authors.forename: Henriëtte B
authors.initials: HB
authors.lastname: Hoeven-Mulder
authors.forename: Wanda J E
authors.initials: WJ
authors.lastname: Bemelmans
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012742:Sex Offenses / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013851:Thinness / Q000453:epidemiology; D014754:Violence / Q000145:classification* / Q000706:statistics & numerical data*