{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:54:43Z","timestamp":1772726083057,"version":"3.50.1"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Research has increasingly focused on the role of social and structural determinants of health (SDoH) in shaping behavioral and mental health-related outcomes, including suicide and substance use disorder. While child sexual abuse (CSA) is a well-established risk factor for these outcomes, less is known about the association with image-based sexual abuse (IBSA) and its relationship to suicide and overdose risk. Moreover, limited research has explored the interaction between abuse experiences and SDoH deficits, particularly how cumulative disadvantages may exacerbate these risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a sample of young adults aged 18\u201328 (<jats:italic>n<\/jats:italic>\u202f=\u202f2,630) recruited through social media, this study examines the links between SDoH deficits and abuse type prior to age 18 (CSA and IBSA) with suicide attempts and overdose outcomes. Participants reported experiences of hands-on CSA, IBSA, or both, along with self-reported deficits in five key SDoH domains: economic stability, social and community context, housing stability, healthcare access, and neighborhood conditions. A cumulative SDoH deficit scale (0 to 4\u202f+\u202fdeficits) was created to examine the compounding effects of social and structural disadvantage. Logistic regression models were used to assess the association between SDoH deficits, abuse type, and two primary outcomes: suicide attempts and drug overdose prior to age 18 and lifetime.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The likelihood of each health indicator increased with each additional SDoH deficit reported. The largest percentage-point increase was in lifetime suicide attempt, which was reported by approximately 15.2% of those with 0 SDoH compared to 49.9% of those with 4 or more SDoH deficits. There were also large differences in lifetime suicide attempt by abuse type (20.3% among those with no abuse vs. 60.6% of those with both types). Notably, across each abuse category, the predicted probabilities of suicide attempt, both before age 18 and lifetime, increased with each additional SDoH deficits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Findings suggest that CSA and IBSA do not operate in isolation but interact with social and structural determinants in their association with key health indicators. The results highlight the need for holistic prevention and intervention strategies that address both childhood trauma and modifiable SDoH.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1595115","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:32:35Z","timestamp":1751002355000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cumulative determinants of adolescent health indicators: the effects of social and structural determinants of health and child sexual abuse on overdose and suicide attempt"],"prefix":"10.3389","volume":"13","author":[{"given":"Deirdre","family":"Colburn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly J.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ateret","family":"Gewitz-Meydan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1177\/15248380231178754","article-title":"Victims of technology-assisted Child sexual abuse: a scoping review","volume":"25","author":"Chauvir\u00e9-Geib","year":"2024","journal-title":"Trauma Violence Abuse"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1080\/1068316X.2020.1781120","article-title":"Experiences and psychological health among children exposed to online child sexual abuse\u2014a mixed methods study of court verdicts","volume":"27","author":"Joleby","year":"2021","journal-title":"Psychol Crime Law"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1177\/10775595241233970","article-title":"Contexts and characteristics of imaged-based sexual exploitation and abuse of children: incident dynamics in a National Sample","volume":"30","author":"Turner","year":"2025","journal-title":"Child Maltreat"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"106269","DOI":"10.1016\/j.chiabu.2023.106269","article-title":"Child sexual abuse images and youth produced images: the varieties of image-based sexual exploitation and abuse of children","volume":"143","author":"Finkelhor","year":"2023","journal-title":"Child Abuse Negl"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e2234471","DOI":"10.1001\/jamanetworkopen.2022.34471","article-title":"Prevalence of online sexual offenses against children in the US","volume":"5","author":"Finkelhor","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"106634","DOI":"10.1016\/j.chiabu.2024.106634","article-title":"The prevalence of child sexual abuse with online sexual abuse added","volume":"149","author":"Finkelhor","year":"2024","journal-title":"Child Abuse Negl"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"107471","DOI":"10.1016\/j.chiabu.2025.107471","article-title":"Links between image-based sexual abuse and mental health in childhood among young adult social media users","volume":"164","author":"Mitchell","year":"2025","journal-title":"Child Abuse Negl"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e1331","DOI":"10.1542\/peds.2013-2166","article-title":"Childhood sexual abuse and suicidal behavior: a meta-analysis","volume":"133","author":"Devries","year":"2014","journal-title":"Pediatrics"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1080\/10538712.2020.1801937","article-title":"A systematic review of the relationship between Child sexual abuse and substance use issues","volume":"30","author":"Fletcher","year":"2021","journal-title":"J Child Sex Abus"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/10538712.2021.1985673","article-title":"Child sexual abuse and problems reported by survivors of CSA: a Meta-review","volume":"31","author":"Nagtegaal","year":"2022","journal-title":"J Child Sex Abus"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/s0272-7358(00)00088-x","article-title":"Concomitance between childhood sexual and physical abuse and substance use problems. 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