to early use of alcohol (9, 10), cigarettes (12, 13), and cannabis (9, 12), as have both depression (32, 33) and PTSD (8, 21). This clustering of risk factors makes it difficult to determine whether the observed elevation in risk for substance use outcomes associated with CSA is attributable to exposure to sexual abuse specifically or to the constellation of risk factors that tend to co-occur with CSA. Making this determination is important with respect to the interpretation of CSA history as a distinct marker of risk for early initiation of substance use, yet few investigations have applied the methodological approaches needed to do so.
