Childhood interpersonal violence and adult alcohol, cannabis, and tobacco use disorders: variation by race/ethnicity?
- Authors
- Meyers, Jacquelyn L; Sartor, Carolyn E; Werner, Kimberly B; Koenen, Karestan C; Grant, Bridget F; Hasin, Deborah
- Year
- 2018
- Journal
- Psychological medicine
- PMID
- 29310741
- DOI
- 10.1017/S0033291717003208
- PMCID
- PMC6545193
BACKGROUND: Exposure to child maltreatment has been shown to increase lifetime risk for substance use disorders (SUD). However, this has not been systematically examined among race/ethnic groups, for whom rates of exposure to assaultive violence and SUD differ. This study examined variation by race/ethnicity and gender in associations of alcohol (AUD), cannabis (CUD), and tobacco (TUD) use disorders with three types of childhood interpersonal violence (cIPV): physical abuse, sexual abuse, and witnessing parental violence. METHOD: Data from the National Epidemiologic Survey of Alcohol-Related Conditions-III (N: 36 309), a US nationally representative sample, was utilized to examine associations of DSM-5 AUD, CUD and TUD with cIPV among men and women of five racial/ethnic groups. Models were adjusted for additional risk factors (e.g. parental substance use problems, participant's co-occurring SUD). RESULTS: Independent contributions of childhood physical and sexual abuse to AUD, CUD, and TUD, and of witnessing parental violence to AUD and TUD were observed. Associations of cIPV and SUD were relatively similar across race/ethnicity and gender [Odds Ratios (ORs) ranged from 1.1 to 1.9], although associations of physical abuse with AUD and TUD were greater among males, associations of parental violence and AUD were greater among females, and associations of parental violence with AUD were greater among Hispanic women and American Indian men. CONCLUSIONS: Given the paucity of research in this area, and the potential identification of modifiable risk factors to reduce the impact of childhood interpersonal violence on SUDs, further research and consideration of tailoring prevention and intervention efforts to different populations are warranted.
Model employed to examine the associations of childhood IPV and adult alcohol, cannabis and tobacco use disorders. Note, that the following covariates are not pictured, but are included in models: age, gender, race/ethnicity (in combined models), interactions between each type of IPV and race/ethnicity (in overall model), household income, employment status, level of education, marital status, parental alcohol and drug use problems, and participantsβ comorbid depression, posttraumatic stress disorder, antisocial personality disorder, and adult trauma exposure. Physical Abuse, Physical abuse experienced prior to age 18; Sexual Abuse, Sexual abuse experienced prior to age 18; Domestic Violence, witnessing parental (father figure to mother figure) violence prior to age 18. AUD, DSM-V Alcohol Use Disorder (lifetime); CUD, DSM-V Cannabis Use Disorder (lifetime); TUD, DSM-V Tobacco Use Disorder (lifetime).
No entities extracted from this document yet.
No uploaded files.
| Citation | PMID | DOI | Status |
|---|---|---|---|
| AkaikeH (1976) Canonical correlation analysis of time series and the use of an information criterion. Mathematics in Science and Engineering 126, 27β96. | β | β | β |
| AndreasenNC, EndicottJ, SpitzerRL and WinokurG (1977) The family history method using diagnostic criteria. Reliability and validity. Archives of General Psychiatry 34, 1229β1235.91122210.1001/archpsyc.1977.01770220111013 | β | β | β |
| BentlerPM (1990) Comparative fit indexes in structural models. Psychological bulletin 107, 238β246.232070310.1037/0033-2909.107.2.238 | β | β | β |
| BonomiAE, AndersonML, CannonEA, SlesnickN and RodriguezMA (2009) Intimate partner violence in Latina and non-Latina women. American Journal of Preventive Medicine 36, 43β48.e1.1909516410.1016/j.amepre.2008.09.027PMC2791785 | β | β | β |
| BottomsBL, Peter-HageneLC, EpsteinMA, WileyTRA, ReynoldsCE and RudnickiAG (2016) Abuse characteristics and individual differences related to disclosing childhood sexual, physical, and emotional abuse and witnessed domestic violence. Journal of interpersonal violence 31, 1308β1339.2555016710.1177/0886260514564155 | β | β | β |
| BreidingMJ, SmithSG, BasileKC, WaltersML, ChenJ and MerrickMT(2014) Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization β national intimate partner and sexual violence survey, United States, 2011. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002) 63, 1β18.PMC469245725188037 | β | β | β |
| CaetanoR and ClarkCL (1999) Trends in situational norms and attitudes toward drinking among whites, blacks, and hispanics: 1984β1995. Drug and Alcohol Dependence 54, 45β56.1010161610.1016/s0376-8716(98)00148-3 | β | β | β |
| CaetanoR, CunradiCB, ClarkCL and SchaferJ (2000) Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the United States. Journal of Substance Abuse 11, 123β138.1098977310.1016/s0899-3289(00)00015-8 | β | β | β |
| CaetanoR, FieldCA, Ramisetty-MiklerS and McGrathC (2005) The 5-year course of intimate partner violence among White, Black, and Hispanic couples in the United States. Journal of Interpersonal Violence 20, 1039β1057.1605172610.1177/0886260505277783 | β | β | β |
| CaetanoR, NelsonS and CunradiC (2001) Intimate partner violence, dependence symptoms and social consequences from drinking among white, black and Hispanic couples in the United States. The American Journal on Addictions 10(Suppl), 60β69.10.1080/1055049015050414611268822 | β | β | β |
| CerdaM, SagdeoA and GaleaS (2008) Comorbid forms of psychopathology: key patterns and future research directions. Epidemiologic Reviews 30, 155β177.1862174310.1093/epirev/mxn003 | β | β | β |
| ChoH (2012) Racial differences in the prevalence of intimate partner violence against women and associated factors. Journal of Interpersonal Violence 27, 344β363.2185976110.1177/0886260511416469 | β | β | β |
| ChouSP, GoldsteinRB, SmithSM, HuangB, RuanWJ, ZhangH, JungJ, SahaTD, PickeringRP and GrantBF (2016) The epidemiology of DSM-5 nicotine use disorder: results from the national epidemiologic survey on alcohol and related conditions-III. The Journal of Clinical Psychiatry 77, 1404β1412.2713583410.4088/JCP.15m10114PMC8154113 | β | β | β |
| ClarkHM, GalanoMM, Grogan-KaylorAC, Montalvo-LiendoN and Graham-BermannSA (2016) Ethnoracial variation in womenβs exposure to intimate partner violence. Journal of Interpersonal Violence 31, 531β552.2539238210.1177/0886260514555871 | β | β | β |
| CunradiC and CaetanoR (2002) Alcohol-related problems, drug use, and male intimate partner violence severity among US couples. Alcoholism: Clinical and Experimental Research 26, 493β500.11981125 | β | β | β |
| CunradiC, CaetanoR and ClarkC (1999) Alcohol-related problems and intimate partner violence among white, black, and Hispanic couples in the U.S. Alcoholism: Clinical and Experimental Research 23, 1492β1501.10512315 | β | β | β |
| DavisRG, ResslerKJ, SchwartzAC, StephensKJ and BradleyRG (2008)Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder. Journal of Traumatic Stress 21, 218β222.1840464910.1002/jts.20313PMC2444044 | β | β | β |
| DohrenwendBP (2000) The role of adversity and stress in psychopathology: some evidence and its implications for theory and research. Journal of Health and Social Behavior 41, 1β19.10750319 | β | β | β |
| EatonWW, NeufeldK, ChenLS and CaiG (2000) A comparison of selfreport and clinical diagnostic interviews for depression: diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore epidemiologic catchment area follow-up. Archives of General Psychiatry 57, 217β222.1071190610.1001/archpsyc.57.3.217 | β | β | β |
| FergussonDM, HorwoodLJ and WoodwardLJ (2000) The stability of child abuse reports: a longitudinal study of the reporting behaviour of young adults. Psychological Medicine 30, 529β544.1088370910.1017/s0033291799002111 | β | β | β |
| Fuller-ThomsonE, RoaneJL and BrennenstuhlS (2016) Three types of adverse childhood experiences, and alcohol and drug dependence among adults: an investigation using population-based data. Substance Use & Misuse 51, 1451β1461.10.1080/10826084.2016.118108927326749 | β | β | β |
| GrantBF, GoldsteinRB, SahaTD, ChouSP, JungJ, ZhangH, PickeringRP, RuanWJ, SmithSM, HuangB and HasinDS (2015) Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72, 757β766.2603907010.1001/jamapsychiatry.2015.0584PMC5240584 | β | β | β |
| HasinD and PaykinA (1999) Alcohol dependence and abuse diagnoses: concurrent validity in a nationally representative sample. Alcoholism, Clinical and Experimental Research 23, 144β150.10029216 | β | β | β |
| HasinDS, KerridgeBT, SahaTD, HuangB, PickeringR, SmithSM, JungJ, ZhangH and GrantBF (2016) Prevalence and correlates of DSM-5 cannabis use disorder, 2012β2013: findings from the national epidemiologic survey on alcohol and related conditionsβIII. American Journal of Psychiatry 173, 588β599.2694080710.1176/appi.ajp.2015.15070907PMC5026387 | β | β | β |
| HasinDS, ShmulewitzD, StohlM, GreensteinE, AivadyanC, MoritaK, SahaT, AharonovichE, JungJ, ZhangH, NunesEV and GrantBF (2015) Procedural validity of the AUDADIS-5 depression, anxiety and posttraumatic stress disorder modules: substance abusers and others in the general population. Drug and Alcohol Dependence 152, 246β256.2593972710.1016/j.drugalcdep.2015.03.027PMC5089368 | β | β | β |
| HeimanGA, OgburnE, GorroochurnP, KeyesKM and HasinD (2008) Evidence for a two-stage model of dependence using the NESARC and its implications for genetic association studies. Drug and Alcohol Dependence 92, 258β266.1793347310.1016/j.drugalcdep.2007.08.007PMC2266584 | β | β | β |
| HowellKH, BarnesSE, MillerLE and Graham-BermannSA (2014) Developmental variations in the impact of intimate partner violence exposure during childhood. Journal of Injury and Violence Research 8, 43β57.10.5249/jivr.v8i1.663PMC472933326804945 | β | β | β |
| JohnstonLD, OβMalleyPM, MiechRA, BachmanJG and SchulenbergJE (2016) Monitoring the Future National Survey Results on Drug Use, 1975β 2015: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan. | β | β | β |
| KendlerKS, BulikCM, SilbergJ, HettemaJM, MyersJ and PrescottCA (2000) Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of General Psychiatry 57, 953β959.1101581310.1001/archpsyc.57.10.953 | β | β | β |
| KendlerKS, EdwardsAC and GardnerCO (2015) Sex differences in the pathways to symptoms of alcohol use disorder: a study of opposite-sex twin pairs. Alcoholism, Clinical and Experimental Research 39, 998β1007.10.1111/acer.12694PMC445242325845269 | β | β | β |
| KesslerRC (2012) The costs of depression. The Psychiatric Clinics of North America 35, 1β14.2237048710.1016/j.psc.2011.11.005PMC3292769 | β | β | β |
| KhouryL, TangYL, BradleyB, CubellsJF and ResslerKJ (2010) Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety 27, 1077β1086.2104953210.1002/da.20751PMC3051362 | β | β | β |
| KlevensJ, ShelleyG, Clavel-ArcasC, BarneyDD, TobarC, DuranES, Barajas-MazaheriR and EsparzaJ (2007) Latinosβ perspectives and experiences with intimate partner violence. Violence Against Women 13, 141β158.1725150210.1177/1077801206296980 | β | β | β |
| KoenenKC, MoffittTE, PoultonR, MartinJ and CaspiA (2007) Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine 37, 181β192.1705237710.1017/S0033291706009019PMC2254221 | β | β | β |
| KrishnanSP, HilbertJC and VanLeeuwenD (2001) Domestic violence and help-seeking behaviors among rural women: results from a shelter-based study. Family & Community Health 24, 28β38.1127556910.1097/00003727-200104000-00006 | β | β | β |
| Kristman-ValenteA and WellsEA (2013) The role of gender in the association between child maltreatment and substance use behavior: a systematic review of longitudinal research from 1995 to 2011. Substance Use & Misuse 48, 645β660.2375077010.3109/10826084.2013.800115 | β | β | β |
| LipskyS, CaetanoR, FieldCA and LarkinGL (2006) The role of intimate partner violence, race, and ethnicity in help-seeking behaviors. Ethnicity & Health 11, 81β100.1633875610.1080/13557850500391410 | β | β | β |
| McLaughlinKA, GreenJG, GruberMJ, SampsonNA, ZaslavskyAM and KesslerRC (2010) Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: associations with persistence of DSM-IV disorders. Archives of General Psychiatry 67, 124β132.2012411210.1001/archgenpsychiatry.2009.187PMC2847359 | β | β | β |
| PolanczykG, CaspiA, WilliamsB, PriceTS, DaneseA, SugdenK, UherR,PoultonR and MoffittTE (2009) Protective effect of CRHR1 gene variants on the development of adult depression following childhood maltreatment: replication and extension. Archives of General Psychiatry 66, 978β985.1973635410.1001/archgenpsychiatry.2009.114PMC3750953 | β | β | β |
| RobertsAL, GilmanSE, BreslauJ, BreslauN and KoenenKC (2011) Race/ ethnic differences in exposure to traumatic events, development of posttraumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine 41, 71β83.2034619310.1017/S0033291710000401PMC3097040 | β | β | β |
| RuanWJ, GoldsteinRB, ChouSP, SmithSM, SahaTD, PickeringRP (2008) The Alcohol Use Disorder and Associated Disabilities Interview ScheduleβIV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence 92, 27β36.1770637510.1016/j.drugalcdep.2007.06.001PMC2246381 | β | β | β |
| SartorCE, AgrawalA, GrantJD, DuncanAE, MaddenPAF, LynskeyMT, HeathAC and BucholzKK (2015) Differences between African- American and European-American women in the association of childhood sexual abuse with initiation of marijuana use and progression to problem use. Journal of Studies on Alcohol and Drugs 76, 569β577.2609803210.15288/jsad.2015.76.569PMC4495074 | β | β | β |
| SartorCE, AgrawalA, McCutcheonVV, DuncanAE and LynskeyMT (2008) Disentangling the complex association between childhood sexual abuse and alcohol-related problems: a review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs 69, 718β727.1878124710.15288/jsad.2008.69.718PMC2575394 | β | β | β |
| SartorCE, McCutcheonVV, NelsonEC, DuncanAE, BucholzKK and HeathAC (2012) Investigating the association between childhood sexual abuse and alcohol use disorders in women: does it matter how we ask about sexual abuse? Journal of Studies on Alcohol and Drugs 73, 740β748.2284623810.15288/jsad.2012.73.740PMC3410942 | β | β | β |
| SartorCE, NelsonEC, LynskeyMT, MaddenPAF, HeathAC and BucholzKK (2013) Are there differences between young African-American and European-American women in the relative influences of genetics versus environment on age at first drink and problem alcohol use? Alcoholism, Clinical and Experimental Research 37, 1939β1946.10.1111/acer.12185PMC377599523763496 | β | β | β |
| SchiffM, PlotnikovaM, DingleK, WilliamsGM, NajmanJ and ClavarinoA (2014) Does adolescentβs exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study. Child Abuse & Neglect 38, 1945β1954.2508242910.1016/j.chiabu.2014.07.001 | β | β | β |
| SmithCA, ElwynLJ, IrelandTO and ThornberryTP (2010) Impact of adolescent exposure to intimate partner violence on substance use in early adulthood. Journal of Studies on Alcohol and Drugs 71, 219β230.2023071910.15288/jsad.2010.71.219PMC2841732 | β | β | β |
| StrausMA (1979) Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage and the Family 41, 75β88. | β | β | β |
| StrausMA (1990) The conflict tactics scales and its critics: An evaluation and new data on validity and reliability In StrausMA and GellesRJ (eds). Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Books, pp. 49β74. | β | β | β |
| SumnerSA, MercyJA, DahlbergLL, HillisSD, KlevensJ and HouryD (2015) Violence in the United States: status, challenges, and opportunities. JAMA 314, 478β488.2624159910.1001/jama.2015.8371PMC4692168 | β | β | β |
| TempleJR, ShoreyRC, TortoleroSR, WolfeDA and StuartGL (2013) Importance of gender and attitudes about violence in the relationship between exposure to interparental violence and the perpetration of teen dating violence. Child Abuse & Neglect 37, 343β352.2349005610.1016/j.chiabu.2013.02.001PMC3670104 | β | β | β |
| TuckerLR and LewisC (1973) A reliability coefficient for maximum likelihood factor analysisi. Psychometrika 38, 1β10. | β | β | β |
| WernerKB, GrantJD, McCutcheonVV, MaddenPAF, HeathAC, BucholzKK and SartorCE (2016a) Differences in childhood physical abuse reporting and the association between CPA and alcohol use disorder in European American and African American women. Psychology of Addictive Behaviors 30, 423β433.2732280110.1037/adb0000174PMC4915219 | β | β | β |
| WernerKB, McCutcheonVV, AgrawalA, SartorCE, NelsonEC, HeathAC and BucholzKK (2016b) The association of specific traumatic experiences with cannabis initiation and transition to problem use: differences between African-American and European-American women. Drug and Alcohol Dependence 162, 162β169.2701243410.1016/j.drugalcdep.2016.03.003PMC4833569 | β | β | β |
| WyattGE (1985) The sexual abuse of Afro-American and White American women in childhood. Child Abuse & Neglect 9, 507β519.408483010.1016/0145-2134(85)90060-2 | β | β | β |
| ZapolskiTCB, PedersenSL, McCarthyDM and SmithGT (2014) Less drinking, yet more problems: understanding African American drinking and related problems. Psychological Bulletin 140, 188β223.2347744910.1037/a0032113PMC3758406 | β | β | β |
| ZimmermanM, CoryellW, PfohlB and StanglD (1988) The reliability of the family history method for psychiatric diagnoses. Archives of General Psychiatry 45, 320β322.328162510.1001/archpsyc.1988.01800280030004 | β | β | β |
In this knowledge base
| Title | Year | PMID |
|---|---|---|
| Psychosocial moderation of polygenic risk for cannabis involvement: the role of trauma exposure and frequency of religious service attendance. | 2019 | 31636251 |
External
| Title | Authors | Journal | Year | Link |
|---|---|---|---|---|
| Alcohol and Cannabis Use in the Context of Violence Experiences and Traditional Masculinity Attitudes Among Black Emerging Adult Men in Baltimore, Maryland. | Marineau L et al. | β | 2026 | β |
| Adverse childhood experiences and preventive health care among rural US children: A cross-sectional examination of 2022 National Health Interview Survey data. | Labuhn M et al. | β | 2025 | β |
| Childhood Trauma and<i>APOEΞ΅4</i>are Associated with Adolescent Brain Function, Posttraumatic Stress, and Alcohol-related Outcomes | Neale ZE et al. | β | 2025 | β |
| Racial/Ethnic Differences in Adverse Childhood Experiences and Health-Related Outcomes: A Scoping Review. | Yang P et al. | β | 2025 | β |
| The impact of adverse childhood experiences on health outcomes of indigenous populations over the life course: A systematic review. | Shahunja KM et al. | β | 2025 | β |
| Association between history of interparental violence and alcohol abuse among reproductive-age women: Evidence from the Peruvian Demographic and Health Survey. | Zamora-RamΓrez CM et al. | β | 2024 | β |
| Associations Between Childhood Trauma and Tobacco Use Outcomes in Adults after Overnight Abstinence. | Palmisano AN et al. | β | 2024 | β |
| Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender? | Stewart SH et al. | β | 2024 | β |
| Tobacco use, trauma exposure and PTSD: a systematic review. | Shevorykin A et al. | β | 2024 | β |
| A longitudinal pathway from ethnic-racial discrimination to sexual risk behaviors among Black women and Latinas: Ethnic-racial identity exploration as a protective factor. | Pahl K et al. | β | 2023 | β |
| Examining interactions between polygenic scores and interpersonal trauma exposure on alcohol consumption and use disorder in an ancestrally diverse college cohort. | Sheerin CM et al. | β | 2023 | β |
| Genetic nurture effects for alcohol use disorder. | Thomas NS et al. | β | 2023 | β |
| Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency. | Kelly L et al. | β | 2023 | β |
| Maternal Childhood Maltreatment, Internal Working Models, and Perinatal Substance Use: Is There a Role for Hyperkatifeia? A Systematic Review. | Olsavsky AK et al. | β | 2023 | β |
| Parental Divorce and Trajectories of Alcohol Consumption in Men: A Genetically Informative Perspective. | Salvatore JE et al. | β | 2023 | β |
| The Relationship Between Trauma and Substance Use Among Healthcare Workers: A Cross-Sectional Analysis. | Okoli CTC et al. | β | 2023 | β |
| Childhood abuse, posttraumatic stress symptoms, and alcohol misuse among African-American women. | Florez IA et al. | β | 2022 | β |
| Role of parental divorce and discord in the intergenerational transmission of alcohol use disorder. | Salvatore JE et al. | β | 2022 | β |
| The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys. | Degenhardt L et al. | β | 2022 | β |
| Cannabis-induced dysphoria/paranoia mediates the link between childhood trauma and psychotic-like experiences in young cannabis users. | Carlyle M et al. | β | 2021 | β |
| The emotional and psychiatric problems of adolescents on parole whose parents are substance users: A Brazilian cross-sectional study. | Perruci LG et al. | β | 2021 | β |
| The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda. | Culbreth R et al. | β | 2021 | β |
| Adverse childhood experiences (ACEs) and transitions in stages of alcohol involvement among US adults: Progression and regression. | Alvanzo AAH et al. | β | 2020 | β |
| Characteristics and Influencing Factors of Real-Life Violence Exposure Among Chinese College Students. | Wang W et al. | β | 2020 | β |
| English use/proficiency, ethnic discrimination, and alcohol use disorder in Hispanic immigrants. | Cano M | β | 2020 | β |
| The interplay between childhood trauma, cognitive biases, and cannabis use on the risk of psychosis in nonclinical young adults in Poland. | Frydecka D et al. | β | 2020 | β |
| Trauma Exposure and Post-Traumatic Stress Disorder Among Youth in a High-Risk Family Study: Associations with Maternal and Paternal Alcohol Use Disorder. | Bender AK et al. | β | 2020 | β |
| Women and substance use disorders in low- and middle-income countries: A call for advancing research equity in prevention and treatment. | Slabbert I et al. | β | 2020 | β |
| Psychosocial moderation of polygenic risk for cannabis involvement: the role of trauma exposure and frequency of religious service attendance. | Meyers JL et al. | β | 2019 | β |
| Examining interactions between genetic risk for alcohol problems, peer deviance, and interpersonal traumatic events on trajectories of alcohol use disorder symptoms among African American college students. | Su J et al. | β | 2018 | β |