Research: Association or Causation

The 9 criteria outlined by Austin Bradford Hill in The Environment and Disease: Association or Causation? are used to determine whether causation can be assumed in medicine. This page will review the research on child sexual abuse to see if these criteria have been met.

• Strength: the demonstration of a strong association between the causative agent and the outcome
  • See Prevalence of Harm and Negative Outcomes
• Consistency: consistency of the findings across research sites and methodologies
• Specificity: the demonstration of specificity of the causative agent in terms of the outcomes it produces
• Temporality: the demonstration of the appropriate temporal sequence, so that the causative agent occurs prior to the outcome
• Biological gradient: the demonstration of a biological gradient, in which more of the causative agent leads to a poorer outcome
  • Forouzan, Elham, and Gijseghem, Hubert Van (2005). "Psychosocial Adjustment and Psychopathology of Men Sexually Abused During Childhood," International Journal of Offender Therapy and Comparative Criminology, 49(6), 626-651

    "Certain studies conducted with clinical participants have revealed that frequency and duration of sexual contacts had a significant effect on the development of the participant (Freeman-Longo, 1986; Friedrich, Urquiza, & Beilke, 1986; Gerber, 1990; Mendel, 1995), whereas studies carried out with nonclinical participants reported no clear link between frequency and duration of contacts and the development or later aggravation of disorders of whatever nature among participants (Finkelhor, 1979; O’Neill, 1990; Sarbo, 1984; Urquiza & Capra, 1990)."

• Plausibility: the demonstration of a biologic rationale, such that it makes sense that the causative agent causes the outcome
• Coherence: coherence of the findings, such that the causation argument is in agreement with what we already know
• Experimental evidence
• Analogy: evidence from analogous conditions