Addiction (1994) 89, 1619-1628

RESEARCH REPORTS

Is having an alcoholic father hazardous for

children's physical health?

PATRICIA L. DOBKIN/'^ RICHARD E. TREMBLAY,'

LYSE DESMARAIS-GERVAIS^ & LOUISE DEPELTEAU^

University J Division of Clinical Epidemiology, Montreal General Hospital^ 1650

Cedar Avenue, Montreal, Quebec, Canada H3G 1A4 & ^Research Unit on Children's
Psychosocial Maladjustment, Universite de Montreal, 750 bouL Gouin est, Montreal, Quebec,
Canada H2C 1A6

Abstract
Eive hundred and ninety-nine French-Canadian pre-adolescent children for whom the alcoholic status of the
parents was known were subdivided i?ito eight groups, according to family structure (intact, non-intact),
alcoholic status of the father (alcoholic, tion-alcoholic) and gender of the target child (girl, boy). ANCOVAs
were conducted (controlling for income, a factor which contributes to illness) for health-related variables in
order to test the hypothesis that children of alcoholic fathers have more physical health problems compared to
children without alcoholic fathers. Data pertaining to use of medical services, serious and minor illnesses and
pregnancy-related events were analysed. It was found that overall, pre-adolescent children of alcoholics were
not more ill than children of non-alcoholics. There were, however, some differences ivorthy of note. Children
of alcoholics had significantly lower birthvjeights than the children of nori-alcoholics. Boys in non-intact
alcoholic families were of shorter stature than the other children. A three-way interaction showed that
daughters of alcoholics and sons of non-alcoholics living in non-intact families were more likely to have used
psychologists' services, as were sons of alcoholics in intact families. The results were discussed in terms of the
heterogeneity of alcoholic families as well as the need to identify subgroups of children of alcoholics zuho are
at risk.

Introduction In West & Prinz's (1987) review of the literature

While the emotional well-being of children
of alcoholics (COAs) has captured the atten-
tion of many researchers (reviewed in Collins,
Leonard & Searles, 1990; Moos, Finney &
Cronkite, 1990; Sher, 1991; Wallace, 1987)
there have been relatively few reports con-
cerning the physical health of these children.
Correspondence to: Patricia L. Dobkin, Division of Clinical
Epidemiolng\', Montreal General Hospital, 1650 Cedar Avenue,
Montreal, Quebec, Canada H3G IA4.
covering the decade between 1975 and 1985,
only five studies addressed this issue. (Fetal
Alcohol Syndrome, which is known to cause
serious physical and cognitive deficits in
children, will not be covered in the present
text. Mothers who are alcoholics were systetn-
atically excluded from the present study. The
reader may find discussions of this issue in
Steinhausen, Gobel & Nestler (1984), von Knor-
ring (1991) and Wallace (1987).) Woodside's
review (1988a) echoed West & Prinz's findmgs

1619
1620 Patncia L. Dobkin et al.
regarding a lack of consensus in tlie literature
regarding whether or not the physical health of
COAs is compromised. While some claim that
COAs do not differ from children of non-alco-
holics (Fitzgerald et ai, 1993; Moos & Billings,
1982; Rimmer, 1982, cited in West & Prinz,
1987; Taner, Laird & Bukstein, 1991), others
find an increase in injuries (for sons), more
hospitalizations (for daughters) and a higher
likelihood for preschoolers (boys and girls) to
have serious illnesses (Putnam, 1985, cited in
Woodside, 1988a; see von Knorring, 1991, for a
review). Two recent studies reported
significantly more somatic (Rubio-Stipec et al.,
1991) and psychosomatic (Bennett, Wolin &
Reiss, 1988) complaints in COAs.
The hypothesis that COAs have more physical
health problems than children of non-alcoholic
parents is based on current knowledge pertaining
to alcoholic families. First, if alcoholism is con-
ceptualized in a broad manner as a family stressor,
it follows that children living in this environment
would be prone to illness and perhaps injuries
(von Knorring, 1991). Consistent with the family
stress theory is the finding that typically alcoholic
families maintain lower incomes than non-
alcoholic families (von Knorring, 1991); lower
class status has consistently been found to be
associated with poorer health (Power, Manor
& Fox, 1991). In addition, alcoholics are often
separated or divorced (Moos et al., 1990); single
parent family status is typically experienced as
stressful (for the mother and her children) and
contributes to both lower socio-economic status
(SES) and perhaps poorer health.
While difficult to tease apart fi-om lower SFS
status, unhealthy behaviours maintained by
many alcoholics (e.g. cigarette smoking; Robins,
Helzer & Przybeck, 1986) provide COAs with
inadequate models for the development of a
healthy life-style. Through observation and imi-
tation, COAs may learn these behaviour patterns
(including excessive use of alcohol) which
compromise physical health. Differences in
COAs' physical health may also stem from ne-
glect and/or abuse, as it has been proposed that
many COAs are subjected to these conditions
(Wallace, 1987; West & Prinz, 1987; Wilson,
1982). A third plausible psychosocial expla-
nation for potential physical healtli problems
stems from the finding that alcoholic families
often fail to provide a consistent coherent family
life for their children (Bennett, Wolin & Reiss,
1988). Regular meals and bedtime, for example,
are essential for the physical well-being and nor-
mal development of children.
While the mechanisms underlying differences
are of interest, it has yet to be determined empir-
ically if COAs are truly at-risk for physical health
problems. Methodological problems which have
hampered most research penaining to COAs
(see Sher, 1991 for a review), as well as simple
global assessments of physical health in the few
children studied (e.g. Moos & Billings, 1982;
Tarter et al., 1991) have precluded the develop-
ment of a solid knowledge base concerning this
issue. It has become clear in recent years that
one must beware not to place all alcoholics (and
their children) into one group since alcoholism is
not a unitary disease (Wallace, 1987). The diag-
nosis of alcoholism must be made with care, and
the gender of the alcoholics and their children
need to be specified since there is reason to
believe that these factors interact. The gender of
the COAs is especially important since it appears
that boys externalize their distress whereas girls
internalize it; if this is true for COAs, one would
expect girls to develop more physical health
problems than boys. This notion is supported by
an early study reported by Roberts & Brent
(1982) who found that female members of al-
coholic families (children and adults combined)
had more health problems than the males. Fi-
nally, in order to increase external validity, an
effort should be made to study a sample derived
from the community since it is known that only
a small minority of alcoholics ever present for
treatment (Cox, 1987).
Method
Subjects
Subjects in the present study were participating
in a longitudinal study aimed at understanding
child development, in general, and child malad-
justment in particular (Vitaro, Tremblay &
Gagnon, 1992). Figure 1 provides information
pertaining to how the present sample was de-
rived. At Time 1, when the children were 6 years
old, 6397 questionnaires were distributed to a
random, representative sample of children at-
tending kindergarten in French school boards in
the province of Quebec, Canada. Of these, 4072
mothers chose to participate in a longitudinal
study of child development. While no psychoso-
cial data are available to compare initial respon-

n = 4072
= 3018
Mothers'report SMAST
on health n = 2094
n = 2193
FS
n=2016
Intact Non-intact
d" 9 CT
n = 731 n = 761 n= 165
n = 341 n = 372
n= 100 n= 100 n= 107
Figure X. Sampling and group composition. SA4AST: Short Michigan Alcoholism Screening Test; FS: family structure.
ders with non-responders it is known that they
were not significantly different in terms of geo-
graphical location or size of school board that
their children attended. Four years later at Time
2, given budget limitations, a subsample consist-
ing of 2267 girls and boys who were representa-
tive of children in Quebec plus a high-nsk
sample (;/ ==751) were selected for further study,
resulting in 3018 cases. During the same period,
for the purposes of a parallel study, 2094 of the
families were surveyed to assess the alcoholic
status of the adult family members (to be de-
scribed below). Of those for whom a question-
naire was completed and for whom the alcoholic
status of both parents was determined, infor-
mation pertaining to family structure was avail-
able for 2016 families and data on income was
available for 1681 subjects. Loss of data pertain-
ing to income is common since many refuse to
answer this question (19.7% in the present sam-
ple). Of the 206 alcoholic fathers identified
(9.8% of the 2094 families assessed) all other
necessary data (i.e. income, family structure) was
available for 189. In order to reduce the likeh-
hood of a Type 1 error, subjects from the intact,
non-alcoholic families were randomly selected in
two steps. First, the criterion of having no miss-
ing data was put forth: thus, from 731 and 761
possible cases, 341 boys and 372 girls were
identified. Of these two subsamples, 100 chil-
Health of children of alcoholic fathers 1621
Aicoholic
mothers
n = 22
Income
n= 1681
Alcoholic
fathers
n = 189
Intact Non-intact
9 cf 9 cf 9
n= 146 n = 31 n=38 n = 64 n = 56
n= 103
dren of each gender were randomly selected to
render the cell sizes more similar across groups.
The final sample consisted of 599 children.
Twenty-two (1.1% of the total population)
families were eliminated due to the alcoholic
status of the mother (10 of these families also
had an alcoholic father). This exclusion criterion
was based on the fact that mothers are usually
children's primary caretakers and their children's
health may be compromised in different ways
and for different reasons than when the father is
an alcoholic (e.g. Fetal Alcohol Syndrome;
Steinhausen et ai, 1984). The small number of
cases were eliminated to render intei-pretation of
the data more parsimonious. Thus, while the
sample was not strictly representative of children
in Quebec, it approximated that ideal, although
751 (24.9%) of the subjects were originally
selected due to their being at risk for maladjust-
ment (children who were aggressive in kinder-
garten). This laner group was essential for the
purposes of the present study, since only about
15% of the adult male population is alcoholic
(Robins et ai, 1986). Given that children who
are aggressive often have alcoholic fathers (Pihl,
Peterson & Finn, 1990), we reasoned that the
trade-off between representativeness and the
identification of subjects was justified.
Thus, as shown in Fig. 1, eight groups were
identified: Gl included 38 girls in intact families
1622 Patricia L Dobkin cl al.
with an alcoholic father; G2 included 31 boys in
intact families with an alcoholic father; G3 in-
cluded 50 girls in non-intact families with an
alcoholic father; G4 included 64 boys in non-in-
tact families with an alcoholic father; G5 in-
cluded 100 girls in intact families with an
non-alcoholic father; G6 included 100 boys in
intact families with an non-alcoholic father; G7
included 103 girls in non-intact families with an
non-alcoholic father; G8 included 107 boys in
non-intact families with an non-alcoholic father.
At Time 2 when health-related data were col-
lected the children's mean age was 9.5 years
Procedures and measures
Telephone interview. A telephone survey using the
Short Michigan Alcoholism Screening Test
(SMAST; Selzer, 1971; Selzer, Vinokur & van
Rooijen, 1975) was conducted by trained inter-
viewers in the same year as the data collection.
The mother of the target child was interviewed
regarding the child's biological father's alcohol-
related behaviours for two reasons: first, approx-
imately one-quarter of the sample was
non-intact, making it difficult, if not impossible,
to interview many fathers directly; secondly, the
mother was the source for information pertaining
to the children's health, therefore it was con-
sidered optimal to remain consistent with regard
to who provided data concerning all family
members' health. The SMAST contains 13
items which have been shown to determine al-
cohohc status reliably even when a family mem-
ber, other than the alcoholic, is interviewed
(Crews & Sher, 1992; Chassin et ai, 1992, using
a similar telephone interview, reported a re-
liability rate of 83.3%, when compared to using
the Diagnostic Interview Schedule; Robins et ai,
1981). The cut-off point recommended by
Selzer et ai (1975) was used to classify the
alcohohcs.
As a means of examining the reliability of the
classification of subjects into the alcoholic and
non-alcoholic groups, a non-random subsample
of 159 men were tested directly using the Diag-
nostic Interview Schedule (Robins et ai, 1981).
Similar to Chassin et al.'s (1992) findings,
84.54% of the men were correctly classified;
there were 71.07% true negative cases and
14 47% true positives, based on DSM-III Al-
cohol Dependence critena. Of the 14.47% cases
which were misclassified, 8.18% were false nega-
tives and 6.29% were false positives. Six of the
10 cases (60%) considered to be false positives
were found to have an Alcohol Abuse (but not
Dependence) disorder, thus the mothers report-
ing on the fathers' alcohol-related behaviours
were not mistaken vis-d-vis a dnnking problem
being present. The successful use of first degree
adult relatives to determine alcoholic status has
been reported by other researchers using similar
methods (e.g. Mann et ai^ 1985). Children,
however, have not been shown to be able to
report reliably regarding their parents' drinking
behaviours (Roosa et ai, 1993).
Health-related data. In the context of a longi-
tudinal study, mothers completed a question-
naire pertaining to their children's development.
Only those questions relevant to the present
study are reported here; these concerned: height,
weight, use of health services (e.g. physician,
psychiatnst, psychologist), serious illness in the
past year, minor illnesses in the past 6 months
(e.g. headaches, nausea) initial insomnia and use
of medications for the target child. Information
concerning siblings of the target child (sisters
and/or brothers) was available for: use of medical
services and serious illness in the past year. A
question concerning whether or not the mother
and father had a senous illness in the past year
was retained, as were questions concerning ma-
jor stressors (e.g. new family member, changed
residence), family income and the welfare status
of the mother. Finally, information pertaining to
mother's pregnancy with the target child was
retained (e.g. birthweight of target child, compli-
cations in childbirth, premature status of target
child).
Results
Family characteristics
A 2 ('alcoholic, non-alcoholic) X 2 (intact, non-
intact) ANOVA was conducted to determine if
there was a significant difference for income
levels: main effects for alcoholic status
(F(l 555) = 18.51, p<0.000) and family struc-
ture, (F(l,555) = 55.17, p<0.000) were found.
Since non-intact and alcoholic families had lower
incomes, subsequent analyses used mcome as a
covariate to control statistically for these difter-
ences Moreover, mtact and non-intact family
structure served as an independent variable to

clarify if structure and/or alcoholic status influ-
enced children's health. Incomes for the four
groups were as follows: intact/alcoholic ^
SCN 35 000; intact/non-alcoholic - SCN 43 000;
non-intact/alcoholic = SCN 23 000; non-intact/
alcoholic = SCN 30 000. Consistent with these
results, a chi-square analysis showed a significant
difference between the eight groups for welfare
status of the mother during the past year (/- (1,
„ = 539) ^ 95.93, p < 0.00) with the non-intact/
alcoholic group reporting the highest level of
dependence on government assistance (62.2%
for girlsj 57.8% for boys), with the non-intact/
non-alcoholic group as second highest (30.3%
for girls, 37.6% for boys), with the intact/al-
coholic group next (21.9% for girls, 16.1"/ri for
boys), and the intact/non-alcoholic group last
(5.0% for girls, 11.0% for boys).
Target children
A 2 (intact, non-intact) > 2 (alcoholic, non-
alcoholic) < 2 (girl, boy) ANCOVA revealed a
significant three-way interaction (F( 1,426)
= 5.79, p < 0.01) for height of children at age 9.5
years (data for a subsample were available only at
age 10.5 years, these subjects were excluded so
as not to confound results due to normal growth;
thus, the n for this analysis was 435). A
significant two-way interaction for Gender by
Alcoholic Status (F(l,426) = 4.96, p < 0.02) was
also found. Boys in the non-intact/alcoholic fam-
ilies were shorter than the other children (see
Table 1). There were no differences regarding
the children's weight at age 9.5.
A series of 2 (intact, non-intact) X 2 (al-
coholic, non-alcoholic) x 2 (girl, boy) ANCO-
VAs were conducted for variables related to the
use of health services. A significant main effect
was found for Gender for minor illness
(F(l,465) = 9.30, p < 0.002) whereby girls were
sicker than boys, but there was no effect for
Alcoholic status of the father. While there were
no significant differences for use of psychiatric
services, there were significant differences for
visits to a psychologist (F(l,549) = 13.24,
p<0.00) whereby there was a three-way interac-
tion as well as a Family Structure by Alcoholic
Status two-way interaction (F(l,549) - 4.86,
p < 0.028) and a main effect for Gender
(F(l,549)-5.43, p<0.02). Daughters of al-
coholic fathers and sons of non-alcoholic fathers,
living in non-intact families, and sons of alco-
Health of children of alcoholic fathers 1623
holics in intact families used psychologists' ser-
vices more than the other children. Table 1 gives
the percentage of children in each group who
had used psychologists' services.
An ANCOVA run for initial insomnia showed
a significant Gender effect (F( 1,471) = 6.16,
p < 0 . 0 4 ) with girls manifesting more problems
falling asleep than boys. Consistent with the
non-significant differences regarding major ill-
ness was the finding of no group differences for
medication use.
A series of chi-square analyses were conducted
with regard to the variables assessing the
mother's experiences pertaining to her preg-
nancy with the target child. There was a
significant difference for pregnancy complica-
tions (/^ (3, n= 170) = 9.36, p<0.02) wixh the
alcoholic/non-intact group showing the most
complications (28.1%), the non-alcoholic/non-
intact showing the second highest (19.4%), and
the other two groups having the least: alcohoHc/
intact (5.0%), non-alcoholic/intact (7.1%). Fi-
nally, a 2 (mtact, non-intact) A 2 (alcoholic,
non-alcoholic) x 2 (girl, boy) ANCOVA revealed
main effects for birthweight for Alcoholic Status
(/^(1,457) = 6.12, p<0.01) as well as Gender,
( F ( l , 4 5 7 ) - 9 . 0 6 , _p<0.01) with babies of al-
coholic fathers, and girls weighing less than those
without an alcoholic father, and boys, respect-
ively. These latter results are shown in Table 1.
Siblings
The use of medical services was examined for the
target children's siblings. While there were no
significant differences for physician visits, a
2 (intact, non-intact) X 2 (alcoholic, non-al-
coholic) ANCOVA revealed a significant main
effect for Alcoholic Status (/^(l,525) = 6.67,
p < 0.01) with alcoholics' children having Wsited
a psychiatrist more often than non-alcoholics'
children. A separate ANCOVA for use of a psy-
chologist's services revealed a significant main
effect for Family Structure (F(l,525) = 5.30,
p<0.02) with non-intact families higher than
intact families. A chi-square analysis showed a
significant difference for having a serious illness
in the past year (x^ (3, « = 564) = 11.91,
/)< 0.007) whereby the siblings of the target
children (10.8%) in the non-intact/alcoholic
group were the most ill, with the other groups as
follows: alcoholic/intact ^ 6.6%, non-intact/non-
alcoholic = 3.8%j intact/non-alcoholic = 2.0%.
1624 Patricia L. Dobkin et al

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ITiis latter analysis did not, however, control for
income levels since the responses were categori-
cal in nature (i.e. yes or no).
Parents/family
A 2 (intact, non-intact) X 2 (alcoholic, non-al-
coholic) X 2 (girl, boy) ANCOVA revealed that
the number of major stressful events in the past
year was significantly different across groups
(F(l,550)= 11.61,/)< 0.001) with a main effect
for Family Structure whereby the non-intact
families had more stressful events than the intact
families. Chi-square analyses revealed that while
there was a non-significant trend for mothers
with regard to having had a serious illness in the
past year (p<0.07, with the wives of alcoholics
in the non-intact families having the most ill-
nesses, 10.6%, with the other three groups
as follows: non-intact/non-alcoholic = 6.9%, in-
tact/alcoholic - 6.2% and intactynon-alcoholic —
3.0%) there was a significant difference for
fathers (/^ (3, H = 576) = 11.91, p < 0.007)
whereby the alcoholic fathers in the intact famil-
ies were the most ill (12.3%, with the other three
groups as follows: non-intact/alcoholic = 7.4%,
non-intact/non-alcohohc = 3.2% and intact/non-
alcoholic = 3.0%). This analysis did not,
however, control for income levels since the re-
sponses were categorical in nature (i.e. yes or
no).
Discussion
Despite widespread interest in the psychological
well-being of children of alcoholics there have
been few reports pertaining to their physical
health (Woodside, 1988b). In the present study
pre-adolescent girls and boys with alcohohc fa-
thers were compared to children without al-
coholic fathers; family structure and income
levels were accounted for through study design
and analysis procedures. The results showed
that, overall, COAs are not more ill than non-
COAs.
Mothers' reports with regard to their pre-ado-
lescent children revealed that sons of alcoholics
who lived in non-intact families were shorter
than the other children. The target chiidrens'
siblings were significantly different with regard to
serious illnesses in the past year, with 10.8% of
sisters and brothers (mixed) in non-intact al-
coholic families having been sick during the past
Health of children of alcoholic fathers 1625
year. There was also a trend for mothers in this
same group to have had a serious illness. About
12% of the fathers in the intact alcoholic families
also had had a serious illness in the past year.
Yet, the findings pertaining to the other family
members' illnesses must be viewed with caution
since the analyses did not control for income
levels.
Retrospective reports concerning the mothers'
pregnancy experiences with the target children
indicated that children from alcoholic families
had more birth-related complications; this
finding was especially true for those in non-intact
families. Caution is advised, however, with re-
gard to the family structure findings since the
intact/non-intact categorization was based on in-
formation obtained when the target children
were 9.5 years old. Nonetheless, there was a
significant main effect for alcoholic status for
birthweight, showing that the COAs were
significantly lower than the non-COAs (while
controlling for income). Low birth weight infants
are known to have negative sequelae, many of
which are considered to be psychological in na-
ture (e.g. attention deficit hyperactivity disorder)
and perhaps this result sheds light on the fre-
quent finding that COAs suffer more in terms of
psychological well-being (von Knorring, 1991;
West & Printz, 1987). This interpretation fits
with the finding that the sons of the alcoholics in
intact families used the most psychologists' ser-
vices (see Table 1). Moreover, this is consistent
with the finding that human infants fathered by
regular drinkers weighed less than those fathered
by non-drinkers, once mothers' alcohol and nic-
otine use were controlled (Little & Sing, 1986),
although this latter study remains controversial.
However, another caveat to keep in mind is
that since the father's alcoholism status was de-
termined when the children were 9.5 years old,
one can not assume that they were alcoholic at
the time of their child's birth (although it is
highly likely that an alcoholic who is first diag-
nosed at age 35 years was abusing alcohol at age
25 years, given the insidious nature of the dis-
order and that the SMAST assesses lifetime his-
tory of alcoholism). Nonetheless the finding is
consistent with Nordberg, Rydelius & Zetter-
stroni (1993), who found a higher risk for pre-
and postnatal death in COAs; although, in this
latter study alcoholics and heavy drinkers were
mixed, as were mothers and fathers with regard
to abuse of alcohol.
1626 Patricia L. Dobkin et al.
Contrary to some reports (e.g. Putnam, 1985;
Schneiderman, 1975, both cited in Woodside,
1988b), daughters of alcoholics were not more ill
than their brothers. While siblings in the al-
coholic families were more ill, the data did not
allow for gender specification regarding serious
illness, nor was income controlled.
The present study findings are consistent with
those of Fitzgerald et al. (1993) who did not find
group differences for somatic complaints (as-
sessed with the Child Behavior Checklist) in
young COAs; however, they fail to corroborate
reports of more (psycho) somatic complaints
(Bennett ei al, 1988; Rubio-Stipec et ai, 1991)
in studies whereby "mostly fathers" were alco-
holics. While these other investigators included
community samples, they failed to control for
income, a factor known to infiuence health. In
fact, when Rubio-Stipec et al. (1991) re-analysed
their data using a regression analysis, including
income in the initial steps, the differences be-
tween COAs and nonCOAs for somatic com-
plaints was no longer significant, supporting the
notion that income contributes to poor health. In
the present study, income was controlled for
statistically (for the data pertaining to the target
children) and thus the results were not biased in
this way. Moreover, the sample size in the pre-
sent study was sufficiently large to rule out a
Type II error. Of the studies reportmg on physi-
cal health, most included samples of under 100
COAs (there were 189 alcoholic families in the
present study).
Finally, it is possible that COAs whose par-
ent(s) who are in treatment for substance abuse
have more problems than COAs from a com-
munity sample and that inconsistencies found in
results are related to this factor (Omestein, Davis
& Wolfe, 1993). Logically, if more serious cases
present for treatment, then by extension the
more negative findings may be related to how
disturbed the individual/family is, rather that
substance abuse per se (Jacob & Leonard, 1986;
Rubio-Stipec et al, 1991). This hypothesis fits
current thinking with regard to the heterogeneity
of alcoholic families (Sher, 1991; Wallace,
1987). Furthermore, one may presume that a
community sample is more representative of the
COA population than a treatment sample since
so few alcoholics ever present for treatment.
It appears that we have reached a turning
point in the study of COAs. Rather than con-
sider them uniformly to be at risk, it is evident
that a subgroup needs to be identified who have
passed a critical threshold with regard to the
number and type of problems they experience. It
is likely that certain risk factors are more detn-
mental than others (e.g. mother's alcohol abuse
during pregnancy compared to exposure to fa-
ther's alcoholism following birth) and that pro-
tective factors may buffer risk factors, to some
extent (Wemer, 1986). The initial "cry for help"
for the "forgotten children" (Cork, 1969) was
useful in that it stimulated much research but
now, two decades later, more refined questions
need to be addressed, such as: which COAs are
at risk, for what, and why?
Acknowledgements
The present study was made possible by grants
from the Social Sciences and Humanities Re-
search Council of Canada, and Quebec's CQRS,
FRSQ and FCAR funding programs. The au-
thors would like to thank Helene Beauchesne
and Lucille David for the data collection,
Nathalie Frechette and Helene Boileau for cre-
ating the data banks, Pierre McDuff for data
analysis, Minh Trinh for the documentation and
Line Ares and Sylvie Martin for manuscript
preparation.
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