Sexual Abuse and Assault in a Large National Sample of Children and Adolescents.

The present study sought to examine features of sexual abuse cases among a U.S. nationally representative sample of 13,052 children and adolescents, ages 0-17 years. The National Survey of Children's Exposure to Violence was collected in three different years (2008, 2011, and 2014) via telephone interviews. Information about sexual abuse and assault was obtained from youth themselves (ages 10-17) or caregivers (for children ages 0-9) using the Juvenile Victimization Questionnaire. Results indicate most offenses are at the hands of other juveniles (76.7% for males and 70.1% for females), primarily acquaintances, and occurring more frequently for adolescents aged 14-17. Whereas girls are mostly abused by males (88.4%), boys are abused by both males (45.6%) and females (54.4%). In 15% of cases, penetration is part of the abuse. Victims report being very afraid in 37.5% of episodes but not at all afraid in 19.8%. Among 10- to 17-year-olds, 66.3% of episodes are not reported to parents or any adult. Police reports occur for 19.1% of all cases. The results in the present study indicate that children and youth are exposed to sexual abuse and assault in varied ways, which require moving beyond conventional stereotypes of the problem.

Assessment of commercially sexually exploited girls upon entry to treatment: Confirmed vs. at risk victims.

BACKGROUND: Research has documented many risk factors for commercial sexual exploitation of children as well as serious emotional and behavioral consequences for such victims. OBJECTIVE: This study aims to provide an understanding of risk factors and symptom presentation of girls who are victims or at risk for commercial sexual exploitation. PARTICIPANTS AND SETTING: Ninety-six girls (12-18 years) who were referred to a child advocacy center's specialized treatment program for commercially sexually abused girls served as participants (56 confirmed victims, 40 at risk of commercial sexual exploitation). METHODS: At intake participants were administered the Youth Self-Report, the Trauma Symptom Checklist for Children, and the UCLA Post-Traumatic Stress (PTSD) Reaction Index for DSM -5. Parents or guardians were asked to complete the Child Behavior Checklist and the UCLA PTSD Reaction Index for DSM - 5(Parent/Caregiver). RESULTS: Intake information revealed significant differences between groups with confirmed victims reporting higher levels of sex work, kidnapping, physical abuse, physical assault and sexual abuse by a non-family member (p < .05) than at risk victims. All participants were exposed to traumas, were racially and ethnically diverse and lived primarily with their families. At risk girls were significantly more likely to be in school than the confirmed victims. The UCLA PTSD Index revealed that the confirmed victims had experienced significantly more physical abuse than the at-risk group and 26.7% of confirmed victims and 7.7% of the at risk victims met the DSM criteria for PTSD. Twenty percent of the confirmed victims met criteria for Dissociative subtype, while only 7.7% of at risk victims did. On the CBCL, victims from both groups scored in the clinical range on Externalizing Problems and Total Problems and the at risk group scored significantly higher on the School subscale than the confirmed victims group. CONCLUSION: Commercially sexually exploited girls have experienced multiple traumas in their lives and display emotional and behavioral difficulties. Early detection of girls who may be at risk for sexual exploitation may allow for prevention and intervention as these girls also have traumatic backgrounds and display similar symptoms.

Early Sexual Experiences, Mental Health, and Risk Behavior among Black Non-Hispanic and Hispanic / Latino Men Who Have Sex with Men (MSM).

Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.

Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions.

Child sexual abuse is a significant problem in many Indigenous communities; there is also evidence of chronic under-reporting of this crime. This study aimed to compare reporting rates between Indigenous and non-Indigenous cases of child sexual abuse across two Australian jurisdictions. Datasets comprising child sexual abuse reports from the Police Information Management Systems of the two jurisdictions were used to calculate reporting rates, and to compare case characteristics and case progression. Results indicated that the reporting rate for child sexual abuse of Indigenous children was between two and four times that of non-Indigenous children. In the Indigenous cases, the second jurisdiction had lower reporting rates than the first jurisdiction. Further analysis of the Indigenous cases only found that cases in the second jurisdiction were more severe, more likely to have a forensic interview, and more likely for the suspect to be charged, than in the first jurisdiction. However, there were no significant differences in conviction rates between the two jurisdictions. Differences observed in severity and case progression suggest that the lower reporting rates observed in the second jurisdiction may be due to comparatively high levels of under-reporting, rather than lower actual levels of child sexual abuse. In conclusion, reporting rates of child sexual abuse can be better understood when further information, such as case characteristics and case progression rates, is available.

Ethnic differences in help-seeking behaviour following child sexual abuse: a multi-method study.

In Western societies, groups from a minority ethnic background are under-represented in formal mental health care. However, it is unknown if the minority ethnic victims of child sexual abuse differ from majority ethnic victims regarding their help-seeking behaviours. This study used a multi-method design to investigate the prevalence of (in) formal help-seeking after child sexual abuse and the influence of attitudes towards gender roles and sexuality on help-seeking among the Dutch minority ethnic and majority ethnic victims. We also examined differences in reasons not to seek help. Quantitative survey data on help-seeking patterns among 1496 child sexual abuse victims were collected. Four qualitative focus groups were conducted with professionals working in the field of child sexual abuse and minority ethnic groups to explore help-seeking behaviour. No significant differences between ethnicity emerged in help-seeking rates. However, respondents with more liberal gender attitudes were more likely to disclose than conservative respondents. Additionally, an interaction effect was observed between ethnicity and gender attitudes, indicating that, contrary to the main effect, young people of Moroccan and Turkish heritage with more liberal gender attitudes were less likely to disclose abuse. Reasons for not seeking help differed among groups. Focus group members emphasised mistrust towards counsellors and perceptions that inhibit minority ethnic youth from seeking help.

Family Violence and Child Sexual Abuse Among South Asians in the US.

Family violence, including child sexual abuse (CSA), is a significant public health problem in the United States. It is particularly difficult to assess family violence and CSA among South Asians because it is often hidden due to cultural and familial stigma. A web-based survey was administered to a convenience sample (n = 368) of South Asian adults in the US. One-fourth (25.2 %) of the sample reported CSA; 13.8 % reported abuse involving exposure; 21.5 % reported abuse involving touching; 4.5 % reported attempted sexual intercourse; and 3.5 % reported forced sexual intercourse. Adjusted odds ratios found that participants who reported any relationship violence were significantly more likely to have experienced CSA (OR 2.28; 95 % CI 1.26-4.13); and suicide attempt was significantly associated with CSA (OR 3.96; 95 % CI 1.27-12.3). The findings presented in this formative study will assist in guiding future studies and interventions for South Asians in the United States.

Pathway to Hope: an indigenous approach to healing child sexual abuse.

BACKGROUND: The Alaska Native (AN) population has endured multiple historical traumatic events. This population has poorer health outcomes on nearly all factors compared with Alaska non-Natives with more than 75% reportedly being physically assaulted in their lifetime, and child sexual abuse nearly 6 times the national average. OBJECTIVE: This article describes the Pathway to Hope (PTH) program, which is an indigenous approach to ending silence and denial related to child sexual abuse and encourages multigenerational healing. DESIGN: PTH was developed by ANs who believe that each community is unique, thus strategies for ending denial and support for healing must be woven from the historical context, cultural strengths of individual communities. Strengths-based solutions built on truth, honesty, compassion and shared responsibility for healing and protecting today's children have been profound and successful. The PTH curriculum addresses child sexual abuse from a historical perspective; that the higher rates of sexual abuse among certain Tribes, regions and communities is linked in part to years of victimisation, but may also be perpetuated by internalised oppression and lateral violence among Tribal members. RESULTS: Data suggest that community-based dialogue and wisdom of Native elders and spiritual leaders paired with readiness of community service providers are necessary for sustained change. At all levels, this Indigenous model for learning, sharing, helping and healing brings hope for an end to denial and silence about child sexual abuse for Native people. CONCLUSION: The PTH program utilises the wisdom and values that have sustained Native people for generations. Ending silence and denial about child sexual abuse and building upon strengths have assisted many Indigenous communities begin the journey toward wellness. Through the PTH, communities have taken steps to accept the challenges associated with establishing safety for children, supporting child victims in healing and to holding offenders accountable.

Prevalence and overlap of childhood and adult physical, sexual, and emotional abuse: a descriptive analysis of results from the Boston Area Community Health (BACH) survey.

Abuse is associated with a wide variety of health problems, yet comprehensive population-based data are scant. Existing literature focuses on a single type of abuse, population, or lifestage. Using a racially/ethnically diverse community-based sample, we document the prevalence of physical, emotional, and sexual abuse by lifestage and gender, assess variation in abuse by sociodemographics; establish overlap of abuses; and examine childhood abuse relationships with abuse in adulthood. Prevalence of abuse ranges from 15% to 27%; women report more adulthood emotional abuse and lifetime sexual abuse than men; reports of abuse can vary by race/ethnicity and poverty status, particularly in women; there is overlap between types of abuse; and a history of childhood abuse is associated with a greater risk of abuse as an adult.

Differences in the association between childhood trauma and BMI in black and white South African women.

OBJECTIVE: Childhood trauma has previously been associated with adult obesity. The aim of this study was to determine if ethnicity altered the relationship between childhood trauma and obesity in South African women. METHODS: Forty-four normal-weight (BMI < 25kg/m(2)) and obese (BMI > 30kg/m(2)), black and white premenopausal women completed the Childhood Trauma Questionnaire (CTQ), which retrospectively assessed emotional and physical neglect, and emotional, physical and sexual abuse in childhood. RESULTS: Body composition did not differ by ethnicity in the normal-weight and obese groups. However,independent of BMI group, there were significant differences in socioeconomic status (SES) between black and white women (P < 0.01). Total CTQ score, as well as the sub-scales, physical and emotional neglect, and physical and sexual abuse were higher in black than white women (all P < 0.05), but these scores did not differ between BMI groups. Apart from the sexual abuse score, the differences in physical and emotional neglect and physical abuse scores were no longer significant after adjusting for ethnic differences in age and SES. For sexual abuse, there was a significant interaction between ethnicity and BMI group(P = 0.04), with scores in normal weight women being higher in black than white women, but scores in obese women not differing by ethnicity. CONCLUSION: Ethnicity alters the association between childhood sexual abuse and BMI status. Larger studies are required to verify this finding, including measures of body image and body size satisfaction that may explain these findings.

The idealized cultural identities model on help-seeking and child sexual abuse: a conceptual model for contextualizing perceptions and experiences of South Asian Americans.

In this paper, we propose an interdisciplinary framework to study perceptions of child sexual abuse and help-seeking among South Asians living in the United States. We integrate research on social marginality, intersectionality, and cultural psychology to understand how marginalized social experience accentuates South Asian immigrants' desire to construct a positive self-identity. Using model minority ideology as an example of such a construction, we highlight its role in silencing the topic of child sexual abuse within this immigrant community as well as its impact on attitudes towards professional mental health services. We contend that our framework, the idealized cultural identities model on help-seeking and child sexual abuse, provides a unique analytical model for clinicians and researchers to understand how South Asian Americans process, experience, and react to child sexual abuse.

Cultural issues in disclosures of child sexual abuse.

Cultural norms affect the likelihood that child sexual abuse will be discovered by an adult or disclosed by a child. Cultural norms also affect whether abused children's families will report child sexual abuse to authorities. This article explores the ways ethnic and religious culture affect child sexual abuse disclosure and reporting, both in the United States and internationally. Guidelines for culturally sensitive child abuse interviewing are provided to facilitate disclosures of abuse from culturally diverse children in formal settings.

Childhood sexual abuse and adult sexual health among indigenous Kanak women and non-Kanak women of New Caledonia.

OBJECTIVES: Few studies have addressed the long-term consequences of adverse childhood experiences among women in Oceania, in particular among indigenous women. This paper aims to report prevalences of childhood sexual abuse (CSA) and to asses the negative sexual health consequences in adulthood by comparing indigenous Kanak to non-Kanak women in New Caledonia. METHODS: Data come from a population survey on violence against women and health. Face-to-face interviews were conducted in 2002-2003 with adult women randomly selected from the electoral list. Separate models for Kanak (n=329) and non-Kanak women (n=426) were performed. Regression models adjusted for relevant socio-demographics factors were conducted to estimate the odds ratios for the associations between childhood sexual abuse and adult sexual health outcomes. RESULTS: A non-significant difference between Kanak (11.8%) and non-Kanak women (14.4%) was found for the prevalence of CSA. Among Kanak women, CSA increases the risk of sexually transmitted infections, of non-desired sexual intercourse with an intimate partner and of experience of adult sexual violence. However, use of modern contraception as an adult was more frequent among CSA Kanak victims, as compared to other Kanak women. Among non-Kanak women, only abortion appeared significantly associated with CSA. CONCLUSIONS AND PRACTICE IMPLICATIONS: The findings show that in all ethnic communities of New Caledonia, a history of child sexual abuse is not rare among women. They also shed light on the long-term consequences of CSA, suggesting that the effect of CSA may differ according to ethnic membership and subsequent social stratification and gender norms. Efforts to break the silence around violence against girls and establish a stronger foundation are required in New Caledonia. Prevention programs on violence against women and sexual health that take into account the cultural and social heterogeneity are needed.

Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children.

American Indians and Alaska Natives are vulnerable populations with significant levels of trauma exposure. The Indian Country Child Trauma Center developed an American Indian and Alaska Native (AI/AN) adaptation of the evidence-based child trauma treatment, trauma-focused cognitive-behavioral therapy. Honoring Children, Mending the Circle (HC-MC) guides the therapeutic process through a blending of AI/AN traditional teachings with cognitive-behavioral methods. The authors introduced the HC-MC treatment and illustrated its therapeutic tools by way of a case illustration.

Childhood sexual abuse and adult binge drinking among Kanak women in New Caledonia.

The long-term consequences of violence against women are poorly documented within the context of political domination, economic inequalities and rapid social change of indigenous communities. Using data from the first population study on violence against women and their consequences on health in New Caledonia, South Pacific, this article investigates the association between childhood sexual abuse and binge drinking among 441 adult Kanak women. Face-to-face standardised interviews were conducted in 2002-2003, among women aged 18-54 years drawn from the electoral rolls. Childhood sexual abuse before 15 years of age was reported by 11.6% of respondents. Nearly all the perpetrators (96%) were known to the victims (63% being a close relative). The rate of frequent binge drinking amongst the women within the last 12 months was 34%. After controlling for social and demographic factors, an independent association was found between childhood sexual abuse and current binge drinking. This study is the first to analyse the contribution of childhood sexual abuse to the likelihood of later heavy alcohol use in an indigenous population in the South Pacific. The findings call for improving and giving priority to care for children who are victims of violence to prevent long-term health consequences and to develop prevention programs aimed at alcohol-related behaviour in women, while taking into account simultaneous individual and collective factors.

Attitudes toward using condoms and condom use: difference between sexually abused and nonabused African American female adolescents.

Rates of many sexually transmitted diseases remain higher among adolescents than among any other age group. The associations between abuse experiences and risky sexual behaviors suggest that exploring the relationships between adolescents' abuse history and condom use beliefs and behaviors is warranted. Females (N = 725) attending an adolescent clinic reported demographic characteristics, beliefs about condom use, sexual behaviors, and sexual abuse or molestation history. Those reporting sexual abuse or molestation (23%) were more likely to think condoms interfered with sexual pleasure and less likely to think condoms were important to partners. They also reported more unprotected vaginal sex and more lifetime sex partners. Beliefs were correlated with condom use consistency, number of lifetime partners, and number of unprotected sex experiences. The greater levels of behavioral risk among those reporting abuse suggest greater risk for acquisition and transmission in abused female adolescents. The authors discuss hypotheses to inform future research and intervention.

Child prostitution in Thailand.

Child prostitution is an old, global and complex phenomenon, which deprives children of their childhood, human rights and dignity. Child prostitution can be seen as the commercial sexual exploitation of children involving an element of forced labour, and thus can be considered as a contemporary form of slavery. Globally, child prostitution is reported to be a common problem in Central and South America and Asia. Of all the south-east Asian nations, the problem is most prolific in Thailand. In Thailand, there appears to be a long history of child prostitution, and this article explores the factors that underpin the Thai child sex industry and the lessons and implications that can be drawn for health care and nursing around the world.

Men's childhood sexual abuse histories by one-parent versus two-parent status of childhood home.

OBJECTIVES: To estimate the association between number of parents in the childhood home and childhood sexual abuse (CSA) with adjustment for childhood socioeconomic status (CSES). METHODS: Probability sample of 298, 18-49-year-old men from Philadelphia County, number of parents living in childhood home, socioeconomic data and CSA histories were obtained. RESULTS: 197 (66%) men participated. 186 (94%) of these lived with at least one parent; 76 (39%) and 110 (56%) lived with one parent versus two parents, respectively. 22 (29%) of 76 and 18 (16%) of 110 reported CSA histories, respectively (OR 2.08, p = 0.04). Two approaches to adjustment for CSES indicated continued association between parent number and CSA (OR 2.38-2.39, p = 0.05-0.07). Parent number was associated with numerous differences in CSA perpetrator characteristics and abuse experiences. Men from one-parent versus two-parent families reported significantly more non-family and female perpetrators (p = 0.03 and 0.01, respectively) and fondling experiences (p = 0.04). CONCLUSIONS: Findings provide additional support for the association between parent number and CSA in boys, suggesting that parent number is not just a proxy for CSES. CSA experiences also differed between one-parent and two-parent homes. Findings generate numerous hypotheses for future study.

Childhood sexual abuse among Black women and White women from two-parent families.

Differences in childhood sexual abuse (CSA) between Black women and White women are explored in a community sample of 290 women raised in two-parent families.A self-administered questionnaire and a face-to-face interview assessed CSA characteristics, aftermath, and prevalence as well as family structure and other childhood variables. Siblings served as collateral informants for the occurrence of CSA. Overall, comparisons of the nature, severity, and aftermath of CSA showed similarities by race; some differences, for example, in age of onset, are potentially relevant for the planning of prevention programs. Logistic regression models examined effects of childhood variables on CSA prevalence. Initial analyses showed a higher CSA prevalence among Black women (34.1% [45] of Black women vs. 22.8% [36] of White women) that was attenuated when family structure (e.g., living with two biological parents throughout childhood or not) and social class were considered. Of interest, differences in family structure remained important even among these two-parent families. Understanding the dynamics of abuse by race and family structure will facilitate the design of more targeted CSA prevention programs.