Responsible Behavior With Younger Children: Results From a Pilot Randomized Evaluation of a School-Based Child Sexual Abuse Perpetration Prevention Program.

Many efforts to prevent child sexual abuse (CSA) aim to teach children strategies for recognizing, resisting, and reporting victimization. There is limited evidence that victimization-focused efforts actually prevent CSA. Moreover, these efforts often overlook the fact that many children and adolescents engage in problem sexual behavior against younger children. Responsible Behavior with Younger Children (RBYC) is a novel universal school-based perpetration-focused intervention that aims to prevent the onset of inappropriate, harmful, or illegal sexual behavior by adolescents against younger children.1 Responsible behavior with younger children was designed to provide adolescents and their parents with the knowledge and tools to help adolescents interact appropriately with younger children and avoid CSA behaviors. In this paper we describe intervention development, summarize lessons learned from implementing RBYC in four urban schools, and report results from our pilot randomized waitlist-controlled trial (RCT) with 160 6th and 7th grade students. Results indicate RBYC was associated with increased accuracy in youth knowledge about CSA and CSA-related laws, and with increased behavioral intention to avoid or prevent CSA with younger children and peer sexual harassment. Although the sample was small and the effects were relatively modest, the findings do suggest that RBYC holds promise for preventing the onset of problem sexual behavior.

The public's knowledge about child sexual abuse influences its perceptions of prevention and associated policies.

BACKGROUND: Child sexual abuse (CSA) prevention requires efforts from all members of society. OBJECTIVE: The current study aimed to examine factors associated with (1) perceptions of CSA as unpreventable and (2) support for policies to prevent CSA and to punish people who perpetrated CSA. We focused on the roles of knowledge and misperceptions about child sexual abuse. PARTICIPANTS AND SETTING: We collected survey data online from a large (N = 5068), nationally representative sample of adults in the United States. RESULTS: Analyses revealed factors promoting perceptions of CSA as unpreventable. Support for or against policies that aim to prevent CSA or to punish perpetrators of CSA were associated with individual factors such as older age (B = 0.08, -0.13), Republican political affiliation (B = 0.10, 0.07), and misperceptions about CSA (B = 0.15, 0.06). CONCLUSIONS: Findings highlight malleable factors that could be targeted to collectivize calls for CSA prevention and to promote support for effective policies to prevent CSA. In particular, ensuring accurate knowledge about CSA, and collective responsibility and government efficacy specific to CSA prevention, were identified as helping shape views of CSA as preventable.

Is the Affordable Care Act Medicaid Expansion Associated With Reported Incidents of Child Sexual Abuse?

There is substantial evidence that adequate access to healthcare among low-income adults through the Affordable Care Act Medicaid expansion mitigates risk factors associated with childhood maltreatment, including parental financial insecurity, substance use, and poor mental health. Indeed, studies identified reduced reports of child neglect in states that expanded Medicaid, relative to those that did not. However, it is unknown whether Medicaid expansion is associated with reported child sexual abuse (CSA). We present findings from a study evaluating the association of Medicaid expansion with incidents of CSA reported to child protective services. Using a difference-in-differences approach, we analyzed data from the National Child Abuse and Neglect Data System to examine the effects of state-level adoption of the Medicaid expansion on CSA reports per 100,000 children across 2008-2018. Results indicated no statistically significant association between Medicaid expansion and CSA incidents. We discuss potential reasons for differential association of macro-level policies on types of child maltreatment.

Adverse Childhood Experiences, Mental Health, and Risk Behaviors in Adulthood: Exploring Sex, Racial, and Ethnic Group Differences in a Nationally Representative Sample.

This study examined sex, racial, and ethnic differences in the short- and long-term associations between adverse childhood experiences (ACEs), mental health, and risk behaviors in a nationally representative sample. Analysis was based on the National Longitudinal Study of Adolescent to Adult Health, a longitudinal cohort of U.S. adolescents followed in five waves of data collection from adolescence to adulthood. Analysis included design-based regression models to examine the associations between ACEs and proximal and distal outcomes (i.e., depression, suicidal ideation, number of sexual partners, binge drinking, current smoker) assessed in the transition to adulthood (mean age 21; 2001-2002) and adulthood (mean age 38; 2016-2018). Sex, racial, and ethnic interactions were included in regression models to examine effect modification in the association of ACEs, mental health, and risk behaviors. In this analytical sample (N = 9,690), we identified a graded association between ACEs and depression, suicide ideation, and current smoker status at both time points (i.e., mean age 21 and 38). Sex moderated the relationship between ACEs and depression at mean age 21, while race (i.e., American Indian versus White) moderated the relationship between ACEs and number of sexual partners at mean age 38. A greater number of cumulative traumatic experiences in childhood may amplify adverse health outcomes among women and adults of American Indian descent in particular.

Impact of Child Sexual Abuse on Socioeconomic Attainment in Adulthood.

PURPOSE: While child sexual abuse (CSA) victimization is linked to adverse mental and behavioral health outcomes, few studies have examined the association between CSA and socioeconomic attainment in adulthood, particularly for men. This study assesses the impacts of CSA victimization on socioeconomic outcomes in adulthood, separately for men and women. METHODS: Analyses are based on the National Longitudinal Study of Adolescent to Adult Health restricted use dataset. Adolescent to Adult Health is a nationally representative cohort of teenagers in grades 7-12 (1994-1995; N = 20,000) followed to ages 33-44 (2016-2018; N = 12,300). These analyses were based on N = 10,119 participants. We used propensity score weighting to equate on observed confounders of those who experienced CSA victimization with those who had not. All analyses were conducted in the R statistical software. RESULTS: In this analytical sample, 25.2% of women and 9.8% of men reported of having been sexually abused as a child. Results from propensity score weighted models showed that by their late 30s, men and women who experienced CSA had lower educational attainment, lower odds of being financially stable, and a decrease in household income compared to their peers. CSA was associated with lower odds of being employed among women only. DISCUSSION: Findings from this study suggest that men and women who survive CSA, experience socioeconomic disadvantages in adulthood relative to peers who did not experience CSA. Preventive programs and treatment and other services for survivors of CSA could positively impact individuals' economic productivity over the life course, reducing the individual and societal costs associated with CSA victimization.

Health insurance expansion and family violence prevention: A conceptual framework.

Family violence, including child maltreatment (CM) and intimate partner violence (IPV), plagues far too many American families, particularly those in low-income communities. CM and IPV are intertwined and impose a significant emotional, health and financial burden on children and families and an economic burden on our country. Although these and other forms of violence are influenced by shared risk factors across the socioecological spectrum, prevention efforts typically intervene on a single type of violence at a microsystem level via individual or family intervention. Research is needed to identify policies operating at macrosystem levels that reduce, at scale, multiple forms of violence affecting children. In this paper, we propose a three-step theory of change through which health insurance expansions might reduce rates of CM and IPV, using Medicaid expansion as an exemplar. The proposed framework can inform research examining the link between health insurance and the primary prevention of CM and IPV.

Examining the Associations between Adverse Childhood Experiences, Health Risk Behaviours, and Psychological Well-Being in a Convenience Sample of Lithuanian University Students.

This study examines the associations between adverse childhood experiences (ACEs), health risk behaviours, and psychological well-being among Lithuanian university students. A cross-sectional survey was carried out with a convenience sample of 393 students (80.7% females and 19.3% males) recruited from mostly undergraduate courses (96.4%) in Lithuanian universities. Participants, aged 18−25 years (21.07 ± 1.53), completed a web-based survey in which they were asked to retrospectively self-report on ACEs while answering questions on health risk behaviours (e.g., smoking, substance use, riding a car with a drunk driver) and psychological well-being. Only 8.7% of the study sample experienced no ACEs, and almost half of the sample (48.9%) experienced ≥4 ACEs. Findings from adjusted models showed that, compared with students with no ACEs, those who experienced ≥4 ACEs had higher odds of lifetime illicit drug use (AOR = 2.73, p < 0.05), riding with a drunk driver (AOR = 2.44, p < 0.05), suicidal ideation before age 18 (AOR = 28.49, p < 0.01) and in the past 12 months (AOR = 5.39, p < 0.01). An increased number of ACEs was also associated with lower psychological well-being (B = −3.94, p < 0.001). Findings from this study have implications for mental health professionals as well as university administrators, as students with a higher number of traumatic experiences may require greater levels of support and services.

Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse.

INTRODUCTION: The U.S. Affordable Care Act Medicaid expansion, which allowed states to expand Medicaid coverage to low-income adults beginning in 2014, has reduced the risk factors for child neglect and physical abuse, including parental financial insecurity, substance use, and untreated mental illness. This study examines the associations between Medicaid expansion and the rates of overall, first-time, and repeat reports of child neglect and physical abuse incidents per 100,000 children aged 0-5, 6-12, and 13-17 years. METHODS: The 2008-2018 National Child Abuse and Neglect Data System was analyzed using an extension of the difference-in-differences approach that accounts for staggered policy implementation across time. Owing to evidence of nonparallel preperiod trends in the 6 states that expanded Medicaid from 2015 to 2017, the main analyses included 20 states that newly expanded Medicaid in 2014 and 18 states that did not expand Medicaid from 2008 to 2018. Analyses were conducted in 2020-2021. RESULTS: Medicaid expansion states were associated with reductions of 13.4% (95% CI= -24.2, -9.6), 14.8% (95% CI= -26.4, -1.4), and 16.0% (-27.6, -2.6) in the average rate of child neglect reports per 100,000 children aged 0-5, 6-12, and 13-17 years, per state-year, relative to control states. Expansion was associated with a 17.3% (95% CI= -28.9, -3.8) reduction in the rate of first-time neglect reports among children aged 0-5 years and with 16.6% (95% CI= -29.3, -1.6) and 18.7% (95% CI= -32.5, -2.1) reductions in the rates of repeat neglect reports among children aged 6-12 and 13-17 years, respectively. There were no statistically significant associations between Medicaid expansion and the rates of physical abuse among children in any age group. CONCLUSIONS: Insurance expansions for low-income adults may reduce child neglect.

Responsible Behavior with Younger Children: Examining the Feasibility of a Classroom-Based Program to Prevent Child Sexual Abuse Perpetration by Adolescents.

Child sexual abuse (CSA) is a preventable public health problem typically addressed with either after-the-fact interventions or prevention programs focused on teaching children to protect themselves and report abuse. Such responses do little to prevent CSA victimization, leading to calls for prevention efforts targeting individuals most at risk of perpetrating CSA. These individuals include young adolescents, who are prone to making mistakes and bad decisions when it comes to their sexual behaviors. To begin to address this call to action, we developed Responsible Behavior with Younger Children (RBYC), a universal school-based prevention program to provide sixth and seventh grade students (and their parents and educators) with the knowledge, skills, and tools to prevent engaging younger children in sexual behaviors. School-based CSA prevention interventions are often met with feasibility and acceptability concerns including that (a) people at risk of offending are impervious to prevention efforts, (b) schools do not have the resources to take on additional programs, and (c) the content is too sensitive for educators, parents, and students. The goal of this article is to describe how the RBYC program was developed to address these concerns. We also summarize data on the feasibility of the RBYC program obtained from focus groups with educators, parents, and students during the development of the program and interviews with educators after a pilot randomized controlled trial (RCT). Feedback received during program development and after the pilot RCT suggests that RBYC is relevant, salient, palatable, and feasible for implementation in middle schools.

Preventing and responding to child sexual abuse: Organizational efforts.

BACKGROUND: Child sexual abuse (CSA) remains an ongoing threat to the wellbeing of children who might be victimized, to the liberty of individuals who might engage in abusive behavior, and to the reputations and livelihood of organizations in which abuse might occur. In the U.S., millions of children participate in youth-serving organizations (YSOs), and it is known that a proportion of CSA occurs in these settings. Despite the severity of these threats, there is little knowledge of the steps that organizations take to prevent and respond to CSA. OBJECTIVE: Our study aimed to index current measures to prevent and respond to CSA in organizational settings, using four of the largest U.S.-based YSOs as exemplars. METHODS: In partnership with our partner YSOs, we completed a qualitative analysis of 74 organizational documents including written policies, codes of conduct, trainings, and other documents that formalize these four organizations' current CSA prevention and intervention efforts. RESULTS: These organizations collectively implement hundreds of distinct measures aimed at preventing, detecting, and responding to CSA. These measures were categorized under eight overarching themes, including: overall commitment to child safety, code of conduct, training and education, assessment, implementation and monitoring, screening and hiring, reporting and responding to child sexual abuse, youth problem sexual behavior, and boundaries for teen leaders and young adult staff. CONCLUSION: Findings from the current study, outlining key prevention and policy areas undertaken by participating YSOs, offer a starting point for discussion about core elements needed to keep children safe from sexual abuse in YSO settings.

Caregivers' Perceptions and Responses to a New Norm: The Missing Link in Addressing Adolescent Sexting Behaviors in the U.S.

Youth sharing of self- or peer-produced sexual content via electronic communications, dubbed by the media as "sexting" (i.e., sexting behaviors), has generated concern among a wide variety of adult stakeholders in the U.S. Experts recognize the need to integrate perspectives and knowledge about adolescents' sexting behaviors from individuals who interact with adolescents (e.g., their caregivers) to inform the development of prevention policy and practice. The present study fills this gap by interviewing 10 separate groups of caregivers in three different states, with the sole focus on adolescent sexting behaviors. Results indicated seven themes: (1) characteristics of adolescent sexting behaviors, (2) influences on sexting behaviors, (3) communication about sexting behaviors, (4) gender and sexting behaviors, (5) sociohistorical conditions and sexting behaviors, (6) consequences of sexting behaviors, and (7) ways to address sexting behaviors; multiple themes emerged within each of the seven parent codes. Findings inform the need to integrate adolescent sexting behaviors into comprehensive sexual education curricula and to develop educational content on adolescent sexting behaviors for adolescents and caregivers in online and printable handout formats. Clearly defining sexting and norms around sexting are of particular importance in such educational materials.

Child Sexual Abuse: The Need for a Perpetration Prevention Focus.

In the evolution of efforts to reduce child sexual abuse (CSA) rates in the United States, there has been a gradual shift to add preventive measures to after-the-fact interventions (i.e., interventions and policies implemented after the abuse has already happened, such as services and treatment for victims and punishment, treatment, and management of offenders). Prevention of CSA perpetration, however, is often missing from these efforts, despite decades of experts calling for broader prevention solutions. The current paper describes the scope of the problem of CSA, highlights problems with an over-reliance on after-the-fact interventions, and describes promising perpetration-focused CSA prevention interventions. While most existing preventive efforts focus on teaching children to protect themselves from incurring sexual harm, perpetration prevention efforts may hold more promise by addressing the onset of harmful behavior. As such, perpetration prevention efforts can contribute to a more robust and comprehensive approach to CSA - an approach that focuses on prevention of harm from occurring in the first place, as well as responding once harm has occurred.

Racial and Ethnic Differences in Teenage Fathers' Early Risk Factors and Socioeconomic Outcomes Later in Life.

BACKGROUND: Understanding racial differences in teenage fathers' early risk factors and later outcomes is critical to inform programs for teenage fathers as our knowledge base on this population remains limited. OBJECTIVE: The goal of this study was to assess how teen fathers' characteristics, including family background, delinquency, living arrangements, socioeconomic resources, and arrests, vary over time by race and ethnicity. METHOD: We analyzed National Longitudinal Study of Adolescent to Adult Health data. The analytic sample consisted of self-identified African American, Latino, and White males who fathered a child before the age of 20 (n = 313). Data come from three time points: adolescence, transition to adulthood, and young adulthood. RESULTS: Latino teen fathers came from families with lower educational attainment and greater reliance on public assistance. No statistically significant differences by race and ethnicity were found in parental involvement, school connectedness, marijuana use, and delinquency during adolescence. By their early 20s, a lower proportion of African American teen fathers were married compared to White and Latino teen fathers. By young adulthood, adjusted regression analyses showed that African American teen fathers were more likely to be arrested and earned a lower mean income than White teen fathers. CONCLUSIONS: Findings suggest that African American teen fathers, while no more disadvantaged or delinquent than the other two groups in their adolescence, experience greater accumulation of disadvantages over the life course. Intervention programs must consider the broader social and institutional context that may contribute to the disproportionate disadvantage among African American teen fathers in their young adulthood.

Gender and Race Informed Pathways From Childhood Sexual Abuse to Sexually Transmitted Infections: A Moderated Mediation Analysis Using Nationally Representative Data.

PURPOSE: Although data suggest child sexual abuse is linked with increased risk of contracting asexually transmitted infection (STI), the mechanisms through which these experiences are connected remain understudied. Moreover, there is a need to explore how race/ethnicity and gender influence these processes. METHODS: The present study examined the mediational pathways from child sexual abuse to risky sexual behavior to STIs and further evaluated the role of depressive symptomatology and nonmedical prescription drug use on the relationship between child sexual abuse and risky sexual behavior. In addition, race and gender were examined as moderators to account for potential different effects of these mechanisms on females and males and on different racial and ethnic groups. A nationally representative sample of 4,181 youth from the Add Health dataset was used. RESULTS: Results from a moderated mediation model indicated risky sexual behavior partially mediated the pathway from child sexual abuse to STI contraction and depressive symptomatology and nonmedical prescription drug use partially mediated pathway from child sexual abuse to risky sexual behavior. Race and gender moderated the relationship between risky sexual behavior and STI contraction. CONCLUSIONS: Findings underscore the need for STI prevention efforts among adolescents to focus on risk factors beyond risky sexual behaviors, such as childhood sexual abuse and mental health screening that includes depressive symptomatology and nonmedical prescription drug use. In addition, findings emphasize the need to further examine the different effects on different racial/ethnic and gender subgroups, particularly black women.

Exploring the Use of Theory in a National Text Message Campaign: Addressing Problem Recognition and Constraint Recognition for Publics of Pregnant Women.

Infant mortality is associated with access to healthcare, knowledge, and health literacy. Text4baby, the largest national texting health initiative, seeks to address these factors. However, no research has examined the program's theoretical framework, an aspect that may impact its success. To address this gap, Text4baby's use of theory was evaluated through a content analysis of Text4baby messages and interviews with Text4baby content developers. We compared the main variables of health behavior theories framing Text4baby messages with the situational theory of publics and its factors of problem recognition and constraint recognition. The situational theory of publics provides an understanding of the types of publics that might emerge from Text4baby's audiences of pregnant women. Aware, latent, and active publics are defined by the situational theory and are created out of problem recognition and constraint recognition along with a level of personal involvement in the issue of prenatal health. We used content analysis and interviewing to explore how Text4baby prenatal messages were constructed using theory and to offer lessons learned for prenatal health campaigns. The multi-methodological approach to understanding meaning construction in the production of these text messages and how meaning played out in the messages is a useful framework for text message campaigns.

Long-term consequences of adolescent parenthood among African-American urban youth: a propensity score matching approach.

PURPOSE: The aim of this study was to improve understanding of long-term socioeconomic consequences of teen parenting for men and women. METHODS: Analysis is based on the Woodlawn Study, a longitudinal study of an African-American cohort from a socially disadvantaged community in Chicago; data were collected at childhood (N = 1,242), adolescence (N = 705), young adulthood (age 32 years, N = 952), and midlife (age 42 years, N = 833). This analysis focused on the 1,050 individuals with data on teen parenting. We used propensity score matching to account for differences in background characteristics between teenage parents and their peers and used multiple imputation to account for differential attrition. RESULTS: The regression models after propensity score matching showed that at the age of 32 years, in comparison to nonteen mothers, teenage mothers were more likely to be unemployed, live in poverty, depend on welfare, and have earned a GED or completed high school compared to finishing college. At the age of 32 years, teen fathers were more likely to be without a job than nonteen fathers. At the age of 42 years, the effect of teen parenting for women remained statistically significant for education and income. There were no significant associations between teen parenting and outcomes for men at the age of 42 years. CONCLUSIONS: Socioeconomic consequences of teenage parenting among African-Americans from disadvantaged background seem to be primarily concentrated in women and persist throughout adulthood. In addition to promoting the delay of parenting after the teenage years, it is critical to provide programs at early stages in the life course to mitigate the negative socioeconomic consequences of teenage motherhood as effects for women are broad.