Child Sexual Abuse Prevention Opportunities: Parenting, Programs, and the Reduction of Risk

Online sexual abuse and exploitation of children in the Philippines: An exploratory study of outcomes after reintegration into the community

BACKGROUND

This study examined psychosocial outcomes for Filipino survivors of online sexual abuse and exploitation of children (OSAEC).

OBJECTIVE

This study aimed to identify relationships between demographic variables, self-reported and caregiver-reported trauma symptoms, and psychosocial functioning among Filipino youth who have experienced OSAEC.

PARTICIPANTS AND SETTING

This study utilized inclusion criteria of survivors of OSAEC between ages 12 and 18 who received residential care and were reintegrated into the community for at least one year (N = 48). Participants were in care at shelters associated with Project PAVE in the Philippines.

METHODS

As measured by three assessment tools, relationships between demographic variables and psychosocial functioning were explored for risk and protective factors of trauma symptoms and psychosocial functioning to better understand this population's needs post-integration.

RESULTS

Results suggest survivors continue to experience psychosocial symptoms after reintegration. Caregivers reported survivors reintegrated outside the home had significantly higher externalizing symptoms (MR = 6.67; H(3) = 14.85, p = .002, η2 = 0.27) compared to survivors reintegrated within the home and survivors who trafficked themselves to have higher internalizing symptoms (MR = 16.79; H(3) = 11.80; p = .008, η2 = 0.20) than survivors trafficked by a relative. Caregivers reported survivors who resided in the shelter for one month or less to have higher internalizing symptoms (MR = 20.12; H(2) = 11.06; p = .004; η2 = 0.20) than survivors who resided in the shelter for six months or longer.

CONCLUSION

This study highlights the importance of further research to better understand the needs of this vulnerable population in order to guide the most effective intervention, aftercare, and reintegration programs to support survivors and their caregivers.

Adapting a selective parent-focused child sexual abuse prevention curriculum for a universal audience: A pilot study

Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape-parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation-interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N = 31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants' mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.

Prevalence and correlates of depressive disorders in commercially sexual exploited children: A cross-sectional study in Mombasa, Kenya

BACKGROUND

Commercial sexual exploitation of children (CSEC) is a global concern and is among the common forms of sexual violence against children. In Kenya, about 32 % of girls and 16 % of boys experience sexual violence before the age of 18 years. While much has been written about the impact of child sexual exploitation, there's little on the prevalence of depressive disorders among CSE children.

OBJECTIVES

This study was conducted to assess the prevalence and correlates of depressive disorders among CSE children in Mombasa, Kenya.

PARTICIPANTS AND SETTING

The study was conducted among CSE children (10-17 years) in Mombasa County.

METHODS

A cross-sectional study conducted between May 2021 and June 2022. A total of 409 CSE children were enrolled, using a case management approach. Data was collected using the child identification tool and the Patient Health Questionnaire (PHQ-9), at the first counselling session to determine the prevalence of depression levels.

RESULTS

Of the 409 children, 367 (90 %) were girls while 42 (10 %) were boys. The mean age was 15 years (10-17) (SD = 1.4, t = 0.765). In 286 (70 %) 'Depression unlikely' was recorded, while 123 (30 %) 'Depression likelihood.' Prevalence of mild to severe depression was significantly higher in girls than boys (p = 0.002). Other determinants of depression were having a primary level of education (p = 0.03) and being an orphan. (p = 0.03).

CONCLUSION

It is important to prioritize mental health interventions such as screening and early diagnosis of mental health among CSE children in order to prevent and manage both short and long term effects.

A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial

BACKGROUND

Evidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group.

METHODS

This study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10-17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff.

DISCUSSION

App-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings.

TRIAL REGISTRATION

The trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ .

Child Sexual Abuse in the United States: A Commentary on Current Policy Approaches to Prevention and Aspirations for the Future

Child sexual abuse (CSA) is a significant threat to the health and well-being of children in the United States (US). Public policies are a key public health strategy for the primary prevention of violence, including CSA. In 2021, the Enough Abuse Campaign and Prevent Child Abuse America published a comprehensive report entitled A Call to Action for Policymakers and Advocates: Child Sexual Abuse Prevention Legislation in the States to encourage state leaders to create a comprehensive strategy to prevent CSA in the US. Findings from the report show that the nation has made some effort to address CSA, but more focus needs to be given to primary prevention strategies that stop it from occurring in the first place. The report also illustrates the variability of CSA prevention policies across the US and highlights critical gaps in current approaches that must be addressed. In the spirit of the special issue, the authors reflect on key policy issues in the field, including the lack of a federal policy framework for CSA prevention, dedicated funding for the prevention of CSA, and research on the effectiveness of policies intended to prevent CSA. Suggestions for future directions in relation to policy development provided in this commentary will be useful to a variety of stakeholders interested in the topic of CSA prevention policy.

Parental Involvement in Programs to Prevent Child Sexual Abuse: A Systematic Review of Four Decades of Research

This systematic review is the first to synthesize knowledge of parental involvement in child sexual abuse (CSA) prevention programs. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, 24 intervention evaluations met the inclusion criteria of aiming to change parental knowledge, attitudes, behaviors, behavioral intentions, self-efficacy, response-efficacy, or capabilities for prevention of CSA. Included papers were identified via a combination of electronic database searches (PsycINFO, Web of Science, Scopus, Google Scholar, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform, google.com.au, open.grey.eu, Global ETD, Open Access Theses & Dissertations, EThOS, and Trove) and direct communication with researchers. Improvement post intervention was found most commonly for parental behavioral intentions and response-efficacy, closely followed by parental behaviors, then capabilities, self-efficacy, knowledge, and lastly, parental attitudes. Improvements in behaviors, intentions, and response-efficacy occurred in 88 to 100% of the studies in which they were addressed, improvements in self-efficacy and capabilities occurred in 67 to 75%, and improvements in knowledge and attitudes occurred in only 50 to 56%. Many of the included evaluation studies suffered from methodological and reporting flaws, such as high participant attrition, lack of control group, lack of statistical tests, missed testing time points, and a lack of (or short) follow-up. Future parent-focused CSA prevention evaluations must address these concerns by conducting rigorous empirical research with sound methodologies and comprehensive reporting. Furthermore, study designs should consider measuring the real-world impact of increases in assessed parent variables, including their ability to prevent sexual victimization of children.

A Scoping Review of Programs to Prevent Child Sexual Abuse in Mainland China

Child sexual abuse (CSA) is a worldwide public health concern. With the widespread dissemination of prevention approaches to end CSA, numerous CSA prevention programs exist in developed countries, but there is little evidence on how these programs are performing in Mainland China. The aim of this study was to review the existing research focusing on CSA prevention programs in Mainland China. Studies of CSA prevention programs were identified by conducting a comprehensive search of major academic databases for Chinese and English research. Articles were retained if they were original empirical studies that conducted programs to prevent CSA in Mainland China and measured related outcomes. Twelve studies met the inclusion criteria. A child-targeted, universally focused, and school-based educational program was the most common (n = 7), followed by specifically focused programs that covered migrant and left-behind children using group-based intervention strategies (n = 2) and ordinary parents with self-learning strategies (n = 2); one study delivered agency-based face-to-face education to parents with disabled children. However, the shortcomings in research design limited its replication to the broader population. CSA prevention program research in Mainland China is in an early stage due to the limited target populations, lack of large-scale government-led initiatives, and low involvement of multicomponent collaboration. We provide suggestions for conducting future research involving more inclusive programs for other populations, comprehensive programs with multiple targets and stakeholders, large-scale evidence-based research, culturally tailored and contextual adaptation programs.

Investigation of fathers' metaphors regarding child sexual abuse in Turkey: A metaphor study

BACKGROUND AND PURPOSE

This study was designed to determine the perceptions of fathers about child sexual abuse in Turkey using metaphors to facilitate understanding of child sexual abuse.

METHODS

The study was conducted as a qualitative study based on metaphor analysis. The data were collected from 164 Turkish fathers in Turkey between August 2022 and September 2022 using a descriptive information form for fathers and a semi-structured interview form exploring fathers' perceptions of child sexual abuse. The semi-structured interview form included metaphor statements like "Child sexual abuse is like....... because .......", and "Child sexual abuse reminds me of the color....... because .......". The data were analyzed using the content analysis technique. The study was reported based on Standards for Reporting Qualitative Research (SRQR).

RESULTS

According to the results, 77.4% of the fathers had knowledge about protecting their children from sexual abuse, 40.9% got this information from the internet, and only 11.1% educated their children about sexual abuse. Seventy three percent of the fathers were afraid of confusing their children while educating them. The fathers involved in the study used 20 metaphors related to "child sexual abuse" and "the color evoked by child sexual abuse". The metaphors created by the fathers were analyzed under six categories: "emotions, feeling inadequate, punishment method, abuser, child concept, and uncertainty".

CONCLUSION

Based on the results of the study, fathers had common feelings and emphasize the same concepts about child sexual abuse.

PRACTICE IMPLICATIONS

Metaphors provide a unique approach to identifying fathers' conceptual images of child sexual abuse.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Parental-Led Sexual Abuse Education Amongst At-Risk Parents: Associations with Parenting Practices, and Parent and Child Symptomology

Considering the emphasis on parent-led sexual abuse education (PLSAE) in child sexual abuse (CSA) prevention, and the imperative of prevention in families living with demonstrated risk factors, it is important to understand the extent to which this group delivers PLSAE to their children, whether this is associated with any barriers or facilitators, whether parents are engaging in other protective behaviors (such as monitoring and involvement) and the relationship between these variables and other risk factors such as parent and child symptomology. We surveyed 117 parents, with children ranging in age from 25-89 months (67% boys), attending a parenting program for assistance with a range of parenting difficulties and child behavior problems from 2020-22. A large majority of parents reported not giving their children comprehensive prevention messages, discussing body integrity and abduction dangers to a greater extent. PLSAE was significantly positively associated with child internalizing and externalizing symptoms; parent and child age; and discussion of body integrity and abduction. However, PLSAE was not associated with any other measured variables (protective parenting; CSA knowledge; parenting self-efficacy; general and own-child risk appraisal; parent burnout, stress, depression or anxiety; child diagnosis; parental education level; employment or marital status; or income). The current findings suggest that investing resources into increasing parental knowledge, risk perception and confidence may be misguided. Future endeavors should consider helping parents be protective in other ways, for example, through the creation of safe environments and reducing the risks of CSA.

Analyzing the concept of sexual self-care in preschool children: A qualitative study

BACKGROUND

Child sexual abuse is a global concern for families and societies. Therefore, child protection from sexual harassment is of particular importance. The present study aimed to investigate the concept of sexual self-care in children.

MATERIALS AND METHODS

The present research is a qualitative study conducted with a content analysis approach. The study participants include 39 child sex education specialists, parents of children aged 4-7 years, adolescents who were sexually abused in childhood, and those with no experience of sexual abuse in childhood. The participants were selected through purposive sampling method. Different people's interpretations of the concept of sexual self-care in children were explored using semi-structured and face-to-face interviews, which continued until the saturation of concepts. Data were analyzed using the Graneheim and Lundman method. Guba and Lincoln's criteria were used to strengthen the validity and transferability of the data.

RESULTS

Sexual self-care in children was identified from participants' viewpoints in the study. This self-care includes three main components and six subcomponents of (1) knowledge about privacy, risk situation, and trustworthy people, (2) attitude and perception of risk, and (3) behavioral skills in self-protection (i.e., post-injury reaction).

CONCLUSION

Further injuries can be prevented by improving the level of awareness, forming the right attitude, and strengthening children's behavioral skills toward sexual self-care. Such issues, which are representatives of privacy, risk situations, and self-protection ability, can improve children's sexual self-care skills.

Provider Attitudes and Self-Efficacy When Delivering a Child Sexual Abuse Prevention Module: An Exploratory Study

BACKGROUND

As constant figures in children's lives, parents are key in protecting children from sexual abuse. One barrier to reaching parents is that the topic can be difficult to broach and is sensitive in nature. Such barriers can interfere with implementation and fidelity of evidence-based prevention strategies that are focused on reducing rates of childhood sexual abuse (CSA).

AIMS

In this exploratory study, we examine provider attitudes about delivering CSA-specific content in an evidence-based prevention module and their self-efficacy.

METHOD

Thirty-three providers participated in three surveys: prior to a skills-oriented training on how to deliver the CSA prevention module (pretraining), immediately posttraining, and 6 months posttraining. Changes in self-reported willingness to deliver content, beliefs about parents' role in CSA prevention, and confidence about their ability to deliver content were assessed over time. Open-ended questions were coded thematically to reinforce quantitative findings.

RESULTS

Prior to training, providers were worried that parents would respond negatively to CSA content and were concerned about their comfort level discussing victimization and sexual development. Findings suggest that skill-oriented training and provision scripts effectively supported providers and improved confidence in delivering CSA prevention content.

DISCUSSION

Provider self-efficacy is an important element of implementation fidelity. This exploratory study demonstrated that, though providers may approach CSA content with wariness and trepidation, adequate skills-oriented training can reduce negative attitudes and increase perceived efficacy in the actual delivery of CSA content that persists through implementation.

CONCLUSION

Skills-based training can significantly enhance fidelity in the delivery of difficult content included in parent-focused preventative interventions.

Examining the Awareness Levels of Parents on Child Sexual Abuse

Introduction:

Child sexual abuse (CSA) is defined as all kinds of actions that an adult uses a child for sexual purposes. The studies concluded that parents have incomplete or incorrect information and the protection of children against abuse is the fundamental duty of parents. This study analyses the CSA awareness levels of parents.

Methods:

Descriptive survey model is performed. The research sample covers 455 parents. The Child Sexual Abuse Awareness Scale for Parents and a demographical information form was used for research data collection and analyzed on SPSS 21.0 software.

Results:

A statistically significant difference was found between parents’ CSA awareness levels and age, gender, marital status, duration of marriage, education level, and number of children. The results showed that parents who were married for up to 10 years had a university degree, had only 1 child, and had higher awareness of sexual abuse myths. Contrary to expectations, no significant results were obtained regarding the signs of sexual abuse scores of groups with high awareness of myths of sexual abuse.

Implications for Research and Practice:

Contrary to the literature, the awareness levels of fathers about CSA are lower than the awareness levels of mothers, and the awareness levels of parents decrease as they get older. There is a need for further comprehensive and more scientific studies to identify the CSA problem in North Cyprus and propose solutions, and consequently prevention programs should be developed for professional groups that are related with child and parents.

Prevalence and determinants of sexual abuse among adolescent girls during the COVID-19 lockdown and school closures in Ghana: A mixed method study

BACKGROUND

In the wake of the COVID-19 pandemic, concerns have been raised that the pandemic may derail global efforts against child sexual abuse (CSA).

OBJECTIVES

This study examines the prevalence and associated factors of sexual abuse among adolescent girls in the context of the COVID-19 pandemic in Ghana.

PARTICIPANTS AND SETTING

The sample comprised 853 adolescent girls aged 13-19 (16.03 ± 2.04 years) in Ghana.

METHODS

The study employed a concurrent mixed-method design.

RESULTS

Overall, the prevalence of CSA during the COVID-19 lockdown and school closures was 32.5 %. Protective factors for CSA were feeling safe in neighbourhood (AOR = 0.526, 95 % CI = [0.325, 0.850]) and parents often listen to opinions (AOR = 0.446, 95 % CI = [0.241, 0.826]). Risk factors for CSA were physical activity (AOR = 1.649, OR = 1.783, 95 % CI_AOR = [1.093, 2.487, 95 % CI_OR = [1.241, 2.561]), parents sometimes listen to opinions (AOR = 1.199, OR = 1.924, 95 % CI_AOR = [0.504, 2.853], 95 % CI_OR = [1.034, 3.582]), living with another relative (AOR = 2.352, OR = 2.484, 95 % CI_AOR = [0.270, 20.523], 95 % CI_OR = [0.317, 19.475]), Akan ethnicity (AOR = 1.576, OR = 1.437, 95 % CI_AOR = [0.307, 8.091], 95 % CI_OR = [0.316, 6.534]), having no disability (AOR = 1.099, OR = 1.138, 95 % CI_AOR = [0.679, 1.581], 95 % CI_OR = [0.786, 1.649]) and having a close relationship with parents (AOR = 1.334, OR = 1.752, 95 % CI_AOR = [0.746, 2.385], 95 % CI_OR = [1.096, 2.802]).

CONCLUSION

Knowledge of the risk and protective factors identified in this study can guide and inform the development of CSA prevention programmes during disruptive occurrences like school closures and lockdown.

What Messages Are Communicated to Children in Maltreatment Prevention Programs? Conclusions of a Scoping Review

There is a worldwide consensus that the prevention of child maltreatment (CM) is critical in promoting children's safety. Furthermore, a significant part of the prevention efforts targets the children themselves. This scoping review aimed to map the characteristics of CM prevention programs that targeted children by examining studies that described the relevant implemented programs, published in peer-reviewed journals over the last decade. Thirty-one relevant manuscripts were identified from the online databases. The analysis, guided by scoping review guidelines, examined these programs in terms of content, context of delivery, and practitioners involved. A thematic analysis identified the key messages conveyed to the children. The findings showed that the vast majority of programs are school-based and focused on preventing child sexual abuse (CSA) with considerably less attention given to other forms of maltreatment. In addition, most programs did not promote active parental participation. The content descriptions of the CSA prevention programs revealed several common key messages that focused on children's individual safety skills, specifically recognition, refusal strategies, and disclosure. The discussion addresses the concepts of blame and guilt as crucial to rethinking the CM prevention messages conveyed to children. Key conclusions that were drawn from the current scoping review highlight the need to better align prevention efforts and recent CM research. Additionally, ceiling effects in several studies indicated that children's participation, as information sources and partners in program development, should be promoted, so that prevention efforts will meet their needs within their various relevant life contexts.

Child Sexual Abuse Prevention: Parental Discussion, Protective Practices and Attitudes

Understanding parental practices and attitudes regarding child sexual abuse (CSA) prevention could be used to improve CSA prevention, but little information is available. In this study, we summarise survey data collected from 248 Australian and UK parents (87% female) with at least one child aged 6-11 years (M = 8.6, SD = 1.8). This is the first study to quantify parental use of protective practices, other than prevention education, which may guard against CSA. Parental media mediation, which may safeguard against online dangers, was another unique focus of this study. Participants reported their discussion of sensitive topics with their children including CSA; behaviors that may reduce the incidence of CSA (e.g., monitoring, supervision, delegation of care and checking-in with the child); mediation of their child's media use; and attitudes towards CSA prevention education. Parents reported discussing sexual abuse less than other sensitive topics such as abduction dangers, drugs, and death but more than issues surrounding puberty, sex and pornography. Parents reported using high levels of protective behaviours, however some areas of concern were revealed. Of concern was the low-moderate level of parental media mediation, with substantial numbers of children potentially exposed to online risks such as using devices unsupervised in bedrooms or chatting to individuals unknown to their parents and not having their devices checked for concerning content. Almost all parents were supportive of CSA prevention education and felt they should provide this education. However, two-thirds of parents thought CSA education may be associated with harms for the child and two-thirds of parents believed children could prevent their own abuse. Reported results will aid in our understanding of which areas of parenting could be strengthened to create safer environments for children. This research has particularly highlighted the need for parents to be more protective around their children's access to online devices.

Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis

Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of $43 per student, an average classroom cost of $859, an average district cost of $10,637, and an average site cost of $154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = $34; upper-bound per-student cost = $64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.

Moving school-based CSA prevention education online: Advantages and challenges of the "new normal"

One of the many outcomes of the COVID-19 pandemic was a shift in the delivery of elementary (primary) education. Schools transitioned swiftly to e-learning and prioritized education that was already or could be easily adapted to virtual formats. Given the paucity of online content available, it is not likely that child sexual abuse (CSA) prevention education was prioritized. Given that CSA prevention education has demonstrated success in increasing knowledge, protective behaviors, and disclosures, and the potential long-term need for e-learning options, there is a demand for an exploration of how CSA prevention can be implemented using e-learning strategies. In the current discussion, we explore how school-based CSA prevention education could be implemented in a "new normal" context of e-learning. We first present the existing e-learning content for CSA prevention education. We then describe how best practices for prevention education can be applied to e-learning. Finally, we present considerations for the use of e-learning specifically for CSA prevention education. In short, implementing CSA prevention programs through e-learning offers many affordances for program accessibility and reach, flexibility in implementation and opportunities for greater exposure to content, and a wide range of ways to demonstrate effective skills and engage children in cycles of practice and feedback. E-learning, may also, however, limit important conversations between children and trained instructors that lead to disclosures. The extant literature leaves us unsure as to whether implementing CSA prevention programs through e-learning will result in better or worse outcomes for children. However, given the increasing demand for e-learning options, and the promise of some new e-learning programs, further research on the effectiveness of e-learning CSA prevention programs is warranted.

Using intergenerational photovoice to understand family strengths among Native American children and their caregivers

The purpose of the current study was to examine Native American children and caregivers' perspectives of family and cultural strengths using photovoice and to identify lessons learned from the first-ever implementation of intergenerational photovoice with Native Americans. Participants were Native American, low-income caregivers (n = 6) and their children (n = 12) between the ages of 10 and 15 who participated in six photovoice sessions. The themes that emerged from photos and group discussion included myriad challenges faced by Native American families including exposure to community violence, substance abuse, and criminal offending and incarceration. Themes also emerged that highlighted the strengths of Native families that were used to overcome identified challenges, including religion/spirituality, engagement in traditional cultural practices (e.g., prayer, song, dance), healthy activities (e.g., running, meditation). These data provided foundational information that is currently being used, along with other data, to develop a culturally grounded, strengths-focused, family-based program (Tiwahe Wicagwicayapi [Strengthening/Growing Families in Lakota]) to prevent adverse childhood experiences. We also discuss the challenges of intergenerational photovoice and lessons learned to inform future intergenerational photovoice projects.

Child sexual abuse prevention involving mothers: A Quasi-experimental study with Protection Motivation Theory-based intervention

Child sexual abuse (CSA) is a worldwide problem. The safety of children is everybody's responsibility. Parental and family involvement is crucial in the CSA prevention process. Parental lack of knowledge may increase the risk of abuse among children. Educating parents is crucial as children are mostly dependent on them. The role of mothers in educating children on CSA is of relevance as they are identified as more sensitive and responsible caregivers. The present study aimed to promote knowledge and attitude towards CSA prevention among mothers through a psychoeducation program. A pre- and posttest design (n = 67) was used with an intervention based on Protection Motivation Theory (PMT). A CSA knowledge and attitude scale was developed for the assessment of the participants for the study. There were significant changes in knowledge and attitude among the participants after the intervention. The prevention of CSA will be effective with knowledge gains after the PMT-based intervention. The intervention programs that involve mothers in CSA education have benefits. The findings of this study can be helpful to incorporate public health approaches to devise evidence-based parental programs in community settings.

Effectiveness of school-based child sexual abuse intervention among school children in the new millennium era: Systematic review and meta-analyses

Introduction

School-based child sexual abuse intervention programs were developed to educate the school children to protect them from sexual abuse. The programs were evaluated to make sure the interventions were effective in reducing child sexual abuse cases (CSA). This review aimed to determine the effectiveness of the school-based child sexual abuse intervention programs in the new millennium era (2000-2021) in improving the knowledge, skills, and attitude of school children under 18 years old toward child sexual abuse.

Methods

A systematic search was conducted through MEDLINE (PubMed), EBSCO, and SCOPUS databases to collect full English articles related to school-based CSA intervention programs published from 2000 to 2021.

Results

A total of 29 studies from randomized control trial and quasi-experimental from several countries was analyzed. Comparisons within group of pre-post intervention for knowledge, skills, and attitude were measured by standardized mean difference (SMD) and 95% CI of -1.06 (95% CI: -1.29, -0.84), -0.91 (95% CI: -1.2, -0.61), and -0.51 (95% CI: -3.61, 0.58), respectively. Meanwhile for between intervention and control group comparisons, the SMD of knowledge was 0.9 (95% CI: 0.63, 1.18), skills was 0.39 (95% CI: 0.07, 0.71), and attitude was 1.76 (95% CI: 0.46, 3.07).

Conclusion

The programs were found to be effective in improving the knowledge, skills, and attitude of the students from pre-intervention to post-intervention and between the intervention and control groups.Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022312383, identifier: CRD42022312383.

Recall of sexual abuse prevention education at school and home: Associations with sexual abuse experience, disclosure, protective parenting, and knowledge

BACKGROUND

Child sexual abuse (CSA) prevention is dominated by a focus on child education. However, evidence that this education reduces CSA risk is limited and mixed.

OBJECTIVE

We investigated whether participants' history of receiving school-based child sexual abuse prevention (CSAPP) was associated with experiencing CSA. Uniquely, we also investigated whether parent-led CSA education (PLSAE) and received protective parenting were associated with CSA. CSA knowledge was also considered.

METHODS

Australian university students (N = 1265, M_age = 22.8, SD = 7.7, Mo_age = 18, Md_age = 20, 75% female) reported their history of CSAPP and PLSAE, experience of CSA, disclosure of CSA, parenting, and CSA knowledge.

RESULTS

CSAPP attendance was reported by 29% of respondents, 72% reported PLSAE, and 24% reported CSA. PLSAE was significantly associated with lower risk of CSA, but was CSAPP attendance was not. PLSAE was significantly associated with higher levels of parental involvement/care and monitoring/supervision. In a multivariate logistic regression model, involvement/care and monitoring/supervision were associated with lower risk of CSA, but PLSAE was not. Neither CSAPP attendance nor PLSAE was associated with CSA disclosure or CSA knowledge.

CONCLUSIONS

These findings add to the small body of literature using reports of real-life experiences. Results call into question the over-reliance of child-education in CSA prevention and highlight the role of protective parenting. Building parenting capacity to include parenting practices is most likely to be effective for CSA prevention, such as monitoring and involvement, and should be included in CSA prevention efforts.

Exploring parental understanding of child sexual abuse and prevention as a measure for HIV prevention in Rwampara district

Background

Worldwide, more than 95 million children are sexually abused each year with children in sub-Saharan Africa experiencing sexual assault at higher rates than those in more developed areas. In Uganda, 20% of young people indicated that their sexual debut was non-consensual. The risk for transmission of HIV to children through Child Sexual Abuse is high because of greater mucosal tissue damage and the often repetitive nature of abuse. This contributes significantly to the burden of HIV in Uganda. Despite these risks, studies have shown gaps in active parental involvement in child sexual abuse prevention despite their being the primary protectors of children. Against this background we sought to explore parental understanding of childhood sexual abuse and prevention as a measure for HIV prevention in Rwampara District, South Western Uganda.

Methods

A phenomenological study was carried out in four health centers that serve the communities of Rwampara district. A total of 25 (n = 25) parents or guardians of children aged 9–14 years were purposively selected to participate in the study. The participants were subjected to in-depth semi-structured interviews which were recorded, transcribed, and translated for thematic analysis.

Results

Parents’ understanding of child sexual abuse was limited to penetrative sex between a man and a child. Three of the parents interviewed reported to have had children who had been sexually abused while one of the parents had been abused when she was young. The children reported to have been abused were female and were between 3-14years. We also identified gaps in the sensitization of parents regarding home-based prevention of child sexual abuse and psychological support for the victims of abuse.

Conclusion

Our study shows that child sexual abuse exists in rural western Uganda. There remains a significant gap in the awareness of parents regarding the extent of sexual abuse, signs of sexual abuse, case handling, and psychological support for victims of sexual abuse. This significantly affects the capacity of parents as the primary protectors of children to identify and protect the children against the multiple forms of child sexual abuse.

Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial

This study tested whether a child sexual abuse (CSA) prevention program, Smart Parents-Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. In a cluster randomized trial, six community-based organizations were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). CSA-related awareness and protective behaviors, as well as general parenting behaviors taught by PAT were assessed at baseline, post-PAT, post-SPSHK, and 1-month follow-up. Multilevel analyses revealed significant group by time interactions for both awareness and behaviors (ps < .0001), indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Results indicate adding SPHSK to existing parent training can significantly enhance parents' awareness of and readiness to engage in protective behavioral strategies. Implementing SPHSK as a selective prevention strategy with at-risk parents receiving parent training through child welfare infrastructures is discussed.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

Knowledge and Awareness Level of Parents Regarding Preschool Children's Privacy According to Demographic Characteristics

Although the concept of privacy is as old as human history, it has attracted attention as a social need in recent years. An important issue regarding child protection is privacy. This research was carried out to determine the awareness and knowledge of children's parents on awareness of child privacy right. A total of 107 students' parents, registered in preschool, consisted of the sample of the study. This research was descriptive research. To determine the relationships between categorical variables, chi-square analysis was used as the statistical methods of the research. Total of 29% of parents stated that they always asked permission from their children to enter their room, 80.4% never took off their children's clothes nearby someone else, 83.2% never preferred clothes older than their children's age, 69.2% never showed affection for child's private parts, 54.2% they never loved their children by battering him/her (biting, squeezing, etc.). It was found that parents with boys preferred more clothes older than their age for their children compared to parents with girls, and the rate of waiting in the toilet with their children decreased as the age of their children increased. It was determined that as the education level of the mothers of the children increased, they entered the children's room with permission. It was observed that as the education level of fathers increased, they preferred clothes older than their age significantly less for their children and working mothers did not wait in the toilet with their children. Parents' awareness of privacy can contribute to their awareness of abuse. Overall, this study provided evidence that parents' awareness of privacy may have universal characteristics as well as aspects specific to sociocultural context.

"I Have to Watch Them Closely": Native American Parenting Practice and Philosophies

One of many ways that Native American (NA) families demonstrate resilience is by parenting children in some of the most adverse contexts in U.S. society. We use the framework of historical oppression, resilience, and transcendence (FHORT) in a critical ethnography to qualitatively explore the parenting philosophies and practices that NAs use to protect children from the risks of an oppressive context. Data were drawn from 436 members of two Southeastern NA tribes. A team-based critical ethnographic data analysis approach was used to analyze these findings, revealing the following themes: (a) "Your Kids Come First": Prioritizing Children's Needs; (b) "They Should Enjoy their Childhood": Sheltering Children from Family Stressors; (c) "I Have to Watch Them Closely": Closely Monitoring Children; and, (d) "There's No Drinking at My House": Preventing Children's Exposure to Substance Abuse. Results indicate that NA parents adopt child-centric mindsets and use a number of positive practices to protect their children from the potentially harmful environments created through historical oppression.

Longitudinal associations between childhood sexual abuse-related PTSD symptoms and passive and active suicidal ideation among sexual minority men

BACKGROUND

Sexual minority men report high rates of childhood sexual abuse (CSA) and adulthood suicidality. However, mechanisms (e.g., PTSD symptoms) through which CSA might drive suicidality remain unknown.

OBJECTIVE

In a prospective cohort of sexual minority men, we examined: (1) associations between CSA and suicidal thoughts and behaviors; (2) prospective associations between CSA-related PTSD symptoms and suicidal ideation; and (3) interpersonal moderators of these associations.

PARTICIPANTS AND SETTING

Participants included 6305 sexual minority men (M_age = 33.2, SD = 11.5; 82.0% gay; 53.5% White) who completed baseline and one-year follow-up at-home online surveys.

METHODS

Bivariate analyses were used to assess baseline demographic and suicidality differences between CSA-exposed participants and non-CSA-exposed participants. Among CSA-exposed participants, multivariable logistic regression analyses were used to regress passive and active suicidal ideation at one-year follow-up on CSA-related PTSD symptoms at baseline. Interactions were examined between CSA-related PTSD symptoms and interpersonal difficulties.

RESULTS

CSA-exposed sexual minority men reported two-and-a-half times the odds of suicide attempt history compared to non-CSA-exposed men (95% CI = 2.15-2.88; p < 0.001). Among CSA-exposed sexual minority men, CSA-related PTSD symptoms were prospectively associated with passive suicidal ideation (adjusted odds ratio [aOR] = 1.38; 95% CI = 1.19; 1.61). Regardless of CSA-related PTSD symptom severity, those with lower social support and greater loneliness were at elevated risk of active suicidal ideation at one-year follow-up.

CONCLUSIONS

CSA-related PTSD symptom severity represents a psychological mechanism contributing to CSA-exposed sexual minority men's elevated suicide risk, particularly among those who lack social support and report loneliness.

Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study

Background

Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers.

Objective

This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention.

Methods

 HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game.

Results

Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities.

Conclusions

The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.

The problematization of child sexual abuse in policy and law: The Indonesian example

BACKGROUND

Indonesia has a strong national child protection policy. Yet significant limitations exist in laws, policy implementation, and coordination of services, especially regarding child sexual abuse. This is related to a lack of knowledge about child sexual abuse in Indonesia and associated taboos that constrain policy development.

OBJECTIVE

To understand how child sexual abuse problems have been represented in national child protection policy.

METHOD

'What's the problem represented to be' (Bacchi, 2009) is an analytic approach that uses discourse analysis. This method was employed to examine how child sexual abuse problems in Indonesia are constructed and represented in six government documents (two laws and four national policies).

RESULTS

Three overarching problem representations of child sexual abuse were identified: (1) children are a vulnerable, at risk, and disempowered group; (2) service access is limited and services are not coordinated; and (3) there is a lack of agreement and clarity across laws and policy in child protection. For example, inconsistencies of policy and laws regarding the minimum age for marriage can result in gender discrimination and limit a child's access to justice, protection, and services.

CONCLUSION

Policy discourses play a crucial role in the construction and representation of child sexual abuse problems in Indonesia. Current inconsistencies constrain the implementation of effective intervention and prevention programs. Further work on policy harmony is needed as well as improving community understanding of child sexual abuse.

Zero Tolerance of Children’s Sexual Abuse from Interreligious Dialogue

Child sexual abuse is a social problem that concerns our societies. The sustainable development goals have highlighted the eradication of child sexual abuse as one of the highest-priority goals of this century. Breaking the silence within religious communities is an essential step going forward. Therefore, establishing a dialogue between people of different religions is crucial to achieving this goal. The purpose of this article is to explore whether there are current interreligious dialogue initiatives based on scientific recommendations to prevent child sexual abuse. The method used herein is a qualitative document analysis of the selected initiatives. The results indicate that interreligious dialogue initiatives include scientific recommendations in their prevention programs. Furthermore, these successful initiatives connect religious values and the need to support victims and to break their silence. Based on these results, it can be concluded that interreligious initiatives for child sexual abuse prevention programs based on scientific evidence are crucial in order to eradicate child sexual abuse.

Child sexual abuse knowledge/attitude scale for parents: Reliability and validity of the Turkish version

PURPOSE

The aim of this study was to determine the validity and reliability of the Turkish version of the child sexual abuse knowledge/attitude scale for parents (CSAKAS).

DESIGN AND METHODS

This methodological study was carried out with 193 parents in between February and May 2018.

FINDINGS

The validity and reliability of the six-factors structure scale were confirmed. The Cronbach's alpha coefficient of the whole scale is 0.793, the item-total score correlations ranged between 0.341 and 0.719 and the test-retest coefficient was 0.841.

PRACTICE IMPLICATIONS

The CSAKAS Turkish scale was found to be a valid and reliable tool that can be used to evaluate the knowledge and attitudes of parents about child sexual abuse.

Evaluation of a School-Based Child Physical and Sexual Abuse Prevention Program

BACKGROUND

Evidence-based child sexual and physical abuse prevention programs delivered in schools are needed and require rigorous evaluation of program effects prior to widespread dissemination. The Play it Safe! program is a one-time session delivered by trained facilitators to teach students about recognizing, resisting, and reporting abuse.

AIMS

To evaluate a school-based child sexual and physical abuse prevention intervention Play it Safe! among elementary school students using a cluster randomized design.

METHOD

Six elementary schools in Texas were matched on demographic characteristics, and then randomized to intervention or wait-list control groups. Participants included third to fifth graders (n = 539). Participants received the pretest assessing vignette-based knowledge of physical and sexual abuse prevention (14 items). The intervention group immediately had the program. One month later, both groups received a posttest using the same validated scale. Multilevel linear regression analyses were estimated, and interaction effects were used to evaluate the effect of Play it Safe! while controlling for other factors.

RESULTS

A statistically significant interaction between the treatment group and time (b = 1.30, p < .01) indicated a greater increase in the knowledge score over time in the intervention group. Moderating effect of grade was also observed as the intervention tended to have less effect for fifth grade compared with third grade (b = -1.04, p = .01).

CONCLUSION

This study provides evidence to support the efficacy of the Play it Safe! program for increasing children's physical and sexual abuse prevention knowledge and skills among a racially and ethnically diverse sample of elementary school students.

Childhood Trauma Linked to Adult Waterpipe Smoking: A Survey of Health Science Students in Iran

Background

Explaining the risk and protective factors of waterpipe tobacco smoking (WTS) is the most important principle in designing preventive interventions. This study examined the relationship between self-reported childhood abuse and WTS among health science students in Iran.

Methods

This cross-sectional study was conducted among 776 health science students in Kerman City, located in southeast of Iran, who were selected by quota sampling approach. The study was performed using two valid short instruments for measuring WTS and child abuse including physical, emotional, and sexual abuse using a self-report method.

Findings

The prevalence of ever use and current use (last 30 days) of WTS among participants was 49.6% and 33.4%, respectively. The initiation age of WTS in 60% of students was < 18 years. Child sexual abuse (CSA) was [odds ratio (OR) = 3.05, 95% confidence interval (CI): 2.06-4.52, P < 0.001] the main predictor for WTS among students.

Conclusion

Protecting children during childhood to prevent them from becoming victims may be an essential primordial preventive strategy for WTS.

Parents as Teachers: Mothers' Roles in Sexual Abuse Prevention Education in Gorgan, Iran

BACKGROUND

Parents play an important role in protecting their children from sexual abuse. Mothers, in particular, play key roles in the sexual socialization of their children and in educating their children about child sexual abuse (CSA).

OBJECTIVES

The purpose of this study was to determine whether preschool girls in Gorgan (a city in northern Iran) could learn personal safety skills when taught by their mothers.

PARTICIPANTS AND SETTING

Fifty-six participants (mother-daughter pairs) were recruited from patients visiting health centers. Mean age of girls was 6.34 years.

METHODS

Girls were pretested using Persian versions of the Personal Safety Questionnaire and 'What If' Situations Test, randomly assigned to either a mother-taught program or wait-list control, and post-tested. Mothers assigned to the education group participated in a two-hour workshop on preventing CSA and were given the Body Safety Training workbook to teach their daughters. Following the one-week training by their mothers, children in both groups were post-tested and follow-up tested one month later.

RESULTS

Children taught by their mothers demonstrated significant increases in knowledge about sexual abuse and higher levels of personal safety skills compared to controls, and these gains were maintained at the one-month follow-up.

CONCLUSION

Results suggest that mothers can effectively teach their young daughters personal safety skills. Difficulties female children have in recognizing appropriate-touch requests are discussed and compared to results in other developing countries. Advantages of home-based instruction for young children are described and suggestions for increasing parent participation are offered.

Educating children through their parents to prevent child sexual abuse in Turkey

PURPOSE

The aims of this study were to train parents to recognize and prevent child sexual abuse (CSA); evaluate the problems encountered by parents; and evaluate the overall effectiveness of the CSA training program.

DESIGN AND METHODS

The study used a pretest/posttest design. The study was conducted with a sample of 58 children (aged 3-6 years) and 64 parents.

FINDINGS

Children who received CSA prevention education from their parents demonstrated improved knowledge about private parts and about what they should do if they suspect sexual abuse. The parents stated that they encountered some problems (other family members objected to the child being given such training).

PRACTISE IMPLICATIONS

Children's risk of abuse may be reduced if their parents teach them about CSA correctly.

Sexual Abuse Prevention Education for Preschool-Aged Children: Parents' Attitudes, Knowledge and Practices in Beijing, China

The purpose of this study was to investigate Chinese parents' attitudes, knowledge, and practices with their preschool-aged children on sexual abuse prevention education, and to explore the associated factors of parental educative practices on child sexual abuse (CSA) prevention. Four hundred and forty parents of young children from 16 classes in 3 preschools in Beijing completed the questionnaire anonymously and voluntarily (response rate = 80%). Less than one third of parents believed that children most often were sexually abused by familiar persons, and less than 30% of parents believed that if a child has been sexually abused, there will usually be no obvious physical evidence. Parents were reluctant to discuss CSA protective skills with their young children. Less than half of the parents had told their children that if sexual abuse happens, parents or other trusted adults should be told. The multivariate linear regression equation showed that both parents' knowledge (B = 0.11, SE B = 0.05, p = 0 .03) and attitudes (B = 0.27, SE B = 0.10, p = .01) were significant factors for parents' communication about CSA prevention with their children. Findings from this study suggest that it is urgent to implement the sexual abuse prevention education with Chinese parents of preschoolers. Applications and limitations of these findings are discussed.

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.

Overcrowded housing: One of a constellation of vulnerabilities for child sexual abuse

BACKGROUND

Effective prevention of child abuse depends on an understanding of factors associated with the abuse. Increased risk of child sexual abuse has been associated with parental substance use and adverse socio-economic factors such as living in poverty and parental unemployment. This study investigated overcrowding as a potential socio-economic risk factor in child sexual abuse taking into account other socio-economic, child and parental factors.

METHOD

This study used de-identified linked data from health and child protection data collections for the cohort of children born in Western Australia from 1990 to 2009 (n = 524,478). Cox regression was used to estimate adjusted and unadjusted hazard ratios and 95% confidence intervals for time to first sexual abuse allegation and first substantiated allegation, relative to the level of overcrowding and controlling for other risk factors.

RESULTS

Higher levels of household overcrowding were associated with a 23%-46% increase in the risk of child sexual abuse allegations. Only the highest level of overcrowding was associated with a 40% increased risk of substantiated sexual abuse.

CONCLUSION

The findings suggest that overcrowded living conditions are associated with an increased risk of sexual abuse for some children. This factor needs to be considered alongside other risk factors when assessing and improving child safety.

A Parent-focused Child Sexual Abuse Prevention Program: Development, Acceptability, and Feasibility

OBJECTIVES

Child sexual abuse (CSA) affects nearly 60,000 children in the U.S. annually. Although prevention efforts targeting adults in the community and school-aged children have been somewhat successful, there is a clear gap in the current prevention efforts: parents. Generalized parent-education (PE) programs have effectively reduced the rates of physical abuse and neglect; however, currently no PE program targets risk factors for CSA specifically. We sought to develop a brief module to be added onto existing PE programs thereby leveraging the skills and implementation infrastructure to ensure sustainability.

METHODS

In three phases, we developed the curriculum, refined content and presentation while simultaneously developing and psychometrically evaluating a measurement tool, and conducted an acceptability and feasibility pilot. These phases are described in detail such that intervention scientists wishing to develop a module to be added onto existing programs can follow our procedures.

RESULTS

The results of each phase are described so that the reader can see how information gleaned in one part of a phase informed subsequent phases of research. This was an iterative process of development, refinement, and piloting.

CONCLUSIONS

The resultant module is designed to be added onto extant evidence-based PE programs. The module, and the additive approach of the intervention, will be evaluated in a future randomized controlled trial.

Commercial Sexual Exploitation of Children: An Update for the Forensic Nurse

Commercial sexual exploitation of children (CSEC) is the sexual abuse of children through buying, selling, or trading their sexual services. This may involve engaging a child under the age of 18 years in prostitution, pornography, stripping, exotic dancing, escort services, or other sexual services. CSEC is a problem of epidemic proportions throughout the world including the United States; however, the actual number of CSEC victims in the United States is unknown. Studies indicate that most child victims are seen by a healthcare provider while being trafficked and that many victims receive care at a pediatric hospital within 1 year of their identification as a victim. CSEC is a significant pediatric healthcare problem. It is vital that forensic nurses possess a thorough understanding of the problem and be poised to better identify, intervene, and prevent CSEC. In this article, we focus on risk factors commonly experienced by victims, recruitment strategies used by traffickers, indicators to identify child victims, and intervention and educational strategies of relevance to forensic nurses.

Outcomes of In Situ Training for Disclosure as a Standalone and a Booster to a Child Protective Behaviors Education Program

In this study, the effectiveness of the Observed Protective Behaviors behaviors test, a single-session, disclosure-focused, in situ skills training (IST), was evaluated as a standalone program (IST only) or as a booster to the child protective education program, Learn to be safe with Emmy and friends ^™ (program + IST). Participants included 281 Year 1 children (5-7 years; 52% male), randomly assigned to IST only, program + IST, program only or waitlist, and followed across 6 months. At each assessment, children completed interviews to assess their intention and confidence to disclose unsafe situations (disclosure intentions and confidence) and their ability to identify unsafe situations (safety identification skills). Children also reported their anxiety symptoms to assess for a possible iatrogenic effect. The IST-only condition was effective, with children showing increased disclosure intentions relative to waitlist children. The program + IST condition was also effective, with children showing increased disclosure intentions relative to children in the waitlist or program-only conditions as well as greater increases in disclosure confidence relative to waitlist children. No differences were observed between conditions in children's safety identification skills, and no iatrogenic effect on anxiety was found. Future research may seek to develop an IST that will also boost children's safety identification skills.

Parents as protectors: A qualitative study of parents' views on child sexual abuse prevention

Although parents are essential to child sexual abuse (CSA) prevention efforts, their views on prevention and protection are not always represented in the research literature. In this qualitative study of 24 Australian parents, beliefs about CSA, its risk factors, prevention methods, and parents' role in CSA protection, and parents' approaches to protection of their own children, are examined. Findings were condensed into five themes: (a) parents' understanding of child sexual abuse, grooming and risk; (b) parent-led CSA education; (c) parents' beliefs about CSA education; (d) children recognizing and resisting CSA; and (e) parent responsibility for protection. Findings suggest that parents have a good knowledge of CSA and its risks. However, they do not provide their children with the comprehensive prevention messages recommended by prevention campaigns and many concentrate on abduction dangers. This gap between knowledge and parental communication with children could be due to parents' beliefs that there may be harms associated with education of children about CSA (e.g., such as inciting new fears and worries or reducing trust in others) and that the method may not be effective in protecting children from CSA. This study adds to the existing literature by presenting information that could be useful in designing programs to include parents in CSA protection and by approaching CSA research with parents as the key agents in the protection of children.

Parental Discussion of Child Sexual Abuse: Is It Associated with the Parenting Practices of Involvement, Monitoring, and General Communication?

We investigated whether parents who reported more positive parenting practices (i.e., monitoring, involvement, and communication) reported more discussion of child sexual abuse (CSA) with their children. Parents from Australia and the UK (N = 248), with children aged 6 to 11 years, completed an online survey. About half of parents reported directly discussing CSA, whereas 35% reported telling their children that CSA perpetrators may be family members. Rates of discussion were higher for other CSA-related topics such as body integrity and abduction. Correlational analyses showed that parents who reported speaking to their children about CSA also reported more positive parenting practices, more discussion of other sensitive topics, and assessed CSA risk for children (in general) to be higher. Discussion of CSA risk was not associated with parents' CSA knowledge, confidence or appraisal of own-child risk. Parents higher in positive parenting believed their children to be at less CSA risk. Parents who appraised higher own-child risk reported less positive parenting practices and were less confident about their parenting and their ability to protect their children from CSA. The findings are the first to report on the associations of parenting practices with parents' CSA discussion with their children.