Child Sexual Abuse: Toward a Conceptual Model and Definition

Maximizing the reach of universal child sexual abuse prevention: Protocol for an equivalence trial

Background

Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities.

Methods

The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3).

Conclusion

Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools.

Clinical trial registration

NCT06195852.

Timing and chronicity of child maltreatment in Germany: results from a representative sample

OBJECTIVES

Child maltreatment (CM) is a major risk factor across the lifespan. While research on CM and its consequences has risen strongly during the last decades, research is mainly focused on the prevalence of types of CM incidents. As valid prevalence rates on timing and chronicity of CM are lacking to date, we aimed to assess the timing of experienced CM by describing the age of onset, duration, and prevalence at each year of age for each CM subtype in a population-based sample.

STUDY DESIGN

Cross-sectional, observational study in a representative sample.

METHODS

Using different sampling steps including a random route procedure, a probability sample of the German population above the age of 16, encompassing 2514 persons (50.6% female, mean age: 50.08 years) was generated. Participants were asked about sociodemographic information in a face-to-face interview, CM was assessed using the ICAST-R questionnaire.

RESULTS

The earliest mean age of onset was seen in neglect with 8.07 (±3.07) years for boys and 7.90 (±2.96) years for girls, while the mean age of onset for sexual abuse was in adolescence with 13.65 (±3.86) years for boys and 13.91(±3.17) years for girls. The overall duration of CM was lowest for sexual abuse with 2.12 (±2.01) years for boys and 2.35 (±1.73) years for girls, the highest duration was seen for emotional abuse with 4.00 (±3.54) years for boys and 4.21 (±3.77) years for girls.

CONCLUSIONS

Our novel results provide important epidemiological information for prevention efforts.

Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People

There is a growing body of evidence that adolescents, and other children, are responsible for a significant proportion of sexual abuse against children. However, there are substantial differences in how this phenomenon is defined and conceptualized between and within sectors. This scoping review explored the current definitions of harmful sexual behaviors (HSB), and other similar terms, used across a range of stakeholder groups. In all, 141 papers were reviewed from both empirical and gray literature sources, including key policy and practice documents. Included papers needed to list a clear definition for the behavior of interest. There was disagreement and inconsistency across the included papers in their conceptualization of harmful, abusive, or problematic sexual behavior (PSB) in children and adolescents. Although the term HSB has been adopted as an umbrella term or continuum in many policy, practice, and research settings, there is a large variance in behaviors, treatment needs, etiology, and harms present across different types of sexual behavior. Relying solely on one term to describe a wide range of sexual behaviors in children and young people may limit the understanding of this issue and imply similarities between groups that are not present. We suggest that clearly defined subsets of HSB, such as sexual abuse, technology-assisted HSB, and PSB, may give more context to the behavior of concern and may be helpful in informing further research, prevention, and best practice approaches.

Association of Childhood Sexual Abuse with Adolescent's Psychopathology: A Systematic Review and Meta-Analysis

Childhood Sexual Abuse (CSA) poses a significant risk to mental health, especially among adolescents. This systematic review and meta-analysis investigates the association between CSA and adolescent psychopathology. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted an extensive search across multiple databases, including PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest, resulting in 27,207 observational studies. From this pool, 87 studies (n: 189,393) were included in the qualitative synthesis and 78 studies were included in meta-analysis, discussing CSA and adolescent's psychopathology Random effect model with Cohen's d values were used to analyze data. To assess publication bias, funnel plots, Egger's regression test, and the fill and trim method were employed, with no significant bias found. The results indicated a positive correlation between CSA and adolescent psychopathology, for example, depression, anxiety, PTSD, suicidal ideation, nonsuicidal self-injury, anger, substance use, and sexrelated behaviors (Pooled association: 0.13-0.25, 95% CI [0.04, 0.28]). Subgroup analysis showed the strongest association in clinical samples. Furthermore, the moderator analysis suggested minimal influence of study-level variables, as well as men showing higher levels of anger and suicidal ideation. The positive correlation between CSA and psychopathological outcomes highlights the detrimental effects of CSA on adolescents' mental health. To mitigate these effects, increased awareness, prevention efforts, and targeted interventions are essential.

"I remember most of my family seeing it": The presence of others during child physical abuse, as conveyed in forensic interviews with Israeli children

Child physical abuse is often perceived as a crime perpetrated within the family and out of sight. However, recent studies have indicated the presence of others during incidents of physical abuse. The current study was designed to examine the experiences and perceptions of children who were physically abused in their families concerning the presence of others, as conveyed during their forensic interviews. A thematic analysis of 26 forensic interviews was conducted with Israeli children aged 5-13. Three main themes were identified: (1) Patterns, roles, and coping mechanisms: The multifaceted spectrum of familial abuse; (2) The echoes of family reactions: Shaping children's abuse experiences; and (3) Navigating the storm together: Sibling bonds amidst familial abuse. The children's narratives highlighted their distress and pointed to the abusive and chaotic daily routine in which they lived. In spotlighting their encounters with physical abuse, the children focused on their need to be seen and gain certainty in their daily routines. The discussion highlights the unique and elusive dynamics of families in which child physical abuse occurs and challenges the social perception that physical abuse occurs secretly. The characteristics of such abuse highlight the urgent need for policymakers and professionals to treat the phenomenon of physical abuse within the family as a visible phenomenon.

Five Forms of Coerced "Self-Produced" Child Sexual Exploitation Material: A Critical Interpretive Synthesis

This review explored how the phenomenon of coerced "self-produced" child sexual exploitation material (CSEM) has been constructed in the literature using Critical Interpretative Synthesis. Selected keywords were systematically searched on relevant databases. Types of papers included were: peer-reviewed research articles; conceptual papers; commentary papers; theses; book chapters; systematic reviews; and government reports. Papers published in English between January 2005 and November 2022 were included. The initial search revealed 1,021 papers, after two reviewers applied the inclusion and exclusion criteria, 38 papers were selected for the final sample. Findings indicated five forms of coerced "self-produced" CSEM: Solicitation; Peer Sexting; Viral Challenge; Sextortion; and Financial Coercion. The forms are described and critically analyzed through an "Accountability Lens." This Lens was developed to be victim-centered including identifying the coercive actions of the person responsible for the exploitation. The review found an absence of a consistent victim-centered approach to how the phenomena of coerced "self-produced" CSEM is understood that would ensure children are not held responsible for being exploited.

Examination of parents' sensitivity levels to violence against children during the COVID-19: A post-pandemic evaluation

PURPOSE

This study aimed to evaluate parents' thoughts, and sensitivity levels about violence against children during the COVID-19 period after the pandemic.

DESIGN AND METHODS

The population of this descriptive, cross-sectional, correlational, and multicenter study consisted of parents registered in six family health centers in a city in southern Turkey. Study data were collected between April and November 2023 using information forms that included questions about parents' personal information, and their thoughts about violence against children during the pandemic and the Sensitivity to Violence Against Children Scale and analyzed.

RESULTS

According to 42.3% of parents, children's exposure to violence increased during the pandemic; 64.7% stated that children experienced emotional violence the most. Parents who thought that there was a decrease in the reports of violence due to school closures, social distancing, and restriction of children's access to health, and social and legal services had higher SVACS mean scores than those who did not think so (p < 0.01).

CONCLUSIONS

Most of the parents thought that children's exposure to violence increased and reports of violence decreased during the pandemic. In addition, parents' thoughts toward violence against children during the pandemic period were associated with their level of sensitivity to violence against children.

IMPLICATIONS FOR PRACTICE

During the pandemic period, it is important that pediatric nurses, who are in direct contact with children, are in contact with parents and take an active role in the process in the prevention, early detection and reporting of violence against children.

Coping strategies and psychological resilience of parents with children victimized of sexual abuse: A cross-sectional descriptive study

AIM

The aim of this study is to assess the coping strategies and psychological resilience of parents of children who are victims of sexual abuse.

METHODS

The study's sample was compiled from parents of sexually abused children admitted to the Child Advocacy Centre for forensic interviews in a Northern Turkish province (N = 75). Data were collected from May to September 2022. A cross-sectional design was used to assess psychological resilience and coping skills. The Introductory Information Questionnaire, the Strategies for Coping with Family Stressors Scale, and the Psychological Resilience Scale for Adults were administered verbally during individual interviews. The study was approved by the institutional ethics committee.

RESULTS

According to the results, the psychological resilience and coping skills of parents played a significant role, particularly concerning touch-based abuse, a single occurrence of abuse, and the absence of family violence. Moreover, there was a positive correlation between coping skills with stressors and psychological resilience (p < 0.05).

CONCLUSION

In conclusion, empowering parents of children exposed to abuse proves crucial for reducing the traumatic impact on the victimized child. Further research, identifying risk factors for both the child and the family, and strategizing follow-up, educational, and counseling initiatives can enhance the provision of holistic health services in this context.

IMPLICATIONS TO PRACTICE

This study emphasizes the need to restructure issues of not only trauma in children who are victims of sexual abuse but also coping skills and psychological resilience in parents within nursing approaches aimed at children who are victims of sexual abuse.

The prevalence of child sexual abuse perpetrated by leaders or other adults in religious organizations in Australia

BACKGROUND

Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce.

OBJECTIVE

To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia.

METHODS

The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS).

RESULTS

One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3-0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5-1.2 %), compared to women (0.1 %, 95 % CI, 0-0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3-0.6 %), compared to women (0 %, 95 % CI, 0-0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16-24-year-old men).

CONCLUSIONS

Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.

Feelings expressed by professionals caring for children and teenagers victims of sexual violence

OBJECTIVE

to describe the feelings expressed by health professionals when caring for child and adolescent victims of sexual violence from the theoretical perspective of Symbolic Interactionism.

METHOD

qualitative research carried out with 30 female health professionals. An instrument was used consisting of closed questions for sociodemographic data and a script with open questions for interviews. The data was organized and analyzed using Nvivo software version 12, according to Bardin's proposal, from the perspective of Symbolic Interactionism in the work of Charles Morris. The project was approved by the Research Ethics Committee.

RESULTS

five thematic categories emerged, revealing feelings of empathy, fear, indignation, suffering, and consternation. These feelings remained in the interviewees' memories, making caring for child and adolescent victims of sexual violence a moving and difficult experience that deeply marks the life of the health professional.

CONCLUSION

there is a need to adopt strategies to support the mental health of professionals who work in services that provide general care to children and adolescents, considering that there is a possibility that they will provide care to child and adolescent victims of sexual violence in compliance with pre-existing public policies.

HIGHLIGHTS

(1) Feelings stem from individual impressions in line with social interaction. (2) Caring for child and adolescent victims has a negative impact on professionals' emotions. (3) Service managers need to pay attention to the health of professionals who assist victims.

When Is Online Sexual Solicitation of a Minor Considered Sexual Abuse? Recommendations for Victim Prevalence Surveys

Many new surveys have been developed to assess the prevalence of online sexual abuse. An important type of question asked in many of these surveys is about online sexual solicitation. However, not all sexual solicitations of children necessarily qualify as sexual abuse as it has conventionally been defined. Sexual solicitations from other same age youth may be legal and nonabusive. Solicitations of youth above the age of consent by adults may also be legal. At the same time, many true online sex offenses may not be identified with questions about solicitation wanted or unwanted. This article reviewed 25 online sexual abuse survey reports. It also examined episodes and narratives from the U.S. National Technology Facilitated Abuse (TFA) survey, which asked about online solicitation and other online sexual offenses. Among the surveys reviewed, 9 of 25 elicited and counted online sexual solicitation from adults only, but the rest counted other youth solicitors as well as adults. Eight of 25 asked about only "unwanted" solicitations, but the rest had no such qualification, possibly including solicitations with positive or neutral reactions. Analysis of the TFA survey showed that in over half of solicitation episodes, the recipients did not actually know the age or identity of the solicitor. Very large differences in prevalence rates can occur depending on what types of solicitation are counted and how missing information is classified. Recommendations are made about classifying and reporting on findings about online solicitation.

Online sexual abuse of children with disabilities: Analyzing reports of social workers' case files in Israel

BACKGROUND

Online child sexual abuse (OCSA) is a growing social concern. However, its manifestations among children with disabilities (CWDs), who face an increased risk of sexual abuse, remain largely unexamined.

OBJECTIVE

This study aims to fill this gap by examining professionals' perspectives of the OCSA of CWDs through their work at the 105 Hotline, an Israeli national call center that accepts queries and reports of the cyber victimization of minors.

METHODS

A mixed methods research design was employed. A quantitative analysis was performed on 114 case files involving the OCSA of CWDs, followed by a thematic content analysis of 23 follow-up files by social workers.

RESULTS

The quantitative findings revealed various characteristics of the survivors, their families, and OCSA. The qualitative analysis revealed that professionals indicate multiple interrelated risk factors for the OCSA of CWDs on three levels: child, related to the child's characteristics and disability traits; family, referring to familial complexities, parenting challenges, and socio-economic position; and relational, referring to the online abusive relationships between the perpetrator and the survivor. Furthermore, the online platform comprised characteristics that enhanced the risk of OCSA of CWDs.

CONCLUSIONS

The understanding that the OCSA of CWDs as a compounded risk that encompasses personal and environmental risk dimensions is necessary and should guide all professionals' decisions and actions. There is also an urgent need for governmental and community efforts to develop measures, policies, and support systems to reduce OCSA risks for CWDs. Moreover, knowledge and interventions should be developed for professionals and parents of CWDs to improve the identification and response to this overlooked phenomenon.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BACKGROUND

Childhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA.

OBJECTIVE

To analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI).

PARTICIPANTS AND SETTING

Data from the Global Burden of Disease 2019 Public Database.

METHODS

Summary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant.

RESULTS

In 2019, 1.63 million (95 % UI 0.23-3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78-47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87-47.77], 2019: 23.61 [95 % UI 3.55-54.94]).

CONCLUSIONS

Substantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.

Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis

Introduction

Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions.

Methods

In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated.

Results

The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse.

Discussion

These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.

Childhood sexual abuse and cholesterol risk: Testing body mass index as a mediator across gender in a national sample of adults

BACKGROUND

Childhood sexual abuse (CSA) is associated with health problems, including cardiometabolic outcomes. Findings directly linking CSA to cholesterol levels are mixed, and identifying mediating pathways is the next logical step. Body mass index (BMI) is one possible mediator, given its association with both CSA and cardiometabolic outcomes. Gendered effects of CSA indicates that BMI may operate differently in men and women.

OBJECTIVE

We tested BMI as a mediator linking CSA to high-density lipoprotein (HDL) and low-density lipoprotein (LDL) using a multiple group structural equation model stratified across gender to test the indirect effects.

PARTICIPANTS AND SETTING

We utilized a sample of 1054 adults (54.7 % women) from the study of Midlife Development in the United States, who were drawn from the general population.

METHODS

Using two waves of data, participants responded to a questionnaire assessing CSA, provided measurements from which to calculate BMI, and a fasting blood sample from which cholesterol levels were measured.

RESULTS

The indirect effects in the overall sample yielded a significant effect from CSA to HDL via BMI (β = -0.03, 95 % CI [-0.050, -0.010]), but not LDL (β = 0.006, 95 % CI [-0.002, 0.014]). The indirect effect from CSA to HDL cholesterol was significant among women (β = -0.04, 95 % CI [-0.066, -0.012]) only. Indirect effects to LDL among both genders were both non-significant.

CONCLUSIONS

BMI appears to be a possible mediator linking CSA to lower HDL cholesterol among women suggesting BMI could be a point of trauma-informed prevention and intervention especially impactful.

Child and Adolescent Exposure to Sexual Harassment: Relationship to Gender, Contact Sexual Abuse, and Adult Psychological Symptoms

In contrast to adults, there is considerably less research on childhood or adolescent exposure to sexual harassment (CAESH), its lasting psychological correlates, and whether such experiences should be included in definitions of childhood sexual abuse. The current study examined the prevalence and symptomatic sequels of unwanted flirting, being "checked out" sexually, unwanted sexual attention, sexual comments, propositions, and related noncontact behaviors that occurred before age 18, as well as the multivariate relationship between CAESH and contact child sexual abuse (C-CSA) in a diverse online sample of 528 individuals. CAESH was very common, with over 95% of women and 64% of men reporting at least one experience of noncontact sexual harassment before age 18. When childhood sexual abuse was operationalized as the presence of either C-CSA or a total CAESH score of 18 or higher (corresponding to an average score of "3-5 times" prior to age 18), the prevalence was 67% for women and 26% for men, more than three times higher than C-CSA alone. This expanded definition was associated with significantly more anxiety, depression, and posttraumatic stress relative to C-CSA alone. These results suggest that CAESH is a significant source of symptoms in adults and support the emerging perspective that childhood sexual abuse may be best understood as including both contact and noncontact events.

Prevention and Intervention Strategies for the Sexual Abuse and Commercial Sexual Exploitation of Children Who Run Away from Foster Care: A Scoping Review

Literature on human trafficking suggests the vulnerability to commercial sexual exploitation of children (CSEC) and child sexual abuse (CSA) changes by the prevalence of certain risk factors (e.g., runaway), trafficker-used lures (e.g., isolation), and the environmental conditions present at the time of victimization (e.g., foster care). Often, youth in foster care are at high risk for CSEC and CSA victimization associated with runaway instances. This scoping review aims to identify prevention and intervention strategies for CSEC/CSA of youth who run away from foster care. PRISMA scoping review guidelines were followed to review the literature across two search parameters (CSEC; CSA). An electronic review was conducted between August 2022 and January 2023 across four databases: PubMed, SAGE Journals Online, ScienceDirect, and Web of Science. The CSEC and CSA search parameters comprised three domains (sexual exploitation, foster care, and runaway; sexual abuse, foster care, and runaway, respectively). Literature published between 2012 and 2022 was included regardless of the methodological approach. Literature not concerning youth who run from foster care was excluded. Database searches yielded 206 publications for CSEC and 351 for CSA, reduced to 185 and 212, respectively, after removing duplicates. Seventy-one articles were identified, of which, 64 articles (28 CSEC, 36 CSA) were categorized as prevention strategies and seven (five CSEC, two CSA) as interventions. The intersection and dual victimization of CSEC and CSA of youth who run away from foster care are discussed. This paper also discusses applied behavior analysis principles for developing function-based interventions.

Differences Between Girls and Boys in the Disclosure of Sexual Violence

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

Prevention of child sexual abuse in the United States: Scoping review of United States legislative policies

BACKGROUND

States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA.

OBJECTIVE

Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies.

METHODS

The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed.

RESULTS

2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics.

CONCLUSIONS

Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended.

The shame of sexual violence towards women in rural areas

This perspective paper presents a discussion around the issues of sexual violence (SV) in rural and remote areas and the associated discourses of shame. The authors propose that shame of SV adds additional trauma to survivors, further impacting survivors' mental health which may be exacerbated in rural areas. Shame is a complex emotion that can result in increased feelings of guilt, humiliation, and embarrassment. Shame has been identified as an underlying risk factor and a mechanism for post-assault mental health problems. We propose it can be particularly pronounced for women subjected to sexual assault in rural or remote areas. This paper will explore the link between SV and shame, explain how shame attached to SV may be used as an informal social control mechanism for women, particularly in rural and remote areas, and discuss the role of health practitioners, particularly mental health nurses, who play a key role in supporting people impacted by SV. SV is an insidious social phenomenon that can have profound consequences for individuals, families, and communities. Addressing shame and stigma is a crucial component of supporting survivors of SV in rural and remote areas. There is a need for targeted community-led interventions and responsive support services to address the complex and multifaceted issues contributing to SV in rural and remote communities.

Ecological approach to the characteristics and determinants of sexual violence against adolescents in Perú

Introduction. Sexual violence against adolescents is a global problem that affects young people around the world. The ecological model examines its forms and determinants through interconnected levels. Objective. To determine the frequency, characteristics, and predictors of sexual violence in adolescents attending school in Perú. Materials and methods. This was a cross-sectional study that secondarily analyzed data from the Encuesta Nacional de Relaciones Sociales (2019). A stratified probabilistic sample involved 1,579 youth aged 12-17 from 93 schools. The questionnaire evaluated physical, psychological, and sexual violence in the family and at school. Models were estimated using logistic regression analysis, calculating odds ratio (OR). Results. Eighteen point sixty eight per cent (95% CI: 16.80-20.60) suffered some type of sexual assault. In addition, 9.75% (95% CI: 8.28-11.21) reported having been touched in some part of the body and 1.84% (95% CI: 1.17-2.50) reported that was a victim of rape. Age was identified as a risk factor in the microsystem (OR = 1.48) (95% CI: 1.26-1.74), while the age of the first experienced sexual violence acted as a protective factor (OR = 0.61) (95% CI: 0.54-0.69). In addition, in the macrosystem, the perception that violence occurs mainly outside the home increased the risk (OR = 2.06) (95% CI: 1.01-4.19). Conclusions. Approximately two out of ten respondents reported having experienced some type of sexual violence, with verbal harassment and invasive personal contact being the most common. No single level or factor can fully explain adolescent sexual violence without considering its ecological interconnectedness.

An empirical analysis of sibling sexual abuse: Examining offender, victim, and event characteristics in National Incident-Based Reporting System (NIBRS) data, 2018-2022

BACKGROUND

Sibling sexual abuse (SSA) is a pervasive form of intrafamilial sexual violence. A review of existing literature underscores ongoing challenges to comprehensive understanding of this offense due to definitional inconsistencies, small sample sizes, data constraints, methodological shortcomings including reporting practices, and a dearth of empirical scrutiny. Previous studies have relied on retrospective, non-representative, clinical, or homogeneous samples.

OBJECTIVE

The present work updates knowledge on SSA addressing several persistent limitations in previous studies and offering contemporary victim, offender, and incident-based profiles to promote avenues for future risk assessment, prevention, and intervention strategies.

METHODS

This study, both exploratory and descriptive, draws on the five most recent years (2018-2022) of data from the National Incident-Based Reporting System (NIBRS), the largest available dataset (N = 30,640), containing SSA incidents reported to law enforcement.

RESULTS

Significant sex differences were noted across age, race, victim injury, offense type, and relationship. Female victims were more likely to experience abuse from older siblings and were nearly 2.5 times more likely to be victimized as an adult than their male counterparts. Female victims were also more likely to report injury, yet less likely than male victims to experience forcible penetration during an SSA incident.

CONCLUSIONS

Findings substantiate the ongoing need for continued refinement of SSA definitional criteria, which, in turn, will lead to greater identification and reporting of incidents. Moreover, findings here underscore the importance of considering age and gender dynamics to guide risk assessment, intervention, and prevention strategies.

"Today, I Say It's Mine!": Professional Identity Construction among Jewish and Arab School Counselors Coping with CSA Disclosure in Israel

School counselors play a crucial role in preventing, disclosing, and intervening in child sexual abuse cases (CSA) and in maintaining safe and protected school environments. However, research on their experiences coping with CSA remains limited. The purpose of the present study was to describe and analyze the coping experiences of Israeli Jewish and Arab school counselors with CSA disclosure, particularly the consequences for their processes of professional identity construction (the ongoing process through which they develop and refine their sense of self in their profession). Semi-structured interviews were conducted with 21 Israeli Jewish and Arab school counselors working in elementary schools (grades 1-6) with significant experience in coping with CSA. Two themes surfaced, reflecting the counselors' professional identity construction: (1) Counselors' professional identity transformation following encounters with CSA among their students; (2) Integrating professional knowledge, attitudes, and engagement behaviors into professional identity. The findings describe a trajectory of transformation and professional development among the counselors, beginning with defining and refining their professional roles and followed by the integration of professional knowledge, attitudes, and behaviors into their professional routines. Arab counselors also highlighted specific sociocultural challenges within this process, relating to the gap between cultural values and role expectations. Implications for future research, policy, and practice are discussed.

"Pay Attention! Pay Attention! Pay Attention!!!": The Pivotal Role of Educators and the Educational System as Experienced by Survivors of Child Sexual Abuse

Educational institutions and educators are significant in children's lives, and they have a crucial role in implementing policies, practices, and sexual education to enhance children's safety. Such policies and practices should be based on the voices of CSA survivors. This study explored child sexual abuse (CSA) survivors' viewpoints on their past experiences with educators and the educational system. A qualitative thematic approach was used to analyze 61 written testimonies collected in 2020-2021 by the Israeli Independent Public Inquiry on CSA. Two interrelated themes arose: (1) CSA survivors' retrospective perspectives of educators and the educational system's responses to signs of their CSA, described as ranging from abusive to life-saving. Specifically, they shared three types of responses: (a) harmful and hurtful; (b) dismissive and ignoring; and (c) accepting and attending. (2) The second theme described the survivors' messages to educators to promote constructive change. The survivors conveyed expectations that educators should play a central role in CSA prevention, detection, and intervention and, specifically, the need for educators to receive professional training, provide beneficial sexual education, and identify and respond to CSA. The findings promoted moving beyond individual-level interventions to focus on improving educational institutional and organizational cultures related to CSA in both national and international contexts.

Unveiling the shadows: Parental perceptions and familial impact of daycare abuse of preschool children

BACKGROUND

Preschoolers are at an increased risk of experiencing abuse, especially from caregivers. Early child abuse has adverse continuances on children's short and long-term development. The majority of previous studies were conducted in the 1990s in the United States, focusing primarily on sexual abuse. Despite the recently increasing public awareness of daycare abuse (DA), empirical studies on this topic have not yet been conducted in Israel.

OBJECTIVE

The current study was designed to examine parents' perceptions regarding the DA of their preschool children.

METHOD

The data were collected through semi-structured, in-depth interviews with 14 parents of children who underwent DA. Qualitative analysis was performed on the narratives of the participants.

FINDINGS

Three main themes were identified: 1) parental shock, 2) community echoes, and 3) ripples of trauma. The study revealed the dramatic consequences of DA on children and their families. The families dealt with the consequences of the traumatic DA event, which destabilized almost every part of their lives. The study found that parents felt alone and without assistance from the authorities while facing the consequences of the DA.

CONCLUSIONS

In examining the parents' perspectives, the current study's findings presented essential empirical knowledge regarding the DA phenomenon and encouraged future studies in this area. This study has the potential to serve as a basis for the creation of professional training programs.

'A kindergarten teacher must have 100 eyes and 100 ears!': Kindergarten teachers' experiences coping with child sexual abuse and problematic sexual behavior

BACKGROUND

Child sexual abuse (CSA) and problematic sexual behavior (PSB) are worldwide phenomena that occur across all ages. Kindergarten teachers' proactive involvement can be crucial to the prevention, disclosure and intervention of CSA and PSB. However, research on their experiences of contending with CSA and PSB remains limited.

OBJECTIVE

This study examines kindergarten teachers' experiences in Israel with the CSA and PSB of their students.

PARTICIPANTS AND SETTING

Semi-structured interviews were conducted with 31 teachers: 11 secular Jewish, seven religious Jewish, nine Druze Arab, and four Muslim Arab.

METHODS

A qualitative analysis was conducted using the interview transcripts as data.

RESULTS

The analysis revealed three themes illustrating teachers' professional transformations regarding their knowledge of these phenomena: 1) initial shock, uncertainty and sense of responsibility when exposed to CSA and PSB due to missing knowledge, 2) implementation of prevention and intervention strategies regarding CSA and PSB, and 3) embracing a social role to disseminate CSA and PSB knowledge. The findings indicated that the majority of the teachers went from overwhelming shock and fear due to a lack of knowledge in coping with CSA and PSB to a sense of responsibility as a community leader.

CONCLUSIONS

The fragmentation of the Israeli education system isolates kindergartens, and the lack of training and education for the teachers left them alone when contending with the CSA and PSB of their students. Nevertheless, the participants exhibited remarkable agency and resourcefulness, gaining the necessary knowledge and acting as knowledge agents within their communities.

Factors differentiating risk of sexual abuse victimization by adults and peers among adolescents

BACKGROUND

Research suggests that around half of all cases of sexual abuse among children and adolescents are perpetrated by peers. Yet, there is limited understanding of the distinct risk factors associated with adult versus peer offenders.

OBJECTIVE

To identify factors that increase the risk of sexual abuse victimization and explores variations in these factors depending on whether the perpetrator was an adult or a peer.

PARTICIPANTS AND SETTING

9240 secondary school students aged between 12 and 16 years (M = 14, SD = 0.88) in Norway participated.

METHODS

An electronic questionnaire was administered in schools to investigate experiences of sexual abuse and potential risk factors. The data were analyzed using multiple logistic regression analyses.

RESULTS

Two factors were related to a greater risk of being a victim of sexual abuse committed by an adult than a peer: background from a non-European country (OR = 1.93, p = 0.038) and other experiences of violence (OR = 1.63-2.91, p < 0.005). The use of alcohol was found to be related to a greater risk of victimization by peers than by adults (OR = 0.53, p = 0.031).

CONCLUSIONS

Adolescents vulnerable to sexual abuse exhibit common traits, regardless of whether the perpetrator is an adult or peer. Yet, specific factors heighten the risk with peers over adults, and vice versa. Recognizing distinct risk factors for abuse by adults and peers enables decision-makers and community workers to create targeted prevention strategies for children and adolescents.

Child sexual abuse and social identity loss: A qualitative analysis of survivors' public accounts

Emerging evidence suggests that social identities are an important determinant of adaptation following traumatic life experiences. In this paper, we analyse accounts of people who experienced child sexual abuse. Using publicly available talk of people who waived their right to anonymity following successful conviction of perpetrators, we conducted a thematic analysis focusing on trauma-related changes in their social identities. Analysis of these accounts highlighted two themes. The first highlights the acquisition in these accounts of unwanted and damaging identity labels. The second presents child sexual abuse as a key destructive force in terms of important identity work during childhood. Discussion of this analysis centres on the pathological consequences of social identity change. Both the loss of valued identities and the acquisition of aberrant and isolating identities are experienced and constructed as devastating by those affected by child sexual abuse. This has important implications, not only for those impacted by child sexual abuse but for how abuse is discussed in society, and how it is approached by policy makers, educators and individuals working with survivors and their families.

The Prevalence of Peer Sexual Harassment During Childhood in Australia

Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life.

Exploring Categories of Family Violence Across the Lifespan: A Scoping Review

Family violence may be experienced at any stage of the lifespan; however, these experiences are often understood differently based on the age of the victim and who perpetrates the abuse. The significance of age is evident in the three categories of child abuse, domestic and family violence (DFV), and elder abuse. Each of these categories has its own definition which determines who is considered a victim or a perpetrator, and the behaviors counted as violent and abusive. These definitions influence how practitioners view victim-survivors' experiences of violence, and the subsequent available responses. This article reports the findings of a scoping review of international literature published between 2011 and 2021, which explored how family violence is categorized and defined. The review was conducted as part of a larger study exploring how violence against women in intimate and family contexts is conceptualized and experienced, as well as the available responses. Forty-eight articles were included in the final review, and five categories of violence in family and intimate contexts were identified. These were child abuse, DFV, elder abuse, adolescent-to-parent violence, and sibling abuse. Comparison of definitions across categories found similarities in terms of the relationship between victim and perpetrator, behavior, intention, and harm caused to the victim. Review findings suggest that definitions of various forms of family violence do not differ greatly. Further research is needed to determine whether responses to family violence across the lifespan can and should be streamlined.

What Enables Child Sexual Abuse in Sport? A Systematic Review

Sporting environments provide opportunities for perpetrators to commit child sexual abuse (CSA). While awareness of CSA in sport and preventative interventions are increasing, CSA in sport still occurs at alarming rates. A systematic review was conducted to identify and synthesize the extant literature on the enabling factors for CSA in sport. The 34 included articles were peer-reviewed and were primary sources; had full-text versions in English; included the individual, situational, environmental, or systemic antecedent factors and characteristics which enable CSA in organized sport (clubs, schools, universities, and representative teams); and focused on abuse in children (0-18 years old), and included retrospective incidents. The enabling factors from across the broader sports system were identified and mapped using a systems thinking-based approach, the Risk Management Framework (RMF) and the associated AcciMap method. The results indicated that enabling factors for CSA in sport were identified at multiple levels of the sporting system hierarchy. The results show that 24.1% (n = 46) of the enabling factors identified in the literature relate to the hierarchical level of the Athlete, teammates, opponents, and fans levels, and 52.9% (n = 101) of the enabling factors relate to the level of Direct supervisors, management, medical, and performance personnel level. However, only 13% (n = 25) of enabling factors to CSA in sport were identified at the combined top four hierarchical levels. Results indicate that the problem of CSA in sport is a systems issue, and future research is required to explore how these factors interact to enable CSA in sport.

Disclosure of sexual abuse by adolescents treated in a psychiatry department

OBJECTIVES

The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure.

METHODS

This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis.

RESULTS

Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%).

CONCLUSION

This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

"We Need to Raise Awareness and Never Give Up": Israeli Druze and Muslim Arab Kindergarten Teachers' Proactivity When Facing the Sexual Abuse of Their Students

Kindergarten teachers are expected to lead the intervention process in cases of child sexual abuse (CSA) in their kindergarten. This study examines the proactive role of Druze and Muslim Arab kindergarten teachers in addressing and coping with the CSA of their kindergarten students in Israel. A qualitative thematic analysis was used to investigate the semi-structured interviews conducted with eight Druze Arab and six Muslim Arab kindergarten teachers. Three distinct themes were revealed. The first theme described the participants' fear and concern for their personal children and themselves when dealing with CSA incidents involving their students. The second and third themes described their proactive coping on two fronts: (1) inside their homes to protect their own children and (2) as educators within religious communities, using professional and religious principles to support CSA survivors and raise awareness among parents. The results emphasized the personal burden on kindergarten teachers coping with CSA in their kindergarten and, as mainly expressed by Druze kindergarten teachers, the contribution of religious values to CSA intervention and prevention processes among their students and communities. Thus, there is a need for comprehensive support that considers ethnic and religious characteristics and will be available to kindergarten teachers facing CSA in their kindergarten.

Piloting an Alternative Implementation Modality for a School-Based Child Sexual Abuse Prevention Curriculum

BACKGROUND

In the U.S., the most pervasive child sexual abuse (CSA) prevention strategy involves school-based prevention programs; however, the reach of these programs is limited due to implementation constraints, such as budgets or turnover. This is notable as standard delivery of often requires two facilitators in the classroom. Leveraging a natural experiment in the implementation of Safe Touches, the current study sought to explore the feasibility of implementation with a single facilitator using pre-recorded videos compared to the standard in-person delivery.

METHODS

A six-item CSA-related knowledge questionnaire was delivered to (N = 1480) second-graders post-workshop. An independent-samples t-test was used to compare the mean of CSA-related knowledge item responses for each delivery modality. Student-level data were paired with teacher evaluations and an interview with the facilitator.

RESULTS

Across workshops delivered in 25 schools, there was no significant difference in knowledge based on CSA-related questions by workshop modality. Teachers indicated the facilitators responded effectively to the children's questions and comments in both delivery modalities. Input from the facilitator was positive.

CONCLUSIONS

Triangulation of student knowledge, teacher input, and facilitator experience indicates the viability and feasibility of this implementation strategy for Safe Touches, and potentially other school-based CSA prevention programs. To ensure equitable access to the CSA prevention program, the empirical examination of, and investment in, alternative implementation options for school-based CSA preventive programs is encouraged.

The Impact of Childhood Sexual Abuse on Adult Female Sexual Function and Sexual Distress: A Systematic Review and Meta- Analysis

OBJECTIVE

In this study, it was aimed to examine the impacts of exposure to childhood sexual abuse (CSA) on women's sexual function and sexual distress.

METHOD

In this systematic review and meta-analysis study, eight international (EBSCO, Psyc-Info, Proquest, PubMed, Science Direct, Scopus, Ovid, Web of Science) and two national electronic databases (Dergipark and Thesis Database of the Turkish Council of Higher Education) were searched. Studies reporting outcomes of sexual function and sexual distress in women with and without a history of CSA were included. The data were synthesized by meta-analysis and narrative methods.

RESULTS

Two dissertations and five research articles published between 2010 and 2021 were included in the study. In some studies that were not included in the meta-analysis, it was reported that there was no difference in the prevalence of sexual dysfunction, and sexual satisfaction in women with and without a history of CSA. Meta-analysis results demonstrated lower sexual function (sexual arousal, MD: -0.83, p<0.001; sexual desire, MD: -0.55, p<0.001; lubrication, MD: -0.78, p<0.01; pain, MD: -0.52, p<0.001) and more sexual distress (SMD: -0.79, p<0.05) in women with CSA history.

CONCLUSION

This study showed that CSA negatively affects female sexual function and increases sexual distress. Healthcare professionals should be aware that women with a CSA history may have worse sexual functions and more sexual distress. More research is needed on the role of CSA in the etiology of sexual function problems and its possible mechanisms of action.

Factors associated with delayed disclosure of child sexual abuse: A focus on the victim's having been led to perform sexual acts on the perpetrator

BACKGROUND

Contextual variables associated with children's willingness to disclose sexual abuse have been identified in previous studies, but further investigation is needed to better understand delayed disclosure of child sexual abuse (CSA).

OBJECTIVES

This study aimed to examine the factors associated with the risk of delayed disclosure of CSA. More specifically, it focused on a factor that has rarely, if ever, been looked into: the fact that some victims are led to perform sexual acts on the perpetrator.

PARTICIPANTS AND SETTING

A content analysis was performed on 68 transcripts of investigative interviews with CSA victims aged 4 to 12 years old.

METHODS

Based on our content analysis, the time between the first abuse and the first disclosure was determined for each victim. The age and gender of the victim, the victim's relationship with the perpetrator, the age of the perpetrator, the frequency and severity of the abuse, and whether or not the victim mentioned having performed sexual acts on the perpetrator were also coded.

RESULTS

Chi-square analyses showed that the risk of delayed disclosure was associated with the victim's having performed, or not performed, sexual acts on the perpetrator (χ2 = 16.327, p < 0.001), the victim's relationship with the perpetrator (χ2 = 10.013, p = 0.002), and the frequency of the abuse (χ2 = 11.617, p < 0.001).

CONCLUSION

Our study is the first to demonstrate that having been led to sexually touch the perpetrator is associated with delayed disclosure of CSA.

Child sexual abuse by different classes and types of perpetrator: Prevalence and trends from an Australian national survey

BACKGROUND

Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents).

OBJECTIVE

To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group.

PARTICIPANTS AND SETTING

The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over.

METHODS

We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group.

RESULTS

Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends.

CONCLUSIONS

CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised.

Attachment and mentalization among survivors of sexual abuse: A questionnaire survey

Knowledge of the long-term consequences of child sexual abuse (CSA) is crucial to further develop preventive strategies and treatment programs. The aim of this study is to investigate attachment and mentalizing ability in people who have experienced CSA. Attachment style, measured with the Experiences in Close Relationships-Relationship Structures Questionnaire (ECR-RS), and mentalization, measured with the Reflective Functioning Questionnaire (RFQ), were examined through a quantitative questionnaire survey in a sample of 49 individuals who had experienced CSA, and a control group of 612 with no history of CSA. The CSA group was, to a greater extent, identified with insecure attachment style. In addition, participants with insecure attachment were more likely to use hypomentalizing compared to individuals identified with a secure attachment. No significant association was found between attachment style and the relationship between the victim and the offender or the length of traumatic episodes.

Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis

BACKGROUND

Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time.

OBJECTIVE

To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK.

PARTICIPANTS AND SETTING

The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review.

METHODS

Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model.

RESULTS

The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]).

CONCLUSION

National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden.

"I have a special prayer 'O Lord, open my lips'": Experiences of ultra-Orthodox educators after their students' disclosures of sexual abuse

BACKGROUND

Child sexual abuse (CSA) is a large-scale, worldwide phenomenon. However, research on educators' experiences with CSA in specific social, cultural or religious contexts is limited.

OBJECTIVE

The current study is part of a larger qualitative research project examining Israeli educators' coping with CSA of their students in diverse cultural contexts. This study focused on Jewish ultra-Orthodox educators' perceptions and experiences of CSA disclosure and its impact on their professional and personal lives. Their perceptions of belonging to the ultra-Orthodox community were also explored.

METHODS

Interviews were conducted with 28 ultra-Orthodox educators and analyzed using a thematic approach.

RESULTS

The ultra-Orthodox educators perceived their roles on a continuum, from not being responsible to being fully responsible. They perceived the abused children as having negative behavior or as victims who deserved protection. Their personal lives were deeply affected, impacted by fear, disassociation or devotion to the mission of caring for these children. Finally, educators perceived the ultra-Orthodox community as fragile regarding CSA disclosure and emphasized the importance of encouraging culturally adaptive ways to conceptualize and address CSA.

CONCLUSIONS

This study highlights the importance of ultra-Orthodox educators in identifying CSA and leading interventions. It also raises the need for training to combine reflective, cultural-based practice and support for the educator to maintain their wellbeing. Despite this community's uniqueness, the current findings may be relevant to professionals and policymakers regarding other closed and religious communities and diverse educational settings confronting CSA.

Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study

BACKGROUND

Child sexual abuse (CSA) is a type of maltreatment considered a global health problem. CSA is a traumatic experience with important consequences for the victim's health. It is essential to report the effectiveness of CSA prevention programs to offer society useful tools to combat this abuse.

OBJECTIVE

We aimed to study the effectiveness of CSA prevention programs on the knowledge acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is related to program-related and methodological variables.

PARTICIPANTS AND SETTINGS

Standardised mean change (with studies that report pre-post program measures) of the effectiveness of CSA prevention programs published between 2014 and 2021 was carried out.

METHODS

The general effectiveness of these programs and whether the results were influenced by program-related variables (the duration, the target population, participants' age, or the type of intervention) or by methodology-related factors (the agent who taught them, the geographical area where they were carried out or the way the programs were evaluated) were analysed. A total of 43 samples analysing knowledge about CSA as a dependent variable were included.

RESULTS

The results reported a combined effect size considered large (dMR = -0.96, 95 % CI [-1.10, -0.82], p < .001). High inter-study heterogeneity was observed in the meta-analysis, although only the geographic area where the studies were conducted appears as a significant moderator.

CONCLUSIONS

In conclusion, the prevention programs included in this analysis significantly improved the participants' knowledge acquisition.

What do child maltreatment reports to Child Protective Services tell us about the needs families and communities are experiencing?

Intake reports from child protective service (CPS) agencies are the foundation for subsequent decisions and services within the child welfare system. They provide valuable information for understanding children's needs, yet the unstructured way that information is captured makes the information ascertained in these reports difficult to summarize. Utilizing CPS intake reports from a mid-sized urban county in the southeastern United States (N = 2,724), our study had three aims: (1) develop a coding system to abstract information from narrative CPS intake reports, (2) examine the prevalence of maltreatment subtypes, and (3) compare prevalence of maltreatment subtypes by screen-in/screen-out decisions. Improper discipline/physical abuse was the most common maltreatment subtype (34.6 %); over 40 % of reports involved a physical act toward the child not resulting in injury. Salient risk factors included caregiver drug use (20.6 %) and domestic violence (19 %). While substantial discrepancies were not found between screened-in and screened-out cases with respect to maltreatment types, maltreatment type-specific codes, or contributory factors, they were found for reporter type and child age. Our coding system to extract and assess child maltreatment intake narrative data can provide local agencies with descriptive information about why children come to their agency's attention and provide nuanced details regarding the children's and families' needs. This coding framework could be used to develop validated intake tools to better document and categorize child maltreatment which could inform the assessment/investigation process and create targeted prevention and intervention services for families that come to the attention of CPS.

Treatment Issues While Addressing Child Sexual Abuse: A Review

Child sexual abuse is a traumatic life event that has social, psychological, political and cultural dimensions which is observed in many societies. Sexual abused children are at risk of developing behavioral, emotional, cognitive and physical health problems throughout their lives, and are especially vulnerable when their current condition is combined with other risk factors, such as poverty. In the relevant literature, it is reported that these children have a greater risk of having psychological problems and require treatment. There is evidence that psychotherapeutic treatments have beneficial effects, including ensuring the physical and emotional safety of victims, helping to relieve trauma symptoms, improving quality and functioning of life, and preventing recurrence of abuse. In this review, some of the most common treatment issues for sexual abused children are presented. The appropriateness of the treatment issues and proposed interventions addressed may vary for each victim. These treatment issues and interventions are designed not only to remedy any harm that may have occurred, but also to minimize the negative consequences of experiences of child abuse and prevent future recurrence of maltreatment.

Child sexual abuse images and youth produced images: The varieties of Image-based Sexual Exploitation and Abuse of Children

BACKGROUND AND OBJECTIVE

This paper presents a categorization of sexual image crimes and abuse that occur against children, and it compares their frequency, dynamics, and emotional impact.

PARTICIPANTS

A national sample of 2639 respondents aged 18-to-28 disclosed 369 childhood episodes involving a variety of image abuse.

METHODS

Online self-administered questionnaire.

RESULTS

The analysis classified the cases into five incident types: 1) adult made images (child sexual abuse images), 2) images non-consensually made by other youth, 3) voluntarily provided self-made images that were non-consensually shared by other youth, 4) voluntarily provided self-made images non-consensually shared by adults, and 5) voluntarily provided self-made images to adults that entailed an illegal age difference or were part of a commercial transaction. We propose to refer to this aggregation of types as Image Based Sexual Exploitation and Abuse of Children (IBSEAC). Only 12 % of the image episodes qualified as adult produced, child sexual abuse images. Such adult produced image experiences were also not higher in negative emotional impact than the youth produced images. Only 10 % of the episodes involved images of children under age 13.

CONCLUSION

The study highlights the predominance of youth made sexual images among the image exploitation and abuse affecting youth according to self-report. It also highlights the difference between what victim surveys reveal about the problem and what is inferred from police record studies.

Comparing female- to male-perpetrated child sexual abuse as presumed by survivors - A qualitative content analysis

BACKGROUND

Female-perpetrated child sexual abuse (CSA) is taboo topic in society and an under-recognized issue in research and mental health care.

OBJECTIVE

The aim of the present study was to examine perspectives of individuals surviving female-perpetrated CSA (in parts in addition with male-perpetrated CSA) on the question whether female-perpetrated CSA and its sequelae were considered different compared to male-perpetrated CSA.

PARTICIPANTS AND SETTING

The perspectives of 212 survivors of female-perpetrated CSA were captured in a cross-sectional online study.

METHODS

Answers to the questions "How does female-perpetrated CSA differ from male-perpetrated CSA?" and "How do consequences of female-perpetrated CSA differ from those of male-perpetrated CSA?" were analyzed using qualitative content analysis.

RESULTS

The analyses reveal ten categories of differences, such as a more subtle approach, different levels of violence, and more psychological manipulation. Further, the analyses suggest ten categories of different personal consequences, such as less belief and support, more psychological sequelae, and disturbed relationships with women.

CONCLUSIONS

Approaches to raise awareness about gender stereotypes in the context of CSA are needed and special needs of survivors of female-perpetrated CSA in psychotherapeutic treatment can be derived from the results of this study.

Assessment of Child Sexual Abuse in Victimized Women

Child sexual abuse (CSA) is a frequent phenomenon, and women who report it are at a higher risk of mental disorders and sexual dysfunction. The application of a brief questionnaire could help gynecologists assessment of CSA history in women. This study was carried out including women (n = 593) who had been victims of CSA before the age of 18 years. We used the Early Trauma Inventory Self Report-Short Form (ETISR-SF) Part 4, the Female Sexual Function Index (FSFI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and a semi-structured instrument to assess CSA. Among the 593 women included, 77 agreed to answer the questionnaires, 62(80.5%) had traumatic sexual events, 53(68.8%) had a total FSFI score ≤ 26.55, and 64(84.2%) considered themselves victims of CSA. There was an association regarding the belief that CSA influenced their sex life and their being at risk for GAD (p = 0.001), PTSD (p = 0.02), and sexual abuse by a family member (p = 0.01). The risk factors were the presence of risk for GAD (OR = 5.88[1.3-27.03]) and CSA by a family member (OR = 5.78[1.57-21.28]). This methodology can assist gynecologists in assessing a patient's history of CSA.

Associations between exposure to sexual abuse, substance use, adverse health outcomes, and use of youth health services among Norwegian adolescents

BACKGROUND

A strong association between sexual abuse and adverse health outcomes has been reported among adolescents. The present study aimed to provide more information about adverse health outcomes associated with sexual abuse and substance use, and to examine the use of youth health services among Norwegian adolescents.

METHODS

National representative cross-sectional study among 16-19-year-old Norwegian adolescents (n = 9784). Multivariable regression analyses, adjusted for socioeconomic status and age, were used to examine the association between exposure to sexual abuse, substance use and health risk factors, and the use of youth health services.

RESULTS

Adolescents exposed to sexual abuse had higher odds of depressive symptoms (males: OR:3.8; 95% CI:2.5-5.8, females: 2.9;2.4-3.5), daily headache (males: 5.3;2.8-10.1, females:1.9; 1.5-2.4), high medication use (males: 3.2;1.7-6.0, females: 2.0;1.6-2.6), self-harm (males: 3.8;2.4-6.0, females:3.2; 2.6-3.9), suicidal thoughts (males: 3.3; 2.2-5.0, females:3.0; 2.5-3.6) and suicide attempts (males: 9.5;5.6-16.0, females:3.6;2.7-4.9). Furthermore, exposure to sexual abuse was associated with higher odds of using school health services (males: 3.9;2.6-5.9, females: 1.6;1.3-1.9) and health services for youth (males: 4.8;3.1-7.6, females: 2.1;1.7-2.5). In general, substance use was associated with increased odds of adverse health related outcomes and use of youth health services, but the strength of the relationships varied according to sex. Finally, results indicated a significant interaction between sexual abuse and smoking that was associated with increased odds of having suicidal thoughts for males (2.6;1.1-6.5) but a decreased odds of having suicidal thoughts and have conducted suicide attempts once or more for females (0.6;0.4-1.0 and 0.5;0.3-0.9, respectively).

CONCLUSIONS

The present study confirmed a strong relationship between exposure to sexual abuse and health risks, especially among males. Moreover, males exposed to sexual abuse were much more likely to use youth health services compared to sexually abused females. Substance use was also associated with adverse health outcomes and use of youth health services, and interactions between sexual abuse and smoking seemed to influence risk of suicidal thoughts and attempts differently according to sex. Results from this study increase knowledge about possible health related effects of sexual abuse which should be used to identify victims and provide targeted treatment by youth health services.

Culturally Competent Interventions for Child Sexual Abuse: A Scoping Review of the Literature and the Implications for American Samoa

Significant stigma regarding child sexual abuse exists in American Samoa. Although cultural interventions may help prevent child sexual abuse, very little is known about such interventions. Therefore, through a scoping review process, this study aimed to gain a broad understanding of past and current culturally tailored interventions to prevent child sexual abuse. Because no studies examine interventions to prevent child sexual abuse in American Samoa specifically, the reviewed literature investigates interventions in different cultures. The literature search initially identified 180 relevant articles. After applying inclusion and exclusion criteria, nine studies met the eligibility criteria for review. Extracted data from these articles included the country or population, sample, study methods, children's age, intervention type, and details about the intervention. Results suggest that culturally tailored interventions for preventing child sexual abuse exist in various countries and cultural contexts. Results highlight that child sexual abuse prevention interventions are effective if translated into the native language. Findings from this study highlight the importance of using a culturally tailored approach to addressing child sexual abuse and can help guide the development of new interventions. Although more research on the prevention of child sexual abuse in American Samoa is needed, the results of this study might inform the development of culturally tailored interventions for the region.

Differential Profiles of Sexually Abused Adolescent Boys

Victims of child sexual abuse (CSA) are a heterogeneous population. Several characteristics may influence the outcomes associated with this adverse childhood experience, including personal (e.g. age) and CSA characteristics (e.g. relationship to the perpetrator). This study relied on a person-centered approach to account for this heterogeneity and focused on adolescent boys, an understudied population. Data were drawn from a representative sample of high school students aged 14 to 18 years old in Quebec, Canada. A total of 3.9% (n = 138) of boys reported CSA. Various CSA characteristics (severity, relationship to the perpetrator, and number of events) were used as indicators to derive classes. A four-class solution emerged from the latent class analysis: CSA in a sports context (6%), intrafamilial CSA (8%), extrafamilial CSA (52%) and multiple CSA (34%). The multiple CSA profile included boys who were sexually abused in multiple situations by different perpetrators and who were victims of acts involving penetration. The exploration of correlates associated with class membership revealed that adolescent boys included in the multiple CSA profile were distinguished by higher rates of delinquent behaviors and alcohol and drug use. They were more likely than members of other latent classes to belong to sexual minorities. This exploratory study sheds light on sexually victimized adolescent boys and the deleterious consequences that may affect them, particularly boys who have experienced multiple CSA events. We conclude that prevention efforts should focus on the demystification of sexual trauma among boys and on using trauma-informed care approaches for adolescent externalizing behaviors.