Healing from childhood sexual abuse: a theoretical model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Gender matters: constructing a model of adolescent sexual health

This article illustrates the construction of a new model of adolescent sexual health, one that addresses the complex relationships between gender and adolescent sexuality. A review of sexual health models highlights the absence of gender; in contrast, research illuminates the significance of gender. This article describes the process of building a model of sexual health explicitly for girls, guided by feminist research on adolescent girls' sexuality and a "web of theories". It also describes the unanticipated challenges of making a companion model for boys and the ensuing shift from a gender-specific approach to an integrated gendered model of adolescent sexual health. Gender complementarity is defined and forwarded as a way to incorporate gender into a model of adolescent sexual health.     

Family influences on adolescent sexual and contraceptive behavior

Studies of adolescent pregnancy risk are relevant to understanding responsible adolescent sexual behavior because most investigators have focused on the key proximal determinants of pregnancy--sexual intercourse and contraceptive use--rather than analyzing pregnancy status per se. Lesser pregnancy risk is associated with teens remaining sexually abstinent, postponing onset of intercourse, and having intercourse less often or with fewer partners, as well as by using contraception at first or most recent intercourse and by using contraception consistently over time. Living with a single parent, in a lower SES family, having older sexually active siblings or pregnant/parenting teenage sisters, being a victim of sexual abuse, and residing in disorganized/dangerous neighborhoods all place teens at elevated risk of adolescent pregnancy. Parent-child closeness or connectedness, and parental supervision or regulation of children, in combination with parents values against teen intercourse (or unprotected intercourse), decrease the risk of adolescent pregnancy. Studies about parent-child sexual communication and adolescent pregnancy risk are less conclusive, largely because of methodological complexities.     

The impact of schools and school programs upon adolescent sexual behavior

Because most youth are enrolled in school for many years before they initiate sex and when they initiate sex, schools have the potential for reducing adolescent sexual risk-taking. This paper reviews studies which examine the impact upon sexual risk-taking of school involvement, school characteristics, specific programs in school that do not address sexual behavior, and specific programs that do address sexual risk-taking. Multiple studies support several conclusions. First, involvement in and attachment to school and plans to attend higher education are all related to less sexual risk-taking and lower pregnancy rates. Second, students in schools with manifestations of poverty and disorganization are more likely to become pregnant. Third, some school programs specifically designed to increase attachment to school or reduce school dropout effectively delayed sex or reduced pregnancy rate, even when they did not address sexuality. Fourth, sex and HIV education programs do not increase sexual behavior, and some programs decrease sexual activity and increase condom or contraceptive use. Fifth, school-based clinics and school condom-availability programs do not increase sexual activity, and either may or may not increase condom or contraceptive use. Other studies reveal that there is very broad support for comprehensive sex- and HIV-education programs, and accordingly, most youth receive some amount of sex or HIV education. However, important topics are not covered in many schools.     

The protective role of religious coping in adolescents' responses to poverty and sexual decision-making in rural Kenya

In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported praying for God to partner with them to engage in positive behaviors, praying for strength to resist unwanted behaviors, and passive strategies characterized by waiting for God to provide resources or protection from HIV. Adolescents in Sub-Saharan Africa may benefit from HIV prevention interventions that integrate and build upon their use of religious coping.     

Reliability of self-reported contraceptive use and sexual behaviors among adolescent girls

This study examines two issues relevant to adolescents' self-reported sexual and contraceptive use behaviors: reliability of partner-referent reports versus 3 and 6 month reports, and test-retest reliability of reports completed over a 2 week period. Data are from 196 13 to 18 year old girls recruited into this study while they south reproductive care from health clinics in a metropolitan area. All participants reported having had sexual intercourse during the past 6 months. Twice over a 2 week interval, participants completed the same paper and pencil surveys. The survey presented questions about sexual behavior and contraceptive use using 3 sequential frames of reference: within the past 6 months, within the past 3 months, and by specific sexual partners in the past 6 months. Findings demonstrate that adolescent girls can reliably report sexual behavior and contraceptive use over a 6 month interval. Study findings have implications for future research utilizing adolescents' self-reported sexual and contraceptive use behaviors.     

Identifying the causal pathways from religiosity to delayed adolescent sexual behavior

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.     

Explaining heterogeneity in the child poverty rate among immigrant families: Differences by parental citizenship

Much of the debate about child poverty among immigrant families has centered on factors that place immigrant children at a high risk for poverty. What is missing in this debate and the literature is that children in immigrant families are economically heterogeneous and that children in naturalized families are doing as well as or better than children in native families in terms of economic status. To examine the heterogeneous economic status of children in immigrant families, this study compared children's poverty rates by parental nativity and citizenship status, decomposing demographic risk factors of child poverty. The results indicate that whereas lower parental education and employment status largely explain the relatively higher poverty rate among children in noncitizen families, higher parental education and employment rates and a lower rate of single parenthood explain why children in naturalized families have a lower rate of poverty than those in noncitizen families. Implications of these findings are discussed in detail.     

The impact of family structure and social change on adolescent sexual behavior

This article presents a biophysical perspective on adolescent sexual feelings and behavior. The study particularly analyzes sexual attraction, desire, and mate selection as evolutionary adaptations just as important to species survival. Sex differences in mating strategies are described as part of this evolutionary adaptation. Recent research findings demonstrate how these strategies explain contemporary sexual and reproductive behavior in Western societies today, as they do sexual behavior in the past or across diverse cultures. The implications of this analysis are significant to intervention efforts to postpone sexual initiation and avert nonmarital births. Discussion on demographic and normative changes that affect adolescent sexual behavior included trends in sexual maturation and changing marriage norms. The author urges greater emphasis on the early pubertal years; increased attention to teaching adolescents more about their own sexual development; a less absolutist focus on sexual abstinence, which may be appropriate and more feasible for 12 year olds but not for 16 year olds; better and more widespread sex education at earlier ages and throughout the school curriculum; frank discussion of all the options available for those who experience an unwanted pregnancy; and same level of attention towards adolescent boys and girls.     

Sex, lies, and videos in rural China: a qualitative study of women's sexual debut and risky sexual behavior

This paper attempts to understand the sexual behaviors of young, unmarried women living in rural China with a special focus on sexual debut, sexual risk-taking behaviors, and reproductive health consequences. The analysis is based on forty in-depth interviews with young women who had undergone induced abortion as well as information from focus group discussions. Study participants identified pornographic videos and parents' tacit approval and even encouragement as factors instigating their sexual debut. Reasons for unprotected intercourse include spontaneous sexual activity, misconceptions about fertility and the effective use of contraceptives, and the lack of negotiation skills. The results indicate the importance of making reproductive health education more accessible to rural populations in China, a group usually considered to be more traditional and less likely to engage in premarital sex.     

Participatory child poverty assessment in rural Vietnam

There are increasing calls for more child specific measures of poverty in developing countries and the need for such measures to be multi‐dimensional (that is not just based on income) has been recognised. Participatory Poverty Assessments (PPAs) are now common in international development research. Most PPAs have been undertaken with adults and there are still relatively few PPAs with children. The objective of the current study was to understand adults' and children's perceptions of the causes and consequences of child poverty in rural Vietnam using a variety of participatory methods. Poor children are perceived by poor children as those who lack basic needs such as food, clothes, and safe shelter. Poor children feel they do not receive enough attention from their parents, have to work and have no safe place to play.     

The encounter with family violence and risky sexual activity among young adolescent females

In this article, we analyze the relationship between family violence and risky sexual activity for female adolescents (age 14 to 17). We examine two forms of family violence: experience (receiving physical abuse from a parent or parent-figure) and exposure (witnessing interparental physical violence). We hypothesize that either form of violence will predict greater odds of engaging in risky sexual behavior. We define risky sexual activity as any of the following: having multiple partners within the last 12 months or having sex with partners who are themselves engaging in risky behavior (e.g., having multiple partners of either sex, injecting unprescribed drugs, sharing unprescribed needles for injecting drugs). We analyzed data from 710 respondents taken from the National Survey of Family Growth, Cycle V, living with at least one biological parent. Results showed that experiencing violence from a parent greatly increased the likelihood of risky sex, even when controlling for the experience of forced sex, age, mother's age at first birth, race, socioeconomic status, and religiosity. Female adolescents who had experienced forced sex, those who were older (especially 17-year-olds), non-Hispanic Blacks (but not Hispanics), those living in a family with low educational attainment (less than a high school diploma), and those for whom religion was not or only somewhat personally important were more likely to report risky sex compared to others. These effects were not modified by whether the respondents lived in single- or two-parent families. An interaction between the two forms of physical violence suggests that either form is sufficient to increase significantly the odds of risky sex; an analysis in which respondents were differentiated by their experience of either form of violence showed a strong effect of experience on risky sex, net of the control variables.     

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.     

High-risk sexual behavior among students of a minority-serving university in a community with a high HIV/AIDS prevalence

OBJECTIVE: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. PARTICIPANTS AND METHODS: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. RESULTS: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. CONCLUSIONS: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.     

A structural model of early indicators of school readiness among children of poverty

Factors that affect children’s school readiness potential are evident even from birth. Structural equation modeling was used to test the hypotheses that certain factors related to gender, approaches to learning, age at school entry, family income, and the health status of the child at birth have an effect on low-socioeconomic status (SES) children’s readiness for school. Data from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B) was used to test the hypotheses. Included in the sample were 1700 children of diverse racial/ethnic backgrounds. All the children were in the lowest SES quintile of the children making up the ECLS-B cohort. The hypothesized model suggested that there were both direct and indirect influences on children’s school readiness performance. Potential risk factors and implications for ameliorating negative influences were identified.     

Treatment of the adolescent sexual offender

This article is intended to provide a broad overview of the treatment issues and processes for adolescent sexual offenders. Through the authors' experience treating hundreds of juvenile sex offenders in a state correctional institution, five major treatment tasks are identified: 1. breaking through the offender's denial; 2. addressing offenders' own history of victimization and its impact on their present lifestyle; 3. confronting dysfunctional attitudes and values that support sexual victimization; 4. teaching social skills and 5 changing deviant arousal patterns.Mr. Kahn is Program Director, Echo Glen Children's Center and Affiliate Instructor, University of Washington, School of Social Work. Ms. Lafond is a Juvenile Rehabilitation Administrator at Echo Glen Children's Center.     

Testing an etiological model for male juvenile sexual offending against females

Research on the origin of sexual aggression has identified several important contributing factors: (a) early abuse (physical and sexual), (b) personality/behavioral traits (callousness and unemotionality, antisocial behavior/impulsivity, and hypersexuality), and (c) attitudinal/cognitive variables (negative masculinity, hostility toward women, misogynistic fantasies). We developed and tested an etiological model of sexual coercion on adult samples of sexual offenders and community controls. The model proposes three major causal pathways to sexual coercion. Using data gathered from a computerized interview, we employed this same model to predict sexually coercive behavior in a sample of 218 juvenile sexual offenders. The cross- sample consistency of the model provides support for a unified theory of sexual aggression against women.     

Sex,lies, and videos in rural china: A qualitative study of women's sexual debut and risky sexual behavior

We studied the sexual behaviors of young, unmarried women living in rural China with a special focus on sexual debut, sexual risk‐taking behaviors, and reproductive health consequences. The analysis was based on 40 in‐depth interviews with young women who had undergone induced abortion, as well as information from focus group discussions. Study participants identified pornographic videos, parents’ tacit approval, and even encouragement as factors instigating their sexual debut. Reasons for unprotected intercourse included spontaneous sexual activity, misconceptions about fertility and the effective use of contraceptives, and the lack of negotiation skills. The results indicate the importance of making reproductive health education more accessible to rural populations in China, a group usually considered to be more traditional and less likely to engage in premarital sex.     

Ethnicizing poverty through social security provision in rural Hungary

Rural poverty has become an increasingly ethnicised category for the majority society in contemporary Hungary. The article aims to explore the process and practice of social exclusion and ethnicisation in relation to mutual effects of post-socialist welfare restructuring and changing discourse on poverty in the post-socialist rural reality. The empirical data were gathered during ethnographic fieldwork carried out in a village in 2009 and 2010. Employing a relational, processual concept of ethnicity, this paper focuses on the ways in which the Magyar majority applies the approach of ‘groupism’ to imagine and discuss Roma as an ethnically bounded, distinctive group with a considerable set of distinguishable ethnic traits and degree of homogeneity. To point out how the discursive context influences social care and in what way the local implementation of social provision is able to formulate this context the paper deconstructs the local notion of ‘Roma ethnic group’ along with understandings of deservingness and social entitlement. It goes on to show the dual role that local state actors play in this process. The article concludes that both ideologies and practices of social care legitimise the identification of Roma as an ethnic category negatively equating this group with notions of deservingness and thus institutionalising ethnicised poverty.