Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, we more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

A comparison of risk factors for sexual victimization among gay, lesbian, bisexual, and heterosexual homeless young adults

Although high rates of sexual victimization have been reported among homeless youth, less is known about whether the risk factors vary for gay, lesbian, and bisexual youth compared to heterosexual youth. Based on a sample of 172 homeless young adults ages 19 to 26, results revealed that depressive symptoms, prostitution, and having friends who traded sex were significantly associated with higher levels of sexual victimization. Gay, lesbian, and bisexual young adults experienced more sexual victimization compared to heterosexual young adults. A test for interactions revealed that the effect of sexual orientation on sexual victimization was moderated by trading sex and having friends who traded sex. Finally, there is support for partial mediation of the effects of sexual abuse, neglect, and depressive symptoms on sexual victimization through other risk factors.     

Mental disorder,subsistence strategies,and victimization among gay,lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post‐traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, were more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

Sexual Risk‐Taking Among Recently Emancipated Female Foster Youth: Sexual Trauma and Failed Family Reunification Experiences

Foster youth evidence shows elevated rates of risk behaviors, including sexual risk‐taking (e.g., unprotected sex). Some studies have identified child maltreatment, particularly sexual abuse, as a risk for later sexual risk‐taking, but none have examined how child welfare placement experiences relate to youth's sexual risk‐taking. This study investigated relations among child maltreatment, child welfare placements, and sexual risk‐taking among 114 recently emancipated female foster youth. Sexual abuse and failed reunifications with parents were associated with greater sexual risk‐taking. Moreover, dissociative symptoms exacerbated the relation between sexual abuse and sexual risk‐taking. These findings highlight the need for greater consideration of risks associated with emancipated youth's sexual risk‐taking and for more research to understand how youth experience unsuccessful family reunifications.     

Sexual Coercion within Mixed-Sex Couples: The Roles of Sexual Motives,Revictimization, and Reperpetration

Research suggests that a history of childhood sexual abuse, and previous experiences of sexual coercion, may predict sexual coercion victimization and perpetration. More recently, sexual motivation has been found to correlate with both consensual and non-consensual sexual activity. However, sexual motivation has not been examined in association with previous experiences of abuse and sexual coercion. The aim of this study was to investigate childhood sexual abuse, previous sexual coercion experiences, and sexual motives of both partners as possible risk factors for current sexual coercion victimization and perpetration within a sample of 209 mixed-sex couples. This study examined whether power, stress relief, partner pressure, and imposition motives contributed unique variance to the prediction of sexual coercion beyond that accounted for by past childhood sexual abuse and sexual coercion events. Using hierarchical logistic regressions, four predictive models were examined for both male and female sexual coercion perpetration and victimization. Results show that childhood sexual abuse was only a significant predictor of female sexual coercion perpetration, whereas male sexual coercion victimization and perpetration were predicted by sexual coercion victimization and perpetration in previous relationships. Power motives were also significant predictors of sexual coercion perpetration, and imposition was a significant predictor of sexual coercion victimization for both genders.     

Sexual coercion within mixed-sex couples: the roles of sexual motives, revictimization, and reperpetration

Research suggests that a history of childhood sexual abuse, and previous experiences of sexual coercion, may predict sexual coercion victimization and perpetration. More recently, sexual motivation has been found to correlate with both consensual and non-consensual sexual activity. However, sexual motivation has not been examined in association with previous experiences of abuse and sexual coercion. The aim of this study was to investigate childhood sexual abuse, previous sexual coercion experiences, and sexual motives of both partners as possible risk factors for current sexual coercion victimization and perpetration within a sample of 209 mixed-sex couples. This study examined whether power, stress relief, partner pressure, and imposition motives contributed unique variance to the prediction of sexual coercion beyond that accounted for by past childhood sexual abuse and sexual coercion events. Using hierarchical logistic regressions, four predictive models were examined for both male and female sexual coercion perpetration and victimization. Results show that childhood sexual abuse was only a significant predictor of female sexual coercion perpetration, whereas male sexual coercion victimization and perpetration were predicted by sexual coercion victimization and perpetration in previous relationships. Power motives were also significant predictors of sexual coercion perpetration, and imposition was a significant predictor of sexual coercion victimization for both genders.     

Child Sexual Abuse and Women's Sexual Health: The Contribution of CSA Severity and Exposure to Multiple Forms of Childhood Victimization

Research studies have provided increasing evidence for the potential adverse impact of child sexual abuse on women's sexual health. The present study examined the association between child sexual abuse and sexual health while controlling for various forms of childhood victimization. Self-report questionnaires were administered to 889 young women from the province of Quebec. Results suggest that child sexual abuse survivors were more likely to report having experienced other forms of childhood victimization than were women without child sexual abuse. Women with a history of both child sexual abuse and multiple forms of victimization were at greater risk of experiencing more adverse outcomes, including risky sexual behaviors, sexual problems, and negative sexual self-concept. Regression analyses revealed that child sexual abuse was significantly related to indicators of sexual health outcomes even when controlling for the effect of single forms of victimization. Clinically, interventions optimizing sexual health may be particularly helpful for a subgroup of child sexual abuse survivors.     

Social and psychological resources among homeless youth: protection against risk for physical victimization?

ABSTRACT

This study examines child physical abuse, social and psychological resources, and street physical victimization among 150 homeless youth from the Midwest. Path analyses results show that males have higher self-efficacy than females, while older youth and those who experienced less child physical abuse reported higher self-esteem. Self-efficacy and self-esteem were positively associated with social support as was being younger and having experienced less child physical abuse. Younger respondents reported fewer difficulties obtaining basic necessities, and those who had less trouble finding these necessities experienced less street physical victimization. Females, younger youth, and those who experienced less child physical abuse reported lower rates of physical victimization. Agencies should be aware that many youth experiencing homelessness have trouble obtaining basic necessities, which increases risk for victimization. Moreover, the ability to obtain necessities appears to override the influential role of social support, further affirming the foundational importance of agencies helping youth meet their basic needs.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.     

Physical Abuse in Early Childhood and Transition to First Sexual Intercourse among Youth in Cape Town,South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape Area Panel Survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

Sexual Risk-Taking among High-Risk Urban Women with and without Histories of Childhood Sexual Abuse: Mediating Effects of Contextual Factors

This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse histories. Childhood sexual abuse survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the childhood sexual abuse group. The mechanisms of risk are different for those with divergent childhood sexual abuse histories and thus interventions should be developed to educate women with a history of childhood sexual abuse about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use.     

Childhood Sexual Experiences and Adult Health Sequelae Among Gay and Bisexual Men: Defining Childhood Sexual Abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.     

Sexual abuse,family violence,and female delinquency: findings from a longitudinal study

The current study examines the effects of three forms of childhood victimization on self-reported delinquency and aggression in adolescent girls. These analyses are based on a longitudinal sample of 141 mother-daughter pairs participating in a study about marital violence and child development. When the children were school aged, mothers and children provided reports describing (a) child exposure to marital violence, (b) escalated physical abuse against the child, and (c) child sexual abuse. Children were followed up into adolescence and re-interviewed. Self-reports of delinquency (violent and nonviolent), running away, and violence against parents were collected. Results indicate that out of the three forms of victimization, child sexual abuse emerged as the strongest predictor of girls' violent and nonviolent criminal behavior. Girls with a history of physical abuse in childhood were most likely to assault their parents. Witnessing marital violence failed to contribute further to delinquency, beyond the adverse association with childhood sexual abuse. Findings highlight a unique avenue for delinquency in girls via childhood sexual exploitation.     

Self‐Mutilation and Homeless Youth: The Role of Family Abuse,Street Experiences,and Mental Disorders

Self‐mutilation, which is the act of deliberately harming oneself, has been overlooked in studies of homeless and runaway youth. Given their high rates of abuse and mental health disorders, which are associated with self‐mutilation, homeless and runaway youth provide an ideal sample in which to investigate factors associated with self‐mutilation among a nonclinical population. Based on interviews with 428 homeless and runaway youth aged 16 to 19 years in 4 Midwestern states, the current study revealed widespread prevalence of self‐mutilation among these young people. Multivariate analyses indicated that sexual abuse, ever having stayed on the street, deviant subsistence strategies, and meeting diagnostic criteria for depression were positively associated with self‐mutilation. The findings are interpreted using stress theory and affect‐regulation models.     

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

ABSTRACT

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.     

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.     

Child Sexual Abuse and Intimate Partner Violence Victimization in Adulthood: Sex-Differences in the Mediating Influence of Age of Sexual Initiation

Child sexual abuse is a major public health concern in the United States with devastating sequelae. Although the relationship between child sexual abuse and intimate partner violence victimization in adulthood is known, little is known about the mediating influence of the age of sexual initiation on the association, or whether sex differences exist. Using data from waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (N = 1,163), we aimed to examine the mediating influence of age of sexual initiation on the association between child sexual abuse and intimate partner violence victimization in adulthood and identify sex differences. Findings reveal that in female survivors, age of sexual initiation partially mediated the association between child sexual abuse and physical intimate partner violence victimization in adulthood. In male survivors, no mediational effect was observed. Public health practitioners should be aware of sex differences in the effect of early sexual initiation on intimate partner violence victimization in adulthood among child sexual abuse survivors.     

The Connections of Mental Health Problems,Violent Life Experiences,and the Social Milieu of the “Stroll” with the HIV Risk Behaviors of Female Street Sex Workers

Abstract

This paper examines the connections of mental health, victimization, and sexual risk behaviors among a sample of 278 street-based female sex workers in Miami. Using targeted sampling strategies, drug-using sex workers were recruited into an HIV prevention research program. Data were collected by trained interviewers, and focused on drug use and sexual risk for HIV, childhood abuse, recent victimization, and mental health. More than half of the participants reported histories of physical (51.1%) or sexual (53.1%) abuse as children, 37.4% were classified with moderate or severe anxiety symptoms, and 52.9% had symptoms of moderate or severe depression. Logistic regression analyses demonstrated significant associations between mental health issues and engagement in recent unprotected vaginal and oral sex. The program development and policy implications of these findings are discussed.     

The effects of a high-risk environment on the sexual victimization of homeless and runaway youth

Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized.