Gisela Priebe

Child sexual abuse is largely hidden from the adult society An epidemiological study of adolescents' disclosures.

OBJECTIVES The aim of this study was to investigate disclosure rates and disclosure patterns and to examine predictors of non-disclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse. METHOD A sample of 4,339 high school seniors (2,324 girls, 2,015 boys) was examined with a questionnaire concerning sexual experiences in this study with a focus on disclosure of sexual abuse (non-contact, contact or penetrating abuse, and including peer abuse). RESULTS Of the sample, 1,505 girls (65%) and 457 boys (23%) reported experience of sexual abuse. The disclosure rate was 81% (girls) and 69% (boys). Girls and boys disclosed most often to a friend of their own age. Few had disclosed to professionals. Even fewer said that the incident had been reported to the authorities. Logistic regression showed that it was less likely for girls to disclose if they had experienced contact sexual abuse with or without penetration, abuse by a family member, only a single abuse occasion or if they had perceived their parents as non-caring. Boys were less likely to disclose if they studied a vocational program, lived with both parents or had perceived their parents as either caring and overprotective or non-caring and not overprotective. CONCLUSIONS Disclosing sexual abuse is a complex process. Much is hidden from the adult society, especially from professionals and the legal system. Since peers are the most common receivers of abuse information, programs for supporting peers ought to be developed. Differences in disclosure patterns for girls and boys indicate that a gender perspective is helpful when developing guidelines for professionals. PRACTICE IMPLICATIONS Professionals, especially in the school system, need to be more aware of the finding that few sexually abused children seek help from professionals or other adults and that support offers should be directly addressed not only to the vulnerable young persons themselves but also to peers who wish to help a friend.

Sexually Coercive Behavior in Male Youth: Population Survey of General and Specific Risk Factors

Little is known about risk/protective factors for sexually coercive behavior in general population youth. We used a Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) and investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn. Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. The findings could inform preventive efforts and the assessment and treatment of sexually coercive male youth.

Sexual Coercion Experience and Sexually Coercive Behavior: A Population Study of Swedish and Norwegian Male Youth

The authors tested the hypothesis that experiencing sexual coercion and engaging in sexually coercive behavior are positively associated in a representative sample totaling almost 4,000 Swedish or Norwegian male high school students (estimated response rate 80%). In both surveys, youths who had experienced sexual coercion were approximately three times more likely to engage in sexually coercive behavior than those without such experience (10%—12% vs. 4%). The association between sexual coercion experience and sexually coercive behavior was attenuated but remained significant and moderately strong in both surveys when controlling for nonsexual antisocial behavior, substance use, and noncoercive sexual behavior in multivariate logistic regression models. The population attributable fraction (proportion of sexually coercive behavior that can be explained by sexual coercion experience) was 18%—25%. The findings support a robust link between having been sexually coerced and engaging in coercive sexual behavior in the general population.

Prevalence, Characteristics, and Associations of Sexual Abuse with Sociodemographics and Consensual Sex in a Population-Based Sample of Swedish Adolescents

The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.

The strengths and difficulties questionnaire as a screening instrument in a community sample of high school seniors in Sweden

The Strengths and Difficulties Questionnaire (SDQ) has been used among Swedish children since 1996, usually the parent or the teacher version. The self-report version was originally developed for children aged 11–16 years. The aim of this study was to investigate the application of the Swedish self-report version to a representative sample of 1015 senior high school students aged 17–19 years. Girls reported more emotional symptoms and scored higher on prosocial items than boys. Boys on the other hand scored higher on both conduct and peer problems. The means were similar to means in two Nordic studies that have included subjects of this age group. A confirmatory five-factor analyses explained 44.5% of the variance with a good fit for all subjects and boys but somewhat weaker for girls. The item-subscale correlation (ISC) ranged from moderate to high (r=0.47–0.76) and the Cronbachs alpha was 0.74 (ranging in the five subscales 0.50–0.70). The SDQ seems to be useful even in this older age group. The psychometric qualities were acceptable but can probably be improved by changing the oppositely worded questions and by considering development of different questionnaires for boys and girls at least in late adolescence.

Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life

This study investigated the relationship between sexual debut before 14 years of age and socio‐demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of age.

Operationalization of three dimensions of sexual orientation in a national survey of late adolescents

This study investigated three dimensions of sexual orientation—identity, attraction, and behavior—in a national survey of late adolescents. Prevalence rates and the diversity of dimensions of sexual orientation when combined were studied. A representative sample of 3,432 Swedish high school seniors completed an anonymous school-based self-report survey about sexuality, Internet use, and health. Four measures of sexual orientation were included—one for sexual identity, two for attraction (emotional or sexual attraction, romantic attraction), and one for sexual behavior. Prevalence rates of sexual minority orientation varied between 4.3% for sexual behavior (males 2.9%, females 5.6%) and 29.4% for emotional or sexual attraction (males 17.7%, females 39.5%). Different measures of sexual orientation were significantly associated with one another. Bisexual or homosexual orientation was reported by 1.5% of the participants in all four measures and by 17.6% in at least one measure. Researchers need to carefully choose, depending on the research questions under investigation, which dimensions of sexual orientation and which measures they wish to include in their survey. Recommendations based on findings from the study are given.

Vulnerable adolescent participants’ experience in surveys on sexuality and sexual abuse : Ethical aspects

OBJECTIVE The aim of this research was to study the discomfort experienced by adolescents when answering questions in a survey about sexuality and sexual abuse and to investigate factors that may determine possible experience of discomfort. The research focused particularly on vulnerable adolescents-sexually abused and sexually inexperienced. METHOD Adolescents in their final year of high school in Estonia (n=1,334) and Sweden (n=3,401) who had completed a survey about experiences of sexuality and sexual abuse answered additional questions about experiences of discomfort related to the survey questions. RESULTS A majority of the participants did not feel discomfort when completing the survey. This was also the case for the two vulnerable groups. Experience of penetrating sexual abuse, sexual inexperience, mental health problems, rape myth acceptance, gender, immigrant background, and country were included in a structural equation model. Experience of penetrating sexual abuse was not significantly related to discomfort in the final model, while sexual inexperience was associated with increased discomfort (standardized coefficient .20) and rape myth acceptance was the strongest indicator of discomfort (.27). The total amount of explained variance was 17%. CONCLUSIONS Our data do not support the view that adolescents in general or vulnerable subgroups such as sexually abused or sexually inexperienced adolescents experience discomfort when answering a survey about sexuality and sexual abuse. As discomfort ratings were not highly related to any of the predictors further research is needed that includes other factors. It is important to follow existing ethical guidelines since there may always be some individuals who feel discomfort.

Voluntary sexual exposure online among Swedish youth - social background, Internet behavior and psychosocial health

Studies have described the phenomenon of voluntary sexual exposure among youth online but only a few focus on the typical young person who has this experience. The purpose of this study was to investigate Swedish youth with experience of voluntary sexual exposure online, with regard to Internet behavior, social background, and psychosocial health including parent-child relationships. A representative sample of 3503 Swedish youths in their third year of high school completed a survey about Internet behavior, Internet-related sexual harassment, sexuality, health, and sexual abuse. Out of those taking part in the survey, 20.9% (19.2% boys and 22.3% girls) reported experiences of voluntary sexual exposure online. Multivariate analysis showed a significant association between voluntary sexual exposure online and a number of different forms of harassment online. Neither poorer psychosocial health nor problematic relationships with parents remained significant in the final model. The results underlined the fact that voluntary sexual exposure online is associated with vulnerability on the Internet among both boys and girls and that there is a need for parents and professionals to better understand what young people do on the Internet and the risks they may incur.

Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support—a study of a Swedish national sample

Background: Selling sex is not uncommon among adolescents and we need to increase our knowledge of how this affects them. Aim: The aim of this study was to investigate adolescents who sell sex regarding sexual, mental and physical abuse, mental health as estimated by using the Hopkins Symptom Check List-25 (HSCL-25), self-harm behaviour and the adolescents’ experience of receiving help and support. Methods: The study was carried out on a national representative sample of adolescents (mean age 18.3 years) in Swedish high schools in the final year of their 3-year programme. The study had 3498 participants and a response rate of 60.4%. Results: Of the adolescents, 1.5% stated that they had sold sexual services. The selling of sex was associated with a history of sexual, mental and physical abuse. Poorer mental health and a higher degree of self-harm behaviour were reported among the adolescents who had sold sex. Help and support was sought to a greater extent by adolescents who had sold sex but these adolescents were not as satisfied with this help and support as the other adolescents. Conclusions: Adolescents that sell sex are a group especially exposed to sexual, mental and physical abuse. They have poorer mental health and engage in more self-harm behaviour than other adolescents. They are in need of more help and support than other adolescents and it is reasonable to assert that more resources, research and attention should be directed to this group to provide better help and support in the future.