The Impact of a History of Sexual Abuse on High-Risk Sexual Behaviors among Females Attending Alternative Schools
Buzi, Ruth S., Tortolero, Susan R., Roberts, Robert E., Ross, Michael W., Addy, Robert C., Markham, Christine M., Adolescence
Epidemiological studies indicate that one third of females and one sixth of males experience sexual abuse before age 18 (Finkelhor, 1979; Finkelhor, Hotaling, Lewis, & Smith, 1989; Wyatt, 1985). Studies have shown that abuse during childhood and adolescence is linked to long-term emotional impairment, such as excessive anger, anxiety, and depression, as well as behavioral problems, such as school failure, substance use, running away, and delinquency (Beitchman et al., 1991; Briere & Runtz, 1991). Recent studies also have documented an association between a history of child sexual abuse (CSA) and high-risk sexual behaviors among adolescents. For example, findings from the 1997 Massachusetts Youth Risk Behavior Surveillance Survey indicated that Among 1,610 sexually experienced girls and 831 sexually experienced boys in the 9th through 12th grades, 30.2% of the girls and 9.3% of the boys disclosed a sexual contact against their will. Sexually abused girls were significantly more likely than those without such a history to report early sexual activity, to report multiple partners, and to have been pregnant (Raj, Silverman, & Amaro, 2000). Fergusson, Horwood, and Lynsky (1997) also examined the extent to which exposure to CSA was associated with increased rates of sexual risk-taking behaviors among 520 young women (aged 18) in New Zealand. Retrospective reports of CSA indicated that females who experienced sexual abuse (intercourse) were 4.4 times more likely to engage in sexual activity and be pregnant, 9.3 times more likely to have had five or more sexual partners, and 6.6 times more likely to have had sexual intercourse before age 16. The association remained significant even after controlling for other adverse childhood experiences. Further, Brown, Lourie, Zlotnick, and Cohn (2000) conducted a study of 208 adolescent patients who attended psychiatric day schools and residential programs, and found that more than half reported a history of sexual abuse. Those with a history of sexual abuse were three times more likely than their peers to report inconsistent condom use. They demonstrated significantly less condom self-efficacy, less knowledge of HIV, less impulse control, less frequent purchase and use of condoms, and significantly higher rates of sexually transmitted diseases (STDs), compared to adolescents without a history of sexual abuse.
A number of hypotheses have been offered to explain how a history of sexual abuse leads to sexual risk-taking behavior. For example, Finkelhor and Browne (1985) proposed a model that describes how children who have experienced CSA learn inappropriate sexual behaviors. The processes can be analyzed in terms of four factors: traumatic sexualization, betrayal, stigmatization, and powerlessness. Children who are given a variety of incentives, such as affection, attention, and gifts, in return for sex develop distorted sexual morals. They also learn to associate sexuality with shrine and guilt because of messages about the sexual behavior from the abuser or others who learned about the abuse. These processes interrupt normal sexual development and lead to inappropriate sexual behaviors.
From a social learning perspective (Bandura, 1977), CSA may lead to maladaptive behaviors, beliefs, and attitudes. Through modeling and reinforcement by the perpetrator, the child may learn inappropriate sexual behaviors. Other hypotheses suggest that indirect contributory factors lead to this association. For example, Mackey (1992) suggested that depression is the pathway by which sexual trauma is expressed. Long-term symptoms of depression in combination with reduced capacity to interact lead to sexual problems. In line with this, Miller (1999) has developed a model that suggests that the relationship between sexual abuse and sexual risk-taking behaviors is mediated by three pathways: drug abuse that is used to self-medicate, sexual adjustment problems related to taking sexual risks, and psychopathology, especially depression. …