The impact of sexual abuse in the lives of young women involved or at risk of involvement with the juvenile justice system

Girls in the juvenile justice system have high rates of past sexual abuse. To better understand the relationship between sexual abuse and justice system involvement, we analyzed survey interviews with 169 young women involved or at risk of involvement with juvenile justice, comparing girls who experienced sexual abuse with those who did not. Girls experiencing sexual abuse had more negative mental health, school, substance use, risky sexual behavior, and delinquency outcomes. These findings highlight a need for interventions to assist girls who have experienced abuse and efforts to prevent abuse and improve child welfare and social service systems.     

Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain

OBJECTIVE: To examine the roles of physical and sexual abuse in women with chronic pelvic pain using multi-dimensional pain assessment and to compare the chronic pelvic pain experiences of women with physical abuse to those of women with sexual abuse. STUDY DESIGN: Structured questionnaires were used to measure self-reported abuse, pain severity, psychological distress, physical functioning, interpersonalfunctioning, and coping in 63 women attending a tertiary care gynecologic clinic for diagnosis and treatment of chronic pelvic pain. RESULTS: Women with chronic pelvic pain who reported abuse demonstrated significantly more psychological distress than did women who reported no abuse, but there were no differences in pain severity, physical functioning, interpersonal functioning or coping. Women with physical abuse reported more overall psychological distress, depression, anxiety and somatization than women who reported no physical abuse. Women who reported sexual abuse showed more overall psychological distress and anxiety than women who reported no sexual abuse. While physical abuse was more consistently associated with psychological distress than was sexual abuse, both types of abuse were risk factors for distress. CONCLUSION: These results suggest that both physical and sexual abuse are associated with psychological distress in women with chronic pelvic pain but not with other domains of pain experience. Additional research to improve identification and treatment of women with both chronic pelvic pain and abuse is indicated.     

Past physical abuse is significantly correlated with pregnancy as an adolescent.

STUDY OBJECTIVE: To determine which type or types of childhood abuse are associated with adolescent pregnancy and other adverse health outcomes. DESIGN: 100 females between the ages of 12 and 24 years of age, attending either an adolescent/young adult clinic (for ages 12 to 24), or teen obstetrics clinic (for ages 13 to 18) at an urban academic medical center, were recruited to participate in an interview study during their clinic visit. The clinician or research assistant used a 186-item structured interview form to record answers to detailed questions on abuse, in addition to traditional questions about the patient's feelings on home, education, activities, drugs and depression, sex and suicide (HEADS). RESULTS: 32% of subjects reported a history of sexual abuse, 29% reported physical abuse, and 46% reported past emotional abuse. The frequency of any past abuse was significantly higher in girls who had ever been pregnant (29 of 50, 58%), compared with "never pregnant" girls (19 of 49, 38%)( P < .05). A past history of physical abuse (P = .04), but not sexual or emotional abuse, was significantly associated with pregnancy as a teen. Other factors significantly correlated with teen pregnancy were: frequent alcohol use, older age, and Mexican-American or African-American ethnicity. Past history of abuse was significantly correlated with depression, suicidal thoughts, absent father, school failure, alcohol and tobacco use, and delinquency. CONCLUSIONS: A history of past physical abuse is strongly associated with adolescent pregnancy, and questions about all types of abuse should be routinely asked of adolescent patients.     

Reproductive health education and sexual risk among high-risk female adolescents and young adults

STUDY OBJECTIVE: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female adolescents and young adults. DESIGN: Female adolescents and young adults (n=113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal education occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. RESULTS: Most participants reported receiving reproductive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. CONCLUSIONS: Early reproductive health education and education from both parental and formal sources is associated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also associated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters' increasing sexual risk behavior. Future research should examine multiple sources of reproductive health education and the timing of education from these sources to enhance understanding the dynamic interactions between reproductive health education and adolescent sexual risk.     

Childhood Abuse and Common Complaints in Pregnancy

Background: Childhood abuse affects adult health. The objective of this study was to examine the prevalence of emotional, physical, and sexual childhood abuse within a large Norwegian cohort of pregnant women and its association with common complaints in pregnancy. Methods: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Regression analyses were used to examine associations of childhood abuse and 16 common complaints in pregnancy. Results: Eighteen percent (10,363/55,776) of the women reported some type of childhood abuse. Of all women, 3,870 (6.9%) reported sexual abuse, 3,075 (5.5%) physical abuse, and 7,619 (13.6%) emotional abuse as a child. Of those reporting childhood abuse, 31 percent reported two or more types of abuse. All 16 common complaints in pregnancy were associated with reported childhood abuse. Women reporting three types of childhood abuse reported 5.4 common complaints in pregnancy (mean) compared with 3.7 for women without childhood abuse (p < 0.001). Women reporting childhood abuse are more likely to report seven or more common complaints in pregnancy: adjusted odds ratio (AOR) 1.7 (95% CI 1.6–1.9) for emotional abuse; AOR 2.5 (95% CI 2.0–3.1) for combined physical and sexual abuse; and AOR 3.5 (95% CI 3.0–4.0) for all three kinds of abuse. Sociodemographic characteristics and other risk factors did not explain this graded association. Conclusions: Abuse in childhood is associated with increased reporting of common complaints of pregnancy. Clinicians should consider the possible role of childhood abuse when treating women with many common complaints in pregnancy.     

Factors influencing gender based violence among men and women in selected states in Nigeria

This study determined the factors associated with gender based violence among 3000 men and women in selected states in Nigeria. Respondents who had experienced physical violence were 806 (26.9%), comprising 353 (11.8%) males and 453 (15.1%) females (p<0.001). Respondents who had experienced sexual violence were 364 (12.1%) of which 221 (7.4%) were males and 143 (4.8%) were females (p<0.0001). Married female respondents were more likely to experience physical violence than single respondents (OR= 1.71, 95%CI: 1.15-2.53 p=0.008). In addition, lower risk of experiencing sexual violence among males was observed among those who do not drink alcohol. The study has shown that gender based violence still constitutes a problem in Nigeria, affecting women more than men. However, efforts should be geared towards addressing the factors that promote violence among both sexes through increased awareness and education.     

Childhood Abuse and Fear of Childbirth—A Population‐based Study

Abstract: Background: Childhood abuse affects adult health. The objective of this study was to examine the association between a self‐reported history of childhood abuse and fear of childbirth. Methods: A population‐based, cross‐sectional study was conducted of 2,365 pregnant women at five obstetrical departments in Norway. We measured childhood abuse using the Norvold Abuse Questionnaire and fear of childbirth using the Wijma Delivery Expectancy Questionnaire. Severe fear of childbirth was defined as a Wijma Delivery Expectancy Questionnaire score of ≥85. Results: Of all women, 566 (23.9%) had experienced any childhood abuse, 257 (10.9%) had experienced emotional abuse, 260 (11%) physical abuse, and 290 (12.3%) sexual abuse. Women with a history of childhood abuse reported severe fear of childbirth significantly more often than those without a history of childhood abuse, 18 percent versus 10 percent (p = 0.001). The association between a history of childhood abuse and severe fear of childbirth remained significant after adjustment for confounding factors for primiparas (adjusted OR: 2.00; 95% CI: 1.30–3.08) but lost its significance for multiparas (adjusted OR: 1.17; 95% CI: 0.76–1.80). The factor with the strongest association with severe fear of childbirth among multiparas was a negative birth experience (adjusted OR: 5.50; 95% CI: 3.77–8.01). Conclusions: A history of childhood abuse significantly increased the risk of experiencing severe fear of childbirth among primiparas. Fear of childbirth among multiparas was most strongly associated with a negative birth experience. (BIRTH 37:4 December 2010)     

A Review of the Health Effects of Sexual Assault on African American Women and Adolescents

ObjectiveTo review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault.Data SourcesSearches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape.Study SelectionCriteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty‐one publications met inclusion criteria.Data ExtractionArticles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents.Data SynthesisSexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes.ConclusionSexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents’ responses to assault.     

Sexually Transmitted Infections and First Sexual Intercourse Age in Adolescents: The Nationwide Retrospective Cross‐Sectional Study

IntroductionSexually transmitted infections (STIs) are major causes of medical and psychological problems globally, while adolescents in South Korea have recently shown rapid changes in sexual behaviors.AimsWe aimed to examine the association between the age of first sexual intercourse and the experience of STIs among adolescents. Additionally, in which specific time period would more likely to get infected from sexual intercourse.MethodsWe used data from the 2007–2013 Korea Youth Risk Behavior Web‐based Survey. Only adolescents with sexual intercourse experience (N = 22,381) were included, and multiple logistic regression analysis was performed.Main Outcome MeasuresOne dichotomized measure and one continuous measure were assessed: (i) STIs experience (defined as having had STIs); and (ii) association between STIs experience and absolute age gap (defined as temporal differences between secondary sexual character emergence age and first sexual intercourse age).ResultsApproximately 7.4% of boys and 7.5% of girls reported had STI. For both boys and girls, the chance of experiencing STIs increased as the age of first sexual intercourse decreased (boys: before elementary school [age 7 or under]: odds ratio [OR] = 10.81, first grade [age 7 or 8]: OR = 4.44, second grade [age 8 or 9]: OR = 8.90, fourth grade [age 10 or 11]: OR = 7.20, ninth grade [age 15 or 16]: OR = 2.31; girls: before elementary school: OR = 18.09, first grade: OR = 7.26, second grade: OR = 7.12, fourth grade: OR = 8.93, ninth grade: OR = 2.74). The association between the absolute age gap and STI experience was examined additionally (boys: OR = 0.93, girls: OR = 0.87).ConclusionsThis study shows that earlier initiation of sexual intercourse increases the odds of experiencing STIs. Also as the age gap gets shorter, the odds of experiencing STIs increase. Our study suggests that it is important to consider the time period of first sexual intercourse and to reinforce a monitoring system along with the development of other preventive strategies. Lee SY, Lee HJ, Kim TK, Lee SG, and Park EC. Sexually transmitted infections and first sexual intercourse age in adolescents: the nationwide retrospective cross‐sectional study. J Sex Med 2015;12:2313–2323.     

Physical and sexual assault of women with disabilities

North Carolina women were surveyed to examine whether women's disability status was associated with their risk of being assaulted within the past year. Women's violence experiences were classified into three groups: no violence, physical assault only (without sexual assault), and sexual assault (with or without physical assault). Multivariable analysis revealed that women with disabilities were not significantly more likely than women without disabilities to have experienced physical assault alone within the past year (odds ratio [OR] = 1.18, 95% Confidence Interval [CI] = 0.62 to 2.27); however, women with disabilities had more than 4 times the odds of experiencing sexual assault in the past year compared to women without disabilities (OR = 4.89, 95% CI = 2.21 to 10.83).     

Effects of domestic violence on preterm birth and low birth weight

BACKGROUND: Domestic violence is increasingly recognized as a potentially modifiable risk factor for adverse pregnancy outcomes. This study was conducted to evaluate the relationship between abuse during pregnancy or within the last year and low birth weight and preterm birth. METHODS: From 1997 to 2001, 3149 low income, relatively low-risk pregnant women (82% African-American) participated in this prospective study. The Abuse Assessment Screen, a validated screening tool, which assesses emotional, physical or sexual abuse, injuries due to physical abuse and physical abuse in the index pregnancy, was filled out by 3103 women. RESULTS: Of the women screened, 26.6% reported emotional abuse, 18.7% reported physical abuse in the past year and 10.3% women reported being beaten, bruised, threatened with a weapon or being permanently injured. Abuse during pregnancy was reported by 5.9% of the women. Low birth weight and preterm birth occurred in 10.9% and 10.2% of the pregnant women, respectively. Logistic regression analyzes indicated that injury due to physical abuse within the past year was significantly associated with both preterm birth [adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) after adjusting for other covariates. The mean birth weight of infants born to women who were injured due to physical abuse was significantly lower (-75.2 g, p = 0.04) than the mean birth weight of infants of women who were not injured. CONCLUSION: These results indicate that in our population, injuries resulting from physical abuse are associated with both low birth weight and preterm birth.     

Experiences of physical and sexual abuse and their implications for current health

OBJECTIVE: To estimate the prevalence of a history of physical and sexual abuse in adulthood among gynecological patients and the association with general and reproductive health. METHODS: A cross-sectional questionnaire study on abusive experiences of gynecologic outpatients in a tertiary hospital. The total sample size was 691. RESULTS: Of all women, 42.4% had experienced moderate or severe physical or sexual abuse as an adult. One hundred forty-seven (21.6%) women reported physical abuse, 84 (12.3%) sexual abuse, and 58 (8.5%) both. The abused and nonabused women did not differ in mean age, education, or parity. Sexually abused women and those who were both sexually and physically abused reported poor general health significantly more often (P=.005 and P=.001, respectively) than the nonabused. They also rated their sex life as significantly worse than the nonabused women (P=.002 and P=.012, respectively). Over half of abused women had experienced common physical complaints during the previous 12 months compared with one third of the nonabused (P<.001). Two thirds of both the abused and the nonabused women preferred that their gynecologist not ask directly about abuse. CONCLUSION: Abusive experiences were common in gynecologic outpatients. Women with abusive experiences had ill health and poor sexual life more often than the controls. In contrast to the results of previous studies, most of the women did not want to be asked about abuse by their gynecologist.     

Risk of sexual dysfunction in a randomly selected nonclinical sample of the Swedish population

OBJECTIVE: To investigate the risk of sexual dysfunction as a result of childhood sexual abuse or sexual assault in a randomly selected nonclinical sample of men and women. METHODS: In 1996, a randomly selected sample of 2,810 Swedish males and females completed a 322-item interview and questionnaire. Age-adjusted odds ratios (ORs) were calculated to assess risk of sexual dysfunction and analysis of variance was employed to test differences by gender and abuse or assault history in regard to seeking assistance for sexual dysfunction. RESULTS: For females with a history of childhood sexual abuse, an increased risk of anorgasmia for more than 12 months was found for women aged between 31 and 45 years (OR 1.21, P=.009). For females with a history of sexual assault; an increased risk for hypoactive sexual desire disorder was found for women who between the ages of 16 and 30 years (OR 1.51, P=.03), 31 and 45 years (OR 1.28; P=.02), 46 and 60 years (OR 1.21, P=.03), and 61 and 84 years (OR 1.62, P=.04); lubrication problems in the past year for women between 46 and 60 years (OR 1.28, P=.02) and for more than 12 months (OR 1.38, P=.02). No statistically significant increased risk of sexual dysfunction was found for males with a history of childhood sexual abuse. Males who reported a history of sexual assault as an adult had a significant increased risk of retarded ejaculation in the last 12 months if they were between the ages of 31 and 45 years (OR 2.00, P=.008) or 46 and 60 years (OR 2.11, P=.02). Women most often reported sexual dysfunction to their gynecologists (18%) or midwives (8.4%), whereas men reported their sexual dysfunction to their physicians (5.6%) or urologists (4.3%). CONCLUSION: Future research should focus on predictors of sexual dysfunction and resilience subsequent to childhood sexual abuse and sexual assault as an adult. LEVEL OF EVIDENCE: III.     

Prevalence and risk factors for LSD use among young women

STUDY OBJECTIVE: To report the lifetime prevalence of lysergic acid diethylamide (LSD) and to identify unique correlates of using this substance in the last year among a large multiethnic sample of sexually active adolescent and young adult women aged 14 to 26 yrs. DESIGN, SETTING, PARTICIPANTS: A cross-sectional survey, administered at university-based ambulatory reproductive health clinics, was completed by 904 women between April and November of 1997 to identify risk factors associated with their use of LSD within the past 12 months. Subjects who reported lifetime, but not past 12 months', use of marijuana, LSD, or other illicit drugs were excluded, leaving a sample of 368 nonusers and 56 users of LSD. In addition, 231 young women who reported only using marijuana in the last year were used as a comparison group to identify unique factors associated with LSD use. RESULTS: Of the total sample (n=904), 13% (n=119) reported lifetime use of LSD, and 58% (n=536) reported lifetime use of marijuana. Logistic regression analyses controlling for age and race/ethnicity found distinct profiles for those who reported using LSD or only marijuana in the last year when compared to those who reported no substance use. Common to both groups was reporting being drunk at least 10 times during the last year, regular smoking of at least half a pack of cigarettes, and identification as a high-sexual-risk taker. However, LSD users as compared to nonusers were more likely to report white ethnicity (as compared to nonwhite), be less than or equal to 17 years of age (as compared to at least 18 years), report a history of physical abuse, and be categorized as having severe depressive symptomatology. In contrast, those who reported only using marijuana were more likely to report single marital status, young age at first intercourse, having half or more of their friends use marijuana, and poor grades. CONCLUSIONS: The female LSD user presents a distinct profile that might aid clinicians in identifying potential LSD use in this population as well as alerting clinicians to the relationship between LSD use and high-risk sexual behaviors.     

History of Sexual and Physical Abuse in Women with Dyspareunia: Association with Pain,Psychosocial Adjustment,and Sexual Functioning

AimDyspareunia is a women's sexual health problem that still often goes undiagnosed despite its high prevalence and its detrimental impact on sexual, relationship, and psychological adjustment. Although sexual and physical abuse may constitute risk factors for the development of dyspareunia, the effects of past abuse on current pain and associated sexual and psychosocial impairments have never been examined. Thus, the aim of this study is to determine the relation between a history of sexual and physical abuse and a series of pain, psychological, dyadic, and sexual functioning variables in a sample of women with dyspareunia.MethodsA hundred and fifty-one women took part in the study via health professional referrals and advertisements in local newspapers. Each participant underwent a standardized gynecological examination and a structured interview in order to confirm the diagnosis of dyspareunia. They also completed self-report questionnaires investigating past sexual and physical abuse, in addition to current pain, psychosocial adjustment, and sexual functioning. Dependent measures included: (i) The Brief Symptom Inventory; (ii) the Sexual History Form; and (iii) the Locke-Wallace Marital Adjustment Scale. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale.ResultsResults revealed that a history of sexual abuse involving penetration was associated with poorer psychological adjustment and sexual functioning. Additionally, findings showed that women who perceived a link between their dyspareunia and their past sexual abuse reported worse sexual functioning than those who did not. Finally, the experience of sexual abuse was not associated with pain intensity and physical abuse was not associated with any of the outcome measures.ConclusionsFindings suggest that the presence of a sexual abuse history in women with dyspareunia is associated with increased psychological distress and sexual impairment, although there is no relation between a history of physical abuse and these outcomes. Leclerc B, Bergeron S, Binik YM, and Khalifé S. History of sexual and physical abuse in women with dyspareunia: Association with pain, psychosocial adjustment and sexual functioning.     

Human Papilloma Virus infection in sexually active adolescent girls

Purpose

Adolescents are a vulnerable group with regard to sexually transmitted infections, including Human Papilloma Virus (HPV). This is thought to be both because of their more liberal sexual behavior and also the relative immaturity of their genital tract.The aim of the study was to examine trends in HPV infection among sexually active adolescents attending for a sexual health screen.

Methods

Sexually active adolescents were offered cervical screening, HPV typing and conventional genital cultures as part of a sexual health prevention protocol. Participating adolescents also completed a sexual health questionnaire.

Results

Between January 2008 and July 2011, 149 sexually active girls were examined for reproductive health issues (mean age 17.3 years). 62 (42%) tested positive for HPV DNA, 30 were infected by multiple types and 54 had at least one high risk type identified. The most commonly identified HPV DNA was for low risk type 42 (15 cases, 7.8%), followed by high risk types 51 (14 cases, 7.3%) and 59 (11 cases, 5.7%). E6-E7 mRNA expression was detected in 16 girls (11%), of which half were for HPV 16. Girls who tested positive for HPV DNA and mRNA had similar age at sexual debut with those that tested negative (15.1 years in all groups) but had on average more sexual partners (4.1 vs1.9 p = 0.007).Only 9 girls in this cohort had been vaccinated against HPV. Approximately half of the girls reported using inadequate or no contraception.

Conclusions

HPV infection rate was high in our sample. Furthermore a high percentage was infected with high risk types and a proportion of girls demonstrated mRNA HPV expression. As age at first sexual intercourse drops, vaccination against HPV and sexual education should be instituted in early adolescence, in order to reduce long term reproductive sequelae of unsafe sexual practices.     

Are sociodemographic and regional and sample factors associated with prevalence of abuse?

BACKGROUND: The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables. METHODS: This cross-sectional study used a validated postal questionnaire in four Swedish samples; patients at three gynecologic clinics with different character and in different regions (n = 2439) and women in one randomized population sample (n = 1168). RESULTS: Any lifetime emotional abuse was reported by 16.8-21.4% of the women; physical abuse by 32.1-37.5%; sexual abuse by 15.9-17.0%; and abuse in the health care system by 14.0-19.7%. For 7-8% abuse had included life threats and 9-20% of all women in the study currently suffered from their experiences of abuse. Most women had not disclosed their background of abuse to the gynecologist. There were differences in sociodemographic variables between the four samples. Generally, in the multivariate analyses we found associations between prevalence of abuse and age, educational level, civil status and occupation, but no consistent association between prevalence of abuse and sample variables. CONCLUSION: Lifetime prevalence rates of the four kinds of abuse were high in all samples as measured by the NorVold Abuse Questionnaire (NorAQ), and 1/10-1/5 women in the study suffered currently from abusive experiences. In multivariate analyses prevalence of abuse was consistently associated with sociodemographic but not to sample variables.     

The association between reported childhood sexual abuse and breastfeeding initiation.

This study examined the association between self-identified childhood sexual abuse and breastfeeding initiation. A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone about child-rearing needs. Respondents were asked to report childhood sexual abuse and breastfeeding practices. Responses of 1220 biological mothers were analyzed. A possible association between self-reported childhood sexual abuse and breastfeeding initiation was investigated through multivariate logistic regression. Seven percent of the respondents reported experiencing childhood sexual abuse. Women who reported childhood sexual abuse were more than twice (adjusted odds ratio = 2.58; 95% confidence interval = 1.14, 5.85; P = .02) as likely to initiate breastfeeding compared with women who did not report childhood sexual abuse. Parenting attitudes and behaviors were compared to consider whether greater concern with parenting is an explanation for this association. In this nationally representative sample, self-identified childhood sexual abuse is associated with an increased likelihood of breastfeeding initiation.