Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

CONTEXT: Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known. OBJECTIVE: To estimate the risk of self-reported adult HIV-risk behaviors and heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to determine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse. DESIGN: A population-based telephone survey, the 1997 Washington State Behavioral Risk Factor Surveillance System (BRFSS), asked a representative sample of adults whether they had ever been physically or sexually abused in childhood, and if so, the age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 years, about HIV-risk behaviors. PARTICIPANTS: Three thousand four hundred seventy-three English-speaking non-institutionalized civilian adults in Washington State. MAIN OUTCOME MEASURES: Self-reported HIV-risk behaviors in the past year and heavy drinking in the past month. RESULTS: We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with more than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% confidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a 5-fold increase in these risk behaviors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and physical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16.9). Physical abuse alone was not associated with either health-risk behavior for women. For men, any sexual abuse was associated with an 8-fold increase in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alone was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of the men who were asked about HIV-risk behaviors reported any history of childhood abuse, these accounted for 51% and 50% of those reporting HIV-risk behaviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively. CONCLUSIONS: Efforts to prevent or remediate adult health-risk behaviors should consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a general-population survey also reported childhood abuse.     

北京市200名HIV阳性男大学生性取向和性行为特征

  目的  了解北京市HIV阳性男性大学生的性取向及其与HIV感染者的相关性行为特征,为制定学生人群的性健康教育和艾滋病防控策略提出建议。  方法  招募北京地区2016年至2019年6月30日确诊HIV感染的200名男性大学生,利用问卷回顾性调查HIV感染前的性取向和性行为特征,对比分析绝对同性性行为取向者与其他性取向者的差异。  结果  男性大学生HIV感染者首次确诊时平均年龄为(22.18±2.70)岁,61.5%(123名)处于本科阶段,69.5%(139名)为外地户籍,38.5%(77名)感染前性伴来源于网聊约见的人,83.0%(166名)发生过同性性行为。性取向自我评分显示,50.0%为绝对同性性行为者,绝对同性性行为组确认HIV感染时的平均年龄低于其他性行为取向组, 差异有统计学意义(t=2.77,P=0.01),Rush的使用率、首次插入性行为对象为男性、18岁前发生首次同性性行为、同性性伴数>3人、未坚持使用安全套、有固定性伴、同性性行为频率多于每月1次比例均高于其他性行为取向者(χ2值分别为5.15,28.06,4.16,5.34,5.89,7.39,6.68,P值均 < 0.05)。绝对同性性行为组中Rush使用者性病的确诊比例高于不使用Rush者(χ2=6.26,P=0.01)。  结论  男性大学生HIV感染者中绝对同性性行为者高危性行为比例高于其他性取向者。学校和家庭需要关注学生的性健康教育,利用网络传媒加强健康宣传,提高大学生群体对艾滋病的警觉性。     

广州市青少年性相关行为发生情况分析

目的 了解广州市青少年性相关行为现况,为制定干预措施提供科学依据.方法 采用“中国青少年健康相关行为调查问卷”,对分层整群随机抽取的广州市66所大中学校11939名学生进行问卷调查.结果 15.22％的中学生看过色情书籍和音像制品,农村(16.46％)高于城市(14.44％)；男生(25.07％)高于女生(6.23％)；职中生最高(25.41％),普通中学(13.93％)高于重点中学(10.71％),差异均有统计学意义(P值均＜0.01).在看过色情书籍、音像制品的学生中,曾发生性行为率高达22.35％.在高中、职中学生中,35.82％曾单独约会异性朋友,34.95％有亲密行为,7.26％曾经发生过性行为,2.10％学生有被迫性行为,73.97％从学校接受过有关艾滋病知识教育,63.44％知道艾滋病病原体是病毒,31.76％对艾滋病感染者持正确态度.8.87％大学生有过性行为,使用安全套的比例占68.52％.结论 广州市青少年性相关行为频发但预防教育不足,要加强对青少年性观念及行为的正确引导.     

童年期性虐待与大学生性取向的相关性

目的 探讨童年期性虐待与大学生性取向之间的关联及其性别差异,为中国青少年童年期性虐待和性取向研究提供基础数据.方法 采用多阶段整群抽样的方法,抽取合肥市4所大学4 034名学生作为研究对象进行问卷调查,调查人口统计学特征、童年期性虐待经历以及性取向.采用Logistic回归模型分析不同类型和不同时期的性虐待经历与大学生...     

Prevalence of childhood sexual abuse among Mexican adolescents

Background   To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students.
Methods   A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse.
Results   The prevalence of child sexual abuse was 18.7% ( n  = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling.
Conclusions   In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3–8.4%), although it was similar to that found in the Spanish child population (15–23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.     

Child sexual abuse and premarital intercourse among high-risk adolescents

This study examined the extent to which child sexual abuse was associated with an increased likelihood of premarital sex among adolescents at high risk of sexual abuse. The sample consisted of 177 teenage girls who, because of evidence of family dysfunction, had become part of a public child welfare system. Half the sample had been placed in a foster home and the remainder were receiving protective services in their own home. About 40% of the teens in both groups had been sexually abused, although teens still living at home were less likely to have reported abuse. Victims of sexual abuse were found to be more likely to have engaged in voluntary sexual intercourse, even after background factors were controlled. Teens in foster home were somewhat less likely to be sexually active than the teens who remained at home.     

Sexual orientation and substance use among adolescents and young adults

Objectives. We examined interrelationships among the 3 dimensions of sexual orientation—self-identity, sexual attraction, and sexual experience—and their associations with substance use among adolescents and young adults.Methods. To estimate total and net associations of sexual identity, attraction, and experience with use of tobacco, drugs, and alcohol, we applied logistic regression to cross-sectional data from the National Survey of Family Growth Cycle 6.Results. We found a lack of concordance among the different dimensions of sexual orientation. More youths reported same-gender sexual attraction and same-gender sexual experiences than identified as lesbian, gay, or bisexual. Estimates of substance use prevalence differed significantly by gender and across dimensions of sexual orientation. Sexual experience was the most consistent predictor of substance use. Women and men with no sexual experience had the lowest odds of all forms of substance use; those reporting sexual experience with partners of both genders had the highest odds.Conclusions. Our findings indicate that sexual identity was less strongly associated with substance use than sexual experience and attraction were, pointing to the need for more nuanced indicators of sexual orientation in public health studies.Increasing evidence points to an association between sexual orientation (SO) and substance use among adolescents and young adults. Population-based research has confirmed earlier studies reporting elevated rates of illicit drug use and problem drinking among youths who reported same-gender attractions or same-gender sexual experiences, or who self-identified as lesbian, gay, or bisexual (LGB).^1–5 Although most quantitative studies lack the measures necessary to elucidate the mechanisms underlying this association, the higher prevalence of substance use among sexual-minority youths typically is understood within the rubric of social stress theory as a manifestation of what has been referred to in research on LGB health as minority stress.^6,7Social stress theory conceptualizes the stigma and prejudice associated with a minority status as psychosocial stressors that are activated by experiences of discriminatory treatment, including both major events and everyday discrimination, continual anticipation of negative treatment, and internalization of negative societal attitudes.^8–11 Substantial evidence links discrimination-based stress to compromised psychological health, including substance use disorders, particularly among African Americans.^12–15 SO has received less attention in this context, but relevant findings so far are largely consistent with the findings for racial/ethnic minorities. Compared with heterosexual persons, lesbians and gay men report greater experience of discrimination^16–18 and have a higher incidence of psychosocial disorders.^19–22In light of the dearth of formal support systems (e.g., school-based gay–straight alliances, LGB community centers) for youths questioning their sexuality and the difficulty some LGB youths face in revealing themselves to family and friends, this evidence makes minority stress a compelling explanation for the association between SO and substance use. However, extant research provides only limited insight into which youths are at elevated risk for substance use because of gay-related stress.²³ This shortcoming reflects the paucity of nationally representative data sets containing information on both substance use and SO, as well as a lack of consensus about how to measure SO.^24,25 In the substance use literature, SO has been operationalized variously as sexual self-identity, sexual (or romantic) attraction, and sexual (or romantic) relationships. Although findings are similar across studies regardless of the measures used and the specific population represented, evidence increasingly suggests that these measures—which correspond approximately to the cognitive, affective, and behavioral dimensions of SO—are not interchangeable.²⁶An evaluation of school-based health surveys that included multiple measures of SO found that within each survey, groups defined on the basis of 1 measure of SO overlapped substantially—but were not entirely congruent—with groups defined by other measures.²⁷ An earlier study of a probability survey of US adults reported similar divergence across subgroups defined by sexual self-identity, attraction, and behavior.²⁸ In short, self-identity, attraction, and behavior are not wholly concordant. Not all individuals who have sexual experience with same-gender partners identify as LGB; nor do individuals who acknowledge same-gender attractions or sexual fantasies necessarily act on them.^29–32The divergence of the cognitive, affective, and behavioral dimensions of SO raises the possibility that identifying as LGB, recognizing same-gender attractions, or engaging in same-gender sexual behavior need not engender similar levels of distress or be similarly associated with substance use. In this study, we used data for teens and young adults from the National Survey of Family Growth Cycle 6 (NSFG-6) to examine the net associations of identity, attraction, and experience with various forms of substance use. We did not assume that all substance use by young people is motivated by psychological distress. Rather, we assumed that any distress associated with a sexual-minority status is sufficient to increase the risk of substance use above what is typical at that stage of the life course. Our analyses addressed 3 issues: (1) the alignment of sexual self-identity, attraction, and experience among youths aged 15 to 24 years; (2) the prevalence of substance use across groups defined by sexual self-identity, attraction, and experience; and (3) the net associations of identity, attraction, and experience with substance use.     

Sexual abuse of children and adolescents: characteristics of sexual victimization in family relations

This study analyzes the characteristics of sexual abuse committed within the family against age groups classified according to the Brazilian Statute for Children and Adolescents (the prevailing legislation on matters pertaining to minors) and treated at the Reference Center for Children and Adolescents and the Guardianship Councils in Ribeir?o Preto, S?o Paulo State, Brazil, from 1995 to 2000. Some 234 abuses were identified, committed by 217 aggressors, against 210 families and a total of 226 victims. A total of 131 children (48.7%) and 95 adolescents (41.2%), predominantly females, were victimized. Children ranging from 10 to 12 years were the most frequently abused (19.5%), as well as adolescents from 12 to 14 years old (17.3%). The majority of the victims live in families with 3 (19.9%) or 4 children (177%), and the firstborn are the most frequently abused (33.6%). The majority of aggressors who acted alone victimized only one individual (86.7%). Fathers (34.2%) and stepfathers (30.3%) were the most frequent aggressors, with the former victimizing more children (19.7%) and the latter adolescents (17.1%).     

Risky sexual behaviors among Malay adolescents: a comparison with Chinese adolescents in Singapore

Objective: Malays, with majority of the individuals being Muslim, form the largest ethnic group in Southeast Asia. This region is experiencing a rising incidence of HIV infections. Due to circumcision and prohibition of sex outside marriage, being Muslim was argued to be a protective factor against sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). However, Malay adolescents were found to be more likely to contract chlamydia and gonorrhea than non-Malay adolescents in Singapore.

Design: Using a cross-sectional survey, we examined and compared safer sex knowledge, attitudes and self-efficacy, and sexual behaviors of 248 sexually active Malay adolescents with 384 Chinese adolescents aged 16–19 years in Singapore. Poisson regression, adjusted for socio-demographic characteristics, was used for modeling each dependent variable. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were obtained.

Results: On multivariate analysis, Malay adolescents were more likely to report marginally unfavorable attitude towards condom use (aPR 1.21 CI 1.00–1.48) and significantly lower confidence in using condoms correctly (aPR 1.24 CI 1.05–1.47) than Chinese adolescents. They were also more likely to report significantly younger first sex age (aPR 0.98 CI 0.96–1.00), never use of condoms for vaginal sex (aPR 1.32 CI 1.16–1.49) and anal sex (aPR 1.75 CI 1.11–2.76) and non-use of contraceptives at last sex (aPR 1.30 CI 1.17–1.45) than Chinese respondents. Malay males were less likely to buy sex (aPR 0.56 CI 0.37–0.85), but they reported higher likelihood of inconsistent condom use with female sex workers (aPR 2.24 CI 1.30–3.87).

Conclusion: Malay ethnicity was associated with unfavorable condom use attitude and lower self-efficacy in using condoms, which was consistent with risky sexual behaviors such as non-use of condoms. Future research should use mixed methods to explore and identify cultural influences to these behaviors.     

Risky sexual behaviors among adolescents with alcohol use disorders.

Little is known about risky sexual activity among adolescents with alcohol use disorders. This study of 371 adolescent drinkers found that those with alcohol disorders were more likely than other drinkers to be sexually active, to have greater numbers of partners, and to initiate sexual activity at slightly younger ages. Independent of alcohol group, females were more likely than males to have unprotected sexual encounters.     

Parental physical abuse and sexual orientation in males

Because male homosexuals have usually been found to have poorer relationships with their fathers than male heterosexuals, and because children who are disappointments to their parents are more likely to be physically abused than other children, it was hypothesized that gays are more likely than heterosexual men to have been physically abused by parents. This hypothesis was tested comparing 17 gay male college students and 67 heterosexual male college students. Gay males were found to have been more abused during adolescence. Abuse was related to a history of childhood femininity, to having poor relationships with fathers, and to having engaged in gay sex during adolescence. A history of childhood femininity and engaging in gay sex may provoke parental abuse.     

Sexual orientation and disordered eating behaviors among self-identified male and female college students

This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008–2009) were utilized (N = 110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2 weeks), stress (last 12 months), smoking (past 30 days), depression (past 12 months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p < .002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p < .002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.     

Sexual orientation and consistency of sexual identity

The semantic confusion in the use of the terms sexual and gender identity and role is discussed. Theories concerning the development of the sense of sexual identity in normals have been based largely on the sense of sexual identity in sexually deviant subjects. It is suggested that such subjects may have a stronger and more consistent sense of sexual identity than subjects unaware of sexually deviant impulses. Male medical students in two consecutive years anonymously completed a questionnaire concerning their sexual orientation, preference, role, and identity. In both years, students aware of a homosexual component answered the items investigating their sexual identity with greater consistency than did the students unaware of a homosexual component.     

Child sexual abuse as a risk factor for sexual risk behaviours among socially disadvantaged adolescents in Ibadan,Nigeria

This study documents the prevalence and association between child sexual abuse (CSA) and risky sexual behaviours among in-school adolescents in Ibadan, Nigeria. A cross-sectional study with 1,079 boys and 1,211 girls was conducted in 22 socially disadvantaged public secondary schools in a suburb of Ibadan, Nigeria. A 70-item sexual risk behaviour questionnaire was used to collect information on lifetime and current sexual experiences. Fifty-five per cent of students reported to have ever experienced at least one form of CSA. Thirty-six per cent reported a history of intra-family CSA, whereas 46% had experienced inter-family CSA. Five hundred and sixty-four (24.6%) of these adolescents were sexually active at the time of the study. There was a strong relationship between having ever experienced CSA and sexual risk behaviours: adolescent boys and girls with CSA were three-fold as likely not to use condom at last vaginal intercourse; thrice as likely to engage in casual sex with a partner known for a day; twice as likely to drink alcohol heavily before sex; thrice for tobacco smoking and three- fold for STD. Logistic regression shows that the relationship between CSA and non-use of condom at last vaginal intercourse remained after controlling for age, family type, parents staying together and hawking after school. We found that experiences of CSA may precipitate risky sexual behaviours in this population. A structural and educational approach towards educating both adolescents and parents of the possible effect of CSA to sexual risk behaviours is presented in this article.     

Association between employment and substance abuse behaviors among public high school adolescents.

PURPOSE: To examine the relationship between adolescents' after-school and weekend employment and substance abuse behaviors in a cross-sectional sample of public high school students in South Carolina. METHODS: The Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) was used to secure usable data from 4800 subjects. Logistic regression adjusting for age and using SUDAAN were performed. Odds ratios and 95% confidence intervals were calculated from the regression analyses. RESULTS: Thirty percent of white males, 29% of white females, and 20% of black males and females worked at a job for pay during the academic year. For white males employment, ranging from 11 to 15 h and 26 to > or =31 h was associated with cigarette smoking, working from 11 to > or =31 h was associated with alcohol use, working > or =31 h was associated with binge drinking, working from 26 to > or =31 h was associated with marijuana use, and working from 26 to 30 h was associated with cocaine use. For white females, working from 16 to 20 h was associated with alcohol use, working from 21 to 30 h was associated with binge drinking, and working from 26 to 30 h was associated with marijuana and cocaine use. CONCLUSION: Youth who work above 15 h/week at a job for pay during high school appear to have an increased risk for substance abuse and its consequences.     

青少年性知识、性态度和性行为现状研究

【目的】了解青少年性与生殖健康知识、态度和行为现状,为相关研究和干预提供依据。【方法】于2005年6~9月对武汉市桥口区、武昌区和青山区三所中学共2 987名初中学生进行知识、态度、行为(knowledge,attitude and practice,KAP)问卷调查。【结果】青少年已具备一定的青春期知识,但对生殖系统和功能缺乏系统的认识,一些概念模糊不清;男性的知识好于女性;初一学生的知识水平低于初二、初三学生。男性在对待青少年谈恋爱和性行为问题上的态度要比女性宽容。14.0%的调查对象谈过恋爱;随着年级升高,有过恋爱经历的比例逐渐增高。1.3%的调查对象有过性交经历;男生有过性交经历的比例(1.7%)高于女生(0.9%)。大多数青少年认为青春期性教育是必需的。【结论】充分了解青少年的性知识、性态度和性行为现状对设计良好的干预项目极有帮助。青春期性教育应是全社会关注的焦点之一。