Advancing Sexual and Reproductive Health and Rights
 
Family Planning Perspectives
Volume 33, Number 1, January/February 2001
DIGEST

A History of Sexual Abuse Elevates the Massachusetts Teenagers' Risk of Engaging in Unsafe Sexual Practices

Almost one-third of females and nearly one in 10 male high school students in Massachusetts say they have experienced sexual abuse.1 Moreover, teenagers who have had such experiences are more likely than others to take sexual risks. Young women who say they have had sexual contact against their will are more likely than those who have not to have had intercourse before age 15 and to have had multiple sex partners. Adolescent males with a history of sexual abuse are more likely than those without to have had three or more partners in their lifetime and to have had two or more partners within the past three months. Both males and females who have had sexual contact against their will are also more likely than their counterparts to have ever been pregnant or had sex that resulted in a pregnancy.

To assess the association between sexual abuse and risky sexual behavior among adolescents, researchers analyzed data from the 1997 Massachusetts Youth Risk Behavior Survey. Students from 58 randomly selected Massachusetts public high schools participated in the survey, and data were weighted to reflect all such students in the state. The analyses are based on respondents who reported having ever had sexual intercourse (779 females and 831 males). These young people were evenly distributed by age-group and grade. Of the females, 74% were white, 10% were Hispanic and 8% were black. Among males, 69% were white, 12% were Hispanic and 10% black. Ninety-six percent of females and 94% of males reported having partners of the opposite sex only.

Looking at sexual risk behaviors, the researchers found that 50% of males were younger than 15 when they first had intercourse, that 43% had had three or more partners in their lifetime and that 19% had had two or more partners in the past three months. Among males, 30% reported alcohol use at last sex, 35% said they had not used a condom at last intercourse and 13% reported that they had impregnated a partner. Among females, 43% were younger than 15 when they first had intercourse, 36% had had three or more partners in their lifetime and 12% had had two or more partners in the past three months. Almost half of female adolescents who had had only male partners reported not having used a condom at last intercourse (45%). Overall, 18% said that they had been pregnant, and 23% said that they had used alcohol at last sex. Among all students who reported having partners of the opposite sex only, close to 30% said they had not used any contraceptive at last intercourse.

The authors also examined behaviors related to sexual risk, including aggressive and delinquent activities, as well as alcohol and drug use. In response to the question "During your life, has anyone ever had sexual contact with you against your will?" 30% of females and 9% of males answered yes. Whereas 56% of young men reported fighting within the past 30 days, 37% of young women did so. Additionally, 40% of males said that they had carried a weapon, 72% that they had used alcohol, 51% that they had participated in binge drinking and 51% that they had used marijuana within the past 30 days. Thirteen percent of females reported that they had carried a weapon, 67% that they had used alcohol, 44% that they had participated in binge drinking and 45% that they had used marijuana within the past 30 days. While 38% of young women had thought about suicide within the past 12 months, 23% of males had done so. Nearly all adolescents had received HIV education in school (91-94%).

The researchers used logistic regression analyses to determine the relationship between sexual risk and sexual abuse, controlling for demographic variables found in chi-square analyses to be significantly associated with sexual risk (age, grade, and race or ethnicity). Young women with a history of abuse were significantly more likely than other females to have first had sex before the age of 15 (odds ratio, 2.3), to have had three or more partners in their lifetime (2.9), to have had two or more partners in the past three months (2.1), to have ever been pregnant (2.2) and to have used substances prior to last intercourse (1.5). Despite slightly elevated odds ratios, females who reported abuse were no more likely than other young women to have not used a condom or to have not practiced contraception at last intercourse.

Males who reported having been sexually abused were significantly more likely than those who did not to have been younger than 15 at first intercourse (odds ratio, 2.4), to have had three or more partners in their lifetime (4.2), to have had two or more partners within the past three months (5.1) and to have used substances at last sex (2.7). They were also more likely to have not used a condom (1.5) and to have not practiced contraception (2.2) at last intercourse and to have ever had sex that resulted in a pregnancy (5.3).

To further assess the effects of a history of sexual abuse on sexual risk behaviors, the authors conducted stepwise logistic regression analyses (controlling for selected demographic characteristics and other factors associated with these risk behaviors). Females with a history of abuse remained significantly more likely than those without a history of abuse to have experienced first intercourse before age 15 (odds ratio, 2.2) and to have had three or more partners in their lifetime (2.5). Young women who had experienced sexual contact against their will also continued to be significantly more likely than their counterparts to have ever been pregnant (1.9).

Among males, those with a history of abuse remained significantly more likely than other young men to have had three or more partners ever (odds ratio, 3.2) and to have had two or more partners within the past three months (2.9). Furthermore, those with this history continued to be more likely than those without this background to have gotten someone pregnant (3.4). Condom use and contraceptive use did not remain significantly associated with a history of sexual abuse in analyses for adolescent males.

Because they found an association between sexual abuse and risky sexual behaviors, the authors conclude that sexuality education programs should raise awareness about sexual abuse and existing referral services and that health personnel should screen for sexual assault among adolescents and provide referrals. They also emphasize that a more integrated approach is required to respond to the needs of adolescents with a history of sexual abuse because they often engage in sexual and other risk behaviors. Finally, they stress that "interventions for gay, lesbian, and bisexual youth as well as heterosexual boys, populations much overlooked in prevention research and practice, are also needed to reduce both sexual abuse trauma and sexual risk."--L. Schreck

REFERENCE

1. Raj A, Silverman JG and Amaro H, The relationship between sexual abuse and sexual risk among high school students: findings from the 1997 Massachusetts Youth Risk Behavior Survey, Maternal and Child Health Journal, 2000, 4(2):125-134.