Thompson Richard, Lewis Terri, Neilson Elizabeth C, English Diana J, Litrownik Alan J, Margolis Benyamin, Proctor Laura, Dubowitz Howard
1 Juvenile Protective Association, Chicago, IL, USA.
2 University of Colorado Denver, Aurora, CO, USA.
Child Maltreat. 2017 Feb;22(1):69-78. doi: 10.1177/1077559516674595. Epub 2016 Oct 24.
Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of each form of maltreatment were coded. At age 16, potential mediators (trauma symptoms and substance use) were assessed. At age 18, risky sexual behavior (more than four partners, unprotected sex, unassertiveness in sexual refusal) was assessed. Neglect significantly predicted unprotected sex. Substance use predicted unprotected sex and four or more partners but did not mediate the effects of maltreatment. Trauma symptoms predicted unprotected sex and mediated effects of emotional maltreatment on unprotected sex and on assertiveness in sexual refusal and the effects of sexual abuse on unprotected sex. Both neglect and emotional maltreatment emerged as important factors in risky sexual behavior. Trauma symptoms appear to be an important pathway by which maltreatment confers risk for risky sexual behavior. Interventions to reduce risky sexual behavior should include assessment and treatment for trauma symptoms and for history of child maltreatment in all its forms.
危险的性行为是一个严重的公共卫生问题。儿童性虐待是一个既定的风险因素，但其他形式的虐待似乎也会增加危险行为。儿童虐待影响风险的机制尚未得到充分理解。本研究使用了来自859名高危青少年的数据，跟踪至18岁。对每种虐待形式的官方报告进行了编码。在16岁时，评估了潜在的中介因素（创伤症状和物质使用情况）。在18岁时，评估了危险的性行为（有四个以上性伴侣、无保护性行为、在性拒绝方面不坚定）。忽视显著预测了无保护性行为。物质使用情况预测了无保护性行为和有四个或更多性伴侣，但并未介导虐待的影响。创伤症状预测了无保护性行为，并介导了情感虐待对无保护性行为以及对性拒绝时的坚定程度的影响，还有性虐待对无保护性行为的影响。忽视和情感虐待都成为危险的性行为中的重要因素。创伤症状似乎是虐待导致危险的性行为风险的一条重要途径。减少危险的性行为的干预措施应包括对创伤症状以及各种形式的儿童虐待史进行评估和治疗。
