Gender Differences in Pathways from Child Physical and Sexual Abuse to Adolescent Risky Sexual Behavior

Background:Adolescent risky sexual behavior represents a serious public health concern that jeopardizes adolescent health and well-being. A robust body of literature has indicated that child physical abuse and sexual abuse are associated with increased likelihood of risky sexual behavior in adolescence. However, the underlying mechanisms through which physical and sexual abuse influence risky sexual behavior remain unclear. Further, little is known about gender differences in these mechanisms. To address these gaps, this study examined 1) direct and indirect (via internalizing and externalizing symptoms and substance use) pathways linking child physical and sexual abuse to adolescent risky sexual behavior; and 2) tested if these pathways are moderated by gender.

Methods:Structural equation modeling was performed with a total of 862 adolescents (383 males and 479 females) drawn from Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Child physical and sexual abuse was measured using the total number of alleged reports made to child protective services (CPS) from birth to age 12. Internalizing and externalizing symptoms at age 14 were assessed using the Child Behavior Checklist and substance use was assessed at age 16 using adolescent self-report of alcohol, cigarette, and marijuana use frequency in the past 30 days. Risky sexual behaviors were assessed at age 18 using 3 items from the LONGSCAN-developed assessment of sexual experiences (>5 partners, no condom use, no methods of protection used in the last time of sexual intercourse). Adolescents reporting one or more items were coded yes (1). Control variables included the child’s gender, race and early sexual initiations (< age 15).

Results: The path model had a good model fit, indicated by the CFI of .95, RMSEA of .02 (90% CI .01-.04), and WRMR of .83. In the overall sample, physical abuse was associated with elevated externalizing symptoms, which in turn, predicted substance use, leading to risky sexual behavior (β=.03, p=.001). Sexual abuse did not have direct or indirect effects on adolescent risky sexual behavior. Significant gender differences emerged, c² (31)=81.16, p<.001. For males, physical abuse and sexual abuse did not have direct effects but had indirect effects via substance use on risky sexual behavior. For females, physical abuse was directly related to increased risk for adolescent risky sexual behavior (β=.12, p=.031). Further, physical abuse indirectly influenced risky sexual behavior through externalizing symptoms and substance use (β=.02, p=.011) and sexual abuse had indirect effects through substance use (β=.06, p=.018).

Conclusions and Implications: The current study contributes to the literature by identifying significant gender differences in pathways through which child physical and sexual abuse influence risky sexual behavior in adolescence. Adolescent substance use appears to be a key underlying mechanism through which child physical and sexual abuse influence risky sexual behavior for both males and females, whereas externalizing symptoms appear to be unique pathways by which child physical abuse increases the chances for risky sexual behavior in females. Gender-focused and substance-misuse preventive intervention strategies may be effective in eliminating or reducing risky sexual behavior among physically and/or sexually abused adolescents.