Childhood victimization history and adolescents' sexual behavior development

Background and Purpose: Various types of child abuse and neglect are among the major public health concerns across the world. Studies show that early sexual initiation and subsequent sexual behavior trajectory development are linked to childhood experience of maltreatment. Understanding the mechanisms through which early victimization is associated with subsequent trajectories of sexual risks is particularly important, because these risk behaviors have been linked to negative outcomes such as sexually transmitted disease, unwanted early pregnancies, prostitution, and re-victimization. Nonetheless, less is known about the mechanisms underlying the link between abusive and neglectful early childhood experience and later sexual behaviors. Using a nationally representative sample of young adults, this study adds to the existing knowledge regarding the overall and gender specific association between childhood victimization history and sexual risk behavior development.

Methods: This study utilized data from the National Longitudinal Study of Adolescent Health (Add Health). Participants in the study (N = 20,745) were a nationally representative sample of adolescents in grades 7 – 12 between 1994 and 1995. Experience of childhood victimization was measured by respondents' self-reports on their childhood experiences of neglect(NG), physical abuse(PA), and sexual abuse(SA). Based on their experiences of the three types of victimization, seven dummy groups (NG; PA; SA; NG/PA; NG/SA; PA/SA; and NG/PA/SA) were created and compared to the children with no victimization experiences. Age of sexual debut and whether they used contraception and/or condom at respondents' first sex based on their self reports were used to capture their sexual behaviors. We used Cox regression with proportional hazard assumption to model the relationship of childhood victimization history with adolescents' age of sexual debut. We conducted logistic regressions to model the same relationship with contraception and/or condom use at their first sex. All the analyses were conducted controlling for the effects of adolescents gender, age, race/ethnicity, immigration status, poverty status, and region. To take account of design effects (e.g., oversampling of specific groups in the Add Health data), all data were weighted. The svy command in Stata 10 was utilized for all statistical analyses and results.

Results: After adjusting for socio-demographic controls, all groups but PA+SA group (Adjusted hazard ratio(aHR)-NG=1.22; aHR-PA=1.13; aHR-SA=1.70; aHR-NG/PA=1.22; aHR-NG/SA=2.29; aHR-NG/PA/SA=1.44) initiated their first sex significantly younger than no victimization group did. Adolescents in NG/PA group were less likely to use contraception (aOR=0.63, p<.001) and/or condom (aOR=0.69, p=.003) in their first sex than no victimization group.

Conclusions and Implications: Using data from a nationally representative sample, the association between adolescents sexual behaviors and childhood victimization history were investigated. This study's finding indicated that combinations of various childhood victimizations were associated with adolescents' earlier initiation of sexual intercourse. Adolescents' experiences of both neglect and physical maltreatment in their childhood were associated with their lowered likelihood of using contraception and/or condom to protect themselves from unwanted pregnancy or sexually transmitted disease. Findings of this study suggest that special attention need to be provided for victims of childhood maltreatment to protect them from developing risky sexual behaviors.