Childhood sexual abuse and revictimization in adolescence.

OBJECTIVE: The aim of this study was to examine the link between childhood experiences of sexual abuse and subsequent revictimization in adolescence. METHOD: A sample of 281 female adolescents between 17-20 years of age, who participated in a prevalence survey of unwanted sexual contacts, completed the Sexual Experiences Survey as a measure of unwanted sexual contacts in adolescence and indicated whether or not they had experienced childhood sexual abuse. RESULTS: Childhood experiences of sexual abuse were reported by 8.9% of the respondents, a further 8.5% indicated they were not sure if they had been sexually abused as children. Both abused women and women uncertain about their victimization status were significantly more likely to report unwanted sexual contacts as adolescents than women who did not state abuse. The link between childhood abuse and subsequent victimization was mediated by a higher level of sexual activity among the abuse victims. CONCLUSIONS: The results support existing evidence on the impact of childhood sexual abuse on sexual relationships in subsequent developmental stages and underline the need to consider childhood sexual abuse as a risk factor of adolescent sexual victimization.     

The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

OBJECTIVE: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. METHOD: The sample consisted of 8472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. RESULTS: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. CONCLUSIONS: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.     

Relationships with mothers and peers moderate the association between childhood sexual abuse and anxiety disorders

OBJECTIVE: The objective of the current study was to assess whether relationships with mothers and peers moderate the association between childhood sexual abuse (CSA) and anxiety disorders. That is, positive and supportive experiences were expected to minimize the effects of CSA whereas nonsupportive experiences were expected to magnify them. METHOD: Participants from a large, stratified, multistage-area, probability community sample provided retrospective reports of CSA and childhood relationships with mothers and peers and a modified version of the Composite International Diagnostic Interview produced life-time psychiatric diagnoses of four non-phobic anxiety disorders after the age of 18. RESULTS: Utilizing multiple-regressions, a two-way interaction found that for those reporting low levels of friendship quality there was a stronger link between CSA and the number of diagnosed anxiety disorder than those reporting high levels of friendship quality. In addition a three-way interaction found that those reporting to have no friends and a low quality mother-child relationships had the strongest association between CSA and the number of diagnosed anxiety disorders, while those reporting to have many friends and a high quality relationship had the weakest association. CONCLUSIONS: The findings from the current study suggest that relationships with friends and parents may play an important role in understanding the links between childhood sexual abuse and later anxiety disorders and that these relationships may also be important sources of protection against the negative effects of childhood sexual abuse.     

Self-reports of forgetting and remembering childhood sexual abuse in a nationally representative sample of US women

OBJECTIVE: The purpose of this article is to describe patterns of forgetting and remembering childhood sexual abuse (CSA) in a nationally representative sample of US adult women. METHOD: The respondents were a national probability sample of 711 women, aged 26 years to 54 years, residing in noninstitutional settings in the contiguous 48 states. In a 1996 face-to-face interview survey, trained female interviewers asked each respondent whether she had experienced any sexual coercion by family members or nonfamily members while growing up; whether she believed that she had been sexually abused (by family members or others); and whether she had ever forgotten the CSA experiences and, if so, how she had subsequently remembered them. RESULTS: Twenty-one and six-tenths percent of respondents reported having sexually coercive experiences while growing up; of these, 69.0% indicated that they felt they had been sexually abused. More than one-fourth of respondents who felt sexually abused reported that they had forgotten the abuse for some period of time but later remembered it on their own. Only 1.8% of women self-described as sexually abused reported remembering the abuse with the help of a therapist or other professional person. CONCLUSIONS: The findings indicate that, among women who report CSA, forgetting and subsequently remembering abuse experiences is not uncommon. According to the women surveyed, however, very few (1.8%) of those who felt abused recovered memories of CSA with help from therapists or other professionals. As one of the few studies of CSA memories in a nationally representative sample, this study suggests that therapist-assisted recall is not a major source of CSA memories among women in the US general population.     

The relationship between parental psychiatric disorder and child physical and sexual abuse: findings from the Ontario Health Supplement

OBJECTIVE: The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents. METHOD: A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse. RESULTS: The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent. There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder. CONCLUSIONS: The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased.     

Childhood sexual abuse by representatives of the Roman Catholic Church: A prevalence estimate among the Dutch population

Estimates of the extent of childhood sexual abuse (CSA) within in the Roman Catholic Church (RCC) in the general population are difficult to find. The independent Commission of Inquiry into sexual abuse of minors in the RCC in the Netherlands collected population-based data to estimate its prevalence. A large random online population sample was surveyed using a two-phase stratified sampling procedure. In Phase 1, 34,267 subjects aged 40 years and older were screened for childhood exposure to sexual abuse by non-family members, a history of institutionalization and a Roman Catholic upbringing. In Phase 2, a stratified subset of 2,462 subjects was assessed to obtain more detailed target information about sexual abuse reports within the RCC. We employed multiple imputation for the estimation of RCC CSA in the original Phase 1 sample. The prevalence of non-familial CSA in general (14.0%) was higher among women (17.2%) than among men (10.6%). The prevalence of CSA within the Dutch RCC (1.7%) was higher among men (2.7%) than among women (0.7%). As expected, older subjects reported more often CSA in the RCC than their younger counterparts. Respondents who stayed for some time in RCC run institutions for education or child protection had a higher risk to report sexual abuse. Although sexual abuse of minors by representatives of the RCC was a structural problem during a period that the Church was highly influential in the Netherlands, the estimated prevalence of the phenomenon is only a fraction of the prevalence rate of non-familial CSA.     

Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.     

Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires,Argentina

This study sought to describe childhood sexual experiences with older partners (CSEOP) among men who have sex with men (MSM) in Buenos Aires, Argentina. MSM were recruited through respondent driven sampling. They responded to a computer administered self-interview with questions on CSEOP, operationalized as manual, oral, genital, or anal contact prior to age 13 with a partner at least 4 years older. Of the 500 respondents, only 25% identified as gay. Eighteen percent of the respondents reported CSEOP, the majority of whom did not feel they were hurt by the experience and did not consider it to be childhood sexual abuse (CSA). Over two-thirds of MSM who reported CSEOP said that their older partner was a female. Only 4% of those with a female partner felt their experience was CSA compared to 44% of those who had a male partner. Among all men reporting CSEOP, those who felt sexually abused were more likely to have been physically forced or threatened, physically hurt, and emotionally hurt than those who did not feel sexually abused. Having CSEOP, being hurt by the experiences, and perceiving the experiences as sexual abuse were not associated with current HIV sexual risk or substance use behavior. In this sample of MSM in Argentina, a substantial minority reported CSEOP. Those who felt they had been sexually abused were much more likely to have had an older male partner than an older female partner, and were more likely to report having been physically forced and threatened by their older partner.     

History of childhood abuse in Portuguese parents

OBJECTIVE: The study examines the self-reported prevalence of childhood physical and sexual abuse in a large sample of Portuguese parents. METHOD: Nearly 1,000 parents (506 mothers and 426 fathers) were selected through public primary schools from the Northern area of Portugal. All completed the Portuguese version of the Childhood History Questionnaire (CHQ) [Journal of Family Violence 5 (1990) 15]. RESULTS: Results show that the prevalence of abuse was 73%, but more severe physical abuse involving sequelae/injury was reported by 9.5%. Most physical abuses began prior to age 13, with half continuing after age 13. No gender differences were found for rates of physical abuse. However, among the milder physical abuse without sequelae/injury, those women who experienced "whipping" or "slapping/kicking" were more likely to do so from their mothers than fathers. Among men who were "slapped/kicked" this was more likely to be from their fathers. Low rates of sexual abuse were found at 2.6% with no gender or age differences. Lack of a supportive adult in childhood related to the more severe abuses, but only in adolescence. Portuguese rates of abuse were consistently lower than those reported in USA and Spanish studies using the CHQ. CONCLUSIONS: This is the first retrospective, self-report study of childhood abuse in a large sample of Portuguese parents and, even with a participation rate of 69%, shows lower rates than in US and Spanish samples.     

Childhood sexual abuse among university students in Tanzania

OBJECTIVES: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. METHOD: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. RESULTS: The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse. CONCLUSION: The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the "sugar daddy/mammy" phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania.     

Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress

ObjectiveTo investigate the extent to which childbirth may function as a retraumatization of childhood sexual abuse, and may exacerbate postpartum posttraumatic stress reactions.MethodsData was obtained from a convenience sample of 837 women in mid-pregnancy, at 2 and 6 months following childbirth. Three groups were drawn from this sample: women who experienced childhood sexual abuse (CSA), women survivors of trauma other than CSA, and women who reported no-trauma experiences.ResultsPTSD subcategories of intrusion and arousal were increased in the CSA group following childbirth, although the overall PTSD score did not increase following childbirth in any of the groups CSA survivors scored higher at all data collection time points.ConclusionsCSA is a traumatic event that has greater negative long-term effects than other traumas in the population of pregnant women.Practice implicationsIdentifying women who are survivors of CSA early in their pregnancy and establishing a risk assessment may significantly reduce delivery complications and consequently mitigate postpartum PTS outcomes.     

Childhood risk factors for alcohol abuse and psychological distress among adult lesbians

OBJECTIVE: This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians. METHODOLOGY: Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians. RESULTS: Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress. CONCLUSION: While the cross-sectional design precludes causal conclusions, study findings--especially those related to CSA--are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse.     

Men's and women's childhood sexual abuse and victimization in adult partner relationships: A study of risk factors

Objectives(1) Document the prevalence of childhood sexual abuse (CSA), childhood physical assault, psychological, physical and sexual intimate partner violence (IPV) in a nationally representative sample. (2) Assess the predictive value of CSA and other characteristics of the respondents and their current partners as potential risk factors for IPV. (3) Assess factors predicting IPV in adulthood in a subsample of women reporting CSA.MethodsThe role of CSA as a risk factor for adult IPV was examined using data from the 1999 Canadian General Social Survey. A national stratified sample of 9170 women and 7823 men with current or previous partners were interviewed by telephone by Statistics Canada. Multiple logistic regressions were used.ResultsCSA consistently predicted IPV for women and men, although this relationship was weaker for men. Age, current marital status and limitations due to physical or mental condition or chronic illness were also predictors of IPV for men and women. For women reporting CSA, age (being younger) or being in a more recent relationship and being limited due to either physical, mental conditions or chronic illness were predictive of adult victimization.ConclusionsThese findings indicate that CSA is associated with a greater risk of IPV beyond sociodemographic risk factors.Practice implicationsTo prevent IPV in women already at risk because of CSA, education about protective strategies seems important, particularly for women with physical or mental limitations, in the beginning stages of intimate relationships or for women with partners who drink excessively.     

Risk factors and child sexual abuse among secondary school students in the Northern Province (South Africa)

OBJECTIVE: This is an investigation into the risk factors that could discriminate childhood sexual abuse (CSA) from non-abuse in the Northern Province (South Africa). METHOD: 414 students in standard 9 and 10 in three secondary schools in the province filled-in a retrospective self-rating questionnaire in a classroom setting. Questionnaires included modified and adapted questions from the Finkelhor's (1979) Risk Factor Checklist, and asked for physical contact forms of sexual abusive experiences of participants before the age of 17 years with an adult or a person at least 5 years older or a person in a position of power. RESULT: It shows an overall (N = 414) CSA prevalence rate of 54.2%. Only four factors (from eight)-ethnicity not Northern Sotho, mother employed and not as laborer, a stepparent present in the family during childhood, and violence at home not seldom-significantly discriminated CSA from non-abuse. Increase in the number of combination of the four significant factors also increases the probability of the discrimination in a linear manner. CONCLUSION: With some caution, we recommend the four significant risk factors for use while planning preventive strategies against childhood sexual abuse, and a massive campaign against child sexual abuse in the province. More job opportunities should be created in the province.     

Prevention of child sexual abuse in China: knowledge, attitudes, and communication practices of parents of elementary school children

OBJECTIVE: Active involvement by parents may contribute substantially to the success of school-based programs to prevent child sexual abuse (CSA). In China, little is known about parental understanding of CSA. This study investigated Chinese parents' knowledge, attitudes, and communication practices with their children about CSA. METHOD: Six hundred and fifty-two parents of Grade 3 pupils of seven elementary schools in Jingzhou city, Hubei province (central China), completed an anonymous questionnaire (response rate=81%). RESULTS: More than 95% of respondents agreed that elementary schools should provide programs to prevent CSA and were willing to have their children participate in such programs. Although nearly all parents talked with their children about stranger danger, they were much less likely to talk specifically about sexual abuse. Many parents personally lacked basic knowledge about characteristics of perpetrators, the sexual abuse of boys, and nonphysical consequences of CSA. About half (46.8%) expressed some concern that CSA preventive education could cause their children to know "too much about sex." Contrary to expectations from research in western nations, parents who talked with their children about CSA did not have better knowledge or more supportive attitudes to CSA prevention than did parents who said they never discussed CSA with their children. CONCLUSION: This study confirms and extends two recent surveys indicating strong support for the concept of school-based CSA prevention in China. However, given the apparently low levels of knowledge about CSA, even among those who talk about this problem with their children, future prevention programs should include community-wide efforts to educate adults to ensure that parental advice is accurate and hopefully, effective.     

Childhood physical and sexual abuse: prevalence and correlates among adolescents living in rural Taiwan

OBJECTIVE: The aims of this cross-sectional survey study were to examine the prevalence and correlates of childhood physical and sexual abuse in adolescents living in the rural areas of Taiwan. METHOD: A sample of indigenous (n=756) and non-indigenous (n=928) adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. Structured questionnaires were used to collect data anonymously. The prevalence of childhood physical and sexual abuse was examined and their correlates were examined using univariate and multivariate logistic regression. RESULTS: A total of 374 (22.2%) adolescents reported experience of physical abuse and 42 (2.5%) reported sexual abuse in their childhood. Multivariate logistic regression analyses revealed that the adolescents who perceived poor family function, frequent family conflicts and whose parents drank habitually were more likely to experience physical abuse. The adolescents who were indigenous and perceived frequent family conflicts were more likely to experience childhood sexual abuse. Further analyses indicated that indigenous boys had a higher risk of being the victims of sexual abuse than non-indigenous boys, while no difference was found between indigenous and non-indigenous girls. CONCLUSION: The results remind clinical workers of the importance of taking abuse histories from adolescents on a routine basis, and this is especially important in the case of dysfunctional families. PRACTICE IMPLICATIONS: Adolescents who live in rural areas have less social and medical resources for early detection and intervention of physical and sexual abuse. Correlates of physical and sexual abuse identified in this study may be helpful for the design and implementation of preventive intervention.     

Memories of childhood sexual abuse: a survey of young adults

Objective: To explore the prevalence of, characteristics of, and factors associated with forgetting of childhood sexual abuse memories in a large non-clinical sample (N = 1712).Method: Using an anonymous survey, we asked respondents about (a) the nature and severity of their childhood abuse; (b) the continuity of their abuse memories; and (c) their experiences with others suggesting to them that they might have been abused.Results: A substantial minority of victims in our sample reported having temporarily forgotten their childhood sexual abuse. Forgetting was largely unassociated with victim or abuse characteristics. Compared to individuals who always remembered their abuse, however, individuals who temporarily forgot were more likely to report that someone had suggested to them that they might have experienced abuse. Those who received such suggestions were particularly likely to suspect that they may have experienced childhood sexual abuse that they do not yet remember.Conclusion: Forgetting may be less common than implied by earlier estimates from clinical samples, yet it is not uncommon. Also, a sizable minority of the population is wondering whether they have experienced unremembered abuse, and these suspicions are linked to having encountered suggestions from others. We discuss the implications of these findings for understanding the phenomenon sometimes labeled repression.Spanish abstract was not available at time of publication.     

Prevalence of child sexual abuse reported by a cross-sectional sample of New Zealand women

OBJECTIVE: The objective is to describe the prevalence of child sexual abuse (CSA) among women in New Zealand, document ethnic specific rates, and outline the frequency of abuse experienced and the most commonly identified perpetrators. Associations between CSA and later adverse consequences were also explored. METHODS: Retrospective report from a random sample of 2,855 women aged 18-64 years old in two regions in New Zealand. Face-to-face interviews with one randomly selected woman from each household were conducted. RESULTS: The overall prevalence rates for CSA were 23.5% for women from the urban region and 28.2% from the rural region. In both urban and rural regions, Māori women more frequently reported experiences of CSA than women from European and other ethnic groups (urban: 30.5% vs. 17.0% and rural: 35.1% vs. 20.7%). The median age of onset of the abuse was 9 years, and the median estimated age of the abuser was 30 years. Half of those who experienced CSA reported that it occurred once or twice, 27% "a few times," and 23% "multiple times." Sole perpetrators were involved in 83% of cases. The majority of cases were perpetrated by a family member, most frequently male. Compared with non-victims, victims of CSA were twice as likely to experience later intimate partner violence and violence by others. CONCLUSIONS: This study reports on a large, population-based sample in an ethnically diverse population in New Zealand, providing the first ethnic-specific rates of CSA available. Findings suggest important priorities for prevention and intervention activities.     

Memories of childhood sexual abuse: a survey of young adults

Objective: To explore the prevalence of, characteristics of, and factors associated with forgetting of childhood sexual abuse memories in a large non-clinical sample (N = 1712).Method: Using an anonymous survey, we asked respondents about (a) the nature and severity of their childhood abuse; (b) the continuity of their abuse memories; and (c) their experiences with others suggesting to them that they might have been abused.Results: A substantial minority of victims in our sample reported having temporarily forgotten their childhood sexual abuse. Forgetting was largely unassociated with victim or abuse characteristics. Compared to individuals who always remembered their abuse, however, individuals who temporarily forgot were more likely to report that someone had suggested to them that they might have experienced abuse. Those who received such suggestions were particularly likely to suspect that they may have experienced childhood sexual abuse that they do not yet remember.Conclusion: Forgetting may be less common than implied by earlier estimates from clinical samples, yet it is not uncommon. Also, a sizable minority of the population is wondering whether they have experienced unremembered abuse, and these suspicions are linked to having encountered suggestions from others. We discuss the implications of these findings for understanding the phenomenon sometimes labeled repression.Spanish abstract was not available at time of publication.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.