Published online August 10, 2009
PEDIATRICS Vol. 124 No. 3 September 2009, pp. 941-949 (doi:10.1542/peds.2008-3836)
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ARTICLE

Sexual Intercourse Among Adolescents Maltreated Before Age 12: A Prospective Investigation

Maureen M. Black, PhDa, Sarah E. Oberlander, PhDa, Terri Lewis, PhDb, Elizabeth D. Knight, MSWc, Adam J. Zolotor, MD, MPHc, Alan J. Litrownik, PhDd, Richard Thompson, PhDe, Howard Dubowitz, MS, MDa and Diana E. English, PhDf

a Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
b Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina
c University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina
d Department of Psychology, San Diego State University, San Diego, California
e Juvenile Protective Association, Chicago, Illinois
f School of Social Work, University of Washington, Seattle, Washington

OBJECTIVE: To examine whether child maltreatment (physical, emotional, and sexual abuse, and neglect) predicts adolescent sexual intercourse; whether associations between maltreatment and sexual intercourse are explained by children's emotional distress, and whether relations among maltreatment, emotional distress, and sexual intercourse differ according to gender.

METHODS: The Longitudinal Studies of Child Abuse and Neglect was a multisite, longitudinal investigation. Participants ranged from at-risk to substantiated maltreatment. Maltreatment history was assessed through Child Protective Service records and youth self-report at age 12. Youth reported emotional distress by using the Trauma Symptom Checklist at the age of 12 years and sexual intercourse at ages 14 and 16. Logistic and multiple regressions, adjusting for gender, race, and site, were used to test whether maltreatment predicts sexual intercourse, the explanatory effects of emotional distress, and gender differences.

RESULTS: At ages 14 and 16, maltreatment rates were 79% and 81%, respectively, and sexual initiation rates were 21% and 51%. Maltreatment (all types) significantly predicted sexual intercourse. Maltreated youth reported significantly more emotional distress than non-maltreated youth; emotional distress mediated the relationship between maltreatment and intercourse by 14, but not 16. At 14, boys reported higher rates of sexual intercourse than girls and the association between physical abuse and sexual intercourse was not significant for boys.

CONCLUSIONS: Maltreatment (regardless of type) predicts sexual intercourse by 14 and 16. Emotional distress explains the relationship by 14. By 16, other factors likely contribute to intercourse. Maltreated children are at risk for early initiation of sexual intercourse and sexually active adolescents should be evaluated for possible maltreatment.

Key Words: child maltreatment • adolescent sexuality • sexual intercourse • neglect • sexual abuse • physical abuse • emotional abuse • emotional distress

Abbreviations: CPS—Child Protective Services • TSC-C—Trauma Symptom Checklist for Children • CI—confidence interval • OR—odds ratio

Accepted Mar 2, 2009.


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