Childhood Sexual Abuse and Sexual Behaviors Among College Students in Appalachia

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Childhood Sexual Abuse (CSA), along with other Adverse Childhood Experiences (ACES), has been linked to a range of adverse health outcomes among adults. However, there is paucity of research specifically studying CSA and sexual risk behaviors among adolescents. Even less is known for the population in Appalachia. The few researchers who study this topic have mostly focused on females or have failed to use advanced statistical techniques to generate evidence on causality. This research was undertaken to investigate the association between CSA and sexual risk behaviors of college students in Appalachia. College students enrolled in introductory psychology classes in the Appalachian region were administered an online questionnaire on CSA, ACES, and current sexual behaviors in 2015. Simple and multivariate logistic regressions were completed for CSA to predict illegal drug use before sex, use of condom during sex, and perceived risk of HIV. Age, gender, and other ACEs (physical, emotional, verbal abuse, substance abuse in family, family mental illness, and family incarceration) were considered as covariates. Only statistically significant covariates were included in the final model. All analyses were completed using STATA. Of the total 982 adolescents, 67% were female. The average age of the participants was 20 years. In the unadjusted model, CSA was significantly associated with illegal drug use before sex (OR 2.32, CI 1.46 - 3.68) and perceived risk of HIV (OR 2.19, CI 1.39 - 3.46). The association between CSA and illegal drug use before sex (OR 1.67, CI 1.03 - 2.73) was significant in the final model too. Further, based on the final model, CSA increased the odds of perceiving oneself at risk of HIV by 1.9 times (CI 1.19 - 3.03). Verbal abuse was also found to be significantly associated with illegal drug use before sex (OR 2.22, CI 1.55 - 3.19) and perceived risk of HIV (OR 1.8, CI 1.26 - 2.57). However, neither CSA (OR 1.02, CI 0.55 - 1.89) nor other covariates was associated with condom use among these adolescents. It is a noteworthy result and suggests the need of further investigation of the factors related to condom use among adolescents in order to understand the peculiar nature of this behavior. Finally, CSA was found to increase the odds of some risky sexual behaviors among college students in Appalachia. Consideration of this relationship can enrich the knowledge base required to design effective interventions targeted at sexual behaviors of adolescents. Additionally, further exploration can be useful to enhance the understanding of effects of other ACES like verbal abuse on sexual risk behaviors, and predictors of condom use among adolescents.


Johnson City, TN

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