Adolescents who have been sexually abused are more likely to smoke, drink, use drugs, have disordered eating habits, and consider suicide than those who have not, say researchers at the University of Rochester's Children's Hospital at Strong. Researchers analyzed data from the 1997 Commonwealth Fund Survey, a school-based, nationally representative sample of 6,728 adolescents in grades 5-12. A self-administered questionnaire measured history of sexual abuse, substance abuse, use of health care, and mental and physical health status.
Ten percent of girls answering a survey question about a history of sexual abuse said they had been sexually abused, as did four percent of boys.
"Children who reported being sexually abused were significantly more likely to engage in risky behaviors, including smoking and substance abuse," says Karen Wilson, M.P.H., the study's lead author.
Girls and boys who reported being sexually abused were more likely to have thought about suicide, to report fair or poor health, to have missed needed health care, and to have seen a mental-health provider than those who reported no abuse.
They were also more likely to smoke, drink alcohol, use drugs, and report binge eating or purging. Most of the adolescents who reported abuse had not discussed it with their provider.
"Adolescent-care providers need to be aware of the high rate of sexual abuse, and that, while rates of risky behavior are higher among abused adolescents, many did not report any risky behaviors," Wilson says. "Health-care professionals should screen each adolescent for a history of sexual abuse, as recommended by most guidelines for the care of adolescents, including Bright Futures and Guidelines for Adolescent Preventive Services."
"Talking about a history of abuse in a confidential, non-judgmental atmosphere, allows providers to assess whether the adolescent has been sexually abused, and whether they're dealing with it adequately, or whether a referral to a mental-health professional is needed," Wilson says. "Most importantly, providers must try to ascertain whether any abuse is ongoing."
Wilson's research team also included Jonathan Klein, M.D., M.P.H., and Linda Barthauer, M.D., all of the University of Rochester's Children's Hospital at Strong.
Barthauer is director of the hospital's Referral and Evaluation of Child Abuse (REACH) Program, which provides clinical evaluation of children for sexual and physical abuse, as well as conducts ongoing research on child abuse.
"This study is important not only for its findings, but also for the questions it raises," Barthauer says. "For example, will adolescents who do not currently engage in high-risk behaviors do so in adulthood? What are the long-term outcomes for these kids? In any case, the research underscores the importance of routine screening for abuse in adolescents."
