Globally, young people face challenges in having their sexual and reproductive health and rights recognized and respected, for instance being protected from sexual abuse and violence by same-aged peers. There is a lack of consensus in the literature regarding the definition of problematic or harmful sexual behavior among young people, including youth with intellectual disabilities. This scoping review aimed for producing a comprehensive picture of recent research (conducted between 2014 and 2025) related to problematic/harmful sexual behavior in children and young people with intellectual disabilities. Specifically, studies of interventions developed to prevent the occurrence or re-occurrence of problematic/harmful sexual behaviors were sought, as well as studies exploring the experiences of young people and professionals in relation to these behaviors and interventions. The database searches generated 582 hits, and 14 publications were included. Results are presented narratively in two sections: 1) Interventions and 2) Stakeholder voices on interventions. The main findings are that extensive, well-documented, research on interventions addressing problematic/harmful sexual behavior among youth with intellectual disabilities is lacking, indicating that youth with intellectual disabilities displaying problematic/harmful sexual behavior have arbitrary access to interventions. Moreover, professionals lack knowledge and systematic approaches to working with these young people. To prevent problematic/harmful sexual behavior and sexual abuse, and thus ensure equitable opportunities for achieving sexual health, adequate education for youth with intellectual disability, and for professionals, is required. Furthermore, an international definition of problematic and harmful sexual behavior would aid knowledge transfer between contexts.
Individuals who experience sexual violence are at increased risk of reproductive health problems but often underutilize preventative reproductive healthcare. This mixed-methods analysis qualitatively explored factors influencing reproductive healthcare attendance by women and sexual/gender minority (SGM) individuals who experienced sexual violence and quantitatively compared Pap test utilization and attitudes/beliefs about Pap tests between the two groups. Participants (n = 554) completed an online survey measuring sexual violence exposure, Pap test utilization, and attitudes/beliefs toward Pap tests, and provided an open-ended response describing experiences, beliefs, or social factors influencing their attendance at reproductive healthcare appointments. Contrary to our hypothesis, SGM participants were more likely to be up to date on their Pap test (χ2[543] = 8.4, p < .004) and endorsed more perceived benefits (t[453.5] = 5.9, p < .001, d = .49) and fewer perceived risks (t[404.2] = 2.2, p = .031, d = .19) to Pap testing compared to cisgender/heterosexual sexual violence survivors. In the participants' descriptions of their beliefs and perceived barriers, six qualitative themes were identified: Safeguarding Health and Routine Maintenance, Emotional Barriers, Agency and Disempowerment, Resource Barriers, Provider Characteristics, and Community Influence. Factors influencing healthcare participation that were more common in the SGM group were their sexual violence history, fear of pain, discomfort, or feeling judged by providers. This analysis provides insight into and offers recommendations regarding reproductive healthcare utilization in sexual-violence-exposed women and SGM individuals.
Youth sports can be ideal settings for supporting youth development. Youth sports can also, however, create settings that put athletes at risk for experiencing child sexual abuse (CSA). Many youth coaches are encouraged or required to complete child abuse prevention education modules to learn how to identify warning signs of abuse and how to help if CSA is identified. However, research on coaches' confidence in identifying and preventing CSA is limited. In this formative research study, we develop and test new measures that will be used in a randomized controlled trial to evaluate the effectiveness of an adult-focused CSA prevention program. Measures include coach knowledge of CSA, confidence in preventing and responding to CSA, and engagement in CSA prevention and response behaviors. We recruited a national sample of 107 youth football coaches and league leaders to complete the survey. In the current study, we discuss preliminary findings on the relationships between knowledge, perception, and behaviors in our sample. We also discuss current limitations of the measures and offer recommendations for addressing them in future use.
Preliminary evidence has suggested that perceived political stress may be a relevant mental health outcome for investigation among sexual assault survivors. The present study focused on 195 cisgender sexual minority women who were predominantly White or Caucasian (71.3%), lesbian (46.7%) or bisexual (46.7%), and working class (44.1%). The participants completed an online survey in August 2024 and then again in February 2025. The survey consisted of measures of sexual assault history, coping strategies, and perceived political stress. The results demonstrated a total association such that an increase in sexual assault history predicted greater perceived political stress 6-months later. Additionally, sexual assault history was associated with political stress via maladaptive coping, but not adaptive coping. The findings suggest that the consequences of sexual assault extend beyond the traditional diagnostic framework to include other outcomes, such as perceived political stress. Furthermore, the results are consistent with prior literature that has supported maladaptive coping strategies, such as avoidance and rumination, as potential targets for psychotherapy.
Sexual violence in the military remains a pervasive public health and organizational concern. Although the U.S. military has implemented prevention policies and trainings, few evaluations have examined their cultural relevance or effectiveness. This exploratory study used a theory-informed qualitative design, guided by the Kirkpatrick model, to explore how military culture shapes the design, reception, and impact of sexual assault prevention trainings. Seventeen male current and former service members from four military branches participated in semi-structured interviews analyzing their perceptions and experiences with these trainings. Codebook thematic analysis revealed multiple factors influencing effectiveness across the model's four levels -reaction, learning, behavior, and results- with leadership emerging as the most influential. Participants emphasized that when leaders modeled engagement and accountability, trainings were perceived as more meaningful, whereas inaction or apathy reinforced skepticism and fear of retaliation. Findings illustrate how cultural elements such as hierarchy, masculinity norms, and heteronormativity affect training outcomes and reporting behaviors. Drawing on Connell's concept of hegemonic masculinity, the study underscores that prevention efforts must move beyond content delivery to address the cultural systems that sustain sexual violence. Results highlight the need for culturally responsive, leadership-driven approaches to effectively reduce sexual violence within military settings.
Social support is a strong protective factor against PTSD symptoms; however, it may be less effective for individuals with a sexual assault (SA) history. The diminished presence of gratitude may contribute to a diminished effect of social support, as gratitude is often defined as the recognition and appreciation of support from others. The current study examined gratitude as a moderator between social support and SA PTSD vs. non-SA PTSD. We hypothesized that those with a history of SA would have lower gratitude and that SA would moderate the association between gratitude and social support. Results showed that gratitude was significantly lower among those with a history of SA. A significant interaction between gratitude and SA history suggested that social support was less effective without gratitude in those with a non-SA history. However, among those with an SA history, gratitude was unrelated to the association between social support and PTSD severity. These results highlight the role of gratitude in social support and how protective effects are impacted by trauma type.
Sexual aggression (SA) is a major public health concern with serious consequences for victims and significant costs for society. The majority of acts are committed by men from the general population who are rarely prosecuted. The Confluence Model (CM) is one of the most empirically supported frameworks for explaining SA, primarily tested in samples from the United States of America. However, its cross-cultural validity remains understudied. This study aimed to evaluate the explanatory power of the CM in relation to SA perpetrated by Argentinian men without criminal records for sexual offenses. A total of 354 cisgender heterosexual or bisexual men from the general population completed an anonymous online survey. Hierarchical multiple regression and structural equation modeling were used. Results partially replicated the original model: hostile masculinity had a stronger and more consistent association with SA than impersonal sex, which was removed in the most parsimonious model. Childhood victimization, adolescent antisocial behavior, and tolerant attitudes toward violence showed indirect effects. The findings contribute to an assessment of the CM in a Latin America context and underscore the importance of culturally grounded prevention strategies that integrate risk factors proposed by the model. Implications for future research and practice are discussed.
Sexual violence against children and adolescents is still a challenge, worsened by the rise in the use of internet, computers, and mobile devices leading to novel online routes of perpetrating child sexual violence (OCSV). However, OCSV remains inadequately addressed within Uganda's existing policy and child protection frameworks. This study reviews existing policies and global interventions for OCSV, and identifies gaps and opportunities in Uganda, proposing evidence-based and cost-effective recommendations for prevention. Data were analyzed using thematic analysis, which examined mapped organizations, relevant policies, and preventive interventions. The analysis reveals country-specific and international gaps in legislation. It highlights key strategies for prevention, including educational programs on internet safety, early detection and reporting, victim support, and workforce training. Tertiary prevention includes offender treatment and sentencing. Canada's comprehensive approach to sextortion offers a valuable case study. Despite Uganda's "Safer Schools" initiative and child protection laws, OCSV remains under-addressed. We recommend targeted education, a national reporting system, and international cooperation to combat OCSV.
Individuals from minoritized communities face a higher risk of sexual violence; however, they have fewer opportunities to access recovery services and resources. Understanding the processes of trauma recovery by identifying strategies that helped survivors in their journey is essential for clinicians to provide proper care to clients reporting similar traumatic experiences. In this pilot study, we explored the process of healing from sexual trauma by conducting two rounds of semi-structured in-depth interviews with six survivors from disability, gender, sexuality, and racially minoritized communities, offering insights into transferable healing strategies to support both survivors and those providing care. The transcribed data were coded and analyzed using NVivo to identify categories and subcategories informing the process of healing sexual trauma. Results showed that survivors' journey of healing was influenced by survivors' experiences of navigating sociocultural contexts and socializations, disclosure, trauma responses, and moments of relief. The processes that connected social-contextual factors and power and privilege with survivors' healing responses contributing to moments of relief were identified as notable factors that provided a positive shift in the participants' recovery journey. Due to the small sample size, the results of this study limit transferability of participants' experiences; however, they can be used as an initial finding for other large‑scale research aimed at exploring experiences of healing from sexual trauma. This article highlights considerations for clinical practice.
Child sexual abuse (CSA) is a preventable public health problem affecting millions of children annually. While many strategies exist that show promise for preventing CSA perpetration, very few programs and policies have been rigorously evaluated. To address this gap and build the evidence base of what works to prevent CSA, the Division of Violence Prevention (DVP) within the Centers for Disease Control and Prevention (CDC) established an extramural research portfolio focused on rigorous outcome evaluations of primary prevention programs and policies to determine effectiveness in preventing CSA. Currently, the research portfolio funds nine ongoing studies evaluating primary prevention strategies implemented across multiple settings, including online, in schools, in youth-serving organizations, and within larger communities. This paper describes the development of DVP's innovative CSA prevention research portfolio, provides an overview of its research priorities and currently funded projects, and illustrates how this research seeks to expand the evidence base for effective CSA prevention approaches and move the field toward implementation and dissemination of policies, programs, and practices to prevent CSA before it occurs.
Bisexual women experience more sexual victimization, drink more, and engage in more frequent heavy episodic/binge drinking than heterosexual and lesbian women. However, few studies include women with other plurisexual identities (i.e. bisexual+ women), and fewer studies examine the relationship between sexual victimization and binge drinking in this population. Three hundred and eight women (122 bisexual+; aged 18-34) completed an online survey of their past‑year/since-age-14 sexual assault victimization experiences and past‑year alcohol use. We examined the relationship between bisexual+ identity and past‑year binge drinking frequency, moderated by past‑year and since-age-14 sexual victimization, with age and relationship status as covariates. Bisexual+ identity was not associated with past‑year binge drinking frequency, and there was no difference between bisexual+ and heterosexual women experiencing sexual victimization in the past year. We also explored whether there was a relationship between bisexual identity and past‑year sexual victimization, moderated by past‑year binge drinking. There was a significant interaction between past‑year sexual victimization and past‑year binge drinking frequency. Decomposing the interaction, bisexual+ women were more likely to report past‑year sexual victimization compared to heterosexual women at all levels of binge drinking frequency. These data provide insight into the relationship between sexual victimization and binge drinking frequency for bisexual+ women. It also indicates that reducing binge drinking alone may not reduce bisexual+ women's sexual victimization risk. Future research is needed to understand the mechanisms of the association between drinking and sexual victimization in women with plurisexual identities.
Women with childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) histories demonstrate higher levels of heavy drinking and risky sexual behaviors. Sex motives and sex-related drinking motives provide insight into why individuals may engage in these behaviors. The current study uses Latent Profile Analysis (LPA) to examine profiles of co-occurring sex motives and sex-related drinking motives and their relationships with CSA and ASA. Women (n = 489) completed the Sexual Motivations Scale and the Drinking Motives Questionnaire. Average scores for each domain of sex motives (intimacy, enhancement, self-affirmation, coping, peer approval, and partner approval) and sex-related drinking motives (enhancement and coping with sex-related distress) were used to conduct the LPA. A 5-profile solution was identified. One profile (n = 45) emerged as particularly risky with highest levels of coping, partner and peer approval sex motives, and sex-related drinking motives. Next, the presence of CSA (n = 136, 28%) and ASA (n = 257, 53%) were used to predict LPA profile membership through multinomial logistic regression. Women who experienced CSA (OR = 2.06, p < .05) or ASA (OR = 2.24, p < .05) had significantly higher odds of belonging to the high approval and drinking motives profile compared to the reference class. The findings highlight heterogeneity in the co-occurrence of sex motives and sex-related drinking motives. Women with CSA or ASA histories were significantly more likely to belong to the high approval and drinking motives profile, which reflects a riskier motivational pattern and underscores the need for targeted interventions addressing overlapping sex and drinking motives to mitigate risky behaviors and negative health outcomes.
Child sexual abuse (CSA) is recognized as a major public health problem affecting a significant number of children and youth worldwide. Despite heightened awareness, professionals working with children and adolescents, particularly within religious settings, often hold misconceptions that hinder effective prevention and intervention. This study aimed to assess Spanish pastoral agents' knowledge of CSA and identify subgroup differences (e.g. by gender or age group). A total of 403 individuals (72.8% women, 27.2% men; age range 16-80, M = 44.6 years, SD = 17.3) responded to ten statements evaluating common myths and factual misconceptions about CSA. Results indicated that pastoral agents generally demonstrated accurate knowledge, though significant gaps remained, especially regarding prevalence. Notably, misconceptions such as "CSA is more frequent in low socioeconomic status families" and "the perpetrator is always a stranger" revealed marked gender-based differences. In addition, agents working primarily with younger children showed a higher level of belief in CSA myths compared to those working with adolescents. These findings underscore critical areas for targeted educational interventions. Training should address overlooked dimensions, particularly prevalence data and socioeconomic stereotypes, and be tailored to specific subgroups. Incorporating current empirical evidence and highlighting contextual risk factors may enhance pastoral agents' capacity to recognize, prevent, and respond effectively to CSA within their communities. By clarifying misunderstandings and strengthening professional preparedness, tailored programs can help bridge existing knowledge gaps and foster safer, more informed environments for vulnerable youth.
This paper provides results from a survey on the practices and challenges for multidisciplinary investigation teams working with abuse cases that involve child sexual abuse material (CSAM) at Children's Advocacy Centers (CACs). Survey respondents were primarily executive directors of 379 CACs from across the United States. Most CACs had a process before the forensic interview for investigators to discuss CSAM (88.4%), regularly screen for CSAM (69.1%), and document CSAM in a case tracking system (71.2%). Although half of CACs required CSAM training for forensic interviews (54.9%), it was less common for other multidisciplinary members. About one-third of CACs reported helping families remove images from the internet. Over half (59.9%) of CACs reported collaborating with schools to provide CSAM education, with 69.7% indicating that this was a practice of top importance. Most participants mentioned the need to provide support and resources to parents as one of the top challenges as well as one of the top important practices when working with victims of CSAM. Overall, there were more similarities than differences across small and large CACs, suggesting that multidisciplinary team members across all CACs, regardless of size, would benefit from active discussions about improving the CAC response to cases involving CSAM, identifying more ways to support families in these cases, and accessing additional opportunities for training on providing care to victims.
This study examines the sexual violence experiences of Black women aged 18-25 through Black feminist and life course frameworks. From qualitative focus group data originally centered on sexual and reproductive health, themes of sexual violence emerged as a significant, unanticipated finding. Our analysis reveals how participants (1) experience trauma and trust violations across family, intimate partnerships, and institutional settings; (2) receive informal tools for sexual autonomy and advocacy from loved ones; (3) navigate exposures to narratives of sexual trauma; and (4) experience silencing within Black communities. Findings contribute to understanding the intergenerational transmission of sexual health knowledge and the need for communication-focused interventions that address both the explicit and silenced aspects of Black women's sexual and reproductive lives.
Sexual minority college students have a higher prevalence of sexual assault victimization in college, which is associated with negative mental health consequences. Previous research suggests that the circumstances of the assault, campus climate, social support, and perceptions of institutional response to sexual assault are each associated with mental health outcomes for survivors. This study used social media ads to recruit sexual minority college students in the United States. A subsample of 127 participants who had experienced sexual assault at their current college was attained. Three linear regression models were assessed to determine the unique relationship of each independent variable when controlling for other variables in the model, on mental health (i.e, anxiety, depression, and stress). Results indicate that institutional response to sexual assault and social support uniquely predicted the level of anxiety in survivors when controlling for campus climate, the type of assault, whether the perpetrator was known to the survivor, racial background, and gender identity. Implications from these findings include measures leadership in higher education can take to support the well-being of survivors, such as increased transparency on campus response efforts and a focus on social support for LGBQ college students within sexual assault response efforts.
Child sexual abuse (CSA) is a globally recognized public health problem with severe consequences for victims, families, and society. In such cases, victims interact frequently with the justice system, often serving as the primary witnesses to the crime and contributing significantly to case outcomes. Consequently, forensic interviews are essential in criminal investigations, providing invaluable information. However, questions remain regarding the most effective procedure for conducting forensic interviews with CSA victims. This systematic review analyzes the effectiveness of forensic interview procedures used with CSA victims. Following PRISMA guidelines, articles were identified through manual reference checks and searches in four electronic databases, yielding 93 articles that met the inclusion criteria. Twenty-seven distinct forensic interview procedures were identified, with the National Institute for Child Health and Human Development (NICHD) investigative interview protocol being the most extensively studied. Procedures adhering to standardized protocols demonstrated greater use of recommended best practices than those that did not follow any guidelines. The NICHD protocol, particularly its revised version, showed the strongest evidence of efficacy, with interviewers employing more open-ended questions and fewer suggestive prompts. This approach resulted in more detailed and reliable disclosures from children. This review highlights the critical role of standardized protocols in enhancing the quality and reliability of child testimony while avoiding unnecessary or prolonged involvement in the justice system. The NICHD protocol, especially its revised version, is strongly recommended for global adoption. Additional best practices are also discussed to inform policies and practices to enhance forensic interviews with CSA victims.
Sexual trauma, such as childhood sexual abuse (CSA) and adolescent and adult sexual assault (ASA), is associated with sexual abdication - letting a partner decide how far to go sexually - which contributes to condom nonuse. Difficulties with emotion regulation related to goal-directed behavior and impulsivity when distressed are associated with risky sexual behaviors. The cumulative effects of multiple sexual traumas (i.e. CSA, ASA) may influence emotion regulation and sexual risk-taking. Additionally, alcohol intoxication may also disrupt emotion regulation processes. This study leverages an alcohol administration design with mood induction to examine how sexual trauma predicts impulse control and goal-directed behavior emotion regulation difficulties and sexual abdication intentions in the context of acute intoxication and negative or positive mood. Cisgender female non-problem drinkers (N = 484; Mage = 24.98, SD = 2.65) completed surveys assessing emotion regulation difficulties and CSA and ASA victimization. Participants were randomized to beverage condition [control (BrAC = .00) vs. alcohol (BrAC = .08%gm)] and mood induction (negative vs. positive mood). Participants projected themselves into a scenario depicting a sexual encounter and reported their sexual abdication intentions. Survivors of CSA + ASA reported greater abdication intentions via impulse control and goal-directed behavior emotion regulation difficulties relative to other participants. Impulse control difficulties were positively associated with abdication intentions among those experiencing negative moods. Multiple sexual traumas across the lifespan may contribute to difficulties regulating impulsive actions when distressed and subsequent sexual abdication. Treatment of sexual trauma should include strategies to promote sexual health.
Sexual assault (SA) is alarmingly prevalent and is associated with increased risk for posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Exposure-based treatments are a first-line treatment for PTSD and have potential for implementation early after trauma. However, scarce research has been conducted on the application of exposure following recent SA among people with PTSD symptoms and AUD, which is critical to inform the development of effective and tailored early interventions for this population. The present study addressed this gap by using thematic analysis to examine content included in written exposure narratives among 10 adults with recent SA (i.e., in the past 3 months) who received a five-session telehealth-delivered integrated intervention: Skills Training and Exposure for PTSD and Substance Misuse (STEPS). STEPS integrates Written Exposure Therapy for PTSD with cognitive-behavioral skills for AUD to address both concerns simultaneously. Participants demonstrated current symptoms of PTSD and met criteria for AUD. Nineteen themes were identified and organized under five categories: Sensory and Memory Processing, Description of Emotions, Description of Cognitions, Individual-Social Impact, and Reactions to Writing. Findings from this study demonstrate that recent SA survivors with AUD can engage in early exposure-based interventions, such as STEPS, with high protocol adherence (e.g. including sensory details, labeling emotions, expressing cognitions). Results also suggest that interpersonal and sociocultural factors may be important for survivors to process and make meaning of after recent SA.
Live-streaming child sexual abuse (LSCSA) represents a rapidly evolving and concealed form of child exploitation emerging at the intersection of technology, poverty, and opportunity. This scoping review synthesizes empirical findings to characterize the actors involved and the socioeconomic conditions facilitating LSCSA. Drawing on a thematically synthesized PRISMA-ScR approach, 12 relevant articles were identified, supplemented by an expert interview with the Dutch National Police, offering valuable insights on the current issues and challenges faced by law enforcement. Evidence highlights that most LSCSA offenders are demographically homogenous, predominantly older men from developed countries. They exploit economically vulnerable families in low-income countries to obtain customized, real-time sexual abuse content. LSCSA differs from other forms of child sexual abuse material (CSAM) due to its real-time, financially driven nature, posing unique legal and technological challenges to detection and prosecution. Furthermore, its interactive and on-demand nature allows offenders to direct the abuse as it happens, further compounding its psychological harm to victims and complicating efforts to trace and prosecute the crime. Traditional investigative tools have limited utility due to technological barriers, including end-to-end encryption, anonymous payment systems, and browser privacy features. Therefore, data-driven solutions, including machine learning, transaction monitoring, and international collaboration, are emphasized to disrupt LSCSA networks. By consolidating current knowledge on LSCSA and proposing evidence-based policy recommendations tailored to law enforcement needs, particularly those of the Dutch National Police, this research contributes to a more data-driven, ethically sound, and globally coordinated response to online child sexual exploitation in an increasingly digital world.
