The prevalence of child sexual abuse among Slovak late adolescents

Abstract

The present study aimed to assess the prevalence and characteristics of child sexual abuse (CSA) in a large-scale sample of Slovak late adolescents. Randomized cluster sampling was used to sample 2186 students in their final school year of secondary school with mean age of 18.6 years (SD = .7 years). The study employed the Child Sexual Abuse Questionnaire consisting of multiple behavior-specific questions. The prevalence of CSA was analyzed separately for three clusters of CSA and gender. The prevalence of non-contact forms of CSA was 40.6% among girls and 17.7% among boys. CSA with physical contact without penetration was reported by 30.2% girls and 11.6% boys. The prevalence of CSA with penetration was 5.6% among girls and 1.3% among boys. More than half of CSA occurred between 16 and 18 years of age. The severity of abuse was positively associated with acquaintance to the perpetrator. Roughly 43–56% disclosed the abuse to another person. The majority of disclosed CSA was revealed to peers and partners. A negligible proportion of CSA instances were reported to the police. Prevention activities should consider a broad spectrum of CSA in order to counteract tendencies to associate CSA only with unwanted sexual intercourse.

Full text

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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The prevalence of child sexual abuse among Slovak late adolescents
Slavka Karkoskova a & Ivan Ropovik b
a Judicial Academy of the Slovak Republic,
& St. Elisabeth University of Health Care and Social Work
b University of Presov
Author note
Slavka Karkoskova, Judicial Academy of the Slovak Republic, Slovakia, & St.
Elisabeth University of Health Care and Social Work, Slovakia; Ivan Ropovik, Department of
Preschool and Elementary Education and Psychology, University of Presov, Slovakia
This work was supported by the Slovak Research and Development Agency [APVV-
16-0471]. The authors are also grateful to the research assistants who administered the
questionnaire, namely: Tomáš Horvát, Beáta Vasková, Erika Tarasovičová, Viktória Peštová,
Simona Kravcová, Marianna Ficeková, Michal Lörinc, Róbert Toth, Ingrid Senková, Jana
Bernátová, Paulína Klimková and Petra Vavreková.
Declaration of interest: none.
Correspondence concerning this article should be addressed to Slavka Karkoskova,
Judicial Academy of the Slovak Republic, Suvorovova 5/C, 902 01 Pezinok, Slovakia.
E-mail: slavka.karkoskova@gmail.com

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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Abstract
The present study aimed to assess the prevalence and characteristics of child sexual abuse
(CSA) in a nationally-representative sample of Slovak late adolescents. Randomized cluster
sampling plan was used to sample 2186 secondary school students in their final school year
with mean age of 18.6 years (SD = 0.7 years). The study employed the Child Sexual Abuse
Questionnaire (Mohler-Kuo et al., 2014) consisting of multiple behavior-specific questions.
The prevalence of CSA was analyzed separately for three clusters of CSA and gender. The self-
reported lifetime prevalence of at least one form of CSA was 47.3% among girls and 22.0%
among boys. The prevalence of noncontact forms of CSA was 40.6% among girls and 17.7%
among boys. CSA with physical contact without penetration was reported by 30.2% girls and
11.6% boys. The prevalence of CSA with penetration was 5.6% among girls and 1.3% among
boys. More than half of CSA occurred between 16-18 year of age in all three CSA cluster types.
The severity of abuse was positively associated with the acquaintance with the perpetrator.
Roughly 43-56% disclosed the abuse to another person. The majority of disclosed CSA was
revealed to peers and partners. Negligible proportion of CSA instances were reported to the
police. The results show that CSA is a widespread and considerably covert phenomenon within
the population of Slovak late adolescents. Prevention activities should consider broad spectrum
of CSA forms in order to counteract tendencies to associate CSA only with unwanted sexual
intercourse.
Keywords: child sexual abuse, prevalence, late adolescence, disclosure.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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The prevalence of child sexual abuse among Slovak late adolescents
Child sexual abuse (CSA) is one of the most serious socio-pathological phenomena due
to its widespread international prevalence (Barth et al.. 2013; Finkelhor, 1994; Pereda et al.,
2009; Sapp & Vandeven, 2005; Stoltenborgh et al., 2011) as well as because it is related to
significantly higher risk of both short term and long-term negative consequences (Cutajar et al.,
2010; Fergusson et al., 2008; Paolucci et al., 2001).
Society shall take all appropriate measures to protect children from all forms of violence
and abuse, including sexual abuse (United Nations, 1989; 2011). The level of awareness
regarding the prevalence of CSA in any particular country can influence the character and
intensity of protective measures. In this regard, lack of research on the prevalence of violence
against children is a crucial problem (Slovak national strategy, 2013) as it can lead to
underestimation of the problem by relying solely on statistical data on cases reported to
authorities.
Establishing accurate estimates of the occurrence of CSA is complicated. Extremely
discrepant rates of CSA are reported in a number of empirical studies conducted in this field in
different countries and populations over the past decades (de Tychey et al., 2015). In
Finkelhor’s (1994) study, prevalence rates from 21 countries ranged from 7 to 36 % among
females and a 3 to 29 % among males. More recent meta-analysis indicated prevalence rates
ranging from 8 to 31 % among females and from 3 to 17 % among males (Barth et al., 2013).
It is well established that methodological differences (especially different definitions of
CSA, measurement issues, sample characteristics, or design of the survey) account for variance
in rates of CSA across studies. Researchers identified several aspects in which definitions of
CSA vary: cut-off age for childhood (varying from 15 to 17 years); whether or not a minimum
age difference between victim and perpetrator is set (ranging from no restriction, to offenders
aged at least 3–5 years older, to adults only), and the level of contact qualifying an incident as

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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CSA (ranging from penetrative acts only, through a broad spectrum of contact and noncontact
forms of abuse) (Bolen & Scannapieco, 1999; Goldman & Padayachi, 2000; Stoltenborgh et
al., 2011). Related to this issue, the number and specificity of questions asked in order to assess
CSA may affect the outcomes; more questions might also cover more aspects of CSA, and thus
lead to higher prevalence rates (Bolen & Scannapieco, 1999; Finkelhor, 1994; Goldman &
Padayachi, 2000; Mathews & Collin-Vézina, 2017; Stoltenborgh et al., 2011). What is defined
as abuse may differ from one person to another unless it is clarified. Thus, using behaviorally
specific rather than general “label” questions can minimize the rate of false-negative and false-
positive results from respondents’ subjective perception or interpretation (Cranera et al., 2015;
Fricker et al., 2003; Mohler-Kuo et al., 2014). Lifetime CSA prevalence may vary considerably
depending on the sampling techniques (random samples, convenience samples, clinic
populations) as well as on the actual age of the respondents in a sample (Finkelhor, 1994;
Goldman & Padayachi, 2000). While some surveys are made on young teens, because of high
continuing victimization during the late teen years, assessments are most complete when
conducted among the oldest youth (Finkelhor et al., 2014). Variations in rates can also be partly
linked to the design of the survey (e.g. confidentiality guarantee as perceived by the
respondents).
To date, there has been just a few studies in Slovakia which provide partial data on CSA
prevalence (Fedor et al., 2011; Fico, 2013; Máthé, 2006; Slonad, 1999 In: Slovak national
strategy for the protection of children against violence, 2013). None of them focused solely on
CSA. Questions regarding CSA were just a small subgroup of questions (5-7) among many
others enquiring about respondents’ experiences with various forms of violence during
childhood (Fedor et al., 2011; Fico, 2013; Slonad, 1999 In: Slovak national strategy, 2013) or
about sexual behavior of Slovak citizens (Máthé, 2006). Respondents of those surveys were
children aged 14-16 years (Fico, 2013; Slonad, 1999 In: Slovak national strategy, 2013) or

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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children and adults aged 15–28 years (Fedor, et al. 2011) and 15–69 years (Máthé, 2006).
Questions used in those surveys did not cover noncontact forms of CSA and mostly defined
childhood only up to 15 years of age and perpetrator as an adult.
Considering that (1) within the Convention on the Rights of the Child (United Nations,
1989), the fundamental document for all policy documents related to the protection of children's
rights, child is defined as every human being below the age of eighteen years; (2) substantial
proportion of CSA victims do not reveal the abuse to anyone during childhood and among
children who do disclose during childhood, delay of disclosure is common (London et al., 2007;
McElvaney, 2015; Olafson & Lederman, 2006); (3) even the so-called ‘less severe’ non-contact
types of CSA may have detrimental effects (Landolt et al., 2016; Paolucci et al., 2001), and (4)
a significant percentage of CSA may be committed by individuals under the age of 18 (Ryan et
al., 2012), our study purposed to cover several gaps which characterized previous surveys on
CSA prevalence among Slovak population.
The present study aimed to assess the prevalence of, and characteristics and
circumstances associated with, CSA in a nationally representative sample of late adolescents in
Slovakia using the Child Sexual Abuse Questionnaire (CSAQ) (Mohler-Kuo et al., 2014)
consisting of multiple behavior-specific questions which cover also noncontact forms of CSA.
We consider late adolescence to be an appropriate time for undergoing survey focusing on CSA
experiences. It is more probable that late adolescents (rather than young adolescents)
understand survey questions properly and answer them responsibly. Also their memory
retrieval can be most reliable at the given age given the fact that, although CSA can be well
retained in memory, it may be vulnerable to ‘normal’ memory processes such as forgetting in
later age (Goodman-Delahunty et al., 2017). As no representative study concerning CSA
prevalence among Slovak population has been published in English language yet, our findings

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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will provide the most contemporary prevalence estimates useful for any prevalence meta-
analyses.
Method
Participants
The present study was carried out between November 2nd, 2015 and January 27th, 2016
on a population of Slovak secondary school students in their final year (usually the 4th grade)
with target modal age of 18 to 19 years. A randomized cluster sampling plan was employed.
First, based on an index of all (public and private) secondary schools in Eastern part of Slovakia
(195 schools, 474 final year classes, 11454 students), 120 classes (in 100 schools) were selected
by random number generation. Having no legal obligation, 27 schools chose not to participate
for various reasons.
Overall, 14 questionnaires were either lost due to technical problems or were deemed
invalid and 5 students chose to withdraw from the study, resulting in a final sample size of n =
2186, representing 19.1% of the defined population. The sample comprised 874 (40%) boys
and 1312 (60%) girls, having the mean age of 18.58 years (SD = .72). Since past nation-wide
survey (Fico, 2013) has shown that Eastern and Western part of Slovakia are equivalent with
respect to the prevalence of CSA, the current sample can be regarded representative of Slovak
population. The sociodemographic characteristics of the sample can be seen in Table 1.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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Table 1
Characteristics of participants
n
% (95% CI)
Gender
Male
874
40.0 (37.9, 42.1)
Female
1312
60.0 (57.9, 62.0)
Age
17
17
0.8 (0.5, 1.2)
18
1122
51.4 (49.3 53.4)
19
834
38.2 (36.2, 40.3)
20
191
8.8 (7.6, 10.0)
21+
18
0.8 (0.5, 1.3)
Residence
Urban
1048
47.9 (45.8, 50.1)
Rural
1138
52.1 (49.9, 54.2)
School type
High school (Gymnasium)
529
24.2 (22.4, 26.1)
Vocational
1656
75.8 (73.9, 77.5)
Mother’s education
Elementary school
87
4.0 (3.2, 5.0)
Secondary school
1678
77.8 (76.0, 79.5)
University
392
18.2 (16.6, 19.9)
Father’s education
Elementary school
48
2.2 (1.7, 3.0)
Secondary school
1777
83.5 (81.9, 85.1)
University
302
14.2 (12.7, 15.8)
Family structure
Both biological parents
1896
86.7 (85.2, 88.1)
Other
289
13.2 (11.8, 14.7)
Number of siblings
0
174
8.0 (6.9, 9.2)
1
942
43.1 (41.0, 45.2)
2+
1070
48.9 (46.8, 51.1)
Procedure
The study was approved by the Department of Education of the concerned Self-
governing Region Authorities. The school managements were assured that the data collection
procedure precludes the possibility to identify any individuals and their school affiliation. The
questionnaires were administrated by trained research assistants who also got acquainted with

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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privacy and data protection issues. Within the informed consent, all the participants were
briefed on the purpose of the study and confidentiality and were further informed about their
right to withdraw from the study at any time without stating a reason. Moreover, it was
emphasized that, by design, the time needed to finish the questionnaire is the same regardless
whether the participant identifies herself as a victim of CSA or not. Participants who did not
identify themselves as the victims of CSA were automatically given a questionnaire on CSA-
related urban myths and deeply rooted beliefs (these data are not a part of the present study).
Regarding the sitting arrangement of participants, each of them was having a free chair on both
sides, which prevented the participants from seeing the content at each other’s monitors. The
computer-assisted administration of the questionnaire took place in a dedicated computer room
of the given school, supervised by a research assistant and a teacher. Most participants finished
the questionnaire within 40 minutes and at the end, they were provided contact information for
organizations offering specialist support, counselling and further information about CSA-
related issues.
Measures
The present study employed the Child Sexual Abuse Questionnaire (CSAQ) (Mohler-
Kuo et al., 2014). CSAQ measures the prevalence of CSA in a comprehensive manner, covering
15 forms of child sexual abuse within three overarching clusters. (1) CSA without physical
contact involved 8 yes/no items. For contact forms of abuse, there were 7 items with three
response options, namely “No”, “Yes, someone tried but did not succeed”, and “Yes, someone
tried and succeeded in doing so”. These seven items (3 main items with any of the “Yes”
responses, 4 shared items with “Yes, someone tried but did not succeed” responses) indicated
the cluster (2) CSA with physical contact without penetration. (3) CSA with physical contact
with penetration involved the above mentioned 4 shared items with “Yes, someone tried and
succeeded in doing so” response. In case the participant endorsed any of the items, a question

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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targeting the frequency of the abuse immediately followed. After completing the CSAQ, the
participant who identified herself as a victim of CSA (responding “Yes” to any of the items)
was presented a follow-up set of items targeting various aspects of the abuse. If more than one
form of abuse was reported, the participant was asked to focus on the one that she subjectively
considers as the most severe.
Analysis
The prevalence of CSA was analyzed separately for the three given clusters of CSA and
gender. As usual in prevalence studies, a rather large number of associations between the CSA
rates and various sociodemographic characteristics can be tested. However, that leads to
experiment-wise inflation of the Type I error and the α level needs to be adjusted for the number
of hypothesis tests, considerably attenuating the statistical power especially when the
hypothesis tests are being carried out on a smaller subset of the sample. Apart from that,
classical frequentist approach of null hypothesis significance testing employing χ2 tests or
likelihood ratio tests cannot (without additional procedures like equivalence testing) provide
formal support for the null hypothesis, posing, e.g., no difference in prevalence rates for
different levels of a demographic variable. Last but not least, the associated p-values, when
seen as evidence, tend to overestimate the evidence against the null hypothesis (Wagenmakers,
2007). As usual in high-powered studies, practically negligible effects may get statistically
significant (due to very small standard errors), even though they are in fact more consistent
with the null hypothesis.
Due to these reasons, prevalence studies frequently provide rather uninformative
measures of evidence, e.g., p < .001 (sometimes given tiny effects), or non-significance – the
failure to reject H0. Whether this failure is due to underpowered testing of real effect or genuine
absence of a noteworthy effect remains usually unknown. These shortcomings can be tackled
by using Bayesian methods. To assess the independence of the observed categorical variables,

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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the current study employed the Gunel-Dickey default Bayes factors for contingency tables with
Poisson sampling plan – assuming all cell counts to be random and a uniform prior distribution
according to which all possible values are equally probable (Gunel & Dickey, 1974; Jamil et
al., 2016). Bayes factor (BF) is a continuous measure of evidence, defined as the ratio of two
conditional probabilities tied to alternative (HA) and null hypothesis (H0), given the observed
data. It represents the degree to which the data should shift our beliefs about the relative odds
for these two competing hypotheses (Jeffreys, 1961). BF thus reflects the relative plausibility
of a theory postulating the existence of an effect to the theory of null effect in terms of their
predictive accuracy. The magnitude of these effect sizes was assessed by relative risk (risk
ratio) calculated by unconditional maximum likelihood estimation (Wald) with the associated
bootstrap confidence intervals (based on 1e6 bootstrap replicates).
Prior to analyses, the data were screened for improbable values. No data transformations
or imputation techniques were employed. All the following analyses were performed in R
(version 3.2.3) The following R packages were employed: epitools (Aragón, 2012),
BayesFactor (Morey & Rouder, 2015), dplyr (Wickham & Francois, 2016), car (Fox &
Weisberg, 2011), and stringr (Wickham, 2015). All the analyses reported in this paper are
meant to be fully reproducible. As a supplementary material, data can be found in an online
repository here: https://goo.gl/zbKAeu. The complete R code documenting the entire analytic
workflow is available here: https://goo.gl/jQjY6c (both links temporarily anonymized for the
purposes of peer review).
Results
Prevalence of CSA
The self-reported lifetime prevalence of at least one form of child sexual abuse was
47.3% among girls and 22.0% among boys, with a corresponding relative risk of 2.2, i.e.
compared to boys, girls are more than two times more likely to experience CSA. Almost

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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identical risk ratios were observed for the two non-penetrative clusters, with the following
prevalence proportions: 40.6% among girls and 17.7% among boys for CSA without contact,
and 30.2% among girls and 11.6% among boys for CSA with physical contact without
penetration. The prevalence of CSA with penetration was 5.6% among girls and 1.3% among
boys, with girls’ risk to be sexually abused being 4.4 times the risk for boys. Overall, the data
on the CSA prevalence as categorized within the three clusters provide overwhelming evidence
for the strong association of CSA prevalence and gender. Here, the Bayes factors vastly
exceeded the suggested (Jeffreys, 1961) level for claiming extreme evidence (BF > 100) by
several orders of magnitude. However, when broken down by the specific forms of CSA, the
following could be concluded:
(1) With regard to CSA without physical contact, the evidence for higher overall
population difference in favor of girls were driven exclusively by two relatively most frequent
abuse forms, i.e., “molested by someone verbally or by e-mail/message” and “sexual
harassment via Internet” (with huge BFs of 2.2e34 and 2.6e21, respectively). Although the
abuse forms “forced to show naked body” and “given intimate pictures against will” would
have been statistically significant if tested for gender effect within the frequentist approach, the
data were in fact insensitive (BF10 within the 1/3 – 3 range). Regarding the other 4 non-contact
abuse forms, the data provide rather strong evidence (BF01 ranging from 10.1 to 24.6, i.e., data
under H0 being 10-25 times more likely than under HA) for the independence of their prevalence
and gender.
(2) As for the CSA with physical contact without penetration, the most frequent sexual
abuse form was “kissed or touched against will” (> 3-4 times more likely than any other non-
penetrative contact CSA form). Given the associated BFs, there was good evidence for female
being at greater risk of CSA in all of the respective forms.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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(3) Concerning the CSA with penetration, there was compelling evidence for
significantly higher prevalence in girls only for “forced oral intercourse”. With other CSA
penetrative forms, despite slightly higher relative risks, the data did not allow for a robust
formal inference, as is the case with any other prediction of low base-rate events. For CSA
prevalence rates, relative risks, and Bayes factors, see Table 2.
Seventy-four percent of participants reporting CSA without contact were revictimized,
with 36.0% being revictimized more than 5 times. For CSA with contact without penetration,
48.5% experienced the abuse more than once and 16.9% more than 5 times. Relatively high
number of revictimization (54.8%) was found among participants reporting any penetrative
form of CSA, 26.2% reported experiencing more than 5 instances of penetrative sexual abuse.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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Table 2
Prevalence of CSA by gender and type of abuse
Girls (n = 1312)
Boys (n = 874)
Relative riska
(95% CI)
Bayes Factorb
n
% (95% CI)
n
% (95% CI)
Any type of child sexual abuse
621
47.3 (44.6, 50.1)
192
22.0 (19.3, 24.9)
2.2 (1.9, 2.5)
BF10 = 3.3e31
Sexual abuse without physical
contact
533
40.6 (38.0, 43.3)
155
17.7 (15.3, 20.4)
2.3 (2.0, 2.7)
BF10 = 9.1e27
Forced to witness sexual exposure
39
3.0 (2.1, 4.0)
17
1.9 (1.1, 3.1)
1.5 (0.9, 2.9)
BF01 = 10.1
Forced to show naked body
53
4.0 (3.0, 5.3)
17
1.9 (1.1, 3.1)
2.1 (1.3, 3.9)
BF10 = 1.7
Forced to watch people having sex
26
2.0 (1.3, 2.9)
10
1.1 (0.5, 2.1)
1.7 (0.9, 4.3)
BF01 = 12.4
Forced to watch pornographic
material
49
3.7 (2.8, 4.9)
36
4.1 (2.9, 5.7)
0.9 (0.6, 1.4)
BF01 = 20.0
Pictures taken of nude body against
will
36
2.7 (1.9, 3.8)
20
2.3 (1.4, 3.5)
1.2 (0.7, 2.2)
BF01 = 24.6
Given intimate pictures against will
46
3.5 (2.6, 4.6)
16
1.8 (1.0, 3.0)
1.9 (1.1, 3.7)
BF01 = 1.9
Molested by someone verbally or
by e-mail/message
398
30.3 (27.9, 32.9)
74
8.5 (6.7, 10.5)
3.6 (2.9, 4.6)
BF10 = 2.2e34
Sexual harassment via Internet
359
27.4 (25.0, 29.9)
88
10.1 (8.2, 12.3)
2.7 (2.2, 3.4)
BF10 = 2.6e21
Sexual abuse with physical
contact without penetration
396
30.2 (27.7, 32.7)
101
11.6 (9.5, 13.9)
2.6 (2.2, 3.2)
BF10 = 9.1e22
Kissed or touched against will
319
24.3 (22.0, 26.7)
81
9.3 (7.4, 11.4)
2.6 (2.1, 3.6)
BF10 = 2.5e17
Forced to kiss someone
87
6.6 (5.3, 8.1)
24
2.7 (1.8, 4.1)
2.4 (1.6, 4.0)
BF10 = 280
Forced penetration with finger or
object; tried but not succeeded
77
5.9 (4.7, 7.3)
12
1.4 (0.7, 2.4)
4.3 (2.5, 9.1)
BF10 = 185783
Forced vaginal intercourse (girls
only); tried but not succeeded
109
8.3 (6.9, 9.9)
0
0 (0, 0.4)
NA
NA
Forced anal intercourse; tried but
not succeeded
64
4.9 (3.8 6.2)
8
0.9 (0.4, 1.8)
5.3 (2.9, 14.7)
BF10 = 109202
Forced oral intercourse; tried but
not succeeded
62
4.7 (3.6, 6.0)
10
1.1 (0.5, 2.1)
4.1 (2.3, 9.8)
BF10 = 5080
Forced into prostitution
54
4.1 (3.1, 5.3)
13
1.5 (0.8, 2.5)
2.8 (1.6, 5.8)
BF10 = 24.1
Sexual abuse with penetration
73
5.6 (4.4, 6.9)
11
1.3 (0.6, 2.2)
4.4 (2.6, 9.9)
BF10 = 117661
Forced penetration with finger or
object
35
2.7 (1.9, 3.7)
9
1.0 (0.5, 1.9)
2.6 (1.3, 6.7)
BF10 = 1.2
Forced vaginal intercourse (girls
only)
32
2.4 (1.7, 3.4)
0
0 (0, 0.4)
NA
NA
Forced anal intercourse
11
0.8 (0.4, 1.5)
0
0 (0, 0.4)
NA
BF10 = 1.0
Forced oral intercourse
34
2.6 (1.8, 3.6)
6
0.7 (0.3, 1.5)
3.8 (1.8, 13.0)
BF10 = 8.8
Note. a Boys as the reference group. bBF10 = Bayes factor in favor of the alternative hypothesis, Ha/H0. BF01 = Bayes factor in favor of the
null hypothesis, H0/Ha. NA = not applicable.
Characteristics of reported CSA
As can be seen in Table 3, more than half of the reported CSA occurred between 16-18
year of age in all three CSA cluster types. For CSA without physical contact and CSA with
physical contact without penetration, most girls reported that the perpetrator was older than 18
years. For most of the CSA cluster types, relatively high number (18-37%) of participants

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
14
reported not knowing the age of the perpetrator. However, for penetrative CSA, the proportion
of “don’t know” response by girls was 70% (only 15% of these perpetrators were strangers).
The girls were abused almost exclusively by males. In boys, females accounted for 62% to 78%
of CSA without contact and CSA with contact without penetration, respectively. With regard
to the relationship with perpetrator, the severity of abuse was inversely related to the proportion
of reporting stranger as the perpetrator and positively associated with roughly rising reported
proportion of partner and acquaintance as perpetrators. A family member engaging into sexual
abuse was uniformly reported by approximately 5-7% of abused participants (overall, the
frequencies related to boys reporting penetrative CSA cannot be considered stable due to small
n). Most of the CSA instances happened at home, at another house, and at public place, across
all the CSA cluster types. Internet accounted for approximately 23-29% of non-contact CSA.
Roughly 43-56% disclosed the abuse to another person. The relatively highest proportion of
disclosure was among girls that experienced penetrative CSA. The majority of disclosed CSA
was revealed to peers and partners. Only 7-18% of CSA was disclosed to parents. Negligible
proportion of CSA instances were reported to the police.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
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Table 3
Characteristics of the reported CSA
CSA without physical contact
CSA with physical contact
without penetration
CSA with physical contact
with penetration
Girls (n = 533)
Boys (n = 155)
Girls (n = 396)
Boys (n = 101)
Girls (n = 73)
Boys (n = 11)
Age of first CSA occurrence
< 6
3.9 (2.5, 6.0)
11.0 (6.5, 17.0)
4.0 (2.3, 6.5)
11.9 (6.3, 19.8)
2.7 (0.3, 9.5)
9.1 (0.2, 41.2)
6 - 11
5.6 (3.8, 7.9)
3.2 (1.1, 7.4)
5.1 (3.1, 7.7)
5.0 (1.6, 11.2)
2.7 (0.3, 9.5)
9.1 (0.2, 41.2)
12 - 15
35.1 (31.0, 39.3)
31.6 (24.3, 39.6)
30.3 (25.8, 35.1)
21.8 (14.2, 31.1)
37.0 (26.0, 49.1)
9.1 (0.2, 41.2)
16 - 18
55.3 (51.0, 59.6)
54.2 (46.0, 62.2)
60.6 (55.6, 65.4)
61.4 (51.2, 70.9)
57.5 (45.4, 69.0)
72.7 (39.0, 94.0)
Age of perpetrator
< 15
2.8 (1.6, 4.6)
3.2 (1.1, 7.4)
3.5 (2.0, 5.9)
3.0 (0.6, 8.4)
4.1 (0.9, 11.5)
0
15 - 18
14.4 (11.6, 17.7)
27.1 (20.3, 34.8)
21.0 (17.1, 25.3)
42.6 (32.8, 52.8)
2.7 (0.3, 9.5)
54.5 (23.4, 83.2)
> 18
58.7 (54.4, 62.9)
32.3 (25.0, 40.2)
57.3 (52.3, 62.3)
29.7 (21.0, 39.6)
23.3 (14.2, 34.6)
18.2 (22.8, 51.8)
Don’t know
24.0 (20.4, 27.9)
37.4 (29.8, 45.5)
18.2 (14.5 22.3)
24.8 (16.7, 34.3)
70.0 (58.0, 80.1)
27.2 (0.6, 61.0)
Sex of perpetrator
Male
99.2 (98.1, 99.8)
38.1 (30.4, 46.2)
100 (99.1, 100)
21.8 (14.2, 31.1)
100 (95 , 100)
0
Female
0.8 (0.2, 2.0)
61.9 (53.8, 69.6)
0
78.2 (68.9, 85.8)
0
100 (71.5, 100)
Relationship with perpetrator
Family
member
5.1 (3.4, 7.3)
7.1 (3.6, 12.3)
7.3 (5.0, 10.3)
6.9 (2.8, 13.8)
6.8 (2.3, 15.3)
18.2 (2.3, 51.8)
Partner
18.8 (15.5, 22.3)
20.0 (14.0, 27.1)
23.0 (18.9, 27.4)
30.7 (21.9, 40.7)
35.6 (24.7, 47.7)
54.5 (23.4, 83.2)
Acquaintance
26.6 (22.9, 30.6)
27.1 (20.3, 34.8)
39.1 (34.3, 44.1)
37.6 (28.2, 47.8)
42.5 (31.0, 54.6)
18.2 (2.3, 51.8)
Stranger
49.2 (44.8, 53.5)
45.8 (37.8, 54.0)
30.3 (25.8, 35.1)
24.8 (16.7, 34.3)
15.1 (7.8, 25.4)
9.1 (0.2, 41.2)
Place of CSAa
At home
20.6 (17.3, 24.3)
25.8 (19.1, 33.4)
26.8 (22.5, 31.4)
23.8 (15.9, 33.3)
34.2 (23.5, 46.3)
36.4 (10.9, 69.2)
At another
house
21.6 (18.2, 25.3)
16.8 (11.3, 23.6)
27.2 (22.9, 31.9)
30.7 (21.9, 40.7)
42.5 (31.0, 54.6)
36.4 (10.9, 69.2)
Public place
29.1 (25.3, 33.1)
30.3 (23.2, 38.2)
36.4 (31.6, 41.3)
44.6 (34.7, 54.8)
31.5 (21.1, 43.4)
45.5 (16.7, 76.6)
School/on
way to school
3.4 (2.0, 5.3)
11.0 (6.5, 17.0)
4.0 (2.3, 6.5)
9.9 (4.9, 17.5)
6.8 (2.3, 15.3)
36.4 (10.9, 69.2)
Internet
28.9 (25.1, 32.9)
22.6 (16.3, 30.0)
9.6 (6.9, 12.9)
2.0 (0.2, 7.0)
0
0
Other
7.5 (5.4, 10.1)
6.5 (3.1, 11.5)
10.4 (7.5, 13.8)
4.0 (1.1, 9.8)
9.6 (3.9, 18.8)
0
Disclosure
Yes
43.0 (38.7, 47.3)
42.6 (34.7, 50.8)
47.5 (42.5, 52.5)
50.5 (40.4, 60.6)
56.2 (44.1, 67.8)
45.5 (16.7, 76.6)
To whom was CSA discloseda
Parent
13.7 (10.9, 16.9)
5.8 (2.7, 10.7)
16.9 (13.3, 21.0)
6.9 (2.8, 13.8)
16.4 (8.8, 27.0)
18.2 (2.3, 51.8)
Other family
member
7.9 (5.7, 10.5)
9.0 (5.0, 14.7)
9.1 (6.4, 12.4)
10.9 (5.6, 18.7)
6.8 (2.3, 15.3)
18.2 (2.3, 51.8)
Peer, partner
38.9 (34.7, 43.1)
34.2 (26.8, 42.2)
43.2 (38.2, 4.8)
40.6 (30.9, 50.8)
53.4 (41.4, 65.2)
36.4 (10.9, 69.2)
Other(s)
5.3 (3.5, 7.5)
6.5 (3.1, 11.5)
7.6 (5.2, 10.6)
7.9 (3.5, 15.0)
23.3 (14.2, 34.6)
9.1 (0.2, 41.2)
Police
Yes
2.1 (1.0, 3.7)
2.5 (0.1 6.5)
2.5 (1.2, 4.6)
0.1 (0.0, 5.4)
5.5 (1.5, 13.4)
9.1 (0.2, 41.2)
Note. a multiple responses allowed. In case of revictimization, participants were asked to provide characteristics of the subjectively most
severe abuse.
Characteristics associated with CSA
The only characteristic that is uniformly strongly associated with the prevalence of CSA
across all three cluster types of CSA was gender, as discussed above (see Table 4). With respect
to residence, the data provide moderate-to-strong evidence for the hypothesis of no effect in all

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
16
cluster types. The BFs also generally strongly support the null effects of parent’s education and
number of siblings. Here, relatively high risk ratios for underrepresented population of parents
with only elementary education were largely outweighed by overall moderate risk for
participants having parents with secondary school (vocational or high school). Further on, there
is highly convincing evidence for the association of school type and prevalence of non-contact
CSA and contact CSA without penetration, with participants attending vocational schools being
at greater risk. For penetrative CSA, the data support the null hypothesis with regard to the
effect of school type. With regard to family structure, there was a convincing pattern with
increased risk for other family structure compared to a family with two biological parents (BFs
equal to 46 and 556 for non-contact and contact CSA without penetration, respectively). For
penetrative CSA, given the low natural frequencies and a relative risk of 2.2, the probability of
the data assuming the existence of an effect was 2.8 times higher than the probability of data
given no effect of family structure on the prevalence of penetrative CSA.

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
17
Table 4
Characteristics of participants
CSA without physical contact
CSA with physical contact
without penetration
CSA with physical contact
with penetration
Relative risk
(95% CI)
Bayesa
factor
Relative risk
(95% CI)
Bayesa
factor
Relative risk
(95% CI)
Bayesa
factor
Gender
Male
1
BF10 =
1
BF10 =
1
BF10 =
Female
2.3 (1.9, 2.7)
9.1e27
2.6 (2.2, 3.2)
9.1e22
4.4 (2.6, 10.0)
117661
Residence
Urban
1
BF01 =
1
BF01 =
1
BF01 =
Rural
1.0 (0.9, 1.2)
9.4
0.9 (0.8, 1.1)
4.8
0.9 (0.6, 1.3)
20.2
School type
High school
1
BF10 =
1
BF10 =
1
BF01 =
Vocational
1.5 (1.2, 1.7)
4216.8
1.4 (1.2, 1.7)
27.3
1.6 (1.0, 3.2)
7.4
Mother’s education
University
1
BF01 =
1
BF01 =
1
BF01 =
Secondary school
1.1 (1.0, 1.4)
24.9
1.3 (1.0, 1.6)
2.7
1.2 (0.7, 2.4)
323.1
Elementary school
1.4 (1.0, 1.8)
1.8 (1.2, 2.5)
2.1 (0.6, 5.2)
Father’s education
University
1
BF01 =
1
BF01 =
1
BF01 =
Secondary school
0.9 (0.8, 1.1)
33.6
0.9 (0.8, 1.2)
15.0
1.8 (1.0, 5.6)
510.9
Elementary school
1.2 (0.8, 1.7)
1.6 (1.0, 2.4)
0.9 (0.0, 4.2)
Family structure
Both biological parents
1
BF10 =
1
BF10 =
1
BF10 =
Other
1.4 (1.2, 1.6)
46.34
1.6 (1.3, 1.9)
556.3
2.2 (1.3, 3.4)
2.8
Siblings
0
1
BF01 =
1
BF01 =
1
BF01 =
1
1.0 (0.9, 1.1)
115.3
1.0 (0.8, 1.4)
125.9
1.8 (0.8, 8.5)
23.7
2+
1.0 (0.8, 1.3)
1.0 (0.8, 1.4)
1.0 (0.5, 4.9)
Note. aBF10 = Bayes factor in favor of the alternative hypothesis, Ha/H0. BF01 = Bayes factor in favor of the null hypothesis, H0/Ha.
Discussion
In the given sample of late adolescents, we found CSA to be relatively prevalent. Till
reaching 18 years of age, 47.3% of girls and 22.0% of boys experienced at least one form of
CSA. This high prevalence of CSA should be interpreted within the context of our wide
definition of CSA, including a spectrum of CSA forms reflected in behaviorally specific
questions (Cranera et al., 2015; Fricker et al., 2003), full period of childhood (Finkelhor et al.,
2014) and no age limitations regarding perpetrators.
The most commonly reported form was CSA without physical contact (40.6% among

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
18
girls and 17.7% among boys). As internet accounted for approximately 23-29% of non-contact
CSA, preventive programs should involve recommendations on online behavior. 30.2% of girls
and 11.6% of boys reported CSA with physical contact without penetration and 5.6% of girls
and 1.3% of boys admitted CSA with penetration. The high prevalence of seemingly less severe
forms of CSA should not be trivialized. Even non-contact types of CSA may have negative
consequences on victim’s health and wellbeing (Landolt et al., 2016; Paolucci et al., 2001).
Pérez-Fuentes et al. (2013) pointed out that the experience of abuse may be more important for
the victim than the specific type of abuse, leading different types of abuse to generate similar
stress; moreover, forms of abuse that may appear less severe can have serious consequences on
adult mental health if they occur repeatedly. In this connection it is worth noting that the level
of revictimization in our sample was highest in the non-contact cluster of CSA.
In line with past research (e.g. Fico, 2013; Mohler-Kuo et al., 2014; Pereda et al., 2009;
Stoltenborgh et al., 2011) being female was a significant predictor of CSA. Another risk factor
was not living with both biological parents (Berliner, 2011; Laaksonen et al., 2011). The fact
that in our sample, participants attending vocational schools had a greater risk of experiencing
non-contact CSA and contact CSA without penetration, calls for intensifying of CSA preventive
activities within this type of schools.
Rising invasiveness of CSA is generally positively associated with the proportion of
perpetrators being known to the victim. It is well known that widespread stereotypes about a
dangerous stranger grossly relativize the risk of attack and harm caused by someone familiar.
In fact, the sexual assault from a known person is not only more frequent but potentially more
pervasive than attack committed by stranger because it involves element of betrayal, increases
the likelihood of delayed detection and well as likelihood of unsupportive social reactions
towards the victim (Freyd & Birrell, 2013).

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
19
The important finding coming from our research is that more than half of CSA occurred
between 16-18 year of age in all three CSA cluster types. As also shown by previous research
(Finkelhor et al., 2014), late adolescence represents a life-time with a significantly increased
risk of sexual victimization. The impact of CSA is then amplified by the fact that with rising
age, victims are at greater risk of facing victim-blaming attitudes (Back & Lips, 1998; Bottoms
& Goodman, 1994; Davies & Rogers, 2009; Klettke & Mellor, 2017; Maynard & Wiederman,
1997; Rogers et al., 2007).
Our study also revealed that in approximately one third of all CSA cases, the perpetrator
was the partner. Dating violence is a widespread phenomenon (Vagi et al., 2015; Wincentak et
al., 2017) and this topic should be a part of sexual violence preventive programs focused on the
population of adolescents (Lundgren & Amin, 2015).
In our study, on average, less than half of respondents victimized during childhood
disclosed abuse to another person. Our findings are in line with previous research literature
uncovering a high rate of nondisclosure (Finkelhor, 1994; London et al., 2007; McElvaney,
2015; Mohler-Kuo et al., 2014; Olafson & Lederman, 2006). Multiple reasons described in
research literature (e.g. Collin-Vézina et al., 2015; Crisma et al., 2004; Wager, 2015), including
self-blame, shame, lack of awareness of being abused, or fear of negative social reactions to
disclosure, can play a role in the reluctance to disclose.
Consistent with previous studies (Fico, 2013; Mohler-Kuo et al., 2014; Priebe & Svedin,
2008) our findings also reveal that peers or partners are the most frequent recipients of victims’
disclosure. This fact has important implications for preventive measures, as it emphasizes the
importance of bystander-oriented prevention models applied mostly on high school and college-
age population (Cook-Craig et al., 2014; Katz & Moore, 2013). Bystanders (as the carriers of
community norms related to sexual violence) play a role not only in primary and secondary
prevention, but they are also a crucial part of tertiary prevention as their quality of reaction to

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
20
victims’ disclosure can either help or hinder the victims’ recovery process (Banyard, 2015).
Bystanders “can offer support and referral to resources or provide negative responses that
silence victims and compound their distress” (Banyard, 2015). While a number of promising
prevention programs that train bystanders exist abroad (Katz & Moore, 2013), implementation
of such programs is still a challenge for Slovakia. The urgency of this challenge is even stronger
in the light of previous Slovak study which found that friends are not only the most frequent
recipients of victims’ disclosure but at the same time they are those who most often
doubt/question the victims (Fico, 2013).
The results also provide support for the widely held assumption and previous research
findings (e.g. Mills et al., 2016; Mohler-Kuo et al., 2014; Priebe & Svedin, 2008; Stoltenborgh
et al., 2011) that the vast majority of CSA cases go unreported to the authorities. Abusive
dynamic, evidential difficulties, the risk of secondary victimization and other reasons can
prevent majority of CSA victims from reporting to police. The fact that criminal justice system
is largely limited in its response to sexual offences (McAlinden, 2007) raises questions whether
efforts should be invested into reduction of its limitations or rather into promotion of restorative
justice approach to these type of offenses (Marsh & Wager, 2015; Yantzi, 1998).
The present study adopted the Mohler-Kuo et al.’s (2014) behavior-specific items
questionnaire, which covers a wide range of possible CSA types. Noncontact forms of CSA
were largely ignored and contact and penetrative forms of CSA were inquired in a more
superficial way in previous Slovak screening studies providing data on CSA prevalence.
Because the adopted measure covered many types of behavior-specific manifestations of CSA,
the data can be conveniently meta-analyzed because it is fully comparable with any other
studies irrespective of how narrow or broad a definition those studies used, facilitating the
cumulative character of the knowledge in the field.
Since the questionnaire was administered to respondents on the verge of adulthood, the

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
21
data can thus reflect the whole time-span of childhood until late adolescence. At the same time,
the age of our respondents makes it reasonable to assume, that most of them are mature enough
to be aware of the severity of the phenomenon surveyed and thus answered the survey in a more
responsible manner.
Moreover, we have made every effort to eliminate the risk of social stigmatization of
those who identified themselves as CSA victims in our survey. Considering that many victims
would not wish to uncover their CSA related experiences to other schoolmates, we designed
the questionnaire to be filled in by respondents online, offering them a different set of questions
depending on whether they did or did not identify themselves as victims. The length of time
needed to finish the questionnaire was designed to be invariant regardless whether the
participant identified self as a CSA victim or not. We believe that higher level of privacy we
provided to our respondents made them responding to the questionnaire more sincerely.
The current study also had certain limitations. While only 5 students chose to withdraw
from the study, 27 schools chose not to participate for various reasons. We cannot rule out the
possibility that CSA prevalence among students attending those schools is higher, as avoidance
of this sensitive topic can contribute to an environment in which CSA thrives. Another
limitation is that our sample did not involve students from special schools who are more
vulnerable to sexual victimization than intact population (Berliner, 2011). Furthermore, as
common with any victimological surveys based on self-reported retrospective recollection,
there will always be some uncertainty about whether the reported experiences actually took
place (Goldman & Padayachi, 2000), although it is widely accepted that denial of real CSA is
a greater threat to validity than fabrication (Fergusson et al., 2000; Hardt & Rutter, 2004; Lyon,
2007). Mills et al. (2016) in their population-based birth cohort study found that a substantial
proportion (nearly 40%) of victims whose exposure to CSA was officially reported and
substantiated, failed to recall any CSA when asked in early adulthood (age 21). It is virtually

THE PREVALENCE OF CSA IN SLOVAK LATE ADOLESCENTS
22
certain that some offenses will not be recalled e.g. because they could have occurred in early
childhood before child’s ability to encode memories developed, were not understood as abusive
(Goodman-Delahunty et al., 2017), or will be consciously not disclosed because of discomfort
or shame.
The present study showed that CSA is a relatively widespread and considerably covert
phenomenon in the population of Slovak late adolescents. Prevention activities should consider
broad spectrum of CSA forms in order to counteract tendencies to associate CSA solely with
unwanted sexual intercourse. It is clear than vulnerability to sexual victimization continues to
be present even in late adolescence. In this regard, the rights described in United Nations
Convention on the Rights of the Child (United Nations, 1989) are in no way less relevant for
adolescents than they are for younger children (Ruck et al., 2016). Negligible proportion of
CSA instances reported to the police also emphasizes the importance of respecting presumption
of victim status – principle according to which unless proven otherwise “a person should be
considered to be a victim regardless of whether an offender is identified, apprehended,
prosecuted or convicted” (Directive 2012/29/EU). This principle should be also stressed in
prevention activities focusing on wide public as well as in educational activities intended for
professional. Implementation of bystander-oriented prevention models could equip adolescents
as well as adults to be more safe and active recipients of victims’ disclosure.
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