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Journal of Child Sexual Abuse
ISSN: 1053-8712 (Print) 1547-0679 (Online) Journal homepage: http://www.tandfonline.com/loi/wcsa20
The Prevalence of Child Sexual Abuse among
Slovak Late Adolescents
Slavka Karkoskova & Ivan Ropovik
To cite this article: Slavka Karkoskova & Ivan Ropovik (2018): The Prevalence of Child
Sexual Abuse among Slovak Late Adolescents, Journal of Child Sexual Abuse, DOI:
10.1080/10538712.2018.1553224
To link to this article: https://doi.org/10.1080/10538712.2018.1553224
Published online: 11 Dec 2018.
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The Prevalence of Child Sexual Abuse among Slovak Late
Adolescents
Slavka Karkoskova
a,b
and Ivan Ropovik
c
a
Judicial Academy of the Slovak Republic,, Pezinok, Slovakia;
b
St. Elisabeth University of Health Care
and Social Work, Slovakia;
c
Department of Preschool and Elementary Education and Psychology,
University of Presov, Bratislava, Slovakia
ABSTRACT
The present study aimed to assess the prevalence and character-
istics 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 major-
ity 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.
ARTICLE HISTORY
Received 31 July 2018
Revised 12 November 2018
Accepted 13 November 2018
KEYWORDS
Child sexual abuse;
prevalence; late
adolescence; disclosure
Child sexual abuse (CSA) is one of the most serious socio-pathological phenomena
due to its widespread international prevalence (Barth, Bermetz, Heim, Trelle, &
Tonia, 2013;Finkelhor,1994; Pereda, Guilera, Forns, & Gómez-Benito, 2009;Sapp
&Vandeven,2005; Stoltenborgh, van IJzendoorn, Euser, & Bakermans-
Kranenburg, 2011) as well as its relation to significantly higher risk of both
short- and long-term negative consequences (Cutajar et al., 2010; Fergusson,
Boden, & Horwood, 2008; Paolucci, Genuis, & Violato, 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
CONTACT Slavka Karkoskova slavka.karkoskova@gmail.com Judicial Academy of the Slovak Republic,
Suvorovova 5/C, Pezinok 902 01
JOURNAL OF CHILD SEXUAL ABUSE
https://doi.org/10.1080/10538712.2018.1553224
© 2018 Taylor & Francis
against children is a crucial problem (Slovak national strategy, 2013); by
relying solely on statistical data from cases only reported to authorities, it
can lead to a gross underestimation of the problem.
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, Laurent, Lighezzolo-Alnot, Garnier, & Vandelet,
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 indicates 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 (e.g., different definitions of
CSA, measurement issues, sample characteristics, or design of the survey) account
for variance in the 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
CSA (ranging from penetrative acts only, through a broad spectrum of contact and
non-contact 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
mightalsocovermoreaspectsofCSA,andthusleadtohigherprevalencerates
(Bolen & Scannapieco, 1999; Finkelhor, 1994; Goldman & Padayachi, 2000;
Mathews & Collin-Vézina, 2017;Stoltenborghetal.,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,Smith,Davis,&Hanson,2003;
Mohler-Kuo et al., 2014). Lifetime CSA prevalence may vary considerably depend-
ing on the sampling techniques (e.g., random samples, convenience samples, clinic
populations) as well as on the actual age of the respondents in a sample (Finkelhor,
1994; Goldman & Padayachi, 2000). Because of high rates of continuing victimiza-
tion that occur during the late teen years, assessments of CSA are more accurate
when conducted among the oldest youth (Finkelhor, Shattuck, Turner, & Hamby,
2014). Variations in prevalence rates can also be partly linked to survey design
(e.g., confidentiality guarantee as perceived by the respondents).
To date, few studies have provided only partial data on the prevalence of CSA in
Slovakia (Fedor, Buchanec, Uchaľová, Fedor Ml., & Bánovčin, 2011;Fico,
2013;Máthé,2006 In: Slovak national strategy for the protection of children against
violence, 2013). None of these studies have focused solely on CSA. Questions
regarding CSA were just a small subgroup of questions (5–7) among many other
enquiring about respondents’experiences with various forms of violence during
2S. KARKOSKOVA AND I. ROPOVIK
childhood (Fedor et al., 2011;Fico,2013; Slonad, 1999 In: Slovak national strategy
for the protection of children against violence, 2013)orabouttheirsexualbehavior
(Máthé, 2006). Survey questions did not cover non-contact forms of CSA and
mostly defined childhood as 15 years of age or younger; in these surveys the
perpetrator was also defined as an adult. In these studies, survey respondents
were children aged 14–16 years (Fico, 2013; Slonad, 1999 In: Slovak national
strategy for the protection of children against violence, 2013)orchildrenand
adults aged 15–28 years (Fedor et al., 2011)and15–69 years (Máthé, 2006).
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 18 years; (2) a 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, Bruck, Ceci, & Shuman, 2007;
McElvaney, 2013; Olafson & Lederman, 2006); (3) even the so-called ‘less severe’
non-contact types of CSA may have detrimental effects (Landolt, Schnyder, Maier,
& Mohler-Kuo, 2016; Paolucci et al., 2001); and (4) a significant percentage of
CSA may be committed by individuals under the age of 18 (Ryan, Hunter, &
Murrie, 2012), our study sought to address several gaps which characterized
previous surveys on CSA prevalence among Slovak population.
Thepresentstudyaimedtoassesstheprevalenceof,andcharacteristicsand
circumstances associated with, CSA in a large-scale 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 also covers non-
contact forms of CSA. We consider late adolescence to be an appropriate age for
participation in a survey study focusing on CSA experiences. It is more probable
that late adolescents (rather than young adolescents) will understand survey
questions properly and answer them responsibly. Also, memory retrieval among
late adolescents may be more reliable given the fact that, although CSA can be
retained well in the memory, it may be vulnerable to ‘normal’memory processes
such as forgetting in later age (Goodman-Delahunty, Nolan, & Van Gijn-
Grosvenor, 2017). Because no representative study concerning CSA prevalence
among Slovak late adolescents has been published in English yet, our findings will
provide the most contemporary estimates for future prevalence meta-analyses.
Method
Participants
The present study was carried out between November 2, 2015 and January 27, 2016
on a population of Slovak secondary school students in their final year with a target
modal age of 18–19 years. A randomized cluster sampling plan was employed.
Based on an index of all (public and private) secondary schools in eastern Slovakia
JOURNAL OF CHILD SEXUAL ABUSE 3
(195 schools, 474 final year classes, and 11,454 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.
The sample comprised 874 (40%) boys and 1,312 (60%) girls, having the mean
age of 18.58 years (SD = .72). Overall, 14 questionnaires were either lost due to
technical problems or were deemed invalid and five students chose to withdraw
fromthestudy,resultinginafinalsamplesizeofn= 2,186, representing 19.1% of
the defined population. Since previous nationwide surveys (Fico, 2013)have
shown eastern and western Slovakia are equivalent with respect to the overall
prevalence of CSA, we assume that our estimates of the overall prevalence of CSA
can be expected to approximately hold also for the Western part. The data from the
2013 study, however, do not allow to infer whether that is necessarily true for
individual CSA subtypes. Although we aimed for a representative sample, a non-
trivial number of approached schools (27) chose not to participate. Moreover, the
sampling frame involving only secondary school students may have induced
selection bias. Namely, the prevalence of CSA in students who dropped out before
getting into the final year is likely higher than for the students who did not. The
prevalence estimates can thus be expected to be a bit downward biased.
Sociodemographic characteristics of the sample can be seen in Table 1.
Procedure
Following study approval by the Department of Education of the concerned Self-
governing Region Authorities, school managements were assured that data collec-
tion procedures were confidential and that the procedure precludes the possibility
to identify individuals or their school affiliation. Questionnaires were administered
by trained research assistants who were acquainted with privacy and data protec-
tion issues. Utilizing informed consent procedures, all participants were briefed on
the purpose of the study, confidentiality, and their rights to withdraw from the
study at any time without reason. Moreover, it was emphasized that, by design, the
time needed to finish the questionnaire was the same regardless of whether the
participant identified as a victim of CSA or not. Participants who did not identify as
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). The
computer-assisted administration of the questionnaire took place in a dedicated
computerlabofeachparticipatingschoolwith supervision by a research assistant
and teacher. Participants sat alone, with a free chair on each side, to prevent study
participants from seeing one another’s content. Most participants finished the
questionnaire within 40 min and at the end, they were provided contact informa-
tion for organizations offering specialist support, counseling and further informa-
tion about CSA-related issues.
4S. KARKOSKOVA AND I. ROPOVIK
Measures
The present study employed the CSAQ (Mohler-Kuo et al., 2014). The CSAQ
measures the prevalence of CSA in a comprehensive manner, covering 15 forms of
CSA 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 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 participants were asked to
focus on the one that they subjectively consider as the most severe.
Table 1. Participant characteristics.
n% (95% CI)
Gender
Male 874 40.0 (37.9, 42.1)
Female 1,312 60.0 (57.9, 62.0)
Age
17 17 0.8 (0.5, 1.2)
18 1,122 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 1,048 47.9 (45.8, 50.1)
Rural 1,138 52.1 (49.9, 54.2)
School type
High school (gymnasium) 529 24.2 (22.4, 26.1)
Vocational 1,656 75.8 (73.9, 77.5)
Mother’s education
Elementary school 87 4.0 (3.2, 5.0)
Secondary school 1,678 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 1,777 83.5 (81.9, 85.1)
University 302 14.2 (12.7, 15.8)
Family structure
Both biological parents 1,896 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+ 1,070 48.9 (46.8, 51.1)
JOURNAL OF CHILD SEXUAL ABUSE 5
Analysis
The prevalence of CSA was analyzed separately for the three given clusters and
gender. As is typical in prevalence studies, a rather large number of associa-
tions between CSA rates and various sociodemographic characteristics can be
tested. However, without the adjustment of the αlevel for the number of
hypothesis tests, this leads to the inflation of Type I errors. The adjustment
considerably attenuates the statistical power especially when the hypothesis
tests are being carried out on a smaller subset of the sample. Apart from that,
the classical frequentist approach of null hypothesis significance testing
employing χ
2
tests or likelihood ratio tests cannot (without additional proce-
dures like equivalence testing) provide formal support for the null hypothesis
(i.e., 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
become statistically significant (due to very small standard errors), even though
they are, in fact, more consistent with the null hypothesis.
For 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 H
0
. Whether this failure is due to underpowered
testing of a real effect or a genuine absence of a noteworthy effect usually remains
unknown. These shortcomings can be overcome with the use of Bayesian methods.
To assess the independence of the observed categorical variables, the current study
employed the Gunel-Dickey default Bayes factors (BFs) for contingency tables with
the 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). BF is a continuous measure of evidence,
defined as the ratio of two conditional probabilities tied to the alternative (H
A
)and
null hypothesis (H
0
), 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). A BF thus reflects the relative plausibility of a theory
postulating the existence of an effect vs. 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, data were screened for improbable values. No data transfor-
mations or imputation techniques were employed. All analyses were performed in
R(version 3.2.3) using the following packages: epitools (Aragón, 2012), BayesFactor
(Morey & Rouder, 2015), dplyr (Wickham & Francois, 2016), car (Fox & Weisberg,
2011), and stringr (Wickham, 2015). All analyses reported in this paper are meant
6S. KARKOSKOVA AND I. ROPOVIK
to be fully reproducible. Data and complete Rcode documenting the entire analytic
workflow are available here: https://osf.io/pq9my/.
Results
Prevalence of CSA
The self-reported lifetime prevalence of at least one form of CSA 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 slightly more than two times
likely to experience CSA). Almost identical risk ratios were observed for
the two non-penetrative clusters, with the following prevalence propor-
tions: 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 but 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 pre-
valence of CSA as categorized within these three clusters provide over-
whelming evidence for the strong association between CSA prevalence and
gender. Here, the BFs 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 forms of abuse, 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 the will”would have been statistically significant if
tested for gender effect within the frequentist approach, the data were,
in fact, insensitive (BF
10
within the 1/3–3 range). Regarding the other
four non-contact abuse forms, the data provide rather strong evidence
(BF
01
ranging from 10.1 to 24.6, i.e., data under H
0
being 10–25 times
more likely than under H
A
) for the independence of their prevalence
and gender.
(2) As for CSA with physical contact but 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 girls being at
greater risk of CSA in all of the respective forms.
JOURNAL OF CHILD SEXUAL ABUSE 7
(3) Concerning CSA with penetration, there was compelling evidence for
significantly higher prevalence in girls only for “forced oral inter-
course.”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 BFs, see Table 2.
Seventy-four percent of participants reporting CSA without contact were
revictimized, with 36.0% being revictimized more than five times. For CSA
with contact without penetration, 48.5% experienced the abuse more than
once and 16.9% more than five times. A relatively high number of revicti-
mization (54.8%) was found among participants reporting any penetrative
form of CSA; 26.2% reported experiencing more than five instances of
penetrative sexual abuse.
Characteristics of reported CSA
As can be seen in Table 3,morethanhalfofreportedCSAoccurred
between 16 and 18 years of age in all three cluster types. For CSA without
physical contact and CSA with physical contact but without penetration,
most girls reported that the perpetrator was older than 18 years. For most
of the CSA cluster types, a relatively high number of participants
(18–37%) reported not knowing the age of the perpetrator. However, for
penetrative CSA, the proportion of “don’tknow”responses by girls was
70% (only 15% of these perpetrators were strangers). The girls reported
abuse almost exclusively by males. In boys, females accounted for 62–78%
of CSA without contact and CSA with contact without penetration,
respectively.
With regard to the perpetrator, the severity of abuse was inversely related
to the proportion of reports involving a stranger as the perpetrator and
positively associated with rising reported proportion of a partner or acquain-
tance as the perpetrator; it is notable that in approximately one-third of all
CSA cases, the perpetrator was the partner. A family member engaging into
sexual abuse was uniformly reported by approximately 5–7% of victims
(overall, the frequencies related to boys reporting penetrative CSA cannot
be considered stable due to small n). Most of the instances of CSA occurred
at home, at someone else’s house, or public places, across all the CSA cluster
types. Internet accounted for approximately 23–29% of non-contact CSA.
Roughly 43–56% of participants disclosed the abuse to another person. The
majority of disclosed CSA was revealed to peers and partners. Only 7–18% of
CSA was disclosed to parents. A negligible proportion of CSA instances were
reported to the police. The highest proportion of disclosure was among girls
who experienced penetrative CSA.
8S. KARKOSKOVA AND I. ROPOVIK
Table 2. Prevalence of CSA by gender and type of abuse.
Girls (n= 1,312) Boys (n= 874)
n% (95% CI) n% (95% CI) Relative risk
a
(95% CI) Bayes factor
b
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 the 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 the 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 the 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 = 185,783
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 = 109,202
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 = 5,080
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 = 117,661
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.
b
BF10 = Bayes factor in favor of the alternative hypothesis, H
A
/H
0
. BF01 = Bayes factor in favor of the null hypothesis, H
0
/H
A
. NA = not
applicable.
JOURNAL OF CHILD SEXUAL ABUSE 9
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 CSA
a
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 disclosed
a
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.
10 S. KARKOSKOVA AND I. ROPOVIK
Characteristics associated with CSA
The only characteristic that is uniformly and strongly associated with the
prevalence of CSA across all three cluster types 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 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 an underrepresented
population of parents with only elementary education were largely out-
weighed by overall moderate risk for participants having parents with sec-
ondary education (vocational or high school). Further, there is highly
convincing evidence for the association of school type and prevalence of non-
contact CSA and contact CSA without penetration; participants attending
vocational schools being at greater risk. For penetrative CSA, the data sup-
port 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.
Discussion
In this sample of late adolescents, we found CSA to be relatively prevalent.
Through 18 years of age, 47.3% of girls and 22.0% of boys experienced at
least one form of CSA. These findings should be interpreted within the
context of our expanded 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 girls and 17.7% among boys). As Internet accounted for
approximately 23–29% of non-contact CSA, prevention programs should
involve recommendations regarding 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
a victim’s health and wellbeing (Landolt et al., 2016; Paolucci et al., 2001).
Pérez-Fuentes et al. (2013) point out that the experience of abuse may be
more important for the victim than the specific type of abuse, leading
JOURNAL OF CHILD SEXUAL ABUSE 11
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) Bayes
a
factor Relative risk (95% CI) Bayes
a
factor Relative risk (95% CI) Bayes
a
factor
Gender
Male 1 BF10 = 9.1e27 1 BF10 = 9.1e22 1 BF10 = 117,661
Female 2.3 (1.9, 2.7) 2.6 (2.2, 3.2) 4.4 (2.6, 10.0)
Residence
Urban 1 BF01 = 9.4 1 BF01 = 4.8 1 BF01 = 20.2
Rural 1.0 (0.9, 1.2) 0.9 (0.8, 1.1) 0.9 (0.6, 1.3)
School type
High school 1 BF10 = 4,216.8 1 BF10 = 27.3 1 BF01 = 7.4
Vocational 1.5 (1.2, 1.7) 1.4 (1.2, 1.7) 1.6 (1.0, 3.2)
Mother’s education
University 1 BF01 = 24.9 1 BF01 = 2.7 1 BF01 = 323.1
Secondary school 1.1 (1.0, 1.4) 1.3 (1.0, 1.6) 1.2 (0.7, 2.4)
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 = 33.6 1 BF01 = 15.0 1 BF01 = 510.9
Secondary school 0.9 (0.8, 1.1) 0.9 (0.8, 1.2) 1.8 (1.0, 5.6)
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 = 46.34 1 BF10 = 556.3 1 BF10 = 2.8
Other 1.4 (1.2, 1.6) 1.6 (1.3, 1.9) 2.2 (1.3, 3.4)
Siblings
0 1 BF01 = 115.3 1 BF01 = 125.9 1 BF01 = 23.7
1 1.0 (0.9, 1.1) 1.0 (0.8, 1.4) 1.8 (0.8, 8.5)
2+ 1.0 (0.8, 1.3) 1.0 (0.8, 1.4) 1.0 (0.5, 4.9)
12 S. KARKOSKOVA AND I. ROPOVIK
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 context, it is worth noting that the
level of revictimization in our sample was highest in the non-contact cluster
of CSA.
Consistent 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). In our sample, the fact that
participants attending vocational schools had a greater risk of experiencing
non-contact CSA and contact CSA without penetration calls for intensifying
CSA preventive activities within these types of schools.
The severity 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, sexual assault perpetrated by a person
known to the victim is not only more frequent but potentially more pervasive
than stranger perpetrated assaults because it involves an element of betrayal,
increases the likelihood of delayed detection, and increases the likelihood of
unsupportive social reactions toward the victim (Freyd & Birrell, 2013).
The most important finding originating from this research is that more
than half of CSA occurred between 16 and 18 years of age in all three
CSA cluster types. Consistent with research (Finkelhor et al., 2014), late
adolescence represents a lifetime with a significantly increased risk of
sexual victimization. The impacts of CSA are then amplified by the fact
that as victims age they 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, Josey, & Davies, 2007).
This study also revealed that in approximately one-third of all CSA cases,
the perpetrator was the partner. Dating violence is a widespread phenom-
enon (Vagi, O’Malley Olsen, Basile, & Vivolo-Kantor, 2015; Wincentak,
Connolly, & Card, 2017) and this topic should be a part of sexual violence
prevention programs focused on adolescents (Lundgren & Amin, 2015).
In this study, on average, less than half of respondents victimized during
childhood disclosed abuse to another person. These findings are consistent
with the previous literature uncovering a high rate of nondisclosure
(Finkelhor, 1994; London et al., 2007; McElvaney, 2013; Mohler-Kuo et al.,
2014; Olafson & Lederman, 2006). Multiple reasons described in the litera-
ture (e.g., Collin-Vézina, De La Sablonnière-Griffin, Palmer, & Milne, 2015;
Crisma, Bascelli, Paci, & Romito, 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 keeping victims silent.
JOURNAL OF CHILD SEXUAL ABUSE 13
Consistent with previous studies (Fico, 2013; Mohler-Kuo et al., 2014;
Priebe & Svedin, 2008) these findings also reveal that peers or partners are
the most frequent recipients of victims’disclosure. This has important impli-
cations for preventive measures, as it emphasizes the importance of bystander-
oriented prevention models applied mostly to high school and college-age
populations (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 the quality of their reaction to 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), the implementation of such programs is still a challenge in
Slovakia. The urgency to address this challenge is even stronger in the light of
a previous Slovak study which found that friends are not only the most
frequent recipients of victims’disclosure, but they are also those who most
often doubt or question the victims (Fico, 2013).
Our findings also provide support for the widely held belief that the vast
majority of CSA cases go unreported to the authorities; this is consistent with
previous research findings (e.g. Mills, Kisely, Alati, Strathearn, & Najman,
2016; Mohler-Kuo et al., 2014; Priebe & Svedin, 2008; Stoltenborgh et al.,
2011). Abuse dynamics, evidential difficulties, the risk of secondary victimiza-
tion and other reasons discourage many CSA victims from ever reporting to
police. The fact that the criminal justice system is largely limited in its response
to sexual offenses (McAlinden, 2007) raises questions whether efforts should
be invested into reducing its limitations or into promoting a restorative justice
approach to these types of offenses (Marsh & Wager, 2015; Yantzi, 1998).
The present study adopted Mohler-Kuo et al.’s(2014) behavior-specific
items questionnaire, which covers a wide range of possible CSA types. In
previous Slovak studies examining the prevalence of CSA, non-contact forms
of CSA were largely ignored, and contact and penetrative forms of CSA were
inquired more superficially. Because the adopted measure covered many types
of behavior-specific manifestations of CSA, the data can be conveniently meta-
analyzed. In this way, our data is fully comparable to other CSA prevalence
research irrespective of the narrowness or broadness of the definitions utilized,
thereby facilitating the cumulative character of the knowledge in the field.
As the questionnaire was administered to respondents on the verge of
adulthood, the 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 are mature enough to be aware of the severity
of the phenomenon surveyed and thus answered the survey in a more
responsible manner.
14 S. KARKOSKOVA AND I. ROPOVIK
Moreover, we have made every effort to eliminate the risk of social stigma-
tization for those who identified 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 completed online by
respondents, offering them a different set of questions depending on whether
they did or did not self-identify as a victim. The length of time needed to finish
the questionnaire was designed to be invariant regardless of whether the
participant identified self as a CSA victim or not. We believe that the higher
level of privacy provided to respondents made their responses sincerer.
Limitations and conclusion
The current study is not without limitations. While only five 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 attend-
ing 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 include students who are more vulnerable to sexual victimization than intact
population and who attend special schools (Berliner, 2011). Furthermore, as is
common with any victimological survey relying on a self-reported retrospective
recollection, there isuncertainty about whether the reported experiences actually
occurred (Goldman & Padayachi, 2000), although it is widely accepted that
denial of real CSA is a greater threat to validity than fabrication (Fergusson,
Horwood, & Woodward, 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 about it in
early adulthood (age 21). Recall bias is thus an important issue in retrospective
reports on CSA. It is virtually certain that some offenses will not be recalled
because, e.g., they could have occurred in early childhood before a child’s ability
to encode memories developed; were forgotten due to being considered unim-
portant or not understood as abusive (Goodman-Delahunty et al., 2017));
traumatic memories can fluctuate in their persistence, with periods of time in
which some memories are relatively less accessible (Sivers, Schooler, & Freyd,
2002). In addition, current mood or mental health can also lead to recall bias,
where mood-congruent information is more readily recalled than mood-
incongruent information (Colman et al., 2015;Lewis,Critchley,Smith,&
Dolan, 2005). Some victims may also consciously choose not to disclose CSA
because of discomfort, feelings of guilt, or shame (Freyd & Birrell, 2013).
The present study demonstrates that CSA is a relatively widespread and
considerably covert phenomenon among Slovak late adolescents. Prevention
activities should consider the broad spectrum of CSA forms in order to counter-
act tendencies to associate CSA solely with unwanted sexual intercourse. It is
JOURNAL OF CHILD SEXUAL ABUSE 15
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, Keating,
Saewyc, Earls, & Ben-Arieh, 2014). The negligible proportion of CSA instances
reported to the police also emphasizes the importance of respecting presumption
of victim status –a 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 also be stressed in prevention activities focused on the larger
public as well as in educational activities intended for professionals.
Implementation of bystander-oriented prevention models could equip adoles-
cents as well as adults with the tools necessary to be safer and more active
recipients of victims’disclosure.
Acknowledgments
The authors are also grateful to the research assistants who administered the questionnaire,
namely: TomášHorvát, Beáta Vasková, Erika Tarasovičová, Viktória Peštová, Simona
Kravcová, Marianna Ficeková, Michal Lörinc, Róbert Toth, Ingrid Senková, Jana Bernátová,
Paulína Klimková, and Petra Vavreková.
Disclosure of Interest
The authors do not have any interests that might be interpreted as influencing the results
reported in this study.
Funding
This work was supported by the Slovak Research and Development Agency [APVV-16-0471
and APVV-17-0418].
Ethical standards and informed consent
All procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation, namely the Department of Education of the concerned
Self-governing Region Authorities and with the Helsinki Declaration of 1975, as revised in
2000. Informed consent was obtained from all participants for being included in the study.
Notes on contributors
Slavka Karkoskova, PhD., is an associate professor at St. Elisabeth University of Health Care
and Social Work, Bratislava, Slovakia, a researcher at Judicial Academy of the Slovak
Republic, and founder and director of the non-governmental organization ASCEND, speci-
fically focused on child sexual abuse.
16 S. KARKOSKOVA AND I. ROPOVIK
Ivan Ropovik, PhD., is a researcher at the Faculty of Education, University of Presov,
Slovakia.
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