标题：Sexual Violence Victimization History and Sexual Risk Indicators in a Community-Based Urban Cohort of “Mostly Heterosexual” and Heterosexual Young Women
摘要：Objectives. We sought to examine sexual violence victimization in childhood and sexual risk indicators in young adulthood in a primarily Latina and Black cohort of “mostly heterosexual” and heterosexual women in the Project on Human Development in Chicago Neighborhoods (PHDCN). Methods. In 2000, a comprehensive survey that assessed sexual orientation, sexual risk indicators, and sexual abuse victimization was completed by 391 young women (aged 18 to 24 years) who had participated in PHDCN. We used multivariable regression methods to examine sexual orientation group differences in sexual risk indicators and to assess whether childhood sexual abuse may mediate relationships. Results. Compared with self-reported heterosexual women, self-reported “mostly heterosexual” women were more likely to report having been the victim of childhood sexual abuse, to have had a sexually transmitted infection, to report an earlier age of first sexual intercourse, and to have had more sexual partners. Childhood sexual abuse did not mediate relationships between sexual orientation and sexual risk indicators. Conclusions. Our findings add to the evidence that “mostly heterosexual” women experience greater health risk than do heterosexual women. In addition, “mostly heterosexual” women are at high risk for having experienced childhood sexual abuse. Adolescent girls and young women who report having attractions to both genders but who may not describe themselves as bisexual make up an estimated 6% to 10% of female youth. 1 , 2 This group may be several times larger than the proportion of adolescent girls and young women who describe themselves as lesbian or bisexual, which is estimated to be approximately 1% to 2% of girls and young women. 1 , 3 , 4 Recent research has documented that this newly identified subgroup of adolescent girls who describe themselves as “mostly heterosexual” are at higher risk for tobacco use, binge drinking, eating disorder symptoms, and sexual risk behaviors compared with those who describe themselves as heterosexual. 1 , 5 – 7 Little is known about factors that may contribute to elevated rates of high-risk behaviors in this group. Based on research findings about the effects of sexual violence victimization on subsequent risk behaviors in multiple health domains, 8 – 12 it is possible that violent victimization in childhood may be a contributor to elevated health risks experienced by “mostly heterosexual” girls and women. History of childhood sexual abuse, defined as sexual abuse victimization occurring before the age of 18 years, 13 is associated with greater likelihood to engage in sexual risk behaviors in adolescence and adulthood, which increases risk for unwanted pregnancy, and HIV infection and other sexually transmitted infections (STIs). 8 – 12 A meta-analysis of published studies of the effects of childhood sexual abuse found that across 37 studies (N = 25 367), there was a minimum 14% increase in the risk of engaging in early sexual behavior for those sexually abused as children. 8 Another meta-analysis of the relationship between childhood sexual abuse and HIV risk behavior among women found that across 46 studies, there was an increased risk of unprotected sexual activity; having multiple partners; engaging in sexual intercourse in exchange for money, drugs, or shelter; and sexual revictimization in adulthood. 9 It has been proposed that youths whose same-gender attractions or same-gender sexual involvement is known to others may be singled out for maltreatment and abuse by parents, other adults, or other youths because of antigay bias. 14 , 15 This pattern of maltreatment may be relevant not only for lesbian, gay, and bisexual but also for “mostly heterosexual” youth. Saewyc et al. found in a school-based sample of girls in grades 7 to 12 in British Columbia that an estimated 23% to 27% of “mostly heterosexual” girls compared with 15% to 21% of heterosexual girls reported having experienced sexual abuse in their lifetimes. 16 It is plausible that elevated risk behaviors experienced by “mostly heterosexual” girls and young women are in part sequelae of violence victimization that occurred earlier in childhood. Violence victimization, then, may be a mediator of the relationship between “mostly heterosexual” orientation and risk indicators. The 2 aims of our study were (1) to compare patterns of sexual risk indicators between “mostly heterosexual” and heterosexual young women in a representative, multi-ethnic sample and (2) to examine childhood sexual abuse that occurs temporally prior to onset of sexual risk indicators as a possible mediator of a relationship between “mostly heterosexual” orientation and sexual risk indicators.
