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Perceptions of Child Sexual Abuse as a Public Health Problem -- Vermont, September 1995

CDC and the World Health Organization have declared violence prevention a public health priority (1,2). One particular form of violent victimization, child sexual abuse *, is a risk factor for suicide attempts, depression, sexually transmitted diseases, and subsequent sexual assault (3). The public health approaches to child sexual abuse are intervention (e.g., treatment) and prevention. To assist in developing public health measures for preventing child sexual abuse in Vermont, in September 1995, STOP IT NOW! and Market Street Research, Inc. **, surveyed a representative sample of households in Vermont to assess knowledge and attitudes about child sexual abuse as a public health problem. This report summarizes the survey findings, which indicate that levels of awareness of child sexual abuse are high among Vermont residents.

The random-digit-dialed telephone survey of Vermont households employed a randomizing matrix procedure to select the specific household respondent aged greater than or equal to 18 years to be interviewed based on the number of men and women of different ages within the household. Of the 297 eligible participants, 200 (67%) were interviewed. Demographic characteristics of respondents were similar to the total population of Vermont in 1990 based on the U.S. Census profile. Of all respondents, 54% were female, 44% had a high school diploma or less, and 30% had college degrees; the median age was 41.7 years. The standard error for all results ranged from 0.7 to 3.5.

Overall, 97% of the respondents were familiar with the term "child sexual abuse." Most (90%) had seen or heard news media reports about the subject during the year preceding the survey, and nearly half (49%) had discussed the topic during the preceding year.

A total of 74% of the respondents described child sexual abuse as either a "major problem" or "somewhat of a problem" in Vermont, compared with 92% who described alcohol and drug abuse and 94% who described drinking and driving as major problems. In addition, although nearly all respondents had heard about child sexual abuse, 53% were unable to define the term or repeated the term as the definition (e.g., "Child sexual abuse is the sexual abuse of children."). Approximately three fourths of the respondents did not know the behavioral characteristics of an adult who may be sexually abusing a child ***. Six percent reported knowing an adult who they suspected was sexually abusing a child, and 14% reported knowing a child who they suspected was being sexually abused.

Most survey respondents believed that child sexual abuse exists in Vermont (73%), that treatment programs can help stop child sexual abuse (79%), and that persons who sexually abuse children should "get help" while in prison (87%). A total of 31% believed that adults who sexually abuse children can stop if motivated to do so.

When asked what they would do if confronted with a potentially harmful situation involving either drunk driving or potential sexual abuse of a child, 75% of the respondents reported they would confront someone who was drinking and trying to drive (e.g., by taking the car keys); in comparison, only 9% reported they would directly confront someone who was sexually abusing a child. In addition, 65% of the respondents reported that they would confront the problem by contacting police or local child protective services.

Reported by: J Tabachnick, MPPM, F Henry, MBA, STOP IT NOW!, Haydenville; L Denny, PhD, Market Street Research, Northampton, Massachusetts. Family and Intimate Violence Prevention Team, Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Previous studies have reported comparable estimates of the occurrence of child sexual abuse in the United States. In a national study in 1985, sexual abuse during childhood was reported by 27% of adult females and 16% of adult males (4). In addition, a nationwide poll commissioned by the National Committee to Prevent Child Abuse in 1995 indicated that 23% of parents (30% of mothers and 9% of fathers) reported that as a child, they had been "forced to touch an adult or older child or had been forcibly touched by an adult or older child in a sexual way; or that they had been forced to have sex with such an individual" (5).

Attitudes are one important indicator of the level of public knowledge about child sexual abuse and willingness to act to prevent it. In Vermont, most respondents believed that child sexual abuse is a problem and reported that they would respond to a hypothetical situation of child sexual abuse by directly confronting the abuser or by reporting it. However, a previous study in Kentucky reported a discrepancy between attitude and behavior under circumstances of real abuse: in that study, although 99% of respondents accurately defined as an example of abuse a man having sex with his 15-year-old step-daughter, only 31% of those who had reason to suspect child abuse during the previous 2 years had actually reported it (6).

The findings in this report are subject to at least two limitations. First, because of the small sample size, differences across demographic groups (e.g., urban versus rural) could not be analyzed. Second, because persons without telephones were excluded from the survey, the results may not be generalizable to Vermont households without telephones.

A substantial proportion of rapes among females in the United States are classified as child sexual abuse. Based on findings of the National Women's Study during 1989-1990, of all forcible rapes, 29% occurred when the victim was aged less than 11 years, and 32% when the victim was aged 11-17 years. Overall, 84% of all rape victims did not report the crime to police (7). The discrepancy in the number of rapes committed and the number reported underscores the need for intervention strategies to encourage persons to question suspicious behaviors and report abuse. STOP IT NOW! educates the public about child sexual abuse, encourages adults who suspect or perpetrate child sexual abuse to report the incident(s), and refers abusers to treatment programs. Because treatment programs may be effective for some sex offenders, the general public should be educated about the importance of identifying and referring sex offenders to effective intervention programs (8).

For many public health problems, one important prevention strategy is to increase public awareness about the issue. For example, social marketing campaigns have been components of programs successful in reducing deaths caused by drinking and driving and acquired immunodeficiency syndrome (9,10). Prevention programs for child sexual abuse may be effective if the public views child sexual abuse as a problem relevant in their communities. In Vermont, STOP IT NOW! addresses child sexual abuse systematically as a public health issue by using social marketing and public education to emphasize the responsibility of adults for prevention. Specific goals of this innovative approach to prevention are to educate the public about child sexual abusers and to motivate adults to action to prevent child sexual abuse. The findings in this report are being used by STOP IT NOW! to monitor the impact of the social marketing strategy on attitudes and knowledge about appropriate intervention strategies for child sexual abusers in Vermont.


  1. Foege WH, Rosenberg ML, Mercy JA. Public health and violence prevention. Current Issues in Public Health 1995;1:2-9.

  2. World Health Assembly. Prevention of violence: public health priority. Geneva, Switzerland: World Health Organization, 1996; resolution no. WHA 49,25.

  3. Bryant SL, Range LM. Suicidality in college women who were sexually and physically abused and physically punished by parents. Violence Vict 1995;10:195-201.

  4. Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl 1990;14:19-28.

  5. The Gallup Organization. Disciplining children in America: a Gallup Poll report. Princeton, New Jersey: The Gallup Organization, 1995.

  6. Dhooper SS, Royse DD, Wolfe LC. A statewide study of the public attitudes toward child abuse. Child Abuse Negl 1991;15:37-44.

  7. Kilpatrick DG, Edmunds CN, Seymour AK. Rape in America: a report to the nation. Arlington, Virginia: National Victim Center, 1992.

  8. Hall GC. Sexual offender recidivism revisited: a meta-analysis of recent treatment studies. J Consult Clin Psychol 1995;63:802-9.

  9. Holtgrave DR, Qualls NL, Curran JW, Valdiserri RO, Guinan ME, Parra WC. An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Rep 1995;110:134-46.

  10. Voas RB, Holder HD. The effect of drinking and driving interventions on alcohol-involved traffic crashes within a comprehensive community trial. Addiction 1997;92:S221-S236.

* Defined by STOP IT NOW! as any sexual touching or sexual assault of a child by an adult, adolescent, or older child. In addition, sexual abuse includes nontouching sexual actions, such as exposing oneself, showing pornography to a child, and photographing a child in sexual poses. 

** STOP IT NOW! is a nonprofit organization, and Market Street Research, Inc., is a market research and evaluation company. 

*** A group of related characteristics, including insistence on hugging or kissing a child when the child does not want the attention and asking intrusive questions about the sexual activities of adolescents.

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