CHILD ABUSE & NEGLECT | Volume 117 | https://doi.org/10.1016/j.chiabu.2021.105061
Rebecca L. Fix, Daniel S. Busso, Tamar Mendelson, Elizabeth J. Letourneau
ABSTRACT
Child sexual abuse (CSA) is common, severe, and substantively contributes to the global burden of disease through its impact on physical, mental, and behavioral health problems. While CSA is preventable through non-justice system response efforts, the vast majority of resources support criminal justice efforts to identify, prosecute, punish and monitor offenders after CSA has already occurred. Policy makers have not supported CSA prevention efforts in part because the public does not view CSA as a preventable public health problem. Here, we describe a program of research to be conducted to bridge the gaps between expert and public opinion about CSA as a preventable public health problem. We propose such research use a three-step approach to alter the way experts communicate about CSA to increase audiences’ understanding of CSA as preventable. The three steps are: 1) identify consensus expert and public perspectives about CSA and the differences between these perspectives; 2) develop and test communication strategies to align public with expert perspectives; and 3) broadly disseminate validated communication strategies. Through this approach, we seek to develop and disseminate an informed communications strategy that effectively and accurately translates the science of CSA prevention to the public and the media.
INTRODUCTION
Violence, including child maltreatment, has been recognized as a legitimate public health concern and not solely a criminal justice problem for decades. Indeed, the U.S. Child Abuse Prevention and Treatment Act was first passed in 1974, and leading experts on child maltreatment have supported a public health approach to violence prevention since the 1980s (Child Welfare Information Gateway, 2019). As a result, successful prevention strategies were developed and broadly disseminated to address many forms of child maltreatment, including child physical abuse, bullying, and other forms of peer harassment and violence (Bradshaw, 2015; Dahlberg & Mercy, 2009; Hawkins, Clinton-Sherrod, Irvin, Hart, & Russell, 2009). Largely absent from these prevention efforts is a focus on child sexual abuse (CSA). Experts recognized this glaring omission and called for inclusion of CSA within broader violence prevention efforts, but largely to no avail (Freyd et al., 2005; Mercy, 1999; Wurtele, 1987). We believe this failure might be overcome by improving how we – as experts – communicate with the public about CSA, both directly and through the media. We describe the steps we are taking in an ongoing study to develop more effective communication strategies to portray CSA as a preventable public health problem.
Although prevalence of CSA appears to be at a historic low in some parts of the world (e.g., Finkelhor, 2020), it affects 12 % of the world’s children and is recognized by the World Health Organization as a leading preventable risk factor associated with the global burden of disease (Mathers, Stevens, & Mascarenhas, 2009). CSA exposure confers substantial risk for severe physical, mental, and behavioral health problems across survivors’1 lives (Diaz & Petersen, 2014; Krug, Mercy, Dahlberg, & Zwi, 2002; World Health Organization, 2014). CSA also confers considerable risk for subsequent sexual and nonsexual victimization to survivors and to their offspring (Noll, Trickett, Harris, & Putnam, 2009) and is associated with increased risk of future violence perpetration (Ogloff et al., 2012). The fiscal costs associated with CSA are considerable; a recent U.S. cost study estimated individual losses approaching $283,000 per non-fatal CSA survivor, producing a lifetime economic national burden of approximately $9.3 billion (Letourneau, Brown, Fang, Hassan, & Mercy, 2018). Effective efforts that reduce offending and/or crime victimization would prevent harm from occurring to children in the first place, avert the cascade of negative effects that burden survivors and their family members, and reduce monetary and nonmonetary costs borne by society.
Why haven’t such obviously beneficial prevention efforts been the focus of national policy and resources? Several barriers prevent a focus on CSA in child maltreatment prevention efforts (Letourneau, Eaton, Bass, Berlin, & Moore, 2014; Mercy, 1999). These include the relatively complex etiology of CSA coupled with perceptions of CSA as unpreventable (Sterman, 2006). With respect to complexity, CSA might be perpetrated by virtually anyone of almost any age and any relationship to the survivor, whereas child physical abuse is almost exclusively perpetrated by a parent or other direct caregiver of the survivor (Black, Heyman, & Slep, 2001; Snyder, 2000). Moreover, CSA engenders stronger emotional reactions than other crimes, even murder (Quinn, Forsyth, & Mullen-Quinn, 2004). This high emotionality interferes with objective policy discussions through disengagement from the issue entirely or through channeled efforts driven by fear and focused on vengeance. Perhaps most importantly, research indicates that the public views CSA as a uniquely unpreventable problem (Dorfman et al., 2014; Mejia, Cheyne, & Dorfman, 2012). Sex offenders are viewed as monsters who are unwilling or unable to control their behaviors, impervious to prevention or rehabilitation efforts and destined to offend and reoffend (Levenson, Brannon, Fortney, & Baker, 2007). Reasoning from this perspective, the only viable strategies are to arrest, prosecute, punish, and monitor offenders (O’Neil, Simon, & Haydon, 2015; Wallack & Lawrence, 2005).
Yet this public narrative of CSA as unpreventable flies in the face of available evidence. For example, between one-third and three-quarters of sexual offenses against children under age 18 are caused by other children under age 18 (Finkelhor, Shattuck, Turner, & Hamby, 2014; Gewirtz-Meydan & Finkelhor, 2020). The vast majority of children adjudicated for a sex crime (95 %) will not go on to commit another sex crime (Caldwell, 2016). Likewise, most adults convicted of sex crimes (over 80 %) do not go on to commit another sex crime (Hanson, Bourgon, Helmus, & Hodgson, 2009; Hanson, Harris, Letourneau, Helmus, & Thornton, 2018; Schmucker & Lösel, 2008). These low sexual recidivism rates indicate that problematic sexual behaviors can be controlled and managed and therefore that initial first-time sex crimes might also be avoided (Hanson et al., 2018; Letourneau, Schaeffer, Bradshaw, & Feder, 2017).
Indeed, several factors associated with sexual offending, particularly adolescent sexual offending, appear to be good targets for universal prevention efforts. For example, adolescents may have limited knowledge about what constitutes appropriate sexual behavior and may be unable to discern how children of different ages vary in their psycho-sexual development and maturity (Chaffin, 2008; Letourneau et al., 2017). These factors can be addressed effectively with school-based prevention interventions (Foshee et al., 1998; Letourneau et al., 2017; Taylor, Stein, Mumford, & Woods, 2013). Incorporating content into sexual education programming specific to risk of engaging younger children in sexual behavior is one feasible strategy (Ruzicka, Assini-Meytin, Schaeffer, Bradshaw, & Letourneau, 2021). Other factors associated with sexual offending, such as having a history of sexual abuse, are also addressable, albeit with more intensive interventions aimed at selected populations (Cohen, Mannarino, & Deblinger, 2016; Mendelson & Letourneau, 2015). A key risk factor for CSA is sexual interest in children (Seto, 2008). Even here, prevention efforts are indicated. Many people who identify as having a sexual interest in children experience this interest as an unwanted affliction and seek help to avoid acting on their interests, knowing that doing so would harm children (Beier et al., 2015; Letourneau & Shields, 2016; Levenson, Willis, & Vicencio, 2017). Thus, universal (e.g., school-based) and selective (e.g., focused on CSA survivors and on people attracted to children) prevention interventions offer real promise in the prevention of CSA. However, developing, validating, and disseminating effective prevention strategies requires national resources and these are unlikely to be supported by policy makers until their constituents – the public – view CSA as preventable.
In North America, evidence suggests that members of the public have come to recognize that child sexual abuse is an important and widespread problem, with serious ramifications for survivors over the lifecourse (Volmert, Fond, & O’Neil, 2015). This recognition is due, in part, to feminists, advocates’ and other communicators’ determined efforts to raise awareness of CSA (Whittier, 2009). Often, these communication efforts emphasized alarming statistics and vivid imagery to draw attention to the scale and impact of the problem. For example, early communication efforts emphasized the absolute culpability of those who engaged in illegal sexual behavior and highlighted the most severe sequelae of sexual crime victimization (Letourneau et al., 2014). Sensationalist media portrayal of particularly horrific cases have also heightened the emotionality associated with CSA (Mejia et al., 2012).
While these early strategies succeeded in increasing public awareness of CSA, they also encouraged beliefs that offenders were incorrigible predators for whom draconian criminal justice penalties were the only practical responses. Overreliance on the criminal justice system to address CSA is in part problematic because it occurs after harm has already occurred. Other problematic aspects of relying heavily on the justice system are primarily associated with use of incarceration and registration and notification policies that are ineffective in preventing CSA (Letourneau & Levenson, 2011; Levenson & Vicencio, 2016) and are not evidence-based (Meloy, Curtis, & Boatwright, 2013). While we could fund research and evidence-based efforts toward prevention of CSA, we currently allocate a disproportionately high proportion of our resources toward enactment of harsh policies designed to punish those who have sexually harmed a child (Letourneau & Levenson, 2010; Letourneau & Shields, 2016).
The manner in which CSA is portrayed in the media also inhibits a prevention focus. Analyses of media coverage of CSA and sexual violence in the U.S. find that such coverage rarely includes any background information about the broader societal context of sexual violence, overwhelmingly focuses on specific cases, emphasizes perpetrator punishment, and almost never includes a prevention focus (Mejia et al., 2012). Social media provides a very different platform from which to influence public views about CSA. In some cases, CSA survivors leverage social media to evoke public outrage and action regarding survivor treatment (Salter, 2013). However, many of the same limits that characterized traditional media reporting of CSA also characterize social media stories, including a strong “punish the perpetrator” frame that denies (or at least minimizes) rehabilitative or preventive potentials. In summary, new communication efforts will need to address complexity and emotionality associated with CSA and penetrate both traditional and social media to encourage a focus on prevention of CSA.
