A Comparative Study Among College Students of Sexual Abuse in Childhood Lynn Rew, Delia Esparza, and Dolores Sands

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609. P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5. 237) and main effects for abuse (F = 3.225, P = ,008) were found. Although abused men scored lowest on wellbeing, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults. Copyright 0 1991 by W.B. Saunders Company

A

THE long-term effects of child sexual abuse have been relatively unexplored, experts believe that such abusive experiences lead to maladaptive coping responses and destructive patterns of behavior. Destructive behaviors that are among the most costly to society and for which individuals may seek help are eating and sleeping disorders, depression, anxiety, alcohol and drug abuse, isolation, sexual dysfunction, promiscuity, and suicidal behavior (Brooks, 1985; Brown, 1985; Browne & Finkelhor, 1986a; Lindberg & Distad, 1985). In one societal group of college and university students, recent counseling literature indicates there are increasing demands for crisis intervention and counseling by students suffering from ineffective coping and selfdestructive behaviors (Bishop, 1990; Kagan, 1987; Roscoe, 1987; Terry, 1989). LTHOUGH

Archioes of Psychiatric Nursing, Vol. V, No. 6 (December),

These problems may be associated with early experiences of sexual abuse since a significant percentage of college students have experienced unwanted sexual experiences in childhood, including exposure to pornography, sexual harassment, fondling, attempted or completed intercourse, and rape (Fritz, Stoll, & Wagner, 1981; Mims & Chang, 1984; Rew, 1989). Moreover, Peters,

From the School of Nursing, University of Tevas at Austin. Supported by Grant No. NR 0131503 from the National Center for Nursing Research, National institutes of&&h. Bethesda, MD. Address reprint requests to Lynn Rew, Ed.D., R.N., C., Associate Professor, School of Nursing, University of Texas at Austin, 1700 Red River, Austin, TX 78701, Copyright 0 1991 by W.B. Saunders Company 0883-9417/91l0506-0002$03.00/0

1991:

pp. 331-340

331

332

REW, ESPARZA, AND SANDS

Wyatt, and Finkelhor (1986) found prevalence rates for child sexual abuse among college students to be 5% to 30% for men and 8% to 35% for women. Researchers also point out that boys and girls respond differently at the time of childhood sexual abuse (Burgess, 1985; De Young, 1982; Fritz, Stoll, & Wagner, 1981; McCormack, Janus, & Burgess, 1986). For example, Friedrich, Urquiza, and Bielke (1986) studied a clinical sample of 85 children (24 boys and 61 girls) and noted differences between boys and girls in emotional and behavioral problems associated with sexual abuse. Girls were more fearful, inhibited, and depressed; their coping strategies were emotive and palliative in nature. Boys were more antisocial, aggressive, and lacked control of their behavior, exhibiting confrontive coping strategies. These patterns of response to stressors of childhood sexual abuse may continue through young adulthood (Crockett, 1984). Attending a college or university is a major transition for young adults and is a stress that can deplete the adaptational resources of the individual (Lapsley, Rice, & Fitzgerald, 1990) and lead to illness. Those individuals who believe they can perform behavior required for a new role, such as that of an independent college student, display self-efficacy or feelings of competence. This quality of self-efficacy has been identified as a significant predictor of health-promoting behaviors in adults (Weitzel & Waller, 1990). In contrast, those individuals who perceive themselves as unable to perform the required behaviors associated with a new role display self-inefficacy, use palliative coping techniques of avoidance, and are vulnerable to physical ailments (Kaliski, Rubinson, Lawrance, & Levy, 1990). Lack of self-efficacy, ineffective coping responses, and poor adjustment or lack of well-being may be related to childhood sexual abuse among young adults, such as college and university students, leading them to seek physical and psychological interventions to alleviate discomfort and distress. PURPOSE

The purpose of this study was to explore among one group of college students the differences in the responses of men and women to childhood sexual

abuse. One research question was posed: What are the differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between men and women college students who had experienced childhood sexual abuse and those who had not? We hypothesized that (1) women would report more incidents of childhood sexual abuse than men, (2) students who had experienced childhood sexual abuse would exhibit lower levels of selfefficacy and well-being than students who had not been abused, and (3) women students who had experienced childhood sexual abuse would exhibit more emotive and palliative coping strategies and less confrontive coping strategies than men. LITERATURE REVIEW

Both men and women experience both initial and long-term effects of childhood sexual abuse (Brunngraber, 1986; Johnson & Shrier, 1985; Nasjleti, 1980; Robertson & Wilson-Walker, 1985; Russell, 1984; Sarrel & Masters, 1982; Vander Mey, 1988). In a review of recent investigations, Browne and Finkelhor (1986b) found that initial effects include reactive anxiety, fear, depression, anger, and inappropriate sexual behavior, whereas the main long-term effect was depression. De Young (1982) suggests that strategies for coping with experiences of sexual abuse may be related to the sex of the victim: Girls are more likely than boys to disclose information about sexual exploitation. De Young suspects that long-term effects associated with childhood sexual abuse may also differ between men and women. Finkelhor, Hotaling, Lewis, and Smith (1990) surveyed 2,626 men and women over the age of 18 years and found significant sex differences for risk of abuse. They also found that boys were less likely to disclose information about the abuse than girls. In a qualitative study of women who were physically and sexually abused in childhood, Crockett (1984) explored the development of coping beliefs over time. She found that subjects believed their coping strategies were consistent throughout their life span, were formed initially as a response to child physical and sexual abuse, and were maintained after the abuse stopped. Moreover, she found that those subjects who coped constructively by working, helping others, and protecting others were more well-adjusted as adults than those who

CHILDHOOD

SEXUAL ABUSE

engaged in more passive or palliative coping strategies, such as withdrawing or fleeing. Burgess, Hartman, Wolbert, and Grant (1987) assessed the impact of child molestation by a male bus driver on 12 girls. Through interviews and drawings these researchers identified three different coping strategies used by this sample: four children blocked the experience through dissociation, six blamed themselves, and two blamed the offender. Burgess et al. suggest that these appraisals of the abuse may be linked to guilt, depression, and symptoms of posttraumatic stress disorder later in life. Reinhart (1987) conducted a retrospective review of 189 men matched for age and race to women victims of sexual abuse. Although he found similar patterns of spontaneous and prompted disclosure between men and women, Reinhart also found that the men’s abuse was more often disclosed by a third party. Such a finding suggests differences between men and women in strategies used to cope with such an experience through disclosure. In a sample of 168 military women between the ages of 18 and 35 years, Mims (1982) found that over 50% of the women had experienced sexual exploitation. The short-term coping behaviors of these women were indirect and included selfdestructive behavior through the use of drugs, overeating, and abuse of alcohol. In contrast, longterm coping behaviors were more constructive and included elements of self-care such as seeking information about prevention of sexual exploitation, taking direct action once exploitation had occurred, and taking action to avoid a similar situation in the future. In describing the long-term outcomes for men who were sexually molested in childhood, Sarrel and Masters (1982) presented the cases of 11 men. All subjects were adults who sought treatment for sexual problems that were related to a lack of social support at the time of the molestation. In addition to outcomes of sexual dysfunction, one subject was also hospitalized for suicidal behavior. Brunngraber (1986) examined both the immediate and long-term effects of incest on 21 women. Approximately 85% of the subjects rated the overall effects of these experiences as negative. Longterm negative effects were primarily in areas of sexual and interpersonal relationships. However,

333

some subjects also identified positive long-term effects of the incestuous experiences that were related to the receiving of support from family and friends and the development of adaptive coping strategies. Briere, Evans, Runtz, and Wall (1988) compared 40 women and 40 men adult clients at a crisis center and found significant differences between the sexually abused group and the nonabused group, but found no differences by sex on long-term sequelae that included dissociation, anxiety, depression, and sleep disturbance. They found, however, that the women in their sample had had more extensive abuse. One of their interpretations was that sexual abuse might be “more traumatic for males than for females, since lower male abuse levels were associated with symptomatology equal to that of more severly abused females” (p. 460). Haugaard and Emery (1989) studied 1,089 men and women undergraduate students attending social science classes to determine incidence of sexual abuse as well as measures of personality characteristics and social competence. These researchers found no significant differences between the women and men in terms of consequences (lack of trust, lack of emotional stability, and problems in intimate relationships). However, Haugaard and Emery noted one methodological issue related to recruiting college students as subjects in investigations of the long-term consequences of child sexual abuse: They believe that because young adults admitted to colleges and universities appear to be functioning at levels above average. consequences seen in such samples “may underestimate those in more heterogeneous samples of victims” (p. 99). While previous researchers have identified both the initial and long-term effects of child sexual abuse, differentiated responses in men and women, and provided preliminary evidence that coping responses at the time of abuse are associated with coping strategies used to manage stress later in life, little has been done to examine complex interactions of factors associated with coping strategies of young adults who have survived childhood sexual abuse. As Briere, Evans, Runtz, and Wall point out, “Future research in this area is clearly indicated, with special attention to those gender-specific mechanisms that may mediate be-

REW, ESPARZA, AND SANDS

334

tween psychological impact and subsequent behavior toward both self and others” (1988, p. 460). METHOD

Design A randomized survey design was used to explore and compare measures of self-efficacy, coping, and well-being among students at a major southwestern state university. Multivariate analysis of variance (MANOVA) was used to test for effects of gender and childhood sexual abuse on these psychosocial outcome variables. Subjects A disproportionate random sample of 600 students (200 women and 400 men) whose names were published in the official directory of the university was invited to participate. Research packets containing a consent letter approved by the institutional review board for protection of human subjects and the research instruments were delivered to 551 of the students in the sample. Respondents included 27 1 students, representing an approximately 49% rate of return: 55% women and 40% men. The final sample included 111 women (41%) and 160 men (59%). Participants ranged in age from 17 years to 57 years; the average age was 24 years (SD = 6.4). The majority of the sample was single (74.5%), 19.6% were married, 0.4% were widowed, and 3.7% were divorced. The final 1.8% marked Other for marital status. The majority was white (75.6%), 2.2% were Hispanic, 0.4% were black, and 12.5% were Asian or Other, not specified. Although the percentage of whites, Asians, and Others in the sample were similar to the population of students at the university, the percentage of Hispanics and blacks was different (Hispanics in the university make up 9.9% of the population and blacks make up 3.6%). Measures A battery of instruments to measure number and type of sexual abuse experiences (Childhood Sexual Experiences Survey [CSES]), self-competence (Self-Efficacy Scale), coping strategies (Jalowiec Coping Scale), and well-being (General WellBeing Schedule) was mailed to the potential subjects. Confidentiality and anonymity of all subjects were protected. The same battery of instruments was mailed to each of the randomly selected stu-

dents on two subsequent occasions at intervals of 2 weeks and 2 months to encourage response. Subjects were directed to complete the instruments and return the packets to the investigator via a stamped and self-addressed envelope included in the packet. A letter of invitation to participate warned potential subjects of the risk of triggering anxiety by completing the research instruments. Subjects were directed to contact the project director (who is a certified medical psychotherapist and mental health nurse) for crisis counseling and/or referral to the student counseling center, as needed. None of the subjects reported incidents of undue anxiety to the project director or counseling center during the course of the study. The CSES is a demographic and historical information form designed by the first author for the purposes of this study. The CSES was developed following the guidelines provided by Berdie, Anderson, and Niebuhr (1986) and was submitted to a panel of three experts in human development for content and clarity. It contains five demographic items asking for age, sex, marital status, level of education, and race in order to accurately describe the sample. It also contains seven items to which subjects respond by checking those sexual experiences that occurred against their wishes and before the age of 18 years. These items are similar in content and wording to the interview schedule used by Russell (1984) in her study of childhood sexual exploitation. Table 1 displays the CSES and the frequency of responses to each item, by gender, by the subjects in this study. The Self-Efficacy Scale (Sherer, Maddux, Mercandante, Prentice-Dunn, Jacobs, & Rogers, 1982) is a 17-item self-report scale. For each item, the subject responds to a five-point Like&type scale ranging from Strongly Disagree to Strongly Agree. An investigation of 376 college students in an introductory psychology course yielded a Cronbath a-reliability coefficient of .86 for the 17 items. In the study reported here the a-coefficient was .88. Evidence of construct validity was tested through correlations with a variety of related measures; all were statistically significant correlations (P < 0.0001). The Jalowiec Coping Scale (Jalowiec, 1988) contains 40 items rated on a five-point Likert scale from Never (1) to Almost Always (5). The scale contains three subscales: confrontive, emotive, and palliative coping. Confrontive coping refers to

335

CHILDHOOD SEXUAL ABUSE

Table 1. Childhood Sexual Experience Survey: Frequency of Response to items by Gender of a Sample of University Students Insrructions:Please check each of the following experiences that happened to yoo against your wishes before you were 18 years old:

Women

Items

MC?fl

Total

A person older than me exposed his or her sex organs directly to me. A person older than me masturbated

in front of me.

26

21

47

9

9

18

A person older than me invited me to look at pornographic magazines or videotapes/movies

or took pictures of me for

these media. A person older than me touched my breasts or sex organs.

7

11

18

33

10

43

13

6

19

29

10

39

15

8

23

A person older than me made me touch his or her breasts or sex organs. A person older than me rubbed against my body in a sexual way. A person older than me had oral, anal, or vaginal intercourse with me.

handling problems straight on and includes using strategies of seeking information, setting goals, and taking systematic steps associated with problem-solving. Emotive coping refers to affective responses to stressful situations and includes worrying, getting angry, and taking tension out on others. Palliative coping refers to keeping stress under control without addressing problems directly. Jalowiec (1988) adds that this type of coping is akin to the concepts of avoidance and powerlessness and includes strategies such as hoping for improvement, resigning oneself to a fateful situation, withdrawing, and letting someone else solve the problem. Through linear structural relations factor analysis, coefficient of determination was computed as .95 for the full scale and Cronbath a-coefficients of .85, .70, and .75 for the three subscales (confrontive, emotive, and palliative, respectively) were determined (Jalowiec, 1988). cl-Reliability coefficients in the present study were .72 for the total scale and .8 1, .7 1, and .67 for the three subscales, respectively. The General Well-Being Schedule (McDowell & Newell, 1987) contains 18 items for self-report. The first 14 questions include a six-point Likerttype response scale that represents intensity or frequency of a feeling. The final four questions use a visual analogue of equal intervals, 0 to 10, representing distress. Test-retest reliability coefficients, after 3 months, of .68 and .85 are reported for 98 college graduates and for 195 college students respectively (McDowell & Newell, 1987). McDowell and Newell (1987) report evidence of signifi-

cant construct validity and recommend that the schedule be used in its entirety to indicate subjective well-being. Reliability coefficient (Y for the study sample reported here is .92. RESULTS

Fifty percent of the women and 22.5% of the men in the sample checked one or more items on the CSES, thus meeting the operational definition of childhood sexual abuse. Data from 27 1 subjects were analyzed by 2 X 2 (gender X child sexual abuse) MANOVA techniques. The dependent variables were measures of self-efficacy, coping (subscale scores for confrontive, emotive, and palliative coping), and general well-being. There were significant interaction effects (F = 2.609, P = .025, df 5, 263). A univariate F test showed significant differences in palliative coping (F = 5.386, P = ,021. df 1, 267) with abused men showing higher scores on the palliative coping scale than nonabused men and all women. There were also significant effects for gender (F = 3.346, P = ,006) and the univariate F test identified the difference in emotive coping (F = 9.049, P = .003), with women having higher emotive scores than men. There were no significant effects shown for child sexual abuse (F = 1.938, P = .088), but univariate F tests indicated significant differences in well-being (F = 7.276, P = .007). There were no significant differences demonstrated for self-efficacy and confrontive coping. However, means and standard deviations for these

336

REW, ESPARZA, AND SANDS

Table 2. Means, Standard

Deviations, and Confidence Intervals of Self-Efficacy, Coping, and Well-Being Among Sexually Abused and Nonabused College Students.

Dawndent Variables

Meall

Standard

Deviation

95% Confidence

Interval

Self-Efficacy Nonabused Women (n = 56)

66.196

9.166

63.742-68.651

Men (n = 124)

65.121

11.466

63.08&67.159

Women (n = 55)

63.218

10.837

60.289-66.148

Men In = 36)

65.917

8.993

62.874-68.960

65.063

10.585

63.797-66.329

Women

45.357

7.731

43.28747.427

Men

46.210

7.351

44903-47.516

Women

44.345

8.300

42.10246.589

Men

44.833

7.603

42.26147.406

Entire sample

45.472

7.657

44.55746.388

Women

24.571

4.842

23.275-25.860

Men

22.331

5.395

21.372-23.290

Women

25.709

6.652

23.91 l-27.507

Men

23.417

5.798

21.455-25.379

Entire sample

23.624

5.752

22.936-24.312

Women

31.750

5.632

30.242-33.258

Men

30.952

6.271

29.837-32.066

Women

31.400

5.866

29.814-32.986

Men

34.389

6.438

32.21 l-36.567

Entire sample

31.664

6.154

30.928-32.400

Women

66.000

18.858

60.95Ih71.050

Men

71.234

17.655

68.09674.372

Women

61.855

18.090

56.964-66.745

Men

62.278

18.562

55.997-68.558

Entire sample

67.059

18.476

64.849-69.269

Abused

Entire sample (N = 271) Confrontive coping Nonabused

Abused

Emotive coping Nonabused

Abused

Palliative coping Nonabused

Abused

Well-being Nonabused

Abused

variables were in the predicted directions. Table 2 contains a summary of means, standard deviations, and 95% confidence intervals for all dependent measures. Additional analyses were done to determine whether the outcomes of self-efficacy, coping, and well-being also were related to age of the students. A 2 X 2 (below or above median age of 22 years by abused or nonabused) MANOVA resulted in

significant main effects for age (F = 2.228, P = .05,df 1, 267) and for abuse (F = .953, P = .027, df 1, 267) but not for the interaction of age and abuse. Univariate analyses were significant for the effect of age on confrontive coping and selfefficacy (F = 4.946, P = .027 and F = 4.300, P = .039, respectively) and for the effect of abuse on emotive coping and well-being (F = 5.7 18, P = .017 and F = 10.554, P = .OOl, respectively).

CHILDHOOD

SEXUAL

ABUSE

Older subjects had significantly higher scores on confrontive coping and self-efficacy than younger subjects. Those subjects who had been sexually abused demonstrated higher scores on emotive coping and lower scores on well-being than those who had not been abused. In addition, differences in the dependent variables were examined using a more stringent operational definition of sexual abuse; that is, childhood sexual abuse was defined as those subjects who reported incidents of contact sexual abuse as measured by checking any of the last four items on the CSES (Table 1, e.g., attempted or completed oral, anal, or vaginal intercourse, and masturbation of perpetrator or victim). Data from a subsample of 245 subjects were analyzed by 2 X 2 (gender by abuse) MANOVA. Significant interaction effects (F = 2.26, P = .049, df 5, 237) and main effects for abuse (F = 3.225, P = .OOS), but not for gender (F = 1.46, P = .21), were found. Univariate analyses were significant for interaction of gender and abuse on well-being (F = 5.125, P = .024). Men who reported one or more incidents of contact sexual abuse had lower scores on wellbeing than all other groups. Both men and women who reported incidents of contact sexual abuse had higher scores on emotive coping and lower scores on well-being than nonabused men and women. Although univariate F tests showed significant interaction effects of gender by abuse on wellbeing only, mean scores on emotive coping were as predicted with abused women scoring higher (M = 26.10, SD = 6.29) than abused men (M = 25.41, SD = 6.23). Unexpected findings were that mean scores on palliative and confrontive coping were not in the predicted directions. Abused men had higher mean scores on palliative coping (M = 33.53, SD = 6.25) than abused women (M = 31.31, SD = 6.08), and abused women had higher mean scores on confrontive coping (M = 44.38, SD = 8.27) than abused men (M = 43.59, SD = 9.02). DISCUSSION

The sample was randomly selected from a population of university students and was approximately one-half the total invited to participate in the investigation. The sample represents volunteers who were willing to respond; perhaps the most seriously abused students and those with the lowest self-efficacy and well-being were in the

337

nonrespondent category. However, the subjects who did respond were similar in age and ethnic profile to the general student body of the university in which the study took place. This homogeneity of demographic traits removes much of the bias that could be otherwise attributed to the response rate (Leslie, 1972). Results of this study partially support all of the hypotheses and indicate that a greater percentage of women reported more incidents of childhood sexual abuse than men. These findings support previous research concerning ( 1) differences in reported rates of childhood sexual abuse between men and women and (2) numbers of college students who are the survivors of such abuse (Mims & Chang, 1984; Rew, 1989). Findings of this investigation are similar to those of Mims (1982) who found that over 50% of a sample of military women aged 18 to 35 years had experienced unwanted sexual exploitation before the age of 18 years. However, it is still unknown whether these rates represent actual differences in the incidence of abuse, in the reporting of the abuse, or in the perception of sexual experiences of childhood as abusive. Further study should be done to clarify these differences. As shown in Table 2, the mean scores on selfefficacy and well-being are lower for the students who reported sexual abuse in childhood than in students who did not. However, these findings did not reach statistical significance except in the univariate F test for effects of abuse only. This may be due to the relatively small sample size and the rather broad definition of sexual abuse used in the study. Sherer and Adams (1983) reported a mean score of 64.3 on self-efficacy among students enrolled in an introductory psychology course. This is comparable with the means reported for this study. Even with the narrow definition of sexual abuse (contact) used in the second analysis, there were no significant differences between groups on this measure of self-efficacy, although means are in the predicted direction. Abused men and women had lower mean scores than nonabused subjects, but these are still comparable with the mean reported by Sherer and Adams for college students. There are at least two possible explanations for this finding. First, the self-efficacy scale used in this study measures the general construct of selfefficacy and may not be sensitive to specific indicators of competence that could be related to ex-

REW, ESPARZA, AND SANDS

periences of sexual abuse. For example, previous researchers have found that both men and women adults who have been sexually abused in childhood do not feel competent in interpersonal relationships or sexual intimacy (Brunngraber, 1986; Sarrel & Masters, 1982). Second, because Sherer and Adams’s norm-reference group for their sample was college students attending an introductory psychology course, it may be assumed that such a group probably included both nonabused and abused men and women, not unlike the sample recruited for this study. Thus, while no significant differences in self-efficacy were demonstrated in this study, this matter deserves further investigation with an instrument designed to measure self-efficacy or social competence directly related to sexual intimacy and interpersonal relations. Obtained mean scores on well-being, in the first analysis, although not significantly different between groups, were in the predicted direction. Cutting points for moderate and severe distress on the well-being scale are 61 to 72 and 0 to 60, respectively (McDowell & Newell, 1987). It should be noted that all subjects in this study had scores in the “moderate distress” category. Mean scores of both sexually abused men and women were borderline when the broad definition of sexual abuse was used (62.278 and 61.855, respectively). When the operational definition of contact sexual abuse was used in the second analysis, abused men scored significantly lower on well-being than abused women and all nonabused subjects. This finding supports the above interpretation that a broader definition may attenuate the actual differences between abused and nonabused groups. It is important to note that the mean score of sexually abused men, using sexual contact as the operational definition for sexual abuse, was 53.41 and falls within the range of “severe distress” (McDowell & Newell, 1987). This supports the findings of Briere, Evans, Runtz, and Wall (1988) that men suffer more trauma from incidents of sexual abuse than previously thought. This has implications for psychiatric-mental health nursing and warrants further investigation. The operational definition of childhood sexual abuse used in the analysis of this study was very broad, Additional information about the age of the child at the onset of the sexual abuse, relationship between child and perpetrator, duration of abuse, disclosure, and others’ responses to disclosure may

be important variables in explaining the findings. This information was not gathered and should be collected in further studies. Using this broad definition, sex differences in palliative coping was the only significant finding and is new information about this population. However, when the operational definition of contact sexual abuse was used, significant differences between men and women in all types of coping were found. Abused men scored higher on emotive and palliative coping and lower on confrontive coping than abused women. These findings also support the findings of Briere, Evans, Runtz, and Wall (1988) and suggest that abused men’s limited coping skills may be causally related to their subjective feelings of distress indicated by their lower scores on the well-being variable. The additional findings about the differences in confrontive coping and self-efficacy when analyzed by age are new and significant. They provide some support for Brunngraber’s (1986) results, showing that not all long-range effects of childhood sexual abuse are negative and are, instead, more positive than previously reported. Over time, these experiences may provide the stimulus for developing more strategies that are self-protective. SUMMARY

AND CONCLUSION

The finding of no significant differences in selfefficacy and in well-being between abused and nonabused subjects provides some support for Haugaard and Emery’s (1989) claim that college and university students generally appear to be functioning well despite their histories of child sexual abuse. In contrast, the findings from the second analysis, using contact sexual abuse as the independent variable, support the hypothesis that there are significant differences between men and women and between abused and nonabused students on the outcome of well-being; scores of abused men indicated significantly more distress than scores of the other groups of subjects. Because college counseling centers report increasing demands for crisis counseling and intensive therapy for students who continue to exhibit maladaptive behaviors associated with childhood sexual abuse, further studies are needed. The findings of this study indicate that such a cohort of students needs more understanding and support from a variety of college and community health services than now exists. Moreover, research also

CHILDHOOD

SEXUAL

339

ABUSE

is needed among students from smaller colleges than the ones in this study, among branches of the armed forces (which represent structured environments), and within other nonstructured cohorts. To date, the long-term effects of childhood sexual abuse among men, in particular, has been seriously neglected. Further study should be done to determine what helped these students apparently to cope well with their experiences. Findings from such an investigation would provide the basis for planning and testing both theoretical models and interventions such as self-help groups and group counseling to improve self-efficacy, coping, and general wellbeing among young adults who experienced childhood sexual abuse. Furthermore, parental training groups could be developed and tested to assist with breaking the cycle of repetition of childhood sexual abuse and reducing long-term effects such as depression, suicide, drug or alcohol abuse, and social isolation among young adults who experienced sexual abuse in childhood. Psychiatric/ mental health nursing can provide strong leadership in developing such programs. Finally, results of additional analyses about the differences in confrontive coping and self-efficacy when analyzed by age are evidence that some of the long-range outcomes of childhood sexual abuse may not be entirely negative. It is possible that these undesirable and stressful childhood experiences may stimulate the development of healthy self-protective strategies. This finding offers hope for both the families in which abuse has occurred and the mental health nurses who work with them.

Brooks,

B. (1985). Sexually abused children and adolescent identity development. American Journal qf Psychotherapy, 39, 401-410.

Brown, W.K. (1985). Undersranding child abuse and neglect. York, PA: William Gladden Foundation. Browne,

A., & Finkelhor, D. (1986a). Impact of child sexual abuse: A review of the research. Psychological Bullerin. 99(l),

Browne.

66-77.

A., & Finkelhor, D. (1986b). Initial and long-term effects: A review of the research. In D. Finkelhor (Ed.). A sourcebook on child sexual abuse. Beverly Hills. CA: Sage.

Brunngraber, L.S. (1986). Father-daughter incest: Immediate and long-term effects of sexual abuse. Advances in Nursing

Science.

Burgess,

Anderson. J.F., & Niebuhr, M.A. (1986). QuesDesign

and use. Metuchen,

J.B. (1990). The university agenda for the 1990s. Journal velopment,

of and

ing, l(I).

33-39.

Crockett, M.S. (1984). Surviving child abuse: Self-reported coping histories of fourteen women. Health Care ,for Women International.

5. 49-75.

De Young. M. (1982). The sexual vicrimization of children. London. England: McFarland. Finkelhor. D., Hotaling. G.. Lewis, I.A.. & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics. and nsk factors. Child Abuse & Neglect. 14, 19-28. Friedrich. W.N.. Urquiza. A.J., & Beilke. R.L. ( 1986). Behavior problems in sexually abused young children. Journal

of Pediatric

Psychology.

I I, 7-57.

Fritz, G.S., Stall, K., & Wagner, N.N. ( 198 1). A comparison of males and females who were sexually molested as children. Journal of Sex and Marital Therapy. 7(l). 54-59.

Haugaard. J.J.. & Emery. R.E. (1989). Methodological issues in child sexual abuse research. Child Abuse & Neglect. Jalowiec. A. (1988). Confirmatory factor analysis of the Jalowiec Coping Scale. In C. Waltz & 0. Strickland (Eds.). Measuremenr of nursing outcomes (Vol. 1). New York, NY: Springer. Johnson,

R.L.. & Shrier, D.K. (1985). Sexual victimization of boys: Experience at an adolescent medicine clinic. Jour-

Student Journal.

NJ: Scarecrow.

counseling

center:

of Counseling

An

Kaliski,

and De-

Briere, J., Evans, D., Runtz, M., & Wall, T. (1988). Symptomatology in men who were molested as children: A comparison study. American Journal of Orthopsychia-

Health Care,

6. 372-376.

Kagan. D.M. (1987). Stress in the college and university classroom: A synthesis of eight empirical studies. College 21, 3 12-3 16.

E.M., Rubinson, L., Lawrance, L., & Levy, S.R. (1990). AIDS. runaways, and self-efficacy. Family & Community Health,

68, 408-4 13

wy. 58, 457-461.

Nursing

A.W., Hartman, C.R.. Wolbert. W.A., & Grant, C.A. (1987). Child molestation: Assessing impact in multiple victims (part I). Archives of Psychiatric Nurs-

nal of Adolescent

REFERENCES tionnaires:

the science

13. 89-100.

The authors express gratitude to David Finkelhor, Ph.D., Ann Burgess, D.N.Sc., and Karl Slaikeu, Ph.D., for their expert consultations; to Heather Becker, Ph.D., for her guidance in data analysis; and to Paul Wailer. Ph.D., for assistance in data analysis.

Bishop,

15-35.

A.W. (1985). Interview: Advancing victomology. Journal of Psychosocial Mental Health Services. 23(l). 35-38.

ACKNOWLEDGMENT

Berdie, D.R.,

8(4),

Burgess,

Lapsley.

13(I),

65-72.

D.K.. Rice, K.G., & Fitzgerald, D.P. (1990). Adolescent attachment, identity, and adjustment to college: Implications for the continuity of adaptation hypothesis. Journal

of Counseling

and Development,

68, 561-565.

REW, ESPARZA, AND SANDS

Leslie, L.L. (1972). Are high response rates essential to valid surveys? Social Science Research, 1, 323-334. Lindberg, F.H., & Distad, L.J. (1985). Post-traumatic stress disorders in women who experienced childhood incest. Child Abuse & Neglect, 9, 329-334. McConnack, A., Janus, M., Burgess, A.W. (1986). Runaway youths and sexual victimization: Gender differences in an adolescent runaway population. Child Abuse & Neglect, 10. 387-395. McDowell, I., &Newell, C. (Eds.). (1987). Measuring health: A guide to rating scales and questionnaires. New York, NY: Oxford University Press. Mims, F.H. (1982). Sexual stress: Coping and adaptation. Nursing Clinics of North America, 17, 395405. Mims, F.H., & Chang, A. (1984). Unwanted sexual experiences of young women. Journal of Psychosocial Nursing and Mental Health Services, 22(6), 6-14. Nasjleti, M. (1980). Suffering in silence: The male incest victim. Child Wetfare, 59, 269-275. Peters,

S.D., Wyatt, G.E., & Finkelhor, D. (1986). Prevalence. In D. Finkelhor (Ed.), A sourcebook on child sexual abuse. Beverly Hills, CA: Sage. Reinhart, M.A. (1987). Sexually abused boys. Child Abuse & Neglect, 11, 229-235. Rew, L. (1989). Childhood sexual exploitation: Long-term effects among a group of nursing students. Issues in Mental Health Nursing, 10, 181-191. Robertson, K.E., & Wilson-Walker, J.A. (1985). A program

for preventing sexual abuse of children. Maternal Child Nursing, 10, 100-102. Roscoe,

B. (1987). Concerns of college students: A report of self-disclosures. College Student Journal, 21, 158-161.

Russell,

D.E.H. (1984). CA: Sage.

Sexual exploitation. Beverly

Hills,

Sarrel, PM., & Masters, W.H. (1982). Sexual molestation of men by women. Archives of Sexual Behavior. 11, I 17131. Sherer, M., & Adams, C.H. (1983). Construct validationof the self-efficacy scale. Psychological Reports, 53, 899902. Sherer, M., Maddux, J.E., Mercandante, B., Prentice-Dunn, S., Jacobs, B., & Rogers, R.W. (1982). The selfefficacy scale: Construction and validation. Psychological Reports, 51, 663-67 I. Terry,

L.L. (1989). Assessing and constructing a meaningful system: Systemic Perspective in a college counseling center. Journal of Counseling and Development, 67, 352-355.

Vander Mey, B.J. (1988). The sexual victimization of male children: A review of previous research. Child Abuse & Neglect, 12, 61-72. Weitzel, M.H., & Waller, P.R. (1990). Predictive factors for health-promotive behaviors in white, Hispanic, and black blue-collar workers. Family & Community Health, 13(l), 23-34.