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Incarcerated Adolescents' Experiences as Perpetrators of Sexual Assault
Robert E. Morris, MD;
Martin M. Anderson, MD, MPH;
George W. Knox, PhD
Arch Pediatr Adolesc Med. 2002;156:831-835.
ABSTRACT
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Objectives To identify self-reported characteristics of past sexual assaults perpetrated
by incarcerated juveniles and to determine potential precursors of this behavior.
Participants and Methods Participants completed an anonymous written questionnaire regarding
their experiences of sexual abuse and/or assault as both a victim and a perpetrator.
The questionnaire was incorporated into an existing annual survey of gang-related
behaviors.
Results A total of 805 adolescents (707 boys, 91 girls, and 7 gender-not-designated)
participated. Of these teens, 79 males (11% of the males), 9 females (10%
of the females), and 5 (71%) gender-not-designated said they had forced sex
on someone (165 did not answer the question). Twenty-eight males (30% of the
male perpetrators) and 4 females (44% of the female perpetrators) were both
victims and perpetrators. Drugs and/or alcohol were frequently used by both
the assailant (58% of the males and 55% of the females) and the victim (56%
for the males and 66% for the females). The attributes of adolescent boys
at highest risk of becoming perpetrators were all related to violence, including
exposure to parents who were violent in the home (adjusted odds ratio, 2.68),
being a victim of physical or sexual assault (adjusted odds ratio, 2.83),
having parents who encouraged gang membership (adjusted odds ratio, 3.58),
and knowing a perpetrator of sexual violence (adjusted odds ratio, 3.83).
Conclusions Adolescent boys and girls were both victims and perpetrators of sexual
assault. Programs that identify and target violence in young children's lives,
particularly intrafamilial violence, may reduce the risk of teenagers becoming
perpetrators of sexual violence. Anticipatory guidance during teen years,
regarding risk and avoidance of sexual exploitation, may be helpful in reducing
the chances of sexual assaults.
INTRODUCTION
DETAINED YOUTH may have many negative life experiences linked to their
delinquent and maladaptive behaviors.1-7
Physical and sexual abuse have been reported in juvenile murderers,1-2 chemically dependent youths,8 and youths involved in illegal behavior,3
including running away, prostitution, and drug abuse.4, 8
It is clear from this that both physical and sexual maltreatment may contribute
to delinquency behaviors including sexual and other forms of violence against
others, thus turning victims into victimizers. Most crimes are not reported9-12; therefore,
it is reasonable to assume that some incarcerated teens have committed additional
crimes, such as sexual assaults, beyond those for which they were incarcerated.
We wished to explore self-reported perpetration of sexual assault by
incarcerated male and female teens, focusing on potential precursors of this
violent behavior. We chose the following areas to explore based on previous
work relating violence and delinquency: family discord and/or stress,13-15 childhood maltreatment,16 sexual abuse,7, 17
gang involvement,18 and drug and/or alcohol
use19-20 based on significant
numbers of positive drug screenings at the time of arrest.21
PARTICIPANTS AND METHODS
The National Gang Survey is designed and implemented yearly by one of
us (G.W.K.), 27 collaborators from various US institutions (eg, criminology,
health care, special education, and criminal justice practitioners), and Chicago
State University's National Gang Crime Research Center, Chicago, Ill. The
National Gang Survey focuses on a different area of gang activity each year.
The survey in 1996, titled GANGFACT, involved 10 000
juvenile and adult inmates in 75 institutions from 17 states. It posed 99
questions regarding bullying behavior, family dynamics, risks associated with
joining gangs, gang society, and gang activity within correctional facilities.22
A representative of Chicago State University, who tells them they may
ignore any or all questions, administered the anonymous paper-and-pencil survey
simultaneously to detainees gathered in classrooms or dining halls after delivering
a brief introductory explanation. Almost all residents of the facility took
part, except those in court or sickbay. No attempt was made to determine how
many youths were absent. The survey identifies those incarcerated youth with
gang membership.22
Two of the 3 juvenile detention facilities in a large southwest city
participated simultaneously in the survey in 1995 and 1996. The third hall
did not participate because only 2 representatives of Chicago State University
were available each year. The 3 facilities house primarily preadjudicated
youth with a few who were sentenced and awaiting transfer. The average length
of stay in the halls is 6 weeks. Youth are transferred daily back and forth
among the 3 halls to balance the institutions' populations. Thus, the populations
are almost identical and the tests must be administered simultaneously in
both halls to avoid duplication of questionnaires.
A group of physicians and health educators from these 2 juvenile halls
were invited by the gang surveyors to develop questions regarding juvenile
detainees' experiences of sexual abuse and/or assault. These questions were
added to the end of the survey. Data derived from these added questions were
analyzed only for the 2 institutions, not nationally.
The questions were constructed to assess the "who," "what," and "where"
of the youth's experiences of being a victim and of perpetrating sexual assault.
Independent variables were constructed from the primary questionnaire that
related to sexual assault victimization, family and social dynamics, gang
membership, and the questions we added related to drug and/or alcohol use.21 Most of the questions in the primary questionnaire
were dichotomous (ie, yes-no or true-false) with the exception of age and
race questions, and questions such as "It is all right to demand my needs
be met" where a Lickertlike scale was used (from always [5] to never [1]).
In our analysis, youth choosing "always" were compared with all other answers
less than always. We constructed dichotomous questions for "did an event happen,"
and multiple-choice questions for identities of victims and locations of assaults.
In each question, sexual assault was defined as "sex someone did not want."
In 1995, after pilot testing by 20 incarcerated teens to determine readability
and comprehension, the questions were administered to 281 juveniles from the
same 2 juvenile detention centers as part of that year's National Gang Survey.
Using the results of that survey, some questions were rewritten and additional
questions were created regarding the identity of victims. This article presents
only the 1996 data.
The chief juvenile court judge and the probation department administering
the institutions approved the survey. The institutional review board of the
National Gang Crime Research Center also approved the study.
Comparisons of 2 variables were done using the  2 test
and, where applicable, Fisher exact test. The attributes of adolescent boys
who were perpetrators of sexual assault (79 of 707) were analyzed further
using logistic regression. A pool of 14 potential predictor variables was
selected based on the professional experience of the study designers and the
previously quoted literature.1-7,13-18
The variables were dichotomous and included father only household; prior victim
of sexual assault; started a fight in a facility; it is "always all right
to demand that my needs be met"; knew another male perpetrator of sexual assault;
"my parents" attitudes toward drugs, crime, or violence was favorable; parents
had spent time in prison; "my parents were physically violent in my home";
juvenile gang membership; parents knew about gang membership; parents encouraged
gang membership; parents would be embarrassed by gang membership; and 2 variables
regarding ethnicity (African American vs other or Hispanic vs other). Logistic
regression using both forward and backward selection (P = .05 for inclusion) was used to identify predictor variables for
the final multivariate model. All predictors appearing in the final model
of either of these methods was retained for further analysis. If 2 variables
were so closely correlated that they each eliminated the other reciprocally
during forward and backward elimination, they would have been combined into
a composite variable. In this study, that effect was not seen. All values
are reported as adjusted odds ratios (ORs).
RESULTS
A total of 805 adolescents (707 boys, 91 girls, and 7 gender-not-designated)
participated in the survey study. Eighty-six percent were between 15 and 18
years old (overall mean, 16.2 years; 16.2 years for males and 16.1 years for
females) (n = 692). The ethnicity of the youths reflected the general population
of the halls, 33% black, 48% Hispanic, 8% white, 5% Asian, 1% Native American,
and 5% mixed race. Sexual abuse and/or assault was reported by 147 teens (4
did not answer the question) (94 males [13% of the males], 48 females [52%
of the females], and 5 gender-not-designated [71% of the GND]).
ADOLESCENT GIRLS AS PERPETRATORS
The adolescent girls made up 10% of the sample that is equal to their
percentage in the halls. Nine (10% of the females) reported sexually assaulting
at least 1 person, while 17 (19%) declined to answer the question. Four (44%)
of 9 perpetrating females reported previous sexual victimization that was
not significantly different than the rate of victimization among nonperpetrating
females (44/82 or 54%).
Their victims were extrafamilial and known to them (Table 1). The assaults took place in homes (their own, relatives',
or boyfriends'). Four (44%) used verbal coercion, 1 (11%) physical force,
and 1 (11%) both verbal and physical force, to accomplish the assault.
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Table 1. Relationship of Study Perpetrators to Their Victims of Forced
Sexual Activity*
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During the perpetration of sexual assault, 5 females (55%) always used
drugs and/or alcohol, while 1 female, with more than 1 assault, sometimes
used drugs and/or alcohol. Five (55%) reported their victims were using drugs
and/or alcohol at the time of the assault and 1 (11%) said some of her victims
were using drugs and/or alcohol.
ADOLESCENT BOYS AS PERPETRATORS
Seventy-nine adolescent boys (11% of the males) sexually assaulted at
least 1 person. One hundred forty-three declined to answer the question. Of
the 94 male victims of sexual abuse and/or assault in this study, 28 (30%)
became perpetrators compared with only 51 (8%) of 613 of the nonvictims becoming
perpetrators (P<.001).
Adolescent boys almost always knew their victims, which included family
and nonfamily persons (Table 1).
Similar to adolescent girls, they assaulted in homes (their own, relatives',
or girlfriends'). The remaining places were school (4), car (3), party (5),
outside (5), with 9 in a variety of other locations. Thirty males (40%) used
verbal coercion, 10 males (13%) used physical force, and 13 (16%) used both
to accomplish the assault. When engaged in sexual assault, 28 males (35%)
said they were always under the influence of drugs and/or alcohol and 18 (23%)
were sometimes under the influence of drugs and/or alcohol. As for their victims,
males reported 26 (33%) were using drugs and/or alcohol while 18 respondents
(23%) said some of their victims were under the influence of drugs and/or
alcohol.
Logistic regression using the 2 selection methods yielded the same model
with 4 predictors (Table 2); living
with violence at home (OR, 2.68), being a victim of sexual assault (OR, 2.83),
parents encouraging violence (ie, gang membership) (OR, 3.58) as well as knowing
a "role model" for sexual assault (OR, 3.83) independently increased the risk
of engaging in sexual assaults. The Hosmer-Lemeshow goodness-of-fit statistic
(P = .35) indicated that the model fit.23
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Table 2. Logistic Regression Model of Variables Associated With Being
a Male Perpetrator of Sexual Assault*
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COMMENT
ADOLESCENT GIRLS AS PERPETRATORS
While females are often studied as victims of sexual assault, less is
known about them as possible perpetrators. Monteleone et al24
reported that 85% of perpetrators are males but states that little is known
about females and it is likely their offenses are underreported. The Minnesota
Student Survey Report of 71 594 9th and 12th graders by Borowsky et al25 found 1.3% of females admitting to perpetrating sexual
abuse and/or assault. Our delinquent population's rate of victimization (52%)
and rate of perpetrating were higher (10%) than the general population, while
the risk of becoming a perpetrator was not higher for our victims (8%) vs
nonvictims (11%). However, we had very few female perpetrators and, thus,
may have lacked the power to show an effect of sexual victimization. The review
by Lodico et al7 of the Minnesota data had
more victims becoming perpetrators (3.5%) compared with 1.3% of the nonvictims.
This area deserves more study. Although we thought some female gang members
might have been involved in sexual assaults as part of initiation rites, we
found only 1 adolescent girl assaulted a gang member.
ADOLESCENT BOYS AS PERPETRATORS
An equal number of males were victims (13%) and perpetrators (11%).
We found that 30% of the male victims became perpetrators, a figure nearly
identical to the rate of 27.6% reported by Lodico et al7
although their odds risk ratio was somewhat higher (4.4 vs 2.83 [ours]). This
may be because our youth had many additional risk factors that affected their
propensity to force sexual activity.
Unlike females, some males were not limited by the boundaries of the
family and abused family members. In fact, all of the male victims in this
study were family members. The reasons for this are unclear and deserve more
study.
Girlfriends made up the largest group of victims targeted by our male
perpetrators. Bennett and Fineran26 in 1998
also reported high school acquaintances or dating and/or ex-dating partners
as most likely to engage in sexual or physical violence. Rickert and Wiemann's
review of date rape found a prevalence of 20% to 68% for adolescents,27 which is much higher than our total figures for all
sexual assaults. Risks for dating violence include parent-child violence,
drug use, knowing a perpetrator of date violence, and especially for males
believing that violence is justified to solve problems,28
which are similar to our findings. The Minnesota survey found similar results
with the addition of frequent drug and/or alcohol use and suicidal behavior.25 Thus, violent experiences and psychoactive drug abuse
remain the core elements leading to sexual assault. When parents held neutral
attitudes regarding gang involvement, that is, they knew of the affiliation
but did not actively support membership, the children had less risk of becoming
an assailant. Further study of teens' beliefs regarding their parents' attitudes
toward unlawful behavior would help complete our understanding of the parents'
role in encouraging delinquency, especially violence.
We did not ask our respondents if they felt violence was acceptable
in a relationship or whether male victims of forced sexual activity felt justified
in forcing others. We did find that both males and females forced their partners
to have sex. The area of date and/or acquaintance rape deserves more study,
especially for delinquent youths. Adolescent care providers (ie, pediatricians,
nurse practitioners, and health care workers in adolescent care sites) should
provide anticipatory guidance to their patients about identifying risks of
sexual assault and methods to avoid that risk, especially in romantic relationships.
DRUG AND/OR ALCOHOL USE
We found high rates of drug and/or alcohol use in the episodes of sexual
assault as have others,29 but not all assaults
were accompanied by substance use. Rickert and Weimann27
cited alcohol or illicit drug or alcohol use as contributing to date rape
and Johnson and Knight30 suggested that alcohol
might play more of a role in coercive sexual acts than previously hypothesized.
Since drug and/or alcohol use is so prevalent in delinquent youth,31 attention to this is imperative during rehabilitation
for delinquency.
LIMITATIONS OF THE STUDY
Although the questionnaire was anonymous, the emotional sensitivity
of sexual subject matter may have influenced some answers. Placing these questions
at the end of a long questionnaire was meant to reduce some of the emotional
reaction to the sex abuse questions but the usefulness of this technique is
unknown. The survey reports the results from a large number of youth that
may help to reduce the effect of overreporting and underreporting of the activities.
Nevertheless, self-reports are subject to bias and far fewer females participated.
Generally youth self-report higher levels of criminal activity but not all
investigators agree.32
Although face-to-face interviewing may result in more accurate responses,
it is expensive and mandatory reporting laws make conducting nonanonymous
sexual abuse surveys impossible. In addition, protecting the confidentiality
of prisoners' answers remains an important concern. Anonymous written surveying
remains one of the few ways of polling large numbers of detained youth. The
results may not be generalizable to other cities owing to this study being
performed only in one large urban city. We did not ask about circumstances
leading to the assaults or the respondents' feeling regarding past and future
possible assaults. We recommend that this be investigated further.
About 20% of youths (n = 160) did not answer the question regarding
whether they were sexual assailants. A comparison of refusals to answer other
questions revealed that demographic questions had low refusal rates, knowing
other sexual perpetrators had a 20% refusal rate, and questions regarding
gang membership and parental attitudes had higher refusal rates of 30% and
36%, respectively. After youths admitted to perpetrating sexual assaults,
then only 12% to 20% of them refused to provide details except for their own
age and that of victims, which approached a 35% refusal rate. It seems possible
that some incarcerated youths were withholding information they felt could
be used against themselves or their parents. It is reasonable to assume many
or most of the 160 youths who refused to discuss the sexual assault questions
were in fact assailants, but this remains conjecture.
PREVENTION
There are no systematic studies of large programs designed to reduce
the incidence of sexual abuse of children or their subsequent risk of becoming
adolescent sexual assaulters. However, a few interventions have reduced child
abuse generally. Between 1978 and 1980, Olds et al33-35
reported the implementation of home visits by nurses for pregnant high-risk
poor white rural mothers in New York State continuing for 2 years post partum.
After 15 years, the risk of child abuse, neglect, and subsequent delinquency
was reduced by 75% compared with a control group.34-35
This economical home-visitation cost only $1582 per family.33
Kitzman et al36 provided similar services to
African American women and found similar outcomes, especially fewer personal
beliefs about childrearing that could lead to abuse. The program seemed to
benefit those mothers who most needed help and might be at risk for raising
delinquent children.
The National Longitudinal Study of Adolescent Health (ADD HEALTH), a
longitudinal study of adolescents in grades 7 through 12, compared their living
social contexts to health risk behaviors. Parent-family connectedness protected
them from most health risk behaviors including violence. This leads to the
conclusion that the family context has a strong effect on adolescents' behavior.37 Despite this, certain individual factors played the
most significant role in a teen's involvement in violence such as a history
of victimization and/or witnessing violence, weapon carrying, deviant behavior
(ie, destruction of property, theft, skipping school in the past year, and
ever being suspended or expelled from school), and drug selling. In actuality,
except for the first, these are measures of violent and/or risk behavior and
would be expected to be common among teens engaging in violence. This returns
us to the family and its important role in early childhood violence. Pediatricians
can provide a valuable service by screening for family violence and referring
to appropriate services. Of course, family support services must be available.
CONCLUSIONS
These data highlight the fact that, in addition to physical violence,
youthful offenders may also be engaging in sexual violence. Our data and that
of others show an association between exposure to violence (ie, witnessed,
condoned in the home, and/or being a victim) and an increased risk of becoming
a perpetrator of sexual violence. Early intervention in troubled families
appears to be a promising intervention strategy to prevent later teenage violence
including sexual assaults. Anticipatory guidance for teens should include
discussion of sexual assault. For youths already in the "system," rehabilitation
of antisocial behavior should be broad and include sexual victimization.
| What This Study Adds
Although it is commonly believed and self-reports of offenders support
the premise that delinquents may commit a variety of crimes, there is little
literature about the sexual offenses committed by juveniles incarcerated for
other, unrelated crimes. We asked questions regarding sexual offenses in a
longer questionnaire about violence and gang activity.
Data show that both adolescent boys and girls are involved in sexual
exploitation. Exposure to and infliction of violence on youths along with
parental approval of antisocial behavior are related to sexual victimization
on the part of males. The study also reinforces the understanding that alcohol
and other drugs play a role in these behaviors.
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AUTHOR INFORMATION
Accepted for publication April 5, 2002.
Reprints: Robert E. Morris, MD, 12-358 Marion Davies Children's Center,
Department of Pediatrics, UCLA Center for Health Sciences, 10833 LeConte Ave,
Los Angeles, CA 90095-1752 (e-mail: rmorris{at}ucla.edu).
From the Department of Pediatrics, UCLA School of Medicine, Los Angeles,
Calif (Drs Morris and Anderson); and the National Gang Crime Research Center,
Chicago State University, Chicago, Ill (Dr Knox).
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ABSTRACT
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