Child Abuse Statistics
on this page
- Unavoidable Controversies and Biases, in Historical Contexts
- Sources of Statistics
- Statistics Are Human Creations
- Retrospective Survey Methods
- Sexual Abuse of Boys In Depth
This page provides overviews and in-depth discussions of child abuse statistics – where they come from, how to make sense of them, etc. When it gets into specific statistics, the focus is on the sexual abuse of boys, because that’s typically neglected and something that I studied in depth starting in the early 1990s.
Unavoidable Controversies and Biases, in Historical Contexts
When thinking about statistics on child abuse, it helps to understand that the very idea of ‘child abuse’ can be controversial.
- Only recently, and only in particular countries and cultures, has the abuse of children come to be seen as a major social problem and public health issue.
- Of course children have been abused throughout human pre-history and history. But for people to think about child abuse as we do now, to create legal definitions and government agencies that can remove children from their homes, and to conduct thousands of research studies on the effects of abuse - these are historically and culturally embedded developments.
- Some believe that, for the first time in history, we are beginning to face the true prevalence and significance of child abuse. Others worry that many people have become obsessed with child abuse and underestimate people’s responsibility for their problems while ‘blaming’ them on abuse and bad parenting. (I believe each view has some validity.)
- Clearly, then, some very large contexts and controversies shape debates about particular issues concerning child abuse.
All statistics on the incidence and prevalence of child abuse and neglect are disputed by some experts. (Incidence refers to the number of new cases each year, and prevalence to the percentage of people in a population who have had such experiences.)
Statistics on rates of child abuse and neglect can be controversial.
- Complex and subtle scientific issues are involved in studies that generate these statistics.
- Even the most objective scientific research is imperfect. At least one or two methods used in any study must be chosen by researchers based on opinions and judgments, not just facts and logic. The objectively best methods available may still have limitations.
- For example, there are important controversies about how to define abuse and neglect. This is true for official government studies and any other research study.
- The definitions of abuse used in official government studies are based on laws, because government definitions are needed for more than research purposes. They are also needed for purposes like determining whether or not suspected abuse should be reported, investigated, ‘substantiated’ (as actually having occurred), and lead to action by a social service agency or court.
- In contrast, independent researchers can use different definitions because they have different purposes than government agencies, like understanding the different effects of mild and extreme emotional, physical, and/or sexual abuse.
- No matter what kind of study it is, small changes in definitions can result in big differences in statistics on abuse and neglect.
Some bottom lines:
- Emotions and moral commitments influence everyone’s reasoning and judgment to some extent.
- Any experts who claim to be without bias are fooling themselves or trying to fool you.
- The contents of this page are influenced by my values, my informed opinions, and my experiences as a researcher and therapist over many years.
- This section includes links to web sites that address these issues and provide statistics, including sites with different statistics and points of view on these issues.
Sources of Statistics
Most abused and neglected children never come to the attention of government authorities.
This is particularly true for neglected and sexually abused children, who may have no physical signs of harm. In the case of sexual abuse, secrecy and intense feelings of shame may prevent children, and adults aware of the abuse, from seeking help.
Therefore, official government statistics do not indicate actual rates of child abuse.
Government statistics are based on cases that were (a) reported to social service agencies, (b) investigated by child protection workers, and (c) had sufficient evidence to determine that a legal definition of ‘abuse’ or ‘neglect’ was met. In the official government studies linked to below, terms like ‘substantiated cases’ (United States) and ‘registered children’ (England) refer to such cases.
In short, official government statistics are only ‘the tip of the iceberg.’
In general, four major types of studies are the sources for large-scale child abuse statistics:
- Studies that collect official government statistics. (To find the U.S. government’s reports, Google ‘Children’s Bureau child maltreatment report’.)
- Studies that include official government statistics plus additional sources of data intended to “provide a more comprehensive measure of the scope of child abuse and neglect known to community professionals, including both abused and neglected children who are in the official statistics and those who are not” (quoted from the U.S. National Incidence Study of Child Abuse and Neglect, also available on the web).
- Studies that survey a ‘representative’ sample of people (e.g., from a country) about their first-hand knowledge of child abuse. Typically questions refer to incidents in respondents’ own households over the past year, and usually only adults are surveyed, but sometimes adolescents as well.
- Studies that survey adults and ask them to recall and report abuse that they may have experienced in childhood.
All four types of studies are discussed and/or critiqued in this section. The critical discussions of methogological issues – that is, tools to help you to avoid being confused and misled – are in the sections entitled “Statistics Are Human Creations” and “Retrospective Survey Methods.”
- To begin thinking critically about the issues involved, consider these questions: Which of the following are easier for people to do? In which resulting statistics would you have more confidence?
- To choose to tell someone in authority, particularly if you are a child, family member, victim or perpetrator, that you know or suspect abuse is currently occurring, especially if you know that your report could result in an investigation by a social service agency, removal of the child or perpetrator from the home, etc. (Source of official statistics.)
- To acknowledge, anonymously, as an adult or adolescent, that incidents researchers could define as ‘abuse’ - but probably do not in the survey - have occurred in your own household within the past year. (Source of incidence statistics from surveys on directly witnessed abuse.)
- To report, as a professional trained to recognize child abuse, an estimate of how many cases came to your attention over the past year. (Source of supplemental data in studies like the U.S. National Incidence Study.)
- To acknowledge, anonymously, as an adult, in an interview or on a questionnaire, that when you were a child someone behaved toward you in a way that fits a definition of ‘abuse’ - again, without ever having to label the experience as abusive. (Source of prevalance statistics from retrospective surveys.)
Statistics Are Human Creations
I’ve already mentioned (above) that historical and cultural factors have created and shaped the concept of ‘child abuse’ as most of us understand it today. The same is true of our relationship to statistics: it is embedded in historical and cultural patterns, particularly how science and statistics are used to define important social problems, shape debates about them, and decide public policies.
Unfortunately, our healthy respect for scientific research, empirical data and quantifiable knowledge is often untempered by critical thinking:
- We often don’t believe a problem is significant, or even real, unless those who say so can provide impressive-sounding statistics.
- The media often insist on such statistics for their stories, even if no good ones exist.
- The media often report on statistics, good and bad, without providing the information we need to evaluate their quality and meaning.
- The media seldom tell us:
- How was the problem defined?
- What questions were asked?
- What methods were used to seek answers?
- Who was studied or asked the questions?
- If one statistic is compared to another statistic from an earlier study, were different methods of measurement used, or was the object of measurement changed or redefined?
- Finally, even when the necessary information is provided, most people simply don’t have the tools to think critically about statistics.
Again, widespread uncritical faith in statistics is historically fairly recent. And it causes significant confusion - among members of the media, politicians, judges, and advocates for various causes, not to mention average citizens. Therefore, having tools for thinking critically about statistical findings reported in the media (and on the web) will help you better understand a variety of important issues, not just child abuse.
Two good, recently published books can help you cut through the confusion and hype that surround most presentations of statistical and scientific findings in the popular media. In this section, I introduce those books, provide a few short excerpts from each, and link to a radio show in which the authors discuss these issues.
Keep in mind that the authors of these books, like everyone else, have their biases. The trick is to take what they can teach you (quite a lot), and use it to detect and critically evaluate those biases, even when they are presented as obvious truths.
Murray, D., Schwartz, J., & Lichter, S. R. (2001). It Ain’t Necessarily So: How Media Make and Unmake the Scientific Picture of Reality
This book is the longer of the two, and more focused on how the media can generate confusion and mislead people. However, it covers much of the same territory as Best’s book (below), in terms of how to think critically about the statistics we encounter every day, and has more discussion of child abuse statistics (excerpts below).
Praise from the book jacket:
“Fake statistics flood the news media these days. This book is the essential antidote.” - John Leo, U.S. News & World Report
“Risk and uncertainty plague our daily lives, especially when they drive media headlines. But savvy consumers of news have a new ally with the appearance of this timely and entertaining read that manages to take the process apart and show us the guts of how news is really made.” - John D. Graham, Harvard Center for Risk Analysis
First excerpts on child abuse statistics from It Ain’t Necessarily So- Is the trend really down?
“A group of researchers conducted two surveys of child abuse, in 1975 and 1985. Their second survey found that reports of child abuse had dropped by almost 50 percent. In 1975, respondents were interviewed in their homes whereas in 1985 respondents were interviewed on the phone. Could this change in interviewing technique have contributed to the decrease? Or would the change have made an increase in reports more likely? “[T]he answers that [researchers] receive (and newspapers report) greatly depend on precisely what the [researchers] ask and how they ask it. For this reason, the most important problem with survey data was outlined in a conversation having nothing to do with [survey research] that took place at the deathbed of the modernist writer Gertrude Stein. Alice B. Toklas, Stein’s companion, hoping for a final illumination from her brilliant friend, is reported to have asked the question, ‘Gertrude, Gertrude, what is the answer?’ But Stein offered no blinding insight, instead parrying Toklas’s question with one of her own: ‘Alice, Alice, what is the question?’” (page 98).
Asking in Person and on the Phone
“In 1975 sociologists Murray A. Straus of the University of New Hampshire, [Suzanne Steinmetz of Indiana University-Purdue University at Indianapolis] and Richard J. Gelles of the University of Pennsylvania conducted the National Family Violence Survey to determine the incidence of child abuse and spousal abuse in the United States. In 1985 they conducted a second survey (the National Family Violence Re-Survey) to update their findings. Their most striking discovery was that child abuse (which they defined as kicking, biting, punching, beating, threatening with a gun or knife, or using a gun or knife) had declined by 47 percent among two-parent families with at least one child aged three to seventeen. There were thirty-six incidents of child abuse per thousand children in 1975, but only nineteen such incidents of child abuse per thousand children in 1985.
“Straus and Gelles stressed that this encouraging finding could be interpreted in different ways: child abuse could actually have decreased over the ten years, or respondents could have been more reluctant to admit to child abuse in 1985 than 1975. They argued that the decrease probably reflected real behavioral changes (resulting from factors such as the rise in average age for first-time parents, the decline in the number of unwanted children, an improved economy, expanded treatment programs for offenders, and a greater sense that child abuse is wrong and that abusers risk punishment). They did not, however, rule out the possibility that abusers were becoming less willing to own up to their own deeds in interviews with strangers. Because child abuse is stigmatized, one must always be cautious about equating what people report with what they actually did.
“For our purposes, though, the possible impact of methodological changes between the surveys is of great interest. The 1975 findings on child abuse derived from hour-long in-person interviews with parents in 1,146 households; the 1985 emerged from thirty-five-minute telephone interviews with parents in 1,428 households. What was the likely impact of the methodological changes between the two surveys?
“Interestingly, Straus and Gelles contended that ‘the differences in methodology should have led to higher, not lower, rates of reported violence.’ First, ‘the anonymity offered by the telephone [used in 1985 but not 1975] leads to more truthfulness and, therefore, increased reports of violence.’ In addition, 85 percent of the 1985 telephone interviews were completed, compared with only 65 percent of the 1975 in-person interviews; and it is ‘more likely that the violence rate is higher among those who refuse to participate.’ Thus ‘a reduction in refusals would tend to produce a higher rate of violence, whereas we found a lower rate of violence in 1985 despite the much lower number of refusals.’ Finally, in 1975 ‘never’ was an option offered respondents as an answer to questions about violent acts; in 1985, by contrast, the response categories began with ‘once’ and continued to more than 20 times,’ so that respondents had to volunteer an answer of ‘never’ themselves. Again, this shift in interviewing technique would tend to have decreased the number of denials that child abuse ever occurred.
“In short, the reported decline in child abuse was all the more significant because it seems to have occurred in spite of the methodological changes between the surveys. We see yet again that survey answers are much more meaningful when they are understood in the contexts of the way in which the questions are asked. It is interesting to look at newspaper reports of Straus and Gelles’s 1985 survey to see how the methodological issues were covered or ignored. Bear in mind that it required no effort to address the survey’s methodology (Straus and Gelles did not conceal the methodological issues, as tendentious researchers will sometimes do) but instead called attention to them.
“The New York Times reporting was exemplary. To begin with, the Times story was careful to note (both in the headline and in the body of the story) that the survey examined admissions of child abuse (as opposed to incidents of it): Straus and Gelles necessarily looked at what parents said they did, not what they actually did. The story also took note of the competing interpretations of the decline in reports and explored the possible impact of the switch from in-person to telephone interviewing. The San Diego Tribune also noted the possible impact of interviewing by telephone; but the Chicago Tribune and Christian Science Monitor ignored the methodological context for Straus and Gelles’s substantive finding. Too often, even when researchers themselves stress the importance of methodology, reporters limit themselves to recounting substantive findings in a procedural vacuum” (pages 110-113).
Second excerpts on child abuse statistics from It Ain’t Necessarily So- Is the trend really up?
“Secretary of Health and Human Services Donna Shalala recently declared that ‘between 1986 and 1993, the number of children who were physically abused nearly doubled.’ She based this claim on an increased number of reports of child abuse. But do more reports clearly show that conditions are worsening? Could they also indicate that even though behavior has not worsened, the standards by which it is judged have become more strict?” (page 133).
Stricter Standards for Child Abuse
“The National Incidence Study of Child Abuse and Neglect was released in September 1996, following up on previous studies conducted in 1980 and 1986. The study found that child abuse and neglect were seriously worsening. Between 1986 and 1993 the number of cases doubled, going from 1.4 million to 2.8 million; and the number of cases involving serious injuries nearly quadrupled, rising from 143,000 to almost 570,000. “Commendably, newspaper accounts (presumably following a lead raised by the study itself) alerted readers to the possible divergence between reports of child abuse and the reality of child abuse. The Chicago Tribune, for example, described the increase as ‘a ‘true rise’ in the severity of the problem rather than one based solely on heightened awareness.’ There is certainly reason to suppose the number of cases of actual abuse might be rising, since child abuse could be expected to rise when drug and alcohol abuse were increasing and when broken homes were becoming more common.
“Nevertheless, despite the study’s assurance to the contrary, there is also good reason to suppose that much of the increase reflects heightened awareness rather than worse behavior. American Enterprise Institute researcher Douglas J. Besharov (writing with research assistant Jacob W. Dembosky) advanced this argument in an article in the on-line Journal Slate [Child Abuse: Threat or Menace. How common is it really?]. Besharov and Dembosky noted that child abuse fatalities (for which there is, of course, objective evidence that cannot easily be hidden) have risen only modestly, going from 1,104 in 1986 to 1,216 in 1993. If serious abuse had in fact quadrupled, one would expect to see a comparably enormous increase for the most deadly abuse of all.
“Why might the study’s alarming findings indicate heightened awareness rather than a true rise in awful behavior? Besharov and Dembosky observed that the study’s conclusions emerge from a survey of a representative sample of 5,600 child-welfare professionals. Of the 1.4 million additional cases counted in 1993, almost 80 percent consisted of cases that do not involve physical or sexual abuse. (Note that the survey examined child neglect as well, although Shalala’s written comments in releasing its findings referred only to abuse.) Fully 55 percent of the additional cases involved endangered children: those who are not actually harmed by parental abuse or neglect, but are simply ‘in danger of being harmed according to the views of community professionals or child-protection service agencies.’ Cases of emotional abuse and neglect made up an additional 15 percent of cases; and educational neglect, the frequent failure to send a child to school, accounted for another 8 percent.
“A similar pattern emerges regarding the serious cases that were said to have quadrupled. Of the 427,000 additional cases of serious abuse found in 1993, emotional maltreatment was at issue in half. Furthermore, cases were characterized as serious physical abuse even if they were restricted to mental or emotional injury. Finally, in three categories (sexual abuse, physical neglect, and emotional neglect), the increase in serious cases was accompanied by a decline in moderate ones - which might suggest that the increases resulted in some measure from upgraded standards, whereby behavior once thought to be only moderately bad has now come to be considered seriously harmful.
“In short, the child abuse study appears to be a perfect example of what we have elsewhere described as the tactic of ‘bait and switch’: the increase does not appear to stem from many more cases of real physical abuse (as Shalala’s remarks and the Tribune article, which nowhere discussed the study’s definition of ‘abuse and neglect,’ implied). Instead, what is mostly at issue is a heightened awareness and sensitivity among child-welfare professionals, who now report more behavior as abusive and neglectful than they would have earlier. It seems likely that more stringent standards, rather than a greater amount of adult depravity, is what chiefly explains the rise reported in the child abuse study” (pages 138-139).
“…. In principle, of course, there is nothing wrong with making standards stricter, for judging child abuse or anything else; it’s certainly possible that prior standards were too lax (and not that the new, toughened standards are unreasonably exacting). But… the problem is that we won’t properly understand the trendline unless we realize that our measuring instrument has been altered so that it catches examples of abuse that would have gone unrecognized in the past.
“Ironically, then, the increased conscientiousness of public servants can be mistaken for increased social depravity. If the people who keep count of various pathologies get better at their jobs, it is easy to reach the possibly false conclusion that pathology is on the upswing. In other words, an actual decline in pathology is altogether consistent with an increased number of reports of pathology (and increased societal focus on it). As new and higher standards arise, behavior that had once seemed acceptable comes to be thought heinous, so it is reported where once it had been ignored; what that can mean, though, is not that behavior has gotten worse, but that the standards of judging it have risen.
“That point has been nicely argued (with specific respect to child abuse) by sociologists Murray A. Straus and Richard J. Gelles.
Those concerned with America’s children might be pleased that each year’s ‘official statistics’ on child abuse tops the previous year’s figures. This is because the figures might indicate something quite different from a real increase in the rate of child abuse. The true incidence of child abuse may actually be declining, even though the number of cases is increasing…. New standards are evolving in respect to how much violence parents can use in childrearing…. This can create the misleading impression of an epidemic of child abuse [emphasis in original article; M. A. Straus & R. J. Gelles (1986), “Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys,” Journal of Marriage and the Family, 48, 466-467].
“In sum, being aware of the occasional disparity between reports and reality can be helpful, in that it can remind us of likely disparities between subjective self-reports and objective reality. But it may be still more helpful if we learn not to confuse objective observers’ improvements in tabulating pathologies with actual increases in the pathologies themselves” (pages 142-143).
See also Explanations for the Decline in Child Sexual Abuse Cases, a 2004 paper on this issue written for the US Department of Justice by David Finkelhor and Lisa Jones. Dr. Finkelhor is an internationally renowned researcher and Director of the Crimes Against Children Research Center.
This book has extremely clear and concise explanations of how activists, the media, experts and other key players like politicians and the staff of government agencies create good and bad statistics. The author gives you lots of tools for critical thinking about how statistics are created by people and organizations.
In fact, Best gives you some good critical tools for seeing his own biases, which come across when he addresses issues like child abuse and sexual assault. Still, we would cheat ourselves of much knowledge if we failed to learn from people we don’t agree with - and Best has a lot of valuable things to teach about the social and political creation and uses of statistics. Just reading the excerpts will be very informative.
Praise from the book jacket:
“A real page turner. Best is the John Grisham of sociology.” - James Holstein, coauthor of The New Language of Qualitative Method
“In our era, numbers are as much a staple of political debates as stories. And just as stories so often turn into fables, so Best shows that we often believe the most implausible of numbers–to the detriment of us all.” - Peter Reuter, coauthor of Drug War Heresies
Excerpt 1: ‘The Rise of Social Statistics’
“[T]he first ‘statistics’ were meant to influence debates over social issues. The term acquired its modern meaning – numeric evidence – in the 1830s. . . The forerunner of statistics was ‘political arithmetic’; these studies – mostly attempts to calculate population size and life expectancy – emerged in seventeenth-century Europe, particularly in England and France. Analysts tried to count births, deaths, and marriages because they believed that a growing population was evidence of a healthy state; those who conducted such numeric studies – as well as other, nonquantitative analyses of social and political prosperity – came to be called statists. Over time, the statists’ social research led to the new term for quantitative evidence: statistics.
”. . . . From year to year, they discovered, the number of births, deaths, and even marriages remained relatively stable; this stability suggested that social arrangements had an underlying order, that what happened in a society depended on more than simply its government’s recent actions, and analysts began paying more attention to underlying social conditions.
“By the beginning of the nineteenth century, the social order seemed especially threatened: cities were larger than ever before; economies were beginning to industrialize; and revolutions in America and France had made it clear that political stability could not be taken for granted. The need for information, for facts that could guide social policy, was greater than ever before. A variety of government agencies began collecting and publishing statistics…. Scholars organized statistical societies to share the results of their studies and to discuss the best methods for gathering and interpreting statistics. And reformers, who sought to confront the nineteenth-century’s many social problems. . . found statistics useful in demonstrating the extent and severity of suffering. Statistics gave both government officials and reformers hard evidence – proof that what they said was true. . . .
“During the nineteenth century, then, statistics – numeric statements about social life – became an authoritative way to describe social problems. There was growing respect for science, and statistics offered a way to bring the authority of science to debates about social policy. In fact, this had been the main goal of the first statisticians – they wanted to study society through counting and use the resulting numbers to influence social policy. They succeeded. . . But, beginning in the nineteenth century and continuing through today, social statistics have had two purposes, one public, the other often hidden. Their public purpose is to give an accurate, true description of society. But people also use statistics to support particular views about social problems. Numbers are created and repeated because they supply ammunition for political struggles, and this political purpose is often hidden behind assertions that numbers, simply because they are numbers, must be correct. People use statistics to support particular points of view, and it is naive to simply accept numbers as accurate, without examining who is using them and why” (pages 11-13).
Excerpt 2: ‘Creating Social Problems’
“[S]ocial problems are products of what people do.
“This is true for two reasons. First,. . . . social problems have their causes in society’s arrangements. . . . Most people understand that social problems are social in this sense.
“But there is a second reason social problems are social. Someone has to bring these problems to our attention, to give them names, describe their causes and characteristics, and so on. Sociologists speak of social problems as ‘constructed’ – that is, created or assembled through the actions of activists, officials, the news media, and other people who draw attention to particular problems. ‘Social problem’ is a label we give to some social conditions, and it is that label that turns a condition we take for granted into something we consider troubling. . . .
“The creation of a new social problem can be seen as a sort of public drama, a play featuring a fairly standard cast of characters. Often, the leading roles are played by social activists – individuals dedicated to promoting a cause, to making others aware of the problem. . . .
“Successful activists attract support from others. The mass media – including both the press (reporters for newspapers or television news programs) and entertainment media (such as television talk shows) – relay activists’ claims to the general public. Reporters often find it easy to turn those claims into interesting stories. . . . Activists need the media to provide that coverage, just as the media need activists and other sources for news to report.
“Often activists depend on the support of experts – doctors, scientists, economists, and so on – who presumably have special qualifications to talk about the causes and consequences of some social problem. . . Activists use experts to make claims about social problems seem authoritative, and the mass media often rely on experts’ testimonies to make news stories about a new problem seem more convincing. In turn, experts enjoy the respectful attention they receive from activists and the media.
“Not all social problems are promoted by struggling, independent activists; creating new social problems is sometimes the work of powerful organizations and institutions. Government officials_who promote problems range from prominent politicians trying to arouse concern in order to create election campaign issues, to anonymous bureaucrats proposing that their agencies’ programs be expanded to solve some social problem. And _businesses, foundations, and other private organizations sometimes have their own reasons to promote particular social issues. . . .
“Statistics play an important role in campaigns to create – or defuse claims about – new social problems. Most often, such statistics describe the problem’s size. . . When social problems first come to our attention, we’re usually given an example or two (perhaps video footage of homeless people living on city streets) and then a statistical estimate (of the number of homeless people). Typically this is a big number. The media like to report statistics because numbers seem to be ‘hard facts’ – little nuggets of indisputable truth. Activists trying to draw media attention to a new social problem often find that the press demands statistics. . . Experts, officials, and private organizations commonly report having studied the problem, and they present statistics based on their research. Thus, the key players in creating new social problems all have reasons to present statistics” (pages 14-18).
Excerpt 3: ‘The Public as an Innumerate Audience’
“Most claims drawing attention to social problems aim to persuade all of us – that is, the members of the general public. We are the audience, or at least one important audience, for statistics and other claims about social problems. If the public becomes convinced that prostitution or homelessness is a serious social problem, then something is likely to be done: officials will take action, new policies will begin, and so on. Therefore, campaigns to create social problems use statistics to help arouse the public’s concern.
“This is not difficult. The general public tends to be receptive to claims about new social problems, and we rarely think critically about social problems statistics. Recall that the media like to report statistics because numbers seem to be factual, little nuggets of truth. The public tends to agree; we usually treat statistics as facts.
“In part, this is because we are innumerate. Innumeracy is the mathematical equivalent of illiteracy; it is ‘an inability to deal comfortably with the fundamental notions of number and chance.’ Just as some people cannot read or read poorly, many people have trouble thinking clearly about numbers.
“One common innumerate error involves not distinguishing among large numbers. . . . Because many people have trouble appreciating the differences among big numbers, they tend to uncritically accept social statistics (which often, of course, feature big numbers).
“Innumeracy – widespread confusion about basic mathematical ideas – means that many statistical claims about social problems don’t get the critical attention they deserve. This is not simply because an innumerate public is being manipulated by advocates who cynically promote inaccurate statistics. Often, statistics about social problems originate with sincere, well-meaning people who are themselves innumerate; they may not grasp the full implications of what they are saying; reporters commonly repeat the figures their sources give them without bothering to think critically about them.
“The result can be social comedy. Activists want to draw attention to a problem. . . The press asks for statistics. . . Knowing that big numbers indicate a big problems and knowing that it will be hard to get action unless people can be convinced a big problem exists (and sincerely believing that there is a big problem), the activists produce a big estimate, and the press, having no good way to check the number, simply publicizes it. The general public – most of us suffering from at least a mild case of innumeracy – tends to accept the figure without question” (pages 19-21).
Excerpt 4: ‘Organizational Practices and Official Statistics’
“One reason we tend to accept statistics uncritically is that we assume that numbers come from experts who know what they’re doing. Often these experts work for government agencies…. Data that come from the government – crime rates, unemployment rates, poverty rates – are official statistics. There is a natural tendency to treat these figures as straightforward facts that cannot be questioned.
“This ignores the way statistics are produced. All statistics, even the most authoritative, are created by people. This does not mean that they are inevitably flawed or wrong, but it does mean that we ought to ask ourselves just how the statistics we encounter were created….
“[C]onsider a… complicated example: statistics on suicide. Typically, a coroner decides which deaths are suicides. This can be relatively straightforward: perhaps the dead individual left behind a note clearly stating an intent to commit suicide. But often there is no note, and the coroner must gather evidence that points to suicide – perhaps the deceased is known to have been depressed, the death occurred in a locked house, the cause of death was an apparently self-inflicted gunshot to the head, and so on. There are two potential mistakes here. The first is that the coroner may label the death ‘suicide’ when, in fact, there was another cause (in mystery novels, at least, murder is often disguised as suicide). The second possibility for error is that the coroner may assign another cause of death to what was, in fact, a suicide. This is probably a greater risk, because some people who kill themselves want to conceal that fact (for example, some single-car automobile fatalities are suicides designed to look like accidents so that the individual’s family can avoid embarrassment or collect life insurance benefits). In addition, surviving family members may be ashamed by a relative’s suicide, and they may press the coroner to assign another cause of death, such as accident.
“In other words, official records of suicide reflect coroners’ judgments about the causes of death in what can be ambiguous circumstances. The act of suicide tends to be secretive – it usually occurs in private – and motives of the dead cannot always be known. Labeling some deaths as ‘suicide’ and others as ‘homicides,’ accidents,’ or whatever will sometimes be wrong, although we cannot know exactly how often. Note, too, that individual coroners may assess cases differently; we might imagine one coroner who is relatively willing to label deaths suicide, and another who is very reluctant to do so. Presented with the same set of cases, the first coroner might find many more suicides than the second.
“It is important to appreciate that coroners view their task as classifying individual deaths, as giving each one an appropriate label, rather than as compiling statistics for suicide rates. Whenever statistical reports come out of coroners’ offices (say, total number of suicides in the jurisdiction during the past year), are by-products of their real work (classifying individual deaths). That is, coroners are probably more concerned with being able to justify their decisions in individual cases than they are with whatever overall statistics emerge from these decisions.
“The example of suicide records reveals that all official statistics are products – and often by-products – of decisions by various officials: not just coroners, but also the humble clerks who fill out and file forms, the exalted supervisors who prepare summary reports, and so on. These people make choices (and sometimes errors) that shape whatever statistics finally emerge from their organization or agency, and the organization provides a context for those choices…. In other words, official statistics reflect what sociologists call organizational practices – the organization’s culture and structure shape officials’ actions, and those actions determine whatever statistics finally emerge” (pages 21-25).
Excerpt 5: ‘Thinking About Statistics as Social Products’
“The lesson should be clear: statistics – even official statistics such as crime rates, unemployment rates, and census counts – are products of social activity. We sometimes talk about statistics as though they are facts that simply exist, like rocks, completely independent of people, and that people gather statistics much as rock collectors pick up stones. This is wrong. All statistics are created through people’s actions: people have to decide what to count and how to count it, people have to do the counting and the other calculations, and people have to interpret the resulting statistics, to decide what the numbers mean. All statistics are social products, the result of people’s efforts.
“Once we understand this, it becomes clear that we should not simply accept statistics by uncritically treating numbers as true or factual. If people create statistics, then those numbers need to be assessed, evaluated. Some statistics are pretty good; they reflect people’s best efforts to measure social problems carefully. But other numbers are bad statistics – figures that may be wrong, even wildly wrong. We need to be able to sort out the good statistics from the bad. There are three basic questions that deserve to be asked whenever we encounter a new statistics.
“1. Who created the statistic? Every statistic has its authors, its creators…. In asking who the creators are, we ought to be less concerned with the names of the particular individuals who produced a number than their part in the public drama about statistics. Does a particular statistic come from activists, who are striving to draw attention to and arouse concern about a social problem? Is the number being reported by the media in an effort to prove that this problem is newsworthy? Or does the figure come from officials, bureaucrats who routinely keep track of some social phenomenon, and who may not have much stake in what the numbers show?
“2. Why was this statistic created? The identities of the people who create statistics are often clues to their motives….
“3. How was this statistic created? We should not discount a statistic simply because its creators have a point of view, because they view a social problem as more or less serious. Rather, we need to ask how they arrived at the statistic. All statistics are imperfect, but some are far less perfect than others…. Once we understand that all statistics are created by someone, and that everyone who creates statistics wants to prove something (even if that is only that they are careful, reliable, and unbiased), it becomes clear that the methods of creating statistics are key. The remainder of this book focuses on this third question” (pages 26-28).
Retrospective Survey Methods
This section is focused on sexual abuse and the sexual abuse of boys largely because I have conducted research on that issue. Another reason is that research on the abuse of male children was once my main area of expertise, and the sexual abuse of males remains virtually unacknowledged throughout the world.
Please consider reading this section before reading (or reading about) studies of child abuse prevalence. It will help you to understand this kind of research, and to think more critically about opinions you encounter in the popular media.
When it comes to measuring prevalence – that is, how many children are sexually abused in childhood – the methods used by researchers are absolutely crucial.
Five important methodological issues are covered below:
- Population from which the research sample is drawn.
- Whether or not ‘gate questions’ are used.
- Wording of questions or items, especially whether or not the word ‘abuse’ is used.
- Definitions of abuse used to categorize research data.
- Number of questions or items.
Please note: I do not attempt or claim to address the definitional issue completely or authoritatively. Indeed, this is a most complex and controversial (methodological) issue, not only among researchers but in society as a whole, and not only in terms of sexual abuse but physical and emotional abuse as well. Thus I will only touch on a few important points, though certainly the definitions of ‘sexual abuse’ applied by researchers to study data have decisive effects on estimates of the prevalence of sexual abuse.
1. An important methodological issue has to do with the population (group of people) from which a sample, or selected group of a population actually researched, is drawn. Different prevalence rates have been found in samples of: college students; clinical populations or people receiving psychological treatment; and community populations or whoever lives in some area (e.g., a city, state, or country). Other methods being equivalent, compared to samples of people receiving mental health treatment, broad community samples will yield lower prevalence rates and provide more accurate data about the rate of child sexual abuse in a society.
2. Whatever the population and sample, researchers have to ask questions. They can ask questions by interviewing research subjects, over the phone or face-to-face. They can also ask questions by giving people questionnaires, typically anonymous ones. Some have argued that anonymous questionnaires are better for research on men, who may be less willing to acknowledge unwanted sexual experiences in the presence of another person. Some who conduct interview studies disagree, and there is not yet sufficient evidence to make this judgement. Whichever of these methods is employed, there are other methodological issues related to the nature of the questioning; for example, whether or not a subject must answer ‘yes’ to an initial ‘gate question’ in order to be asked more questions, the wording of the questions, and the number of questions asked. These are important methodological parameters that have had significant effects on the prevalence rates researchers have found.
For some studies researchers have used gate questions, in which a subject is only asked a series of questions about possible abuse experiences if he or she answers ‘yes’ to an initial question. Not surprisingly, these studies have tended to find lower rates of sexual abuse in their samples. For example, someone may answer ‘no’ to this question: “Before the age of 16, did you ever experience unwanted sexual contact with someone more than 10 years older than you?” But one minute later this same person may reply ‘yes’ to this question: “Before age 16, did anyone more than 10 years older than you use threats or force to get you to fondle his or her genitals?” If subjects in a research study are not asked further questions after answering ‘no’ to a general question about unwanted sexual experiences in childhood, many of those who were in fact sexually abused will be categorized as never sexually abused.
3. The wording of research questions is extremely important, and can dramatically skew prevalence rates. Imagine that an interviewer or even an anonymous questionnaire begins by asking, “Were you ever sexually abused before age 16?” This question requires subjects to scan their memories, and to decide whether or not to label any memories that come up as ‘abuse,’ which would be to accept the identity of ‘sexual abuse victim.’ Obviously most people, especially men, will automatically resist doing these things, even if they have experienced unwanted and emotionally harmful sexual experiences in childhood. So any study that uses the words ‘sexual abuse’ will wrongly categorize some people who have been sexually abused–but don’t label their experience that way–as not having been sexually abused.
This methodological issue, the wording of questions, touches on the issue of definition, and all the attendant controversy. Some people given attention by the popular media have focused on the wording of questions in ways that misrepresent research on sexual abuse and rape. Major publications like The New York Times Magazine have given cover-story treatment to people who have minimal understanding of social science methodology, and apparently even less interest in the truth about rates of abuse and assault in our country. These people have claimed that researchers ‘make up’ abuse that never happened by labeling subjects’ experiences as abusive even though the subjects might not.
This charge has been made against Mary Koss, an accomplished researcher who has conducted studies on prevalence rates of rape among college women (and has found that one in four have experienced rape or attempted rape since age 14). In constructing her questionnaire items, Koss made a good faith effort to use language that fit the legal definition of rape in the state where she lived when she conducted the research. Yet she has been accused of irresponsibly mislabeling her subjects’ experiences and exaggerating rates of rape. (Decide for yourself: read Koss, M., Gidycz, C., & Wisniewski, N. . The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162-170.) One way that Koss has answered this critique is by referring to an analogous situation. I will paraphrase her argument. Imagine yourself questioning an alcoholic: Do you have more than six alcoholic drinks in one sitting several times a week? Yes. Do you often wake up with such a hangover that you can’t go to work? Yes. Have friends and family members repeatedly tried to help you stop drinking? Yes. Do you suffer from withdrawal symptoms when you stop drinking? Yes. Are you an alcoholic? No.
The point here is that good prevalence research must use behavioral descriptions to which definitions like ‘alcoholic’ or ‘sexual abuse’ may be applied. Researchers should not rely on people defining themselves as alcoholics or defining their sexual experiences as abusive. Such definitions can only be uninterpretable and unreliable. Again, for many people who have been sexually exploited and hurt by others in childhood–especially men, who aren’t supposed to be victims–it’s very painful to acknowledge what has happened. Researchers must not ignore the effects this can have on subjects’ responses to questions about childhood experiences that may have been abusive.
For these reasons, researchers seeking to determine prevalence rates should not use the word ‘abuse’ in their interviews or questionnaire items. Instead, they should provide clear behavioral descriptions of experiences to which subjects can answer ‘yes’ or ‘no.’ When an answer is yes, further information should be elicited, including: the age of the subject and the other person involved; the nature of the relationship (parent, sibling, friend, priest, etc.); the level of coercion or violence; the number of times and period of time over which the experience happened; and the person’s emotional appraisal of the event when it occurred and at the time of the research.
Here are two examples of questionnaire items employing behavioral descriptions and follow-up questions. Both are from research on the sexual abuse of males conducted by David Lisak and his colleagues, including me (e.g., Lisak, Hopper, & Song, 1996):
Someone fondled you (i.e., touched your genitals or other parts of your body) in a sexual way. YES__NO__
Who was the person? _____
Was the person male or female? _____
How old were you at the time? _____
About how old was the other person? _____
How many times did it happen? _____
For how long did it happen (i.e., days,weeks, months, years)? _____
How do you now feel about the experience (i.e., negative, neutral or positive) _____
How distressing did you find this at the time:
Not at all distressing - A . . . . . B . . . . . C . . . . . D . . . . . E - Very distressing
How much force or persuasion did the person use?
(Please check off the appropriate categories below.)
Activity was voluntary _____
They took advantage of your trust _____
They used bribes or enticements _____
They used sexual seduction _____
They used intimidation or adult authority _____
They used threats against you or someone else _____
They used physical force _____
Other (please explain) _____
A woman had you perform vaginal intercourse on her. YES__ NO__
Who was the person? _____
. . . . [see above]
4. With this kind of information researchers are in a better position to evaluate whether or not an experience fits a reasonable and understandable definition of sexual abuse.
As noted already, the definition of child sexual abuse employed in a prevalence study may be the most important methodological parameter. I will only make a few points here, to suggest some of the definitional issues in prevalence research. For example, it’s easy to imagine the differences in prevalence rates the very same data will yield when categorized with each of these definitional criteria:
- A child is a person under age 16, and a sexual experience is abusive if verbal threats were used and the person feels negatively about the experience.
- A child is a person under 14 years old, and sexual abuse must involve physical force.
Besides the age of the subject at the time and the level of coercion involved, any age difference between the subject and the other person is an important factor. If a twenty year old woman has sexual intercourse with a ten year old boy, this is clearly abusive even if no physical force is used or no threats are made. Because large age differences may constitute vast discrepancies of power, especially with younger children, reasonable definitions of child sexual abuse must address the issue of age difference.
Of course, there are no clear-cut answers when it comes to definitions of child sexual abuse employed in research studies–or, for that matter, definitions used by all of us in conversation and debate. There will always be disagreements about what constitutes ‘sexual abuse,’ even among experts in this area. Some will ground their definitions in the exploitive intention of the person having the sexual experience with the child, no matter how the child or remembering adult feels about the experience. Others will believe this dilutes the meaning of the words and trivializes the suffering of people who, for example, have been raped by a parent repeatedly for years. These people will advocate for very conservative definitions.
Though they will never all agree, researchers have become increasingly sensitive to the need for carefully considered, and clearly articulated, definitions of child sexual abuse. Unfortunately, this has not been the case for most commentators and critics given attention by the popular media.
5. Finally, the number of questions asked of subjects in a research study can have a large effect on prevalence rate findings. Sadly, there are many ways to sexually abuse a child. Thus only a number of specifically worded behavioral descriptions of possible experiences (probably at least 10 to 15), will suffice for researchers trying to determine whether a person was sexually abused in childhood. Having subjects answer a number of questions also increases the likelihood that some memory of an abusive experience will be accessed. For example, a subject may read several questions before remembering and reporting an experience of sexual abuse, even though earlier questions described aspects of the same experience. Thus only by using multiple questions consisting of clear behavioral descriptions can researchers generate sufficient data to which definitions of abuse may be applied. Obviously, studies that ask fewer questions will yield lower prevalence rates for childhood sexual abuse.
These are some of the most important methodological issues in research conducted on adults to estimate prevalence rates of child sexual abuse. Keeping these issues in mind, and the built-in biases of certain methods, will help you to understand the research below or any other studies you read about, and to think more critically about what you encounter in the popular media–especially from people who claim abuse rates are exaggerated and base their claims on uninformed or misleading critiques of research conducted by social scientists.
And there is one more very important point to keep in mind: Any research study, even one with the most effective methodology, is likely to underestimate the actual prevalence of sexual abuse in the population being investigated.
Why? There is evidence that a substantial minority of adults who were sexually abused as children do not remember those abusive experiences, and that the younger the child was at the time of the abuse, and the closer the relationship to the abuser, the less likely he or she is to remember. See the section on Linda Williams’ research on Scientific Research under Recovered Memories of Sexual Abuse.
Sexual Abuse of Boys In Depth
This section is for those who want to understand how different research methods yield different prevalence statistics, in this case, of the sexual abuse of boys.
Approximately one in six boys is sexually abused before age 16.
This discusses in-depth the research up to 1996, when I conducted a comprehensive review for my masters thesis (after that I became focused on all kinds of abuse and assault, how they can affect men and women, and how best to help them receive therapeutic and legal help and to heal from their traumas).
For the most authoritative evidence supporting the 1 in 6 prevalence estimate, read the study of 17,000 California residents, Long-term consequences of childhood sexual abuse by gender of victim, published in 2005 by Shanta Dube and colleagues in the American Journal of Preventive Medicine.
Please note: The Additional Resources page under Sexual Abuse of Boys contains a list of references to all the articles and books cited in this section, along with others addressing potential lasting effects of child sexual abuse in men.
The following review is grouped into three sections, according to the sample studied:
- Male college students.
- Men from an identified community.
- Men receiving mental health services.
As noted above, please keep in mind: All of the rates below are likely to be underestimates of the actual prevalence of the sexual abuse of boys in our society. Why? There is evidence that a substantial minority of adults who were sexually abused as children do not remember those abusive experiences, and that the younger the child was at the time of the abuse, and the closer the relationship to the abuser, the less likely he or she is to remember. See the section on Linda Williams’ research on my page, Recovered Memories of Sexual Abuse: Scientific Research & Scholarly Resources.
1) Studies of male college students have found prevalence rates from 4.8% to 28%. At the lower extreme of 4.8% is a study by Fritz, Stoll and Wagner (1981) in which 412 students responded to a self-report questionnaire that required them to label their experiences as ‘abusive’–a method guaranteed to cause under-reporting (see discussion in section above). Risin and Koss (1987) obtained a rate of 7.3% in a national sample of 2,972 male college students. They used eight self-report behavioral descriptions about sexual behaviors before age 14. As pure behavioral descriptions, none of the items included the word ‘abuse.’ Finkelhor (1979) used a similar list of behavioral self-report items in a study of 266 college students and found an 8.3% prevalence rate; he included non-contact experiences and used specific age criteria (if under 14 there had to be a 5 year age difference with the perpetrator, if 14-15, a 10 year difference).
Higher prevalence rates of 20% and 24% came from Fromuth and Burkhart’s (1987) study of students in two separate schools. They compared the effect of different definitions of sexual abuse on prevalence rates. However, their questionnaire utilized a gate question. The highest rates of 20% and 24% came from the most inclusive definition: the same as Finkelhor’s 1979 study (including non-contact and age differential criteria), but with the addition that sexual contact between peers involving force or threat was categorized as abuse.
Research on college students also has been conducted by David Lisak and his colleagues, including myself (Lisak & Luster, 1994; Lisak, Hopper, & Song, 1996). The college samples in these studies were not typical, but consisted of men who commuted to an urban university, were an average of 25 years old, and from socioeconomic background more typical of the surrounding community than many college student populations used in this research. This work yielded prevalence rates of:
- Approximately 17% for child sexual abuse of males involving physical contact.
- Over 25% when non-contact forms of abuse were included.
Non-contact experiences (e.g., a relative exposing her or his genitals to a child) were investigated because such acts are sexually exploitive and can have negative long-term psychological and interpersonal effects. However, this definition also includes experiences, like a single ‘flashing’ episode involving a stranger, that many would argue are not abusive because the subject suffered no significant or lasting harm, if any at all. As clarified below, Lisak and his colleagues (1994, 1996) deliberately chose to weight their definition of sexual abuse in terms of the power differential accompanying significant age differences and the older person’s presumed deliberate sexual use and exploitation of the younger subject. So long as significant differences in age and power existed, Lisak and his colleagues defined incidents as abusive, regardless of subjects’ emotional appraisal or lasting effects (the latter were not measured).
Lisak and his colleagues (1994, 1996) used an anonymous questionnaire which has 17 behavioral descriptions of possible experiences and an 18th item for “other” experiences subjects describe. If subjects endorsed an item, they were then directed to provide further information about the experience, which was used to categorize the experience as abusive or not. If the subject was age 13 or younger when the incident occurred and the other person was at least 5 years older, the incident was classified as sexually abusive. If the subject was age 13 or younger when the incident occurred and the other person was less than 5 years older, two criteria had to be met for the incident to be classified as abusive: the subject reported feeling ‘negative’ about it and reported that some degree of coercion was used by the other person. Similar principles apply to incidents occurring when the subject was age 14-15: the incident was classified as abusive if the other person was at least 10 years older; if the other person was less than 10 years older, the abuse classification was assigned only if the subject reported feeling negative about it and reported some level of coercion by the other person.
Though the definitional criteria in Lisak and his colleagues’ studies are complex, they address two important issues:
- The reality of the power differential which characterizes relationships between adults and children, and between young children and adolescents, because whether or not a sexual experience is abusive can depend on this dynamic.
- The fact that whether or not a sexual experience is abusive can also depend on one’s subjective appraisal and emotional response to the incident.
Lisak and his colleagues argue that the criteria they employed to assess sexual abuse are clear and relatively conservative in their treatment of the issues of power and subjects’ responses.
A prevalence rate similar to the Lisak et al. studies was found in another study of college males. Collings (1995) used an anonymous questionnaire and defined sexual abuse as ‘unwanted’ sexual experiences taking place before the age of 18. The term ‘unwanted’ is likely to bias rates downward, as noted above, but the inclusion of subjects aged 16 and 17 is likely to increase the found prevalence rate. Not surprisingly, Collings found that 29% of the 284 male respondents had been sexually abused, with 20% reporting non-contact abuse and 6% reporting abuse experiences involving physical contact.
2) Studies with community samples have ranged in their prevalence rates from 2.8% to 16%. Again, methodology has been crucial. Kercher and McShane (1984) mailed a single self-report question including the word ‘abuse’ to a random sample of Texas drivers. They found a prevalence rate of 3%. Given the wording of their single question, this rate is not surprising.
Two random-sample telephone interview studies by Murphy (1987, 1989, cited in Urquiza & Keating, 1990) also demonstrate the profound effects of single questions including the word ‘abuse’ rather than instruments with multiple behavioral descriptions. In one of the studies (1987) the former method was employed, and it produced a rate of 2.8% with a sample of 357; in the other study (1989) the latter method yielded a prevalence rate of 11% with a sample of 777.
Bagley, Wood and Young (1994) conducted a community study of men aged 18 to 27 in the Canadian city of Calgary. They first contacted subjects by phone, then administered anonymous questionnaires in their homes via programs on portable computers. Their questionnaire asked about ‘unwanted’ experiences before the age of 17. This wording is likely to result in under-reporting because people who have been sexually abused, but especially males, are sometimes convinced that they wanted and were responsible for the sexual contact. Bagley and his colleagues found a prevalence rate of 15.5%, and that 6.9% of their subjects had experienced multiple episodes of sexual abuse. Interestingly, this rate for multiple episodes was identical to that found for women in a previous study that employed the same methodology, despite the fact that the prevalence rate for any unwanted sexual experiences in that study was 32%, or double that found for males (Bagley, 1991).
The highest community-sample prevalence rate of 16% was found in a random telephone survey of 2,626 men, known as the ‘L.A. Times survey’ (Finkelhor, 1990). However, these findings are very difficult to interpret, since the wording of the questions would be expected to produce contradictory effects: each question used the word ‘abuse,’ but ended with the phrase, ‘or anything like that?’
In contrast to studies with women, published studies using face-to-face interviews with men have yielded very low prevalence rates, perhaps due to subjects’ adherence to stereotypes about males not being victims (Urquiza & Keating, 1990). Finkelhor’s (1984) face-to-face interview with Boston-area fathers yielded a rate of 6%. Siegel and colleagues (1987), using gate-question interviews with 1,480 Los Angeles-area men, found a prevalence rate of 3.8%. Baker and Duncan (1985) used a single question that described various sexual acts and found the highest face-to-face prevalence rate of 8% in their random sample of 970 men in Great Britain.
2) Studies with clinical samples have obtained prevalence rates from 3% to 23%. The lowest rate was reported from a study that used psychological records of 954 male and female patients of a large regional medical center (Belkin, Greene, Rodrique, & Boggs, 1994). In a chart review of emergency room records of a Buffalo, New York hospital, Ellerstein and Canavan (1980) found an 11% prevalence rate. DeJong and colleagues (DeJong, Emmett, & Hervada, 1982) reviewed several clinical studies and found rates from 11% to 17%, and in their own hospital population found a rate of just under 14% (1982). Metcalfe and his associates (1990) found a prevalence of 23% in their survey of 100 male psychiatric inpatients.
However, it is important to note here that assessment for sexual abuse histories in hospitals has traditionally been extremely poor, and remains so in many settings. Thus these rates, based on reviews of records, are likely to be vast underestimates. For example, Briere and Zaidi (1989) reviewed intake reports on women presenting to an urban psychiatric emergency room. They randomly reviewed 50 charts before and 50 after the intake staff were instructed to question clients about previous sexual victimization. The first 50 charts had recorded rates of 6%, and the second set, 70%.