Child Abuse & Neglect 134 (2022) 105932
Contents lists available at ScienceDirect
Child Abuse & Neglect
journal homepage: www.elsevier.com/locate/chiabuneg
Child abuse prevention education policies increase reports of child
sexual abuse
Melissa A. Bright a, *, Alexander Roehrkasse b, Sarah Masten c, Ashton Nauman c,
David Finkelhor d
a
Center for Violence Prevention Research, United States of America
Butler University, United States of America
c
University of Florida, United States of America
d
Crimes Against Children Research Center, University of New Hampshire, United States of America
b
A R T I C L E I N F O
A B S T R A C T
Keywords:
Child sexual abuse
Policy
Primary prevention
Education
School
Background: It is well supported that engaging in prevention education increases a child's
awareness of child sexual abuse. However, due to methodological limitations, prior research has
yet to determine whether this knowledge leads to increases in reporting or substantiation of child
sexual abuse.
Objective: We examined whether state mandates for school-based prevention education correlate
to changes in reports of child sexual abuse.
Methods: We used a quasi-experimental design to investigate the association between child sexual
abuse report rates from 2005 to 2019 and presence of state legislation mandating school-based
child sexual abuse prevention curricula. Child sexual abuse report data were obtained from the
National Child Abuse and Neglect Data System child files. We focused on reports for school-aged
children ages 5–17. Data on state laws on prevention curricula were extracted from enoughabuse.
org, Prevent Child Abuse America, ErinsLaw.org, and directly from published legislation.
Results: State education mandates were associated with an increase in the incidence of child
sexual abuse reports made by education personnel (IRR = 1.22, 95 % CI, 1.01–1.48). Policies
were not associated with increases in incidence of child sexual abuse reports made by noneducation personnel (IRR = 1.08, 95 % CI, 0.95–1.22) or decreases in likelihood that any
given report was confirmed (OR = 1.00; 95 % CI, 0.90–1.12).
Conclusions: There is moderate evidence that adopting state mandates for child sexual abuse
prevention education may increase disclosures and reporting of child sexual abuse by schoolbased sources. There is no evidence that mandates decrease the validity of child sexual abuse
reporting by school-based sources.
1. Introduction
Between 1 % and 5 % of children experience child sexual abuse (CSA) annually in the US (Finkelhor et al., 2015). Schools are widely
Abbreviations: Child Sexual Abuse, (CSA); Research Electronic Data Capture, (REDCap) tool; National Child Abuse and Neglect Data System,
(NCANDS).
* Corresponding author at: PO Box 702, Melrose, FL 32666, United States of America.
E-mail address: mbright@scienceofviolence.org (M.A. Bright).
https://doi.org/10.1016/j.chiabu.2022.105932
Received 20 June 2022; Received in revised form 28 August 2022; Accepted 12 October 2022
Available online 21 October 2022
0145-2134/© 2022 Elsevier Ltd. All rights reserved.
Child Abuse & Neglect 134 (2022) 105932
M.A. Bright et al.
regarded as an important setting for teaching children how to identify CSA, how to protect themselves from CSA, and how and to whom
to report suspected experiences of CSA (Walsh et al., 2018). The extant research supports this belief. In a meta-analysis of CSA pre­
vention education research, Walsh et al. (2018) found that, overall, CSA prevention curricula were effective at increasing children's
knowledge of abuse, self-efficacy, and use of protective behaviors. Although the assumption is that teaching children about CSA will
lead to increased reports and decreased victimization, the empirical support for this outcome is limited.
As there are no formal criteria for prevention education, the format and presentation of CSA prevention programs vary signifi­
cantly, as may the quality of their implementation. In general, programs are presented to small groups of students (typically a single
classroom) by adults with training in school counseling, social work, and/or child advocacy. Some programs focus exclusively on CSA
whereas others include CSA among other topics such as body development, human trafficking, and relationships. Presentations often
include use of videos, interactive activities, and story books. In a review of programs that underwent evaluation, duration of programs
ranged from a single 45-min session to eight 20-min sessions, with most including 90- to 180-min of program content over multiple
days (Walsh et al., 2018). Best practices recommend that programs are positively framed, avoid scare tactics, and use varied methods
to convey information such as group learning, skill-building activities, reinforcement materials, role-play, and collaborative activities
(Gaffney, Farrington, et al., 2019; Gaffney, Ttofi, & Farrington, 2019; Gubbels et al., 2021; Kenny & Wurtele, 2012; Lemaigre et al.,
2017; Nation et al., 2003).
In a longitudinal survey, approximately 65 % of school-aged youth reported participating in an abuse prevention program at school
(Finkelhor et al., 1995). Youth who participated in prevention education were more likely to disclose their victimization than youth
who did not participate in prevention education. In a similar study of undergraduate students, women who reported participating in
school-based prevention education as children were less likely to report experiencing subsequent sexual victimization compared to
women who reported not participating in prevention education (Gibson & Leitenberg, 2000).
The current evidentiary support for CSA prevention education is promising but is limited by methodological issues. Studies that
evaluate specific CSA prevention programs rarely measure disclosures or victimizations. Surveys address this issue but are limited by
participants' memory of participating in prevention education and inhibitions about disclosing experiences of victimization. Exam­
ining the impact of prevention education at the policy level is an approach that can overcome these limitations but has not yet been
pursued.
In 2009, Vermont became the first state to mandate that schools include child sexual abuse prevention in public education. With
this mandate, all K-12 students, their parents, school employees, and staff at licensed childcare facilities were required to complete
child sexual abuse prevention education. Texas also passed legislation that year mandating prevention education which similarly
included not only K-12 students but also educators, counselors, coaches, and other professional staff members. As of 2021, 34 states
passed some type of legislation around CSA prevention education. State-level variation in the timing of policy adoption provides a
natural quasi-experimental design through which we can examine the possible impact of CSA prevention policies on CSA reporting.
Table 1 details dates of adoption.
In the current study, we examine this association using administrative child protection data. We propose the following hypotheses:
first, we anticipate that states enacting policies will have increased incidence of CSA reporting by education personnel relative to states
not enacting policies mandating prevention education. Higher incidence is expected because prevention education should promote
Table 1
States that passed legislation mandating or recommending prevention education in schools
2019
Missouri
New Jersey
New York
North Carolina
2018
Georgia
West Virginia
Virginia
Washington
Wyoming
2017
Montana
2016
Delaware
Maryland
New Hampshire
2015
Alabama
Alaska
Maine
Oklahoma
Oregon
Rhode Island
Mississippi
2014
Mandated
Mandated
Mandated
Mandated
Connecticut
Louisiana
New Mexico
South Carolina
Tennessee
Utah
California
2012
Indiana
Michigan
2011
Illinois
2009
Texas
Vermont
No legislation passed
Arizona
Arkansas
Hawaii
Iowa
Kansas
Kentucky
Massachusetts
Minnesota
Nebraska
Mandated
Mandated
Recommend
Recommend
Recommend
Recommend
Mandated
Mandated
Mandated
Mandated
Mandated
Mandated
Mandated
Mandated
Mandated
Recommend
2
Mandated
Mandated
Mandated
Mandated
Mandated
Mandated
Recommended
Mandated
Mandated
Mandated
Mandated
Mandated
Ohio
South Dakota
Wisconsin
Colorado
Florida
Idaho
Nevada
North Dakota
Pennsylvania
Child Abuse & Neglect 134 (2022) 105932
M.A. Bright et al.
more disclosure and discussion between children and adults. Second, we anticipate that association between mandates and reporting
will be weaker for reports made by non-education personnel (e.g., physicians, relatives). This difference is expected because many of
the reports triggered by the educational programs will be made in the school context where the programs are delivered. Third, we
expect that the likelihood that any given report was substantiated would decrease. This decrease is expected because education
programs may lead children to disclose and educators to report instances of non-abuse.
2. Method
2.1. Design
This is a quasi-experimental design in which we examine CSA reporting rates among states that adopted legislation mandated CSA
prevention education compared to states that did not adopt legislation. During the 2005–2019 study period, 32 states (excluding
Washington, DC) adopted legislation (Fig. 1). Use of data was approved exempt by our University Institutional Review Board (IRB).
2.2. Measures
2.2.1. Child sexual abuse reports
Child sexual abuse reporting data were obtained from the National Child Abuse and Neglect Data System (NCANDS) child files from
2005 to 2019. NCANDS is a voluntary data collection system that combines data submitted by state child protection systems. Child files
include comprehensive information on individual reports of suspected child maltreatment. Each record is a report of suspected
maltreatment, and individual children can have multiple reports in each year. We limited analysis to reports of child sexual abuse
(CSA), which NCANDS defines as “involvement of the child in sexual activity to provide sexual gratification or financial benefit to the
perpetrator, including contacts for sexual purposes, molestation, statutory rape, prostitution, pornography, exposure, incest, or other
sexually exploitative activities.” We included reports that included only CSA and reports that included CSA and other forms of
maltreatment. We limited analyses to school-aged children, defined as 5–17 years. We did not exclude based on sex or race/ethnicity
status. We categorized reports according to whether they were made by educational personnel (school-based) or not (non-schoolbased).
2.2.2. Confirmed child sexual abuse
Instances of confirmed child sexual abuse were measured using information about the reports' final disposition. Reports that were
“substantiated” or “indicated” were treated as instances of confirmed CSA.
Fig. 1. Nationwide geographic distribution of school-based child sexual abuse prevention education mandates.
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Child Abuse & Neglect 134 (2022) 105932
M.A. Bright et al.
2.2.3. Children at risk of sexual abuse
Data on the school-aged child population in each state and year were obtained from intercensal age-specific estimates of the
residential population by the U.S. Census Bureau. The population at risk was used to calculate rates of CSA reporting (reports per 1000
children aged 5–17).
2.2.4. School-based prevention education policies
Data on state laws on prevention curricula were extracted from enoughabuse.org, Prevent Child Abuse America, ErinsLaw.org, and
directly from published legislation. States that enacted policies requiring prevention education were categorized as having a mandate.
States that enacted policies recommending prevention education and states that never enacted policies were categorized as having no
mandate.
2.3. Missing data
Sixteen state–year observations were missing data on CSA reports from school-based and non-school-based sources, and 14 ob­
servations were missing data on the number of confirmed CSA reports from school-based and non-school-based sources. We estimated
missing values using multiple imputation by chained equations. We estimated 20 imputations. Descriptive statistics represent the
average across imputations.
2.4. Analyses
We compared outcomes of interest in states that adopt mandates to outcomes in states that did not adopt mandates, before and after
adoption. We used a differences-in-differences design, generalized to the case of time-varying exposure using a fixed-effects estimator.
To model the annual number of reports of child sexual abuse in each state, we estimated generalized linear models using a negative
binomial distribution. We chose this distribution because our data were overdispersed. Negative binomial models used a log link and
included an exposure parameter specified as the residential population aged 5–17. Estimates were reported as incident rate ratios.
To model the likelihood that reported instances of CSA were confirmed, we estimated generalized linear models using a logit link.
Estimates were reported as odds ratios. All models included state and year dummy variables as covariates to control for time-invariant
state-level characteristics and national time trends that may have confounded the association between mandates and CSA reporting
and confirmation. To account for time-varying state-level confounders, some models also included linear state-specific time-trend
parameters, created by interacting state dummy variables with a continuous year variable.
All 95 % CIs accounted for uncertainty from the imputation model and the main models. Variance estimates were clustered by state
to account for serial autocorrelation. Analyses were conducted using Stata software, version 16.1 (StataCorp LLC) and R statistical
software version 3.6.3 (R Project for Statistical Computing) between May 28, 2021 and January 3, 2022.
3. Results
3.1. Descriptive statistics
Twenty-six states adopted school-based child sexual abuse prevention education mandates by December 31, 2019, the end of our
study period, compared to 24 states that had not adopted mandates by that time (Fig. 1). State characteristics are summarized in
Table 2. States that did not adopt mandates had lower mean (SD) rates of CSA reporting from school-based sources than did states in
the years before adopting mandates (0.53 per 1000 [0.23] vs. 0.58 per 1000 [0.42]). In states that adopted mandates, rates of schoolbased CSA reporting were higher in years after adoption than before adoption (1.07 per 1000 [0.61] vs. 0.58 per 1000 [0.42]). The
proportion of CSA reports from school-based sources that were confirmed was lower after adoption than before adoption (0.20 [0.12]
vs. 0.36 [0.26]).
Trends in CSA reporting are shown in Fig. 2A–C. Fig. 2A shows trends in school-based reporting over time in the 24 states that did
Table 2
Characteristics of states without, before, and after adoption of prevention education mandates.
No mandate
Pre-mandate
Post-mandate
0.58 (0.42)
3.44 (2.11)
0.36 (0.26)
0.34 (0.22)
1,022 (883)
262
26
1.07 (0.61)
4.58 (1.99)
0.20 (0.12)
0.25 (0.11)
1,166 (1,379)
128
26
Mean (SD)
Reporting rate, school-based sources
Reporting rate, non-school-based sources
Proportion confirmed, school-based
Proportion confirmed, non-school-based
Population ages 5–17, thousands
State–years (n)
States (n)
0.53 (0.23)
3.06 (1.45)
0.23 (0.11)
0.28 (0.12)
1,078 (1,357)
360
24
Note: Reporting rate represents annual reports per 1,000 children. Proportion of reports confirmed includes substantiated and indicated reports.
Means and SDs of reporting rates and confirmation proportions are weighted by the state–year population ages 5–17. *p<.05
4
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M.A. Bright et al.
not adopt CSA prevention education mandates before December 31, 2019. Fig. 2b shows trends in school-based reporting before and
after mandate adoption in the 26 states that adopted mandates. Fig. 2C shows trends in non-school-based reporting before and after
mandate adoption in the same states. The largest absolute post-mandate increases in both school-based and non-school-based CSA
reporting were in Vermont, Indiana, and Alaska.
3.2. Model results
Main estimates of changes in CSA reporting over time are shown in Table 3. The unit of analysis is the state–year. Incident rate
ratios (IRR) represent the factor by which rates of CSA reporting increased in association with the adoption of a mandate. The basic
differences-in-differences model with state and year fixed effects indicates that school-based CSA reporting increased by a factor of
1.22 (95 % CI, 1.01–1.48) following adoption. The model including state trends indicates that school-based CSA reporting increased by
a factor of 1.13 (95 % CI, 1.00–1.28). The state trends model also indicates increases in non-school-based CSA reporting associated
with mandate implementation (IRR, 1.08; 95 % CI, 0.99–1.18), but this association was statistically insignificant. Differences in in­
creases between school-based and non-school-based sources were also statistically insignificant.
Table 4 shows main estimates from logistic models of changes in the likelihood that CSA reports were confirmed. The unit of
analysis is the report. Coefficients represent the proportion by which the likelihood of confirmation increased in association with the
adoption of a mandate. The state trends model indicates that mandate adoption was not associated with any statistically significant
Fig. 2. Trends in child sexual abuse reporting.
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Table 3
Association between prevention education mandates and reports of child sexual abuse: differences-in-differences estimates.
Non-school-based reports
Difference
State trends
No
School-based reports
Yes
No
Yes
No
Yes
Mandate IRR (95 % CI)
Pseudo R2
N
1.22 (1.01− 1.48)
0.12
750
1.13 (1.00− 1.28)
0.16
750
1.08 (0.95− 1.22)
0.12
750
1.08 (0.99− 1.18)
0.15
750
0.14 (− 0.04− 0.35)
NA
750
0.05 (− 0.06− 0.17)
NA
750
Note: Unit of analysis is state–year. All models controlled for state and year fixed effects. Abbreviations: IRR, incident rate ratio; CI, confidence
interval; NA, not applicable. *p<.05
change in the proportion of CSA reports that were substantiated/indicated (OR 1.00; 95 % CI, 0.90–1.12).
4. Discussion
Overall, we found that the number of reports of child sexual abuse by education personnel increased in states that adopted
legislation mandating CSA prevention education in schools relative to states that did not adopt such legislation. We found no such
association for reports by non-education personnel. Finally, we found no association between policies and the proportion of CSA
reports that were confirmed. These findings offer evidence that child-focused prevention education may increase CSA disclosures and
are consistent with the few studies to find that receipt of CSA prevention education is associated with more disclosures (Finkelhor et al.,
1995; Gibson & Leitenberg, 2000; Oldfield et al., 1996).
Our findings align with studies suggesting that training on child abuse of all types increases identification and reporting by pe­
diatricians, nurses, and teachers (Ferrara et al., 2017; Fraser et al., 2010; Walsh et al., 2012). Interestingly, while curricula are critical
for providing education to their subjects, they were also found to play a critical role in attitudes towards reporting of child abuse. One
study showed that compared to before the training they received, after training, surveyed teachers had significantly increased
knowledge, awareness and willingness to take action on CSA in the future (Gushwa et al., 2019). A study in the Philippines in 2020 also
found that implementing a curriculum raised the confidence of teachers to report, reduced their fears in reporting, and improved their
knowledge of CSA and the reporting process (Madrid et al., 2020). While many different groups are targeted for training, ultimately the
largest percentage of child maltreatment reports come from school professionals (Pollack, 2014), highlighting the significance of
focusing on school-based curricula. Boosting knowledge, skills, and attitudes towards CSA reporting may be a step towards addressing
adult gatekeepers, allowing for improved reporting, and later, intervention to take place.
4.1. Strengths and limitations
Mandated curricula have been reported on since at least as far back as the 1990s (Reiniger et al., 1995). The current study is, to our
knowledge, the first to use national data to analyze the impact of governmental policy on CSA across multiple states and years.
However, several limitations of our study should be noted. First, we did not measure if accountability or funding was included in
legislation. It is reasonable to expect that both may serve as modifying factors tied to the likelihood of school districts implementing
and maintaining the mandated prevention curricula. Second, we have no measure of whether curricula were implemented; it is
possible that school districts in states where legislation was present did not implement. In addition, we have no measure of quality of
programs. The quality of prevention programming matters (Finkelhor et al., 2014) as does the frequency for both for knowledge
retention (Bright et al., 2020) and sustained attitudes about reporting (Brassard & Fiorvanti, 2015). Likewise, there is no legislation –
to our knowledge – preventing schools from implementing CSA prevention curricula. Thus, it is also possible that school districts in
states where legislation was not present did implement it. Variation in the degree and quality of program implementation may bias our
results. Third, because this study is not a randomized trial, the reported results may not reflect causal relationships. State-level
characteristics may exist that vary non-linearly over time and which are associated with both mandate adoption and CSA report­
ing. For example, mandate adoption may reflect increasing activities and awareness that promote educator reporting, independently of
the impact of the mandate itself. Additionally, our finding of a positive association between prevention education mandates and CSA
reporting is statistically imprecise, and a wide range of positive effect sizes are statistically possible. Therefore, emphasis should not be
placed on the specific magnitude of our reported coefficients. Fourth, we have no measure of the mechanisms underlying this effect.
Table 4
Association between prevention education mandates and confirmation of reported child sexual abuse: differences-in-differences estimates.
School-based reports
Non-school-based reports
Difference
State trends
No
Yes
No
Yes
No
Yes
Mandate OR (95% CI)
Pseudo R2
N
1.04 (0.89− − 1.12)
0.06
518,677
1.00 (0.90− 1.12)
0.06
518,677
1.10 (0.98− 1.23)
0.05
2,787,861
0.98 (0.90− 1.07)
0.06
2,787,861
− 0.05 (− 0.16− 0.02)
NA
NA
0.02 (− 0.06− 0.12)
NA
NA
Note: Unit of analysis is state–year. All models controlled for state and year fixed effects. Abbreviations: OR, odds ratio; CI, confidence interval; FE,
fixed effects; NA, not applicable.
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M.A. Bright et al.
The increase found in reporting could reflect increasing disclosures by children. Alternatively, the education could have made school
personnel more observant of existing abuse. Fifth, the relationship between CSA programs and reporting may vary across time. For
example, adoption may have a lagged influence on reporting, and this influence may grow or decay over time. Our data are statistically
underpowered to analyze these temporal dynamics. Finally, definitions of child sexual abuse and our focal outcome of “substantiated”
and “indicated” reports vary by state. Although the NCANDS data reporting system provides definitions of each variable collected so
that data are reported consistently across states, it is possible that reports of CSA in one state would receive different dispositions than
that same report of CSA in another state.
4.2. Future directions
Future analyses should explore what defines a successful curricula mandate such as differences in accountability, funding, and who
– beyond children – is required to receive education. It would also be helpful to understand if these effects are consistent across child
age groups as there is documented variability in the timing of CSA. Future work could also examine if these findings are maintained
across socioeconomic status, particularly because these “success” factors may constrain the access to and modality of the mandated
curricula. Finally, important next steps outside of policy analysis include investigating the efficacy of evidence-based response stra­
tegies by directly observing changes in reporting or reductions in victimization.
5. Conclusion
There is moderate evidence to support the conclusion that school-based prevention education mandates may lead to increased CSA
reporting by school-based sources. There is no evidence to support the conclusion that mandates decrease the validity or reliability of
CSA reporting by school-based sources.
Funding source
This project was supported in part by a Clinical and Translational Science Institute (CTSI) NIH National Center for Advancing
Translational Sciences (NCATS) grant (UL1R000064) and by Agreement No K05187 through funds issued by the State of Florida, Office
of the Attorney General to the Monique Burr Foundation for Children. The Monique Burr Foundation for Children did not participate in
the acquisition of data, analysis, or interpretation of findings.
Declaration of competing interest
None.
Data availability
The authors do not have permission to share data.
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