title: Examining mediators of child sexual abuse and sexually transmitted infections.
abstract: BACKGROUND
  Interpersonal violence has increasingly been identified as a risk factor for sexually transmitted infections. Understanding the pathways between violence and sexually transmitted infections is essential to designing effective interventions.
  
  
  OBJECTIVE
  The aim of this study was to examine dissociative symptoms, alcohol use, and intimate partner physical violence and sexual coercion as mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis among a sample of women.
  
  
  METHODS
  A convenience sample of 202 women was recruited from healthcare settings, with 189 complete cases for analysis. A multiple mediation model tested the proposed mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis. Bootstrapping, a resampling method, was used to test for mediation. Key variables included child sexual abuse, dissociative symptoms, alcohol use, and intimate partner violence.
  
  
  RESULTS
  Child sexual abuse was reported by 46% of the study participants (n = 93). Child sexual abuse was found to have an indirect effect on lifetime sexually transmitted infection diagnosis, with the effect occurring through dissociative symptoms (95% confidence interval = 0.0033-0.4714) and sexual coercion (95% confidence interval = 0.0359-0.7694). Alcohol use and physical violence were not found to be significant mediators.
  
  
  CONCLUSIONS
  This study suggests that dissociation and intimate partner sexual coercion are important mediators of child sexual abuse and sexually transmitted infection diagnosis. Therefore, interventions that consider the roles of dissociative symptoms and interpersonal violence may be effective in preventing sexually transmitted infections among women.
authors.affiliation: School of Nursing, Boston College, Chestnut Hill, Massachusetts 02467-3812, USA. melissa.sutherland.1@bc.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016009:Chi-Square Distribution; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data*; D003068:Coercion; D003430:Cross-Sectional Studies; D004213:Dissociative Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008960:Models, Psychological; D015233:Models, Statistical; D015999:Multivariate Analysis; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric