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Child Abuse & Neglect 37 (2013) 623630

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Child Abuse & Neglect

Young childrens knowledge and skills related to sexual


abuse prevention: A pilot study in Beijing, China
Wenjing Zhang, Jingqi Chen , Yanan Feng, Jingyi Li, Xiaoxia Zhao, Xiaoling Luo
Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing
100191, China

a r t i c l e i n f o a b s t r a c t

Article history: To examine the level of knowledge and skills related to prevention of child sexual abuse
Received 6 March 2013 (CSA) in a sample of Chinese preschoolers in Beijing and to explore the associations between
Received in revised form 22 April 2013
childrens scores on the knowledge and skills and their parents reports on the knowl-
Accepted 30 April 2013
edge and communication with children about CSA prevention. One hundred and thirty-six
Available online 12 June 2013
preschoolers were interviewed by researchers using the Chinese versions of Personal Safety
Questionnaire and the What If Situation Test, and one parent of each child was invited
Keywords:
Child sexual abuse to complete an anonymous questionnaire regarding parental knowledge and parentchild
Prevention communication about CSA prevention. Less than half children knew that strangers were
Young children not the only perpetrators and only 16% thought that children should report secret touch-
Parentchild communication ing. In 3 inappropriate touching requests, less than 30% of the children were aware of
Parents using verbal response to denitely refuse the inappropriate touching and less than 20% of
China the children were aware of denitely removing themselves from the abusive situations.
Parentchild communication about CSA and parental educational level were the signif-
icant factors for childrens self-protection skills. Preschool children lack CSA prevention
knowledge and related self-protection skills. Culturally relevant primary CSA prevention
programs in China need to be developed and parental education should be a part of CSA
prevention. Parents need to be informed about CSA knowledge concepts and need to be
encouraged to communicate with their children about sexual abuse prevention.
2013 Elsevier Ltd. All rights reserved.

Introduction

Child sexual abuse (CSA) is a serious problem around the world. In China, although ofcial statistics on the incidence of
veried CSA cases are not routinely collected or reported, recent studies have found that CSA is not uncommon in Chinese
society (Chen, Dunne, & Han, 2004; Lin, Li, Fan, & Fang, 2011; Lu, 1997; Sun, Dong, Yi, & Sun, 2006; Tang, 2002). In a cross-
sectional study conducted among students from 6 colleges/universities in Beijing, Hebei, Shanxi, Jiangsu, Shaanxi, and Anhui
provinces of China, it was reported that the prevalence of unwanted physical contact sexual experiences before age of 16
years was 11.2% (Chen, Han, Lian, & Dunne, 2010). Some local retrospective studies based on samples of students and children
in Chinese society have revealed that preschool children may also suffer from sexual abuse in China (Chen, Dunne, et al.,
2004; Chen, Han, & Dunne, 2004; Chen, Dunne, & Han, 2006; Chen et al., 2010; Sun et al., 2006). In another case-based study

Corresponding author.

0145-2134/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.chiabu.2013.04.018
624 W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630

of forensic medicine, it was reported that about 34% of 128 female sexually abused children under the age of 14 years old
were preschool-aged children and the age of the minimum child victim was 2 years of age (Lu, 1997). The ndings are similar
to that found in other countries (Cupoli & Sewell, 1988; Modelli, Galvo, & Pratesi, 2012; Putnam, 2003; Vogeltanz et al.,
1999; Wyatt, Loeb, Solis, & Carmona, 1999).
Researchers have suggested that some characteristics of Chinese traditional culture may increase the CSA risks for Chinese
children (Ho & Kwok, 1991; Tang, 2002). The Chinese tradition of sexual conservatism makes it difcult for children to talk
about sexual issues openly and the Chinese pattern of child rearing (e.g., lial piety) encourages children to be always
subordinated to adults (Ho & Kwok, 1991; Liao, Lee, Roberts-Lewis, Hong, & Jiao, 2011). Moreover, in order to defend the
family from shame, child victims and their family members are often unwilling to tell anyone about CSA experiences in
Chinese societies (Tang, 2002).
Previous studies in China have also indicated that mental health and behavioral consequences of CSA for Chinese children
are very similar to those found among children in other cultures (Chen, Dunne, et al., 2004; Lin et al., 2011). Child sexual abuse
has been found to have a very negative effect on childhood (e.g., age-inappropriate sexual behavior, behavioral problems)
(Friedrich, Urquiza, & Beilke, 1986; Friedrich et al., 2001; Maikovich-Fong & Jaffee, 2010; Mian, Marton, & LeBaron, 1996)
and can cause a signicant dysfunction (e.g., anxiety, depression) or revictimization in an adult life (Chen et al., 2010;
Messman-Moore, Walsh, & DiLillo, 2010; Putnam, 2003).
Currently, the most widely used strategy to prevent CSA in the western world is focused on the education of children
in personal safety knowledge and skills (Davis & Gidycz, 2000; Finkelhor, Asdigian, & Dziuba-Leatherman, 1995; Kenny,
Wurtele, & Alonso, 2012; Rispens, Aleman, & Goudena, 1997; Tutty, 1997; Wurtele & Owens, 1997). Previous studies have
found that preschool-aged children could benet from CSA prevention programs (Berrick & Barth, 1992; Kenny et al., 2012;
Wurtele & Owens, 1997). In one meta-analysis of nine CSA prevention studies, Berrick and Barth (1992) found that there was
a large effect size for preschool-aged children (d = .86), supporting the effectiveness of prevention at this early age. Compared
with controls, preschool-aged child participants have demonstrated increased ability to distinguish the difference between
appropriate and inappropriate touches and to resist the inappropriate touching requests (Kenny & Wurtele, 2010; Kenny
et al., 2012; Wurtele & Owens, 1997). For instance, Wurtele and Owens (1997) employed data compiled from 5 studies
with preschool-aged children and found that preschoolers who had participated in a 5-day Behavioral Skills Training (BST)
program had signicant improvement in their skills of recognizing, resisting, and reporting inappropriate touch requests.
Preschoolers can also learn that it is not the childs fault if abuse occurs and that the child should tell someone even if the
perpetrator tells them to keep a secret (Wurtele & Owens, 1997).
The ndings in western world have identied that beginning primary prevention with preschool-aged children is impor-
tant (Kenny, 2010; Wurtele & Owens, 1997; Wurtele, Moreno, & Kenny, 2008). However, very few studies on CSA prevention
among young children have been conducted in Chinese societies; We found only four studies on CSA prevention among
Chinese children. One study conducted in Hong Kong (Lee & Tang, 1998; Tang & Lee, 1999) and three studies in Hubei
province (Chen, 2012), Beijing (Chen, Zhang, et al., 2012), and Henan province (Chen, Du, et al., 2012) in China mainland
have demonstrated that Chinese children lack the knowledge and skills related to CSA prevention and could benet from
child-directed CSA prevention program (Chen, 2012; Lee & Tang, 1998). For example, Lee and Tang (1998) found that female
Chinese adolescents with mild mental retardation in the Behavioral Skills Training group had greater CSA knowledge (e.g.,
being boss of own body, knowing that touching an adults private parts is inappropriate and touching own private parts is
acceptable) and self-protection skills (e.g., recognizing the inappropriate touching requests and removing from the abusive
situations) compared with controls. Similarly, Chen (2012) found that compared with controls, Grade 2 pupils in education
group reported they were more likely to disclose the CSA if it occurred. Up to now, we have found no research on sexual
abuse prevention education among Chinese preschool-aged children and no data of describing preschool-aged childrens
knowledge and skills related to CSA prevention.
Many researchers have asserted that childrens performances on CSA knowledge and self-protection skills can be posi-
tively affected by parents knowledge of sexual abuse and communication with children about CSA prevention (Burgess &
Wurtele, 1998; Chen & Chen, 2005; Deblinger, Thakkar-Kolar, Berry, & Schroeder, 2009; Finkelhor & Dziuba-Leatherman,
1995; Wurtele et al., 2008; Zielinski & Bradshaw, 2006). Some CSA prevention programs involving parents are able
to enhance childrens knowledge and skills related to sexual abuse (Finkelhor & Dziuba-Leatherman, 1995). Previous
child-focused research has indicated that children taught by parents demonstrate greater CSA knowledge and higher
levels of personal safety skills compared with controls (Wurtele, Gillispie, Currier, & Franklin, 1992; Wurtele, Kast, &
Melzer, 1992), however, almost all the studies used the data of either parents or children. Few studies have been con-
ducted with child plus parent, and even fewer have provided the factual data of the relationships between parental
reports on CSA knowledge and communication and their childrens performance on CSA knowledge and self-protection
skills.
As above, the current study had two objectives. First, this study aimed to examine the level of CSA prevention
knowledge and personal self-protection skills of preschoolers in Beijing, China. Consistent with previous research,
it was predicted that Chinese preschool-aged children had impoverished knowledge of CSA prevention and self-
protection skills. Second, the study sought to explore the relationship of childrens CSA knowledge and skills with
their parents CSA knowledge and parentchild communication about CSA. It was hypothesized that childrens CSA
knowledge and skills were positively associated with their parents knowledge and parentchild communication about
CSA.
W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630 625

Methods

Participants

One hundred and thirty-six children served as child participants; all children were enrolled in the three preschools that
committed to participating in this study in Beijing, China. Child participants included 3- (16%), 4- (51%), and 5- (33%) year-old
children (M age = 4.17, SD = .68), and 74 (54%) were boys. With the requirement that only 1 parent of each child was asked to
participate in this study, 30 fathers (22%; M age = 37.8, SD = 4.17) and 106 mothers (78%; M age = 33.8, SD = 3.68) participated.
Approximately 25% of parents education level was at junior college or below, 75% had Bachelor degree or above.

Procedure

The present study was approved by Peking University Biomedical Ethics Committee and conducted during September
and October 2012. Consents to participate in the study were obtained from preschools, parents, and children. Four research
interviewers who were graduate students in child and adolescent health worked on the research. Prior to data collection,
the interviewers received trainings in interview skills and how to record the childrens responses. Research interviewers
assessed each child individually in the preschools during the school time. A child was called from his/her classroom and
took about 20 min to complete the tests in an empty classroom the children were familiar with, such as childrens reading
room, or sleeping room. After the data collection in the children completed, their parents were asked to complete the
self-administered structured questionnaire anonymously at home. The completed questionnaire was sealed by each parent
participant before returning it to the research group.

Measures

What If Situations Test (WIST). The WIST was used to measure childrens ability to recognize and respond in hypothet-
ical abusive situations (Wurtele, Hughes, & Owens, 1998). This measure includes 6 vignettes: 3 describe appropriate requests
to touch childrens genitals and 3 describe inappropriate requests to touch childrens genitals. The WIST has 3 scale scores: (1)
Appropriate Request Identication (range = 03); (2) Inappropriate Request Identication (range = 03); (3) Total Personal
Safe Skills (range = 024). Alpha reliability for Appropriate Request Identication, Inappropriate Request Identication, and
Total Personal Safe Skills were .70, .75, and .80 respectively for the present study. The WIST Total Personal Safe Skills scale
consists of 4 Specic Skills subscales:(1) WIST SAY, such as denitely refusing to go along with the inappropriate request
by making a verbal response (range = 06); (2) WIST DO, such as removing self from the abusive situation (range = 06); (3)
WIST TELL, such as listing 1 or more trusted persons to tell (range = 06); and (4) WIST REPORT, such as describing both
the offender and what had occurred (range = 06). Internal consistency analyses of subscales of SAY, DO, TELL, and REPORT
produced alpha levels of .80, .81, .78, and .71, respectively.
Personal Safety Questionnaire (PSQ). The PSQ (Wurtele, Gillispie, et al., 1992) consists of 12 questions designed to assess
childrens knowledge about sexual abuse (e.g., If a baby-sitter wants to touch a kids private parts, what should the kid say?
and Is it OK for kids to touch a bigger persons private parts?) and attitudes toward sexuality (e.g., Is it OK for you to touch
your own private parts? and Do you like your private parts?). Children responded by saying Yes, No, or I dont know.
Each correct response received 1 point and scores ranged from 0 to 12. The Cronbach alpha of the 12-item scale was .61 for
the present study.
Parent Questionnaire (PQ). The PQ comprised three sections: demographic background, parental CSA knowledge, and
parentchild communication about CSA. A 10-item CSA knowledge subscale was adapted from the study by Chen and Chen
(2005). Correct responses to each knowledge item were scored as 1 point, while incorrect and unsure responses were
scored as 0 (range = 010). Scores on the CSA knowledge subscale were divided into low (05 points) and high (610 points).
The Cronbach alpha of the 10-item CSA knowledge subscale was .52 for the present study. The parentchild communication
subscale included 3 items (Chen & Chen, 2005) and parents were asked the following questions: Talked with their child
about their private parts (parts covered by swimsuit/bathing suit) and said they should not be touched by others, Told
child if someone wants to see or touch their private parts, they should denitely say No and leave at once, and Told
child if sexual abuse happens, parents or other trusted adults should be told (response options yes or no). Afrmative
responses were scored as 1 point and negative responses were scored as 0 (range = 03). For analyses presented in this study,
communication scores were classied as low (01 point) and high (23 points). Internal consistency analyses of parentchild
communication about CSA subscale produced alpha level of .75.

Data analysis

All data were entered using the program Epidata and were analyzed using SPSS software. Firstly, descriptive statistics
were used to report the characteristics of the children and their parents as well as childrens scores on the WIST, PSQ and
parents responses to the PQ items. Secondly, Independent-samples t-tests were used to explore the associations between
626 W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630

Table 1
Item analysis of the PSQ (N = 136).

Item Answered correctly (%)

1. Are you the boss of your body? 74.3


2. If a big person touches a kids private parts, has the kid done something wrong? 68.4
3. Do kids have to let all big people touch their private parts? 66.2
4. If a big person touches a kids private parts and tells the kid to keep it a secret, should the kid tell someone about it? 16.2
5. Are strangers the only people who try to touch kids private parts? 49.3
6. If a stranger wants to look at a kids private parts, should the kid try to get away? 92.6
7. Is it ok for doctors to look at kids private parts if theyre hurt? 86.0
8. Is it ok for kids to touch a bigger persons private parts? 64.7
9. If kids need help cleaning their bodies, is it ok for Mom or Dad to touch their private parts? 76.5
10. If a baby-sitter wants to touch a kids private parts, what should the kid say? 58.1
11. Is it ok for you to touch your own private parts? 67.6
12. Do you like your private parts? 69.9

childrens scores on the WIST and PSQ and their parents scores on the PQ. Finally, a stepwise multiple regression analysis
was conducted to determine the factors that predicted childrens personal self-protection skills.

Results

Child measures

Childrens responses to questions of the Personal Safety Questionnaire (PSQ) and What If Situation Test (WIST) were
summarized in Tables 1 and 2. As shown Table 1, the preschoolers lack CSA knowledge. Only one child provided the correct
responses to all 12 items of the PSQ; additionally, only 16% of the children asserted that children should tell someone if the
perpetrator tells them to keep it a secret and more than 40% of the children believed that it is acceptable that the baby-sitter
touches their private parts. About one third of the children believed that the abuse was the childs fault and all big people
could touch their private parts. Similarly, 35% of the children believed that the child could touch a bigger persons private
parts. Encouragingly, more than 90% of the children reported that the child should get away, if a stranger wants to look at
the childs private parts and approximately 70% reported that they liked their private parts. On average, the preschoolers
knew 66% of the CSA knowledge as measured by the PSQ (Mean = 7.90, SD = 1.72).
Results of the WIST showed that approximately 80% of the children could accurately recognize all of the three situations
related to appropriate sexual requests and 64% of the children could accurately recognize the three inappropriate situations
(see Table 2). However, the childrens WIST Total Skills scores were low; about 21% of the children failed to use any self-
protection skills and only 2% of the children achieved the maximum skills score (with 24 being the maximum). Furthermore,
more than 50% of the children would not tell anyone about the abusive incident, and about 71% of the children failed to use
any report skills (see Table 2).

Parent measures

Although more than 90% knew that perpetrators often repeat the offense, only about one quarter of the parents knew that
children who reported being sexually abused almost always should be believed. Few parents (27%) believed that children
most often were sexually abused by familiar persons. Results of the PQ showed that the parents had a lack of CSA knowledge

Table 2
Distribution of children across various scores on the WIST (N = 136).

Criterion children measures Mean SD

WIST appropriate (03) (0) (1) (2) (3) 2.65 .77


3.7% 6.6% 11.0% 78.7%
WIST inappropriate (0) (1) (2) (3) 2.37 .98
(03) 8.8% 9.6% 17.6% 64.0%
WIST SAY (06) (0) (13) (45) (6) 3.05 2.41
27.9% 25.8% 17.7% 28.7%
WIST DO (06) (0) (13) (45) (6) 2.35 2.40
41.9% 18.4% 30.6% 19.1%
WIST TELL (06) (0) (13) (45) (6) 1.68 2.13
52.2% 22.8% 13.2% 11.8%
WIST REPORT (06) (0) (13) (45) (6) .92 1.66
70.6% 16.2% 9.6% 3.7%
WIST Total Skills (0) (111) (1223) (24) 7.99 6.84
(024) 21.3% 48.3% 28.2% 2.2%

Note: Numbers in round brackets represent the scores of the measures.


W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630 627

Table 3
Means and standard deviations for Parental Questionnaire (PQ) measure (N = 136).

Parents measures n (%) Mean SD Range

Parental CSA knowledge 6.68 1.73 110


Low (05) 30 (22.1%) 4.03 1.04 15
High (610) 106 (77.9%) 7.40 1.08 610
Parent child communication about CSA 1.81 1.16 03
Low (01) 50 (36.8%) .44 .50 01
High (23) 86 (63.2%) 2.60 .49 23

(Mean = 6.68, SD = 1.73) (see Table 3). As a whole, less than 4% of the parents could provide the correct responses to all 10
items of the CSA knowledge subscale.
Furthermore, parentchild communication scores were low as well. The least discussion content was that Told child if
sexual abuse happens, parents or other trusted adults should be told (45%), followed by Told child if someone wants to
see or touch their private parts, they should denitely say No and leave at once (58%). Only 38% of the parents discussed
all three topics with their children and about 20% did not have any discussion with their children about CSA. On average,
the parents achieved about 60% of the maximum communication score (Mean = 1.81, SD = 1.16).

Associations between parent reports and child performances

Table 4 displays the associations between demographics variables and childrens scores on the WIST and PSQ. The results
indicated that boys and girls had similar levels on the WIST and the PSQ. Compared to 4- and 5-year old children, 3-year-olds
had more difculty in recognizing appropriate-touch requests (p < .01) and reporting the offenders identity and the incident
(p < .05). While, there were no age effects on the PSQ, WIST inappropriate, WIST Total Skill, and the skills of SAY, DO, and TELL.
Results also showed that parental education level did not affect the childrens scores on the PSQ, WIST appropriate, WIST
inappropriate, WIST DO, and WIST TELL. But, the ndings showed that the children whose parents had Bachelor degree or
above scored higher on the WIST Total Skill (p < .05), WIST SAY (p < .05), and WIST REPORT (p < .05) than those whose parents
had junior college or below (see Table 4).
The ndings showed that parents high scores on the CSA knowledge were signicantly associated with childrens high
scores on the WIST Total Skill (p < .05), and the skills of TELL (p = .01), and REPORT (p < .05). Similarly, the results showed
that there were signicant positive associations between parentchild communication about CSA and their childrens per-
formances on the WIST Inappropriate (p < .05), WIST Total Skill (p < .01), and the skills of SAY (p < .05), and DO (p < .01) (see
Table 5).

Regression analyses

A stepwise multiple regression analysis was used to examine the associations between childrens scores on the WIST Total
Skills and the ve independent variables, including child age, child gender, parental education level, parental CSA knowl-
edge, and parentchild communication about CSA. The multiple regression equation showed that among all the variables,
only parentchild communication about CSA (B = 3.85, SE B = 1.17 p = .001) and parental education level (B = 3.41, SE B = 1.29
p = .009) were signicant factors. The two variables together accounted for 10.6% (R2 ) of the variance in childrens scores on
the WIST Total Skills (p = .001).

Table 4
Associations between demographics variables and childrens scores on the WIST and PSQ.

WIST WIST inap- WIST SAY WIST DO WIST TELL WIST WIST total PSQ (012)
appropriate propriate (06) (06) (06) REPORT skills
(03) (03) (06) (024)

Child age
3 2.00 1.20 2.36 1.22 2.36 2.65 1.86 2.25 1.27 1.70 .14 .47 5.64 5.09 7.73 1.42
4 2.70 .67a 2.36 .92 3.07 2.26 2.39 2.40 1.68 2.12 1.01 1.75a 8.16 6.49 7.73 1.85
5 2.89 .38a 2.38 .96 3.36 2.51 2.51 2.49 1.87 2.33 1.16 1.81a 8.89 7.89 8.24 1.61
p value .000 ns ns ns ns .049 ns ns
Child gender
Girls 2.74 .60 2.23 1.11 3.27 2.40 2.61 2.59 1.69 2.24 1.05 1.86 8.63 7.24 7.94 1.80
Boys 2.57 .88 2.49 .85 2.86 2.42 2.12 2.21 1.66 2.05 .81 1.49 7.46 6.47 7.86 1.66
p value ns ns ns ns ns ns ns ns
Parents education level
Junior college or below 2.60 .85 2.09 1.20 2.17 2.57 2.09 2.23 1.17 1.92 .46 1.29 5.89 6.65 7.60 1.67
Bachelor degree or above 2.66 .74 2.47 .88 3.36 2.29 2.44 2.46 1.85 2.18 1.08 1.75 8.72 6.78 8.00 1.73
p value ns ns .012 ns ns .029 .034 ns
a
Indicates difference (p < .05) between age 3 and other age groups.
628 W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630

Table 5
Associations between parental CSA knowledge and parentchild communication about CSA and childrens scores on the WIST and PSQ.

WIST WIST inap- WIST SAY WIST DO WIST TELL WIST WIST total PSQ (012)
appropriate propriate (06) (06) (06) REPORT skill (024)
(03) (03) (06)

Parental CSA knowledge


Low (05) 2.53 1.00 2.10 1.18 2.60 2.49 1.87 2.11 .97 1.47 .30 .84 5.73 5.11 7.77 1.17
High (610) 2.68 .68 2.44 .91 3.18 2.39 2.48 2.47 1.88 2.25 1.09 1.80 8.63 7.14 7.93 1.85
p value ns ns ns ns .010 .001 .015 ns
Parentchild communication about CSA
Low (01) 2.72 .67 2.12 1.08 2.40 2.40 1.54 2.16 1.28 2.08 .60 1.23 5.82 6.54 7.74 1.63
High (23) 2.60 .82 2.51 .89 3.43 2.35 2.81 2.41 1.91 2.13 1.10 1.85 9.26 6.72 7.99 1.77
p value ns .024 .016 .002 ns ns .004 ns

Discussion

The ndings of the present study indicated that Chinese preschoolers had poor knowledge and skills related to sexual
abuse prevention. The results are consistent with the previous research done with young children in the western context
(Kenny et al., 2012; Wurtele & Owens, 1997) and other Chinese research (Chen, Du, et al., 2012; Chen, 2012; Tang & Lee,
1999). Chinese preschool childrens scores on the WIST inappropriate and WIST Total Skill are higher than western childrens
(Kenny et al., 2012; Wurtele & Owens, 1997). However, approximately 40% of the children were still unable to identify all
three inappropriate touching requests and 20% of the children were unaware of using any self-protection skills in three inap-
propriate touching conditions. Childrens personal safety skills (e.g., SAY, DO, TELL, REPORT) scores were low as well. In three
abusive situations, less than 30% of the children were aware of using verbal response to denitely refuse the inappropriate
touching (SAY), less than 20% of the children were aware of denitely removing themselves from the abusive circumstances
(DO). Moreover, few children were willing to tell anyone about the abusive incident (TELL) and fewer children could cor-
rectly describe both the offenders and the abusive incidents (REPORT). These ndings manifest that Chinese preschool-aged
children lack self-protection skills thought to be benecial to avoid sexual abuse.
In addition, although a majority of children (90%) reported that if a stranger wants to look at the childs private parts,
the child should get away, Chinese preschoolers, as a whole, lack CSA knowledge. Most children were not able to recognize
that the sexual perpetrator included someone they trusted or liked (e.g., babysitter) in this study. Since most abusers are
known to the victim and often to the family (Cupoli & Sewell, 1988; Elliott, Browne, & Kilcoyne, 1995; Tang, 2002), it is
important for children to learn (in sexual abuse prevention programs) that someone they are familiar with can be a potential
perpetrator. Furthermore, very few (16%) Chinese preschoolers knew that children should report the abusive incident even
if the perpetrator tells them to keep it a secret, similar to other Chinese research with elementary school children (Chen,
2012; Chen, Du, et al., 2012), but much lower than western research with young children (about 40% in Wurtele & Owens,
1997; 54% in Kenny, 2010). These ndings may be related to Chinese culture, which is very conservative regarding sexuality.
It may be that children are reluctant to tell someone the abusive incident. Moreover, Chinese cultural value of lial piety
teaches children the importance of obedience and encourages children to defer to the words of adults in daily life, thus
Chinese preschoolers may be more likely to comply with the words of abuser and keep the sexual abuse incident secret. As
perpetrators recognize a child who has the knowledge of disclosing abuse as a less likely target (Elliott et al., 1995), the CSA
prevention in China should focus on teaching Chinese children about disclosing sexual abuse.
For the second purpose of this study, the ndings provided the factual basis that childrens self-protection skills were
positively related to parentchild communication about CSA prevention. Results of this study suggested that these con-
versations could improve childrens self-protection skills, reected in skills of identifying inappropriate touching, verbally
refusing the inappropriate touch requests, and removing themselves from the abusive situations. The current results are
consistent with western research demonstrating that parental involvement in CSA prevention education is good for enhanc-
ing childrens self-protection skills (Finkelhor & Dziuba-Leatherman, 1995; Wurtele, Gillispie, et al., 1992; Wurtele, Kast,
et al., 1992). The ndings also support previous studies with an objective of increasing parentchild communication about
CSA by providing parent-focused prevention education on sexual abuse (Burgess & Wurtele, 1998; Wurtele et al., 2008).
Childrens CSA knowledge had little relationship with parentchild communication in this study, however, previous studies
indicate that providing parents with communication materials about sexual abuse prevention could increase their childrens
CSA knowledge (Wurtele, Gillispie, et al., 1992; Wurtele, Kast, et al., 1992). In China, only about 4% of parents have access
to communication materials on sexual abuse prevention (Chen & Chen, 2005; Chen, Dunne, & Han, 2007), therefore, for the
sake of helping children to acquire CSA knowledge and personal safety skills, future research should not only encourage
parents to communicate with their children about CSA, but also provide the suitable print or audiovisual resource materials
to facilitate parentchild communication in China.
Results from this study indicate that childrens CSA knowledge and personal safety skills had no clear relationship with
their parents CSA knowledge. Parents lacking CSA knowledge probably makes it difcult to nd the associations between
parents CSA knowledge and their childrens sexual abuse knowledge and self-protection skills. In this study, few (27%) of
parents knew that children often are sexually abused by familiar people and only 25% parents realized that children who
W. Zhang et al. / Child Abuse & Neglect 37 (2013) 623630 629

report being sexually abused should in most cases be believed. Children are unable to be taught accurate pictures of CSA by
their parents, who lack critical information of sexual abuse knowledge (Chen et al., 2007; Deblinger et al., 2009; Wurtele
et al., 2008). For this reason, education of parents in accurate CSA knowledge is important in prevention programs in helping
them to teach their children CSA knowledge and personal safety skills, and to supply safer surroundings for their children
(Wurtele et al., 2008).
The present study also found that the children whose parents had junior college education or below (low SES) scored
signicantly lower than those whose parents had Bachelor degrees or above (high SES) on the WIST Total Skill, the skills of
SAY, and REPORT. The nding suggests more attention should be paid to conducting CSA prevention programs in low SES
populations in China.
This study has several limitations. First, the sample was small, convenient, and consisted of mostly college-educated
parents and their children in Beijing, thus ndings cannot be generalized to less educated parents and their children, or to
the whole China. Second, as the parent questionnaire was designed to be simple, the measurement of the knowledge and
communication was relatively supercial. Third, this study used only childrens self-report in abusive situations to reect
upon their level of CSA knowledge and self-protection skills. This form of child assessment always raises concerns regarding
whether childrens verbal responses to questionnaire would be generalized to their actual behaviors in the face of CSA.
Finally, the information collected was cross-sectional; causation between associated factors (e.g., parental CSA knowledge
and parentchild communication about CSA) and childrens abilities to avert sexual abuse cannot be inferred from this
research.

Conclusion

This study shows that preschool-aged children have a lack of sexual abuse knowledge and related self-protection skills
in Beijing, China. Culturally relevant primary prevention programs toward the young children should be developed in Chi-
nese society. Children need to be educated to identify uncomfortable or inappropriate touching requests, and be effective
in stopping the abusive behavior (e.g., say No! and try to get away from the abusive situation). It is important to teach
Chinese children not to keep the abusive incident secret and to tell a trusted adult if an abusive incident occurs. Child-focused
education prevention is only one part of CSA prevention programs; this study also provides evidence that parents involved
in CSA prevention programs is important, and parental education should be a part of CSA prevention. The ndings show that
parents do not have enough knowledge about CSA prevention to pass to their children, and parentchild communication
about CSA is positively associated with childrens self-protection skills. Parents must be equipped with more accurate CSA
knowledge (e.g., the prevalence and consequences of CSA, how to deal with CSA disclosures, and how to recognize the poten-
tial offender), and need to be provided education materials to promote parentchild communication about CSA prevention
(e.g., how to discuss with their children about sexuality and personal boundaries, and how to teach their children to identify
the threat of sexual abuse and to tell an adult if it occurs).

Acknowledgements

The authors wish to thank Dr. Wurtele and Dr. Kenny for their help in using the childrens assessment tools as well as the
directors, teachers, children, and parents who participated in this study.

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