Abuse Characteristics Research Articles

Defining child maltreatment for research and surveillance: a Delphi study in 34 countries

Abstract Background Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to measure child maltreatment and identify interventions and services are constrained by a lack of uniform definitions across sectors and countries. We conducted a Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research in Europe. Methods Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries participated in three rounds of online data collection. We defined consensus as ≥ 70% agreement or disagreement with each statement after the final round. Results Consensus was reached on 26/31 statements, with a participant retention rate of 94%. The definition states that child maltreatment is a subtype of violence against children. The perpetrator can be an adult or minor, but must be in a position of power over the child. To define an act or omission as child maltreatment, it must cause harm or have the potential to cause harm, regardless of intention, severity, chronicity, or the traditional/cultural beliefs of the perpetrator. In addition, the broad umbrella term encompassing emotional, behavioural or cognitive maltreatment should be “psychological”, and psychological maltreatment should be split into sub-types of psychological abuse and psychological neglect. “Neglect” is a broad type of child maltreatment within which there are subtypes that can all be characterised as “failure to provide” or “failure to supervise”. Conclusions This is the first study to demonstrate consensus on the types and key characteristics of child maltreatment across multiple sectors and countries, providing a unified definition of child maltreatment to improve consistency of measurement and surveillance in Europe. This abstract is submitted on behalf of Working Group 1 COST Action 19106. Key messages • A standardised definition is essential for monitoring child maltreatment. • We propose a consensus-based definition that can be used to improve child maltreatment measurement in research and surveillance.

ASPECTOS ORAIS DO ABUSO SEXUAL INFANTIL E CONDUTA DO CIRURGIÃO DENTISTA: REVISÃO DE LITERATURA

The study presents a literature review, the aim of which was to point out the main characteristics for detecting cases of child sexual abuse from the point of view of dentistry, as well as to highlight the importance of the dental surgeon in identifying and reporting cases of suspected child maltreatment and/or abuse. The bibliographic research was carried out in different databases, such as SciELO, Bireme, LILACS and PubMed, selecting studies that addressed the descriptors provided by the DECS database: children, child sexual abuse and dentistry, published between 2015 and 2023. To prepare the literature review, 40 articles were found. However, national and international articles that met the inclusion criteria were selected for the expanded abstract. The literature shows the importance of identifying child mistreatment and abuse in the dental field, listing the main manifestations of injuries in the head and neck region. This research is linked to increasing dental surgeons’ knowledge of child violence, so that professionals are better able to recognize the signs of abuse or neglect in children, which is crucial for identifying cases of violence and taking the necessary measures. Therefore, this paper aims to point out the main characteristics of child sexual abuse, as well as what the dental surgeon’s conduct should be when faced with this occurrence.

Trends in Contacts Made by Immigrants to the National Domestic Violence Hotline, Before and During the COVID-19 Pandemic.

Immigrants in the United States are more likely than nonimmigrants to experience risk factors for intimate partner violence (IPV) and problems in getting support. The COVID-19 pandemic and recent incidents of xenophobia and anti-immigrant sentiment may have exacerbated exposure to IPV risk factors. We examined immigrant experiences of IPV before and during the COVID-19 pandemic. This study identified changes in characteristics of abuse, services used, referrals, and barriers to services among those who contacted the National Domestic Violence Hotline (NDVH) and identified as immigrants, reported immigration status as a concern, needed immigration support, and/or identified immigration status as a barrier to accessing services (N = 49 817). We used joinpoint regressions to examine whether the rate of change differed significantly from 2016-2019 (before the pandemic) to 2019-2021 (during the pandemic). The number of immigrant contacts to NDVH peaked in 2017 (n = 9333) and declined 25% to 6946 in 2021. During 2016-2019, the percentage of contacts reporting the following increased significantly: technology-facilitated violence (+12.7 percentage points), economic/financial abuse (+10.8 percentage points), and involvement of firearms (+4.8 percentage points); during 2019-2021, these trends reversed. The percentage of contacts reporting separation or divorce was relatively flat until 2019 and then increased from 14.6% in 2019 to 19.9% in 2021 (+5.2 percentage points). Housing instability increased during 2017-2020 (+9.3 percentage points), but requests for shelters decreased (-4.5 percentage points). Immigration status and personal finances were commonly reported barriers to services; both decreased during 2016-2019 but then increased during 2019-2021. This study can inform prevention and response strategies relevant for immigrants experiencing or reporting IPV.

"I remember most of my family seeing it": The presence of others during child physical abuse, as conveyed in forensic interviews with Israeli children.

Child physical abuse is often perceived as a crime perpetrated within the family and out of sight. However, recent studies have indicated the presence of others during incidents of physical abuse. The current study was designed to examine the experiences and perceptions of children who were physically abused in their families concerning the presence of others, as conveyed during their forensic interviews. A thematic analysis of 26 forensic interviews was conducted with Israeli children aged 5-13. Three main themes were identified: (1) Patterns, roles, and coping mechanisms: The multifaceted spectrum of familial abuse; (2) The echoes of family reactions: Shaping children's abuse experiences; and (3) Navigating the storm together: Sibling bonds amidst familial abuse. The children's narratives highlighted their distress and pointed to the abusive and chaotic daily routine in which they lived. In spotlighting their encounters with physical abuse, the children focused on their need to be seen and gain certainty in their daily routines. The discussion highlights the unique and elusive dynamics of families in which child physical abuse occurs and challenges the social perception that physical abuse occurs secretly. The characteristics of such abuse highlight the urgent need for policymakers and professionals to treat the phenomenon of physical abuse within the family as a visible phenomenon.

The Richness of Reports Provided by Children in Israel: Examination of the Impact of Social Affiliations.

Forensic interviews following child sexual abuse (CSA) are of central importance to the children, their families and all those involved. Moreover, the legal system expects rich, forensically relevant reports from the children. The current study focuses on the impact of children's social affiliation on the richness of their reports, and how question types contribute to rich reports. The sample included 314 forensic interviews conducted in Israel between 2015 and 2018. The findings revealed a relationship between child characteristics (gender), abuse characteristics (perpetrator identity, abuse type, abuse frequency) and social affiliation with report richness. Furthermore, question types (free recall prompts, summaries, directive, option-posing, suggestive) moderated the relationship between the child's characteristics, abuse characteristics, and social affiliation with report richness, when these effects were not equal. The findings emphasized that contextual observation of sexually abused children may promote better services for them and, in addition, stressed the importance of advancing future training and practical guidelines for practitioners.

‘Honor’ and Its Upholders: Perpetrator Types in ‘Honor’-Based Abuse

ABSTRACT ‘Honour’-based abuse (HBA) studies tend to focus on survivors’ lived experience, with less emphasis on perpetrator characteristics. This study aims to investigate whether various HBA characteristics correlate with different types of perpetrators, based on their relationship with survivors. Savera UK, a charity specialising in HBA and harmful practices, provided 107 cases which were coded for 66 variables. Three main perpetrator types were identified: 1. “Intimate Partner”, 2. “Family” and 3. “Intimate Partner and Family”. Chi-squared analyses were conducted and odds ratios of any significant associations were calculated. The distinct profile of survivor, perpetrator and abuse characteristic for each type was presented. The average number of abuse characteristics reported for the “Intimate partner and Family” perpetrator type was 19, much higher than the other two sub-samples. The implications for professional practice are discussed, highlighting the importance of increasing understanding into ‘honour’-based abuse to improve investigative, safeguarding and prevention interventions.

가정 내 아동학대 행위자 특성에 따른 유형분류: 잠재계층분석(Latent Class Analysis)을 중심으로

The purpose of this study is to identify the type of group classification through latent class analysis for domestic child abuse and to examine the characteristics of each group and various psychosocial factors. As a result of the analysis, domestic child abuser was classified into three sub-types: “personality problems and recidivism”, “improper parenting attitude”, and “complex causes and drinking”. Next, chi-square test was conducted to confirm the characteristics of the classified groups. The “personality problems and recidivism” had high rates of characteristic deficit, and recidivism, and the usual marital relationship was not good. In the “improper parenting attitude”, the motive of the crime was improper parenting attitude and skill, and the type to which the most abusers belonged. The “complex causes and drinking” was were found to be the most at-risk group, with accomplices, likely recidivism, and the possibility that the abuser experienced abuse. In this study, it is meaningful that groups were classified, including the characteristics of child abuser in the family and the context of child abuse crimes recognized by criminal justice agencies, and intervention measures were suggested accordingly.

Patterns of childhood maltreatment and maternal substance use disorder on the development of emerging adult offspring substance use.

Exposure to child maltreatment and maternal substance use disorder represent two highly consequential and co-occurring experiences of family-level adversity for the development of concerning substance use behaviors among offspring. The present study uses latent class analysis to identify how characteristics of childhood maltreatment and maternal substance use disorder naturally cluster. Further, this study investigates how distinct patterns of maltreatment and maternal substance use differentially predict emerging adult substance use in offspring. Participants (N = 405) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories, all of whom experienced low socioeconomic status. Patterns of child maltreatment experiences, based on coded Child Protective Services record data, and maternal substance use behaviors, per a diagnostic interview, were used to predict Wave 2 (emerging adulthood) substance use. Results indicated that children who were exposed to a pattern of multitype maltreatment and multitype maternal substance dependence, relative to those exposed to multitype maltreatment alone, reported greater alcohol dependence symptoms during emerging adulthood. Additionally, these same individuals reported greater past-year hard liquor consumption relative to those who experienced chronic, multitype maltreatment and maternal alcohol dependence. These findings highlight how a pattern of maternal polysubstance use and multitype maltreatment is particularly consequential for the intergenerational transmission of substance use behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patterns and sociodemographic characteristics of substance abuse among hepatitis C virus-infected patients in Iraq: a cross-sectional study

BackgroundSubstance use disorders are a widely recognized problem among hepatitis C-infected patients; moreover, substance abuse by intravenous injection is a common mode of transmission of the hepatitis C virus worldwide. The frequency of substance use disorders and their relation to hepatitis C infection are still unknown in Iraq. This cross-sectional study, conducted among a sample of hepatitis C- infected patients attending the Gastrointestinal Tract Center in Baghdad Medical City, aimed to examine the prevalence of substance use disorders, the sociodemographic characteristics of the abusers, and the relation between intravenous drug abuse and hepatitis C virus infection. All participants were subjected to an Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) questionnaire and a data form to determine sociodemographic characteristics and hepatitis C virus-related risk factors.ResultsIn a total of 300 hepatitis C virus-infected patients, the prevalence of substance use disorders was 53.6%. Among these patients, 43.6% abused nicotine, 6% abused licit drugs, and 4% abused alcohol. No one reported illicit drug abuse. Intravenous drug abuse was rare, and there was no relationship found between intravenous drug abuse and hepatitis C infection. Cupping (23%) and blood transfusion (20.3%) were both significantly associated with hepatitis C transmission in this study (p > 0.001).ConclusionThis study revealed a high prevalence (53.6%) of substance abuse in this sample of hepatitis C-infected patients, with nicotine being the most commonly abused substance. However, there was no relationship between hepatitis C infection and intravenous drug abuse. Common risk factors that might contribute to hepatitis C transmission among this population include cupping and blood transfusion.

Factors facilitating and delaying disclosure and reporting of child sexual abuse: insights from forensic interviews

ABSTRACT In light of limited existing knowledge, we aimed to examine the connection between disclosure facilitators and delays in the context of forensic interviews. We examined interview records from 403 children under 18 suspected of sexual abuse at a child advocacy center. The forensic interview records, family interview forms, and psychiatric examination reports in the files were retrospectively examined. Frequency, mean, and chi-square tests were implemented to analyze the data. The reasons for facilitating and delaying the disclosure of abuse were evaluated using a descriptive analysis method. Of the cases, 79.4% were girls, and 74% were in the 12–18 age group. It was determined that the presence of witnesses, evidence, and messages (16.37%) and discomfort with the suspect’s/abuser’s behavior (11.66%) facilitated the disclosure of abuse. On the other hand, reporting of abuse was delayed due to the suspect’s/abuser’s threats (18.85%) and the victim’s fear, embarrassment and avoidance of her/his family (10.66%). The characteristics of abuse and disclosure reasons varied based on age groups and the intimacy level of the suspect. It has been observed that pre-adolescent children may face cognitive obstacles in disclosing abuse.

Anxiety disorders in the elderly: the effect of child maltreatment

Introduction: Anxiety disorders in the elderly, when analyzed in light of the effects of childhood maltreatment, are notable not only for the high prevalence of these disorders in this age group, but also for the growing evidence that traumatic childhood experiences may play a significant role in its late development. Objective: To evaluate the influence of the occurrence and characteristics of child abuse and the clinical manifestation of anxiety disorders in the elderly. Methodology: This is a cross-sectional study, carried out with elderly people from socioeconomically disadvantaged neighborhoods in Porto Alegre, Brazil (n = 274), who responded to the Childhood Trauma Questionnaire (CTQ) and the Mini International Neuropsychiatric Interview 5.0 (MINI). more. Results: The development of anxiety disorder in the elderly was associated with several factors, reflecting a complex interaction between past experiences and present conditions. Among these factors, it was possible to deduce that the presence of child abuse, psychiatric comorbidities, disadvantaged financial conditions and low levels of education stood out. Conclusion: It is concluded that these findings support the hypothesis that child maltreatment is associated with anxiety disorders in the elderly and with specific levels of financial and educational conditions. Although they suggest that improving maladaptive social conditions in childhood could prevent anxiety disorders in the elderly.

Self-preferencing: Practices and Characteristics of Abuse of Dominant Position in Digital Markets

Self-preferencing is a new form of anti-competitive practice used to maintain a dominant position in the digital market. Platforms are suspected of playing a dual role as service providers while competing with third parties. This is manifested through preferential treatment towards their goods and services, potentially erecting entry barriers and impeding consumer substitution rights. The research method used is normative research with a statutory and case approach. The results show that the practices and characteristics of self-preferencing in several countries have certain behavioural similarities with those in Indonesia: providing discounts, market coverage, or limited facilities. This practice forms an entry barrier while eliminating consumers' rights to choose and compare with substitute products. The regulation that is used as a reference for the existence of prohibited behaviour as an abuse of dominant position is regulated in Article 25. The absence of explicit regulations addressing these behaviours creates challenges for competition authorities, particularly in AI-driven markets. Advanced economies have already begun enacting specialized laws and enforcement actions against platforms engaging in self-preferencing and other digital market transgressions. Indonesia's regulatory landscape must evolve to encompass these developments and technological advancements in the digital sphere.

Child Maltreatment and Psychopathology: A Brief Review on the Potential Role of the Hypothalamic-pituitary-adrenal Axis.

Child maltreatment is a widespread global issue involving any form of harm or neglect by a parent or caregiver, leading to various forms of physical or emotional damage, with approximately 150 million affected children globally. This study discusses the potential mechanism of the hypothalamic-pituitary-adrenal axis dysfunction and cortisol hormone changes in linking child maltreatment to mental health disorders. It also discusses supportive strategies to prevent mental diseases and counteract the biological embedding of these conditions, emphasizing the need for comprehensive interventions to address the long-term impact of child maltreatment on mental health. Articles were selected using established methods previously described. Key information was obtained from scientific articles published during the past 20 years, including original studies, systematic reviews, and meta-analyses. Articles search was performed using top academic search engines. While research on hypothalamic-pituitary-adrenal axis response to stress in maltreated children is ongoing and far from conclusive, its impact and implications for physiological functioning and the predisposition to psychopathology are significant. Childhood maltreatment increases the risk of psychiatric illnesses, severity of diseases, and poor treatment responses. Childhood maltreatment manifests as disruptions to hypothalamic-pituitary-adrenal axis functioning, with the extent varying based on factors, such as the age of onset, parental responsiveness, and the type and characteristics of maltreatment. The complex interplay of these factors contributes to the diversity of hypothalamic-pituitary-adrenal axis responses to stress in maltreated children, creating a spectrum of physiological functioning and vulnerability to psychopathology.

The Aesthetic Characteristics of Emotional Abuse in The Japanese Movie “0.5mm”

The Aesthetic Characteristics of Emotional Abuse in The Japanese Movie “0.5mm”

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia.

Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients. A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form. Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients. These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.

Extent of substance abuse among patients with psychiatric disorders in Amman, Jordan

IntroductionThe issue of substance abuse is increasingly being recogniszed as a significant global public health concern. In relation to its influence on the Arab world, scholarly investigation continues to be regarded as relatively constrained in scope.ObjectivesThe primary goal of the present study was to investigate the extent of substance abuse in a sample of patients with psychiatric disorders who attended a psychiatric clinic in Amman and analyse this in relation to demographic and clinical variables.MethodsIn this prospective study, we investigated the prevalence, sociodemographic, and clinical characteristics of substance abuse among patients with psychiatric disorders who attended an outpatient private psychiatric clinic in Amman, Jordan between January and May 2023. Overall, 671 patients were enrolled. We compared demographic and clinical parameters of drug abuse and non-drug abuse patients.ResultsAmong the 671 patients included in the study, 48.0% (n=322) reported substance use, while 52.0% (n=349) did not. The mean age of the patients was 32.45±10.18 years. The sample included 546 male patients (81.4%). Among the participants, 388 (57.8%) were single, 360 (53.7%) held a bachelor’s degree or higher, 394 (58.7%) were employed, and 545 (81.2%) lived with their families. 506 (75.4%) were smokers, 110 (16.4%) reported having a medical illness, and 25% reported engaging in self-harm. The most prevalent psychiatric diagnosis was major depressive disorder, accounting for 30.6% of cases, followed by anxiety disorders. Additionally, 148 patients (22.1%) reported emotional abuse, 40 (6.0%) reported physical abuse, 57 (8.8%) reported sexual abuse, and 47 (7.0%) had a family history of substance use.ConclusionsOur research findings indicate that substance abuse is more prevalent among certain demographic groups, specifically young, unemployed, male patients with a low level of education and a family history of substance use. These findings highlight the need for further research in diverse settings and populations to better understand the scope and underlying factors contributing to substance abuse in Arab countries. Additionally, targeted interventions and prevention strategies should be developed to address the specific needs of these high-risk groups and reduce the burden of substance abuse in these communities.Disclosure of InterestNone Declared

Hereditary and cortical morphological biomarker of sensitivity to reward in short-term withdrawal methamphetamine abusers.

Higher sensitivity to reward (SR) and weaker sensitivity to punishment (SP) construct the fundamental craving characteristics of methamphetamine abuse. However, few studies have appraised relationships between SR/SP (SR or SP) and cortical morphological alterations in methamphetamine abusers and whether hereditary factors take effects on SR/SP is unclear. Based on surface-based morphometric analysis, cortical discrepancy was investigated between 38 methamphetamine abusers and 37 healthy controls. Within methamphetamine abusers, correlation profiling was performed to discover associations among aberrant neuroimaging substrates, SR, SP, and craving. According to nine single nucleotide polymorphism sites of dopamine-related genes, we conducted univariate general linear model to find different effects of genotypes on cortical alterations and SR/SP/craving (SR, SP, or craving). Ultimately, mediation analyses were conducted among single nucleotide polymorphism sites, SR/SP/craving, and cortical morphological alterations to discover their association pathways. Compared to healthy controls, thinner cortices in inferior temporal gyrus, lateral orbitofrontal cortex, medial orbitofrontal cortex, inferior parietal lobule, and lateral occipital cortex in the left hemisphere were found in methamphetamine abusers (P < 0.05, family-wise error corrected). Cortical thickness in the inferior temporal gyrus was negatively correlated with SR scores. We found that rs1800497 A-containing genotypes had lower cortical thickness in the left inferior parietal lobule than the GG genotype. The rs5751876 had effects on SR scores. This study would provide convincing biomarkers for SR in methamphetamine abusers and offer potential genetic targets for personalizing relapse prevention.

Female Sexual Violence: A 12-Year Experience at a Single University Hospital in North-East Italy.

This retrospective study analyzed a case series of female sexual violence (SV) victims who were admitted to the emergency department of the University Hospital in Udine between January 2012 and April 2023. A total of 155 cases were divided into two groups according to their age: 115 adult victims and 40 minors. Compared with minors, adults had risk factors such as psychiatric disorders and past experience of SV, and reported bodily injuries and extragenital lesions more frequently. Moreover, a positive screening for sexually transmitted diseases and its association with genital injuries turned out to be significantly more present among adult victims than minors. In contrast, victims younger than 18 years tended to delay seeking medical help and more often did not report genital penetration. To conclude, a deeper knowledge of the different characteristics of sexual abuse among female adults and minors may help us to understand what the focus of prevention programs and public awareness campaigns should be.

The Transition of Sociodemographic and Substance Abuse Characteristics, Pairwise Co-occurrences and Factors Associated with Polysubstance Use Among US Adolescents and Young Adults.

Substance abuse by adolescents and young adults is a major public health issue. This study aimed to (i) show the transition of sociodemographic and substance abuse characteristics from 1992 to 2017 among US adolescents and young adults, (ii) evaluate the likelihood of co-occurrence of substances, and (iii) identify significant sociodemographic characteristics in association with polysubstance abuse. This study extracted data for adolescents and young adults from 1992 and 2017 Treatment Episode Data Set-Admission (TEDS-A) datasets. The extracted sample included 337858 admissions in 1992 and 333322 in 2017. Both years experienced significant admissions. A significant transition in 2017 compared to 1992 was evident in education, living status, and ethnicity. Substance-specific transition showed alcohol was dominant in 1992, while marijuana/ hashish was dominant in 2017. Also, heroin, other opiates/synthetics, and methamphetamine experienced an increase, while cocaine/crack decreased. The pairwise co-occurrences exhibited a considerable variation in the likelihood of using one substance given another one. The odds ratios (ORs) obtained from generalized ordered logit models showed significantly higher odds of one or more substances with age, while education showed the opposite scenario. A mixed effect of gender was evident in 1992, whereas females were significantly less likely with one or more substances than males in 2017. Other significant vulnerable groups were those not in the labor force, homeless, white, and Mexican Americans. The findings may help to understand the overall changes between 1992 and 2017 and take necessary measures to reduce the burden of this public health problem.

Contexts and Characteristics of Imaged-Based Sexual Exploitation and Abuse of Children: Incident Dynamics in a National Sample.

This paper describes incident characteristics and dynamics associated with six specific forms of image-based sexual exploitation and abuse of children (IBSEAC). Data were collected on a national sample of 2639 individuals aged 18-to-28 from a probability-based online panel. Respondents completed a self-administered survey questionnaire, providing detailed follow-up information on their experiences of image-based sexual victimization before the age of 18. A total of 607 incidents of IBSEAC were included in the analyses. Findings show substantial diversity in incident characteristics within and across the six forms of IBSEAC (nonconsensual sharing of sexual images, nonconsensual taking or making of images, forced image recruitment, threatened sharing, voluntary image sharing with an older adult, and commercial sexual exploitation involving images). Some notable patterns include frequent involvement of perpetrators who are other youth or young adults, who are known in-person to the victim, and who are intimate partners. The diversity and complexity of dynamics revealed in this study underscores the need for careful design and evaluation of prevention programs and the core messages directed at youth.