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. Author manuscript; available in PMC: 2018 Nov 2.
Published in final edited form as: J Subst Use. 2018 Jul 2;23(5):520–527. doi: 10.1080/14659891.2018.1489478

History of child sexual abuse among women consuming illicit substances in Mexico City

Miguel Ángel Mendoza-Meléndez a,b, Alice Cepeda c, Jessica Frankeberger c, Mateo López-Macario b, Avelardo Valdez c
PMCID: PMC6214458  NIHMSID: NIHMS989277  PMID: 30393464

Abstract

Introduction:

Child sexual abuse (CSA) is a pervasive problem that has been linked to numerous developmental, social, health, and substance use consequences. Nevertheless, the relationship between CSA and the consumption of psychoactive substances has not been adequately studied in Mexico. The present study aims to examine this association between history of CSA and illicit substance use and associated risk behaviors in a sample of young adult women in Mexico City.

Design and Methods:

The present study uses a cross-sectional design to examine sexual abuse history among women who use illicit substances. Data collection consisted of a questionnaire administered through face-to-face interviews with 101 women who sought treatment for substance use in Mexico City. A bivariate analysis was used to examine women who experienced sexual abuse and those who did not. Odds ratio and relative risk were estimated.

Results:

A total of 101 women were interviewed with an average age of 19.2 years. The average age of onset of drug use was 15.4 years. Among participants, 68% reported having been victims of sexual abuse and rape. The average age of reported sexual abuse was 12.2 years. Participants reported a high rate of polydrug use (32.7%), consuming more than two drugs. Sexual abuse was associated with detention by police for drugs, forced prostitution, and consumption of substances during pregnancy.

Discussion and conclusions:

This study found that sexual abuse and rape were highly associated with substance abuse outcomes and associated risk behaviors.

Keywords: Child sexual abuse, consume illicit substances, risk behaviors, substances use

Introduction

Child sexual abuse (CSA) is an important and pervasive problem that has been linked to numerous social, health, and developmental consequences for victims. For instance, CSA has been found to impact on the neurocognitive and brain development of children and adolescents, putting stress on susceptible regions of the brain throughout development (Anda et al., 2006; Andersen et al., 2008; Navalta, Polcari, Webster, Boghossian, & Teicher, 2006; Trickett, Noll, Susman, Shenk, & Putnam, 2010). While research has identified differences in outcomes based on severity, age at abuse, and relationship to the perpetrator (Cantón-Cortés & Rosario Cortés, 2015; Díaz-Negrete, Gutiérrez-López, Fernández-Cáceres, & Sánchez-Huesca, 2015; McLean & Gallop, 2003; O’Leary, et al, 2010; Pérez Del Río & Mestre Guardiola, 2013; Schoedl et al., 2010), CSA overall has been documented as a significant predictor of deterioration in mental health during adolescence and adulthood (Cantón-Cortés & Rosario Cortés, 2015; Chen et al., 2010; Echeburúa & Corral, 2006; Evrim, 2009; Hillberg, Hamilton-Giachritsis, & Dixon, 2011; Ramos-Lira, Saldívar-Hernández, Medina-Mora, Rojas-Guiot, & Villatoro-Velázquez, 1998). For instance, CSA is associated with an increased risk of anxiety and depression (Fergusson, McLeod, & Horwood, 2013; Maniglio, 2010), self-harm (Noll, Horowitz, Bonanno, Trickett, & Putnam, 2003), suicidal ideation (Chen et al., 2010; Fergusson et al., 2013), posttraumatic stress disorder (PTSD) (Chen et al., 2010; McLean & Gallop, 2003; Schoedl et al., 2010), borderline personality disorder (Ball & Links, 2009; Bandelow et al., 2005; McLean & Gallop, 2003), eating disorders (Smolak & Murnen, 2002; Wilson, 2010), and sleep disorders (Chen et al., 2010; Noll et al., 2006).

Similarly, epidemiological studies have found an increased risk of an array of physical health concerns and risky behaviors among women with a history of CSA, including obesity (Noll, Zeller, Trickett, & Putnam, 2007; Wilson, 2010), autoimmune disorders (Wilson, 2010), unplanned pregnancy (Trickett, Noll, & Putnam, 2011), and sexually transmitted infections (Mosack et al., 2010; Schacht et al., 2010; Springer, Sheridan, Kuo, & Carnes, 2003). A meta-analysis conducted by Irish, Kobayashi, and Delahanty (2010) found that a history of CSA was systematically associated with adverse outcomes in all physical health areas tested, including gastrointestinal, gynecologic, chronic pain, cardiopulmonary, and obesity. Moreover, research has documented the heightened rates of risky sexual behaviors and associated health conditions in adolescence and young adulthood among women who have experienced CSA (Mosack et al., 2010; Schacht et al., 2010; Springer et al., 2003; Trickett et al., 2011).

CSA has also been identified as a risk factor for substance abuse and dependence. Results of a systematic review, for example, found that adolescent and adult women with a history of CSA were twice as likely to develop later substance abuse problems (Simpson & Miller, 2002). Sartor et al. (2013) found that, after controlling for genetics and family influences, CSA was a distinct risk factor for tobacco and marijuana use in adolescent girls. Similarly, adolescent girls with a history of CSA have also been found to have increased rates of polydrug use compared to those who have not been abused (Shin, Hong, & Hazen, 2010). In a multisite study across the United States, CSA was found to be associated with an earlier initiation of injection drug use among young adult women (Ompad et al., 2005). On the other hand, Kingston and Raghavan (2009) found that CSA was not associated with an earlier age of drug use initiation in adolescents, but further victimization after CSA was associated. Thus, the relationship between CSA and the consumption of psychoactive substances has not been fully understood and requires more research, particularly in distinct risk environments and communities (Pérez Del Róo & Mestre Guardiola, 2013; Rodríguez et al., 2015).

While the impact of childhood sexual abuse is well documented (Chen et al., 2010; Evrim, 2009; Trickett et al., 2011; Wilson, 2010), CSA has been particularly understudied in Mexico (Pérez Del Río & Mestre Guardiola, 2013; Rodríguez et al., 2015). In 2009, the Organization for Economic Cooperation and Development (OCDE, 2013) and the United Nations Children’s Emergency Fund (UNICEF) ranked Mexico first in physical violence, sexual abuse, and homicides of minors 14 years old, which were mainly committed by their parents (UNICEF, 2014). High rates of CSA were recorded in Mexico with 77% of the victims being girls with an average age of 5.7 years and in almost all cases the victim knew the offender: the brother (19%), the stepfather (18%), an uncle (16%), and the father (15%) Dirección General de Prevención del Delito y Participación Ciudadana. (2010). Comparatively, in the United States, approximately 1 in every 10 children has experienced sexual victimization and approximately 15–32% of women reported having been sexually abused in childhood (Pulido et al., 2015). The data on sexual abuse in Mexico are scarce. The currently available data do not reflect the social reality of many victims, and it has not been fully incorporated in research and public policy discourse (Frías & Erviti, 2014). A recent global metaanalysis, for example, found a single study examining sexual abuse from Mexico (Stoltenborgh, Van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). Further, the existing epidemiological data of CSA in Mexico are believed to be underreported due to cultural norms that often silence and stigmatize issues related to sex and sexuality (Stoltenborgh et al., 2011). To fill these gaps in the literature, the current work aims to examine the association between history of CSA and illicit substance use and associated risk behaviors in a sample of women in treatment in Mexico City.

Methods

Participants

The present study uses a cross-sectional design to examine sexual abuse history among women who use illicit substances. Participants were recruited from 11 public nongovernmental substance abuse treatment facilities exclusively for women in Mexico City. All women (n = 160) were provided the opportunity to participate in the study and enrolled in the study only after providing informed consent. A total sample of 101 women agreed to participate. Data were collected through questionnaires administered in face-to-face interviews by trained personnel.

Measures

Data were collected through a 57-item questionnaire, which consisted of four sections:

  1. Socioeconomic demographics, such as age, income, marital status, place of residence, medical insurance status, employment, and education.

  2. Patterns of substance use, including marijuana, cocaine, crack, inhalants, tranquilizers, and amphetamines. Selfreported lifetime, past year, and past month use was measured for each drug.

  3. Sexual risk, including a history of sexual abuse or rape, prostitution, onset of being sexually active, consensual sexual intercourse, condom use with primary partner, condom use with casual partner, condom use with a partner who paid them, and condom use with partner with whom she paid.

  4. Use of illicit drugs during pregnancy.

  5. Main variables:
    • Sexual abuse: forcing a person to engage in sexual acts without her consent that may include sexual coercion, undue touching, sexual harassment, and child abuse (World Health Organization, 2012).
    • Rape: sexual intercourse, or other forms of sexual penetration, committed by a perpetrator against a victim without her consent (World Health Organization, 2012).

Analysis of data

A descriptive bivariate analysis was performed to examine the sociodemographic differences among women with a history of CSA compared to women with no such history. T-tests and chi-square (χ2) tests were utilized to compare these groups. Additionally, an ANOVA test was conducted to compare women who have been sexually abused, those who reported being raped, and those who have experienced both. Multivariate models estimated the odds ratio (OR) and relative risk (RR) of each variable. All analyses were conducted in IBM SPSS version 20 software.

Results

Among the sample of 101 participants, the average age was 19.24 (SD = 4.96). Most participants had a basic primary and secondary level education (84.1%), but only 5.9% completed high school. The average age of the onset of drug use was 15.43 years (SD ± 0.98%) with 32.7% reporting polydrug use in the last month. Almost all women (98.0%) were sexually active with an onset at 14.9 years of age on average. The demographic characteristics of the study sample are summarized in Table 1.

Table 1.

Demographic characteristics of sample (n = 101).

Characteristics n Average aS.D. ± Range
Age 101 19.24 4.96 (13–43)
School (years) 101 7.86 1.40 (6–16)
Average age of drug use 101 15.43 0.98 (7–43)
Age of crack intake 54 15.78 3.54 (8–26)
Age of marijuana consumption 89 16.60 3.84 (8–23)
Age of onset of inhalation 99 14.20 2.63 (7–43)
Age of onset of cocaine 48 14.27 4.32 (7–41)
Age of onset of amphetamines 30 15.71 4.90 (12–31)
Age of onset of tranquilizers 38 16.03 5.34 (8–42)
Number of drugs used in last year 101 3.03 1.40 (1−6)
Number of drugs used in last month 101 2.02 1.17 (0–6)
Age of onset of sexual activity 99 14.09 2.50 (10–24)
Age of sexual abuse (rape) 60 12.20 5.04 (3–24)
Number of sexual couples 101 3.36 3.71 (0–18)
Occasional couples 101 6.49 7.17 (0–28)
Couples who paid you 101 0.42 1.08 (0–60)
Couples to whom you paid 101 4.45 8.00 (0–9)
Average number of couples 101 4.45 3.20 (0–60)
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a

S.D. standard deviation

Figure 1 shows that 69 participants (68.3%) reported having been victims of sexual abuse and rape and 32 participants (31.7%) did not report any CSA. Among the sample of women with histories of CSA, 61% reported the abuse before initiation of drug use, with the remaining 39% indicating drug use before experiences of sexual abuse or rape. More specifically, a total of 60 women (59.4%) reported having been raped at an average 12.2 years of age, with only 10.9% of these women being 18 years or older at the time of the abuse. Results indicated significant differences among female drug users who suffered abuse and rape versus women who did not report any CSA [t = 6.81, gl = 1, p < 0.000)].

Figure 1.

Figure 1.

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Sample of participants who reported having been victims of sexual abuse and rape. The sample of participants (68%) reported being victims of sexual abuse and rape, and 32 (32%) who did not. The analysis indicates significant differences among users who suffered abuse and rape.

Table 2 presents the prevalence of sociodemographics in relation to abuse and rape. As illustrated, the population has scarce economic resources with 45.5% obtaining income from third parties and 44.6% reporting no employment. In addition, 12.9% reported having an informal job, although 44.6% benefits from some type of health insurance with 27.7% reporting use of public subsidized medical insurance seguro popular. Additionally, 36.6% live at the home of their parents or partner.

Table 2.

Prevalence of sociodemographic and consumption of substance drugs variables in relation to abuse, rape, and both. The substance use: 68.32% of the participants reported substance use in their lifetime, 64.36% in the last year, and 40.59% in the last month. As can be seen, most of the participants presented polydrug use.

Rape
 Sexual abuse
 Both
n Prevalence CI 95% n Prevalence CI 95% n Prevalence CI 95%
Age 18 years old or less 32 31.68 (22.61–40.76) 29 28.71 (19.89–37.54) 39 38.61 (29.12–48.11)
Over 18 years old 28 27.72 (18.99–36.45) 21 20.79 (12.88–28.71) 30 29.70 (20.79–38.61)
Marital status Married/ civil Union 13 12.87 (6.34–19.40) 12 11.88 (5.57–18.19) 15 14.85 (7.92–21.79)
Single 46 45.54 (35.83–55.26) 38 37.62 (28.18–47.07) 53 52.48 (42.74 −62.21)
Subsidized medical care No 22 21.78 (13.73 −29.83) 16 15.84 (8.72–22.93) 24 23.76 (15.46–32.06)
Yes 38 37.62 (28.18–47.07) 34 33.66 (24.45–42.88) 45 44.55 (34.86–54.25)
Type of medical care IMSS 14 13.86 (7.12–20.60) 8 7.92 (2.65–13.19) 14 13.86 (7.12–20.60)
ISSSTE 1 0.99 (−0.94–2.92) 2 1.98 (−0.74–4.70) 2 1.98 (−0.74–4.70)
Seguro popular 22 21.78 (13.73–29.83) 23 22.77 (14.59–30.95) 28 27.72 (18.99–36.45)
Private 1 0.99 (−0.94–2.92) 1 0.99 (−0.94–2.92) 1 0.99 (−0.94–2.92)
Does not count 22 21.78 (13.73–29.83 16 15.84 (8.72–22.96) 24 23.76 (15.46–32.06)
Job No 40 39.60 (30.07–49.14) 32 31.68 (22.61–40.76) 45 44.55 (34.86–54.25)
Yes 20 19.80 (12.03–27.57) 18 17.82 (10.36–25.29) 24 23.76 (15.46–32.06)
Job type Formal Job 3 2.97 (−0.34–6.28) 4 3.96 (0.16–7.76) 3 2.97 (−0.34–6.28)
Informal Job 17 16.83 (9.53–24.13) 14 13.86 (7.12–20.60) 13 12.87 (6.34–19.40)
Economic income by third parties No 17 16.83 (9.53–24.13) 20 19.80 (12.03–27.57) 23 22.77 (14.59–30.95)
Yes 43 42.57 (32.93–52.22) 30 29.70 (20.79–38.61) 46 45.54 (35.83–55.26)
Income from illicit activities No 52 51.49 (41.74 −61.23) 41 40.59 (31.02–50.17) 57 56.44 (46.77–66.11)
Yes 8 7.92 (2.65–13.19) 9 8.91 (3.35–14.47) 12 11.88 (5.57–18.19)
Education No education/incompleted 6 5.94 (1.33–10.55) 5 4.95 (0.72–9.18) 6 5.94 (1.33–10.55)
Elementary school 26 25.74 (17.22–34.27) 19 18.81 (11.19–26.43) 28 27.72 (18.99–36.45)
Middle school 23 22.77 (14.59–30.95) 23 22.77 (14.59–30.95) 30 29.70 (20.79–38.61)
High School 4 3.96 (0.16–7.76) 2 1.98 (−0.74–4.70) 4 3.96 (0.16–7.76)
Post-secondary education 1 0.99 (−0.94–2.92) 1 0.99 (−0.94–2.92) 1 0.99 (−0.94–2.92)
Where do you live House or independent apartment 8 7.92 (2.65–13.19) 10 9.90 (4.08–15.73) 11 10.89 (4.82–16.97)
Parent or couple home 33 32.67 (23.53–41.82) 25 24.75 (16.34–33.17) 37 36.63 (27.24–46.03)
Shelter or prison 11 10.89 (4.82–16.97) 9 8.91 (3.35–14.47) 11 10.89 (4.82–16.97)
Street 8 7.92 (2.65–13.19) 6 5.94 (1.33–10.55) 10 9.90 (4.08–15.73)
Consumption of illicit substances at some time in life No 0 0.00 (0.00–0.00) 0 0.00 (0.00–0.00) 0 0.00 (0.00–0.00)
Yes 60 59.41 (50.45–69.55) 50 49.50 (40.25–59.75) 69 68.32 (59.98–78.02)
Consumption of illicit substances in the last year No 3 2.97 (−0.34–6.28) 3 2.97 (−0.34–6.28) 4 3.96 (0.16–7.76)
Yes 57 56.44 (46.77–66.11) 47 46.53 (36.81 −56.26) 65 64.36 (55.02–73.70)
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In relation to the use of substances among women who experienced CSA, 68.3% reported consumption of illicit substances sometime in their lifetime, 64.4% in the last year, and 40.6% in the last month. High rates of polydrug use, which is a consumption of two or more drugs, were also observed. Those who did not present polydrug use at the initiation of drug use were 64.4%. Of those who reported polydrug use, 62.4% used more than two illicit substances in the last year and 47.5% in the last month.

For women with a history of sexual abuse whose main partners were stable, 64.4% used condoms as a method of protection. Likewise, 56.4% of participants with occasional partners also used condoms. Moreover, 28.7% of the women reported a pregnancy during which they did consume illicit substances.

Table 3 presents the main variables associated with sexual abuse and rape. Women with a history of sexual abuse were significantly more likely to access and receive public subsidized medical benefits (seguro popular) (χ2 [1] = 4.147 P = 0.042). Abused women were also more likely to receive financial support from their social networks (χ2 [1] = 11.10 P = 0.001). Women who experienced sexual abuse and rape reported significant rates of use of condoms with partners who paid for sex (χ2 [1] = 14.418 P = 0.000; OR = 0.185, 95% CI = 0.075–0.457). In contrast, for those women reporting paying for sex, condom use was less frequently used (χ2 [1] = 5.417 P = 0.020; OR = 0.268, 95% CI = 0.84–0.853).

Table 3.

Main variables associated with sexual abuse and rape: detained by the police for consumption of drugs, forced into prostitution, and consumed drugs while pregnant.

Victim of abuse sexual and rape sexual
Yes % No % % Total Chi-square OR CI 95% RR CI 95%
Age Under 18 years old 38.61 18.81 57.42 χ2 (1) = 0.073
P = 0.787		 0.889 (0.380–2.083) 0.964 (0.738–1.258)
Over 18 years old 29.7 12.87 42.57 - - - - -
Marital status Married/Civil Union 15.00 9.00 24.00 χ2 (1) = 0.439
P = 0.508		 0.723 (0.277–1.890) 0.896 (0.636–1.264)
Single 53.00 23.00 76.00 - - - -
Subsidized Medical Care No 23.76 17.82 41.58 χ2 (1) = 4.147
P = 0.042		 0.415* (0.176–0.977) 0.749 (0.556–1.009)
Yes 44.55 13.86 58.41 - - -
Employed No 44.55 15.84 60.40 χ2 (1) = 2.116
P = 0.146		 1.875 (0.800–4.395) 1.230 (0.916–1.650)
Yes 23.76 15.84 39.60 - - - - -
Job type Informal Job 18.81 12.87 31.68 χ2 (1) = 0.026
P = 0.872		 0.887 (0.178–4.325) 0.950 (0.917–1.746)
Formal Job 4.95 2.97 7.92 - - -
Financial Support from Social Network No 22.77 21.78 44.55 χ2 (1) = 11.10
P = 0.001		 4.400* (1.790–10.818) 0.622 (0.456–0.849)
<bold>Yes</bold> 45.54 9.9 55.44 - - - -
Income from illicit activities No 56.44 28.71 85.15 χ2 (1) = 1.111
P= 0.292		 2.035 (0.532–7.786) 0.828 (0.617–1.112)
Yes 11.88 2.97 14.85 - - -
Education Compulsory education (Elementary school and Middle school) 57.43 26.73 84.16 χ2 (1) = 0.600
P = 0.439		 0.430 (0.048–3.858) 0.817 (0.557–1.205)
Compulsory education (High School) 4.95 0.99 5.94 - - -
Where do you live Hostel, street or prison 20.79 4.95 25.74 χ2 (1) = 2.508
P = 0.113		 2.363 (0.800–6.980) 0.792 (0.615–1.020)
House or apartment 47.52 26.73 74.26 - - - - -
Consumption of illicit substances at some time in life No 3.96 1.98 5.94 χ2 (1) = 0.008
P = 0.929		 1.083 (0.188–6.244) 1.026 (0.573–1.837)
Yes 64.36 29.7 94.06 - - - - -
Consumption of illicit substances in the last year No 27.72 11.88 39.6  χ2 (1) = 0.087
P = 0.768		 0.879 (0.371–2.080) 0.960 (0.734–1.255)
Yes 40.59 19.8 60.39 - - - - -
Age of onset of crack consumption Under 18 years old 31.68 9.90 41.58 χ2 (1) = 0.441
P = 0.507		 1.600 (0.397–6.453) 1.143 (0.740–1.764)
Over 18 years old 7.92 3.96 11.88 - - - - -
Age of onset of marijuana use Under 18 years old 54.46 24.75 79.21 χ2 (1) = 0.016
P = 0.898		 1.100 (0.254–4.757) 1.031 (0.635–1.675)
Over 18 years old 5.94 2.97 8.91 - - - - -
Age of onset of inhalants consumption Under 18 years old 60.40 25.74 86.14 χ2 (1) = 0.681
P = 0.409		 1.676 (0.487–5.768) 1.202 (0.731–1.977)
Over 18 years old 6.93 4.95 11.88 - - - - -
Age of onset of cocaine use Under 18 years old 29.70 10.89 40.59 χ2 (1) = 0.743
P = 0.389		 2.045 (0.393–10.637) 1.280 (0.657–2.497)
Over 18 years old 3.96 2.97 6.93 - - - - -
Age of onset of amphetamine use Under 18 years old 17.82 4.95 22.77 χ2 (1) = 0.140
P = 0.708		 1.440 (0.212–9.782) 1.096 (0.654–1.835)
Over 18 years old 4.95 1.98 6.93 - - - - -
Age of onset of tranquilizers Under 18 years old 25.74 4.95 30.69 χ2 (1) = 0.588
P = 0.443		 2.080 (0.312–13.889) 1.174 (0.174–1.923)
Over 18 years old 4.95 1.98 6.93 - - - - -
Polydrug use at some time in life No 64.36 28.71 93.07 χ2 (1) = 0.434
P = 0.510		 0.595 (0.125–2.830) 0.826 (0.429–1.592)
Yes (2 or more) 3.96 2.97 6.93 - - - - -
Polydrug use last year No 62.38 26.73 89.11 χ2 (1) = 1.082
P = 0.298		 1.944 (0.546–6.921) 1.283 (0.736–2.238)
Yes (2 or more) 5.94 4.95 10.89 - - - - -
Polydrug use last month No 47.52 19.80 67.33 χ2 (1) = 0.496
P = 0.481		 1.371 (0.569–3.308) 1.109 (0.822–1.497)
Yes (2 or more) 20.79 11.88 32.67 - - - - -
Detention for consumption of illicit drugs No 30.69 22.77 53.46 χ2 (1) = 6.381
P = 0.012		 3.133* (1.267–7.743) 1.408 (1.077–1.842)
Yes 37.62 8.91 46.53 - - - - -
Consensual intercourse No 63.37 28.71 92.08 χ2 (1) = 0.136
P = 0.712		 1.324 (0.296–5.917) 0.908 (0.522–1.580)
Yes 4.95 2.97 7.92 - - - - -
Forced to prostitute herself No 57.43 31.68 89.11 χ2 (1) = 5.725
P = 0.017		 1.552** (1.331–1.809) 1.552** (1.331–1.809)
Yes 10.89 0.00 10.89 - - - - -
The use of condom with the main partner No 3.96 0.99 4.95 χ2(1) = 0.332
P = 0.565		 1.908 (0.205–17.789) 1.182 (0.746–1.871)
Yes 64.36 30.69 95.05 - - - - -
The condom use with the occasional partner No 11.88 6.93 18.81 χ2(1) = 0.288
P = 0.592		 0.752 (0.265–2.136) 0.909 (0.626–1.318)
Yes 56.44 24.75 81.19 - - - - -
Using a condom with the partner who paid you No 17.82 20.79 38.61 χ2 (1) = 14.418
P = 0.000		 0.185* (0.075–0.457) 0.561* (0.392–0.803)
Yes 50.50 10.89 61.39 - - - - -
Using a condom with the partner you paid No 44.55 27.72 72.28 χ2(1) = 5.417
P = 0.020		 0.268* (0.084–0.853) 0.719* (0.568–0.910)
Yes 23.76 3.96 27.72 - - - - -
Consumption of illicit drugs in pregnancy No 39.6 26.73 66.33 χ2(1) = 6.825
P = 0.009		 3.915* (1.347–11.383) 1.429* (1.122–1.818)
Yes 28.71 4.95 33.66 - - - - -
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In regard to substance use and related risk behaviors, women who experienced sexual abuse were significantly more likely to have been detained by the police for consumption of drugs (χ2 [1] = 6.381 P = 0.012) with an OR of 3.133 (95% CI = 1.267–7.743). That is, they were more than three times likely to have been detained by police for drugs than women who did not experience sexual abuse, and women who experienced sexual abuse were significantly more likely to have been forced into prostitution (χ2 [1] = 5.725 P = 0.017) with an OR of 1.552 (95%CI = 1.331–1.809). That is, they were more than 1.5 times likely to have been forced into prostitution than women who did not experience sexual abuse. In addition, abused women reported consuming illicit drugs while pregnant significantly more than women who were not sexually abused (χ2 [1] = 6.825 P < 0.01). Women with a history of sexual abuse were 3.915 times more likely to report this (95% CI = 1.347–11.383). It was found that women with a history of sexual abuse were forced into prostitution (RR = 1.552), arrested by the police for drug consumption (RR = 1.408) and who consumed drugs while pregnant (RR = 1.429).

Discussion and conclusions

Findings from this study begin to provide an epidemiological profile of women with histories of CSA in Mexico. This vulnerable population has been largely overlooked given the scarcity of research in Mexico on this issue. Results from this analysis highlight women’s susceptibility for engaging in highrisk behaviors, similar to that which has been found in the United States. For example, we find that those reporting CSA were more likely to have histories of engaging in forced prostitution. This is similar to what researchers in the United States have documented among adult survivors of CSA being reinforced and perpetuated over the life course and expressed in the form of promiscuity or prostitution (Abramovich, 2014). Future research in Mexico will need to look into other factors that contribute to forced prostitution, including labor opportunities, homelessness, and drug dependence (Gómez San Luis & Almanza Avendaño, 2012).

Expanding upon the existing knowledge related to CSA and substance use behaviors, our findings point to women in this Mexican context being more likely to be arrested for drug use and engage in illicit drug use during pregnancy. This supports existing research that documents women’s involvement in detrimental drug use patterns and risky behaviors (Simpson & Miller, 2002). One limitation is the lack of information on the type of substance and the period in which it was consumed. Data on consumption of illicit substances during pregnancy are lacking for the majority of low- and middle-income countries, according to the World Health Organization. Research indicates that cannabis is the most common illicit drug worldwide, followed by amphetamine-type stimulants and opioids, and as such, may be more likely to be used by reproductive-aged women (Forray, 2016). In contrast, the most prevalent drugs in this study were inhalants and crack.

Paradoxically, there were several unexpected findings that should be noted. Women with histories of CSA were found to utilize subsidized medical insurance services and obtain financial support from their existing social networks, in comparison to their non-CSA counterparts. These findings may be unique to the Mexico context and may point to a safety net for women who are disproportionately vulnerable to numerous health and social conditions. The above coincides with the data obtained by the Instituto Nacional de Estadistica y Geografia (2013) (National Survey of Employment and Social Security) conducted in Mexico that shows that women use the following types of health insurance in order of frequency: popular health insurance, Instituto Mexicano del Seguro Social (IMSS), unaffiliated, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), and private institution. Popular health insurance is the program that has the largest number of affiliation (Instituto Nacional de Estadistica y Geografia, 2014). In addition, women with histories of CSA reported higher rates of condom use with clients and/or those they pay for sex. These results support data obtained by the Instituto Nacional de Estadistica y Geografia (2014) (National Survey of Demographic Dynamics) carried out in Mexico, which indicate that 98.7% of women between 15 and 49 years know at least one method of birth control. Although our study method did not allow us to know this category, the majority of the participants reported having used a condom as a method of protection with their main and occasional partner.

Women with histories of CSA were found to have low socioeconomic status (Essabar, Khalqallah, & Dakhama, 2015), no formal employment but rather part of the informal economy, low levels of education, and living with parents. Findings also reveal higher rates of illicit substance use; they started using drugs at a very young age, inhalants being the substance most frequently reported. Finally, a total of 60 women reported having been raped at an average age of 12.2 years. CSA rates reported in this study were found to be higher, in particular with experiences occurring before initiation of drug use. It is possible that these characteristics increase the vulnerability of women with a history of CSA to drug use.

Within the limitations of this study, it should be noted that the sample is small which can influence the fact that no significant difference would be detected in some comparisons. In addition, the study did not have a control group (which is difficult to obtain in this type of study). This study did not include specific forms of abuse and only included general situations exclusively on physical contact (Ramos-Lira et al., 1998; Ramos-Lira, Saltijeral-Méndez, Romero-Mendoza, Caballero-Gutiérrez, & Martínez-Vélez, 2001). It is important to study the substance use, taking into account characteristics that allow for information about their specific needs to inform a comprehensive treatment program (Castillo Franco & Gutiérrez López, 2008). Research on sexual abuse in Mexico is scarce; there is no public policy of comprehensive care for women who use drugs with histories of CSA, contributing to a public health problem that has not been addressed in Mexico. In conclusion, it is evident from the results that women with a history of sexual abuse were highly associated with substance abuse and risk behaviors. CSA has also been identified as a risk factor for substance abuse.

Acknowledgement

The author are grateful to Trinidad Alcantara Mejia for the facilities provided for the realization of this research.

Funding

Interdisciplinary Research Training Institute on Hispanic Drug Abuse at the University of Southern California (USC) NIDA 2R25DA026401 and grant CENSIDA proy-2014-0314.

Footnotes

Disclosure of potential conflicts of interest

The authors have no conflict of interest.

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