Association for Public Policy Analysis & Management

Rationale: Beyond immediate trauma, extant literature suggests that the consequences of childhood sexual abuse may be wide-ranging and long-lasting. Neuroscience literature describes that chronic stress in childhood leads to dysregulation of the neuroendocrine immune circuitry. Prior work has measured higher rates of obesity, diabetes, hypertension, and metabolic syndrome in adults with histories of childhood abuse—while controlling for some measure of childhood socioeconomic status but with some inconsistencies by population. Yet, the literature has largely overlooked acute health conditions of adult survivors of childhood abuse. At the same time, a small body of descriptive literature shows that childhood sexual abuse was associated with poorer labor market outcomes in adulthood. Thus, adults with histories of childhood sexual abuse may have not only a greater health burden but also less ability to pay for health care.

Objective: To examine health and health care access of adult survivors of childhood sexual abuse.

Data: I utilize the National Longitudinal Study of Adolescent to Adult Health, which recruited a random sample of children aged 11-18 in 1994-1995 from both public and private schools. Outcomes were evaluated in Wave IV during 2008-2009 when participants were 24-34 years old. About 15,000 individuals completed both Wave I and Wave IV interviews.

Methods: To study adult health, I examine reports of use of all prescription medications in the past four weeks, by medication class. To study health care access, I examine subjective reports of unmet health care needs in the past 12 months, worse health due to the unmet health care need, and uninsured status. I control for demographics, other adverse childhood experiences, childhood socioeconomic status, and I use school fixed effects in regression analyses to parse out observed and unobserved factors of the childhood neighborhood and schooling environment that may influence health and economic welfare. Childhood sexual abuse is defined as contact sexual abuse before age 18, as reported in the Wave III or Wave IV self-interview sections. I address missing data with multiple imputation. To examine whether there is a plausibly causal link from childhood sexual abuse to adult uninsured status, I will follow methods by Altonji, Elder, and Taber (2002) and Oster (2017) to bound treatment effects.

Results: Survivors of childhood sexual abuse had higher rates of using drugs indicated for mental health disorders, insomnia, and bacterial infections. Survivors were also more likely to be uninsured, to have had an unmet health care need in the past 12 months, and to report a worsening of health due to the unmet health care need.

Discussion: This study showed that, in a sample of young adults in the pre-ACA era, survivors of childhood sexual abuse had lower rates of insurance coverage. By identifying a vulnerable population with reduced coverage rates, results might support insurance expansions. The health care delivery system could respond to findings that survivors had greater health burden by incorporating screening for child maltreatment into well child visits so that children receive needed care in the moment, which might prevent longer-term health care needs and costs.