HEALTH EDUCATION RESEARCH
5 2005
Theory & Practice
Awareness of child sexual abuse prevention education
among parents of Grade 3 elementary school pupils in
Fuxin City, China
Jing Qi Chen1,3 and Da Guang Chen2
Abstract
Several recent studies on child sexual abuse
(CSA) in Chinese society have shown that the
problem is not uncommon, and is associated
with poor mental health and health-related risk
behaviors of abused youth. It is very important
to understand and improve public awareness of
CSA prevention, especially for the parents.
However, there are few published reports on
the problem of parents’ awareness. To fill this
gap, knowledge, attitudes and practice of CSA
prevention education were explored in 385
parents of Grade 3 pupils from four schools in
Fuxin City of Liaoning Province in the north-
east part of China by self-administered anony-
mous questionnaires. Among this sample, more
than 80% of parents approved of school CSA
prevention education. However, at the same
time, 47.3% of parents expressed some concern
that this education may induce the children to
learn too much about ‘sex’. Overall, about 60%
of parents had told their children that their
‘private parts’ should not be touched by others
and discussed strategies of ‘Say ‘‘No!’’, Leave
and Tell’ in dealing with CSA situations or the
situations that may lead to CSA. Only 4.2% of
parents had provided books or other material
1
Institute of Child and Adolescent Health, Health Science
Center, Peking University, Beijing 100083 and 2College
of Adult Education, Liaoning Technical University,
Liaoning Province, Fuxin 123000, China
3
Correspondence to: J. Q. Chen;
E-mail: g3jing_qi@bjmu.edu.cn
Health Education Research Vol.20 no.5, Ó Oxford University Press 2005; All rights reserved
Vol.20 no.
Pages 540–547
Advance Access publication 8 February 2005
about CSA prevention for their children. The
parents’ CSA prevention knowledge was in-
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adequate. The findings from this research will
be useful in developing CSA prevention educa-
tion programs in schools and communities,
designed to improve parents’ knowledge and
practice of CSA prevention.
Introduction
Numerous surveys on child sexual abuse (CSA)
showed that CSA is a common and important
problem in the world. In China, although there is
still no large-scale national survey of the occurrence
of CSA, some recent local retrospective studies
based on convenience samples of students in
Chinese society revealed that the problem of CSA
is not uncommon (Tang, 2002; Chen et al., 2002,
2003, 2004a; Chen and Dunne, 2003).
Due to the fact that CSA is so prevalent, and
impairs the health and welfare of children and
adolescents, a series of CSA prevention pro-
grammes have been conducted in schools and
communities in the USA, Canada and some other
countries since 1977 to increase public awareness
of the CSA problem (Finkelhor, 1986; Finkelhor
and Strapko, 1992).
Such interventions require adequate formative
research, particularly among parents who play an
important role in child growth and development.
Parents’ knowledge of CSA prevention will in-
fluence their children’s CSA prevention awareness
directly. Therefore, this paper raises the following
questions:
 What do parents know about CSA prevention?
doi:10.1093/her/cyh012

 What CSA topics have parents talked about with
their children?
 What are the parents’ attitudes towards CSA
prevention education in schools?
In order to explore these questions, parents in Fuxin
City of Liaoning Province in the northeast of China
were surveyed. The findings of this study will
provide important information for CSA prevention
education planning in schools and communities in
China.
Methods
A cross-sectional study was undertaken among
parents of primary school pupils in Fuxin during
September 2003. The aim of this research was to
understand parents’ awareness about CSA preven-
tion and to provide a basis for designing a CSA
prevention programme in schools and the commu-
nity. The objectives of this survey were (1) to
determine the strengths and weaknesses in the
factual knowledge that the parents have about
CSA prevention, (2) to ascertain parents’ attitudes
towards CSA prevention education, and (3) to
understand parents practice regarding communica-
tion with their children about CSA prevention. The
study did not document CSA itself.
Four schools were chosen and, for convenience,
parents of children in Grade 3 became the study
population. Two Grade 3 classes in each school
were selected and a total of 498 pupils were
enrolled.
Among this population, 447 parents or guardians
participated in this self-administered questionnaire
survey and returned their completed questionnaires.
Of these, 62 questionnaires were rejected due to the
fact that some of the respondents were not pupils’
parents or did not specify their relationship to the
child. Some questionnaires could not be used
because the respondents did not provide key in-
formation, such as children’s gender, or missed four
or more questions.
The questionnaire was based on research object-
ives derived from a comprehensive literature re-
view [especially the publications of (Tutty, 1993;
Awareness of CSA prevention in Fuxin City, China
Finkelhor and Strapko, 1992; Calvert and Munsie-
Benson, 1999; Olsen and Kalbfleisch, 2001)] and
findings from our own previous in-depth interviews
on the problem of CSA.
The questionnaire mainly included general de-
mographics, CSA prevention education-related
knowledge, attitudes and practice, and parents’
experiences of being taught about CSA prevention
in schools and at home when they were children.
There were 10 questions on CSA prevention
knowledge, e.g. that CSA is a common problem
around the world, that children are most likely to be
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sexually abused by people familiar to them, that
there is usually no obvious physical evidence in
a sexually abused child and that boys also can be
sexually abused. Responses to the 10 knowledge
items were scored on a 10-point scale.
Five items were compiled regarding attitudes
towards CSA prevention education. Response
choices to the items were simply ‘Agree’ and
‘Disagree’, with ‘Agree’ being scored as 1 point
and ‘Disagree’ as 0 points. Thus, the range of scores
on the attitude scale was from 0 to 5 points, with the
higher the score, the more supportive the attitude
towards CSA prevention education.
Seven questions were compiled to understand the
parents’ practice of CSA prevention education.
These questions focused on the basic content of
CSA prevention education in children. These
mainly included the concept of their ‘private parts’
(i.e. the genitals and breast areas), that children
should be told that a person’s body belongs to him
or her and no other person should touch a child’s
private parts except for health reason, the skills of
dealing with situations that may lead to sexual
abuse (i.e. ‘Say ‘‘No!’’, Leave and Tell’), the tricks
that adults may use to entice a child to accompany
them, such as offers of candy, requests for help to
find them lost puppies or to accompany them to the
nearest shop, and whether parents had provided
books or other audiovisual materials which in-
cluded CSA prevention content for their children.
Responses to the items dealing with practice were
based on a two-point scale, ‘Yes’ or ‘No’. The
‘Yes’ response was given a score of 1. The ‘No’
response was given a score of 0. The range of scores
541
J. Q. Chen and D. G. Chen
on the parental practice scale is from 0 to 7 points.
The higher the scores, the more actions the parents
took regarding CSA prevention education.
Five parents were surveyed using the question-
naire to test its readability. Psychometric properties
of the instrument were established using all data for
internal reliability. Internal reliability analyses of
subscales of knowledge, attitudes and practice pro-
duced a levels of 0.42, 0.81 and 0.61 respectively.
The parents completed their questionnaire either
in their children’s classroom during school guard-
ians’ meetings (in three schools) or at their home.
The definition of CSA, survey aim and methods of
filling in the questionnaire were explained in the
first page of the questionnaire. The participation
was voluntary and the survey was anonymous.
The Statistical Package for Social Sciences was
used for data analysis. Frequency, percentage and
mean score of relative indicators were calculated to
describe the status of knowledge, attitudes and
practice of CSA prevention education in parents.
Analysis was performed using the t-test, v2-test and
one-way ANOVA to identify possible influencing
factors for parents’ knowledge, attitudes and
practice.
Results
All of the 385 respondents were pupils’ parents—
115 fathers (29.9%) and 270 mothers (70.1%). The
mean age was 34.6 6 2.3 years for men and 33.8 6
2.6 years for women; the women were significantly
younger than the men (t = 2.81, P = 0.005). Most
parents had a high school education, either at the
junior (17.5%) or senior (46.0%) level. One percent
had only primary school education and 35.5% had
junior college education or higher level. Their
children were nearly evenly divided between girls
(51.9%) and boys (48.1%). At the time of the
questionnaire survey, their children’s mean age was
8.8 years.
More than 80% of the respondents knew that the
problems of CSA exist around the world (83.9%)
and that a person who has sexually abused a child
542
will likely repeat the offense (83.6%). Nearly 80%
of respondents knew that the sexually abused child
was not to blame (79.0%) and that boys can also be
sexually abused (78.7%). More than 70% of re-
spondents believed that men sexually abuse chil-
dren in most cases (75.7%).
Sixty percent of the parents knew that the child
who was sexually abused will be ‘held back’ from
disclosing the case by the abuser (61.6%) and that
females also can sexually abuse children (63.4%).
However, relatively few of the respondents be-
lieved that children who report sexual abuse could
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be believed almost all the time (40.7%); that if
a child has been sexually abused, there will usually
be no obvious physical evidence (28.1%); and
children are most likely to be sexually abused by
people familiar to them (28.2%). See Table I.
Concerning attitudes towards school-based CSA
prevention education, more than 80% of the parents
supported school CSA prevention education (89.8%),
were willing to let their children acquire some CSA
prevention knowledge in school (87.3%), did not
agree with the opinion that there is no need to con-
duct CSA prevention education because children
will learn by themselves as they grow up (84.6%)
and did not agree with the opinion that CSA is un-
common so there is no need to for children acquire
such knowledge (85.9%). There were, however,
still 47.3% of parents who showed some concern
that CSA prevention education might lead to their
children learning more ‘sex’. See Table II.
Questions on the practice of CSA prevention
education revealed that almost all of the respond-
ents had talked to their children about not going
with others, even familiar grown-ups, unless they
had parental permission (95.3%). Most had told
their children not to accept gifts from strangers
unless they had parental permission (96.4%). Also,
most had instructed their children that if an un-
familiar person wanted them to show him the way
to the nearest store, they should do not go with him
(96.1%).
In contrast to these topics, relatively few re-
spondents had told their children that their private
parts (parts covered by a swimsuit/bathing suit)
should not be touched by others (59.0%), that if
 Awareness of CSA prevention in Fuxin City, China

Table I. The number and percentages of parents who answered correctly the questions regarding CSA prevention knowledge

Items Response Answered correctly

N %

1. The problems of CSA exist around the world (T) 384 322 83.9
2. Children are most likely to be sexually abused by. . . ? (familiar people) 380 107 28.2
3. A person who has sexually abused a child will likely repeat the offense (T) 379 317 83.6
4. Whose fault is CSA? (molester) 385 304 79.0
5. If a child has been sexually abused, there will usually be 381 107 28.1
no obvious physical evidence (T)
6. Females cannot sexually abuse children (F) 385 244 63.4
7. Boys cannot be sexually abused (F) 385 303 78.7
8. The child who was sexually abused will be held back from 380 234 61.6

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disclosing the episode by the abuser (T)
9. Children, who report being sexually abused, can be believed? 381 155 40.7
(can be believed almost all the time)
10. Men sexually abuse children in most cases (T) 382 289 75.7

Table II. Parents’ attitudes towards school CSA prevention education (%)

Items Responses Agree/willing/yes Disagree/unwilling/no

1. Do you agree to CSA prevention education in school? 384 89.8 10.2

2. Are you willing to let your child learn CSA prevention 385 87.3 12.7
knowledge in schools?
3. Are you afraid that CSA prevention education may induce your 385 47.3 52.7
child to know too much about sex?a
4. There is no need to conduct CSA prevention education, because 384 15.4 84.6
the child will acquire such knowledge as he/she grows upa
5. I believe that CSA cases are very few, so it is unnecessary for 382 14.1 85.9
children to learn how to prevent CSAa
a
For items 3–5, score agree/yes = 0 and disagree/no = 1.

someone wants to see or touch your private parts,
you should definitely say ‘No’ and leave at once
(60.3%), and that if sexual abuse happens, parents
or other trustworthy adults should be told (54.3%).
Parents were also asked whether they had provided
books or audiovisual materials about CSA pre-
vention for their children; only 4.2% of them
reported that they had done so.
Another two questions were designed to explore
the information on CSA prevention education the
respondents had received in school and at home.
Only 7.9% of respondents reported that their
parents or other adults in their family had talked
to them about how to prevent CSA before they were
18 years old and 6.8% answered that they had been
taught about CSA prevention by teachers while
they were at school (including in kindergarten).
Further analysis explored the factors that may be
associated with parents’ knowledge, attitudes and
practices. Parents’ own gender was not associated
with differences in knowledge and practice scores,
but fathers showed a more positive attitude toward
CSA prevention education in schools (4.2 points)
than mothers (3.9). The parents were divided into
two age groups: less than 35 years and 35 years or
greater. There were no significant differences in
knowledge, attitudes and practice scores between
the two groups (Table III). The respondents were

543
J. Q. Chen and D. G. Chen

divided into three groups based on their education
levels: (1) junior high school or lower, (2) senior
high school/technical secondary school and (3)
junior college or higher.
One-way ANOVA showed that the mean know-
ledge scores increased with increasing educational
attainment from 5.5 among those with junior high
school or less to 6.6 among those with junior
college or higher (F = 7.49, P = 0.001). Regarding
the attitudes and practice of CSA prevention edu-
cation scores, there were no significant differences
between respondents who had different education
cant difference. In the item ‘telling child to disclose
sexual abuse episodes to parents or other trusted
adult if it happened’ (told daughter: 60.9% versus
told son: 47.3%; v2 = 7.12, P = 0.008) and the item
related to telling a child not to accompany an
unfamiliar person to the nearest store (told daugh-
ter: 98.0% versus told son: 94.1%; v2 = 4.00, P =
0.046). Regarding the remaining five items, there
were no significant differences between these two
groups. See Tables III and IV.
Finally, the parents own experiences about re-
ceiving CSA education were analyzed. Compared

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levels (P > 0.05) (Table III).
Parents’ knowledge and attitudes were not re-
lated to their children’s gender. Comparing child’s
gender with CSA education practice revealed that
parents were more likely to provide this to girls than
boys (4.8 points versus 4.5, t = 2.47, P = 0.014).
Individual practice items subsequently were ana-
lyzed to determine which items reflected a signifi-
with the respondents whose guardians had not
talked to them about how to prevent CSA, the
respondents whose guardians had talked to them
showed more positive attitudes towards school
CSA prevention education (score 4.55 versus
3.97, t = 4.15, P = 0.000) and were more active
in education practice on CSA prevention (score
5.72 versus 4.56, t = 6.51, P = 0.000). Concerning

Table III. Demographic characteristics of KAP scores of CSA prevention education of the parents (mean 6 SD)

Demographics Knowledge (0–10) Attitudes (0–5) Practice (0–7)

Responses Mean 6 SD Responses Mean 6 SD Responses Mean 6 SD

Gender
male 108 6.37 6 1.96 115 4.24 6 1.28 113 4.49 6 1.52
female 255 6.20 6 1.66 265 3.92 6 1.44 263 4.73 6 1.29
t 0.847 2.096 1.461
P 0.398 0.037 0.146
Age
<35 years 240 6.16 6 1.65 249 4.03 6 1.38 247 4.63 6 1.39
>35 years 117 6.44 6 1.90 125 4.02 6 1.44 123 4.72 6 1.33
t 1.415 0.105 0.555
P 0.158 0.916 0.579
Education level
junior high school or lower 58 5.52 6 1.64 70 3.76 6 1.48 69 4.51 6 1.45
senior high school 170 6.25 6 1.66a 174 3.96 6 1.47 172 4.73 6 1.36
college or higher 133 6.56 6 1.82a 134 4.22 6 1.25a 133 4.62 6 1.33
F 7.494 2.719 0.670
P 0.001 0.067 0.512
Children’s gender
daughter 187 6.32 6 1.63 197 4.02 6 1.40 195 4.82 6 1.34
son 176 6.18 6 1.88 183 4.01 6 1.41 181 4.48 6 1.37
t 0.726 0.065 2.467
P 0.468 0.948 0.014
a
Compared with junior high school or lower education level, the difference is significant, P < 0.05.

544
 Awareness of CSA prevention in Fuxin City, China

Table IV. The number and percentages of parents who undertook various CSA practices

Topics Responses Daughter Son Total

N % N % N %

1. Talked with their children about 383 123 61.8 103 56.0 226 59.0
their private parts (parts covered
by swimsuit/bathing suit) and said
they should not be touched by
others
2. Told child if someone wants to see 385 129 64.5 103 55.7 232 60.3
or touch their private parts, they
should definitely say ‘No’ and
leave at once

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3. Told child if sexual abuse happens, 381 120 60.9b 87 47.3 207 54.3
parents or other trustworthy adults
should be told
4. Told children do not go with 385 191 95.5 176 95.1 367 95.3
others, even familiar grown-ups,
unless they had parental
permission
5. Told child not to accept gifts from 384 193 96.5 177 96.2 370 96.4
strangers, unless they had parental
permission
6. Told child that if a person they did 385 196 98.0a 174 94.1 370 96.1
not know wanted them to show
him the way to the nearest store,
they should not go with him
7. Provided books or audiovisual 383 11 5.5 5 2.7 16 4.2
material about CSA prevention for
their children
a
P < 0.05; bP < 0.01.

knowledge, there was no significant difference
between the two groups. See Figure 1.
Discussion
This study has identified some of the strengths and
gaps in parents’ knowledge, attitudes and practices
regarding CSA. For example, although studies have
shown that children are most likely to be sexually
abused by familiar people (Finkelhor, 1994; Liu,
1996; Li et al., 2000; Shang, 2002), only 28.2% of
respondents in the current study believed most
molesters are familiar to the child. This deficiency
of knowledge was also found in questionnaire
survey of 63 school health personnel from 15
provinces (Chen and Han, 2004), and a survey of
271 parents of pupils from Grades 1–5 of an
elementary school in the southern part of China
(Chen et al., 2004b) found only 48.1% of parents
and 37.1% of school health personnel knew this.
Research has indicated that although sexual abuse
may have physical consequences, the lack of signs
does not imply that a child has not been sexually
abused (Cantwell, 1983, Wells et al., 1995; Lu, 1997).
One reason is the broad definition of CSA that includes
non-penetration harassment. Also, some trauma in-
duced by sexual abuse can heal relatively quickly
(Kerns et al., 1994). The present study showed that
only 28.1% of respondents believed that CSA may not
leave obvious signs. Although children who report
sexual abuse can be believed almost all of the time, in
the current study only 40.7% of respondents believed

545
J. Q. Chen and D. G. Chen
Fig. 1. Parents’ KAP in relation to their early experience of
being taught about CSA by their own parents/guardians.
Note: knowledge score range 0–10, attitudes score range 0–5;
practice of CAS prevention education score range 0–7.
that a child who reports sexual abuse can be believed
almost all the time. These two areas of knowledge are
very important in CSA education.
Boys also can be sexually abused. Although most
parents knew this, 21.3% of respondents did not
believe it. The findings also showed that parents
were more likely to communicate CSA prevention
knowledge to their daughters. This suggests that in
the future CSA prevention education should clarify
this fact to parents and inform them about the
prevalence of CSA in the population and the impact
of sexual abuse on all children, including boys.
In order to protect children from CSA, it is very
important for parents to tell their child that their
private parts should not be seen or touched by
others. However, in our current study a considerable
proportion of parents (about 40%) had not done so.
Most parents just told their children to keep away
from strangers or kidnappers. A possible reason
why so many parents had not explored these key
ideas with their children could be due to the fact that
parents had not received such education them-
selves. Only 7.9% of them had been told about
how to prevent CSA by their guardians and only
6.8% of them reported that their teachers had talked
about CSA prevention during their school years.
Regarding CSA prevention education in school,
more than 80% of respondents agreed on the need for
CSA prevention education in school and were willing
to let their children participate. At the same time,
about half of the respondents expressed some concern
that such education may have the negative effect of
546
leading their children to know more about ‘sex’. Sex
has been a very sensitive topic in China for a long
time, and most parents had not received sex educa-
tion and CSA prevention education. Even today, sex
education in school is still limited (Chen and Liu,
2004). This concern also indicates that, contrary to the
stated support for CSA prevention education in
kindergarten and primary school, such programmes
will meet some resistance. On the other hand, it is
clear that the curriculum for kindergarten and young
pupils in elementary school should be designed very
carefully to address parents’ sensitivities.
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The current survey also showed that only 4.2% of
the respondents had provided written or audiovisual
products on CSA prevention to their children. One
of the reasons is that the relevant books and
audiovisual materials for young children are still
few in number, and research into CSA prevention
education in China is still very limited. There is an
urgent need to develop relevant books and audio-
visual materials for CSA prevention education in
primary school and at home as soon as possible.
Overall, the findings from the current research
show that parents’ knowledge and practice is in-
adequate to protect their children from CSA. The
results highlight the need for CSA prevention
education programmes for parents, to improve
parents’ awareness and practice of CSA prevention.
The results indicate the content, attitudinal and
skills areas that parents need in order to educate and
protect their children. Because of the sensitive
nature of the topic, there must be official support
for schools and parents to cooperate together in
developing a CSA prevention curriculum that will
meet the needs of their children.
Acknowledgement
This study was funded by the Ford Foundation.
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