One in Five: Why Child Sexual Abuse Is Our Biggest Public Health Crisis―and What We Can Do to Stop It

by Elizabeth J. Letourneau, Luke Malone

An urgent argument that child sexual abuse is preventable, not inevitable—and that we are the first generation with the tools to stop it.

One in five children will experience sexual abuse before their eighteenth birthday. It happens in every country, every state, every city, every neighborhood, on every street. The consequences can be devastating. Many survivors suffer from depression and PTSD, struggle in school and at work, and face higher risk of heart disease and cancer. But it doesn’t have to be this way.

In One in Five, experts Elizabeth Letourneau and Luke Malone argue that child sexual abuse is not only the most pressing public health issue of our time—it is also the most preventable. Together, they unveil the scope and reality of child sexual abuse—including that most abuse is perpetrated by other kids—and how efforts to stop it have fallen short.

Until now, it has been treated primarily as a criminal justice problem, which it is. But that response comes too late. Letourneau and Malone explain how we can prevent abuse from happening in the first place, and provide a road map to protect children and intervene with those at risk of causing harm.

Compassionate, clear-eyed, and deeply researched, One in Five is the definitive guide to stopping abuse before it starts.

Genres: Nonfiction, Audiobook, Psychology, Politics

336 pages, Hardcover

Published August 18, 2026

Reviews

[Bry]

I chose to read this book because of my professional role in child abuse and neglect prevention - particularly in the realm of child sexual abuse prevention. While there is A LOT in this book that I agree with… that is probably far less interesting than what I disagree with or what I have questions about. 😆

First and foremost, thank you to the authors for taking on these important topics. In particular, I am excited to see topics like youth problematic sexual behavior being addressed on a larger scale since such a large portion of sexual abuse is perpetrated by other children, and children who have committed such acts hardly ever have issues with healthy sexuality as adults, especially when proper treatments like PSB-CBT are implemented.

I was surprised to hear little to no mention of the effects of pornography on the escalation of sexual interests. I wonder if the authors recognize access to unlimited hardcore pornography in 4K right at the palm of your hand, particularly from very young ages, as a risk factor for developing pedophilic interests or PSB.

Digressions aside, at the end of the day, I’m still left wondering: When discussing the goal of preventing adult perpetration against children, what is/are the solutions to these behaviors? It still sounds like we really don’t have a fleshed-out solution or any proven therapies for adults beyond primary prevention, which is of course critically underfunded. I LOVED that the authors included home visiting as perhaps the single most preventative approach we currently have available for families.

I’ve looked around the Help Wanted website myself, and while I can appreciate what the site is attempting to do, it feels a bit contradictory to preach for 20-25 years, as an industry, that abstinence doesn’t work( and therefore teens and young adults need access to other contraceptive methods to protect themselves), but then somehow expect what is essentially an abstinence campaign to work long term for those with pedophilic interests… I don’t mean to be cynical, but I am skeptical of the course.

Another question:
In chapter 4, regarding the system we’ve built, why throw out the baby with the bath water, so-to-speak, when it comes to sex offender registries? I think most people would agree that there are people included on the sex offender registry who do not need to be there — someone who’s offense happened when they were a child and has never offended again, probably does not need to be on a registry. Someone who urinated in a public park while drunk at 2 a.m. probably doesn’t need to be on a sex offender registry either. However, an adult man who habitually abuses, say, 8-year-old girls in his neighborhood absolutely should be on a registry if not in prison. Why not reform the system we have to be more effective/selective? Would we argue that murderers should not be punished (Maybe bad timing considering Clancy — I mean, current events)? Why are we arguing that adults who abuse children should not be punished? I understand that help/treatment is prevention, but is just and appropriate punishment not preventative as well?

Along the same lines, how do we know that the registry is not preventing recidivism? It seems a logical conclusion that if known sex offenders do not tend to reoffend and those same known sex offenders are on a registry, then perhaps, the registry and restrictions are preventing reoffending among known offenders.

Finally, I am stubbornly skeptical against certain messaging that promotes sympathy for child sex offenders and pedophilia and that asserts that children and families don’t play a critical role in prevention.

Regarding the former, anyone who has knowingly and intentionally viewed CSAM of very young/ pre-pubescent children, even if they’ve never offended in person, has contributed to harming children. They have contributed to child sex trafficking. I refuse to call such people “non-offenders.” They have offended on an entirely different scale. I understand the argument that these are still people, but sympathizing with and “supporting” pedophiles on a wide scale will inevitably lead to social normalizing. Having warm and caring relationships with family and providers who can help you and keep you accountable is one thing. A population-wide effort to destigmatize pedophilia is something else entirely. I don’t like where that road leads regardless of whether it’s deemed “unfair” and “not nice.”

Regarding children and families? Taking away that role and responsibility is just as dangerous. Why should people rely on institutions and governments to protect them? When has that ever gone well? And, I’m sorry, but if a child is deemed responsible enough to hold an iPhone or a tablet in their hands, they are responsible enough to be taught how to stay safe on them or to understand what a boundary violation is. Governments and institutions should do more, yes. Will they? Not likely. So we absolutely MUST continue arming children and families with knowledge and awareness.

Furthermore, children are not equipped to handle being sexually abused. They are equipped to understand safety. I would rather children understand ways to avoid such harms when possible than them inadvertently living in silence and shame for the rest of their lives.

Again, thanks to the authors for their research and their work on this book.

[Eunice R · Rating 5 out of 5]

To me, this book presents a comprehensive, serious, yet understandable, look that is helpful and hopeful in outlook for the prevention of Child Sexual Abuse (CSA). It's helpful in knowing how large the scope of occurance of CSA and how to spot potential hazards for children.

It takes a good look at prevention, incarceration of offenders, laws and legislation governing the issues and offenses. The morphing and epochs of such regulations throughout, and from, the very early years and down through the ages until current times.

The book also offers insight into helplines the world over. It highlights those who feel they have certain tendancies towards CSA but who actually do NOT want to be a perpetrator, which I found to have an encouraging note to it.

I feel there is quite a bit of compassion written into the spine of this book not only for the abused, but for the potential abusers and even post-abusers in the sense that there are some preventative treatments available to help them overcome their unacceptable desires. It leaves the reader with an injuction at book's end.

In my opinion, this book is not for the faint-hearted. It can be gut-wrenching and appalling even just to let the meaning of the title to sink into ones being! Yet because of the care penned into this treatise, this reader has been made more aware of not only the devastating occurence rate but also of the help available. There is a lot to think about and positive actions that can be taken. I really feel thankful for this book and hope many will be helped by it.

~ Eunice C., Reviewer/Blogger ~

July 2026

Disclaimer: This is my honest opinion based on the complimentary review copy sent to me by NetGalley and the publisher.

[Annotations&Air · Rating 5 out of 5]

We have to talk about it. It leads to a myriad of mental and physical health issues, years of trauma and affects everyone in some way - one billion of us here on planet earth directly, and the rest of us by being relatives or friends.
CSA (child sexual abuse) is that common. Horrifying, yes. Unstoppable? Absolutely not.

Psychologist Dr Elizabeth Letourneau, world renown expert in child sexual abuse, and journalist Luke Malone, who’s spent a career reporting on the same subject, came together to explain to everyone - parents, professionals and survivors - how we came to the system of detection, prevention, and punishment that currently exists, and what we can do to make our kids safer.

I have so much to say about this book, both as a professional who has worked with survivors and people who have committed sex offenses against children, and as a survivor myself. I hope to post further to discuss the implications of the strategies Dr Letourneau and Mr. Malone present within the book, as well as educate folks on exactly what we have gotten wrong about this - for all of us.

Thank you Basic Books and NetGalley for the opportunity to read in advance of publication.

[Jake Willems · Rating 5 out of 5]

This is genuinely one of the most interesting, insightful, and informative books I’ve read in the last five years. It talks about childhood sexual abuse, or CSA. It follows the history of CSA and makes the case that the way we handle cases of CSA is not effective and shares strategies and programming that could make an actual difference.

The biggest thing that expanded my knowledge is that we focus our time on punishing and shaming those that have been convicted of CSA. Only 6% of those convicted ever offend again, yet the majority of the work we do in CSA focuses on making people aware of them instead of looking at extremely simple and affordable ways we could prevent it from happening in the first place. For instance it shares a long story over multiple chapters of a young man, himself sexually abused as a minor, that was convicted of sexually abusing a family member as a 13-year old. Over the course of his life until age 25, we as a country spent over a million dollars imprisoning him. We could have instead invested almost $25k in preventative programming and support for his family at a very young age in hope that him offending would have been lowered. We as a country have developed almost nothing to prevention on a national model: either help for victims, or targeting people that are more likely to offend, etc. I learned so much.

The book is utterly gut-wrenching frequently. I cried multiple times. My heart hurt terribly. I think this is an extremely important read and recommend it with the highest recommendation.

[Kelly · Rating 5 out of 5]

As a CSA survivor, I was immediately drawn to this book. My personal history also made this a difficult read. I had to challenge my own gut feelings to this horrific act and what its consequences should be. The authors NEVER dismiss CSA; instead, they present the facts of what works and what doesn't for prevention, and what the reality of CSA is.

For me, I think the big reckoning is that 70% of CSA is child on child. I was truly stunned. And the way we need to approach that as a society is different from our approach for an adult offender. I have alway sort of separated offenses by ages, but there has been an increasing awareness of COCSA that I'm aware of, so getting a fuller picture of what that means in the CSA landscape is an epiphany. COSCA was not my experience, but its prevalence requires that I push past my own understanding to get a fuller picture of the issue.

Ultimately, the authors argue that we need a multilayered prevention approach. We need go see CSA as a public health crisis and allocate funds to deal with it. It IS preventable. There ARE steps we can take. There ARE treatments that work. And we need to focus on that as a society.

One in five. We must do better.

[Janalyn, the blind reviewer · Rating 4 out of 5]

1 in 5; why sex abuse is our biggest medical crisis and what we can do about it by Elizabeth J Letourneau PHD and Luke Malon I thought the book had great examples of failures although when it come to explaining how we could stop this I found it became a bit repetitive but I still found it very interesting there is nothing worse than a man who steals the innocence from a child or a woman for that matter and it’s a slippery slope when it’s other kids doing it I’ve known personally of a brother who did it to his little sister and although this would rip most families apart they ignored it in the last time I heard anything about him he had custody of his own son so I feel like child protection especially since they were directly told about him having his son knowing what he did did nothing about it I see where the problem lies and I get the frustration in the book when she talks about how much we pay for incarceration and how much cheaper it would be if we tried for prevention instead in the book she explains how there’s not even statistics on how much they do pay for counseling and how it’s also admit that once they start abusing they continue it and I thought the book was well research but a tad bit repetitive but it is what the book was mainly about prevention and that’s a good message. I know we’re supposed to feel bad for victims but when victims become perpetrators I see where the prevention is definitely needed. #NetGalley, #TheBlindReviewer, #MyHonestReview,

[Lisa Gray · Rating 4 out of 5]

So I chose this book to read because the statistic that 1 in 5 people will be abused sexually is a significant statistic. I wanted to read the book to see if it spoke specifically to what therapists might need to learn - things to watch for, things that should/shouldn’t be reported, resources to share. I didn’t really get any nuggets like that from the book. The book shares the history of how we have thought about CSA (childhood sexual abuse) over the years, some of the myths and inaccuracies we have and what can be done on a governmental and societal scale. So not necessarily recommending this one for my therapist friends, unless the topic interests you & you just like research-based books like this. Just two things that shifted my perspective: I did not know that MOST CSA is perpetrated on children by other children or adolescents, so that was interesting. And I never really thought about people being aware of their attraction to children, WANTING help with that because they know it’s wrong, but not being able to get that help because you can tell anyone that without facing consequences, even if you haven’t done anything. So that’s interesting and presents a gap in mental health treatment I hadn’t thought of.

[Ryan · Rating 5 out of 5]

I should acknowledge that the authors, Elizabeth Letourneau and Luke Malone, are dear friends and colleagues, and this is also my area of research and work.

Having said that, One in Five is a beautiful, moving, and deeply important book. Letourneau and Malone make a passionate case for prevention, reminding us that child sexual abuse is not inevitable, it is preventable! They thoughtfully explore how we got to where we are, the limits of our current system for addressing child sexual abuse, and what a prevention-focused future could look like. Compassionate, compelling, and accessible, the book offers both hope and tangible steps for change that need to happen! I cannot recommend it highly enough.

[sierra401 · Rating 4 out of 5]

Really important research, a must read for anyone with kids.

I didn't agree with the authors depiction of some of the child abuse enablers, I had some notes about how some of the difficult stories were told. But the research presented in this book was solid and I think this book really needs to be read and widely discussed.

[Emma Call · Rating 5 out of 5]

All I can say is WOW. Absolutely phenominal, timely and essential book. Just a brutal read for most of it when going into the origins of our CSA policy landscape today, so certainly not for the lighthearted, but absolutely essential reading.

[Evil Secret Ninja · Rating 5 out of 5]

This was a different way to look at this problem looking more from a policy than from an individual perspective.

[Mackenzie · Rating 4.25 out of 5]

EXTREMELY hard read but very important to know

[Melany Markham · Rating 5 out of 5]

A hugely important book that is written in an accessible style. The first chapter makes you realise just how long child sexual abuse has been governed by abusers and not the abused.

[Shelly]

Excellent. Everyone should read this as it contains important prevention solutions.

[Claire]

it didn’t feel right rating this book due to the heaviness of the topic. as informative as it was heartbreaking hearing all the statistics.

[oysterie · Rating 4.5 out of 5]

[4.5 stars]

I think that this book is worth reading whether or not you are a person who interacts with children on a regular basis. This is an extremely necessary and eye-opening book. I don’t say that lightly. One in Five sets out to look at how our (USA) current system of “preventing” child sexual abuse came into being and how it has been failing since its conception.

To begin, we look at the three cases of violent child sexual abuse (CSA) that occurred that lead to each of the main aspects of our current legislation: civil commitment for sex offenders, federal tracking (across state lines) of sex offenders, and the sex offender registry. These scenes are graphic, but not overly detailed. The authors give warning and explain their choice to include the descriptions of the scenes and aftermath is because they aim to match in the reader the same feelings felt by the public when these cases occurred. I understand that choice, but still be warned about three graphic descriptions (and a few others throughout to a lesser extent).

This is a bit of a numbers-heavy book in parts, but I still found it incredibly readable (I listened to the audiobook, for the record). There is a good balance found between weaving in specific cases and persons interviewed’s stories around discussions about legislature and statistics. The authors go over CSA through many different avenues, from the people and areas where risk factors are highest to the taxpayer cost of prison time to the personal cost of physical and mental health treatments for the victim and beyond. You could present this book to anyone and tell them to take their pick on what is the most important factor to them.

My criticism is a mix of nitpicks and expected disagreements common in argumentative books like this that don’t necessarily mean that the book has failed in any way. For nitpicks: there are a lot of points where I felt like we repeated the same information over and over. As interesting as the topic was, the need for clear sight lines and windows in doors in areas where children are present (schools, juvenile detention facilities, etc.) was mentioned over and over again. I also cannot find it in me to agree with the current wave of “child safety” legislation (age regulations mostly) being pushed in all online spaces. Even putting aside how they seem so obviously like data farming traps, I don’t know if a teenager giving their drivers license to a third party age verification site, only for that site to be hacked with all the child’s information leaked/sold online (as has happened already) is any safer than the site prior to the implementation of age restriction. However, this is still very new legislation and the book had a responsibility to go over it (the authors also never outright state that they are in support of these laws/requirements specifically, but they do describe them with no acknowledgement of the already happening risks).

For more legitimate disagreements: there is the fact that only 6% of CSA cases are repeat offenders. The authors explore this as a way of saying that less resources need to be put into stopping repeat offenders and more need to be put into first offenses. However, I can read that exact same statistic and come to the opposite conclusion of “Wow, only 6%? Our current system must be working really well to keep it that low!” I don’t fully think this, of course, but the authors never stop to acknowledge that very obvious (in my opinion) reading. Beyond that, I felt like this book was lacking in concrete changes to make. As good as the lead up was, the ending seemed to just say “remember these stories and statistics that disprove the commonly held beliefs… and wait for legislative change”. Maybe it’s more so that I do not interact with children at all (I am not a parent, I don’t work in a public space, and I avoid interacting with minors in fandom spaces online to the best of my knowledge) but I came out of this feeling it lacked a call to action. I suppose if you were a teacher/social worker/parent/etc. you would be able to pull out more specific things that you can do that I just cannot apply to my life.

Overall, this is an incredible work of research and argument that I think everyone in the US should reach for if they are truly interested in helping children and understanding the lasting impacts of CSA.

[Ximena Santaolalla · Rating 5 out of 5]

Es un libro maravilloso que da una visión realista del abuso sexual infantil y de la posibilidad de prevenirlo. Me gusta porque explica por qué el abuso no es inevitable , sino que se puede prevenir. Todos y todas debemos leerlo porque los niños son responsabilidad de todes.

[Stephanie Ravenscroft · Rating 5 out of 5]

First of all, thank you, NetGalley, for the advanced reader copy in exchange for a fair review.

I admit, I was slightly dubious when picking up this book thanks to its title. The phrase '1 in 5' is often referenced to a debunked college assault statistic gleefully expounded by political groups for leverage against immigrants or whatever the outrage de jour is. The topic, however, pushed me forward, because as a CSA survivor myself, it's valuable to be up to date. I'm glad I did.

Don't get me wrong, this is a brutal read on the subject, which is why I have taken my time to grave on it. Every few pages has some grim revelation or harrowing story. It's well written and not meaninglessly verbose, which I appreciate because the name of the game is accessibility. As informative as I found it, I do find myself despairing. The book makes heaps of sense, but I can't imagine being able to translate the knowledge into action. It talks a lot about paedophiles and makes perfectly salient points, but how would we ever change society to act on them? Especially in the wake of the Epstein situation, now more than ever, the field is littered with mines.

This book was hard because it really rams home that forgiveness is difficult and in the modern era empathy is villainised. Society craves endless punishment and dominance, whether or not it has positive outcomes for anyone. It isn't really about making the world better it's about beating someone slightly lower on the dominance hierarchy, so I feel a book like this that is so sensible and compassionate is doomed to provoke change. I hope I am wrong though.

[Donna · Rating 5 out of 5]

If you care about children, you need to read this book. One in five children will be harmed by childhood sexual abuse. That's 4 children in a kindergarten class of 20. If it was any other epidemic, our society would be doing more to prevent it.

But this epidemic depends on silence, complicity, and empty grand gestures that do little or nothing to prevent sexual abuse or support survivors.

We know what to do to prevent childhood sexual abuse. Why aren't we?

This book explores the ways we as a society can stop this horrific crime from happening. The history is discussed, along with the political maneuvers that focus more on punishment than prevention. Why are we spending almost $2,000 on jail time for offenders for each $1 we spend on prevention. Shouldn't it be the other way around?

Read this book to learn how to identify potentially risky situations, step in with support to hopefully prevent someone from abusing, and otherwise protect children.

The upper elementary teacher who abused me and other little girls had all of the risk factors identified in this book. If someone had stepped in much earlier, she could have been prevented from abusing. She could have gotten the support she needed also.

How much is a child's life worth? How much is a child's future worth?

To me, they are priceless. How about you?

Read this, share it with others, create action plans, and more. You will be saving lives.

I already preordered a copy of this. I want my own to highlight and otherwise dive more deeply into.

Thank you to NetGalley and the publisher for a copy of this book!