Sexual Risk Behaviors among Youth in the Child Welfare System

Purpose: Youth in the child welfare (CW) system present with risk factors, such as histories of maltreatment that are believed to increase their vulnerability for engagement in health-risking behaviors. Few studies have examined sexual risk behaviors among youth in CW; those that did, have focused on youth in out-of-home placement. This is of concern given rising rates of HIV/AIDS infection during adolescence overall, in particular among minority youths. This study provides national estimates of sexual risk behavior among youth in CW. Using the Social Development Model as a conceptual framework (Catalano & Hawkins, 1992), it investigates the moderating effects of psychosocial risk and protective factors on sexual risk behavior. Finally, it compares rates of sexual risk behavior between youth with histories in out-of-home placement with those that remained in-home.

Methods: This analysis used data from the National Survey of Child and Adolescent Well-Being (NSCAW), the largest nationally representative sample of children in CW. Data were collected through interviews with youth, caregivers and caseworkers, utilizing standardized measures in multiple domains. The study sample (n=877) consisted of youth age 11-14 at baseline (mean age: 15.3; SE=0.07). Sexual risk behaviors were measured at Wave 4 (36-month) through four variables: (1) consensual sexual intercourse (lifetime); (2) age at first consensual intercourse (<=3; >13); (3) ever been pregnant (consensual); (4) use of protection (never/rarely/sometimes; often/always). Covariates include demographic variables, case status-related variables (maltreatment type, risk assessment), psychosocial risk factors (behavior problems, substance abuse, delinquency, deviant peers, poverty, placement history) as well as protective factors (caregiver connectedness, future expectations, religiosity, caregiver monitoring). Logistic regressions for each DV were performed to examine the effect of individual risk factors after controlling for the effect of all others. Analyses accounted for sample weights and the study's two-stage cluster sample design.

Results: Key findings indicate that half the sample had sex. Over 40% of this sub-group had sex before age 14 and two-thirds reported using protection always/often. Of sexually active girls, 39% reported having been pregnant. We found several psychosocial risk factors (behavior problems, substance abuse history, delinquency, deviancy) to impact the likelihood of engagement in sexual risk behaviors. Notable was the absence of protective factors in moderating sexual risk behaviors. Differences in sexual risk behaviors between youth with a history of out-of-home placement were not statistically different from those who remained in-home.

Implications: The relatively high rate of sexual intercourse in this young sample, the very early onset of sexual activity for a significant number of youth coupled with high rates of pregnancy raise the question of who is responsible or most equipped to talk to youth in the CW system about their sexuality, sexual risks and ways to protect themselves from unwanted pregnancy and STDs. There is a total lack of research in this area preventing sound policy development. - Our findings regarding the absence of protective relational factors suggest that sexual risk reduction interventions for youth involved with the CW system might have to integrate components that focus on building supportive and stable relationships (e.g., mentoring relationships).