"I Tell Her Everything": Social Support and Sexual Well-Being Among Adolescents in Foster Care

Background: More than 90 percent of transitioning age youth in foster care will have had sexual intercourse prior to exiting the child welfare system with rates of sexually transmitted infections (STIs) and unintended pregnancies exceeding the rates of adolescents outside of foster care. While young people in state care have been found to have an extensive network of social support including biological family, foster parents, social workers, and health and mental health professionals, no research exists investigating the support sought when faced with a possible unintended pregnancy or STI scare. The aim of this study is to examine the sources and types of support transitioning age youth in foster care have when concerned about a STI or unintended pregnancy and to explore their support needs when confronted with these issues.

Methods: Part of a larger experimental study currently being conducted in Chicago with adolescents (17-21 years old) in foster care, open- and close-ended questions were analyzed from interviews from 104 African American participants. Univariate and bivariate analyses were used to analyze pregnancy and STI rates, social support and sexual behaviors. A content analysis examined the open-ended question: “Who would you feel comfortable talking to if you were worried about being pregnant (or having gotten someone pregnant)?” A list of 13 possible choices was listed. The item was followed by an open-ended question “Can you tell me why you chose your answer?” Participants were also asked parallel questions about whom they would talk to if they were worried about having a STI and why. Content was coded by two independent coders who refined definitions and recoded data when discrepancies in coding occurred.

Results: Over 93% of the participants ever had sex, with pregnancy and STI rates consistent with previous research. For concerns related to unintended pregnancies, participants most frequently seek support from family, e.g., biological parents and relatives (58.7%) followed by sexual/romantic partners (43.3%), friends (43.3%) foster care, e.g., caseworkers and foster/adoptive parents (36.5%), and therapists (22.1%). For concerns related to STIs, participants seek support most frequently from health providers (36.5%), sexual and/or romantic partners (32.7%), family (29.8%), foster care (22.1%) and friends (17.3%). The number of sources sought for an unintended pregnancy (M=3.08, SD= 2.76; Median = 2.00) was greater than those sought for a STI scare (M=1.79, SD=1.74; Median = 1.00). A significant positive association was found between seeking emotional support for a STI scare and family support (x²=22.67, p<.001) and between emotional support for a STI scare and foster care support (x²=7.90, p<.01).

Conclusions and Implications: The analysis suggests young people in foster care identify different sources of support depending on pregnancy versus STI concerns. Family and foster care professionals play an important supportive role and are ideally positioned to provide primary and secondary STI/pregnancy prevention. Content analysis indicates emotional support is a primary need when foster youth discuss sexual health issues. Greater attention to emotional support needs may increase youth engagement with family and foster care professionals when faced with these concerns.