Risk & Protective Factors Associated with Sexual Intercourse in Prenatally Substance-Exposed Adolescents

Prenatal exposure to substances may have both direct and indirect effects on the cognitive and behavioral functioning of exposed children. Biological and environmental factors are interactive, increasing the likelihood of risky health behaviors occurring in adolescence. There is limited research exploring: (1) the association among risk and protective factors and risky health behavior in high-risk adolescent samples; (2) how risk and protective factors affect youth with prenatal drug exposure; and (3) whether the relationship between substance use risk factors, developmental assets and risky health behaviors is different for males and females.

This study included 265 (122 boys, 143 girls) adolescents with prenatal polysubstance exposure who participated in a prospective birth cohort study. Selected from a group of mothers tested for substance use at birth at a large urban teaching hospital from 1994-1996, participants were assessed at regular intervals through17 years. Risk factors for this present study were measured at age 12 years using the ALEXSA Substance Use Attitude Scale (child’s perception of acceptability of substance use by someone their age) (α = 0.74) and Substance Access Scale (child’s perception of availability of substances) (α = 0.83). Protective factors were assessed at age 12 using the Developmental Assets Profile (α = 0.94). Sexual intercourse by age 16 was a dichotomous yes/no outcome based on self-report. Hierarchical logistic regression was conducted to assess the unique role of risk and protective factors on sexual intercourse by age 16 among a sample of prenatally polysubstance exposed adolescents.

The majority of participants were African American (82%), living in poverty at birth (97%), with a mean IQ of 88.36 (SD=11.36) at age 11. Hierarchical logistic regression in Model 1 included child characteristics (gender, prenatal marijuana exposure, prenatal cocaine exposure, violence exposure, parental monitoring, externalizing behavior); externalizing behaviors (OR 1.04, CI 1.02-1.12, p<.01) were significant. Model 2 added both ALEXSA scales to Model 1; Model 3, added developmental assets; externalizing behavior continued to be significant in both models 2 and 3. In final Model 4 a significant gender by developmental assets interaction (p<.05) was noted. Follow-up analyses to investigate gender differences indicated that for girls externalizing behavior increased the odds of sexual intercourse by 16 (OR 1.07, CI 1.01-1.12, p<.05), while for males greater total developmental assets (OR 1.08, CI 1.01-1.14, p<.05) and exposure to violence (OR 2.27, CI 1.06-4.83, p<.05) were associated with higher odds of sexual intercourse. The model for females accounted for 20% of the total variance and the model for males accounted for 19% of the total variance (p<.05). Risk factors were not significant in any of the models.

Different factors were related to sexual intercourse for boys and girls. Sexual intercourse by 16 was related to greater externalizing behavior for girls but higher total developmental assets and violence exposure for boys. Boys with higher developmental assets may perceive more social capital related to engaging in risky health behaviors, increasing their likelihood of sexual activity. Results suggest that intervention to prevent/reduce prenatally substance exposed adolescents’ risky health behaviors should be gender-informed.