ACEs, Early Sexual Debut, and Substance Use Among Black Adolescents in the Juvenile Justice System

Background and Purpose: Adverse childhood experiences (ACEs) contribute to a range of health problems across the lifespan. Few studies have considered how ACEs effect sexual debut and substance use among Black adolescents involved in the juvenile justice system. Black youth disproportionately experience health disparities including childhood trauma, abuse, and early sexual debut which are risk factors for later HIV infection, STIs, teenage pregnancy and substance use. Further the disproportionality of Black youth in the juvenile justice system suggests that targeted efforts are needed to improve outcomes specifically for Black youth related to health equity. The purpose of this study is to determine how ACEs influence the age of sexual debut and the age of substance use initiation among justice-involved youth as contributing factors for risky sexual behaviors.

Methods: This study used baseline data from the Northwestern Juvenile Project, which is the first large-scale longitudinal survey of mental health and substance abuse service needs and outcomes of adolescent detainees. A total of 368 Black youth (52.7% female, 11-17 years of age) who reported having had substance use and sexual behaviors were included for data analysis. Multivariate path analyses were used to examine the effects of ACEs on youth’s initiation of substance use and sexual behaviors, which further link to risky sexual behaviors.

Results: Nearly the entire sample (97.0%) reported having experienced at least one type of ACE. Almost one-third of the sample (30.6%) had a very early sexual debut (11-12 years of age), and more than half (51.3%) had an early sexual debut (13-14 years of age). Further, more than 10% of the sample initiated their alcohol and/or cannabis use during their childhood (≤10 years of age), approximately 40% initiated substance use during their early adolescence (11-14 years of age), and the remaining initiated use at 15 years of age or older. In addition, nearly 60% of the sample reported having had sex while using substances. Path analyses revealed that ACEs had significantly direct effects on age of alcohol use initiation (OR= 0.76), cannabis use initiation (OR= 0.81) and sexual debut (OR= 0.82). Further, both ACEs (OR= 1.36) and sexual debut (OR= 0.57) are significantly directly related to engagement in risky sexual behaviors. Finally, age of sexual debut significantly partially mediated the effect of ACEs on risky sexual behavior (OR= 1.11).

Conclusions and Implications: Findings present considerable implications for the healthy development of youth—particularly justice-involved Black youth. Comprehensive sexuality health education and psychosocial support for Black youth with exposure to ACEs may mitigate negative health outcomes occurring before detainment. In addition, ongoing sexual health education for justice-involved youth may potentially improve sexual health outcomes. Additional research is needed to address scientific gaps concerning youth’s adoption of health-risk behaviors that contribute to negative health outcomes following ACE exposure.