Maternal Incarceration and Adolescent Girls' Risk of Substance-Exposed Pregnancy, HIV, and STIs

Background and Purpose: Substance-exposed pregnancy (SEP), HIV, and STIs are interrelated public health problems common among adolescent girls in the U.S. Evidence suggests that adolescent girls with maternal incarceration experiences are particularly vulnerable to risk behaviors such as substance use and unprotected sex. However, there is limited research on their overlapping risks of SEP, HIV, and STIs and the role of maternal incarceration in their potentially elevated exposure. This study used data from the Fragile Family and Child Wellbeing Study (FFCW) to examine risk prevalence of SEP, HIV, and STIs among adolescent girls with maternal incarceration histories and assess the relationship between maternal incarceration and these behavioral health risks.

Methods: Data and samples: We used the FFCW Wave 6 data for analysis. The final sample consisted of 1,534 adolescent girls aged 15 years whose primary caregiver was the biological mother.

Measures: Through phone interviews, adolescents self-reported their sexual behavior, use of effective contraception, and substance use. Adolescent girls who were sexually active with their current partner, did not use adequate contraception, and reported substance use in the past month were considered at risk of SEP. Those who were ever sexually active without using condoms or reported injection drug use were categorized as at risk of HIV. Additionally, adolescent girls who had unprotected sex were treated as at risk of STIs. Through mothers’ self-reports, data on the mother’s incarceration histories and sociodemographic characteristics of the mother and the daughter were also obtained.

Analysis: Stata 15 was used for data analysis. Bivariate analysis was conducted to compare the risk of SEP, HIV, and STIs among adolescent girls with and without maternal incarceration histories. After controlling for sociodemographic characteristics, logistic regression models investigated the association between maternal incarceration and adolescent girls’ risk of SEP, HIV, and STIs.

Results: Bivariate analyses suggested that compared to their counterparts without maternal incarceration experiences, a significantly higher proportion of adolescent girls with maternal incarceration experiences were at risk of SEP (14.71% vs. 3.28%, χ² = 12.40, p < .001) and STIs (10.34% vs. 3.31%, χ² = 8.00, p = .005), but not HIV (8.77% vs. 3.95%, χ² = 3.21, p = .073). Regression analyses revealed that maternal incarceration was associated with significantly higher odds of SEP (OR = 3.34, 95% CI = 1.08 - 10.33, p = .03) among adolescent girls, but was not a significant indicator for STI risk (OR = 2.29, 95% CI = .86 - 6.12, p = .10) or HIV risk (OR = 1.44, 95% CI = .50 - 4.19, p = .50).

Conclusions and Implications: This study suggests the strong need for SEP, HIV, and STI prevention interventions among adolescent girls with maternal incarceration histories. It also indicates the importance of considering maternal incarceration and intergenerational family prevention strategies in program development. Future research on risk and protective mechanisms linking maternal incarceration and adolescent girls’ risk of SEP, HIV, and STIs is necessary to better identify intervention points to serve adolescent girls from extremely fragile families.