How Do Longitudinal Classes of ACEs Exposure Predict Sexual Behavior: A Longitudinal Latent Class Analysis

Background: The public health implications of adolescent sexual behavior are significant, given that young people carry a disproportionate burden of sexually transmitted infections and unintended pregnancies. Although there is an established link between adverse childhood experiences (ACEs) and increased sexual risk behaviors, much of the research has focused on individual ACEs or a composite score reflecting the total number of ACEs encountered before the age of 18. This approach overlooks the impact of specific ACE patterns on sexual risk behaviors at various developmental stages. Our study seeks to 1) identify the developmental and multidimensional aspects of ACEs and 2) examine their associations with early sexual initiation—defined as engaging in sexual intercourse before the age of 15.

Method: We used a subset of participants from the Future Family and Child Well-being Study – 3,001 individuals who reported on their sexual activity at the age of 15. To identify distinct classes based on longitudinal patterns of ACEs at ages 3, 5, 9, and 15, we employed Longitudinal Latent Class Analysis (LLCA). These ACEs included physical abuse, emotional abuse, neglect, exposure to maternal intimate partner violence (IPV), material hardship, parental depression, and parental separation. We applied the Bolck-Croon-Hagenaars (BCH) three-step estimation method to explore the association between class membership and early sexual initiation, while differentiating between male and female cohorts. To address issues of nonnormality and missing data, we used Full-information Maximum Likelihood.

Results: Based on model fit indices and interpretability, we selected the 9-class model and identified nine distinctive classes:

• Parental Separation
• Parental Depression, Separation, and Material Hardship
• Low ACEs
• Material Hardship
• Early Childhood maternal IPV, Middle Childhood Separation
• Abuse, Parental Separation, Material Hardship
• Maternal IPV and Material Hardship
• Abuse and Material Hardship class

In male adolescents, the group characterized by Abuse, Parental Separation, and Material Hardship reported the highest early sexual initiation (54%). This was followed by groups experiencing Parental Depression, Separation, and Material Hardship (44%); Abuse and Material Hardship (43%); Parental Separation alone (43%); Maternal IPV and Material Hardship (43%); and Material Hardship (39%). Each of these groups had a significantly higher prevalence than the Low ACEs group (24%).

For female adolescents, the most prevalent early sexual initiation was noted in the class with Early Childhood Maternal IPV and Middle Childhood Separation (32%), with the next highest prevalence in the Parental Depression, Separation, and Material Hardship class (29%). Both prevalences were notably higher than that of the Low ACEs class (13%). The Material Hardship class alone showed the lowest prevalence (8%).

Conclusions and Implications: Most ACEs do not follow a distinctive temporal pattern, tending to be chronic and persisting through childhood and adolescence. The finding underscores the imperative for immediate preventative and interventions targeting ACEs. Different ACE dimensions—such as abuse, maternal IPV, parental separation, and material hardship—differentially influence adolescent sexual behavior, with these effects also varying by gender. Adopting a person-centered approach enhances our understanding of the impact of ACEs. We recommend gender-sensitive and trauma-informed screening and interventions to promote better sexual and reproductive health outcomes for adolescents.