Psychosocial Pathways to Sexually Transmitted Infection Risk Among Youth Transitioning Out of Foster Care: Evidence From a Longitudinal Cohort Study

• Published in: Journal of adolescent health Vol. 53; no. 4; pp. 478 - 485
• Main Authors: Ahrens, Kym R., M.D., M.P.H, McCarty, Cari, Ph.D, Simoni, Jane, M.D., M.P.H, Dworsky, Amy, Ph.D, Courtney, Mark E., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2013; Elsevier
• Subjects: Abuse and neglect; Adolescent; Adolescent Behavior; Adult and adolescent clinical studies; Biological and medical sciences; Caregivers; Child clinical studies; Cohort Studies; Condoms; Epidemiology. Vaccinations; Female; Foster Care; Foster Home Care - statistics & numerical data; Foster youth; Gender; General aspects; Humans; Illinois; Infectious diseases; Intervention; Iowa; Longitudinal Studies; Male; Males; Medical sciences; Moderation; Oppositional and delinquent behaviors; Pediatrics; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk; Risk Factors; Risk-Taking; Sex; Sexual Behavior - psychology; Sexual Behavior - statistics & numerical data; Sexually transmitted disease; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - psychology; Sexually transmitted infection; Social behavior disorders; Social behavior disorders. Criminal behavior. Delinquency; STD; STI; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Trauma; Venereal Diseases; Wisconsin; Young people; Youth; Youth in foster care; Iowa; Illinois; Wisconsin; STD; Youth in foster care; Oppositional and delinquent behaviors; Sexually transmitted disease; Abuse and neglect; Foster youth; STI; Sexually transmitted infection; Trauma; Human; Oppositional defiant disorder; Sexual behavior; Delinquency; Conduct disorder; Foster care placement; Psychosocial factor; Infection; Follow up study; Cohort study; Adolescent; Young adult; Risk factor; Social behavior disorder; Antecedent
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2013.05.010

Abstract Purpose To test the fit of a theoretically driven conceptual model of pathways to sexually transmitted infection (STI) risk among foster youth transitioning to adulthood. The model included (1) historical abuse and foster care experiences; (2) mental health and attachment style in late adolescence; and (3) STI risk in young adulthood. Methods We used path analysis to analyze data from a longitudinal study of 732 youth transitioning out of foster care. Covariates included gender, race, and an inverse probability weight. We also performed moderation analyses comparing models constrained and unconstrained by gender. Results Thirty percent reported they or a partner had been diagnosed with an STI. Probability of other measured STI risk behaviors ranged from 9% (having sex for money) to 79% (inconsistent condom use). Overall model fit was good (Standardized Root Mean Square Residual of .026). Increased risk of oppositional/delinquent behaviors mediated an association between abuse history and STI risk, via increased inconsistent condom use. There was also a borderline association with having greater than five partners. Having a very close relationship with a caregiver and remaining in foster care beyond age 18 years decreased STI risk. Moderation analysis revealed better model fit when coefficients were allowed to vary by gender versus a constrained model, but few significant differences in individual path coefficients were found between male and female-only models. Conclusions Interventions/policies that (1) address externalizing trauma sequelae; (2) promote close, stable substitute caregiver relationships; and (3) extend care to age 21 years have the potential to decrease STI risk in this population.