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What Factors Make Foster Youth More Vulnerable to Adverse Sexual Health Outcomes?

A young person calling for test results on the phone.

Qualitative Evaluation of Historical and Relational Factors Influencing Pregnancy and Sexually Transmitted Infection Risks in Foster Youth” (abstract). Kym R. Ahrens, Renee Spencer, Mavis Bonnar, Alexis Coatney, and Tyson Hall. Children and Youth Services Review, Vol. 61 (February 2016).

What it’s about: Ahrens et al. interviewed 22 current and former foster youth, ages 15 to 21, to learn their perspectives on the factors that put child welfare-involved youth at greater risk for becoming adolescent parents and contracting a sexually transmitted infection (STI) compared with youth in the general population. After being interviewed, participants completed a 20-minute computer-based survey to provide demographic information and to describe their foster care and sexual experiences. The study was a follow-up to an earlier quantitative study led by the same primary author on risk and protective factors for STIs.

The authors divided their qualitative findings into four categories: norms and attitudes regarding sexual health matters such as pregnancy and STIs, responses to early life experiences and how youth think these experiences connect to sexual health risks, protective and risk factors (overall and for sexual health), and ideas from the participants for sexual health interventions.

Why read it: Although some existing interventions have increased sexual health-related knowledge, skills, and attitudes among foster youth, none has demonstrated consistent long-term reductions in young people’s sexual risk behaviors, the authors write. Because this qualitative study provides an in-depth look at young people’s perceptions of factors affecting sexual risk behaviors, the authors hope that it will help inform interventions that lead to long-term behavior change for current and former foster youth.

Biggest takeaways from the research: The authors found that study participants’ perspectives on the prevention of teen pregnancy and STIs were similar in many respects to viewpoints held by other youth populations. For example, participants reported an attitude toward condoms that is shared by many young people—that condoms are not necessary in a long-term relationship.

Other responses reflected participants’ adverse childhood experiences and their involvement with the child welfare system, such as the common belief that teen pregnancy “could happen any time,” as reported by one of the male participants, demonstrating that foster youth did not believe they had control over their lives’ circumstances. Many youth also described an overall lack of trust and discussed examples of experiences in which they failed to accurately assess a potential partner’s trustworthiness.

Ahrens et al. used their findings to develop a set of recommendations to guide organizations in their implementation of sexual health interventions with foster care youth. Here are three of the authors’ suggestions:

Use examples and scenarios that mirror the lived experience of foster youth. Young people who have been involved with the child welfare system make choices and take risks through the prism of their past traumatic experiences. Make sure the curriculum has components that highlight these patterns and provide youth with a trauma-informed perspective on their behaviors, Ahrens et al. suggest.

Promote protective beliefs and identify harmful ones. Help youth develop positive attitudes toward condom and birth control use so they can make self-protective choices. It’s also important to point out myths that make youth vulnerable to risk, such as the belief that they can tell whether someone has an STI by looking at him or her, Ahrens et al. write.

Discuss ways to improve emotion regulation. The trauma histories of foster youth have shaped their emotional response patterns. Ahrens et al. recommend helping youth learn how to self-regulate when they feel anxious or angry. Emotion regulation skills can improve how youth manage their impulses, judge potential partners, and communicate about sex.

Participants suggested ways to tailor sexual health programs to the needs of foster youth, such as implementing interactive activities that engage young people as a group rather than as individuals. Many participants also encouraged the use of peer facilitators because, as a 19-year-old male participant said, “no matter what people say, people who haven’t gone through foster care firsthand will never know what it’s like to be in foster care.”

Additional references: Learn more about foster youth in our digital library.

Learn about the U.S. Department of Education’s Foster Care Transition Toolkit.

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