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Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions

Abstract

Adolescents in foster care present with multiple psychosocial and mental health problems that individually are associated with increased risk for HIV infection. However, few studies have examined empirically the interrelationships among these problems and HIV risk behaviors in this population. This study examined the sexual abuse histories and mental health problems among 343 youths in foster care to determine their association with HIV-risk behaviors and behavioral intentions. Results indicated that 25% reported internalizing behaviors (withdrawn, somatic complaints, depressed) and 28.3% reported externalizing behaviors (delinquent and aggressive behaviors). Of the sample, 37% reported some form of prior sexual abuse. Multivariate analyses using simultaneous entry of variables indicated that controlling for demographic variables and behavioral intentions, externalizing behaviors showed the strongest relationship with HIV-risk behaviors. Likewise, in the multivariate model, it was most strongly associated with behavioral intentions. Moreover, there was a significant race-by-gender interaction, with White females engaging in more risky behaviors than their male counterparts and youths of color.

REFERENCES

  • Achenbach, T. M. (1991). Manual for the Youth Self-Report and 1991 Profile. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Ards, S., Chung, C., and Myers, S. L. (1998). The effects of sample selection bias on racial differences in child abuse reporting. Child Abuse and Neglect, 22, 103–115.

    Google Scholar 

  • Auslander, W. F., Slonim-Nevo, V., Elze, D., and Sherraden, M. (1998). HIV prevention for youths in independent living programs: Expanding life options. Child Welfare, LXXVII, 208–221.

    Google Scholar 

  • Auslander, W. F., Slonim-Nevo, V., Ozawa, M., Shepard, S., and Gehlert, S. (1992). Comparison of skills training, discussion, and control groups to prevent AIDS among abused and delinquent youth. Presented at the VIII International Conference on AIDS/III STD World Congress, Amsterdam, The Netherlands, 19-24 July.

  • Barth, R. P. (1990). On their own: The experiences of youth after foster care. Child and Adolescent Social Work, 7, 419–440.

    Google Scholar 

  • Bensley, L. S., Van Eenwyk, J., and Simmons, K. W. (2000). Self-reported childhood sexual abuse and physical abuse and adult HIV-risk behaviors and heavy drinking. American Journal of Preventive Medicine, 18, 151–158.

    Google Scholar 

  • Brown, L. K., Lourie, K. J., Zlotnick, C., and Cohn, J. (2000). The impact of sexual abuse on the HIV-risk behavior of adolescents in intensive psychiatric treatment. American Journal of Psychiatry, 157, 1413–1415.

    Google Scholar 

  • Canterbury, R. J., Clavet, G. J., McGarvey, E. L., and Koopman, C. (1998). HIV-risk related attitudes and behaviors of incarcerated adolescents: Implications for public school students. High School Journal, 82, 1–2.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2000). Youth risk behavior surveillance: United States, 1999. Morbidity and Mortality Weekly Reports, 49, 1–96.

    Google Scholar 

  • Cunningham, R. M., Stiffman, A. R., Dore, P., and Earls, F. (1994). The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: Implications for public health. Child Abuse and Neglect, 18, 233–245.

    Google Scholar 

  • DiClemente, R. J., Lanier, M. M., Horan, P. F., and Lodico, M. (1991). Comparison of AIDS attitudes and behaviors among incarcerated adolescents and a public school sample in San Francisco. American Journal of Public Health, 81, 628–630.

    Google Scholar 

  • Drake, B., and Jonson-Reid, M. (2000). Substantiation and early decision points in public child welfare: A conceptual consideration. Child Maltreatment, 5, 227–235.

    Google Scholar 

  • Fishbein, M., and Middlestadt, E. E. (1989). Using the theory of reasoned action as a framework for understanding and changing AIDS-related behaviors. In V. M. Mays, G. W. Albee, and F. S. Schneider (Eds.), Primary prevention of AIDS: Psychological approaches. Newbury Park, CA: Sage.

    Google Scholar 

  • Gillmore, M. R., Morrison, D. M., Lowery, C., and Baker, S. A. (1994). Beliefs about condoms and their association with intentions to use condoms among youths in detention. Journal of Adolescent Health, 15, 228–237.

    Google Scholar 

  • Groze, V., McMillen, J. C., and Haines-Simeon, M. (1993). Foster families caring for children with HIV: A pilot study. Child and Adolescent Social Work Journal, 10, 67–87.

    Google Scholar 

  • Jessor, R. (1998). New perspectives on adolescent risk behavior. Cambridge: Cambridge University Press.

    Google Scholar 

  • Jonson-Reid, M. (2002). After a child abuse report: Early adolescents and the child welfare system. Journal of Early Adolescence, 22, 24–48.

    Google Scholar 

  • Jonson-Reid, M. (in press). Exploring the relationship between child welfare intervention and juvenile corrections involvement. Manuscript submitted. American Journal of Orthopsychiatry.

  • Jonson-Reid, M., and Barth, R. (2000). From placement to prison: The path to adolescent incarceration from child welfare supervised foster or group care. Children and Youth Services Review, 22, 493–516.

    Google Scholar 

  • Koopman, C., Rosario, M., and Rotheram-Borus, M. J. (1994). Alcohol and drug use and sexual behaviors placing runaways at risk for HIV infection. Addictive Behaviors, 19, 95–103.

    Google Scholar 

  • Landsverk, J., Litrownik, A., Newton, R., Ganger,W., and Remmer, J. (1996). Psychosocial impact of child maltreatment. Final report to the National Center on Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Service.

    Google Scholar 

  • Morton, T. D. (1999). Letter to the Editor. Child Abuse and Neglect, 23, 1209.

    Google Scholar 

  • Mullings, J. L., Marquart, J. W., and Brewer, V. E. (2000). Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners. Child Abuse and Neglect, 24, 677–688.

    Google Scholar 

  • Nader, P. R., Wexler, D. B., Patterson, T. L., McKusick, L., and Coates, T. (1989). Comparison of beliefs about AIDS among urban, suburban, incarcerated, and gay adolescents. Journal of Adolescent Health Care, 10, 413–418.

    Google Scholar 

  • Perrin, J. M., Simms, M. D., Dubowitz, H., and Szilagyi, M. A. (2000). Health care needs of children in the foster care system. Pediatrics, 106, 909–918.

    Google Scholar 

  • Pilowski, D. (1995). Psychopathology among children placed in foster family care. Psychiatric Services, 46, 906–910.

    Google Scholar 

  • Rotheram-Borus, M. J., and Koopman, C. (1991). Sexual risk behaviors, AIDS knowledge, and beliefs about AIDS among runaways. American Journal of Public Health, 81, 208–210.

    Google Scholar 

  • Rotheram-Borus, M. J., Mahler, K. A., Koopman, C., and Langabeer, K. (1996). Sexual abuse history and associated multiple risk behaviors among runaway youths. American Journal of Orthopsychiatry, 66, 390–400.

    Google Scholar 

  • Russell, D. E. H. (1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books.

    Google Scholar 

  • Slonim-Nevo, V., Auslander, W. F., and Ozawa, M. N. (1995). Educational options and AIDS-related behaviors among troubled adolescents. Journal of Pediatric Psychology, 20, 41–60.

    Google Scholar 

  • Slonim-Nevo, V., Auslander, W. F., Ozawa, M. N., and Jung, K. (1996). The long term impact of AIDS-preventive interventions for delinquent and abused adolescents. Adolescence, 31, 409–421.

    Google Scholar 

  • Slonim-Nevo, V., Ozawa, M., and Auslander, W. F. (1991). Knowledge, attitudes and behaviors related to AIDS among youth in residential centers: Results from an exploratory study. Journal of Adolescence, 14, 17–33.

    Google Scholar 

  • Stiffman, A. R., Dore, P., Earls, F., and Cunningham, R. (1992). The influence of mental health problems on AIDS-related risk behaviors in young adults. Journal of Nervous and Mental Disease, 180, 314–320.

    Google Scholar 

  • Trupin, E. W., Tarico, V. S., Benson, P. L., Jemelka, R., and McClellan, J. (1993). Children on child protective service caseloads: Prevalence and nature of serious emotional disturbance. Child Abuse and Neglect, 17, 345–355.

    Google Scholar 

  • U.S. Department of Health and Human Services. (1996). The third national incidence study of child abuse and neglect: Final report (DHHS Publication No. 105-91-1800). Washington, DC: Westat, Inc.

    Google Scholar 

  • U.S. Department of Health and Human Services, Children's Bureau. (1998). Child maltreatment 1996: Reports from the states to the national child abuse and neglect data system. Washington, DC: Government Printing Office.

    Google Scholar 

  • Wingood, G. M., and DiClemente, R. J. (1997). Child sexual abuse, HIV sexual risk, and gender relations of African-American women. American Journal of Preventive Medicine, 13, 380–384.

    Google Scholar 

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Auslander, W.F., McMillen, J.C., Elze, D. et al. Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions. AIDS Behav 6, 351–359 (2002). https://doi.org/10.1023/A:1021152813774

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  • DOI: https://doi.org/10.1023/A:1021152813774

  • Mental health problems
  • sexual abuse
  • foster care
  • HIV risk
  • adolescents