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Foster care associated with increased risk for STDs among adolescents
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Spending time in the foster care system may up a child’s chances of having at least one laboratory-confirmed STD by young adulthood, according to researchers from the University of Washington.
“These youths have high rates of several factors linked with [STD] risk, including exposure to physical and sexual abuse, neglect, parental substance abuse, poverty, and violence early in life, and high rates of mental health problems, substance abuse disorders, and juvenile or criminal justice system involvement later in life,” they wrote. “Despite the seeming vulnerability of this population, to the author’s knowledge only 2 studies have specifically evaluated the risk for [STDs] for youth who have been in foster care relative to other adolescent subgroups.”
To investigate this potential relationship between foster care status and STD biomarkers and risk behaviors at adolescence, the researchers used data from Waves I to III of the National Longitudinal Study of Adolescent Health that took place from 1994 to 2002. There were 7,563 girls and 6,759 boys were included in the analysis.
Adolescents completed a questionnaire about foster care status, sexual experience and behaviors at some point during grades seven to 12 (Wave I) and underwent follow-up interviews at approximately 2 (Wave II) and 6 years later (Wave III). At Wave III, the researchers also used Ligase Chain Reaction amplification technology to test urine specimens for gonorrhea and chlamydia and enzyme-linked immunosorbent assay for Trichomonas vaginalis DNA.
Data indicated that girls who had been in foster care were more likely to have Trichomonas (OR=3.23; 95% CI, 1.45-7.23) but not gonorrhea or chlamydia. In contrast, boys were more likely to have gonorrhea (OR=14.28; 95% CI, 2.07-98.28) and chlamydia (OR=3.07; 95% CI, 1.36-6.96) but not Trichomonas. The researchers noted, however, that these discrepancies may be due to the difficulty in detecting Trichomonas colonization in boys and the possibility that girls had already been treated for gonorrhea and chlamydia during adolescence.
Results also showed that girls who had been in foster care were more likely to report engaging in risky sexual behaviors, such as having sex with a casual partner, having sex for money or having vaginal intercourse. They were also more likely to report having their first sexual intercourse at a younger age and a higher number of lifetime partners than their peers. Boys who had been in foster care, however, did not show an increased likelihood of engaging in high-risk sexual behaviors when compared with adolescent boys who had not spent time in foster care.
In light of their data, the researchers urged future studies to focus on specific factors associated with foster care that could be responsible for the elevated risk of STDs in adolescence.
“If our findings are confirmed, then health care providers for current and former foster youth should consider modifying their screening practices to reflect the increased [STD] risk of these youth,” wrote the researchers. “Policymakers for the child welfare system should also consider incorporating programming to reduce [STD] risk into existing services for adolescents who are in foster care.”
Ahrens KR. Pediatrics. 2010;126:e97-e103.
These data support the need to fully address the reproductive health care requirements of all of our youth — but particularly youth we know are more vulnerable to health concerns. The authors note that involvement in the foster care system may represent a proxy for other factors that increase the risk of STDs including early exposure to adverse events; but knowledge of previous foster care involvement should alert providers to be even more vigilant regarding the reproductive health care needs of this adolescent population.
– Amy Middleman, MD, MPH
Infectious Disease News Editorial Board