title: Psychosocial pathways to sexually transmitted infection risk among youth transitioning out of foster care: evidence from a longitudinal cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Hospital & Research Institute, Seattle, Washington. Electronic address: kym.ahrens@seattlechildrens.org.
authors.forename: Kym R
authors.initials: KR
authors.lastname: Ahrens
authors.forename: Cari
authors.initials: C
authors.lastname: McCarty
authors.forename: Jane
authors.initials: J
authors.lastname: Simoni
authors.forename: Amy
authors.initials: A
authors.lastname: Dworsky
authors.forename: Mark E
authors.initials: ME
authors.lastname: Courtney
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015331:Cohort Studies; D005260:Female; D005581:Foster Home Care / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois; D007484:Iowa; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014922:Wisconsin
keywords: Abuse and neglect; Foster youth; Oppositional and delinquent behaviors; STD; STI; Sexually transmitted disease; Sexually transmitted infection; Trauma; Youth in foster care