Health-risk behaviors in teens investigated by U.S. Child Welfare Agencies.
OBJECTIVE
The aim of this study was to examine prevalence and correlates of health-risk behaviors in 12- to 17.5-year-olds investigated by child welfare and compare risk-taking over time and with a national school-based sample.


METHODS
Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were analyzed to examine substance use, sexual activity, conduct behaviors, and suicidality. In a weighted sample of 815 adolescents aged 12-17.5 years, prevalence and correlates for each health-risk behavior were calculated using bivariate analyses. Comparisons to data from NSCAW I and the Youth Risk Behavior Survey were made for each health-risk behavior.


RESULTS
Overall, 65.6% of teens reported at least one health-risk behavior with significantly more teens in the 15- to 17.5-year age group reporting such behaviors (81.2% vs. 54.4%; p ≤ .001). Almost 75% of teens with a prior out-of-home placement and 77% of teens with child behavior checklist scores ≥64 reported at least one health-risk behavior. The prevalence of smoking was lower than in NSCAW I (10.5% vs. 23.2%; p ≤ .05) as was that of sexual activity (18.0% vs. 28.8%; p ≤ .05). Prevalence of health-risk behaviors was lower among older teens in the NSCAW II sample (n = 358) compared with those of the 2011 Youth Risk Behavior Surveillance System high school-based sample with the exception of suicidality, which was approximately 1.5 times higher (11.3% [95% confidence interval, 6.5-19.0] vs. 7.8% [95% confidence interval, 7.1-8.5]).


CONCLUSIONS
Health-risk behaviors in this population of vulnerable teens are highly prevalent. Early efforts for screening and interventions should be part of routine child welfare services monitoring.
Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, CA; Department of Pediatrics, the Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: henegha@pamf.org.
Amy
A
Heneghan
Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, New York.
Ruth E K
RE
Stein
School of Social Work, University of Southern California, Los Angeles, California.
Michael S
MS
Hurlburt
Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California.
Jinjin
J
Zhang
Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California.
Jennifer
J
Rolls-Reutz
Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York; Nathan Kline Institute of Psychiatric Services, Orangeburg, New York.
Bonnie D
BD
Kerker
Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California.
John
J
Landsverk
Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York.
Sarah McCue
SM
Horwitz
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D000068216:Child Protective Services / Q000458:organization & administration; D002669:Child Welfare / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D015995:Prevalence; D011859:Radiography; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
Adolescent; Child welfare; Child welfare investigation; Foster care; Health-risk behavior; National Survey of Child and Adolescent Well-Being; Social risk; Teens