Pubertal Development and Sexual Reproductive Health Among Youth in out-of-Home Care: Implications for Policy and Practice

Youth in out-of-home care are at an increased risk for pregnancy and sexually transmitted infections due to their increased likelihood to engage in high-risk behaviors.  These teens are from a variety of racial and ethnic backgrounds and rural, urban, and suburban environments.  Many teens in foster care become parents, either while they are in the foster care system or shortly after transitioning out of the system. Youth in the juvenile justice system, especially girls, have high rates of past sexual abuse and tend to engage in risky sexual behaviors.  Previous research suggests linkages between sexual risk behaviors and abuse and neglect among youth in out-of-home care, but most of these studies have not considered the impact of pubertal development.  This study examined high-risk sexual behavior and pubertal development among adolescents who were involved in out-of-home care in an urban setting. 

Data is from the baseline survey of adolescents (n = 105) enrolled in a sexual reproductive health intervention designed specifically for youth in out-of-home care.  The majority of the youth were African American between 15-19 years of age.  Survey questions were similar to items found on the Youth Risk Behavior Survey.  They included youth and partner age at first sex; contraception use at first sex and in the past three months; number of lifetime sexual partners; pubertal development; adolescent pregnancy; and sexually transmitted disease history.

Odds ratios for early pubertal development and risk behaviors were calculated for each gender by using logistic regression analysis.  The majority of the girls in this sample (59.3%) and a substantial number of boys (37.2%) reported early pubertal development.  Youth in the sample reported an early mean age at first intercourse and a high rate of pregnancy.  Most youth reported an extremely unreliable use of contraception – 77% sex without a condom and 63% sex without any birth control in the past three months.  There was a differential in the odds of engaging in sexual risk behaviors between early and late developers.  Adolescent sexual risk behavior was strongly linked to pubertal development, especially for girls in out-of-home care. 

These findings support the need to develop policies in the child welfare and juvenile justice systems which address the sexual reproductive health needs of youth in out-of-home care.