CONTEXT
Early
sexual debut and unprotected sexual activity place adolescents at risk of
adverse sexual health outcomes. Adolescents involved with child protective
services (CPS) may be a particularly vulnerable population.
METHODS
California
birth records for 86,946 adolescents who became first-time mothers in 2008–2010
were probabilistically linked to statewide CPS records from 1998 and later. The
prevalence of STDs at birth and of abortion history were explored by
preconception CPS involvement. Generalized linear models, adjusted for health,
socioeconomic and demographic characteristics, were used to assess correlates
of current STDs and history of abortion.
RESULTS
At the
time they gave birth, 1% of adolescents had a documented STD, and 5% reported a
previous abortion. After adjustment for other characteristics, CPS involvement
was associated with a significantly elevated prevalence both of STDs (relative
risk, 1.2) and of previous abortion (1.4). Other characteristics also were
associated with both outcomes, but not always in the same direction. For example,
delaying prenatal care until after the first trimester or getting none at all
was associated with an increased prevalence of STDs (1.3), but a reduced
prevalence of abortion (0.8–0.9); having public insurance coverage for the
birth was associated with a reduced STD prevalence (0.9) and an elevated
abortion history prevalence (1.2).
CONCLUSIONS
To assess
whether adolescents with a history of CPS involvement need targeted sexual
health interventions, further research is needed on the mechanisms that underlie
associations between CPS involvement and adverse sexual health outcomes.
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