Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Hospital & Research Institute, Seattle, Washington.
J Adolesc Health. 2013 Oct;53(4):478-85. doi: 10.1016/j.jadohealth.2013.05.010. Epub 2013 Jul 13.
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.
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.
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.
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.
检验一个理论驱动的关于寄养青年向成年过渡过程中性传播感染（STI）风险途径的概念模型的拟合度。该模型包括（1）历史虐待和寄养经历；（2）青少年晚期的心理健康和依恋风格；以及（3）成年早期的 STI 风险。
我们使用路径分析来分析一项针对 732 名从寄养中过渡出来的青年的纵向研究的数据。协变量包括性别、种族和逆概率权重。我们还进行了性别约束和非约束模型的比较分析。
30%的人报告自己或伴侣被诊断出患有性传播感染。其他测量的 STI 风险行为的概率从 9%（为钱发生性行为）到 79%（不规律使用避孕套）不等。总体模型拟合度良好（标准根均方残差为.026）。虐待史与 STI 风险之间的关联通过增加不规律使用避孕套，由对立/叛逆行为的增加来介导。与拥有超过五个性伴侣也有一个边缘关联。与照顾者保持非常亲密的关系并在 18 岁以后继续留在寄养家庭中，降低了 STI 风险。调节分析显示，当系数允许因性别而异时，模型拟合度更好，而在男性和女性专用模型之间，个体路径系数几乎没有显著差异。
（1）解决外在创伤后遗症的干预/政策；（2）促进密切、稳定的替代照顾者关系；以及（3）将护理延长至 21 岁，有可能降低该人群的 STI 风险。
