Childhood Maltreatment and Unprotected Sex among Female Juvenile Offenders: Evidence of Mediation by Substance Abuse and Psychological Distress.

PURPOSE: Research has shown that childhood maltreatment is associated with sexual risk taking among female juvenile offenders; however, the mechanisms by which maltreatment influences sexual risk remain poorly understood. We assessed whether substance abuse, psychological distress, and dating violence mediate the relationship between childhood maltreatment and unprotected sex.
METHODS: Sexually active female juvenile offenders (13-17 years of age) completed audio computer-assisted self-interviews (n = 232). Logistic regression with a risk decrement approach, the Sobel test, and the Goodman I test were used to evaluate mediation.
RESULTS: Maltreatment before sixth grade was common in our sample, including physical abuse (48.7%), sexual abuse (14.7%), supervision neglect (57.3%), and physical neglect (18.5%). Cumulative childhood maltreatment was also high with 42.2% reporting two or more types. In the fully adjusted model, cumulative childhood maltreatment remained associated with unprotected sex (odds ratio, 2.43; 95% confidence interval, 1.27, 4.65). The percent of the total effect in the relationship between childhood maltreatment and unprotected sex that was mediated by substance abuse was 16.4% (Sobel = 2.54 [p = .01]; Goodman I = 2.49 [p = .01]) and psychological distress accounted for 23.7% (Sobel = 2.55 [p = .01]; Goodman I = 2.51 [p = .01]). Dating violence was not a significant mediator in our analyses.
CONCLUSION: We found a strong relationship between childhood maltreatment and unprotected sex among female juvenile offenders that was partially mediated through substance abuse and psychological distress. These findings can be used to develop public health strategies to increase condom use among female juvenile offenders. Trauma-informed approaches to sexual health promotion that address substance abuse and psychological distress are warranted.