Enhancing the Sexual Health of Youth in Systems of Care: Factors Affecting Risky Sexual Behaviors and Implications for Pregnancy Prevention Programs

Abstract

This study investigates factors contributing to risky sexual behaviors and teenage pregnancies among youth in systems of care (YSC). Secondary analyses were conducted on quality improvement data from two sexual education programs in the urban Midwest. Descriptive analyses uncovered disparities in risky sexual behaviors between the study samples; moreover, both groups exhibited higher rates compared to those reported in existing literature and the general population. In the Indiana Proud and Connected Teens (IN-PACT) study (N = 1916, mean age = 16.1 years), multivariate analysis showed that, when controlling for age, adverse childhood experiences (ACEs), and system involvement, pregnancy risk scores—a measure of participants' engagement in risky sexual behaviors—were positively associated with decision-making capacity and negatively associated with perceptions of pregnancy as undesirable. Furthermore, among a population of youth currently involved, or at risk of future involvement, in systems of care, those within juvenile justice (JJ) systems reported higher pregnancy risk scores, while youth in child welfare (CW) systems reported lower scores. In the Healthy Teen Connection (HTC) study (N = 603, mean age = 15.7 years), descriptive analyses revealed that 6.3% of participants scheduled appointments post-intervention, indicating limited success in linking participants to reproductive health clinics. The analyses also highlighted patterns regarding participants’ sociodemographic and sexual health characteristics, including an increased proportion of youth reporting sex under the influence during the pandemic. Thematic analysis of coordinators’ reflections links the intervention’s limited success to multifaceted barriers hindering participants’ access to sexual and reproductive health (SRH) services, resources, and education. However, coordinators suggested that, by fostering a safe and supportive environment and engaging caregivers in the intervention, HTC was successful in empowering participants in their sexual health. Acknowledging limitations such as reliance on self-reported data, the findings lay the groundwork for comprehensive policy and practice recommendations. Collaborative efforts are needed to provide YSC with tailored sexual health programming, including comprehensive and developmentally appropriate sexual health education, and accessible SRH resources and services. Future research should prioritize comprehensive needs assessments and explore disparities in sexual health behaviors and outcomes to enhance program development and implementation efforts.