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Normative Sexual Health Development in Non-Normative Circumstances: Exploring Healthy Intimate Relationships Among Young People in Foster Care

Roni Diamant-Wilson https://orcid.org/0000-0002-4187-0825 [email protected] and Jo WilliamsView all authors and affiliations

Volume 38, Issue 2

https://doi.org/10.1177/07435584211000319

Abstract
References
Biographies

Abstract

While the sexual health risks among young people of color in foster care have been well-documented, healthy sexual development in this population has been less examined. The current study explored the experiences of Black youth in foster care and the factors that influenced their safer sex practices. Qualitative interviews were conducted with 18 sexually active Black participants (18–22 years old) in foster care from a large, Midwestern city in the United States. Grounded theory methods were used to (a) construct a conceptual framework illustrating the conditions the youth experienced that influenced their safer sex efforts, and (b) describe different types of intimate relationships that reflected their sexual health practices. Using specific strategies, the majority of the youth overcame obstacles and participated in positive sexual health practices. More than half (59%) reported they were in an intimate relationship for at least 6 months and either abstained from sex, used condoms 100% of the time, or employed safer sex methods. The findings suggest Black youth in state care can engage in positive sexual health practices and form healthy intimate relationships.

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References

Aalsma M. C., Carpentier M. Y., Azzouz F., Fortenberry J. D. (2012). Longitudinal effects of health-harming and health-protective behaviors within adolescent romantic dyads. Social Science & Medicine, 74(9), 1444–1451. https://doi.org/10.1016/j.socscimed.2012.01.014

Adimora A. A., Schoenbach V. J. (2012). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. The Journal of Infectious Diseases, 191, S115–S121.

Adult connections implementation guide. (2017). https://www.childrenshomeandaid.org/wp-content/uploads/2017/10/ACT.pdf

Ahrens K. R., DuBois D. L., Richardson L. P., Fan M.-Y., Lozano P. (2008). Youth in foster care with adult mentors during adolescence have improved adult outcomes. Pediatrics, 121(2), e246–e252. https://doi.org/10.1542/peds.2007-0508

Ahrens K. R., McCarty C., Simoni J., Dworsky A., Courtney M. E. (2013). Psychosocial pathways to sexually transmitted infection risk among youth transitioning out of foster care: Evidence from a longitudinal cohort study. The Journal of Adolescent Health, 53(4), 478–485. https://doi.org/10.1016/j.jadohealth.2013.05.010

Ahrens K. R., Spencer R., Bonnar M., Coatney A., Hall T. (2016). Qualitative evaluation of historical and relational factors influencing pregnancy and sexually transmitted infection risks in foster youth. Children and Youth Services Review, 61, 245–252. https://doi.org/10.1016/j.childyouth.2015.12.027

Albertson K., Crouch J. M., Udell W., Schimmel-Bristow A., Serrano J., Ahrens K. R. (2020). Caregiver-endorsed strategies to improving sexual health outcomes among foster youth. Child & Family Social Work, 25, 557–567. https://doi.org/10.1111/cfs.12726

Allen K. R., Husser E. K., Stone D. J., Jordal C. E. (2008). Agency and error in young adults’ of sexual decision making stories. Family Relations, 57, 517–529. http://www.jstor.org/stable/20456815

Antle B. F., Johnson L., Barbee A., Sullivan D. (2009). Fostering interdependent versus independent living in youth aging out of care through healthy relationships. Families in Society, 90, 309–315. https://doi.org/10.1606/1044-3894.3890

Arnett J. J. (2004). Emerging adulthood: The winding road from the late teens through the twenties. Oxford University Press.

Auerbach C. F., Silverstein L. B. (2003). Qualitative data: An introduction to coding and analysis. New York University Press.

Bay-Cheng L. Y. (2009). Justifying sex: The place of women’s sexuality on a social justice agenda. Families in Society, 91, 97–103. https://doi.org/10.1606/1044-3894.3962

Bishop H. K. D., Claxton S. E., van Dulmen M. H. M. (2019). The romantic relationships of those who have experienced adoption or foster care: A meta-analysis. Children and Youth Services Review, 105, 104407. https://doi.org/10.1016/j.childyouth.2019.104407

Bowlby J. (1988). A secure base: Parent-child attachment and health human development. Routledge.

Brandon-Friedman R. A., Wahler E. A., Pierce B. J., Thigpen J. W., Fortenberry J. D. (2020). The impact of sociosexualization and sexual identity development on sexual well-being of youth formerly in the foster care system. Journal of Adolescent Health, 66, 439–446. https://doi.org/10.1016/j.jadohealth.2019.10.025

Brenner A. B., Zimmerman M. A., Bauermeister J. A., Caldwell C. H. (2013). Neighborhood context and perceptions of stress over time: An ecological model of neighborhood stressors and intrapersonal and interpersonal resources. American Journal of Community Psychology, 51(3–4), 544–556. https://doi.org/10.1007/s10464-013-9571-9

Bronfenbrenner U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.

Cabrera P., Auslander W., Polgar M. (2009). Future orientation of adolescents in foster care: Relationships to trauma, mental health, and HIV risk behaviors. Journal of Child & Adolescent Trauma, 2, 271–286. https://doi.org/10.1080/19361520903317311

Carpenter L. M., Delmater J. (2012). Studying gendered sexualities over the life course. In Carpenter L., DeLamater J. (Eds.), Sex for life: From virginity to viagra. How sexuality changes throughout our lives (pp. 23–41). New York University Press.

Centers for Disease Control and Prevention. (2020). STD health equity. https://www.cdc.gov/std/health-disparities/default.htm

Charmaz K. (2006). Constructing grounded theory. SAGE.

Charmaz K. (2011). Grounded theory methods in social justice research. In Denzin N. K., Lincoln Y. S. (Eds.), The SAGE handbook of qualitative research (pp. 359–380). SAGE.

Combs K. M. (2019). Evaluation of a sexual health training for child welfare workers [Unpublished dissertation]. https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=2569&context=etd

Courtney M. E., Dworsky A., Lee J. S., Raap M. (2011). Midwest evaluation of the adult functioning of former foster youth. https://www.chapinhall.org/wp-content/uploads/Midwest-Eval-Outcomes-at-Age-23-and-24.pdf

Creswell J. W. (2013). Qualitative inquiry & research design: Choosing among five approaches. SAGE.

Cutrona C. E., Russell D. (1987). The provisions of social relationships and adaptation to stress. In Jones W. H., Perlman D. (Eds.), Advances in personal relationships (Vol. 1, pp. 37–67). JAI Press.

Dettlaff A. J., Boyd R. (2020). Racial disproportionality and disparities in the child welfare system: Why do they exist, and what can be done to address them? The Annals of the American Academy, 692, 253–274. https://doi.org/10.1177/0002716220980329

Diamant-Wilson R., Blakey J. M. (2019). “Strap up”: Sexual socialization and safer sex practices among African American youth in foster care. Child Abuse & Neglect, 88, 466–477. https://doi.org/10.1016/j.chiabu.2018.08.007

Diamant-Wilson R., Leathers S. J. (2020). Safer sex strategies and the role of gender among African American youth transitioning from foster care. Children and Youth Services Review, 111, 104798. https://doi.org/10.1016/j.childyouth.2020.104798

DiClemente R. J., Salazar L. F., Crosby R. A., Rosenthal S. L. (2005). Prevention and control of sexually transmitted infections among adolescents: The importance of a socio-ecological perspective—A commentary. Public Health, 119(9), 825–836. https://doi.org/10.1016/j.puhe.2004.10.015

Dworsky A. (2018). The sexual and reproductive health of youth in foster care. In Trejos-Castillo E., Trevino-Schafer N. (Eds.), Handbook of foster youth (pp. 133–154). Routledge/Taylor & Francis.

Dworsky A., Courtney M. E. (2010). The risk of teenage pregnancy among transitioning foster youth: Implications for extending state care beyond age 18. Children and Youth Services Review, 32(10), 1351–1356. https://doi.org/10.1016/j.childyouth.2010.06.002

Eaglin M., Gagner A., Murray C., Tabidze I., Mikati T., Townsell S. (2014). HIV/STI surveillance report, Chicago. https://www.cityofchicago.org/content/dam/city/depts/cdph/HIV_STI/2014HIVSTISurveillanceReport.pdf

Fincham F. D., Cui M. (2011). Emerging adulthood and romantic relationships: An introduction. In Fincham F. D., Cui M. (Eds.), Romantic relationships in emerging adulthood (pp. 3–12). Cambridge University Press.

Fletcher K. D., Ward L. M., Thomas K., Foust M., Levin D., Trinh S. (2015). Will it help? Identifying socialization discourses that promote sexual risk and sexual health among African American youth. The Journal of Sex Research, 52, 199–212. https://doi.org/00224499.2013.853724

Fluke J., Harden B. J., Jenkins M., Ruehrdanz A. (2010). Disparities and disproportionatlity in child welfare: Analysis of the research. http://centerforchildwelfare.fmhi.usf.edu/kb/dispr/AECFDisparitiesAndDisproportionalityInChildWelfare-2011-1.pdf

Forenza B., Bermea A., Rogers B. (2018). Ideals and reality: Perceptions of health and unhealthy relationships among foster youth. Child and Adolescent Social Work Journal, 35, 221–230. https://doi.org/10.1007/s10560-017-0523-3

Gavin L., Catalano R. F., Markham C. M. (2010). Future directions for positive youth development as a strategy to promote adolescent sexual and reproductive health. The Journal of Adolescent Health, 46(Suppl. 3), S92–S96. https://doi.org/10.1016/j.jadohealth.2009.12.026

Gause N. K., Brown J. L., Welge J., Northern N. (2018) Met-analyses of HIV prevention interventions targeting improved partner communication: Effects on partner communication and condom use frequency outcomes. Journal of Behavioral Medicine, 41, 423–440. https://doi.org/10.1007/s10865-018-9916-9

Guarnieri S., Smorti M., Tan F. (2015). Attachment relationships and life satisfaction during emerging adulthood. Social Indicators Research, 121, 833–847. https://doi.org/10.1007/s11205-014-0655-1

Hadley W., Brown L. K., Lescano C. M., Kell H., Spalding K., DiClemente R., Donenberg G., & Project STYLE Study Group. (2009). Parent-adolescent sexual communication: Associations of condom use and condom discussions. AIDS Behavior, 13, 997–1004. https://doi.org/10.1007/s10461-008-9468-z

Hensel D. J., Fortenberry J. D. (2012). A multidimensional model of sexual health and sexual prevention behavior among adolescent women. Journal of Adolescent Health, 52, 219–227. https://doi.org/10.1016/j.jadohealth.2012.05.017

Higgins J. A., Cooper A. D. (2012). Dual use of condoms and contraceptives in the USA. Sexual Health, 9(1), 73–80. https://doi.org/10.1071/SH11004

Jones N. L., Gilman S. E., Cheng T. L., Drury S. S., Hill C. V., Geronimus A. T. (2019). Life course approaches to the causes of health disparities. American Journal of Public Health, 109, S48–S55. https://doi.org/10.2105/AJPH.2018.304738

Kahn R. L., Antonucci T. C. (1980). Convoys over the life course: Attachment, roles, and social support. In Baltes P. B., Brim O. G. (Eds.), Life span development and behavior (Vol. 3, pp. 253–286). Academic Press.

Kids Count. (2019). Child population by race in the United States. Kids Count Data Center, Annie E. Casey Foundation. https://datacenter.kidscount.org/data/tables/103-child-population-by-race#detailed/1/any/false/1729,37,871,870,573,869,36,868,867,133/68,69,67,12,70,66,71,72/423,424

Kirby D., Lepore G. (2007). Sexual risk and protective factors. Factors affecting teen sexual behavior, pregnancy, childbearing and sexually transmitted disease: Which are important? Which can you change? The National Campaign to Prevent Teen Pregnancy, ETR Associates. https://www.semanticscholar.org/paper/Sexual-Risk-and-Protective-Factors-Factors-Teen-And-Kirby-Lepore/55c06f1dc79317327c6e0bc807baa9d9fe4ce92e

Krieger N. (2019). Measures of racism, sexism, heterosexism, and gender binarism for healthy equity research. From structural injustice to embodied harm-an ecosocial analysis. Annual Review of Public Health, 17, 4.1–4.26. https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040119-094017

Lefkowitz E. F., Gillen M. M., Vasilenko S. A. (2011). Putting the romance back into sex: Sexuality in romantic relationships. In Fincham F. D., Cui M. (Eds.), Romantic relationships in emerging adulthood (pp. 213–233). Cambridge University Press.

Lincoln Y. S., Guba E. G. (1985). Naturalistic inquiry. SAGE.

Manlove J., Fish H., Moore K. A. (2015). Programs to improve adolescent sexual and reproductive health in the US: A review of the evidence. Adolescent Health, Medicine and Therapeutics, 6, 47–79. https://doi.org/10.2147/AHMT.S48054

Markham C. M., Lormand D., Gloppen K. M., Pesking M. F., House L. D. (2010). Connectedness as a predictor of sexual and reproductive health outcomes of youth. Journal of Adolescent Health, 46, S23–S41. https://doi.org/10.1016/j.jadolhealth.2009.11.214

Masten A. S., Burt K. B., Roisman G. I., Obradović J., Long J. D., Tellegen A. (2004). Resources and resilience in the transition to adulthood: Continuity and change. Development and Psychopathology, 16(4), 1071–1094. https://doi.org/10.1017/S0954579404040143

Melkman E., Benbenishty R. (2018). Social support networks of care leavers: Mediating between childhood adversity and adult functioning. Children and Youth Services Review, 86, 176–187. https://doi.org/10.1016/j.childyouth.2018.01.040

Miller D. P., Bazzi A. R., Allen H. L., Martinson M. L., Salas-Wright C. P, Jantz K., Crevi K., Rosenbloom D. L. (2017). A social work approach to policy: Implications for population health. American Journal of Public Health, 107, S243–S249. https://doi.org/10.2105/AJPH.2017.304003

Miller O., Farrow F., Meltzer J., Notkin S. (2014). Changing course: Improving outcomes for the African American males involved with child welfare systems. Center for the Study of Social Policy. https://cssp.org/wp-content/uploads/2018/08/Changing-Course_Improving-Outcomes-for-African-American-Males-Involved-with-Child-Welfare-Systems.pdf

Mojola S. A., Everett B. (2012). STD and HIV risk factors among U.S. young adults: Variations by gender, race, ethnicity and sexual orientation. Perspectives on Sexual and Reproductive Health, 44, 125–133. https://doi.org/10.1363/4412512

Nixon C., Elliott L., Henderson M. (2019). Providing sex and relationships education for looked-after children: A qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers. BMJ Open, 9, 1–21. https://doi.org/10.1136/bmjopen-2018-025075

Noar S. M., Carlyle K., Cole C. (2006). Why Communication is crucial: Meta-analysis of the relationship between safer sexual communication and condom Use. Journal of Health Communication, 11, 365–390. https://doi.org/10.1080/10810730600671862

Norman R. E., Byambaa M., De R., Butchart A., Scott J., Vos T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLOS Medicine, 9, 1–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507962/pdf/pmed.1001349.pdf

Prado G., Lightfoot M., Brown C. H. (2013). Macro-level approaches to HIV prevention among ethnic minority youth: State of the science, opportunities, and challenges. The American Psychologist, 68(4), 286–299. https://doi.org/10.1037/a0032917

Prather C., Fuller T. R., Marshall K. J., Jeffries W. L. (2016). The impact of racism on the sexual and reproductive health of African American women. Journal of Women’s Health, 25, 664–671. https://doi.org/10.1089/jwh.2015.5637

Reyome N. D. (2010). Child emotional maltreatment and later intimate relationships: Themes from the empirical literature. Journal of Aggression, Maltreatment & Trauma, 19, 224–242. https://doi.org/10.1080/10926770903539664

Riggs S. A. (2010). Childhood emotional abuse and the attachment system across the life cycle: What theory and research tell us. Journal of Aggression, Maltreatment & Trauma, 19, 5–51. https://doi.org/10.1080/10926770903475968

Robertson R. D. (2013). The invisibility of adolescent sexual development in foster care: Seriously addressing sexually transmitted infections and access to services. Children and Youth Services Review, 35, 493–504. https://doi.org/10.1016/j.childyouth.2012.12.009

Rogers A. A., Ha T., Stormshak E. A., Dishion T. J. (2015). Quality of parent-adolescent conversations about sex and adolescent sexual behavior: An observational study. The Journal of Adolescent Health, 57(2), 174–178. https://doi.org/10.1016/j.jadohealth.2015.04.010

Romeo K. E., Kelley M. A. (2009). Incorporating human sexuality content into a positive youth development framework: Implications for community prevention. Children and Youth Services Review, 31(9), 1001–1009. https://doi.org/10.1016/j.childyouth.2009.04.015

Russell S. T., Campen K. S., Muraco J. A. (2012). Sexuality development in adolescence. In Carpenter L., DeLamater J. (Eds.), Sex for life: From virginity to viagra. How sexuality changes throughout our lives (pp. 70–87). University Press.

Saldaña J. (2016). The coding manual for qualitative researchers (3rd ed.). SAGE.

Samuels G. M., Cerven C., Curry S., Robinson S., Patel S. (2019). Missed opportunities in youth pathways through homelessness. https://voicesofyouthcount.org/brief/missed-opportunities-youth-pathways-through-homelessness-in-america/

Shah M. F., Liu Q., Eddy J. M., Barkan S., Marshall D., Mancuso D., Lucenko B., Huber A. (2017). Predicting homelessness among emerging adults aging out of foster care. American Journal of Community Psychiatry, 60, 33–43. https://doi.org/10.1002/ajcp.12098

Shpiegel S. (2016). Resilience among older adolescents in foster: The impact of risk and protective factors. International Journal of Mental Health and Addiction, 14, 6–22. https://doi.org/10.1007/s11469-015-9573-y

Shulman S., Sieffge-Krenke I., Ziv I., Tuval-Mashiach R. (2019). Patterns of romantic pathways among 23 year olds and their adolescent antecedents. Journal of Youth and Adolescence, 48, 1390–1402. https://doi.org/10.1007/s10964-018-0951-1

Sexuality Information and Education Council of the United States (SIECUS). (2020). https://siecus.org/

Strauss A., Corbin J. (1998). Basic of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). SAGE.

Sulimani-Aidan Y. (2015). Do they get what they expect? The connection between young adults’ future expectations before leaving care and outcomes after leaving care. Children and Youth Services Review, 55, 110–117. https://doi.org/10.1016/j.childyouth.2015.06.006

Svanemyr J., Amin A., Robles O. M., Greene M. E. (2015). Creating an enabling environment for adolescent sexual and reproductive health: A framework and promising approaches. Journal of Adolescent Health, 56(1), S7–S14. https://doi.org/10.1016/j.jadohealth.2014.09.011

Thigpen J. W. (2012). Childhood sexuality: Exploring culture ad context. In Carpenter L., DeLamater J. (Eds.), Sex for life: From virginity to viagra. How sexuality changes throughout our lives (pp. 45–69). New York University Press.

Thompson R. A. (2015). Social support and child protection: Lessons learned and learning. Child Abuse & Neglect, 41, 19–29. https://doi.org/10.1016/j.chiabu.2014.06.011

Tolman D. (2006). In a different position: Conventionality in family conversations about everyday objects. New Directions for Child and Adolescent Development, 112, 71–89.

Towe V. L., Sifakis F., Gindi R. M., Sherman S. G., Flynn C., Hauck H., Celentano D. D. (2010). Prevalence of HIV infection and sexual risk behaviors among individuals having heterosexual sex in low income neighborhoods in Baltimore, MD: The BESURE Study. AIDS Journal of Acquired Immune Deficiency Syndromes, 53(4), 5220528. https://doi.org/10.1097/QAI.0b013e3181bcde46

Towner S. L., Dolcini M. M., Harper G. W. (2015). African American adolescents: Patterns of monogamy, commitment, and trust. Youth & Society, 47, 343–373. https://doi.org/10.1177/0044118X12462591

U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Children’s Bureau. (2019). The AFCARS report: Preliminary FY 2018 estimates as of August 22, 2019. https://www.acf.hhs.gov/cb/report/afcars-report-26

Vasilenko S. A., Lefkowitz E. S., Welsh D. P. (2014). Is sexual behavior healthy for adolescents? A conceptual framework for research on adolescent sexual behavior and physical, mental, and social health. In Lefkowitz E. S., Vasilenko S. A. (Eds.), New Directions for Child and Adolescent Development: Positive and negative outcomes of sexual behaviors (Vol. 144, pp. 3–19). Jossey-Bass/Wiley.

Viner R. M., Ozer E. M., Denny S., Marmot M., Resnick M., Fatusi A., Currie C. (2012). Adolescence and the social determinants of health. The Lancet, 379, 1641–1652. https://doi.org/10.1016/s0140-6736(12)60149-4

Voisin D. R., Bird J. (2009). What African American male adolescents are telling us about HIV infection among their peers: Cultural approaches for HIV prevention. Social Work, 54(3), 201–210. http://www.ncbi.nlm.nih.gov/pubmed/19530567

Widman L., Choukas-Bradley S., Helms S. W., Golin C. E., Prinstein M. J. (2014). Sexual communication between early adolescents and their dating partners, parents, and best friends. Journal of Sex Research, 51(7), 731–741. https://doi.org/10.1080/00224499.2013.843148

Wildeman C., Emanuel N. (2014). Cumulative risks of foster care placement by age 18 for U.S. children, 2000-2011. PLOS ONE, 9(3), Article e92785. https://doi.org/10.1371/journal.pone.0092785

Wilson H. W., Widom C. S. (2008). An examination of risky sexual behavior and HIV in victims of child abuse and neglect: A 30-year follow-up. Health Psychology, 27(2), 149–158. https://doi.org/10.1037/0278-6133.27.2.149

Winter V. R., Brandon-Friedman R. A., Ely G. E. (2016). Sexual health behaviors and Outcomes among current and former foster youth: A review of the literature. Children and Youth Services Review, 64, 1–14. https://doi.org/10.1016/j.childyouth.2016.02.02

World Health Organization. (2002). Sexual and reproductive health: Gender and human rights. http://www.who.int/reproductivehealth/topics/gender_rights/sexual_health/en/

Young J. C., Widom C. S. (2014). Long-term effects of child abuse and neglect on emotion processing in adulthood. Child Abuse & Neglect, 38, 1369–1381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117717/

Biographies

Roni Diamant-Wilson is committed to improving the lives of vulnerable populations by integrating practice and research and helping meet the needs of marginalized children, families, and communities. She received a PhD in 2017 from the University of Illinois and MSW in 2010 from the University of California, Berkeley.

Jo Williams is an advocate and scholar who is dedicated to the lives and well-being of former foster youth. Using her own experience in foster care as motivation for her work, she is dedicated to co-creating brighter futures with those who have experienced trauma. She graduated from Stanford University in 2016 with a BA in human biology and is pursuing a master’s in public health from the University of California, Berkeley.

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