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Childhood Maltreatment and Unprotected Sex among Female Juvenile Offenders:
Evidence of Mediation by Substance Abuse and Psychological Distress
#MMPMID28087129
Clements-Nolle K
; Larson S
; Buttar A
; Dermid-Gray L
Womens Health Issues
2017[Mar]; 27
(2
): 188-195
PMID28087129
show ga
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.