Adverse Childhood Experiences and Sexual Risk Behavior in Female Youth: Examining the Mediating Role of Externalizing Behaviors and Substance Use and the Moderating Role of Resistance to Peer Influence and Parent Support

Sexual risk behavior in adolescence can result in serious health consequences that persist across the lifespan, particularly for female youth. While experiences of early adversity have been linked with engagement in sexual risk behavior later in life, little research has examined pathways that may help to explain this association nor modifiable factors that may help to buffer against the direct risk conferred by adverse childhood experiences (ACEs) on adolescent sexual risk-taking. To address this gap, the present study examined substance use and externalizing behaviors as two possible pathways through which ACEs might exert influence on sexual risk behavior in female youth. The present study also tested whether the association between ACEs and sexual risk behavior in female youth depended on youth-reported levels of resistance to peer influence and parent support. I examined data from 122 adolescent females, ages 13-18, who were involved in the juvenile justice system or receiving social supports from local agencies and schools. Female youth were asked to report their exposure to ACES, engagement in substance use and sexual risk behavior, and overall degree of resistance to peer influence and parent support. Caregivers were asked to report on youth’s externalizing behaviors. Findings suggest that increased exposure to ACEs may place female youth at heightened risk for externalizing behaviors and substance use and that higher ACEs may indirectly increase sexual risk-taking in female youth through substance use. Additionally, findings indicate that ACEs, in the context of low parent support, are significantly linked with increased sexual risk-taking in female youth. Conversely, among youth reporting average to high levels of parent support, the association between ACEs and sexual risk behavior was not significant, suggesting the protective role of parent support. Interventions aimed at preventing or decreasing substance use may be particularly important in reducing sexual risk behavior among at-risk female youth. Further, female youth with low levels of parent support may particularly benefit from interventions that seek to improve the parent-youth relationship as a means to prevent sexual risk-taking in female youth exposed to early adversity