Two out of three teens involved with child welfare services (CWS) due to alleged maltreatment, practice at least one health-risk behavior, such as substance abuse or risky sexual behaviors -- a percentage that is consistent with the general teen population. However, one alarming difference was that the risk of committing suicide was 50 percent higher among older teens involved with CWS, compared with teens not being investigated by CWS. Younger teens involved with CWS, aged between 12 – 14 years old, also reported higher rates of suicidality compared to ten years ago. The study, conducted by researchers from the Palo Alto Medical Foundation and Children’s Hospital at Montefiore (CHAM), published in print this month in the Journal of Adolescent Health. 

“These behaviors are a major public health concern, not only because they may lead to morbidity and mortality in adolescents but also because they can contribute to poor health throughout adulthood,” said Amy Heneghan, M.D., lead author, Department of Pediatrics, Palo Alto Medical Foundation and adjunct associate professor of pediatrics at Case Western Reserve University. “Our analyses revealed that frequency of health-risk behaviors was relatively similar for youth involved with CWS and for the broader population of adolescents, which indicates that the teen years are a particularly vulnerable time and meaningful interventions should be routine for all teens, especially younger ones to prevent such behaviors from the outset.” 

Previous research has suggested that teens who have been victims of maltreatment may be more likely to practice a number of health-risk behaviors.  However, this study found that teens involved with CWS had rates of most health-risk behaviors that were similar to those found in the general teen population. 

“Health-risk behaviors in adolescents are common and challenging for parents, educators and the health care system,” said Ruth E. K. Stein, M.D., co-author, attending physician, CHAM and professor of Pediatrics, Albert Einstein College of Medicine. “While it was surprising that teens involved with CWS and the broader teen population reported the same level of health-risk behaviors, it’s believed that children growing up in a stable environment with good parental relationships are at less risk for long-term negative outcomes, making it all the more important that efforts to address such behaviors are an ongoing part of CWS monitoring.” 

The study compared two groups. The first were comprised of teens involved with CWS still living in the home and teens involved with CWS living outside the home. The second group was teens not involved with CWS at all. Investigators analyzed data from three national surveys - the first and second National Survey of Child and Adolescent Well-being (NSCAW I and II), which were conducted ten years apart, and the Youth Risk Behavior Survey (YRBS) to examine the prevalence of health-risk behaviors and compared risk-taking over time in 12 - 17.5 year-old adolescents. 

The analyses show that significantly more teens in the 15 – 17.5 year-old age range report health-risk behaviors, across all three subcategories of teens. Substance use, particularly alcohol and marijuana use, was significantly higher among the older teens, especially those who were involved with CWS and not living in their home, as was risky sexual activity. Comparing NSCAW I and II, investigators found that the prevalence of smoking had decreased by half in the decade between the two surveys, and the prevalence of sexual activity was also lower in NSCAW II. 

“While these data suggest we need to look at the state of teen wellness at large, the most concerning finding clearly indicates that screening teens involved with CWS for suicidality is warranted,” Dr. Heneghan said.