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Abstract
Objective To investigate the association of living in foster care (FC) with substance use and subjective well-being in a sample of secondary school students (11–16 years) in Wales in 2015/16, and to examine whether these associations are attenuated by the perceived quality of interpersonal relationships.
Design Cross-sectional, population-based health behaviour and lifestyle questionnaire.
Setting and participants Wales, UK; young people who took part in the 2015/16 School Health Research Network (SHRN) questionnaire (n=32 479).
Primary outcome Health behaviours among young people in FC were compared with those from private households.
Results The prevalence of all adverse outcomes was higher among young people in FC. Those in FC were significantly more likely to report mephedrone use (OR=9.24, 95% CI 5.60 to 15.34), multiple substance misuse behaviours (OR=3.72, 95% CI 2.30 to 6.00), poorer relationships with peers (RR=1.88, 95% CI 1.23 to 2.88) and teachers (RR=1.83, 95% CI 1.31 to 2.56), having experienced bullying (OR=1.80, 95% CI 1.38 to 2.35), dating violence (OR=1.66, 95% CI 1.13 to 2.43) and poor well-being (RR=1.72, 95% CI 1.20 to 2.46). The association between FC and substance use remained significant, though was attenuated after accounting for relationship variables. The association between FC and subjective well-being became non-significant after adjustment for relationship variables.
Conclusions Young people living in FC experience significantly worse outcomes than young people not in care, likely due to a range of care and precare factors, which impact adversely on subsequent social relationships. The analyses are consistent with the hypothesis that the associations of FC with substance use and life satisfaction are partially explained by poorer quality social relationships. Large scale, longitudinal studies are required to investigate the relationship between being in care and health, educational and social outcomes. Mental health interventions and interventions to reduce substance use and improve well-being in FC should include a focus on supporting healthy social relationships.
- PUBLIC HEALTH
- wellbeing
- alcohol
- looked after children and young people
- Social care
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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Footnotes
Twitter Follow Adam Fletcher @dradamfletcher, The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement @DECIPHerCentre and The School Health Research Network @SHRNWales
Direction for future research The contribution of precare and care experiences to outcomes, and interaction between the two, requires further investigation. More high-quality data infrastructure is required for monitoring outcomes among young people in care longitudinally. Routinely collected social care data should be linked to other datasets, including healthcare, criminal justice, education and employment datasets to better understand the trajectories of those in care. There is a need for development and evaluation of interventions to improve outcomes among children in care, specifically those targeting relationship formation and maintenance.
Contributors SJL, GFM and REE conceived and designed the study. SJL and GFM analysed and interpreted the data. SJL drafted the manuscript and all authors contributed to the revisions of the manuscript and approved the final draft for submission.
Funding The School Health Research Network is a partnership between the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Well-being Research. The work was undertaken with the support of DECIPHer, a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. GMs time for analysis and manuscript preparation was funded by an MRC Population Health Scientist Fellowship (MR/K021400/1).
Competing interests None declared.
Ethics approval Ethical approval for the survey was granted by Cardiff University School of Social Sciences Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.