Let's stay together: relationship dissolution and sexually transmitted diseases among parenting and non-parenting adolescents

Interpartner Concordance on Relationship Quality and Sexually Transmitted Infections Among Young Pregnant and Parenting Couples

BACKGROUND

This study examined agreement between partners on perceptions of relationship quality and its impact on later (sexually transmitted infection [STI]) diagnosis in a sample of pregnant (adolescents and young adults [AYAs]) couples.

METHODS

Two hundred ninety-six AYA couples completed structured surveys on relationship quality (satisfaction, cohesion, consensus, affectional expression) and STI diagnosis. An actor-partner interdependence model was used to assess actor effects (whether an individual's perceived relationship quality influenced their getting STI), partner effects (whether a partner's perceived relationship quality influenced the individual getting an STI), and interactive effects (whether an individual's perceived relationship quality interacted with a partner's perceived relationship quality and influenced in the individual getting an STI).

RESULTS

No significant actor or partner effects were observed for positive STI screen. However, there was a significant interaction between actor and partner satisfaction (B = -0.47, exp(B) = 0.63 [95% confidence interval, 0.43-0.93], P = 0.020). When actor satisfaction was high, greater partner satisfaction was associated with lower odds of a positive STI screen at 12 months. A significant interaction between actor and partner affectional expression was also found (B = -4.40, exp(B) = 0.01 [95% confidence interval, 0.00-0.87], P = 0.043). When partner affectional expression was high, greater actor affectional expression was associated with lower odds of a positive STI screen at 12 months.

CONCLUSIONS

Findings suggest that concordant reports of relationship satisfaction and affectional expression are protective against future STI risk. Strengthening romantic relationships may be a promising strategy for preventing STIs in pregnant/parenting AYA couples.

Young Mothers' and Fathers' Perceptions of Relationship Violence: A Focus Group Study

Teens and young adults who are pregnant or parenting are important targets for efforts to prevent intimate partner violence (IPV). To intervene appropriately and effectively, we need to fully understand the unique issues and contexts for IPV in this population. This focus group study examined young parents' ( N = 28) perceptions of their relationships, stressors and sources of conflict, forms of IPV, and help-seeking behaviors. We examined data using template, content, thematic, and framework analyses. Findings about relationships and violence between young parents provide valuable insights for future intervention programs designed to prevent or address IPV among teen parents.

Longitudinal Evaluation of Syndemic Risk Dyads in a Cohort of Young Pregnant Couples

PURPOSE

The burden of syndemics-which are clusters of overlapping risk factors that adversely impact health-has been previously evaluated among high-risk individuals, yet little is known regarding syndemics within the relationship context.

METHODS

We evaluated concordant and discordant syndemic profiles among 296 pregnant couples and their actor-partner effects longitudinally from pregnancy to 1-year postpartum.

RESULTS

Syndemic score and severity were correlated across all time points for men and women. There was a significant difference in syndemic score (β_Men-Women = .2736, p = <.0001) and severity (β_Men-Women = .4282, p = <.0001) during pregnancy. For actor effects, we found score (β_T1-T2 = .273, p = .002; β_T2-T3 = .300, p = .005) and severity (β_T1-T2 = .253, p = .004; β_T2-T3 = .418, p = .001) were significantly associated across all time points for women. For men, only syndemic score predicted subsequent score at later time points (β_T1-T2 = .393, p = <.001; β_T2-T3 = .421, p = <.001). Severity was not significantly associated across time (β_T1-T2 = .043, p = .566; β_T2-T3 = .172, p = .066). For partner effects, we found women's syndemic risk to influence men's syndemic risk, while men had no significant effect on women's syndemic risk.

CONCLUSIONS

Pregnancy provides an opportunity to reduce syndemic burden among men and women. Couples-based prevention programs may serve to reduce syndemic risk for both partners, particularly during the postpartum period.

Intimate Partner Violence, Sexual Autonomy and Postpartum STD Prevention Among Young Couples: A Mediation Analysis

CONTEXT

The transition to parenthood is a stressful time for young couples and can put them at risk for acquiring STDs. Mechanisms underlying this risk-particularly, intimate partner violence (IPV) and sexual autonomy-have not been well studied.

METHODS

Between 2007 and 2011, a prospective cohort study of the relationships and health of pregnant adolescents and their male partners recruited 296 couples at four hospital-based obstetrics and gynecology clinics in the U.S. Northeast; participants were followed up six and 12 months after the birth. Structural equation modeling identified associations among IPV at baseline and six months, sexual autonomy at six months and STD acquisition at 12 months. Mediating effects of sexual autonomy were tested via bootstrapping.

RESULTS

Females were aged 14-21, and male partners were 14 or older. For females, IPV victimization at baseline was positively associated with the likelihood of acquiring a postpartum STD (coefficient, 0.4); level of sexual autonomy was inversely associated with the likelihood of acquiring an STD and of having a male partner who acquired one by the 12-month follow-up (-0.4 for each). For males, IPV victimization at baseline was negatively correlated with a female partner's sexual autonomy (-0.3) and likelihood of acquiring an STD (-0.7); victimization at six months was positively related to a partner's sexual autonomy (0.2). Sexual autonomy did not mediate these relationships.

CONCLUSIONS

Females' sexual autonomy appears to protect against postpartum STDs for both partners. Future research should explore the efficacy of IPV-informed approaches to improving women's sexual and reproductive health.

Smoking concordance during pregnancy: Are there relationship benefits?

OBJECTIVE

Couples often engage in similar patterns of behavior, including substance use, and similarity may benefit relationship quality. Such relationship benefits may be especially salient for adolescent and young couples, whose relationships are often unstable and prone to breakups. This study examined the effect of mutual smoking during pregnancy on relationship quality in pregnant adolescent and young adult couples.

METHODS

Couples (N = 228; M_AgeFemale = 18.69; M_AgeMale = 21.12) were recruited from obstetrics/gynecology clinics in Connecticut from July 2007 to February 2011. Couples completed measures of recent smoking and relationship quality (i.e. satisfaction, affectional expression, cohesion, and consensus) during pregnancy and at six months postpartum. Data were analyzed using multilevel models to account for interdependence within dyads.

RESULTS

Discrepant smoking patterns were associated with a reduction in satisfaction and cohesion over time (B = -1.14, p = 0.03, and, B = -2.74, p = 0.03, respectively), and a reduction in consensus over time for female participants, B = -1.98, p = 0.07, but not for male participants, p = 0.51. Discrepant smoking was not related to affectional expression, p = 0.11.

CONCLUSIONS

Results suggest relationship benefits concordant smoking patterns during pregnancy. Interventions should consider potential unintended relationship consequences of changing individual health behavior and instead work to develop couple-level health interventions.

Perception of partner sexual history: Effects on safe-sex intentions

OBJECTIVE

Sexual intercourse is a dyadic activity, and intentions to engage in safe sex vary across partners. Because pregnant and newly parenting adolescents and young adults are at high risk for sexually transmitted infections (STIs), it is important to understand sexual decision-making in this population.

METHOD

This cross-sectional study examined how participants' own risk behavior and their partners' risk behavior influence perceptions of partner risk, and the impact of risk perceptions on condom use intentions and monogamy intentions in 296 pregnant adolescent and young adult couples (MAgeFemale = 18.71 years; MAgeMale = 21.33 years).

RESULTS

Participants' behavior and their partners' behavior both related to increased perceptions of partner risk. Male participants' perceptions were more strongly influenced by female partners' behavior than participants' own behavior. Perceiving a partner as having a history of more risk behaviors trended toward a negative relationship with condom use intentions and monogamy intentions. For females, more previous sex partners related negatively to condom use intentions and positively to monogamy intentions. Having a male partner with more previous sex partners related positively to condom use intentions and monogamy intentions.

CONCLUSIONS

Perceptions of partner risk did not significantly relate to condom use intentions and monogamy intentions, however, trends suggest that risk perception could reflect similarity bias and ongoing risk engagement. Differences in partner perception by gender suggest that females may communicate more openly about risks. Interventions to reduce STI transmission in couples should work to interrupt trajectories of risky behavior and enhance risk communication. (PsycINFO Database Record

Intimate Partner Victimization and Health Risk Behaviors Among Pregnant Adolescents

OBJECTIVES

To provide lifetime estimates of intimate partner victimization among pregnant adolescents and examine associations between victimization and health risk behaviors identified by the Centers for Disease Control and Prevention as leading causes of adolescent morbidity and mortality.

METHODS

Participants (n = 1233) were predominantly Latina (58%) and non-Latina Black (34%) pregnant adolescents (aged 14-21 years) enrolled in a randomized controlled trial of group prenatal care in 14 clinical sites in New York City (2008-2012). They completed surveys to assess interpersonal victimization and risk behaviors: substance use, risky sexual behaviors, injuries or violence, unhealthy dietary behavior, and inadequate physical activity.

RESULTS

Fifty-two percent reported intimate partner victimization, which was associated with nearly all health risk behaviors.

CONCLUSIONS

Pregnant adolescents who experienced intimate partner victimization were significantly more likely to engage in health risk behaviors, which can have adverse health consequences. Expanded prevention programs tailored to specific needs of pregnant adolescents are needed. Health care providers and others who work with pregnant adolescents should consistently screen for and intervene in intimate partner victimization.

Alcohol Use Problems and Sexual Risk Among Young Adult African American Mothers

Studies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41 % (n = 141) of whom were mothers. Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes.

Co-Parenting Relationship Experiences of Black Adolescent Mothers in Active Romantic Partnerships With the Fathers of Their Children

We conducted an interpretive description of co-parenting relationship experiences of romantically involved Black adolescent mothers and fathers with shared biological children. The study was conducted in Brooklyn, New York, using data from individual in-depth interviews with adolescent mothers and fathers (n = 10). Four themes were identified: (a) putting our heads together; (b) balancing childhood and parenthood; (c) less money, more problems; and (d) if we use condoms, it is for contraception. The co-parenting couples managed very complex relationships, but their mutual interest in the welfare of their children was a relational asset. Co-parents had sparse financial resources but used a moral economy strategy to provide mutual support. Future research is needed that focuses on identifying other co-parent relationship assets and integrating and evaluating their utility for enhancing interventions for adolescent families.

“I'll Be There for You”: Teen Parents' Coparenting Relationships

Marriage promotion policy agendas have focused research attention on coparenting relationships, but little is known about coparenting among teen parents. Qualitative interviews with 76 teen mothers and fathers, supplemented with site observations at a school and clinic, investigated coparenting relationships and those relationships' embeddedness in extended families and social institutions. We identified prevalent coparenting trajectories and analyzed individual-, interaction-, and institutional-level influences on coparenting. Coparenting trajectories diverged depending on whether the couple stayed together and assumed traditionally gendered parenting roles. Participants perceived that coparenting relationships strongly shaped their current and future socioeconomic, emotional, and practical circumstances and their success at "being there" for their child. Extended families, institutions, and social programs often pushed teen parents apart, although many participants felt they needed a functional relationship with the other parent. Coparenting relationships, considered jointly with extended families and social institutions, are fundamental for understanding teen parenthood and shaping effective social policies.

Looking for solutions: gender differences in relationship and parenting challenges among low-income, young parents

The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes.

Gender equity predicts condom use among adolescent and young adult parents in Toronto, Canada

Adolescents and young adults have higher rates of sexually transmitted infections (STI) than any other age cohort in Toronto, Ontario, Canada. The sub-population of young parents is at even higher risk for acquiring STIs than the general population of adolescents and young adults. The purpose of this study was to determine whether and how co-parenting relationship functioning and gender equitable attitudes were associated with condom use among adolescent and young adult parents. We conducted a cross-sectional survey with 102 non-married adolescent and young adult parents in Toronto. Study participants used iPads to self-administer the co-parenting relationship scale, gender equitable men scale, and a sexual behaviour battery regarding their condom use during the last episode of sexual intercourse (including vaginal and anal). Logistic regression was used to determine whether scale scores predicted condom use at last intercourse, adjusting for age and sex. t-tests were performed to assess group mean differences in gender equitable attitudes and co-parenting relationship functioning between condom users and nonusers and between mothers and fathers. We observed that co-parenting relationship functioning was not associated with condom use behaviours. Instead, gender equitable attitudes predicted condom use in the overall sample (AOR=1.13; 95% CI 1.03, 1.25, p<0.05). Fathers who used condoms at last intercourse had higher gender equitable attitude scores than fathers who did not use condoms (M=58 vs. 53, p=0.02). Mothers' gender equitable attitude scores were not associated with condom use behaviours. Attitudes that support gender equity attitudes predict condom use among young parents, particularly among young fathers. Sexual risk reduction programs targeting young parents may benefit from incorporating components that promote gender equity norms.

Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda

We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.

Bringing your baggage to bed: associations of previous relationship experiences with sexual risk

Delaying sexual intercourse after initiating a relationship (i.e., increasing the presexual period) and delaying unprotected sex can reduce HIV/STI risk. Past relationship and risk experiences may influence sexual decisions in a current relationship. We examined how past relationship and risk experiences of both members of 296 young pregnant couples influenced length of presexual period and time to unprotected sex. Forty-six percent of couples had sex within the first month of seeing each other and had unprotected sex within 1 month of having sex. Length of presexual period and time to unprotected sex were significantly shorter in their current relationship than their previous relationship for both men and women (all p < 0.05). Female past relationship and risk factors were more strongly associated with length of presexual relationship than male past relationship and risk factors. Both male and female past relationship and risk factors were associated with time to unprotected sex.

What's love got to do with it: Relationship functioning and mental and physical quality of life among pregnant adolescent couples

The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy.

Black adolescent mothers' perspectives on sex and parenting in nonmarital relationships with the biological fathers of their children

OBJECTIVE

To understand single Black adolescent mothers' perspectives on the sexual and parenting-related aspects of their relationships with the biological fathers of their children.

METHODS

The study was a qualitative description of perspectives from a convenience sample of Black single (nonmarried) adolescent mothers. Data were generated through focus groups and interviews. Participants were recruited using self-referral and health provider referrals.

SETTING

The study was conducted in a county public health department sexually transmitted diseases clinic in Rochester, New York.

PARTICIPANTS

Single mothers (N = 31) ages 15 to 19 participated in the study. The mean age of participants was 17.5 years (SD = 1.4).

FINDINGS

Four themes were identified that reflected the major characteristics of the relationships between the mothers and the biological fathers of their children: (a) You will always care about your "baby daddy" because of your child, (b) Negative behavior is tolerated to keep the family together, (c) The "baby daddy" can get sex as long as we are not on bad terms, and (d) He will always be part of our lives.

CONCLUSION

Black adolescent mothers have complex relationships with the biological fathers of their children that may include ongoing sexual activity. The intersection of coparenting and sexual health needs among adolescent mothers highlights the importance of integrating sexually transmitted infections prevention with perinatal health programs. It is important to consider this unique coparenting relationship when providing risk-reduction counseling to young mothers.

Perceptions about sexual concurrency and factors related to inaccurate perceptions among pregnant adolescents and their partners

BACKGROUND

Inaccurate perceptions about whether a partner has concurrent sexual partners are associated with current sexually transmitted infections status. Despite high sexually transmitted infection rates among pregnant adolescents, studies have not investigated the accuracy of perceptions about sexual concurrency among young pregnant adolescents. The objectives were to assess (1) the accuracy of perceptions about whether one's partner ever had concurrent sexual partners during the relationship and (2) whether self-reported concurrency and relationship factors are related to inaccurate perceptions.

METHODS

Sociodemographic, psychosocial, and sexual behavior data were collected from 296 couples recruited from antenatal clinics. Couples included pregnant adolescents, aged 14 to 21 years, and the father of the baby, aged ≥ 14 years. Percentage agreement and κ statistics assessed the accuracy of perceptions about whether one's partner ever had concurrent sexual partners during the relationship. Logistic regression models using generalized estimating equations assessed associations between respondents' self-reported concurrency, relationship factors, and inaccurate perceptions.

RESULTS

Among participants whose partner was concurrent (n = 171), 60% did not accurately report their partner's concurrency, and greater relationship satisfaction (adjusted odds ratio [AOR]: 1.54) increased the likelihood of inaccuracy. Among participants with a nonconcurrent partner (n = 418), 17% were inaccurate; self-reported concurrency (AOR: 2.69) and greater partnership duration (AOR: 1.25) increased the likelihood of inaccuracy, whereas greater relationship satisfaction decreased the likelihood of inaccuracy (AOR: 0.68).

CONCLUSIONS

Many pregnant adolescents and their partners inaccurately perceived their partner's concurrency status. Self-reported concurrency and relationship factors were associated with inaccuracy, reinforcing the need to improve sexual communication among this population.

In the heart or in the head: relationship and cognitive influences on sexual risk among young couples

Few studies examine how relationship factors influence sexual risk. We investigated gender differences of the influence of relationship functioning on sexual risk behavior and sexually transmitted infections (STIs) among 296 young pregnant couples. Compared to women, men were twice as likely to have a concurrent partner, were less likely to intend to be monogamous in the future, had less HIV/STI knowledge and more perceived risk for HIV/STI, negative attitudes and efficacy toward condom use (all P < 0.05). For men, poor relationship functioning related to less intentions to be monogamous, more partner concurrency, worse sexual communication, and more condom use. For women, poor relationship functioning related to worse sexual communication and less condom use. In addition, women who had good relationship functioning and women who had partners with poor relationship functioning were more likely to have an STI. These results demonstrate the need to include heterosexual men and relationship factors in HIV prevention.