Some (but not much) progress toward understanding teenage childbearing: a review of research from the past decade

Facilitators and barriers to contraception access and use for Hispanic American adolescent women: An integrative literature review

STATEMENT OF THE PROBLEM

Hispanic American adolescents experience high rates of pregnancy with profound consequences. Compared with White teens, Hispanic teens use contraception less frequently and often choose less effective forms of contraception. Access to contraception is a primary barrier to use which contributes to relatively high and disparate rates of pregnancy in Hispanic teens. This integrative review identifies facilitators and barriers of contraception access and use for Hispanic women, 13-17 years of age, living in the U.S.

METHODOLOGY

Following the Whittemore and Knafl (2005) methodology and PRISMA guidelines, peer reviewed studies were retrieved from PUBMED, CINAHL and EMBASE. The Mixed Methods Appraisal Tool was used to assess the study quality and thematic analysis was used to categorize barriers and facilitators.

FINDINGS

Of 131 studies retrieved, 16 met inclusion criteria. Individual, interpersonal and healthcare provider factors were identified as primary categories of barriers and facilitators with structural issues comprising an additional barrier category. Individual level barriers were disproportionately represented and further categorized into themes: beliefs/misconceptions, dislike of contraception, pregnancy risk perception, lack of knowledge, and lack of control. Barriers related to cultural and religious influences were identified in individual, interpersonal and structural levels. The most frequently reported facilitators were perceived parent comfort discussing sexual health and past experience of pregnancy.

DISCUSSION

Limitations in this review may stem from heterogeneity in the acculturation and geography of participants and analysis by a single reviewer. Implications include considering the range of information sources and the influence they have on risk perception and risk mitigation for this population.

CONCLUSION & SIGNIFICANCE

Adolescents describe many modifiable influences on contraception access and use. Misperceptions related to contraception, stemming from beliefs and perceptions, can be corrected through increased access to reliable sources of sex education, parental support, and direct access to nurses and healthcare providers. Awareness of these influences can inform further research and intervention development to address these health disparities.

Incident pregnancy and mental health among adolescent girls and young women in rural KwaZulu-Natal, South Africa: an observational cohort study

Pregnancy can place adolescent girls and young women (AGYW) at risk of poor mental health. However, evidence linking youth pregnancy to mental health in resource-limited settings is limited, especially where HIV incidence is high. We analysed a population-representative cohort of AGYW aged 13-25 in rural KwaZulu-Natal to assess how adolescent pregnancy predicts subsequent mental health. Among 1851 respondents, incident pregnancy (self-reported past-12-month) rose from 0.7% at age 14 to 22.1% by 18. Probable common mental disorder (CMD; 14-item Shona Symptom Questionnaire) prevalence was 19.1%. In adjusted Poisson regression recent pregnancy was associated with slightly higher probable CMD (adjusted prevalence ratio [aPR] 1.19, 95%CI 0.96-1.49), and stronger association among 13-15 year-olds (aPR 3.25, 95%CI 1.50-7.03), but not with HIV serostatus. These findings suggest a possible incremental mental health impact of being pregnant earlier than peers, pointing to the need for age-appropriate mental health interventions for AGYW in resource-limited settings.

Association between Female Reproductive Factors and Risk of Dementia

Women have an over 50% greater risk of dementia than men, which is a main topic of much research. This review aims to investigate the impact of a woman's reproductive history on dementia risk. The consequences of stillbirth are long-term health and psychosocial problems for women. Because of the awareness of an endangered pregnancy, many parents experience deep anxiety and stress in subsequent pregnancies. There are contradictory conclusions from research about abortion and the risk of dementia correlation. When it comes to the late age of first birth, which is said to be above 35 years old, it was observed that older mothers have a decreased risk of dementia compared to those who gave birth in their 20s; however, being a child of the older mother is connected with a higher risk of developing dementia. Using hormonal contraception can result in decreased risk of dementia as estrogen stimulates microglia-related Aβ removal and reduces tau hyperphosphorylation. The influence of postmenopausal hormonal therapy and the duration of the reproductive period on developing dementia remains unclear. Although female disorders like endometriosis and polycystic ovary syndrome are reported to increase the risk of dementia, the research on this topic is very limited, especially when it comes to endometriosis, and needs further investigation. Interestingly, there is no conclusion on whether hypertensive disorders of pregnancy increase the risk of dementia, but most articles seem to confirm this theory.

Associations between parenthood and dementia in men and women: biology or confounding?

BACKGROUND

High parity and extremes of age at first birth have been linked with increased dementia risk in women, with exposure to pregnancy-associated physiological changes proposed as an explanation. However, confounding by socioeconomic and lifestyle factors could also produce such associations, whereby men would share similar patterns of association. We investigated whether these associations hold for both sexes.

METHODS

In a cohort study including all women (N = 2,222,638) and men (N = 2,141,002) ≥ 40 years of age in 1994-2017 in Denmark, we used Cox regression to evaluate associations between number of children, age at first birth, and dementia risk separately for women and men.

RESULTS

During follow-up, 81,413 women and 53,568 men (median age at diagnosis, 83.3 and 80.3 years, respectively) developed dementia. Compared with having one child, having two or more children was associated with modest decreases in overall dementia risk in both sexes (hazard ratio [HR] range 0.82-0.91, P_{difference men vs. women} = 0.07). Although the associations between childlessness and overall dementia risk differed statistically for men and women, the association magnitudes differed only slightly (HR_men 1.04, 95% confidence interval [CI] 1.01-1.06; HR_women 0.99, 95% CI 0.97-1.01; P = 0.002). Associations between age at becoming a parent and overall dementia were also similar for women and men, with the exception of older (≥ 40 years) first-time parents (HR_men 1.00, 95% CI 0.96-1.05; HR_women 0.92, 95% CI 0.86-0.98; P = 0.01). With few exceptions, sub-analyses by dementia subtype and timing of onset also revealed similar patterns and effect magnitudes for women and men.

CONCLUSIONS

Associations between number of children, age at becoming a parent, and dementia risk were similar for both sexes. Lifestyle and socioeconomic factors are more likely to explain the observed associations than normal pregnancy-related physiological changes.

Developmental pathways from child maltreatment to adolescent pregnancy: A multiple mediational model

Adolescent pregnancy (AP) is a significant public health issue. Child maltreatment (CM) represents an established risk factor, yet little is known about the explanatory mechanisms linking the phenomena. Informed by developmental theory, this study prospectively tested seven multi-level, indirect pathways that could plausibly explain the relationship between CM and AP: (1) substance use (polysubstance use and frequency); (2) sexual risk behavior; (3) depressive symptoms; (4) posttraumatic stress disorder symptoms; (5) cognitive dysregulation; (6) pregnancy desire and difficulty expectancies; and (7) age at menarche. Data came from a prospective, longitudinal cohort study of 469 ethnically diverse, nulliparous adolescent females, designed to examine the impact of substantiated CM on reproductive outcomes such as pregnancy and childbirth (265 maltreated and 204 demographically matched comparison adolescents). A multiple-mediator structural equation model was conducted to simultaneously test multiple indirect effects while accounting for confounding variables. Maltreatment had an indirect effect on pregnancy via substance use and higher pregnancy desire/lower perceived difficulty. Findings represent a step towards elucidating pathways linking CM with AP. Recommendations are offered to prevent pregnancy by addressing the pregnancy-specific mechanisms that are part of the maltreatment sequelae.

Post-Pregnancy Factors Predicting Teen Mothers' Educational Attainment by Age 30 in Two National Cohorts

Women who begin childbearing as teenagers attain lower levels of education than women who delay childbearing until age 20 and later. Little is known about post-pregnancy factors that predict educational attainment among teen mothers. The current study examined whether teen mothers' environment and experiences 2 years after their first birth contribute to their educational outcomes by age 30, net of selection factors associated with teenage childbearing. Data were from two cohorts, the National Longitudinal Surveys of Youth 1979 (N = 241) and 1997 (N = 378). Multinomial logistic regression modeling was used to assess associations of post-pregnancy factors with teen mothers' educational attainment. Having child care was associated with increased odds of attaining a high school diploma and of attending college in both cohorts. Providing regular and subsidized child care for teen mothers is an opportunity to support teen mothers in achieving higher levels of educational attainment.

Individual differences in the development of youth externalizing problems predict a broad range of adult psychosocial outcomes

This study examined how youth aggressive and delinquent externalizing problem behaviors across childhood and adolescence are connected to consequential psychosocial life outcomes in adulthood. Using data from a longitudinal, high-risk sample (N = 1069) that assessed children and their parents regularly from early childhood (ages 3-5) through adulthood, multilevel growth factors of externalizing behaviors were used to predict adult outcomes (age 24-31), providing a sense of how externalizing problems across development were related to these outcomes via maternal, paternal, teacher, and child report. Findings indicated strong support for the lasting connections between youth externalizing problems with later educational attainment and legal difficulties, spanning informants and enduring beyond other meaningful contributors (i.e., child sex, cognitive ability, parental income and education, parental mental health and relationship quality). Some support was also found, although less consistently, linking externalizing problems and later alcohol use as well as romantic relationship quality. Delinquent/rule-breaking behaviors were often stronger predictors of later outcomes than aggressive behaviors. Taken together, these results indicate the importance of the role youth externalizing behaviors have in adult psychosocial functioning one to two decades later.

Partner Emotional Support and Child Problem Behaviors: The Indirect Role of Harsh Parenting for Young Mothers and Their Children

Emotionally supportive partners promote the well-being of teenage mothers and their children as they navigate sensitive developmental periods. Yet, having focused on young parents' relationship dissolution, we know very little about benefits of partner supportiveness for the development of children's psychological adjustment or processes that may explain this association. Using five waves of Fragile Families and Child Well-being Study data (N = 771) and parallel process latent growth curve modeling, this study tested whether trajectories of partner supportiveness (measured by maternal reports of fathers' emotional support) directly mitigated trajectories of children's externalizing and internalizing problem behaviors (measured by maternal reports of problem behaviors) and/or whether such effects were indirectly linked through lower levels of maternal harsh parenting (measured by observational ratings of mother-child interactions). Results suggest that higher levels of partner supportiveness at birth were associated with child externalizing and internalizing trajectories that started at lower levels and demonstrated slower improvements across time. Lower starting levels of maternal harsh parenting when children were three years old partially explained associations between partner supportiveness at birth and lower levels of child externalizing symptoms at age three. Lessons gleaned from this study are discussed in context of young families' strengths and applied to practice-based settings.

Trends and factors related to adolescent pregnancies: an incidence trend and conditional inference trees analysis of northern Nicaragua demographic surveillance data

BACKGROUND

We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women.

METHODS

A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies.

RESULTS

The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies.

CONCLUSIONS

Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.

The unequal consequences of family structures for infant health

Rapid changes in American families have reshaped inequalities in child well-being. This paper examines the unequal consequences of family structures for infant health, focusing on birthweight. Existing studies mainly address the average association between marriage (versus singlehood) and birthweight. I extend the literature by 1) explicitly considering cohabitation and 2) exploring the heterogeneous associations based on mother's likelihood of union formation at conception. Pooling nationally representative data from the National Survey of Family Growth 2011-17, I analyze a sample of recent births (N = 4,376) born to mothers aged between 20 and 49 years. Propensity score methods are used to address selections. Results show that 1) compared to single mothers, married mothers reap birthweight benefits, while cohabiting mothers do not; 2) married mothers with a higher likelihood to marry at conception (i.e., more advantaged) reap even larger birthweight benefits than their low-likelihood counterparts (i.e., less advantaged). Overall, the findings reveal important and nuanced roles of family structure in the reproduction of intergenerational inequality through infant health.

Prenatal environmental exposures and associations with teen births

BACKGROUND

Children's prenatal exposure to multiple environmental chemicals may contribute to subsequent deficits in impulse control, predisposing them to risk-taking.

OBJECTIVE

Our goal was to investigate associations between prenatal exposure mixtures and risk of teen birth, a manifestation of high-risk sexual activity, among 5865 girls (1st generation) born in southeast Massachusetts from 1992-1998.

METHODS

Exposures included prenatal modeled polychlorinated biphenyls (PCBs), ρ,ρ'-dichlorodiphenyl dichloroethylene (DDE), hexachlorobenzene (HCB), lead (Pb), and mercury (Hg). We fit adjusted generalized additive models with multivariable smooths of exposure mixtures, 1st generation infant's birth year, and maternal age at 1st generation birth. Predicted odds ratios (ORs) for teen birth were mapped as a function of joint exposures. We also conducted sensitivity analyses among 1st generation girls with measured exposure biomarkers (n = 371).

RESULTS

The highest teen birth risk was associated with a mixture of high prenatal HCB, Hg, Pb, and PCB, but low DDE exposure, with similar associations in sensitivity analyses. The highest OR predicted for girls born in 1995 to mothers of median age (26 years) was at the 95th percentile of the HCB and PCB exposure distributions (OR = 3.09; 95% confidence interval: 0.29, 32.4). Additionally, girls born earlier in the study period or to teen mothers were at increased risk of teen birth.

SIGNIFICANCE

Prenatal environmental chemical exposures and sociodemographic characteristics may interact to substantially increase risk of teen births.

A polygenic score for age-at-first-birth predicts disinhibition

BACKGROUND

A recent genome-wide association study identified molecular-genetic associations with age-at-first-birth. However, the meaning of these genetic discoveries is unclear. Drawing on evidence linking early pregnancy with disinhibitory behavior, we tested the hypothesis that genetic discoveries for age-at-first-birth predict disinhibition.

METHODS

We included participants with genotype data from the two-decade-long Environmental Risk (E-Risk) Study (N = 1,999) and the four-decade-long Dunedin Study (N = 918). We calculated a genome-wide polygenic score for age-at-first-birth and tested whether it was associated with a range of disinhibitory outcomes across the life course, including low childhood self-control; risk for externalizing psychopathology; officially recorded criminal offending; substance dependence; informant reports of disinhibitory problems; and number of lifetime sexual partners. We further tested whether associations were attributable to accelerated pubertal maturation.

RESULTS

In both cohorts, the age-at-first-birth polygenic score predicted low childhood self-control, externalizing psychopathology, officially recorded criminal offending, substance dependence, and number of sexual partners. Associations were modest, but robust across replication. Childhood disinhibition partly mediated associations between the polygenic score and reproductive behaviors. In contrast, associations were not attributable to accelerated pubertal timing.

CONCLUSIONS

Genomic discoveries for age-at-first-birth are about more than reproductive biology: They provide insight into the disinhibitory traits and behaviors that accompany early parenthood. Age-at-first-birth is a useful proxy phenotype for researchers interested in disinhibition. Further, interventions that improve self-regulation abilities may benefit young parents and their children.

Adolescent Self-Reported Use of Highly Effective Contraception: Does Provider Counseling Matter?

STUDY OBJECTIVE

To examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents.

DESIGN

A cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC).

SETTING

Rochester, New York.

PARTICIPANTS

Female students in 9th-12th grade in the Rochester City School District.

INTERVENTIONS

An anonymous, standardized survey was administered to collect data.

MAIN OUTCOME MEASURES

We studied associations between students' reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods.

RESULTS

Among 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P < .001) or SAC (adjusted odds ratio, 2.1; P = .007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception.

CONCLUSION

Adolescents' use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.

A Systematic Review of Programs to Promote Aspects of Teen Parents' Self-sufficiency: Supporting Educational Outcomes and Healthy Birth Spacing

INTRODUCTION

Expectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children's healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents' self-sufficiency by promoting their educational outcomes and healthy birth spacing.

METHODS

We conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review's eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies' findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence.

RESULTS

We identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs.

DISCUSSION

Effective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens' education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness.

Adolescent Fertility Is Lower than Expected in Rural Areas: Results from 10 African HDSS

The adolescent birth rate (ABR) is an important indicator of maternal health, adolescent sexual health, and gender equity; it remains high in sub-Saharan Africa. While Demographic and Health Surveys (DHS) are the main source of ABR estimates, Health and Demographic Surveillance Systems (HDSS) also produce ABRs. Studies are lacking, however, to assess the ease of access and accuracy of HDSS ABR measures. In this paper, we use birth and exposure data from 10 HDSS in six African countries to compute local ABRs and compare these rates to DHS regional rates where the HDSS sites are located, standardizing by education and place of residence. In rural HDSS sites, the ABR measure is on average 44 percent lower than the DHS measure, after controlling for education and place of residence. Strong temporary migration of childless young women out of rural areas and different capacities in capturing temporarily absent women in the DHS and HDSS could explain this discrepancy. Further comparisons based on more strictly similar populations and measures seem warranted.

Externalizing Behavior Problems in Offspring of Teen Mothers: A Meta-Analysis

Young maternal age at birth has been consistently recognized as a factor contributing to externalizing behavior. However, estimates of the magnitude of this association across existing studies are inconsistent. Such inconsistencies cloud the interpretation of the literature and highlight the need for a systematic synthesis of existing empirical evidence. Further, the roles of possible moderators in the association remain to be revealed. Moderation analyses will enhance the field's capacity to evaluate needs and locate a subgroup of children born to teen mothers with particularly heightened vulnerabilities. To address these gaps, the present study had two primary aims. First, a meta-analysis was conducted to quantify the magnitude of the association between being born to young mothers and children's externalizing behavior across existing studies. Second, moderation meta-analyses were conducted to evaluate whether the influence of being born to teen mothers on children's externalizing behavior is stronger during specific developmental periods, for a specific gender, for a specific race, or across contexts with varying teen pregnancy rates at a societal level. The current study followed the PRISMA guidelines. The search utilized multiple electronic databases including Web of Science, ProQuest, PubMed, and Ovid MEDLINE through July 2019. Standardized mean difference, Cohen's d, was used as a summary estimate of effect size. A random-effects model was conducted. Moderating effects were evaluated. Twenty-one effect sizes from 18 independent samples (n = 133,585) were included in the meta-analysis. The main meta-analysis and sensitivity analysis suggested a small yet robust association between teenage motherhood and children's externalizing behavior problems. The relevant moderation analyses detected no statistically significant moderating effect for a specific gender, for racial and ethnic minority groups, during a specific developmental period, or across varying contexts. The current meta-analysis findings suggest that the impact of young maternal age on children's externalizing behavior is small, yet independent. Further, such impacts of young maternal age were similar for girls and boys, in different racial and ethnic groups, across developmental periods, and across different contexts with varying teen pregnancy rates. Prevention efforts seeking to curb the emergence of youth's externalizing behavior should focus on parenting teens, regardless of their child's gender, race, age, or contexts. Further, the current findings suggest that prevention strategies for this specific group may benefit from a hybrid approach that combines universal, selective, and indicated prevention strategies.

Teen childbearing and offspring internalizing symptoms: The mediating role of child maltreatment

Teenage childbearing (age 15-19 years) represents a significant public health issue that can generate considerable deleterious, multigenerational consequences for teen-childbearing mothers and their offspring. However, few studies have examined the potential mediating mechanisms that may explain if and how teen childbearing is associated with the development of offspring psychopathology. The current study used a developmental model to test the mediating role of chronic child maltreatment in the relationship between teen childbearing and offspring internalizing symptoms in childhood and emerging adulthood. The study participants were 384 individuals from socioeconomically disadvantaged, ethnically diverse backgrounds, assessed across two longitudinal waves of data (i.e., ages 10-12 and 18-20). The sample included maltreated and nonmaltreated children, all of whom were comparable in terms of family income. Structural equation modeling was conducted to test direct and indirect pathways from teen childbearing to offspring psychopathology. A multigenerational developmental cascade was found such that individuals born to mothers who began their childbearing in adolescence were more likely to experience chronic maltreatment during childhood, which in turn predicted greater internalizing symptoms throughout childhood and emerging adulthood. Using a developmental psychopathology framework, the results are discussed with regard to implications for prevention and early intervention.

Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review

BACKGROUND

Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents.

METHODS

We used the standardized systematic review methodology based on the process outlined in the World Health Organization's Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence.

RESULTS

We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries.

CONCLUSION

Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.

Financial opportunity costs and deaths among close kin are independently associated with reproductive timing in a contemporary high-income society

Evolutionary demography predicts that variation in reproductive timing stems from socio-ecologically contingent trade-offs between current and future reproduction. In contemporary high-income societies, the costs and benefits of current reproduction are likely to vary by socioeconomic status (SES). Two influential hypotheses, focusing on the parenthood 'wage penalty', and responses to local mortality have separately been proposed to influence the timing of parenthood. Economic costs of reproduction (i.e. income loss) are hypothesized to delay fertility, especially among high childhood SES individuals who experience greater opportunities to build capital through advantageous education and career opportunities. On the other hand, relatively low childhood SES individuals experience higher mortality risk, which may favour earlier reproduction. Here, we examine both hypotheses with a representative register-based, multigenerational dataset from contemporary Finland (N = 47 678). Consistent with each hypothesis, the predicted financial cost of early parenthood was smaller, and mortality among close kin was higher for individuals with lower childhood SES. Within the same dataset, lower predicted adulthood income and more kin deaths were also independently associated with earlier parenthood. Our results provide a robust demonstration of how economic costs and mortality relate to reproductive timing. We discuss the implications of our findings for demographic theory and public policy.

Trends in participation in teen pregnancy and STI prevention programming, 2002-2016

Programs designed to help youth prevent early/unwanted pregnancy and sexually transmitted infection (STI) have been shown to yield a positive impact on youth behavior and key outcomes. However, recent evidence suggests that youth participation in prevention programming for health-risk behavior may be declining. The aim of the present study is to provide up-to-date information on the national trends in adolescent participation in prevention programming targeting early pregnancy and STI in the United States. We examined fifteen years of cross-sectional data (2002-2016, N = 234,803) from the National Survey on Drug Use and Health. Our main outcome was youth self-reported (no/yes) past-year participation in a pregnancy or STI prevention program. Survey adjusted prevalence estimates and logistic regression analysis were used to examine trends in participation. Youth participation in pregnancy and STI prevention programming decreased significantly from a high of 15% in 2003 to a low of 7% in 2016. Representing a 53% proportional decline in youth participation, this downward trend was significant even when controlling for age, gender, race/ethnicity, household income, and urbanicity (AOR: 0.947, 95% CI: 0.943-0.951). The downward trend in participation was observed across racial/ethnic subgroups. A consistent pattern of differences in prevalence was observed with African-American youth reporting the highest levels of participation followed by Hispanic, and then White youth. It is incumbent upon concerned citizens, scientists, and policymakers to push for change that can shift the trend line in adolescent participation in teen pregnancy and STI prevention programming to an upward tilt.

The Intergenerational Transmission of Early Childbearing: Examining Direct and Indirect Associations in a Swedish Birth Cohort

Background. Research shows that early childbearing is associated negatively with educational attainment and socioeconomic status (SES). Children born to young versus older mothers often do less well in school, and many have early first births. Some studies suggest that mothers’ early childbearing operates through SES to influence the daughters’ early childbearing, and some argue that the association is strong net of SES. The current study tests these direct and indirect associations. Methods. We estimate the pathways through which mothers’ early childbearing influences daughters’ early childbearing in several steps. First, we examine bivariate associations between mothers’ early childbearing and SES, followed by bivariate associations between mothers’ SES outcomes and their daughters’ early childbearing. We then estimate the average marginal effects (AMEs) of mothers’ early children on daughters’, and a KHB decomposition to examine direct and indirect associations. Results. Findings suggest both direct and indirect associations. Nested models show that, net of a range of SES characteristics, mothers’ early childbearing increases the probability of daughters’ by approximately 8%; and KHB results suggest 37% mediation, with daughters’ school performance (12%) and household educational attainment (10%) contributing the highest shares. Conclusion. Mothers’ early childbearing and subsequent SES collectively influence the long-term wellbeing of children. Thus, early childbearing has consequences both within and across generations.

Linkage between teen mother's childhood adversity and externalizing behaviors in their children at age 11: Three aspects of parenting

BACKGROUND

Experiences of childhood adversity are consistently associated with compromised behavioral health later in life. Less clear is the intergenerational influence of maternal childhood adversity on developmental outcome in children. Completely unknown are the mechanisms linking teen mother's childhood adversity to child developmental outcomes.

OBJECTIVE

The present study tested whether aspects of parenting (parenting stress, physical discipline, and disagreement with grandparents) served as the pathways between teen mother's childhood adversity and the externalizing behaviors of their offspring at age 11, by gender.

PARTICIPANTS AND SETTING

Data were from a longitudinal panel study of teen mothers and their children, the Young Women and Child Development Study (N = 495; 57% male).

METHODS

The pathways from teen mother's childhood adversity to their offspring's externalizing behavior were tested by two subscales: rule-breaking behavior and aggressive behavior. In addition, multiple-group analysis was examined for potential gender differences.

RESULTS

Teen mother's childhood adversity was positively associated with greater use of parenting stress (β = 0.16, p < .01) and physical discipline (β=0.11, p < .05). In addition, parenting stress, physical discipline, and disagreement with grandparent were all associated with increased rule-breaking and aggressive behaviors in children. Multiple group analysis revealed that the path between physical discipline and externalizing behavior differed by gender, with the path only significant for girls.

CONCLUSIONS

These findings have implications for early intervention efforts that emphasize the need to intervene with children and parents, particularly helping teen mothers gain knowledge and skills to offset the impact of their experiences of childhood adversity on their parenting behaviors.

Family Histories and Teen Pregnancy in the United States and Canada

OBJECTIVE

This study took a long view of childhood experiences that can contribute to the risk of teen pregnancy in the U.S. and Canada, two countries with different norms and policies surrounding family life and inequality.

BACKGROUND

Teenage pregnancy is a major life experience arising from life course trajectories unfolding over a young woman's childhood. Cross-national comparisons can elucidate family-based pathways while embedding youth within broader national contexts of the U.S. and Canada, which are similar in some respects yet different in others.

METHOD

Longitudinal data from the U.S. NLSY79 Young Adult Survey (n = 3,122) and the Canadian NLSCY (n = 2,517) connected childhood histories to teenage pregnancy. Competing risk models estimated the risk of teenage pregnancy with family structure changes and episodes in poverty during childhood.

RESULTS

Teenage pregnancy, family change, and poverty were more common in the U.S. In the U.S., only multiple experiences of instability and poverty were associated with greater risk of teenage pregnancy, but, in Canada, any experience of childhood disadvantage was associated with elevated risk.

CONCLUSION

The risk of teen pregnancy was higher among both U.S. and Canadian adolescents from more unstable and economically insecure families, and that link between cumulative experiences of childhood disadvantage and adolescent pregnancy was stronger in Canada.

IMPLICATIONS

Policies and interventions to reduce teen pregnancy must address childhood socioeconomic disadvantage.

Cognitive development in children of adolescent mothers: The impact of socioeconomic risk and maternal sensitivity

BACKGROUND

Adolescent motherhood is accompanied by a constellation of risk factors that translate into developmental risk for the off-spring. Socioeconomic risk that is associated with adolescent motherhood as well as maternal interactive behaviors may contribute to the impact of adolescent motherhood on children's developmental outcome.

OBJECTIVE

Therefore, the aim of the current study was to investigate differences in children's cognitive development between children of adolescent and adult mothers in their first two years of life and to examine whether socioeconomic risk (e.g. such as educational and financial problems) and/or maternal sensitivity mediate developmental differences between children of adolescent and adult mothers.

METHODS

Adolescent mothers (<21 years; N = 64) and adult mothers (>25 years; N = 34) and their infants were included in the current study. Child cognitive development and maternal sensitivity were assessed at three different time points (T1: mean child age 5.26 months; T2: mean child age 14.69 months; T3: mean child age 21.16 months).

RESULTS

Children of adult mothers showed better cognitive performance at T3 compared to children of adolescent mothers but not at T1 and T2. A multiple mediation model including socioeconomic risk and maternal sensitivity as serial mediators demonstrated that the effect of adolescent motherhood on cognitive development was mediated in a causal effect chain with socioeconomic risk negatively affecting maternal sensitivity and maternal sensitivity affecting children's cognitive development.

DISCUSSION

The present findings demonstrate that maternal interactive behaviors are not only a simple predictor of cognitive development but may also act as a mediator of the association between more distal variables such as socioeconomic risk and cognitive development in adolescent mothers. This supports the need to promote prevention and intervention programs for adolescent mothers during the early postpartum period to reduce socioeconomic problems and enhance maternal interactive behaviors.

The effect of increased alcohol availability on alcohol-related health problems up to the age of 42 among children exposed in utero: a natural experiment

AIM

To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems.

METHOD

Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965-71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967-68, where access to strong beer increased for 16-20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis.

RESULTS

The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06).

CONCLUSION

Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers.

Theoretically-Based Emotion Regulation Strategies Using a Mobile App and Wearable Sensor Among Homeless Adolescent Mothers: Acceptability and Feasibility Study

BACKGROUND

Many adolescent mothers are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school and work, and challenging peer and familial relationships. Mobile health (mHealth) technology has the potential to intervene at various points in the emotion regulation process of adolescent mothers to provide them support for more adaptive emotional and behavioral regulation in the course of their daily life.

OBJECTIVE

The goal of this study was to examine the acceptability, feasibility, use patterns, and mechanisms by which a mobile technology used as an adjunct to in-person, provider-delivered sessions fostered adolescent mothers' adaptive emotion regulation strategies under real-life conditions.

METHODS

Participants (N=49) were enrolled in the intervention condition of a larger pilot study of homeless adolescent mothers living in group-based shelters. The mHealth technology. Calm Mom, consisted of a mobile app and a wrist-worn sensorband for the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We examined logs of mobile app activity and conducted semistructured qualitative interviews with a subsample (N=10) of participants. Qualitative data analysis was guided by the theoretical frames of the intervention and a technology acceptance model and included an analysis of emerging themes and concepts.

RESULTS

Overall, participants indicated that one or more of the elements of Calm Mom supported their ability to effectively regulate their emotions in the course of their daily life in ways that were consonant with the intervention's theoretical model. For many adolescent mothers, the app became an integral tool for managing stress. Due to technical challenges, fewer participants received sensorband alerts; however, those who received alerts reported high levels of acceptability as the technology helped them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations with their children, peers, and family members.

CONCLUSIONS

Calm Mom is a promising technology for providing theoretically driven behavioral intervention strategies during real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology challenges and refining tailoring algorithms for implementation in larger-scale studies.

Assessing Variations in Developmental Outcomes Among Teenage Offspring of Teen Mothers: Maternal Life Course Correlates

This study investigated potential heterogeneity in development among offspring (age 17) of teen mothers and maternal life course as correlates of variation. Using latent class analysis, subgroups of developmental outcomes were identified. Maternal standing in two life course realms (i.e., socioeconomic and domestic) was considered as a potential explanation for heterogeneity in offspring's development. Offspring reported on measures assessing their psychological, academic, and behavioral development. Teen mothers reported on measures of life course realms. Three subgroups of developmental outcomes were identified: on track (52%), at risk (37%), and troubled (11%). Findings suggest that economic hardship and number of pregnancies among teen mothers distinguish developmental patterns among teenage offspring, whereas teen mothers' educational attainment and marital status do not.

Demographic characteristics and pregnancy outcomes in adolescents - Experience from an Australian perinatal centre

BACKGROUND

Adolescent pregnancy is defined as pregnancy in girls aged 10-19 years and can be associated with increased risks.

AIM

To investigate obstetric and perinatal outcomes in a cohort of adolescent girls from a major Australian tertiary centre.

MATERIALS AND METHODS

This was a nine-year retrospective cohort study of women who birthed at the Mater Mother's Hospital (MMH) in Brisbane, Australia between 1 January 2007 and 31 December 2015. The adolescent cohort was aged <19 years and the control group was aged 20-24 years.

RESULTS

Over the study period the total study cohort comprised 8904 women. Of these, the adolescent cohort consisted of 1625 girls (18.2%) and the control group consisted of 7279 women (81.8%). Adolescents were more likely to be nulliparous, single, of Indigenous ethnicity or to have refugee status. They had higher rates of smoking, asthma, diabetes mellitus and thyroid disease. They were more likely to have an uncomplicated spontaneous vaginal delivery but were less likely to have an intact perineum and had higher rates of pre-term delivery and low birth weight babies. There were no differences in rates of postpartum haemorrhage.

CONCLUSIONS

Teenage pregnancy results in poorer obstetric and perinatal outcomes. A focus on optimising maternal health care and providing culturally appropriate antenatal and intrapartum care is imperative to improving outcomes.

An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers

The purpose of this study was to perform an umbrella review of meta-analyses of intervention studies designed to improve outcomes of pregnant or parenting teenagers. An extensive search retrieved nine reports which provided 21 meta-analyses analyses. Data were extracted by two reviewers. Methodological quality was assessed using the AMSTAR Instrument. Most effect sizes were small but high quality studies showed significant outcomes for reduced low birth weight (RR = 0.60), repeat pregnancies/births (OR = 0.47-0.62), maternal education (OR = 1.21-1.83), and maternal employment (OR = 1.26). Several parenting outcomes (parent-child teaching interaction post-intervention [SMD = -0.91] and at follow-up [SMD = -1.07], and parent-child relationship post-intervention [SMD = -0.71] and at follow-up [SMD = -0.90]) were significant, but sample sizes were very small. Many reports did not include moderator analyses. Behavioral interventions offer limited resources and occur too late to mitigate the educational and social disparities that precede teen pregnancy. Future intervention research and policies that redress the social determinants of early childbearing are recommended.

Health Care Factors Influencing Teen Mothers' Use Of Contraceptives in Malawi

OBJECTIVE

The study seeks to examine factors associated with teen mothers' use of modern contraceptives after giving birth.

METHODS

The 2010 Malawi Demographic and Health Survey data was used to test the study objective. A sample of 12, 911 teen mothers aged between 10 and 18 years were extracted from 23, 020 women and were asked of contraceptive usage after first birth experiences, in which, a logistic regression model was employed to estimate correlates of contraceptive usage.

RESULTS

The study found that 54.8% of the teen mothers are still at a risk of having a repeat teenage pregnancy due to their non-use of contraceptives. This implies that less than 50% of teen mothers use contraceptives after experiencing teen birth. It is noted that health care factors such as use of antenatal care, awareness of pregnancy complications, attainment of primary education and exposure to media predict teen mothers' use of modern contraceptives.

CONCLUSION

Despite endeavours made by government to improve access to family planning, health care challenges still exist affecting women's use of contraceptives in Malawi. Ameliorating these health encounters call for wide-range approaches aimed at addressing teen birth comprehensively in order to prevent early motherhood and subsequently high fertility.

FUNDING

None declared.

Rapid Repeat Birth: Intersections Between Meaning-Making and Situational Support Among Multiparous Adolescent Mothers

This study examined interpretations of motherhood among adolescents who have experienced rapid repeat births (second births within 24 months of the primiparous birth). Analyses of participants’ descriptions of their transitions to motherhood indicate four modal narratives that vary along two axes: the adoption of a motherhood identity, and the nature (or stability) of relational support available. By using subjective perceptions of motivation, stability, and feelings of competence, this study linked intrapersonal meaning-making with situational sources of support to describe various pathways through repeat adolescent childbearing in a way that both confirms and enriches extant literature. The implications of this study instruct home visiting programs and other interventions designed to forestall repeat pregnancies by elucidating pathways of reinforcement or increased risk inherent in some maternal trajectories. Following this logic, interventions directed at improving outcomes for young mothers and their children would do well to consider the interplay between internal meaning-making, relational support, and the transformative power of adopting the mother identity.

Why is young maternal age at first childbirth a risk factor for persistent delinquency in their male offspring? Examining the role of family and parenting factors

BACKGROUND

Children born to mothers who were younger than average at their first childbirth are at increased risk for future persistent delinquent behaviour, but explanations for this remain unclear.

AIMS

Our aim was to identify possible family and parenting variables that may help explain this relationship. We hypothesised that parental stress, large number of children in the home, low socioeconomic status (including neighbourhood problems) and poor parenting would account for the link between early first motherhood and their offspring's delinquency.

METHODS

Four hundred and sixty-two boys were selected from the Pittsburgh Youth Study, a longitudinal study of a random sample of school boys in Pittsburgh, initially assessed half-yearly and then annually from 7 to 19 years of age, using self-reporting and other reporting methods. Indirect effect models were used to test relationships between variables.

RESULTS

Higher levels of parental stress, poorer parent-child communication and caring for a larger number of children all mediated the relationship between maternal youth and persistent delinquency by their boys, but only explained about 20% of it.

DISCUSSION

At least partial explanations of the relationship between a mother's age at first childbirth and persistent delinquency in her male offspring suggest that future research should test whether early interventions with younger mothers to decrease their sense of stress in parenting and improve their capacity for communication with their child(ren) may help to prevent persistent delinquency in their boys. Programmes designed to help young women make more informed and planned decisions about their pregnancies should also be evaluated. Copyright © 2015 John Wiley & Sons, Ltd.

Factors Associated with Unwanted Pregnancy among Adolescents in Russia

STUDY OBJECTIVE

To identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia.

DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

The investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons.

INTERVENTIONS

Both groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use.

MAIN OUTCOME MEASURES

Factors associated with unintended pregnancy.

RESULTS

In the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut.

CONCLUSION

Although the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes.

Family formation: A positive outcome for vulnerable young women?

While marriage and childbirth are generally considered positive adult outcomes, it is not clear that this holds true among low income young women. Beyond adolescent parenting, little empirical data exists on various types of family formation in this population. The aims of this study were twofold: (1) to understand predictors of type of family formation (e.g., none, childrearing, marriage, or both) among 4,385 young women with childhood histories of poverty and/or maltreatment; and (2) to explore whether family formation patterns were associated with negative adult behavioral and health outcomes. Results of the AIM 1 multinomial regression analysis of family formation indicated that the likelihood of childrearing with or without marriage increased with an increase in the number of adolescent risk behaviors after controlling for the maltreatment and/or poverty histories. Among women with maltreatment histories, early onset maltreatment was associated with childrearing or marriage compared to no family. Among previously maltreated women, predictors of family formation varied according to prior poverty history. AIM 2 Cox regression results indicated that having children with or without marriage was associated with a higher risk of negative outcomes after controlling for maltreatment and adolescent risk factors. Bivariate analyses suggested that most of the increased risk was associated with having at least two children. Findings underscore the importance of preventing adolescent risk behaviors among low income and maltreated girls as well as early and unplanned births among vulnerable young adult women.

Is underage abortion associated with adverse outcomes in early adulthood? A longitudinal birth cohort study up to 25 years of age

STUDY QUESTION

Is underage abortion associated with adverse socioeconomic and health outcomes in early adulthood when compared with underage delivery?

SUMMARY ANSWER

Underage abortion was not found to be associated with mental health problems in early adulthood, and socioeconomic outcomes were better among those who experienced abortion compared with those who gave birth.

WHAT IS KNOWN ALREADY

Teenage motherhood has been linked with numerous adverse outcomes in later life, including low educational levels and poor physical and mental health. Whether abortion at a young age predisposes to similar consequences is not clear.

STUDY DESIGN, SIZE, DURATION

This nationwide, retrospective cohort study from Finland, included all women born in 1987 (n = 29 041) and followed until 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We analysed socioeconomic, psychiatric and risk-taking-related health outcomes up to 25 years of age after underage (<18 years) abortion (n = 1041, 3.6%) and after childbirth (n = 394, 1.4%). Before and after conception analyses within the study groups were performed to further examine the association between abortion and adverse health outcomes. A group with no pregnancies up to 20 years of age (n = 25 312, 88.0%) served as an external reference group.

MAIN RESULTS AND THE ROLE OF CHANCE

We found no significant differences between the underage abortion and the childbirth group regarding risks of psychiatric disorders (adjusted odds ratio 0.96 [0.67-1.40]) or suffering from intentional or unintentional poisoning by medications or drugs (1.06 [0.57-1.98]). Compared with those who gave birth, girls who underwent abortion were less likely to achieve only a low educational level (0.41 [95% confidence interval 0.31-0.54]) or to be welfare-dependent (0.31 [0.22-0.45]), but more likely to suffer from injuries (1.51 [1.09-2.10]). Compared with the external control group, both pregnancy groups were disadvantaged already prior to the pregnancy. Psychiatric disorders and risk-taking-related health outcomes, including injury, were increased in the abortion group and in the childbirth group similarly on both sides of the pregnancy.

LIMITATIONS, REASONS FOR CAUTION

The retrospective nature of the study remains a limitation. The identification of study subjects in order to collect additional data was not allowed for ethical reasons. Therefore further confounding factors, such as the intentionality of the pregnancy, could not be checked.

WIDER IMPLICATIONS OF THE FINDINGS

Previous studies have found that abortion is not harmful to mental health in the majority of adult women. Our study adds to the current understanding in suggesting that this is also the case concerning underage girls. Furthermore, women with a history of underage abortion had better socioeconomic outcomes compared with those who gave birth. These findings can be generalized to settings of high-quality social and health-care services, where abortion is accessible and affordable to all citizens. Social and health-care professionals who care for and counsel underage girls facing unplanned pregnancy should acknowledge this information.

STUDY FUNDING/COMPETING INTERESTS

This study was financially supported by the Finnish Cultural Foundation and the Päivikki and Sakari Sohlberg Foundation. The researchers are independent of funders and the funders had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. The authors have no competing interests.

Effects of Adolescent Childbearing on Maternal Depression and Problem Behaviors: A Prospective, Population-Based Study Using Risk-Set Propensity Scores

Adolescent mothers are reportedly at risk for depression and problem behaviors in the postpartum period, but studies have rarely considered developmental context and have yet to disentangle the effects of childbearing on adolescent functioning from selection effects that are associated with early pregnancy. The current study examined changes in adolescent depression, conduct problems and substance use (alcohol, tobacco and marijuana) across the peripartum period using risk-set propensity scores derived from a population-based, prospective study that began in childhood (the Pittsburgh Girls Study, PGS). Each of 147 childbearing adolescents (ages 12–19) was matched with two same-age, non-childbearing adolescents (n = 294) on pregnancy propensity using 15 time-varying risk variables derived from sociodemographic, psychopathology, substance use, family, peer and neighborhood domains assessed in the PGS wave prior to each pregnancy (T1). Postpartum depression and problem behaviors were assessed within the first 6 months following delivery (T2); data gathered from the non-childbearing adolescent controls spanned the same interval. Within the childbearing group, conduct problems and marijuana use reduced from T1 to T2, but depression severity and frequency of alcohol or tobacco use showed no change. When change was compared across the matched groups, conduct problems showed a greater reduction among childbearing adolescents. Relative to non-childbearing adolescents who reported more frequent substance use with time, childbearing adolescents reported no change in alcohol use and less frequent use of marijuana across the peripartum period. There were no group differences in patterns of change for depression severity and tobacco use. The results do not support the notion that adolescent childbearing represents a period of heightened risk for depression or problem behaviors.

"Having a Baby Changes Everything" Reflective Functioning in Pregnant Adolescents

Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy.

DESIGN AND METHODS

This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7+1.5years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes.

RESULTS

These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.

The Sociocultural Context of Mexican-Origin Pregnant Adolescents' Attitudes Toward Teen Pregnancy and Links to Future Outcomes

Given the negative developmental risks associated with adolescent motherhood, it is important to examine the sociocultural context of adolescent mothers' lives to identify those most at risk for poor outcomes. Our goals were to identify profiles of Mexican-origin pregnant adolescents' cultural orientations and their attitudes toward teen pregnancy, and to investigate how these profiles were linked to adolescents' pregnancy intentions, family resources, and short-term family, educational, and parenting outcomes. With a sample of 205 Mexican-origin adolescent mothers, we identified three profiles based on cultural orientations and attitudes toward teen pregnancy: Bicultural-Moderate Attitudes, Acculturated-Moderate Attitudes, and Enculturated-Low Attitudes. The results indicated that enculturated pregnant adolescents had the least favorable attitudes toward teen pregnancy, and the lowest levels of family income, pregnancy intentions, pregnancy support, and educational expectations compared to acculturated and bicultural pregnant adolescents; acculturated adolescents (with the highest family income and high levels of pregnancy support) had the highest levels of parenting efficacy 10 months postpartum. Our findings suggest that enculturated adolescent mothers (with less positive attitudes toward teen pregnancy) may benefit from educational support programs and enculturated and bicultural adolescent mothers (with moderately positive attitudes toward teen pregnancy) may benefit from programs to increase parenting efficacy. Such targeted interventions may, in turn, reduce the likelihood of adolescent mothers experiencing negative educational and parenting outcomes.

Child welfare clients have higher risks for teenage childbirths: which are the major confounders?

BACKGROUND

Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors.

METHODS

Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973-1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor's relative contribution to the difference between crude and adjusted odds ratios (ORs).

RESULTS

Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls' school failure was the most potent confounder, accounting for 28-35% of the difference between crude and adjusted ORs.

CONCLUSION

As in majority populations, girls' school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

Determinants of underage induced abortion--the 1987 Finnish Birth Cohort study

INTRODUCTION

Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth.

MATERIAL AND METHODS

All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at <18 years of age and girls with no underage pregnancies (n = 27 605, 95.0%).

RESULTS

Shared risk factors of underage induced abortion and childbirth included early onset behavioral and emotional disorders [adjusted OR 1.9 (1.4-2.5) and 2.7 (95% CI 1.8-3.9)], a history of foster care [1.5 [1.1-1.9] and 3.0 [2.3-4.1)], and socioeconomic factors, including living in a family receiving income support [1.8 (1.5-2.1) and 3.4 (2.7-4.4)], respectively. Specific risk factors of underage induced abortion were psychoactive substance use disorders [2.2 (1.3-3.5)], having a mother who smoked during pregnancy [1.5 (1.3-1.8)] or had undergone induced abortion [1.8 (1.5-2.2)]. Coping with a chronic physical illness [0.7 (0.5-0.9)], and perinatal problems [0.6 (0.4-0.7)] were inversely associated with underage induced abortion.

CONCLUSIONS

The traditionally acknowledged determinants of underage childbirth played a less prominent role in induced abortion. Novel risk factors of underage induced abortion were found, including severe substance abuse and adverse maternal reproductive history, and should be addressed at all levels offering youth healthcare and social welfare services.

Translational Epidemiologic Approaches to Understanding the Consequences of Early-Life Exposures

Prominent developmental theories posit a causal link between early-life exposures and later functioning. Yet, observed associations with early exposures may not reflect causal effects because of genetic and environmental confounding. The current manuscript describes how a systematic series of epidemiologic analyses that combine several genetically-informative designs and statistical approaches can help distinguish between competing theories. In particular, the manuscript details how combining the use of measured covariates with sibling-comparisons, cousin-comparisons, and additional designs can help elucidate the sources of covariation between early-life exposures and later outcomes, including the roles of (a) factors that are not shared in families, including a potential causal effect of the exposure; (b) carryover effects from the exposure of one child to the next; and (c) familial confounding. We also describe key assumptions and how they can be critically evaluated. Furthermore, we outline how subsequent analyses, including effect decomposition with respect to measured, plausible mediators, and quantitative genetic models can help further specify the underlying processes that account for the associations between early-life exposures and offspring outcomes.

A Genetically Informed Study of the Associations Between Maternal Age at Childbearing and Adverse Perinatal Outcomes

We examined associations of maternal age at childbearing (MAC) with gestational age and fetal growth (i.e., birth weight adjusting for gestational age), using two genetically informed designs (cousin and sibling comparisons) and data from two cohorts, a population-based Swedish sample and a nationally representative United States sample. We also conducted sensitivity analyses to test limitations of the designs. The findings were consistent across samples and suggested that, associations observed in the population between younger MAC and shorter gestational age were confounded by shared familial factors; however, associations of advanced MAC with shorter gestational age remained robust after accounting for shared familial factors. In contrast to the gestational age findings, neither early nor advanced MAC was associated with lower fetal growth after accounting for shared familial factors. Given certain assumptions, these findings provide support for a causal association between advanced MAC and shorter gestational age. The results also suggest that there are not causal associations between early MAC and shorter gestational age, between early MAC and lower fetal growth, and between advanced MAC and lower fetal growth.

Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends

PURPOSE

To examine pregnancy rates and outcomes (births and abortions) among 15- to 19-year olds and 10- to 14-year olds in all countries for which recent information could be obtained and to examine trends since the mid-1990s.

METHODS

Information was obtained from countries' vital statistics reports and the United Nations Statistics Division for most countries in this study. Alternate sources of information were used if needed and available. We present estimates primarily for 2011 and compare them to estimates published for the mid-1990s.

RESULTS

Among the 21 countries with complete statistics, the pregnancy rate among 15- to 19-year olds was the highest in the United States (57 pregnancies per 1,000 females) and the lowest rate was in Switzerland (8). Rates were higher in some former Soviet countries with incomplete statistics; they were the highest in Mexico and Sub-Saharan African countries with available information. Among countries with reliable evidence, the highest rate among 10- to 14-year olds was in Hungary. The proportion of teen pregnancies that ended in abortion ranged from 17% in Slovakia to 69% in Sweden. The proportion of pregnancies that ended in live births tended to be higher in countries with high teen pregnancy rates (p = .02). The pregnancy rate has declined since the mid-1990s in the majority of the 16 countries where trends could be assessed.

CONCLUSIONS

Despite recent declines, teen pregnancy rates remain high in many countries. Research on the planning status of these pregnancies and on factors that determine how teens resolve their pregnancies could further inform programs and policies.

Maternal age at childbirth and risk for ADHD in offspring: a population-based cohort study

BACKGROUND

Women who give birth at younger ages (e.g. teenage mothers) are more likely to have children who exhibit behaviour problems, such as attention-deficit/hyperactivity disorder (ADHD). However, it is not clear whether young maternal age is causally associated with poor offspring outcomes or confounded by familial factors.

METHODS

The association between early maternal age at childbirth and offspring ADHD was studied using data from Swedish national registers. The sample included all children born in Sweden between 1988 and 2003 (N = 1 495 543), including 30 674 children with ADHD. We used sibling- and cousin-comparisons to control for unmeasured genetic and environmental confounding. Further, we used a children-of-siblings model to quantify the genetic and environmental contribution to the association between maternal age and offspring ADHD.

RESULTS

Maternal age at first birth (MAFB) was associated with offspring ADHD. Teenage childbirth (<20 years) was associated with 78% increased risk of ADHD. The association attenuated in cousin-comparison, suggesting unmeasured familial confounding. The children-of-siblings model indicated that the association between MAFB and ADHD was mainly explained by genetic confounding.

CONCLUSIONS

All children born to mothers who bore their first child early in their reproductive lives were at increased risk of ADHD. The association was mainly explained by genetic factors transmitted from mothers to their offspring that contribute to both age at childbirth and ADHD in offspring. Our results highlight the importance of using family-based designs to understand how early life circumstances affect child development.