Childhood abuse as a risk factor for adolescent pregnancy in El Salvador

Path Analysis of Adverse Childhood Experiences, Early Marriage, Early Pregnancy, and Exposure to Intimate Partner Violence Among Young Women in Honduras

Purpose

The pathways by which adverse childhood experiences (ACEs) are associated with early marriage and early pregnancy are poorly understood. Early marriage and early pregnancy may be risk factors for adulthood intimate partner violence (IPV). The aim of this study was to assess the relationships among ACEs, early marriage, early pregnancy, and IPV among women in Honduras.

Method

We used weighted data from 1,436 women aged 18-24 years from the nationally representative 2017 Honduras Violence Against Children and Youth Survey. We used path analysis to estimate relationships and accounted for sample design, non-response, and within-country clustering.

Results

We found that ACEs had differential relationships with outcomes of interest. For example, witnessing violence in the community was directly associated with increased probability of early pregnancy (10 percentage points (PP); 95% CI: 0.04, 0.15) and IPV (6 PP; 95% CI: 0.01, 0.10), while emotional violence was not directly or indirectly associated with any outcome. Early marriage and early pregnancy had no direct or indirect effect on IPV, but the total effect of early marriage on IPV was significant.

Conclusions

Understanding the relationship between ACEs, early marriage, early pregnancy, and IPV may help inform prevention efforts. For example, programs aiming to reduce early pregnancy may consider addressing sexual violence experienced in childhood.

Exposure to violence, polyvictimization and youth's mental health and alcohol use in El Salvador

BACKGROUND

Community and family violence are major global health problems. Approximately 1.3 million deaths around the world and 2.5% of global mortality are due to violence. In El Salvador, youth are exposed to multiple levels of physical and emotional violence, abuse, and crime.

OBJECTIVE

The objective of this study was to investigate the various sources of violence against youth and determine the associations with mental distress symptoms, suicidal ideation, and alcohol use outcomes.

PARTICIPANTS AND SETTING

We use information gathered in 2017 from a representative sample of 13- to 24-year-old adolescents and young adults from El Salvador.

METHODS

Data used in this analysis came from a nationally cross-sectional household survey called Violence Against Children Survey (VACS) in El Salvador. We used logistic regression models to determine the associations between lifetime witnessing violence, exposure to physical, sexual, emotional violence, and youth mental health outcomes.

RESULTS

Polyvictimization was associated with greater odds of each mental health outcome after adjusting for confounders. The strongest relative association was observed between emotional violence and mental distress. Sexual violence and emotional violence were predictors of suicidal ideation. Finally, physical violence and sexual violence were associated with alcohol use. The greatest associations were observed between sexual violence perpetrated by a parent, peer, or another adult in the community and suicidal ideation, at a magnitude of approximately six times higher odds.

CONCLUSIONS

Preventing violence against youth is likely to improve mental health and wellbeing in El Salvador and other similar contexts worldwide.

Traumatic Childhood Experiences and Psychiatric Outcomes of Adolescent Mothers in Turkey

The present study aimed to define the sociodemographic characteristics of adolescent mothers in Turkey as well as to compare their traumatic childhood experiences and their depression and anxiety levels with those of adult mothers. Sixty-eight mothers participated in this cross-sectional study. The frequency of traumatic childhood experiences and the severity of depression and anxiety symptoms among the adolescent mothers were found to be significantly lower than among the adult mothers, except for emotional neglect. The severity of anxiety symptoms was found to be significantly higher in those adolescent mothers who did not intend to become pregnant and who live with their own family or in institutional care than in those who live with their partner and/or his family. This is the first study to evaluate the traumatic childhood experiences of adolescent mothers in Turkey. Further, this cross-sectional study demonstrates that the initial psychiatric assessment of adolescent mothers who intended to become pregnant might reflect their level of psychiatric wellbeing. It is clear that additional policies concerning the prevention of adolescent pregnancy and the follow-up of adolescent mothers need to be developed in Turkey.

Experiences of pregnancy in adolescence of internally displaced women in Bogotá: an ethnographic approach

Background

Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement.

Aim

This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia.

Methods

Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement.

Results

The main themes that emerged from participants’ experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners.

Conclusion

Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.

Do village-level normative and network factors help explain spatial variability in adolescent childbearing in rural Honduras?

Adolescent childbearing rates are higher in Central America than almost anywhere else. However, in this research we discovered that adolescent childbearing exhibits variability from one village to another, and we might discover factors associated with this spatial variability that can help us understand key characteristics underlying the pattern of early childbearing. To do this, we assessed the village-level normative and network factors associated with adolescent birth (birth taking place before age 20 years) in rural Honduras and evaluated the geographic dispersion of these patterns. We used full population data from 24,937 people in 176 villages (81% of the eligible population) to assess prevalence and patterns of adolescent childbearing among women. We modeled the predictors of adolescent births among women younger than 21 years. After accounting for individual demographic characteristics, one of the strongest predictors of adolescent birth within the population was village-level collective norms about the acceptability of adolescent childbearing, based on aggregating normative measures from the entire population. The proportion of women in the village who had given birth as an adolescent was also strongly associated with an individual girl's likelihood of having given birth as an adolescent. We used full village-level network analyses to calculate social cohesion within the village. Normative pressure was strongly associated with the likelihood of an adolescent birth in villages with high cohesion (high network density) and was not associated or had a weak association in villages with low cohesion. On the other hand, the longer a girl had lived in the village, the stronger the association between the overall proportion of women in that village who gave birth as adolescents and the girl's own likelihood of having done so. Spatial analyses suggest that levels of adolescent births vary spatially across villages, as do the village-level normative factors associated with them.

A Meta-Analysis of Risk and Protective Factors for Dating Violence Victimization: The Role of Family and Peer Interpersonal Context

Dating violence (DV) is a widespread social issue that has numerous deleterious repercussions on youths' health. Family and peer risk factors for DV have been widely studied, but with inconsistent methodologies, which complicates global comprehension of the phenomenon. Protective factors, although understudied, constitutes a promising line of research for prevention. To date, there is no comprehensive quantitative review attempting to summarize knowledge on both family and peer factors that increase or decrease the risk for adolescents and emerging adults DV victimization. The current meta-analysis draws on 87 studies with a total sample of 278,712 adolescents and young adults to examine effect sizes of the association between various family and peer correlates of DV victimization. Results suggest small, significant effect sizes for all the family (various forms of child maltreatment, parental support, and parental monitoring) and peer factors (peer victimization, sexual harassment, affiliation with deviant peers, and supportive/prosocial peers) in the prediction of DV. With few exceptions, forms of DV (psychological, physical, and sexual), gender, and age did not moderate the strength of these associations. In addition, no difference was found between the magnitude of family and peer factors' effect sizes, suggesting that these determinants are equally important in predicting DV. The current results provide future directions for examining relations between risk and protective factors for DV and indicate that both peers and family should be part of the development of efficient prevention options.

Predictors of teenage pregnancy among girls aged 13-19 years in Uganda: a community based case-control study

BACKGROUND

Teenage pregnancy is a serious public health and social problem, with 95% occurring in developing countries. The aim of the study was to investigate the behavioural, familial and social factors associated with teenage pregnancy among girls aged 13-19 years in Lira District, Uganda.

METHODS

Primary data from a case-control study of teenage girls (aged 13-19 years) in Lira District, Uganda was analysed. A Structured questionnaire was administered using face-to-face interviews to collect data on 495 participants, identified through simple random sampling from 32 villages in two counties in Lira District. Data analyses were done using SPSS Statistics 23 for descriptive, bivariate (i.e. Chi-square tests) and multivariable analyses (i.e. logistics regression) used for determining independent associations.

RESULTS

A total of 495 teenage girls participated in the study, however, final analyses were undertaken for 480 respondents. At bivariable analysis, all variables except alcohol consumption were significantly associated with teenage pregnancy. Among the behavioural factors assessed, multivariable analyses showed that having multiple sexual partners, frequent sex and irregular contraceptive use increased the likelihood of teenage pregnancy. Among familial factors, being married was found to increase the likelihood of teenage pregnancy. Peer pressure, sexual abuse and lack of control over sex was observed to increase the likelihood of teenage pregnancy.

CONCLUSIONS

Demographic, behavioural, familial and social factors are important predictors of teenage pregnancy in Lira District. Interventions focussing on: retaining pregnant and married girls at school, information on sexual and reproductive health of teenage girls, improving access to and information about contraceptive use among teenage girls, improving socio-economic status of households, and law enforcement on sexual abuse among girls may come a long way to improving adolescent sexual and health services in the low-income settings.

"I have the right to feel safe": Evaluation of a school-based child sexual abuse prevention program in Ecuador

BACKGROUND

Child sexual abuse (CSA) is a complex public health problem that has lifelong implications for children's wellbeing. Interventions may provide children strategies to protect themselves against CSA, but few have been studied in Latin America.

OBJECTIVE

Evaluate the immediate and medium-term impact of a 10-week educational program on children's knowledge of CSA self-protection strategies in Ecuador.

PARTICIPANTS AND SETTINGS

Children aged 7-12 years from six public elementary schools in Ecuador were cluster-randomized to either receive the intervention between October and November 2016 (Group 1, k = 4) or between March and April 2017 (Group 2, k = 2).

METHODS

To assess CSA knowledge, a random sample of students completed a questionnaire at three time points: 1) initial: before any group received the intervention, 2) intermediate: immediately after Group 1 completed the program but before Group 2 started it, and 3) final: after Group 2 completed the program. We evaluated changes in scores using mixed linear regression models with school as a clustering variable and adjusted degrees of freedom (df = 4).

RESULTS

Pre-post effect estimates at program completion adjusted for age, sex and clustering by school were 6.5% (95% CI: 2.9, 10.0) and 6.8% (95% CI 3.0, 10.7) for Groups 1 and 2, respectively. Scores did not change among children who had not yet received the intervention at intermediate evaluation (0.94%, 95%CI: -6.0, 7.9). Children in Group 1 maintained the scores six months after the program ended.

CONCLUSIONS

The self-protection program increased and maintained CSA knowledge six months after the intervention finished.

Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review

Introduction

Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model.

Methods

A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were retrieved for analysis.

Results

Thematic analysis revealed that early marriage, sexual risk behaviors, substance use, family experience of adolescent birth, peer pressure, and lack of sex education and health service increased the hazards of adolescent pregnancy. Communication with parents, school activities, community meetings, laws, and government policies protected adolescents from pregnancy.

Conclusions

Results of this study suggests that the background of adolescents and complex interactions among various factors should be considered for pregnancy. In future research, mixed-method that supplements the methodological weaknesses of previous studies is also recommended.

Polyvictimization Among Children and Adolescents in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Most of the world's children and adolescents live in low- and lower-middle-income countries (LALMIC), but there is limited evidence about polyvictimization (experiences of multiple forms of victimization) among them. The aims of this article were to systematically review the evidence from LALMIC about the overall prevalence of polyvictimization and to identify the associations between polyvictimization and health and well-being among children and adolescents.

METHOD

A systematic search of the English-language peer-reviewed literature to identify empirical, quantitative studies conducted in LALMIC between 2005 and 2015, assessing at least four forms of victimization among young people aged up to 19 years. Where prevalence of any victimization and of polyvictimization were reported, meta-analyses were performed.

RESULTS

A total of 30/8,496 articles were included in the review. Evidence was available from 16/84 LALMIC and methodology and quality varied. Pooled prevalence of experiences of any victimization was 76.8% (95% confidence interval (CI) [64.8%, 88.9%]). Prevalence of polyvictimization ranged from 0.3% to 74.7% with an overall estimate of 38.1% (95% CI [18.3%, 57.8%]). None of the studies examined the associations between polyvictimization and physical or reproductive health or quality of life. Polyvictimization was associated with increased likelihood of mental health problems and involvement in health risk behaviors.

CONCLUSIONS

Experiences of polyvictimization among children and adolescents in LALMIC are more prevalent than in high- and upper-middle-income countries and contribute to the burden of poor health among children and adolescents. Most LALMIC lack local data, and research is required to address this knowledge gap.

Adolescent first births in East Africa: disaggregating characteristics, trends and determinants

Background

The use of a single national figure fails to capture the complex patterns and inequalities in early childbearing that occur within countries, as well as the differing contexts in which these pregnancies occur. Further disaggregated data that examine patterns and trends for different groups are needed to enable programmes to be focused on those most at risk. This paper describes a comprehensive analysis of adolescent first births using disaggregated data from Demographic and Household surveys (DHS) for three East African countries: Uganda, Kenya and Tanzania.

Methods

The study initially produces cross-sectional descriptive data on adolescent motherhood by age (under 16, 16–17 and 18–19 years), marital status, wealth, education, state or region, urban/rural residence and religion. Trends for two or more surveys over a period of 18–23 years are then analysed, and again disaggregated by age, wealth, urban/rural residence and marital status to ascertain which groups within the population have benefited most from reductions in adolescent first birth. In order to adjust for confounding factors we also use multinomial logistic regression to analyse the social and economic determinants of adolescent first birth, with outcomes again divided by age.

Findings

In all three countries, a significant proportion of women gave birth before age 16 (7%-12%). Both the bivariate analysis and logistic regression show that adolescent motherhood is strongly associated with poverty and lack of education/literacy, and this relationship is strongest among births within the youngest age group (<16 years). There are also marked differences by region, religion and urban/rural residence. Trends over time show there has been limited progress in reducing adolescent first births overall, with no reductions among the poorest.

Conclusions

Adolescent first births, particularly at the youngest ages, are most common among the poorest and least educated, and progress in reducing rates within this group has not been made over the last few decades. Disaggregating data allows such patterns to be understood, and enables efforts to be better directed where needed.

Association between abuse history and adolescent pregnancy: a meta-analysis

PURPOSE

Although a purported risk factor for early pregnancy is abuse history, the strength of this association has been inconsistent across studies and may vary as a function of abuse type. The purpose of this meta-analysis was to examine the extent to which sexual, physical, and emotional abuse, as well as neglect, increased the risk of adolescent pregnancy.

METHODS

A search of studies through MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, and Web of Science was conducted. Studies were retained if they included (1) women who became pregnant before 20 years of age; (2) a comparison group of nonpregnant adolescents; and (3) abuse experience (<18 years of age).

RESULTS

Thirty-eight independent samples provided 70 estimates of effect sizes, derived from 75,390 participants. Both sexual and physical abuse were associated with an increased risk of adolescent pregnancy (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.75-2.38 and OR, 1.48; CI, 1.24-1.76, respectively). The strongest effect was for the co-occurrence of sexual and physical abuse (OR, 3.83; CI, 2.96-4.97]). Nonsignificant effect sizes were found for emotional abuse (OR, 1.01; CI, .70-1.47) and neglect (OR, 1.29; CI, .77-2.17]), although these were moderated by journal impact factor, that is, greater effect sizes were reported in higher impact journals.

CONCLUSIONS

The results of this meta-analysis reveal that the strength of the association between abuse and adolescent pregnancy varies as a function of abuse subtype. Sexual and physical abuse were associated with increased risk for adolescent pregnancy, whereas emotional abuse and neglect were not.

Pregnancies in young adolescent mothers: a population-based study on 37 million births

OBJECTIVES

Pregnancy in young adolescents is often understudied. The objective of our study was to evaluate the effect of young maternal age on adverse obstetrical and neonatal outcomes.

METHODS

We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age was obtained from the birth certificate and relative risks estimating its effect on obstetrical and neonatal outcomes were computed using unconditional logistic regression analysis.

RESULTS

37,504,230 births met study criteria of which 300,627 were in women aged <15 years with decreasing rates from 11/1,000 to 6/1,000 over a 10-year period. As compared to women 15 years and older, women <15 were more likely to be black and Hispanic, less likely to have adequate prenatal care, and more likely to not have had any prenatal care. In adjusted analysis, births to women <15 were more likely to be IUGR, born under 28, 32, and 37 weeks' gestation and to result in stillbirths and infant deaths. Prenatal care was protective against infant deaths in women < 15 years of age.

CONCLUSION

Although public health initiatives have been successful in decreasing rates of young adolescent pregnancies, these remain high risk pregnancies that may benefit from centers capable of ensuring adequate prenatal care.

Desire for pregnancy and risk behavior in young HIV-positive women

This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling.

Exposure to violence in incarcerated youth from the city of São Paulo

OBJECTIVE

This study aimed to determine the extent of exposure to community violence among delinquent Brazilian youth in the 12-month period prior to their incarceration and to identify factors associated with this exposure.

METHOD

With an oversampling of girls, a cross-section of youth under 18 years of age from juvenile detention units in the city of São Paulo, Brazil completed a structured interview. Key items related to exposure to violence (witnessed and experienced) were drawn from the Social and Health Assessment questionnaire to cover the 12-month period prior to incarceration.

RESULTS

Participants (n = 325, 89% boys) reported high rates of exposure to violence with largely similar levels for boys and girls. Being threatened with physical harm, being beaten or mugged and/or shot at were the most common forms of violence experienced. After controlling for demographic and family variables, the fact of having peers involved in risk behavior, easy access to guns and previous involvement with the justice system were associated with witnessed violence; whereas having slept on the street was the only variable associated with experienced violence.

CONCLUSION

This group of youth was exposed to high levels of violence and other adverse experiences. Future research should examine the effectiveness of strategies aimed at reducing the exposure to violence of high-risk youth.