Social Determinants of Health and Adolescent Pregnancy: An Analysis From the National Longitudinal Study of Adolescent to Adult Health

Contraceptive Use and Its Associations With Social Determinants of Health Among Young Adults

BACKGROUND

Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants.

OBJECTIVE

This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception).

METHODS

Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female.

RESULTS

Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care.

CONCLUSIONS

Interventions that address social determinants of health can potentially promote contraceptive use.

Volunteering in Young Adulthood: Complex Associations With Later Health and Well-Being Outcomes

PURPOSE

To investigate whether changes in volunteering from adolescence to young adulthood are associated with subsequent health and well-being outcomes in adulthood.

DESIGN

Longitudinal cohort study.

SETTING

National Longitudinal Study of Adolescent to Adult Health.

SUBJECTS

U.S. adults from Wave IV (2008/2009; N = 12,234) and Wave V (2016-2018; N = 9,971).

MEASURES

Any volunteering and nine types of volunteering (independent variables) and 41 health and well-being outcomes (dependent variables) using an outcome-wide approach with multiple linear-, logistic-, and generalized linear regressions.

RESULTS

Volunteering in young adulthood was associated with better health behaviors (e.g., 34% decreased risk of binge drinking, 95% CI [0.54, 0.81]) and improved psychosocial and civic outcomes (e.g., lower depressive symptoms (β = -0.08, 95% CI [-0.14, -0.02]) in adulthood. Volunteering showed little evidence of associations with other health and well-being outcomes (e.g., loneliness, (β = -0.04, 95% CI [-0.09, 0.01])). Assessing volunteering by organization types showed a range of positive and negative outcomes. For example, volunteering in hospitals/nursing homes was associated with a 36% increased risk of high cholesterol (95% CI [1.06, 1.73]) and volunteering with political clubs was associated with a 52% increased risk of an anxiety diagnosis (95% CI [1.13, 2.05]).

CONCLUSION

Our findings suggest more work is needed to determine the conditions under which volunteering is health promoting and to minimize potential adverse effects associated with some types of volunteering.

Factors associated with teenage pregnancy in the Scandinavian countries

AIMS

Teenage pregnancy may have negative consequences for the mother and the infant. The aim of the study was to examine whether selected individual factors occurring early in life were associated with teenage pregnancy.

METHODS

In a population-based, cross-sectional questionnaire study among 34,455 women from Denmark, Norway, and Sweden aged 20-45 years, who had first sexual intercourse (FSI) at age 13-19 years, we assessed the association between early smoking and drinking initiation (i.e., before the age of 13), contraceptive use at FSI, and teenage pregnancy. Log-linear binary regression models were fitted to estimate the relative risk (RR) with 95% confidence intervals (CIs) of teenage pregnancy according to the three exposure variables, overall and by age at FSI. Furthermore, the outcomes of the teenage pregnancies were examined according to age at FSI.

RESULTS

Teenage pregnancy occurred in 11% of the population. Both early smoking initiation (RR: 1.6; 95% CI: 1.4-1.8), early drinking initiation (RR: 1.2; 95% CI: 1.0-1.4), and non-use of contraceptives at FSI (RR: 1.9; 95% CI: 1.8-2.0) were associated with teenage pregnancy. The associations for early smoking initiation and non-use of contraceptives remained when analyses were stratified by age at FSI. Almost 60% of all teenage pregnant women had an induced abortion and less than 30% gave birth.

CONCLUSIONS

Individual factors, including early smoking and drinking initiation, and non-use of contraceptives at FSI, were associated with teenage pregnancy regardless of age at FSI. This emphasizes the necessity of focusing on early risk-taking behavior as a potential modifier to prevent teenage pregnancy.

When everyone's doing it: The relative effects of geographical context and social determinants of health on teen birth rates

Geographic disparities in teen birth rates in the U.S. persist, despite overall reductions over the last two decades. Research suggests these disparities might be driven by spatial variations in social determinants of health (SDOH). An alternative view is that "place" or "geographical context" affects teen birth rates so that they would remain uneven across the U.S. even if all SDOH were constant. We use multiscale geographically weighted regression (MGWR) to quantify the relative effects of geographical context, independent of SDOH, on county-level teen birth rates across the U.S. Findings indicate that even if all counties had identical compositions with respect to SDOH, strong geographic disparities in teen birth rates would still persist. Additionally, local parameter estimates show the relationships between several components of SDOH and teen birth rates vary over space in both direction and magnitude, confirming that global regression techniques commonly employed to examine these relationships likely obscure meaningful contextual differences in these relationships. Findings from this analysis suggest that reducing geographic disparities in teen birth rates will require not only ameliorating differences in SDOH across counties but also combating community norms that contribute to high rates of teen birth, particularly in the southern U.S. Further, the results suggest that if geographical context is not incorporated into models of SDOH, the effects of such determinants may be interpreted incorrectly.

The Association of Teen Pregnancy and Violence: A Multilevel Study in Colombia

Background

Colombia has a high teen pregnancy (TP) rate. In 2018, one in five pregnancies was from teen mothers between 10 and 19 years of age. While TP rates are declining globally, Colombia's TP rate decline has been particularly low, despite sexual education and contraception campaigns. Other factors must be studied to prevent TP. Colombia has a long history of violence. We aim to assess whether there is a relationship between TP and exposure to violence in Colombia.

Methods

Data from the Colombian Demographic and Health Survey 2015 and the Colombian National Department of Statistics were analyzed for association between TP and sexual violence, physical violence, physical punishment as a child, and community violence. Univariate, bivariate, multivariate, and multilevel binary logistic regression models were calculated using SPSS v.25 and HLM v.7.

Results

Fifteen percent of teens were pregnant. Emotional violence was reported by 47%, sexual harassment by 27%, physical violence by 17%, physical punishment as a child by 7%, and unwanted sex by 2%. Unwanted sex (odds ratio [OR]: 3.18, 95% confidence interval [95% CI]: 1.96-5.16), sexual harassment (OR: 2.43, 95% CI: 1.89-3.14), and physical punishment (OR: 20.30, 95% CI: 7.96-22.81) were associated with adolescent pregnancy. In unadjusted models, emotional violence was associated (OR: 1.22, 95% CI 1.06-1.40) and community violence showed a tendency (OR: 1.24, 95% CI: 0.99-1.55). Physical violence was not associated.

Conclusions

Violence exposure and particularly physical punishment, unwanted sex and sexual harassment were associated with TP incidence and should be considered risk factors for TP.

Unwinding the tangle of adolescent pregnancy and socio-economic functioning: leveraging administrative data from Manitoba, Canada

BACKGROUND

Understanding the relationship between adolescent pregnancy and adult education and employment outcomes is complicated due to the endogeneity of fertility behaviors and socio-economic functioning. Studies exploring adolescent pregnancy have often relied on limited data to measure adolescent pregnancy (i.e. birth during adolescence or self-reports) and lack access to objective measures of school performance during childhood.

METHODS

We use rich administrative data from Manitoba, Canada, to assess women's functioning during childhood (including pre-pregnancy academic performance), fertility behaviors during adolescence (live birth, abortion, pregnancy loss, or no history of pregnancy), and adult outcomes of high school completion and receipt of income assistance. This rich set of covariates allows calculating propensity score weights to help adjust for characteristics possibly predictive of adolescent pregnancy. We also explore which risk factors are associated with the study outcomes.

RESULTS

We assessed a cohort of 65,732 women, of whom 93.5% had no teen pregnancy, 3.8% had a live birth, 2.6% had abortion, and < 1% had a pregnancy loss. Women with a history of adolescent pregnancy were less likely to complete high school regardless of the outcome of that pregnancy. The probability of dropping out of high school was 7.5% for women with no history of adolescent pregnancy; after adjusting for individual, household, and neighborhood characteristics, the probability of dropping out of high school was 14.2 percentage points (pp) higher (95% CI 12.0-16.5) for women with live birth, 7.6 pp. higher (95% CI 1.5-13.7) for women with a pregnancy loss, and 6.9 pp. higher (95% CI 5.2-8.6) for women who had abortion. They key risk factors for never completing high school are poor or average school performance in 9th grade. Women who had a live births during adolescence were much more likely to receive income assistance than any other group in the sample. Aside from poor school performance, growing up in poor households and in poor neighborhoods were also highly predictive of receiving income assistance during adulthood.

DISCUSSION

The administrative data used in this study enabled us to assess the relationship between adolescent pregnancy and adult outcomes after controlling for a rich set of individual-, household-, and neighborhood-level characteristics. Adolescent pregnancy was associated with higher risk of never completing high school regardless of the pregnancy outcome. Receipt of income assistance was significantly higher for women having a live birth, but only marginally higher for those who had a pregnancy that ended in loss or termination, underlining the harsh economic consequences of caring for a child as a young mother. Our data suggest that interventions targeting young women with poor or average school marks may be especially effective public policy priorities.

Adverse Maternal, Perinatal, and Neonatal Outcomes in Adolescent Pregnancies: A Case-Control Study

BACKGROUND

Despite the increase in the age of marriage, early marriage and subsequent adolescent pregnancy remain a serious problem in many regions and societies. Due to low evidence in this regard, this study was conducted to determine the health consequences of adolescent pregnancy.

STUDY DESIGN

This was a case-control study.

METHODS

The present study was performed on pregnant women who were referred to Ayatollah Mousavi hospital of Zanjan for delivery in 2021. Pregnant women with gestational age less than 19 years were considered as the case group and those with gestational age between 19-35 years as the control group. The pregnancy outcomes on the mother and the neonate were obtained through the researcher-made checklist. Chi-square test and student's t-test were used to compare variables between the two groups.

RESULTS

In this study, 169 adolescent and 258 adult mothers were compared as the case and control groups, respectively. The mean age of cases and controls was 17.41±1.22 and 30.66±6.46 years, respectively. Cesarean delivery (34.5% vs. 23.67%, P=0.017) and anemia during pregnancy (16.28% vs. 10.7%, P=0.005) were significantly higher in the control group, while mood disorder after delivery was significantly higher in the case group (11.24% vs. 5.84%, P=0.04). The Apgar score 5 minutes after birth and birth weight were significantly higher in mothers of the control group (P<0.05).

CONCLUSION

The results demonstrated that adolescent mothers are more prone to postpartum depression, and babies born to these mothers are more prone to low birth weight and a low Apgar score. Therefore, adolescent pregnancy should be managed as a high-risk pregnancy.

Body Mapping and Story Circles in Sexual Health Research With Youth of Color: Methodological Insights and Study Findings From Adolescent X, an Art-Based Research Project

We describe the implementation and select findings from Adolescent X, an arts-based research project that used story circles and body mapping to elucidate how young people understand the relationship between their social contexts and their sexual and reproductive health, with a particular focus on youth's understandings of gender, sexuality, and the body as sites of possibility and power. A community-based sample of N = 24 youth of color was recruited from the South and West Sides of Chicago to participate in 3-day workshops. In addition to story circles and body mapping, data were collected via brief surveys with N = 24 youth, debriefing groups (n = 10 youth), and focus groups (n = 14 youth). Study data consisted of (1) body map visuals, that is, legends, mini-, and full-body maps; (2) written body map narratives; and (3) audio recordings of the story circles, body mapping activities, debriefing groups, and focus groups. All audio recordings were transcribed, deidentified, and uploaded in Dedoose for qualitative thematic analysis. Data analysis was conducted by a team of independent coders. Across all sources of data, three major themes were identified: (1) strong feelings of unsafety related to how young people's bodies are gendered, sexualized, and racialized in different social settings; (2) the extent to which adults and institutions foster youth safety; and (3) sources of young people's coping and resilience. Implications for public health research, practice, and policy are discussed.

Associations Between Social Determinants of Health and Adolescent Contraceptive Use: An Analysis From the National Survey of Family Growth

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

Association between Teenage Pregnancy and Family Factors: An Analysis of the Philippine National Demographic and Health Survey 2017

Adolescence is a key developmental period in one’s life course; health-related behaviors of adolescents can be linked to lifelong consequences, which affect their future health. Previous studies highlight the role of family and its significant association with adolescents’ health. In East Asia and the Pacific, the Philippines is the only country that is showing an upward trend of teenage pregnancy while other countries in the region have declining teenage pregnancy rates. Against this backdrop, this study investigated the association between teenage pregnancy and family factors, specifically parent structure. Data for the study were extracted from the Philippine National Demographic and Health Survey 2017. All adolescent women aged 15–19 years old (n = 5120) were included in the analyses. The dependent variable was teenage pregnancy, while parent structure, defined as a presence or absence of parents in the domicile, was the exposure variable. Multivariable logistic regression was utilized in assessing the association of teenage pregnancy and family factors after adjusting for several potential confounders. Adolescent women were more likely to become pregnant as a teenager when they lived with neither parent (aOR = 4.57, 95% CI = 2.56–8.15), were closer to 19 years of age (aOR = 2.17, 95% CI = 1.91–2.46), had knowledge of contraception (aOR = 1.27, 95% CI = 1.22–1.32) and lived in a big family (aOR = 1.14, 95% CI = 1.09, 1.20). Furthermore, adolescent women who lived with neither parent and belonged to the poorest wealth quintile were more likely to become pregnant as a teenager (aOR = 3.55, 95% CI = 1.67–7.55). Conversely, educational attainment higher than secondary education (aOR = 0.08, 95% CI = 0.01–0.49) and those who belonged to the richest wealth quintile (aOR = 0.40, 95% CI = 0.18–0.92) exhibited a statistically inverse association with teenage pregnancy compared with those with no education and from the middle wealth quintile, respectively. Living with neither parent was found as a risk factor for teenage pregnancy. Furthermore, we found that several sociodemographic factors exhibited a non-uniform increment and reduction in the risk of teenage pregnancy.

Impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context

BACKGROUND

Women who have experienced adolescent pregnancy and early motherhood are disproportionately affected in terms of their health and parenting capabilities, as well as their offspring's health. Guided by Stress Process and Social Determinants of Health (SDH) Frameworks, which posit that multiple sources of stressors and structural determinants of adolescent pregnancy influence adolescent mothers' subsequent health and quality of parenting (Xavier et al 2018, McLoyd 1998, Conger et al 2010, Gipson et al 2008). These dynamics then further impact offspring's outcomes. Using an Integrated Stress-SDH Process for Health Disparities model and we test on whether early motherhood is associated with and subsequent maternal and child health from two informal settlements in Nairobi.

METHODS

A cross-sectional design with 394 mothers of 2-16 years old children who sought maternal and child health services at Kariobangi and Kangemi public health centers between October 2015 to April 2016 were recruited. Participating mothers were asked questions related to their adolescent pregnancy history, their current health, wellbeing, and parenting practices, and their child's health. Structural equation modeling (SEM) was utilized to examine hypothesized mediational pathways that adolescent pregnancy history has negative influences on women's health and parenting during adulthood, which also influence their child's health and development.

RESULTS

Our study supports that women with a history of adolescent motherhood have poor physical and mental health outcomes as adults after adjusting for demographic confounders. SEM results partially support the Stress-SDH Process model that history of adolescent pregnancy had negative consequences on women's adulthood health, which also negatively impacted offspring's physical and mental health.

CONCLUSION

Consistent with the Stress Process and SDH literature, we found consistent cross-cultural literature that adolescent pregnancy set the stage for, subsequent poor maternal health and child outcomes. Although history of adolescent pregnancy and motherhood was not necessarily associated with negative parenting, consistent with parenting literature, negative parenting was associated with poor child mental health. Findings suggest importance of providing integrated care that address health and parenting needs to optimize offspring's development in instances of early motherhood.

Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women's Health Cohort

We investigated if adverse childhood experiences (ACEs) and ACE sub-types were associated with increased odds of planning to have children and adolescent pregnancy. The Gulf Resilience on Women’s Health (GROWH) is a diverse cohort of reproductive-age women living in southeastern Louisiana during the 2010 Deepwater Horizon oil spill. In our sample of 1482 women, we used multinomial logistic regression to model odds ratios of wanting future children and assessed effect measure modification by educational attainment. We also estimated odds ratios of adolescent pregnancy with binomial logistic regression. Exposure to ACEs increased odds of wanting future children across all ACE sub-types. Among women with lower educational attainment, three or more ACEs (overall, childhood, and adolescence) had over two times the odds of wanting future children. History of ACE and the various sub-types, except for emotional abuse, were associated with increased risk of adolescent pregnancy. ACEs may be linked to adolescent pregnancy and reproductive plans, and variations by educational status highlighted social discrepancies and importance of social context in evaluation and intervention.

Trends in teenage motherhood in Ecuador: challenges and inequalities

OBJECTIVES

To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012.

METHODS

We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI.

RESULTS

The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador.

CONCLUSIONS

Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

Characteristics of Mother-Daughter Relationships and Sexual Risk-Coping Consciousness among Japanese Female University Students

For heterosexual Japanese women in their early 20s, it is important to maintain good sexual health, develop intimate relationships with a partner, and go through the process of having a family. This study aimed to determine the characteristics of mother-daughter relationships among Japanese female university students and their associations with students’ sexual risk-coping consciousness. We conducted a cross-sectional study using anonymous self-administered questionnaires. Participants were 329 female university students in their junior and senior years. The mother-daughter relationships of the study respondents were divided into the following three clusters: controlled group, close group, and independent group. The close and independent groups often consulted their mothers about sexual matters and, also, tended to be highly capable of actively expressing their opinions and cooperating with their partner in a sexual setting. In contrast, the controlled group revealed a significantly lower percentages of consulting their mothers on sexual matters and scored lower sexual risk-coping consciousness subscale scores. The controlled group may suffer a negative impact of the relationship with their controlling mothers as they try to build a good, trusting relationship with others. The characteristics of mother-daughter relationships may be associated with daughters’ sexual risk-coping consciousness.

Association of Adverse Neighborhood Exposures With HIV Viral Load in Pregnant Women at Delivery

IMPORTANCE

Racial disparities in maternal morbidity and mortality are in large part driven by poor control of chronic diseases. The association between adverse neighborhood exposures and HIV virologic control has not been well described for women with HIV during pregnancy.

OBJECTIVE

To evaluate the association between adverse neighborhood exposures and HIV viral load at delivery.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study assessed HIV surveillance data for pregnant women with HIV who had live deliveries in Philadelphia from January 1, 2005, through December 31, 2015. Data analyses were completed in August 2020.

EXPOSURES

Neighborhood exposures included extreme poverty, educational attainment, crime rates (using separate and composite measures), and social capital categorized above or below the median. Each neighborhood exposure was modeled separately to estimate its association with elevated HIV viral load.

MAIN OUTCOMES AND MEASURES

The main outcome was elevated HIV viral load of ≥200 copies/mL at delivery. We hypothesized that adverse neighborhood exposures would be associated with higher odds of having an elevated viral load at delivery. Confounders included birth year, age, race/ethnicity, previous birth while living with HIV, and prenatal HIV diagnosis. Prenatal care and substance use were considered potential mediators. We used logistic mixed effects models to estimate the association between neighborhood exposures and elevated viral load, adjusting for confounders in Model 1 and confounders and mediators in Model 2.

RESULTS

There were 905 births among 684 women with HIV, most of whom were aged 25 to 34 years (n = 463 [51.2%]) and were Black non-Hispanic (n = 743 [82.1%]). The proportion of women with elevated viral load decreased from 58.2% between 2005 and 2009 to 23.1% between 2010 and 2015. After adjusting for confounders in Model 1, higher neighborhood education was associated with lower odds of having an elevated viral load (adjusted odds ratio [AOR], 0.70; 95% CI, 0.50-0.96). More violent crime (AOR, 1.51; 95% CI, 1.10-2.07), prostitution crime (AOR, 1.46; 95% CI, 1.06-2.00), and a composite measure of crime (AOR, 1.44; 95% CI, 1.05-1.98) were positively associated with having a higher HIV viral load. These associations remained after adjusting for mediators in Model 2. In addition, the AOR for intermediate prenatal care varied between 1.93 (95% CI, 1.28-2.91) and 1.97 (95% CI, 1.31-2.96), whereas the AOR for inadequate prenatal care varied between 3.01 (95% CI, 2.05-4.43) and 3.06 (95% CI, 2.08-4.49) across regression models.

CONCLUSIONS AND RELEVANCE

In this cohort study, adverse neighborhood exposures during pregnancy and poor engagement in prenatal care were associated with poor virologic control at delivery. These findings suggest that interventions targeted at improving maternal health need to take the social environment into consideration.

Analysis of Pregnancy and Birth Rates Among Black and White Medicaid-Enrolled Teens

PURPOSE

In the United States, black teens overall have higher pregnancy and birth rates than whites, and it is commonly believed that minority race and low income account for this disparity. We examined racial differences in pregnancy and birth rates among teens from low-income households using Medicaid-enrollment as a proxy for low income.

METHODS

This was a retrospective study of Louisiana Medicaid claims data for female teens aged 15-17 years in 2014 (n = 66,069). Pregnancy and pregnancy outcome codes were identified (n = 2,276) and analyzed for differences by black and white race. We conducted validity analyses with different rate definitions and teens' claims status.

RESULTS

The cohort was 36% white and 54% black. More black teens than whites lacked any claims data (15.6% vs. 12.6%; p < .001). Rates calculated as events per 1,000 person-years of Medicaid coverage showed no difference in live birth rates between white and black teens (24.6 vs. 25.8; relative incidence ratio, 1.05; 95% confidence interval, .93-1.18; p = .43); however, pregnancy rates for whites were higher than those for blacks (42.7 vs. 36.1; relative incidence ratio, .85; 95% confidence interval, .77-.93; p < .001).

CONCLUSION

In contrast to national trends, which include teens from diverse racial and socioeconomic backgrounds, Louisiana Medicaid-enrolled teens aged 15-17 years had equal birth rates regardless of black or white race, and whites had higher pregnancy rates. Decreased racial disparities in pregnancy and birth rates among these adolescents highlights socioeconomic influences in sexual health behavior and a need to examine the interplay of risk factors contributing to racial disparities seen among adolescents nationally.

Promoting respectful maternity care for adolescents in Ghana: a quasi-experimental study protocol

BACKGROUND

Intra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC.

METHODS

This study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed.

DISCUSSION

This study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents.

TRIAL REGISTRATION

Name of the registry: Pan African Clinical Trials Registry. PACTR202008781392078 .

[Uneven decline in fertility rates in adolescents in 32 countries of the Region of the Americas, 1960-2019Diminuição desigual nas taxas de fecundidade de adolescentes em 32 países da Região das Américas, 1960-2019]

Objetivo.

Conocer la evolución temporal de las tasas de fecundidad en adolescentes (TFA) de los países de la Región de las Américas, categorizándolas para evaluar su movilidad, sus diferencias y generar una predicción para 2023.

Métodos.

Estudio ecológico y descriptivo de una serie temporal de la TFA de 32 países, de 1960 a 2019, basado en información del Banco Mundial y de la OPS. Se estimaron tendencias de la TFA con un modelo de regresión lineal (método de Prais-Winsten), se evaluaron diferencias entre 2 subperíodos (1960-1989 y 1990-2019) y entre 4 categorías de la TFA de 2019 mediante pruebas de muestras relacionadas y ANOVA, respectivamente, y se hizo una predicción de la TFA para 2023 con modelos ARIMA.

Resultados.

La serie temporal de la TFA de la muestra fue no estacionaria, la tendencia media anual fue decreciente (coeficiente = -1,173; p < 0,001; R² ajustada = 0,968) y disminuyó de 124 por 1 000 en 1960 a 56,1 por 1 000 en 2019. Los países con mayor y menor tendencia anual fueron San Vicente y las Granadinas (-2,783) y Argentina (0,017). Entre subperíodos (1960-1989 frente a 1990-2019) no hubo diferencias estadísticamente significativas entre las TFA en Uruguay y Argentina; sí las hubo entre las cuatro categorías de la TFA de 2019. La TFA media muestral mantendría una disminución para 2023, pero en 8 países podría aumentar.

Conclusiones.

La serie temporal es mayoritariamente no estacionaria, con tendencia decreciente para 2023. Hay disminución desigual de las TFA, con diferencias significativas entre los cuatro grupos de países categorizados con la TFA de 2019. Las menores TFA corresponden a 2 países de Norteamérica, a 5 del Caribe no latino y a 1 sudamericano, y las mayores, a países del Caribe latino y de Centro y Sudamérica.

The use of technology in the sexual health education especially among minority adolescent girls in the United States

PURPOSE OF REVIEW

The purpose of this review is to examine current sexual health education technologies for adolescents and identify gaps in knowledge. Disparities in sexual health education are prominent and mainly affect young women of color. As a result, the use of technology to reach these marginalized populations could potentially invoke change. Thus, it is crucial to determine the viability of technology as a mechanism to bridge the knowledge gap regarding sexual health for adolescents that are most at risk of sexually transmitted infections and unwanted pregnancies.

RECENT FINDINGS

With a lack of standardized, evidenced-based sexual health education programs in the United States, the future of comprehensive sexual health education is moving toward smartphone apps. Many sexual health technologies exist that target adolescents, most of which have been proven to demonstrate positive effects. Use of mobile apps, especially for vulnerable populations, can be more effective because of privacy and widespread dissemination.

SUMMARY

Ultimately, more research needs to be conducted to determine the most effective content for these sexual health apps. Additionally, more research should be conducted on effective sexual health apps for marginalized populations to determine whether technology is a viable solution.

Adverse life experiences and risk of unintended pregnancy in adolescence and early adulthood: Implications for toxic stress and reproductive health

Objective

We examined the effects of adverse life experiences (ALEs) on rates of unintended first pregnancy, including differential effects by race/ethnicity and socioeconomic status, among women in a national longitudinal cohort study.

Methods

We drew upon 15-years of data from 8810 adolescent and young adult females in the National Longitudinal Study of Adolescent to Adult Health. Using 40 different ALEs reported across childhood and adolescence, we created an additive ALE index, whereby higher scores indicated greater ALE exposure. We employed Cox proportional hazard models, including models stratified by racial/ethnic and socioeconomic groups, to estimate the effects of ALEs on time to first unintended pregnancy, controlling for time-varying sociodemographic, health and reproductive covariates.

Results

Among all women, a 1-standard deviation increase in ALE scores was associated with an increased rate of unintended first pregnancy (adjusted Hazard Ratio 1.11, 95% Confidence Interval=1.04-1.17). In stratified models, associations between ALE scores and risk of unintended pregnancy varied across racial/ethnic, socioeconomic, and age groups and according to various elevated ALE thresholds. For example, the 1-standard deviation increase in ALE score indicator increased the unintended pregnancy risk for African-American (aHR=1.12, CI=1.01-1.25), Asian (aHR 1.69, CI=1.26-2.26), and White women (aHR=1.12, CI=1.03-1.22), women in the lowest ($0-$19,999; aHR=1.21, CI = 1.03-1.23) and highest (>$75,000; aHR=1.36, CI=1.12-1.66) income categories, and women aged 20-24 (aHR=1.13, CI=1.04-1.24) and >24 years (aHR 1.25, CI=1.06-1.47), but not among the other sociodemographic groups.

Conclusion

ALEs increased the risk of unintended first pregnancy overall, and different levels of exposure impacting the risk of pregnancy differently for different sub-groups of women. Our ongoing research is further investigating the role of stress-associated adversity in shaping reproductive health outcomes and disparities in the United States.

Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults

Background: Social determinants are the leading causes of health disparities. Yet health care systems have not systemically addressed social determinants of health as it pertains to adolescents and young adults (AYAs), among other populations in need. This study identified promising innovative programs across the United States.

Methods: Thirteen representatives from 10 programs completed a 45-min telephone interview. Transcripts were reviewed and analyzed to identify cross-cutting themes.

Results: Strategies included increasing access to quality, comprehensive and confidential health services, addressing the holistic needs of AYAs, collaborations across the health care delivery systems and other community services, and leveraging technology.

Conclusion: This study showcased innovative approaches to inform future efforts.

Motherhood in early adolescence: a case-control study in Southern Brazil

This paper investigates factors associated with motherhood among adolescents from 14 to 16 years of age in Porto Alegre, Brazil. This is a case-control study with 431 adolescent mothers (cases) and 862 adolescents who had never given birth (controls). D. ata were obtained through home visits by an interviewer-applied questionnaire. Sociodemographic characteristics, quality of social and family relationships, lifestyle and history of abuse were studied as potential determinants to early adolescent motherhood. Conditional logistic regression was used for data analysis according to a two-stage hierarchical model. Results showed that lower economic class, schooling failure, tobacco consumption, alcoholic drunkenness at least once in life and having a mother who gave birth before 20 years of age were positively associated with early adolescent motherhood. Later menarche and having relatives or having friends in whom to trust remained as protective factors. Schooling failure, which obtained the highest risk, points to the important role of the school in this population's development and its potential to stimulate healthy life habits.

Social Disparities in the Relationship Between Depression and Unintended Pregnancy During Adolescence and Young Adulthood

PURPOSE

We investigated the influence of depression on subsequent risk of unintended pregnancy and social disparities within this relationship, during adolescence and young adulthood.

METHODS

Drawing upon 15-year, nationally representative data from 8,810 young U.S. women in the National Longitudinal Study of Adolescent to Adult Health, we estimated associations between depression and time to first pregnancies reported as unintended, overall and stratified by race/ethnicity, socioeconomic status, and age with Cox proportional hazard models.

RESULTS

Moderate/severe depression symptoms were associated with an increased risk of unintended first pregnancy (hazard ratio [HR], 1.21; confidence interval [CI], 1.02-1.44). In stratified models, depression increased the pregnancy risk for all minority groups (HRs, 1.36-3.25) but not white women. Depression increased the pregnancy risk for women with $0-$19,999 (HR, 1.48; CI, 1.11-1.98) and $20,000-$49,999 (HR, 1.33; CI, 1.05-1.68) income levels but not those at higher levels. Depression increased the pregnancy risk for adolescents <20 years (HR, 1.35; CI, 1.07-1.71) but decreased the risk for women >24 years (HR, .47; CI, .25-.86).

CONCLUSIONS

Findings may inform more equitable, holistic public health strategies that target depression as a modifiable risk factor for adverse reproductive outcomes during adolescence and young adulthood.

Characterizing Social Determinants of Health for Adolescent Mothers during the Prenatal and Postpartum Periods

PURPOSE

Significant racial disparities and continuing poor birth outcomes make adolescent pregnancy a significant public health concern in the United States despite declining pregnancy rates. Social determinants of health are associated with increased likelihood of pregnancy and poor maternal and child health outcomes. This study aims to characterize specific elements of social determinants of health in a cohort of predominantly Latina adolescent mothers.

METHODS

Between February 2007 and August 2008, 106 pregnant adolescents participated in a study with assessments at 20 to 24 weeks of gestation, and at 3 and 6 months postpartum. Survey questions addressed residential mobility, financial support and childcare, and perceived need for and use of community resources. Comparative analysis assessed differences between adolescents by age (<16 vs. ≥16 years old) and ethnicity (Latina vs. non-Latina).

FINDINGS

Adolescent mothers experienced high rates of residential mobility, with 59.4% moving at least once in the year before their prenatal survey. Participants relied primarily on public aid (94-96%) and their parents (81-85%) for financial support. Latina participants were more likely than non-Latinas to rely on public aid. Although many participants reported needing financial support and housing, few used available services. Younger adolescents relied less often on the father of the baby for support than older adolescents.

CONCLUSIONS

Adolescent mothers' high rates of residential mobility and increasing reliance on public assistance highlight resource gaps that potentially put them and their children at risk for poor outcomes. Targeted efforts to augment systemic support in these domains are a critical component of addressing health disparities for this population.

Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH.