Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

Positive parenting, parenting stress, and child self-regulation patterns differ across maternal demographic risk

We examined relations between positive parenting, parenting stress, and children's regulatory abilities across infancy and early childhood. First-time mothers and their infants (N = 682) were recruited prenatally. Mothers belonged to one of three potential demographic risk groups: adolescent mothers (AM), adult low-educated mothers (LEM), and adult high-educated mothers (HEM). Parent-child interactions were observed in the home and scored for positive parenting (at 4, 8, and 18 months) and child self-regulation (at 4, 8, 18, and 30 months). Parenting stress was measured by questionnaire at 6, 12, and 24 months. A multigroup cross-lagged panel model indicated different patterns of effects for adolescent and adult mothers: for AM, positive parenting and parenting stress were related early in infancy, but no relations emerged with regulation until 18 months. For LEM, parenting related to regulation only at later ages, and for HEM, positive parenting, parenting stress, and regulation were associated early in the infant's life but not later. Differing patterns of influence indicate, perhaps, the importance of considering demographic risk and timing of parenting in childhood in relation to child regulatory outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parenting Stress Among Adolescent Mothers: An Integrative Literature Review

Adverse maternal and child outcomes are associated with parenting stress. Adolescent mothers may be particularly susceptible to parenting stress because of conflicting parenting and developmental demands. We performed an integrative literature review to identify risk and protective factors for parenting stress, measured by the Parenting Stress Index (PSI), among adolescent mothers. Guided by Belsky's Determinants of Parenting Model (1984) and using Whittemore and Knafl's (2005) five-stage review method, we searched CINAHL, EMBASE, PsycINFO, and MEDLINE databases to identify 786 research articles. After quality appraisal, 26 articles were included. Risk and protective factors were categorized into themes within the context of Belsky's framework, including maternal attributes (e.g. maternal self-efficacy), child characteristics (e.g. child temperament), and contextual influences (e.g. perceived social support). The new conceptual model maps risks, protective factors, and nuanced areas for parenting stress and can guide researchers and clinicians in approaches to prevent and reduce parenting stress among adolescent mothers.

Young women are the most vulnerable to postpartum mental illness: A retrospective cohort study in UK primary care

BACKGROUND

Whilst childbirth is a leading cause of mental illness in women, how it affects women at different ages is unknown.

AIMS

We examine whether the effect of childbirth on mental illness varies at different ages.

METHODS

From 2,657,751 women identified from a UK population-based primary care database, 355,864 postpartum periods, with no history of mental illness, were matched on year of birth and general practice to 1,420,350 non-postpartum periods. Cox regression models were used to compare incident mental illness between postpartum and non-postpartum periods. These were measured using hazard ratios (HR) and hazard ratios adjusted for parity and prior pregnancy loss (aHR).

RESULTS

Strong evidence is presented that the effect of livebirth on mental illness was age-dependant for depression (p <0·001), anxiety (p 0·048) and affective psychosis (p 0·031). In 15-19 year olds, depression was over seven times more likely to occur in postpartum periods than non-postpartum periods (aHR 7·09, 95%CI 6·65-7·56); twice the effect in women overall (aHR 3·24 95%CI 3·18-3·29). 15-19 year olds were 50% more likely to develop anxiety in postpartum periods than non-postpartum periods (aHR 1·52, 95%CI 1·38-1·67), with little effect in women overall (aHR 1·07 95%CI 1·04-1·10). Livebirth had over twice the effect on affective psychosis in women aged 15-24 (15-19 year olds: aHR 2·71 95%CI 1·23-5·97; 20-24 year olds: aHR 2·79 95%CI 1·68-4·63) compared to women overall (aHR 1·66, 95%CI 1·29-2·14).

CONCLUSIONS

Younger women are far more vulnerable to the effect of childbirth on their mental health, particularly depression and anxiety.

Perceived Discriminatory Factors that Impact Prenatal Care Satisfaction and Attendance Among Adolescent and Young Adult Couples

OBJECTIVE

To identify possible discriminatory factors that lead to prenatal care dissatisfaction and disengagement from prenatal care among young, expecting couples with a focus on exploring the experiences of Black and Latinx participants.

METHODS

A total of 296 young adolescent couples were recruited. Each couple consisted of an expecting female (ExpF) and an expecting male (ExpM). Participants were asked to give responses to a survey, and data was collected at 3 different time points.

PARTICIPANTS

The sample consisted of 296 expecting young couples.

SETTING

Participants were recruited from obstetrics and gynecology clinics and ultrasound clinics from 4 university-affiliated hospitals in southern Connecticut.

OUTCOME MEASURES

The main outcome measure was prenatal care satisfaction. The secondary outcome was number of prenatal care visits that were attended by each member of the couple dyad. Both of these outcomes were assessed to evaluate whether discriminatory factors that participants experienced in healthcare had an effect on each outcome.

RESULTS

A total of 51 males (17.5%) and 36 females (12.4%) reported a perception of experiencing discrimination in the healthcare system a few times a year or more. Those who believed that race contributed to discrimination in the healthcare system were 2.45 times more likely to have an unpleasant prenatal visit (P = .018). Those who believed that age contributed to discrimination in the healthcare system were 2.74 times more likely to have an unpleasant prenatal visit (P = .001). Participants who believed that physical appearance contributed to discrimination in the healthcare system were 2.83 times more likely to have an unpleasant prenatal visit (P = .01).

CONCLUSION

Black and Latinx young expecting couples are not exempt from discriminatory experiences during prenatal care. Recommendations for quality improvement in prenatal healthcare settings include implementation of standard evaluative measures specific to personal treatment and supportiveness of the medical team.

Is the Brief Child Abuse Potential Inventory (BCAPI) a valid measure of child abuse potential among mothers and fathers of young children in Germany?

BACKGROUND

In order to prevent child abuse, instruments measuring child abuse potential (CAP) need to be appropriate, reliable and valid.

OBJECTIVE

This study aimed to confirm the 6-factor structure of the Brief Child Abuse Potential Inventory (BCAPI) in a German sample of mothers and fathers, and to examine longitudinal predictors of CAP.

PARTICIPANTS AND SETTING

Two waves of data were collected from 197 mothers and 191 fathers of children aged 10-21 months for the "Kinder in Deutschland - KiD 0-3" in-depth study. Families were stratified based on prior self-report data for screening purposes.

METHODS

138 fathers and 147 mothers were included in the analysis (invalid: 25% mothers, 30% fathers). First, validity of reporting was examined. Second, confirmatory factor analysis (CFA) was employed to assess factor structure. Third, internal reliability and criterion validity were examined. Finally, multivariate poisson regressions investigated longitudinal predictors of CAP in mothers.

RESULTS

A previously established six-factor structure was confirmed for mothers but not fathers. CFA failed for fathers due to large numbers of variables with zero variance. For mothers, internal consistency and criterion validity were good. BCAPI score at follow-up was associated with baseline BCAPI score (β = 00.08), stress (β = 0.06), education (β=-0.19) and alcohol use (β = .58).

CONCLUSIONS

Findings confirm the six-factor structure of the BCAPI among German mothers. The clinical use of the BCAPI in fathers is not recommended as it might produce data that are hard to interpret. Further research with fathers is needed to establish if this is due to limitations with this dataset or with the questionnaire.

Intergenerational transmission of out-of-home care in Sweden: A population-based cohort study

The objective of this study is to examine the intergenerational transmission of out-of-home care. This population-based study used data from the Swedish National Registers and included all children born in Sweden between 1990 and 2012 (followed for up to 13 years), whose parents were both born in Sweden between 1973 and 1980 (278 327 children; 145 935 mothers; 146 896 fathers). Cox regression models are used to obtain crude and adjusted hazard ratios (HR) of OHC placement among children based on parents' history of OHC. Compared with children whose parents both did not have a history of OHC, the risk of being placed in OHC was greater when both parents spent time in OHC (crude HR = 48.70, 95% CI 41.46-57.21; adjusted HR = 3.04, 95% CI = 2.54-3.64), however, children who had only one parent who spent time in care were also at higher risk (mothers only adjusted HR = 2.37, 95% CI = 2.08-2.70; fathers only adjusted HR = 1.33, 95% CI = 1.13-1.55). The crude rate of placement in OHC was highest for children whose parents were placed in care during adolescence, but after adjusting for social and behavioral covariates, children whose parents were in care in early childhood were at greater risk of OHC than children whose parents were in care in adolescence. To reduce this intergenerational transmission of OHC, more supports should be provided to parents who spent time in OHC to ensure a successful transition to parenthood.

The Cycle of Child Protection Services Involvement: A Cohort Study of Adolescent Mothers

OBJECTIVES

To determine if adolescent mothers who were in the care of child protection services (CPS) when they gave birth to their first child are more likely to have that child taken into CPS care before the child's second birthday than adolescent mothers who were not in the care of CPS.

METHODS

Linkable administrative data were used to create a population-based cohort of adolescent mothers whose first child was born in Manitoba, Canada between April 1, 1998, and March 31, 2013 (n = 5942). Adjusted odds ratios (aOR) of having that first child taken into care before their second birthday were compared between mothers who were in care (n = 576) and mothers who were not in care (n = 5366) at the birth of their child by using logistic regression models.

RESULTS

Adolescent mothers who were in care had greater odds of having their child taken into care before the child's second birthday (aOR = 7.53; 95% confidence interval [CI] = 6.19-9.14). Specifically, their children had higher odds of being taken into care in their first week of life (aOR = 11.64; 95% CI = 8.83-15.34), between 1 week and their first birthday (aOR = 3.63; 95% CI = 2.79-4.71), and between their first and second birthday (aOR = 2.21; 95% CIl = 1.53-3.19).

CONCLUSIONS

Findings support an intergenerational cycle of involvement with CPS. More and better services are required for adolescent mothers who give birth while in care of CPS.

Social Support, Parenting Competence, and Parenting Satisfaction Among Adolescent, African American, Mothers

This secondary analysis explored how social support changed during the first 6 months postpartum and examined the relationships among social support, parenting competence, and parenting role satisfaction. Single, low-income, adolescent, new mothers ( N = 34) completed measures of perceived parenting competence, parenting role satisfaction, and four types of received social support (emotional, informational, tangible, problematic) from the entire social network at 1 week, 6 weeks, 3 months, and 6 months postpartum. Results indicated that social support did not change over time. Emotional, informational, and tangible social support were significantly correlated, concurrently and predictively, with perceived competence and satisfaction at most data collection points. Future social support intervention studies using social support as a modifiable variable with this high-risk group of African American adolescent new mothers are advocated. Health care professionals are encouraged to examine existing social support within these mothers' identified family units.

Experiences of Young Parents with Perinatally Acquired HIV

This research explores the perceptions of adolescents and young adults (AYA) living with perinatally acquired HIV (PHIV) as they transition into parenthood. We conducted hour-long, semistructured audio-recorded interviews with a purposive sample of 17 AYA parents with PHIV who were current or former patients at two US pediatric/adolescent infectious diseases clinics. Participants were asked about challenges/rewards of parenting and anticipated future fertility desires/intentions. Analysis of the transcribed interviews was guided by grounded theory. Mean age of participants was 22 years. The majority were African American (n = 8) or Hispanic (n = 6) and female (n = 14). Two participants were pregnant and others had a range of 1-3 children (mean = 1.4), one of whom was HIV positive. Analyses revealed that time with their child was a valuable commodity. Participants expressed concerns about not "being there" for their child due to sickness and worries that their child may experience HIV-related discrimination once a parent's HIV status was disclosed. The importance of being a role model and present in their child's life over time was emphasized and served as motivation to pursue education and employment opportunities. Those parents who intended to have another child were motivated by a strong desire to create a legacy and a family of their own as a way to deal with HIV-related losses and stigma. Participants reported the importance of emotional support offered by providers, as well as concrete social services available in that care setting even if they had transitioned to adult care. AYA also expressed parenting rewards/challenges similar to those of their uninfected peers. As youth with PHIV continue to mature, increasing numbers will become parents. It is incumbent upon both pediatric and adult providers to support newly formed families living in the context of intergenerational HIV infection.

Reducing anxiety among children born preterm and their young mothers

PURPOSE

To examine the efficacy of COPE on maternal and child anxiety associated with younger mothers of premature infants. The COPE program provides instruction and practice in parenting behaviors specific to the NICU, in combination with information that reduces ambiguity about their infant's appearance and behaviors.

STUDY DESIGN AND METHODS

Secondary data analysis was conducted on data obtained from a larger randomized controlled trial with 253 mothers of low birthweight premature infants to examine the efficacy of the Creating Opportunities for Parent Empowerment (COPE) program, an educational-behavioral parent intervention in the NICU, on maternal and child anxiety based on maternal age. For these analyses, child and maternal anxiety were assessed using the Child Behavior Checklist for Ages 2 to 3 and the State-Trait Anxiety Inventory collected at 24 months and 2 to 4 days postintervention, respectively. To test study hypotheses, we conducted multiple regression models using the structural equation modeling approach to path analysis.

RESULTS

Multiple regression results for the full model indicated that there was a significant COPE × mothers' age interaction effect on both mothers' anxiety and child anxiety. Participation in the COPE program significantly predicted lower levels of mothers' anxiety at postintervention as well as lower levels of child anxiety at 24 months for younger mothers (18-21 years old), but not for mothers over 21 years old.

CLINICAL IMPLICATIONS

Participating in COPE was associated with more favorable mental health outcomes for younger mothers and their children than mothers over 21 years old. Participation in the COPE program may help close the health disparities gap by improving behaviors in infants of younger mothers to rates similar to those of children of mothers over 21 years old.

Mothers' experiences in the Nurse-Family Partnership program: a qualitative case study

Background

Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday.

Methods

A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently.

Results

The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent.

Conclusions

Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.