Supporting adolescent mothers and their children through a high school-based child care center and parent support program.

INTRODUCTION: A pilot study was conducted of adolescent parents and their children at a high school-based child care center to examine the influence of the program on parental competence, parent-child interaction, and child development. METHOD: A convenience sample of 18 urban adolescent mothers with children was interviewed at the end of one academic year. Mothers completed the Maternal Self Report Inventory (MSRI; short form) and the Parenting Daily Hassles Scale (PDHS). Parent-child teaching interactions were rated with the Nursing Child Assessment Teaching Scale (NCATS), and the Michigan Early Developmental Profile (MEDP) was used to evaluate child developmental outcomes. RESULTS: Mothers reported positive scores on the MSRI and PDHS. NCATS observations indicated ratings significantly higher when compared (assuming unequal variances) with a group matched for age range and length of time in school of adolescent mothers from the Nursing Child Assessment Satellite Training (NCAST) national database. The MEDP indicated that 77% of the children assessed were within normal limits for all domains (fine motor, cognition, language, gross motor, and self care). DISCUSSION: The results of this pilot study indicate that adolescent mothers and their young children in the sample benefited from the educational and support services offered at a school-based child care and parent support program. Further study is indicated to test the strength and duration of the effects.     

Barriers to breastfeeding among African American adolescent mothers

The purpose of this study was to define the barriers to breastfeeding in the inner city African American adolescent mother. The study was conducted at Johnnie Ruth Clarke Health Center in St. Petersburg, Florida from October 1999 to February 2000. The study population included 25 African American adolescent mothers between the ages of 15 and 21 years. The results indicate that these mothers possess adequate knowledge about the benefits of breast milk. The greatest barriers to breastfeeding included pain, embarrassment, and lack of interest. These concerns are appropriate given their developmental stage; however, interventions are necessary to address these issues.     

Depression among adolescent mothers: a pilot study

Eighteen women less than 22 years old, who had their first child during adolescence, were assessed with a standard in-depth diagnostic interview for the presence of and/or history of depression and other disorders. Eight of the 18 women (44%) had experienced at least one episode of major depressive disorder at some point in their lives. A majority of episodes had their onset during pregnancy. Moreover, six women (33%) were experiencing a diagnosable form of depression at the time of the interview. Most of the women who had been depressed experienced at least part of their depression while they were raising their children. Whereas these preliminary findings need to be replicated due to the small sample size, they draw attention to the need for the integration of mental health assessment and treatment in service programs for adolescent mothers.     

Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial

OBJECTIVE: To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents. DESIGN: Randomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program. SETTING: One Apache and 3 Navajo communities. PARTICIPANTS: Fifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants.Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum. MAIN OUTCOME MEASURES: Child care knowledge, skills, and involvement. RESULTS: Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months (adjusted mean difference [AMD], +14.9 [95% confidence interval (CI), +7.5 to +22.4]) and 6 months post partum (AMD, +15.3 [95% CI, +5.9 to +24.7]). Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum (AMD, +1.5 [95% CI, -0.02 to +3.02]), and scores approached significance at 6 months post partum (AMD, +1.1 [95% CI, -0.06 to +2.2]). No between-group differences were found for child care skills. CONCLUSIONS: A paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.     

Drug use among adolescent mothers: profile of risk

Adolescent pregnancy and adolescent drug use are important clinical and public health problems. Yet, few studies have systematically investigated the patterns of substance use among pregnant and parenting adolescents. Because adverse outcomes are not found uniformly for all adolescent mothers, use of illicit drugs may be a key factor in determining which mothers and their infants will have poor outcomes. In this study, the patterns of drug use are described and differences in the demographic and psychosocial profile among 253 pregnant adolescents are investigated. Results obtained from interviews and urine assay for marijuana and cocaine indicate that lifetime use was 84% for alcohol, 62% for marijuana, and 23% for cocaine, whereas use in the past year was 40% for marijuana and 17% for cocaine. Compared with nonusers, pregnant adolescent drug users were more likely to be North American black, have a history of elective abortion and venereal disease, report more negative life events and violence during pregnancy, and receive more support from the father of the baby who was more likely to use marijuana and cocaine (P less than .01). Furthermore, according to logistic regression analysis results after controlling for age and ethnicity, adolescents who used illicit substances in the past year were three times more likely to have a male partner who used marijuana or cocaine and were two times more likely to have a history of venereal disease compared with nonusers. The findings suggest that drug use, whether as a mechanism or a marker, is associated with social and medical characteristics that are likely to contribute to negative outcomes among adolescent mothers and their infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lactation among adolescent mothers and subsequent bone mineral density

OBJECTIVE: To investigate the association of breastfeeding during adolescence with bone mineral density (BMD) during young adulthood. METHODS: Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional survey conducted from 1988 through 1994, was performed. The BMDs for 5 regions of the proximal femur as measured by dual energy x-ray absorptiometry were compared for 5 groups of women aged 20 to 25 years (n = 819); the groups included those who had been: (1) adolescent mothers and had breastfed (n = 94), (2) adolescent mothers and had not breastfed (n = 151), (3) mothers who first gave birth as adults and breastfed (n = 67), (4) mothers who first gave birth as adults and had not breastfed (n = 89), and (5) nulliparous (n = 418). SUDAAN software was used to account for the complex sampling design of the National Health and Nutrition Examination Survey. Adjusted mean differences in BMD were estimated using least-squares linear regression. RESULTS: During young adulthood, women who breastfed during adolescence had higher adjusted BMDs, which was statistically significant in 4 of the 5 regions, than those who had not breastfed (total proximal femur area difference, 0.049 gm/cm(2) [95% confidence interval, 0.002-0.095]) and BMDs equivalent to nulliparous women (total proximal femur area difference, 0.024 gm/cm(2) [95% confidence interval, -0.023 to 0.071]). Adjusting also for obstetric variables, women who breastfed during adolescence had higher BMDs in all 5 regions compared with their peers who had not breastfed (total proximal femur area difference, 0.053 gm/cm(2) [95% confidence interval, 0.029-0.077]). CONCLUSIONS: In this nationally representative sample, breastfeeding by adolescent mothers was associated with greater BMD in the proximal femur during young adulthood. Lactation was not found to be detrimental and may be protective to the bone health of adolescent mothers.     

Attachment classifications among 18-month-old children of adolescent mothers.

OBJECTIVES: To determine (1) patterns of secure vs insecure attachment relationships in infants of adolescent and nonadolescent mothers and (2) if these patterns are mediated by parenting characteristics, including depression, self-esteem, parenting stress, child abuse potential, psychological distress, rating of infant temperament, and the caregiving environment. PARTICIPANTS: Fifty-one adolescent mothers and their 18-month-old infants were compared with 76 nonadolescent mothers and their 18-month-old infants. MAIN OUTCOME MEASURES: Infant attachment classifications were assessed via the Ainsworth Strange Situation. Maternal and infant characteristics were obtained through self-report measures. RESULTS: There were no differences in attachment classification between infants of adolescent mothers and nonadolescent mothers. Secure attachment classification was found in 67% of the infants of adolescent mothers and 62% of the infants of nonadolescent mothers. There were significant differences in the self-reported maternal characteristics. Adolescent mothers reported lower self-esteem (P<.05), more parenting stress (P<.05), more child abuse potential (P<.05), and provided a lower quality of home environment (P<.05) than nonadolescent mothers. Adolescent mothers also rated their infants as having a higher activity level (P<.05) than infants born to nonadolescent mothers. In multivariate analysis, none of these variables or social classes were found to affect attachment classification. CONCLUSIONS: Infants of adolescent and nonadolescent mothers show similar patterns of attachment. Adolescent and nonadolescent mothers show substantial differences in parenting characteristics and in how they rate their infants' temperaments. However, these differences do not seem to impair the infant-mother attachment relationship.     

Psychosocial predictors of maternal and infant health among adolescent mothers

Past work suggests that stressful life events and social support are significantly associated with a broad range of child health outcomes. Such associations have remained, however, generally modest in magnitude, suggesting that stress and support may be only proxy measures for a deeper, more central aspect of childhood psychosocial experience. One aspect of young people's lives that could plausibly mediate the effects of stress and social support on health is the sense of stability and "permanence" in ongoing life experience. We developed a standardized psychometric instrument for measuring a "sense of permanence" and employed the measure in a prospective 1-year study of health outcomes among 89 adolescent mothers and their infants. Psychosocial and demographic factors were significantly predictive of maternal, but not infant, health outcomes, and the sense of permanence appeared to operate as a "final common pathway" in the influence of psychosocial variables on health and illness end points. Results of the study underscore the importance of continuity and stability in childhood and suggest that changes in an individual's sense of permanence may underlie the previously documented health effects of stressful life events and social support.     

Predictors of repeat pregnancy outcome among black and Puerto Rican adolescent mothers.

This prospective study investigated predictors of repeat pregnancies by 12 months after the delivery of a first child and their outcomes in inner-city adolescent mothers. The sample included four groups: those who had therapeutic abortions, miscarriages, full-term deliveries, and no repeat pregnancy. The therapeutic abortion group had more pregnancies before their first delivery (41%) than did full term (20%) and no repeat (15%), p less than .01. More delayed grade placement was found in therapeutic abortion -1.6 years (1.3) and full term -1.8 years (.9) than in no repeat pregnancy -.6 years (1.1), p less .001. Reading achievement scores were higher in no repeat 86.3 (17.1) than in full term 75.0 (16.5), p less than .05. School attendance was higher in no repeat (65%) than in therapeutic abortion (35%) and full-term (24%) p less than .01 groups. Depressive symptoms at baseline were higher among therapeutic aborters 18.9 (9.9) than among full term 10.2 (8.2) and no repeat pregnancy groups 12.2 (6.2). Logistic regression analyses identified delayed grade placement as the most important predictor of pregnancy outcome.     

Early vaginal bleeding, late prenatal care, and misdating in adolescent pregnancies

Vaginal bleeding early in pregnancy may be mistaken for menstrual bleeding and delay entry into prenatal care by delaying the diagnosis of pregnancy. This study tests the hypotheses that (1) more adolescents report early first-trimester vaginal bleeding than do adults and (2) a history of vaginal bleeding is associated with later entry into prenatal care, particularly among adolescents. Reports of early vaginal bleeding were prospectively obtained from black, predominantly primiparous, unmarried poor women (136 adolescents and 53 adults). As hypothesized, more adolescents reported early first-trimester vaginal bleeding than did adults (16.9% vs 5.7%; P less than .01). Adolescents who reported early vaginal bleeding also entered prenatal care later (16.2 weeks) than did adolescents who reported no bleeding (12.7 weeks) (P less than .03); this was not true for adults. If dating of the gestation is based solely on last menstrual period history, inflation of the incidence of preterm births to adolescents and the mean birth weights of those preterm neonates may occur. The findings suggest that new strategies focusing on the recognition of menstrual irregularities as a symptom of pregnancy may be needed to promote early prenatal care among adolescents. Additionally, adolescent pregnancies should be dated by both ultrasound and Dubowitz examinations.     

Loneliness and associated factors among Brazilian adolescents: results of national adolescent school-based health survey 2015

ObjectiveTo identify the associated factors to loneliness among Brazilian adolescents, considering this is a knowledge gap and given its severity. The United Nations estimates that mental health problems affect approximately 20% of adolescents worldwide.MethodsThis is a cross-sectional study with data from the National Adolescent School-based Health Survey 2015, conducted with students aged 13-17 in Brazil. The statistical analysis was performed with the calculation of the prevalence of feeling loneliness reported. Poisson regression with the adjusted Prevalence Ratio was used to evaluate the association between sociodemographic characteristics, family context, mental health and lifestyles, and feelings of loneliness.Results15,5% of Brazilian students reported loneliness in the last 12 months. Female gender, higher maternal education, insomnia and be bullying victims rarely or sometimes and most of the time or always had a higher prevalence rate of loneliness. Having friends, having a meal with parents or guardians 5 days or more a week and having understanding parents showed a lower prevalence ratio for loneliness.ConclusionLoneliness feeling is frequent among adolescents and is associated with female gender, less social and family support, intra-family violence and risk behaviors such as alcohol consumption and bullying. Policies to promote physical and mental well-being in this age group, stimulating friendship and family participation in the lives of adolescents should be made .     

Adolescent hepatitis B vaccination: comparison among 2 high school-based health centers and an adolescent clinic

OBJECTIVE: To compare the completion rate of hepatitis B vaccination among adolescents who receive primary care at 2 comprehensive high school-based health centers (SBHCs) and a hospital-based adolescent health center (AHC) to assess predictors for successful immunization. METHODS: A retrospective chart review of patients seen for comprehensive history and physical examinations from September 1997 to March 1998 at 2 SBHCs and an AHC was conducted to determine the immunization status for hepatitis B. One SBHC (SBHC-A) had previously implemented an outreach strategy consisting of advertising through the school's loudspeaker, whereas the other SBHC (SBHC-B) and the AHC did not. Completion rates were assessed among all students requesting comprehensive history and physical examinations. A subset analysis among those without prior immunizations was performed. RESULTS: Of 510 records reviewed, 406 had documented data for hepatitis B immunization status, and 191 (37 for SBHC-A, 59 for SBHC-B, 95 for AHC) did not have any prior hepatitis immunizations. The completion rate of hepatitis B vaccination was significantly higher at SBHC-A (76%) compared with the other 2 sites (29% for SBHC-B and 24% for AHC) (P<.001). CONCLUSION: Patients with access to SBHC services that strongly emphasize outreach were more likely to complete the hepatitis B vaccination series.     

Depression,anxiety and stress among adolescent students belonging to affluent families: A school-based study

Objective  

To study depression, anxiety and stress (DAS) among adolescent school students belonging to affluent families and the factors associated with high levels of DAS.     

Breast-feeding rates among black urban low-income women: effect of prenatal education

Many factors are associated with low breast-feeding rates among black low-income women. This study examines whether, despite such factors, health professionals' prenatal education of black poor women is associated with increased breast-feeding rates. Black women born in the United States who attended a midwives prenatal clinic (N = 159) were randomly assigned to two types of prenatal education or were followed up in a control group. All women were interviewed on entry into the study and after delivery of their infants. Women assigned to group classes attended at least one session discussing myths, problems, and benefits of breast-feeding. Women assigned to individual prenatal counseling spoke with a pediatrician or nurse practitioner, who discussed breast-feeding topics similar to those covered in the classes. Women in the control group received no additional prenatal education. The three study groups had significantly different percentages of women who breast-fed (controls 22%, classes 46%, individual sessions 53%). Higher percentages of women in the study groups carried out their prenatal plans to breast-feed (controls 50%, classes 86%, individual sessions 62%) or breast-fed despite prenatal plans to bottle-feed (controls 10%, classes 26%, individual sessions 48%). After multivariable analysis controlling for age, prenatal plans to breast-feed, prior breast-feeding experience, perceived support for breast-feeding, education, gravidity, and employment plans, women in intervention groups had a higher likelihood of breast-feeding than control subjects. These findings suggest that an increase in relatively simple, not-too-time-consuming educational efforts in institutions and offices serving black low-income women might yield significant narrowing of the gap in breast-feeding rates between white affluent women and black low-income women.     

Malnutrition among children of adolescent mothers in a squatter community of Recife, Brazil

In a study of 357 first time mothers in a squatter community of Recife it was found that 1 in 10 were less than 15 years old and 60 per cent less than 20 at the time of their first delivery. Two groups of mothers were distinguished, viz. adolescent mothers with a mean (SD) age at first delivery of 16.7 (0.78) years and older mothers with a mean (SD) age at first delivery of 25 (0.79). More than a third were living in common-law union. Of the adolescent mothers only 58 per cent were living with the child's father. A further 23 per cent had received financial support from their own parents during the pregnancy. The rest were expelled from home. The adolescent mothers were generally worse off with a per capita income generally half of that of older mothers. About a quarter of all children studied were below the 10th centile of NCHS standards (23 per cent by weight/age; 28 per cent by height/age). The undernourished first born was 2.5 times more likely to have an adolescent mother, four times more likely to be in a household with low income, and two times more likely to have an illiterate mother as compared to the first borns who remain well nourished. The implications of these findings for urban primary health care programmes are further discussed.