Intimate Partner Violence Among Economically Disadvantaged Young Adult Women: Associations With Adolescent Risk-Taking and Pregnancy Experiences

CONTEXT: Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences are linked to such violence during young adulthood.
METHODS: Data from 526 participants in the Reach for Health Longitudinal Study who were surveyed during middle school (in 1995–1996 and 1996–1997) and at ages 22–25 (in 2005–2007) provided information on adolescent risk behaviors and pregnancy experiences, as well as experiences of intimate partner violence during young adulthood. Bivariate and multivariate analyses were conducted to identify correlates of intimate partner violence involvement.
RESULTS: As young adults, 29% of women reported having been victims of intimate partner violence in the past 12 months; 21% reported having perpetrated such violence. In multivariate analyses, victimization and perpetration in the last year are positively associated with aggressive behavior in middle school (odds ratios, 1.9 and 2.5, respectively), lifetime number of sex partners (1.3 for both) and having a history of unintended pregnancy or pregnancy problems (1.3 for both). Perpetration also is associated with early sexual initiation (0.5) and living with a partner (1.8).
CONCLUSIONS: It is important to consider women's pregnancy histories in programs aimed at preventing the adverse outcomes of relationship violence and in screening for partner violence in sexual and reproductive health services. Early intervention may help women develop the skills needed for resolving conflicts with peers and partners.     

Association of Child Marriage With Suicidal Thoughts and Attempts Among Adolescent Girls in Ethiopia

PurposeLittle information exists on the mental health implications of child marriage in Africa. This study examined the association between child marriage and suicidal ideation and suicide attempt among girls aged 10–17 years.MethodsData were drawn from a 2007 cross-sectional survey conducted in the Amhara region, Ethiopia. Multilevel logistic regression was used to analyze risk factors for suicidality.ResultsApproximately 5.2% of girls reported ever being married, 5.4% were promised in marriage, and 9.3% reported receiving marriage requests. Girls who were ever married (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.03–3.18), were promised in marriage (OR = 2.35; 95% CI = 1.38–4.01) or had received marriage requests (OR = 2.29; 95% CI = 1.46–3.59) were significantly more likely than girls who were never in the marriage process to have had suicidal thoughts in the past 3 months. Residence in communities with high involvement in stopping child marriage was protective of suicidal ideation. The odds of suicide attempt were twice as high among girls with marriage requests as among those with none.ConclusionsChild marriage was associated with increased odds of suicidality. Findings call for stronger community engagement in child marriage prevention and mental health support for child brides.     

Adolescent E-Cigarette Onset and Escalation: Associations With Internalizing and Externalizing Symptoms

PurposeWe sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents.MethodsAdolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 30 months (spring 2019, end of 11th grade).ResultsA two-part latent growth curve model of e-cigarette use revealed significant positive associations between externalizing factors, past 30-day e-cigarette use, and the number of days of e-cigarette use only at wave 1 (p values <.05). Cigarette smoking was associated with a slowing in the rate of onset of 30-day e-cigarette use across the 30-month follow-up (β = ?.24, z = ?2.41, p = .02). Depression was associated with an increased rate of escalation in the number of days of e-cigarette use across the following 30 months (β = .01, z = 2.52, p = .01), whereas anxiety was associated with a decreased rate (β = ?.72, z = ?2.36, p = .02).ConclusionsThe findings highlight two groups of adolescents at risk for e-cigarette use: adolescents whose e-cigarette use reflects a higher-risk profile with early e-cigarette onset, and adolescents who have a lower-risk profile, at least initially, with later e-cigarette use onset. The timing and content of prevention efforts should be tailored to each group.     

青春期少女妊娠和少女妈妈

对全球普遍存在的少女妊娠和少女妈妈现象进行阐述,分析这一难题形成的复杂原因,通过少女自身、少女生育的孩子、社会3个方面剖析少女妊娠和少女妈妈造成的灾难性影响,介绍一些国家在预防和救助少女妊娠和少女妈妈问题上成功的经验和干预措施。同时提出,应对少女妊娠和少女妈妈这一棘手问题,全球多个组织应积极联合采取措施,共同尽早解决这一问题。     

Associations of Momentary Mindfulness With Affect and Cannabis Desire in a Trial of Cannabis Use Interventions With and Without Momentary Assessment

PurposeMindfulness, awareness resulting from attending to the present without judgment, has been associated with improved health. When considered as a time-varying momentary state, mindfulness is associated with other momentary states such as affect. We examined whether momentary mindfulness, specifically mindful attention and awareness (MAA), changed after counseling interventions to reduce cannabis use that included ecological momentary assessment (EMA) and explored associations with negative affect, positive affect, and cannabis desire.MethodsOutpatients 15–24 years using cannabis ≥3x/week were randomized to one of the three interventions, each including two motivational enhancement therapy (MET) sessions. For two interventions, MET was followed by 2 weeks of EMA (with/without messaging). Momentary MAA, negative affect, positive affect, and cannabis desire were assessed over 1 week of EMA at baseline and 3-month follow-up (N = 1,971 reports, 68 participants). We examined changes in momentary MAA from baseline to follow-up overall and by group (MET + EMA, MET-only) using generalized linear mixed effects models. We tested associations of momentary MAA with momentary affect and cannabis desire using generalized estimating equations.ResultsMomentary MAA increased from baseline to follow-up after MET counseling plus EMA (β = 0.237), but did not change with MET counseling alone. Higher momentary MAA was associated with lower negative affect (β = ?0.526) and cannabis desire (β = ?0.521), but not with positive affect.DiscussionAmong youth using cannabis frequently, momentary MAA was increased 3 months after interventions with EMA after counseling and was inversely associated with momentary negative affect and momentary cannabis desire. Mindfulness may be a useful target for momentary intervention.     

Associations of Sleep With Sedentary Behavior and Physical Activity Patterns Across Pregnancy Trimesters

IntroductionSleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) are altered in pregnancy and may affect pregnancy health; however, how these behaviors are associated with each other is unclear.MethodsPregnant women (N = 120) completed the Pittsburgh Sleep Quality Index and wore an activPAL3 micro and ActiGraph GT3X for 7 days in each trimester to assess sleep, sedentary behavior, and MVPA, respectively. Latent trajectories described patterns of sleep duration, efficiency, and quality as well as sedentary behavior and MVPA. Multinomial logistic regression examined associations of sleep patterns with sedentary behavior and MVPA patterns and, in exploratory analyses, with adverse pregnancy outcomes.ResultsTrajectories were identified for sleep duration (consistently short, 20.7% of sample; consistently adequate, 79.3%), efficiency (consistently low, 17.5%; consistently high, 82.5%), and quality (consistently poor, 15.1%; worsening, 23.5%; and consistently good, 61.5%). Compared with those in more optimal sleep groups, women in the short duration, low efficiency, and worsening quality groups had lower odds of being in the moderate and/or high sedentary behavior group (odds ratio range, 0.21–0.31; 95% confidence interval range, 0.09–0.65). Women in the worsening quality group had greater odds of being in the low MVPA group (odds ratio, 2.51; 95% confidence interval, 1.18–5.38). Trends were observed with women in less optimal sleep groups having greater odds of adverse pregnancy outcomes and lower odds of excessive gestational weight gain.ConclusionsLess optimal sleep patterns in pregnancy are associated with less sedentary behavior and MVPA; additional research is needed to confirm associations between sleep and pregnancy outcomes.     

Methamphetamine Use Is Independently Associated With Recent Risky Sexual Behaviors and Adolescent Pregnancy

BACKGROUND: Lifetime methamphetamine use among adolescents is estimated to be between 5% and 10%. Youth substance use in general is known to be associated with risky sexual behaviors, but the effect of methamphetamine use on recent risky sexual behaviors and adolescent pregnancy has received little attention. The purpose of this analysis was to evaluate the association between lifetime methamphetamine use and recent (past 3 months) risky sexual behaviors and lifetime adolescent pregnancy, adjusting for other substance use. METHODS: We analyzed data from the 2003 National Youth Risk Behavior Survey, a school‐based paper‐and‐pencil survey that assesses risky health behaviors among a nationally representative sample of 9th‐ to 12th‐grade students. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) to examine the association between methamphetamine use and being recently sexually active, having 2 or more recent sex partners, and ever being pregnant or getting someone pregnant. RESULTS: Lifetime methamphetamine use was reported by 7.6% of students. After adjustment for demographic covariates and lifetime use of cigarettes, alcohol, marijuana, and other illicit drugs, lifetime methamphetamine use was associated with recent sexual intercourse (AOR = 1.8, 95% confidence interval [CI] = 1.5‐2.3), having 2 or more recent sex partners (AOR = 3.0, 95% CI = 2.2‐4.2), and ever being pregnant or getting someone pregnant (AOR = 2.9, 95% CI = 2.1‐3.9). CONCLUSIONS: Adolescent methamphetamine use is common and is associated with recent risky sexual behaviors and adolescent pregnancy. Prevention strategies for high school students should integrate education on substance abuse, pregnancy, sexually transmitted infections, and human immunodeficiency virus.     

Family Factors Associated With Suicide Attempts Among Chinese Adolescent Students: A National Cross-Sectional Survey

PurposeTo determine the prevalence and associated family factors of suicide attempts among junior and/or senior high school students, so as to provide bases for preventive measures of suicide in China.MethodsA total of 13,512 students from 32 junior and/or senior high schools in grades 7 to 11 in eight cities of China participated in a self-administered anonymous survey to report their frequency of suicide attempts during the past year. Sociodemographic characteristics, tobacco, and alcohol use in the past 30 days were asked. Stressful family life events were used to evaluate the subjects' family characteristics.ResultsOverall, 2.7% (338/12,470) in-school adolescents reported a suicide attempt during the past year, girls significantly more often than boys. Considered independently, all stressful family life events were strongly associated with increased risk for self-reported suicide attempts. When taking sociodemographic characteristics, life style, and all the five family factors selected from factor analysis into consideration, there was a significant independent impact of three family factors on increasing suicide attempts risk among adolescents. The most notable risks were derived from improper parental rearing behavior, separation from parents, and social problems of the family members. However, neither poor material conditions of family life nor family member's adversity contribute significantly to the risk.ConclusionsThis study not only indicates that suicide attempt is a significant public health issue among in-school adolescents in China, but also confirms that adolescents with family problems commonly manifest suicide attempts, which highlights the importance of considering family environmental factors when assessing suicide risk.     

Co-Occurrence of Substance Use and Loneliness as a Risk Factor for Adolescent Hopelessness

ABSTRACT: This research among a sample of 1,915 Mississippi adolescents investigated whether lonely adolescents who use illicit substances were at increased risk of hopelessness. Relative risk of scoring within the severe hopelessness range was 6.9 for non-substance users who were lonely and 4.2 for substance users who were not lonely. Yet, relative risk for severe hopelessness in substance-using lonely adolescents was 25.2. Lonely, substance-using adolescents were 25 times more likely to be severely hopeless than the reference group composed of non-substance using, not-lonely adolescents. Lonely adolescents who get drunk also were 15.9 times more likely to be severely hopeless than the reference group. Because hopelessness often is an indicator of suicidal behavior, these results may have important implications for school health adolescent suicide prevention efforts.     

Adolescent Alcohol Use,Suicidal Ideation,and Suicide Attempts

PurposeTo examine the association between self-reported alcohol use and suicide attempts among adolescents who did and did not report suicidal ideation during the past year.MethodsScreening data from 31,953 students attending schools in the United States that implemented the Signs of Suicide (SOS) program in 2001–2002 were used in this analysis. Two types of alcohol use were investigated: heavy episodic drinking, and drinking while down. Self-reported suicide attempts were regressed on suicidal ideation and both measures of alcohol use, controlling for participants’ levels of depressive symptoms, and demographic characteristics.ResultsLogistic regression analyses indicated that both drinking while down and heavy episodic drinking were significantly associated with self-reported suicide attempts. Analyses examining the conditional association of alcohol use and suicidal ideation with self-reported suicide attempts revealed that drinking while down was associated with significantly greater risk of suicide attempt among those not reporting suicidal ideation in the past year. Heavy episodic drinking was associated with increased risk of suicide attempt equally among those who did and did not report suicidal ideation.ConclusionsThis study identified the use of alcohol while sad or depressed as a marker for suicidal behavior in adolescents who did not report ideating prior to an attempt, and hence, may not be detected by current strategies for assessing suicide risk. Findings from this study should provide further impetus for alcohol screening among clinicians beyond that motivated by concerns about alcohol and substance use.     

Examining Youth Hopelessness as an Independent Risk Correlate for Adolescent Delinquency and Violence

Prior research has identified a relationship between youth hopelessness and violence perpetration within specific groups of young people. The purpose of this study was to evaluate the relationship between youth hopelessness and violence perpetration in a population-based sample of adolescents. This study is a cross-sectional analysis of data from 136,549 students in the 6th, 9th, and 12th grades responding to the 2007 Minnesota Student Survey. Logistic regression models were used to evaluate the relationship between hopelessness and youth violence perpetration, including comparison analyses for gender and race/ethnic subgroups as well as adjustment for a measure of poor-low affect. One in four youth (25.1%) reported levels of hopelessness at least enough to bother them in the previous month. Moderate-high levels of hopelessness exhibited a statistically significant independent relationship with a range of violence-related outcomes for youth subgroups: delinquent behavior, weapon carrying on school property, and all forms of self-directed violence. Relationships between hopelessness and interpersonal and intimate partner violence suggest a greater contribution by poor affective functioning for some groups. Interventions designed to reduce youth violence perpetration may benefit from increased strategies to address youth hopelessness as well as youth mental health in general.     

Adolescent Pregnancy and Parenthood in South Africa

South Africa's total fertility rate is estimated to be one of the lowest in sub-Saharan Africa, fewer than three births per woman nationally and declining. At the same time, adolescent childbearing levels remain high: More than 30 percent of 19-year-old girls are reported to have given birth at least once. Evidence from focus-group discussions conducted in urban and rural areas in South Africa with young black women and men, and with the parents of teenage mothers, is used to consider the experience of early parenthood, including the role of paternity, education, work opportunities, and subsequent fertility. In South Africa, in contrast to many other settings, teenage mothers may return to school once they have given birth, and this opportunity is strongly related to a long delay before the birth of a second child. Educated girls also tend to bring more bridewealth, which may encourage parents to support their daughters' schooling, and perhaps their return to school following childbirth. The support of the child, however, is often subject to paternal recognition and commitment, even though boys are unwilling to admit paternity because it jeopardizes their educational and employment opportunities.     

Adolescent Pregnancy and Unfinished Developmental Tasks of Childhood

Adolescent pregnancy may occur when developmental needs have not been met adequately during earlier childhood stages. Reasons adolescents give for becoming pregnant may indicate which developmental needs were not met. Once developmental needs have been identified, professionals can help the adolescent and her child by tailoring interventions to fill gaps that occurred during earlier stages of development. This article explores the potential relationship between adolescent pregnancy and unfinished developmental tasks of childhood. Implications for intervention are addressed.     

Social and Affective Factors Associated with Adolescent Pregnancy

Perceptions associated with pregnancy, including life-expectations, desire for pregnancy and knowledge of the menstrual cycle were assessed in a sample of urban adolescents 13 to 18 years old. Data was obtained from 104 primiparous teens in their second and third trimester of pregnancy. The majority of adolescents, although experiencing an unplanned pregnancy, perceived minimal negative social consequences associated with the pregnancy. Although more than 82% of all teens were aware of where to get birth control, they demonstrated no deep understanding of the menstrual cycle and its relationship to intercourse and only 11% used effective contraception. Of the birth control non-users 74% of the girls reported they did not want to get pregnant. In spite of unprotected coitus, most girls were surprised at conception.     

Explaining Associations between Adolescent Substance Use and Condom Use

PurposeThis study examined different explanations for associations between adolescent substance use and lower condom use, in terms of the event-specific effects of alcohol or drugs, psychosocial factors, and sexual behaviors (intercourse frequency, greater number of partners and pill use).MethodsPupils from 25 schools in Scotland, UK provided data on use of alcohol, tobacco, cannabis and psychosocial factors at ages 14 and 16 years; and sexual behaviors at age 16 years. Logistic regression was used to examine associations between substance use and condom use in those reporting intercourse more than once (n = 1322), adjusting for explanatory variables.ResultsRegular use of any of the three substances at age 14 or 16 was associated with lower condom use at age 16, adjusting for gender and social background. The greatest attenuation of the substance use odds ratios was achieved by adjusting for all behaviors and psychosocial factors. This finding applied to different substance use groups, although cigarette-only and alcohol-only groups at age 16 differed in the relative importance of being “drunk or stoned” to other factors explaining condom use.ConclusionsAmong adolescent substance users, being “drunk or stoned” at intercourse was only one factor related to not using condoms. Psychosocial factors (including attitudes to sexual risks and peer sexual norms) and having more sexual partners also explained substance users’ condom use, with lesser effects due to greater intercourse frequency and pill use. Multiple explanations for substance use/condom use associations may guide counseling and education services.     

The Effect of Pregnancy on Adolescent Growth and Development

Adolescent pregnancy represents a triple developmental crisis to young women, that of adolescence, pregnancy, and establishing a relationship with a member of the opposite sex. Physiologically the adjustments of pregnancy are superimposed on those of pubescence. Psychologically and intellectually the pregnant adolescent is still developing, and it is thus difficult for her to meet the physiological demands of pregnancy. Society has responded by developing comprehensive programs for intensive care which have reduced considerably the risks of pregnancy. Contraceptive knowledge has not totally prevented the problems of teenage pregnancy, in pan because the adolescents who become pregnant are not sufficiently developed intellectually to perceive that today's actions may prevent future consequences. This paper reviews the literature and synthesizes the published studies with personal experience gained in over five years of professional work with teenage women.