Characteristics of pregnant adolescents receiving prenatal care at school-based or hospital-based clinics

This study examines characteristics of adolescent females in prenatal care in a hospital-based teen clinic compared to a school-based teen clinic. Interviews were conducted during 1991-92 among 189 pregnant adolescents, whose mean age was 16.22 years. 48% were African American, 42% were Hispanic, and 2% were Asian or other. 75% of adolescents were single or without a spouse. 30% lived with siblings, 21% lived with their husband, 9% lived with their boyfriend, 10% lived with in-laws, 4% lived with a friend, and the rest lived with their mothers. 48% of adolescents' mothers helped with child care. 27% did not have any help. 57% were enrolled in school, 41% dropped out, and 4% graduated. 63% planned to continue their education. 75% had a parent who served as a mentor. Over 50% lived with someone who smoked cigarettes or drank alcohol. 75% had friends or relatives who smoked. Almost 25% had a sexual partner who sold drugs, and 25% had a sexual partner who had been in trouble with the law. 14% had a partner who used drugs. 62% of adolescents who had smoked before their pregnancy quit smoking. 79% of adolescents who had consumed alcohol before their pregnancy stopped consuming alcohol. Adolescents in both clinics showed no significant differences in family welfare status, initiation of prenatal care, parity, and number of living children. There were differences by clinic type for adolescent ethnic patterns of clinic use, educational status, financial and social support, and family setting. Hispanics and Whites and school dropouts were more likely to use hospital-based care. The school-based adolescents were more likely to be single; to receive support from parents, relatives, and a job; and to have higher exposure to alcohol and substance abuse. Hospital-based adolescents were more likely to live with relatives, not to have help, and to be Spanish speakers. It is recommended that services match the characteristics and needs of clients in each local setting.     

Moderating effects of gender on alcohol use: implications for condom use at first intercourse

This study examined whether the effects of level of alcohol consumption on condom use at first sex depend on adolescents' gender, utilizing data from Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Compared to girls who did not consume any alcohol, inebriated girls were significantly less likely to use a condom at first intercourse (odds ratio = 0.41, p 相似文献   

Psychosocial risk and correlates of early menarche in Mexican-American girls

Mexican-American girls have one of the fastest rates of decline in age at menarche. To date, no study has addressed the role of psychosocial factors on age at menarche in this population. Using data from a longitudinal cohort of Mexican-American girls from the Houston, Texas, metropolitan area recruited in 2005, the authors investigated associations between family life and socioeconomic environment and age at menarche in 523 girls. After adjusting for maternal age at menarche, daughter's age, and body mass index at baseline, perception of family life environment as conflict-prone was significantly associated with an earlier age at menarche (< 11 years). Additionally, there was a 2-fold higher risk (odds ratio = 2.22, 95% confidence interval: 1.12, 4.40) of early menarche among daughters of mothers who were single parents compared with those who were not. Furthermore, girls who matured early had a 2.5-fold increased risk (odds ratio = 2.69, 95% confidence interval: 1.04, 6.96) of experimenting with cigarettes compared with those who had an average-to-late age at menarche (≥ 11 years). This study provides important information regarding the role of family life environment and single parenting on age at menarche in Mexican Americans. Awareness of the impact of the family life environment and fathers' absence during the early years should be emphasized when addressing early age at menarche across cultures.     

Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil.

OBJECTIVE: To use a case-control study to analyze risk factors associated with teenage childbearing among adolescents who were in a birth cohort study that began in 1982 in the city of Pelotas, Rio Grande do Sul, Brazil. METHODS: Adolescent mothers in Pelotas who gave birth between January 1995 and March 2001 and who had been born in 1982 were identified through the local birth information system. These subjects from the 1982 birth cohort were compared to adolescents from the same cohort who had not given birth before March 2001. Standardized interviews were used in 2001 to obtain information about socioeconomic, maternal reproductive, demographic, and lifestyle characteristics. This information was combined with data obtained in earlier phases of this 1982 birth cohort study. Unconditional logistic regression was used to analyze the risk factors associated with childbearing during adolescence. RESULTS: A total of 420 parous adolescents from the 1982 birth cohort were identified and then compared with 408 cohort adolescents who had not given birth by March 2001. Higher family income in 1982 and more parental schooling in 1982 were inversely related to childbearing among the birth cohort adolescents. Cohort girls whose mothers were under age 20 when they gave birth in 1982 had a higher risk of becoming pregnant while still an adolescent. Cohort girls who, during childhood, lived with siblings from different fathers were twice as likely to become an adolescent mother. Compared to cohort adolescents who had not failed during the first four years of school, those girls who had done so had twice the risk of giving birth during adolescence. Among the cohort girls a positive association was found between younger age at first intercourse and childbearing in adolescence. CONCLUSIONS: The results indicate that the educational level of the adolescent mothers must be considered in planning policies that attempt to disrupt successive cycles of socioeconomic deprivation. Early interventions to improve sex education and to increase the motivation of young girls to achieve higher levels of education are needed. The interventions should aim for a reduction in the risk of long-term poverty and poorer educational achievements of teenage mothers and their children.     

Experimental use of alcohol in early adolescence: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

The aim of this study was to estimate the prevalence of experimental alcohol intake and associated factors in early adolescence. The overall sample consisted of 4,452 adolescents (mean age = 11.3 years; SD = 0.3) from the 1993 birth cohort in Pelotas, Rio Grande do Sul State, Brazil. Experimental use of alcohol was reported by 17.5% of the interviewees (95%CI: 16.3-18.6), and 5% reported having tried alcohol at nine years of age or younger. Prevalence of experimental alcohol use was higher among adolescents whose mothers had consumed alcohol during pregnancy, whose parents consumed alcohol, who worked outside the home themselves, and who had ever tried smoking. Family strife, parental alcohol intake, and adolescent smoking were strong predictors of experimental alcohol use in early adolescence. Special attention should be targeted to these groups in order to avoid heavy and premature alcohol use in early adolescence.     

Social cognitive factors associated with mother-adolescent communication about sex

To better understand why some mothers talk to their children about sex and others do not, we examined the role of two social cognitive variables--self-efficacy and outcome expectancies--in explaining sex-based communication. The present study was part of a larger study to test the efficacy of two HIV prevention programs for mothers and their adolescents. Mothers and their adolescents were recruited from a large community organization that serves youth who live in disadvantaged circumstances. The sample for the present study included 486 mothers who averaged 38.4 years of age (SD = 6.73). The majority were African American (97.7%), not married (66.7%), and had a high school degree (89.5%). Their adolescents ranged in age from 11 through 14 years of age and most were male (61.3%). The results of the analysis revealed that mothers who expressed higher levels of self-efficacy and more favorable outcomes associated with talking to their children about sex were more likely to do so. In a regression analysis, we learned that the mother's degree of efficacy beliefs, along with her expected outcomes associated with talking about sex, the importance of religious beliefs to her, and the age and sex of her adolescents were important factors associated with talking with them about sex.     

Substance use and risky sexual behaviours among sexually experienced Ghanaian youth

ABSTRACT: BACKGROUND: The association between risky sexual behaviours and substance uses among Ghanaian youth were investigated. METHODS: An in-school cross-sectional representative survey was conducted among 12-18-year- old youth in Ghana in 2008 (N=1165, response rate =90%). Logistic regression analyses were employed to investigate the association between substance use (tobacco use, drunkenness, marijuana use, other drug uses) and risky sexual behaviours (sexual debut, condom use and number of sexual partners). RESULTS: Of all adolescents, 25% (28% boys and 23% girls) were sexually experienced. The mean age for first sexual intercourse was 14.8 years (14.4 years for boys and 15.1 years for girls). Among the sexually experienced, 31% had multiple sexual partners. Older age (OR=3.4, 95% CI=1.7-3.4) and rural residency (OR=1.5, 95% CI=1.1-2.1) were independently associated with sexual debut while only older age (OR=2.4, 95% CI=1.7-3.4) was associated with condom use. Additionally, smoking (OR=3.7, 95% CI=2.0-6.8), tawa use (OR=2.4, 95% CI=1.3-4.7), tobacco use (OR=2.8, 95% CI=1.7-4.7) drunkenness (OR=1.7, 95% CI=1.1-2.8) and marijuana use (OR=3.3, 95% CI=1.6-7.0) were independently associated with sexual debut. Furthermore, all substance uses studied were associated with having one or multiple sexual partners. CONCLUSION: Substance use seems to be a gateway for risky sexual behaviours among Ghanaian adolescents. Public health interventions should take into account the likelihood of substance use among sexually experienced adolescents.     

Adolescent substance use and family problems

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in S?o Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p < 0.05). Adolescents that reported having used alcohol, tobacco, and illicit drugs had more family problems than those who did not consume any substance (p < 0.001). Adolescents that used alcohol and tobacco (p = 0.028) and illicit drugs (p < 0.001) reported having more family problems than those who used only alcohol. The results highlight the importance of awareness of alcohol and tobacco use by adolescents, since such use was associated with significant family impairments, similar to illicit drug use.     

P3 in young boys as a predictor of adolescent substance use

Event-related potentials were recorded during a visual, continuous performance task from 36 boys before use of alcohol or other drugs began. The boys were sons of 13 recovering alcoholics who themselves had a family history of alcoholism, 11 nonalcoholics with a family history of alcoholism, and 12 nonalcoholics with no family history of alcoholism. Four years after electrophysiological assessment, a behavioral questionnaire was administered (mean age = 16.1 years). A Substance Use score was derived from reported use of alcohol and other drugs, and from highly correlated delinquent behavior scores. P3s of lowest amplitude were associated with the highest adolescent Substance Use. The combination of reduced amplitude and prolonged latency of both target and nontarget P3 significantly predicted adolescent Substance Use scores after correction for subjects' age. Although this is the first electrophysiological predictor of adolescent substance use we are aware of, the effect was small, indicating the utility of P3 as a vulnerability marker for substance abuse disorders is likely to depend on its joint use with other measures.     

Age at menarche in relation to maternal use of tobacco, alcohol, coffee, and tea during pregnancy

To investigate the potential effects of common early life exposures on age at menarche, the authors examined data collected in a follow-up study of pregnancies that occurred during the 1960s in California. Among 994 female offspring interviewed as adolescents, 98% had started their menstrual periods at a mean age of 12.96 years. After adjustment, the mean age at menarche was a few months earlier among girls whose mothers smoked a pack or more of cigarettes daily during pregnancy compared with unexposed girls (difference = -0.22 years, 95% confidence interval (CI): -0.49, 0.05) and more so among girls who were not White (difference = -0.52 years, 95% CI: -1.1, 0.08). Girls with both high prenatal and childhood passive smoke exposure had an adjusted mean age at menarche about 4 months earlier than those unexposed. The daughter's mean age at menarche varied little by maternal prenatal alcohol consumption. Daughters of tea consumers had a later mean age (difference = 0.41 years at >/= 3 cups (0.7 liter)/day, 95% CI: 0.03, 0.80) and were more likely to start menarche later (>13 years) (odds ratio = 1.7, 95% CI: 0.91, 3.2), but daughters of coffee consumers did not. These suggestive findings, which merit further investigation, may be related to hormonal effects.     

Prenatal Care Use Among Selected Asian American Groups

OBJECTIVES: This study examined the predictors of 3 patterns of prenatal care use (no care, late initiation of care, and inadequate use after early initiation) for 4 Asian American ethnic groups in the United States. METHODS: Single live births to US resident mothers of Chinese, Japanese, Korean, and Vietnamese ancestry (n = 273 604) were selected from the 1992-1996 US natality files. Logistic regression was used to analyze the effects of maternal characteristics on the 3 use measures. RESULTS: Korean Americans and Vietnamese Americans had the lowest levels of prenatal care use. Young or single motherhood, high parity for age, and low educational attainment were the main risk factors for low use. CONCLUSIONS: Considerable variability exists in prenatal care use among Asian American ethnic groups.     

Blood lead levels and sexual maturation in U.S. girls: the Third National Health and Nutrition Examination Survey, 1988-1994

Using data from the Third National Health and Nutrition Examination Survey, we assessed measures of puberty in U.S. girls in relation to blood lead levels to determine whether sexual maturation may be affected by current environmental lead exposure. The study sample included 1,706 girls 8-16 years old with pubic hair and breast development information; 1,235 girls 10-16 years old supplied information on menarche. Blood lead concentrations (range = 0.7-21.7 micro g/dL) were categorized into three levels: 0.7-2.0, 2.1-4.9, and 5.0-21.7 micro g/dL. Sexual maturation markers included self-reported attainment of menarche and physician determined Tanner stage 2 pubic hair and breast development. Girls who had not reached menarche or stage 2 pubic hair had higher blood lead levels than did girls who had. For example, among girls in the three levels of blood lead described above, the unweighted percentages of 10-year-olds who had attained Tanner stage 2 pubic hair were 60.0, 51.2, and 44.4%, respectively, and for girls 12 years old who reported reaching menarche, the values were 68.0, 44.3, and 38.5%, respectively. The negative relation of blood lead levels with attainment of menarche or stage 2 pubic hair remained significant in logistic regression even after adjustment for race/ethnicity, age, family size, residence in metropolitan area, poverty income ratio, and body mass index. In conclusion, higher blood lead levels were significantly associated with delayed attainment of menarche and pubic hair among U.S. girls, but not with breast development.     

Adolescent alcohol and drug abuse and health

Purpose: To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood.

Methods: We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments.

Results: Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys.

Conclusions: These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.     

Barriers to modern contraceptive use in rural areas in DRC

Little is known about the factors and outcomes associated with young people's subjective relationship assessments. Understanding what young people think makes their relationships ‘good’ or ‘bad’ would give us insight into what is important to them in their relationships as well as their decision-making and behaviour within them. Self-report data from 757 girls (mean age = 17.09 years) and 642 boys (mean age = 17.23 years) were analysed using logistic regression. Relationship primacy was significantly associated with positive relationships for girls and boys. Among girls, partner education and open communication about sexual and reproductive health were additionally related to relationship assessments. Among boys, very little quarrelling was the only additional factor associated with positive relationship assessment. Although relationship assessment was not associated with depression or problem drinking for either girls or boys, drug use was less likely among both girls and boys who reported having a positive relationship. Boys in positive relationships were also more likely to have used a condom the last time they had sex with their main partner. Intervention programmes should equip teenagers with skills to develop and maintain positive relationships.     

Perceived risks and benefits of alcohol,cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.     

Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors

The high prevalence of female genital mutilation has been a concern in Iraqi Kurdistan. This study was undertaken to estimate its prevalence and describe factors associated with its occurrence. A cross-sectional survey was undertaken from March to April 2011 of females aged up to 20 years using interviews and clinical examination. The survey included 1,508 participants with mean age of 13.5 years (SD 5.6). Overall female genital mutilation prevalence was 23%, and the mean age at which it had been performed was 4.6 years (SD 2.4). Type I (partial or total removal of the clitoris) comprised 76% of those who had had female genital mutilation; in 79% of cases the decision to perform it was made by the mother; and in 54% of cases it was performed by traditional birth attendants/midwives. Women aged 16 years and over were more likely to have had female genital mutilation compared to children aged below 6 years (OR 11.9, p < .001). Children of uneducated mothers were eight times as likely to have had genital mutilation compared to children of mothers with over nine years of education (OR 8.0, p < .001). Among women aged 17 years and younger, 34% of those who were married had been circumcised versus 17% of those who were not married (p < .001). Participants residing in the northeast of Kurdistan region were more likely to have been circumcised. The study results show that female genital mutilation is a frequent practice in Iraqi Kurdistan. Attention and intervention is needed to address this aspect of the well-being of girls and women.     

Body modification and substance use in adolescents: is there a link?

PURPOSE: To describe the characteristics of body modification among adolescents and to determine whether adolescents who engage in body modification are more likely to screen positive for alcohol and other drug problems than those who do not. METHODS: Adolescents aged 14 to 18 years presenting to an urban adolescent clinic for routine health care completed a questionnaire about body modification and a substance use assessment battery that included the 17-item Problem Oriented Screening Instrument for Teenagers Alcohol/Drug Use and Abuse Scale (POSIT-ADS). Body modification was defined as piercings (other than one pair of bilateral earlobe piercings in females), tattoos, scarification, and branding. Problem substance use was defined as a POSIT-ADS score > or =1. Data were analyzed using logistic regression to determine whether the presence of body modification was an independent predictor of problem substance use. RESULTS: The 210 participants had a mean (+/- SD) age of 16.0 (+/- 1.4) years and 63% were female. One hundred adolescents (48%) reported at least one body modification; girls were more likely than boys to have body modification (59% vs. 28%, p < or = .0005). Ninety (42%) reported piercings, 22 (10%) tattoos, 9 (4%) scarification, and 1 (< 1%) branding; 21 (10%) had more than one type of body modification. These were in a variety of locations, most commonly the ear and the nose (piercings) or the extremities (tattoos). One-third of the sample (33%) screened positive for problem substance use on the POSIT-ADS questionnaire. Controlling for age, adolescents with body modification had 3.1 times greater odds of problem substance use than those without body modification (95% CI 1.7, 5.8). CONCLUSIONS: Body modification was associated with self-reported problem alcohol and other drug use among middle adolescents presenting for primary care. More research is needed to determine the clinical and sociocultural significance of body modification and its relationship to substance use in this population.     

Vasomotor symptoms are not associated with reduced bone mass in postmenopausal women: the Rancho Bernardo Study

The association of menopause-related vasomotor symptoms with later bone mineral density (BMD) at axial and appendicular sites was examined in community-dwelling older women. Subjects were 894 postmenopausal women from the Rancho Bernardo Study who had BMD measured in 1988-1991 and responded to a 1989 mailed survey that included questions about menopause symptoms. Mean age was 73 years (SE +/- 9.5, range 47-97), and mean age at menopause was 47 years (SD +/- 6.8, range 21-62). Vasomotor symptoms were recalled by two thirds (68%) and night sweats by 36% of all women, with no significant differences in symptom frequency by age or type of menopause. Postmenopausal estrogen (PME) had been used by 644 women (72%) for an average duration of 12.3 (+/-11) years. Among women who reported current estrogen use with a duration >3 years, those who experienced vasomotor symptoms had significantly higher BMD at the lumbar spine (p = 0.01), femoral neck (p = 0.05) and midshaft radius (p = 0.05) compared with women who did not experience symptoms. Vasomotor symptoms were not associated with BMD among past or never PME users or among women who reported current PME use for 3 or fewer years. Analyses stratified by age, type of menopause, or when PME use began showed similar results. Women who reported night sweats also had no difference in BMD compared with women without night sweats. In conclusion, vasomotor symptoms are not a marker for low BMD years after menopause in women with access to healthcare. Vasomotor symptoms significantly increased the likelihood of continued use of PME, which was in turn associated with higher BMD levels.