Related Articles

Objective

To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.

Methodology

Cross-sectional study of 101 sexually experienced adolescent males recruited from an STD clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next six months. ANOVAs examined differences among different combinations of pregnancy plans/likelihood.

Results

Adolescents’ reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (χ2 = 24.33, df = 1, p < .0001). Attitudes toward pregnancy and participants’ mothers’ educational attainment differentiated those with clear pregnancy intentions (Planning, and Likely) from those with clear intentions to avoid pregnancy (Not Planning & Not Likely)

Conclusions

To reduce the rates of adolescent childbearing, males’ pregnancy intentions must be assessed and asked about in multiple ways.

CONTEXT

The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high.

METHODS

Prospective, time-varying data from 2001–2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression.

RESULTS

Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low sexual relationship power with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%.

CONCLUSIONS

Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.

Background

Comprehensive sex education, including the promotion of consistent condom use, is still an important intervention strategy in tackling unplanned pregnancies, HIV/AIDS and sexually transmitted infections (STIs) among Ugandan adolescents. This study examines predictors of the intention to use a condom and the intention to delay sexual intercourse among secondary school students (aged 12–20) in Uganda.

Methods

A school-based sample was drawn from 48 secondary schools throughout Uganda. Participants (N = 1978) completed a survey in English measuring beliefs regarding pregnancy, STIs and HIV and AIDS, attitudes, social norms and self-efficacy towards condom use and abstinence/delay, intention to use a condom and intention to delay sexual intercourse. As secondary sexual abstinence is one of the recommended ways for preventing HIV, STIs and unplanned pregnancies among the sexually experienced, participants with and without previous sexual experience were compared.

Results

For adolescents without sexual experience (virgins), self-efficacy, perceived social norms and attitude towards condom use predicted the intention to use condoms. Among those with sexual experience (non-virgins), only perceived social norm was a significant predictor. The intention to delay sexual intercourse was, however, predicted similarly for both groups, with attitudes, perceived social norm and self-efficacy being significant predictors.

Conclusions

This study has established relevant predictors of intentions of safe sex among young Ugandans and has shown that the intention to use condoms is motivated by different factors depending on previous sexual experience. A segmented approach to intervention development and implementation is thus recommended.

Purpose

This study investigates the predictors of rapid repeat pregnancy (subsequent pregnancy within 24 months of previous pregnancy outcome) in a sample of urban adolescents.

Methods

Adolescents aged 12 to 19 years (N = 354) who were predominantly African American (94.1%) completed individual interviews during pregnancy and at 24 months post-partum. Logistic regression was used to determine the relationship between mental health factors, behavioral factors, and negative life experiences in the prediction of rapid repeat pregnancy.

Results

Forty-two percent (N = 147) of adolescents reported a rapid repeat pregnancy. Baseline reports of later age at menarche (12.43 vs. 11.91; p = .003) and a greater likelihood of aggression were significantly associated with having a rapid repeat pregnancy within 24 months. Age at menarche and self reported aggression contributed independently to the prediction of a closely spaced second pregnancy (p<.05).

Conclusions

It is suggested that pubertal onset and individual mental health as it relates to measures of aggression should be considered when developing programs targeting adolescents at highest risk for rapid repeat pregnancy.

Objective

We examined whether adult women’s intention for future pregnancy predicted actual pregnancies occurring in a 2-year follow-up study.

Methods

Data are from the Central Pennsylvania Women’s Health Study population-based longitudinal survey of women ages 18–45 (n=1,420). The analytic sample consists of 889 non-pregnant women who had reproductive capacity. Intention for future pregnancy was ascertained at baseline, and women were re-interviewed 2 years later to document interval pregnancies. The impact of pregnancy intention on subsequent pregnancy was analyzed using multiple logistic regression adjusting for relevant covariates.

Results

At baseline, 46% of women were considering a future pregnancy. One hundred thirty-seven women became pregnant during the 2-year study; of these pregnancies, 83% were intended (occurring in women considering a future pregnancy at baseline) and 17% were unintended (occurring in women not considering a future pregnancy at baseline). Pregnancies occurred in 28% of women who at baseline were considering future pregnancy and 5% of women not considering pregnancy. In adjusted analysis, baseline pregnancy intention was associated with pregnancy occurrence in women ages 25–34 (adjusted OR 4.19, 95% CI 2.20–7.97) and ages 35–45 (adjusted OR 26.89, 95% CI 9.05–79.93), but not in women ages 18–24.

Conclusions

In this prospective study, pregnancy intention was strongly associated with pregnancy incidence over a 2-year follow-up period among women ages 25 and older, suggesting that pregnancy intentions could be used to identify women at higher risk of pregnancy. Future investigation is needed to confirm these findings and to explore the reasons why pregnancy intentions were not predictive for women ages 18–24.

Background

Adolescents involved with the criminal justice system are at particularly high-risk for the Human Immunodeficiency Virus and sexually transmitted infections.

Purpose

The purpose of this study was to longitudinally examine gender-specific models of condom use, incorporating temporal stability of intentions.

Methods

Adolescents on probation (N=728) were recruited to complete longitudinal surveys including measures of Theory of Planned Behavior and gender-specific constructs, relationship length, and condom use.

Results

Gender-specific models of condom use behavior suggested by previous research were mostly replicated. For young women, the effect of baseline intentions on subsequent condom use behavior was stronger when intentions were either stable or increasing. For young men, more stable, increasing intentions were directly associated with more condom use. There was preliminary evidence to suggest an association between temporal stability of intentions and decreasing condom use in stable relationships.

Conclusions

Intervention efforts should be tailored by gender and aim to forestall decreasing intentions and condom use over time by addressing difficulties in maintaining condom use.

CONTEXT

Traditional measures of pregnancy intentions that are dichotomous and retrospective do not fully capture the complexity surrounding women’s plans to become pregnant.

METHODS

During January–June 2008, 249 women aged 15–44 awaiting pregnancy test results at family planning clinics in Pittsburgh completed a survey containing both single- and multi-item measures of pregnancy intentions. Chi-square analyses were used to assess differences between subgroups of women.

RESULTS

Few women were trying to become or planning for pregnancy (11% on the single-item measure; 20% on the multi-item measure), while approximately one-third of the sample were not trying to become or planning for pregnancy (31% on the single-item and 36% on the multi-item measure). The single-item measure categorized more women as ambivalent about pregnancy (58%) than did the multi-item measure (44%). Of women categorized as ambivalent by the single-item measure, 62% were also categorized as ambivalent by the multi-item measure. Overall, 68% of responses to the two measures were concordant. With both measures, women who were not planning or trying for pregnancy were more likely than those who were planning for pregnancy or who were ambivalent to indicate that they planned to have an abortion if their test was positive (27–29% vs. 0–2%).

CONCLUSIONS

Prospective assessment of pregnancy intention with either a single- or a multi-item measure may allow for a more nuanced assessment of pregnancy intention than current measures. The multi-item measure may reduce the number of women categorized as ambivalent and aid the development of targeted contraceptive and preconception counseling interventions.

Background:

The pregnancy was a risk factor for excessive weight gain for women. However, there is no information about the prevalence of obesity and its relationship with a history of pregnancy in girls. Therefore, the purpose of this study was to investigate differences in the prevalence of obesity in adolescent females with a history of pregnancy and factors associated with it, in Korea.

Methods:

In 2009, 69 of 34,247 female students revealed that they had experienced pregnancy in response to the 5th Korea Youth Risk Behavior Web-based Survey (KYRBWS-V) project by the Korea Centers for Disease Control and Prevention (KCDCP). The body mass index (BMI) and experienced pregnancy categories of the KYRBWS-V were assessed, and, for data analysis, the independent t-test, chi-square test, and multivariate logistic regression were used.

Results:

The risk of pregnancy was increased by approximately 47% per unit increase in age, and 331% per unit increase in depression, respectively. Conversely, the risk decreased by 19% per unit increase in BMI and 33% per unit increase (ranged from 1: very rich to 5: very poor) in the family economic state.

Conclusion:

Obesity in adolescent females is minimally affected by a history of pregnancy, if at all, despite the fact that pregnancy was a risk factor for excessive weight gain in women. However, adolescent females with a history of pregnancy have higher levels of depression than do normal peers in Korea.

Background

Research has suggested the importance of pregnancy desire in explaining pregnancy risk behavior among adolescent females. Much of the literature, however, uses cross-sectional study designs to examine this relationship. Because bias may strongly influence these results, more prospective studies are needed to confirm the relationship between pregnancy desire and pregnancy incidence over time.

Methods

Non-pregnant adolescents aged 14-19 years (N=208) completed baseline interviews and interviews every 6 months thereafter for 18 months. Logistic regression was used to examine demographic and psychosocial correlates of pregnancy desire. Cox regression analysis was used to determine if pregnancy desire predicted pregnancy incidence over time after controlling for potential confounders.

Results

Twenty-four percent of participants either desired pregnancy or were ambivalent towards pregnancy in the next year. Pregnancy desire was associated with older age, relationship duration of less than 6 months, and higher perceived stress. After accounting for potential confounders, pregnancy desire doubled the risk of becoming pregnant over the 18 month follow-up period (RR=2.00, 95% CI=0.99-4.02). Additionally, a heightened risk for pregnancy was found among those who expressed some desire for pregnancy and who were not in school compared to those who expressed no desire for pregnancy and who were in school (RR=4.84, 95% CI=1.21-19.31).

Conclusion

Our analysis reinforces the importance of evaluating pregnancy desire among sexually active adolescent females. Interventions should target young women in new romantic relationships and who are not in school to improve pregnancy prevention efforts. Additionally, improving coping abilities may help reduce feelings of pregnancy desire among adolescent females.

Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents’ intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.

PURPOSE

This study examined the associations between health risk behaviors (i.e., substance use behaviors, physical violence, or carried a weapon) and multiple adolescent pregnancies (i.e., experiencing or causing more than one pregnancy).

METHODS

We analyzed 1999-2003 data (three years: 1999, 2001, and 2003) from the National Youth Risk Behavior Survey (YRBS), a nationally representative survey of high school students (N = 14,211 participants). Multinomial logistic regression was used to compare one and multiple pregnancies versus no pregnancies. Logistic regression was used to compare multiple pregnancies versus one pregnancy.

RESULTS

A dose-response relationship was observed between multiple adolescent pregnancies and health risk behaviors; the more risk behaviors endorsed the greater likelihood of experiencing/causing multiple adolescent pregnancies. Participants who engaged in a “high” degree of risk behaviors were significantly more likely to have experienced/caused multiple adolescent pregnancies than no pregnancies (or only one pregnancy) versus youth who endorsed no risk behaviors. Earlier sexual debut and more lifetime sexual partners were also associated with increased risk of endorsing multiple adolescent pregnancies.

CONCLUSIONS

The health risk behaviors examined in our study can provide warning signs to influential persons who can potentially deliver important prevention messages to at-risk adolescents.

Objective

To describe smoking, heavy drinking, and folic acid supplementation in preconception women and determine if the likelihood of healthy preconception behaviors differs by whether and when women intend future pregnancy.

Methods

Analysis was based on 35,351 nonpregnant women who participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS) who were of reproductive age (18–44 years), sexually active, and capable of future pregnancy. The association between future pregnancy intention and preconception behaviors was determined adjusting for diabetes, weight category, age group, race/ethnicity, marital status, education, income, and children living in household.

Results

Eighty-percent of women were non-smokers, 94.3% non-heavy drinkers, and 42.6% daily folic acid users. In adjusted analysis, only the odds of folic acid supplementation remained higher in women intending pregnancy in the next 12 months (adjusted odds ratio 1.57, 95% confidence interval 1.21–2.04) compared with women not intending future pregnancy. Women intending pregnancy later or ambivalent about future pregnancy were no more likely to be engaging in healthy preconception behaviors than women not intending future pregnancy.

Conclusion

Women intending pregnancy within 12 months were more likely to use folic acid, but pregnancy intention was not associated with preconception smoking or heavy drinking.

Study Objective

To determine associations between religiosity and female adolescents' sexual and contraceptive behaviors.

Design

We conducted a secondary analysis on data from a randomized controlled trial comparing interventions designed to prevent pregnancy and STDs. Multivariable modeling assessed the association between a religiosity index consisting of items related to religious behaviors and impact of religious beliefs on decisions and sexual outcomes.

Participants

572 female adolescents aged 13 to 21, recruited via a hospital-based adolescent clinic and community-wide advertisements.

Main Outcome Measures

Sexual experience, pregnancy, STDs, number of lifetime partners, frequency of sexual activity, previous contraceptive use, and planned contraceptive use.

Results

Mean participant age was 17.4±2.2 years and 68% had been sexually active. Most (74.1%) had a religious affiliation and over half (52.8%) reported that their religious beliefs impact their decision to have sex at least “somewhat.” Multivariate analyses showed that, compared with those with low religiosity, those with high religiosity were less likely to have had sexual intercourse (OR=0.23, 95% CI=0.14, 0.39). Among sexually active participants, those with high religiosity were less likely to have been pregnant (OR=0.46, 95% CI=0.22, 0.97), to have had an STD (OR=0.42, 95% CI=0.22, 0.81), or to have had multiple (≥4) lifetime partners (OR=0.38, 95% CI=0.21, 0.68) compared to those with low religiosity. Levels of religiosity were not significantly associated with frequency of intercourse, contraception use at last intercourse, or planned contraceptive use.

Conclusion

In this cohort, religiosity appeared to be a protective factor rather than a risk factor with regard to sexual behavior and was not associated with contraception use.

Background

Students attending ‘alternative’ high schools form relatively small, highly mobile high-risk populations, presenting challenges for the design and implementation of HIV-, other STI-, and pregnancy-prevention interventions. This paper describes the rationale, study design, and baseline results for the Safer Choices 2 program.

Study Design

Modified group-randomized intervention trial with crossover of schools but not of students. The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up.

Design Results

Of 940 students initially enrolled in the study, 711 (76%) formed the study cohort. There were significant demographic differences between those included and those excluded from the study cohort in sex, age, sexual experience, experience with pregnancy, drug use, and some psychosocial measures. There were no significant differences between the intervention and control groups within the study cohort. The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse.

Baseline Data Results

Students (n = 940) enrolled were predominately African-American (29.7%) and Hispanic (61.3%); 57.3% were female; 66% had ever had sex; and reported drug use in the previous 30 days ran from 4.3% (cocaine) to 26.9% (marijuana). Of the 627 sexually experienced, 41.8% reported their age at first intercourse as 13 years or younger; 28.5% reported ever being or having gotten someone pregnant; 74% reported sex in the past 3 months. Of the 464 sexually active in the last 3 months, 55.4% reported unprotected intercourse and 31.3% reported using drugs beforehand.

Conclusion

The cross-over design will provide a rigorous test of the intervention; however, loss to follow-up of this population can result in some selection bias. Students attending dropout prevention and recovery schools are at high risk for HIV, STIs, and pregnancy, and are in need of interventions.

Physical activity has a high prevention potential in adolescents. This study investigated the relations between physical activity and intention, autonomous regulation, and planning. We hypothesized that planning mediates the relationship between intention and behavior and that this mediation should depend on the level of autonomous regulation. Stratified randomization sampling method was administered to assemble a sample of N = 534 students among two schools in China. To test the hypothesis, autonomous regulation, intention, and physical activity were assessed at baseline as well as planning and follow-up physical activity four weeks after the pretest. A moderated mediation model confirmed that planning mediated the intention-behavior relation with the effect of planning being moderated by autonomous regulation. Study results demonstrated that autonomous regulation facilitated the translation of intention into behavior change via planning. To promote physical activity among adolescents, interventions targeting planning and autonomous regulation might facilitate successful translation of intentions into behavior change.

Objective Maltreated female adolescents are at risk for engaging in sexual behaviors consistent with HIV infection and teen pregnancy. The current study applied a model positing the key role of psychological dysregulation in the development of adolescent females’ sexual behavior. Methods The sample consisted of adolescent females aged 14–17 years who had experienced substantiated childhood maltreatment (n = 275) and a demographically matched, non-maltreated comparison group (n = 210). Results Multiple mediator analysis revealed that, when in company with a host of plausible mechanisms, sexual preoccupation mediated the relationship between psychological dysregulation and risky sexual behaviors. Conclusion Maltreated females may have difficulty regulating emotions, cognitions, and behaviors, which, when coupled with a propensity to entertain sexual thoughts and consume sexually explicit materials, may increase the likelihood that they act on sexual impulses and engage in high-risk sexual behaviors.

Background

Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15–19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya.

Methods

Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models.

Results

Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8–2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1–0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6–4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1–0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5–3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5–1.5).

Conclusions

The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes.

CONTEXT

Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods.

METHODS

Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods.

RESULTS

Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse.

CONCLUSIONS

When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.

The authors used cross-lagged analyses to examine the across-time influences on and consequences of adolescents’ pregnancy intentions, wantedness, and regret. One hundred pregnant Latina adolescents were studied during pregnancy and at 6 and 12 months postpartum. The results revealed 4 main findings: (a) similar to what has been found in adult women, adolescents’ lower prenatal pregnancy intendedness and wantedness predicted initial difficulties in parenting; (b) frequent depression symptoms predicted subsequent lower pregnancy intendedness and wantedness; (c) adolescents’ poor mental health and harsh parenting of their child predicted subsequent higher childbearing regret, and (d) high childbearing regret and parenting stress were reciprocally related across time. In addition, adolescents’ wantedness of their pregnancy declined prenatally to postbirth, and strong pregnancy intendedness and wantedness were not concurrently related to adolescents’ poor prenatal mental health. The findings reveal how adolescents’ thoughts and feelings about their pregnancies are influenced by and predictive of their mental health and parenting experiences.

BACKGROUND

We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years.

METHODS

General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was conducted on self-report data (based on a telephone interview) from a probability-based sample of US women aged 25–45 years. We compare women with infertility who have had a prior pregnancy (secondary infertility, n = 628) to women with infertility with no prior pregnancies (primary infertility, n = 399). We further distinguish between women with infertility who were actually ‘trying’ to become pregnant (the infertile with intent) with those who met the medical definition of infertile but did not describe themselves as trying to become pregnant (infertile without intent).

RESULTS

Both types of infertility (primary versus secondary) (β = 0.31*) and intentionality (infertile with and without intent) (β = 0.08*) are associated with FSD. These associations persist when we control for resource and demographic variables, life course variables, social support and social pressure variables. General distress does not vary by infertility type or intentionality.

CONCLUSIONS

Results reveal variation in women's recalled experiences of infertility and that FSD is more sensitive to effects of different experiences than general distress. Women with primary infertility who were explicitly trying to become pregnant at the time of the infertility episode stand out as a particularly distressed group. Caregivers should be aware that the emotional needs of women with primary infertility may differ from those with secondary infertility.

Purpose

Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. This paper examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention.

Methods

Randomized controlled trial with 253 girls ages 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention employed a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months following enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time.

Results

At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception and dual contraceptive methods with their most recent partner than did the control group. The intervention group also reported greater stress management skills with trends towards higher levels of pro-social connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use.

Conclusions

Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.

OBJECTIVE: To determine the prevalence of pregnancy and contraceptive use among female inpatients at a Denver detoxification center who were at risk of becoming pregnant. METHODS: The authors administered surveys and pregnancy tests to 373 female admissions to the Denver CARES detoxification center between March and September 1996. RESULTS: Most were admitted for alcohol-related reasons, and most reported previous pregnancies. Seven percent of admissions had positive pregnancy tests, and 56% of admissions reported not using contraceptives with every sexual encounter. CONCLUSIONS: Routine assessment of pregnancy status and contraceptive use in women admitted for detoxification, along with on-site family planning services, may be important components of efforts to prevent adverse outcomes associated with substance abuse during pregnancy, including fetal alcohol syndrome.

Background: Few reports have addressed associations between family strengths during childhood and adolescent pregnancy and its consequences. We examined relationships among a number of childhood family strengths and adolescent pregnancy, risk behavior, and psychosocial consequences after adolescent pregnancy.

Methods: Our retrospective cohort of 4648 women older than 18 years (mean age, 56 years) received primary care in San Diego, CA. Outcomes included adolescent pregnancy and psychosocial consequences compared with number of the following childhood family strengths: family closeness, support, loyalty, protection, love, importance, and responsiveness to health needs.

Results: Of the cohort, 3082 participants (66%) reported 6 or 7 categories of childhood family strengths. Teen pregnancy occurred in 39%, 33%, 30%, 25%, 24%, 21%, and 19% of those with 0 or 1, 2, 3, 4, 5, 6, and 7 childhood family strengths, respectively (p for trend < 0.00001). When childhood abuse and household dysfunction were present, adjusted odds ratios (ORs) for adolescent pregnancy demonstrated an increasingly protective effect as numbers of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (1.0 to 0.80), (1.0 to 0.80, 0.60, and 0.54, respectively). These findings were partly explained by progressive delays in initiation of sexual activity as the number of childhood family strengths increased. Adjusted ORs for psychosocial problem occurring decades later decreased as the number of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (job problems, 1.0, 0.8, 0.6, 0.4; family problems, 1.0, 1.1, 0.7, 0.6; financial problems, 1.0, 0.9, 0.9, 0.6; high stress, 1.0, 1.1, 0.9, 0.8; uncontrollable anger, 1.0, 0.7, 0.7, 0.4).

Conclusions: Childhood family strengths are strongly protective against adolescent pregnancy, early initiation of sexual activity, and long-term psychosocial consequences.

Background

Antiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa.

Methodology /Principal Findings

Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women's desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7% of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p<0.0001). This was paralleled by an increase in the proportion of women reporting sexual activity in the past 3 months, from 24.4% at baseline to 32.5% over 24 months of follow-up (p = 0.001). Only 14% of women used permanent or semi-permanent family planning methods by their second year on ART. In the multivariate model, younger age (HR = 2.71 per 10-year decrease, 95% CI: 2.95–3.78), having a BMI>18.5 (HR = 1.09, CI: 1.01–1.18) and not having used condoms consistently in the last 3 months (HR = 1.79, CI: 1.02–3.13) were independently associated with pregnancy.

Conclusion/Significance

Women on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and offered regularly free and comprehensive family planning services as part of their standard package of care.

Juvenile detention settings provide an important venue for addressing the health-related needs of adolescent populations, who often have high rates of sexually transmitted diseases (STDs) and concomitant drug use. This study examines factors associated with methamphetamine use and risky sexual behaviors among 539 incarcerated female adolescents between ages 12–18 years with an STD diagnosis. Data were obtained from interviews with detainees receiving STD case management services within a California juvenile detention facility in January 2006–June 2007. High-risk behaviors characterized the sample, such as low use of condoms consistently (43.3%), prior STD infection (25%), pregnancy history (26%), arrest charge for prostitution or drug use (23%), and a history of prostitution (18%). Half of the sample reported weekly alcohol or drug use; most commonly used drugs were marijuana (37%), alcohol (21%), and methamphetamine (16%). In multivariate analysis, African Americans had a lower odds of methamphetamine use (odds ratio [OR] = .163) compared with whites. Detainees who reported inconsistent condom use had over twice the odds of methamphetamine use (OR = 2.7) compared with consistent condom users. In addition, those who reported alcohol use had twice the odds of methamphetamine use (2.0). There was a significant interaction between Latina ethnicity and having an arrest charge for drugs or prostitution; Latinas who had this charge had over 11 times the odds of using methamphetamine compared with those with other arrest charges (OR = 11.28). A better understanding of the relationship between drug use and sexual risk behaviors of STD-positive incarcerated female adolescents can inform the development of appropriate corrections and community-based interventions serving this segment of high-risk adolescents.