OPA Research & Evaluation Update

Poor maternal mental health and trauma as risk factors for a short interpregnancy interval among adolescent mothers

Patchen, L., Caruso, D., & Lanzi, R. (2009). Journal of Psychiatric and Mental Health Nursing, 16(4), 401-403.

The researchers conducted a preliminary examination of differences in mental health and trauma experiences between adolescent mothers who had a subsequent pregnancy with a short interpregnancy interval (defined as less than 24 months between the birth of one child and the subsequent pregnancy) and mothers who did not.  Data for this study were collected as a part of a three-year evaluation of a long-running program for pregnant and parenting adolescents in Washington, DC.  The evaluation enrolled 232 girls out of 329 who were eligible, and retained 139 girls throughout the 2-year evaluation period.  Of the 139 girls that stayed in the evaluation, 29 became pregnant within 24 months.  The 29 girls who became pregnant were compared to a random sample of 29 participants who were matched by age and race and who did not have a subsequent pregnancy within 24 months.

The authors found significantly more indicators of poor mental health and trauma experiences during the prenatal to postpartum periods among adolescent mothers who experienced a subsequent pregnancy within 24 months of a previous birth, compared to adolescent mothers who did not.  In particular, adolescent mothers with a subsequent pregnancy within 2 years of a previous birth had more recorded incidents of suicidal thoughts and were three times more likely to report being physically abused, compared to adolescent mothers who did not have a subsequent pregnancy within 2 years of a previous birth.

OPA Funded Research Presentations

Teen Perspectives on Healthy Romantic Relationships: Results from Focus Groups

Guzman, L., Manlove, J., & Ikramullah, E. 2009 Population Association of America Annual Meeting.

The authors presented findings from a series of focus groups conducted with African American and Latino youth aged 12-17 in Washington, DC.  The purpose of the focus groups was to have adolescents identify important characteristics of healthy teen relationships and assess how the characteristics compared to those identified as critical for adult relationships.  The researchers found that teens use a complex language to describe their romantic relationships.  The terms used reflected a variation in the intensity and expectations of the relationship, as well as the behaviors occurring within the relationship.  The researchers also found that teens have a clear understanding and expectation of what defines a healthy romantic relationship.  Teen girls identified respect, trust, honesty, and loyalty as critical aspects of a healthy relationship; while teen boys mentioned respect, trust, and sex.  Although teens have high standards for relationships, the focus groups indicated that they don’t necessarily expect to find those qualities in a partner or a relationship.  Overall, much similarity was found in how teens, adults, and the research literature define healthy romantic relationships.

Social Disadvantage and the Early Development of Teenage Parents’ Children

Mollborn, S. & Dennis, J.  2009 Population Association of America Annual Meeting.

The researchers used data from the Early Childhood Longitudinal Study-Birth Cohort to investigate the relationship between having a younger parent and children’s cognitive, behavioral, and health outcomes.  The study found that having a teenage mother or father was associated with children’s compromised development across several domains; however, the negative influence of having a teenage father disappeared when paternal coresidence and maternal age were controlled for.  In addition, preexisting social disadvantage was found to account for most of the relationship between maternal age and child outcomes.   Finally, the researchers found that the presence of financial, social, and material resources either reduced or eliminated each of the significant negative relationships between teenage childbearing and child outcomes.  The researchers suggest that early childhood is an opportunity to provide resources that could improve the developmental trajectories of children with young mothers.

Home-Based Parenting Intervention Promotes Child Resilience at 7 Years among Adolescent Mother Households Characterized by Conflict and Low Support
Oberlander, S., Hurley, K., & Black, M.  2009 Pediatric Academic Societies Annual Meeting.

The purpose of this study was to examine the effect of a home-based parenting intervention on the association between mother-grandmother relationship quality and child resilience at 7 years postpartum. Participants were 103 urban, low-income, African American adolescent mothers enrolled in a longitudinal randomized control trial to promote parenting and adolescent development. Mother-grandmother relationship harmony (support minus conflict) was scored using the Network of Relationship Inventory at 4 time points from 1-24 months. Child resilience scores at 7 years were based on a 6-item academic and behavioral index.  Two harmony trajectories were identified: 1) high and stable and 2) low and decreasing. In the intervention group, 23% had high harmony, and 19% had low harmony, compared to 24% and 33% in the control group.  The study found that the intervention promoted child resilience in households characterized by low support and high conflict to the level of resilience in harmonious households. The resilience status of children in harmonious households was not altered by the intervention.

Relevant Research in the Professional Literature

Cost savings from the provision of specific methods of contraception in a publicly funded program.  Foster, D., Rostovtseva, D., Brindis, C., Biggs, M., Hulett, D., & Darney, P. (2009). American Journal of Public Health, 99(3), 446-451.

This study assessed the cost-effectiveness of contraceptive methods dispensed to women ages 13 to 44 in California’s publicly funded family planning program in 2003.  The researchers estimated the number of months of contraceptive coverage provided by the program, the number of pregnancies averted by each contraceptive method, and the cost of providing each method compared to the savings from averted pregnancies.  In 2003, nearly 1 million female clients received contraceptives through California’s family planning program.  The provision of contraceptive services by the program averted 178,000 pregnancies.  More than half of the averted pregnancies were due to oral contraceptive use, 22% to injectable contraceptives, 10% to the contraceptive patch, 10% to barrier methods, and 6% to use of long-term methods.  All contraceptive methods were found to be cost-effective.  The implant and the IUD were the most cost-effective with cost savings of more than $7.00 for every $1.00 spent on services and supplies, followed by injectable contraceptives ($5.60), oral contraceptives ($4.07), the patch ($2.99), the ring ($2.55), barrier methods ($1.34), and emergency contraceptives ($1.43).

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors.  Cheng, D., Schwarz, E., Douglas, E., & Horon, I. (2009). Contraception, 79(3), 194-198.

The purpose of this study was to examine the relationship between pregnancy intention and preconception, prenatal, and postpartum maternal behaviors.  Data were collected from a random sample of 9,048 postpartum mothers in Maryland who delivered live births between 2001 and 2006, and who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey.  Slightly more than 41% of mothers reported that their pregnancies were unintended - 31% were mistimed and 10% were unwanted.  Compared to women with an intended pregnancy, women with an unwanted pregnancy were more likely to consume less than the recommended level of folic acid, smoke prenatally, smoke postpartum, and report postpartum depression.  Women with an unwanted pregnancy were also less likely to initiate prenatal care during the first trimester and to breastfeed for eight or more weeks, compared to women with an intended pregnancy.  Women with a mistimed pregnancy were more likely to consume less than the recommended level of folic acid, delay prenatal care, and report postpartum depression.  Pregnancy intention was not, however, associated with initiating breastfeeding, placing infants to sleep on their backs, or using postpartum contraception.

Trends in sexual risk behaviors, by nonsexual risk behavior involvement, U.S. high school students, 1991-2007.  Santelli, J., Carter, M., Orr, M., & Dittus, P. (2009). Journal of Adolescent Health, 44(4), 372-379.

The researchers analyzed data from the Youth Risk Behavior Survey (YRBS) for 1991-2007 to examine the relationship between involvement in nonsexual risk behaviors and trends among sexual behaviors.  Students were categorized into groups based on their lifetime or recent involvement in nonsexual risk behaviors, including tobacco, alcohol, and other drug use.  Sexual behaviors were found to vary considerably between youth not engaged in risk behaviors and those engaged in the highest risk behavior groups.  In 2007, 13% of teens in the no-risk group were sexually active compared to 87% of teens in the high-risk group, and 19% of teens in the no-risk groups reported having four or more sexual partners compared to 57% in the highest risk group.  Despite these differences, the trends in sexual risk behaviors from 1991-2007 among youth engaged in multiple nonsexual risk behaviors and those not engaged in any nonsexual risk behaviors were similar.  However, the pattern of change for sexual behaviors was different than the pattern for nonsexual risk behaviors – sexual behaviors declined until the early 2000’s and then began increasing, whereas nonsexual behaviors increased until peaking in the late 1990’s and then began decreasing.  In conclusion, the authors raise questions about the potential impact of interventions that would reduce sexual risk behaviors by targeting nonsexual risk behaviors.

The couple context of pregnancy and its effects on prenatal care and birth outcomes.  Hohmann-Marriott, B. (2009). Maternal and Child Health Journal, published online first.

The purpose of this study was to investigate the association between parents’ relationship context and early prenatal care, preterm birth, and low birth weight.  Data from the Early Childhood Longitudinal Study were analyzed for 5,788 couples who were residing with their biological child at the time the child was nine months old.  Overall, 6 percent of mothers reported no prenatal care in the first trimester, 10 percent of the babies were born preterm, and 6 percent of the babies were born at low or very low birth weight.  The risk of inadequate prenatal care and preterm birth increased when couples did not share pregnancy intentions or when neither partner intended the pregnancy.  Couples were also at increased risk of receiving inadequate prenatal care if they were not married at the time of conception, or if the mother did not tell the father about the pregnancy.  The risk of low birth weight was not associated with pregnancy intentions, but was associated with the father not having discussed the pregnancy with the mother.