Repeat pregnancy among urban adolescents: sociodemographic, family, and health factors

First-time adolescent mothers are at high risk for a repeat pregnancy. The present investigation, part of an ongoing longitudinal study, examined sociodemographic, family, and health factors associated with repeat Pregnancy in a clinic sample of urban, first-time adolescent mothers (ages 13 to 17 years). They were predominantly African-American and from low-income households. Repeat pregnancy within one year and between one and two years postpartum was determined from medical records. Summary statistics, point biserial correlations, and chi-square statistics were used to analyze the data. Results indicated that postpartum contraceptive method was associated with repeat pregnancy at Year 1; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were associated with repeat pregnancy at Year 2. It was concluded that efforts to prevent repeat pregnancies among first-time adolescent mothers should include the continuous monitoring of contraceptive use, as well as the promotion of long-acting contraceptives (e.g., medroxyprogesterone or progesterone implants). Further, counseling should be offered to adolescent mothers with a history offered miscarriages.     

Adolescent autonomy and minors' legal rights: contraception and abortion

During adolescence, dependent children grow into independent and autonomous adults, and it is necessary to make difficult policy judgements about children's rights. Questions that arise include: shoudl minors have the right to work, to marry, to make legal contracts, and to obtain medical care without parental consent; or should parental consent be required by the state in order to protect minors and to preserve parental authority. This discussion focuses upon the area of family planning, a topic of special interest to policymakers because they now face many questions about minor's contraceptive and abortion rights in Congress, in state legislatures, and in the courts. comprehensive response to policy questions about family planning rights for minors would require information about adolescent development, maturity, and autonomy; about teenagers' sexual and contraceptive attitudes and behavior; about the nature of parent-child communication regarding sexual and contraceptive questions; and about politics and values. Many from the legal system want help in answering questions about minors' rights. As little research has been conducted, policymakers can obtain only limited guidance from social scientists. As the policy issue is fundamentally tied to developmental issues, the better the knowledge about the development of cognitive competence, social competence, and autonomy, the easier it will be to make the difficult legal and policy judgements about minor's rights. Regarding minors' access to contraceptives, the situation is somewhat cloudy. There is only 1 state statute that requires parental consent for access to contraceptive medical services, passed in Utah in 1981, and pertaining to services provided with public funds. Yet, common law requires parental consent for any medical treatment (with exceptions for emancipated or mature minors) and "physicians often hesitate to serve young people without first obtaining parental consent because they fear civil liability." The situation is even more cloudy in the case of abortion. The Supreme Court's present position seems to grant emancipated and mature minors access to abortion without a requirement for parental consent or notification, but states may place some requirements for parental involvement upon other minors, as long as these minors have an alternative route to abortion. A thorough search of the literature on adolescent development reveals that the policy questions loom larger than the alternatives. 2 policy alternatives are: to single out a reasonable age below which minors require either parental consent or some form of adult involvement; or treat family planning and fertility control as basic rights which cannot be abridged because of age.     

Parents' behavioral norms as predictors of adolescent sexual activity and contraceptive use

The influence of parental factors on adolescent sexual behavior and contraceptive use has been examined previously, and findings have been contradictory. Previous studies, which found little relationship between parental norms and adolescent sexual activity, have been limited by their failure to recognize developmental differences in the relative weight of parent and peer influences between younger and older teens and by use of selected samples, resulting in a restriction of range. The current study differs in that it utilizes a clustered sample household survey of 329 males and females, aged 14 to 17, and 470 of their parents. Using multiple regression analysis, it was found that parents' reported behavioral norms account for 5% of the variance in whether adolescents have had intercourse, and for 33% of the variance in use of contraception at last intercourse. The study suggests that while parents' normative beliefs have limited effect in the decision to become sexually active, they have considerable impact on later contraceptive use.     

Her own decision: impairment and authenticity in adolescence

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient's decisions in relation to her identity.     

Birth characteristics and developmental outcomes of infants of Mexican-origin adolescent mothers: Risk and promotive factors

Infants of adolescent mothers are at increased risk for negative developmental outcomes. Given the high rate of pregnancy among Mexican-origin adolescent females in the US, the present study examined health characteristics at birth and developmental functioning at 10 months of age in a sample of 205 infants of Mexican-origin adolescent mothers. Infants were relatively healthy at birth and had near average developmental functioning at 10 months. The educational attainment of adolescents and their mothers, and infants' temperamental regulation, promoted positive developmental functioning, while the combination of low adolescent parental self-efficacy and high infant temperamental negativity was associated with greater developmental delay. Findings are discussed with respect to implications for prevention with this at-risk population of mothers and infants.     

Adolescent vicissitudes and medical judgement: a case study

Professional concern about the widespread occurrence of adolescent pregnancy is based upon its negative impact on the social, developmental, and economic prospects of the mother and her infant. The usual presumption is that the pregnant adolescent is in good health but suffers from socioeconomic and cultural disadvantages, which the pregnancy will exacerbate. The problems of the pregnant adolescent are more complex when she also has a severe medical handicap. We draw upon such a case to illuminate the issues which arise when medical problems interact with the vicissitudes of adolescence. Although it is clear that the patient's own behavior contributed substantially to the tragic outcome of this case, we believe that greater professional anticipation of the contingencies of adolescent development might have produced a more favorable result.     

Standing between two worlds in Harlem: A developmental psychopathology perspective of perinatally acquired human immunodeficiency virus and adolescence

Perinatal HIV infection in the US continues to evolve from a fatal pediatric illness to a chronic medical condition of childhood and adolescence. Although navigating this period is influenced by multi-leveled deprivations commonly experienced by low-income minority families, HIV alters the timing and experience of developmental milestones for many adolescents with perinatal HIV. This selective review of the growing developmental psychopathology literature and the authors' clinical work at a pediatric HIV program in Harlem, NY provide an overview of how developmental psychopathology offers an integrative framework that elucidates how autonomy, peer relationships, and self-concept evolve among 13–21 year old adolescents. This paper highlights the importance of considering influences of both perinatal HIV and the culture of poverty on adolescent development, and of adopting multilevel interventions and research to address how interactions among biologic, environmental, and HIV-related stressors (serostatus disclosure, medical treatment adherence, illness stigma) influence the development of adolescents with perinatal HIV.     

Sexual activity and contraceptive use among low-income urban black adolescent females.

A modified form of Nathanson and Becker's (1983) Health Belief Model Questionnaire and other measures designed to assess cognitive processing were administered to low-income black adolescent female clients of an inner-city comprehensive health care clinic. The purpose of the study was to explore determinants of sexual activity and contraceptive use. Subjects were classified as not sexually active (n = 50), sexually active/noncontracepting (n = 20), or sexually active/contracepting (n = 72). Not sexually active subjects tended to be younger, more career motivated, to have a father at home, to be more influenced by family values, and to have more conservative attitudes regarding adolescent sexuality than did sexually active subjects. Sexually active/noncontracepting subjects tended to report fewer benefits and more barriers to the use of contraception. Level of cognitive processing did not differ among the three groups, but was at a lower-than-expected level for age. Finally, inconsistent contraceptive use was common to both sexually active groups.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.     

Clinical Assessment of Child and Adolescent Sleep Disturbance

This article provides guidelines for counselors interested in developing their own assessment procedure to evaluate child and adolescent sleep disturbance. The guidelines include reviewing the developmental and medical history, screening for parental psychopathology, obtaining a child behavior rating scale and sleep diary, and conducting a semistructured clinical interview to identify the sleep history and specific concerns. Considerations for referring clients for additional evaluation such as an overnight sleep study are discussed.     

Personal Control, Self-Efficacy in Sexual Negotiation, and Contraceptive Risk among Adolescents: The Role of Gender

Adolescents’ sexual decision making is shaped by normative ideas about “appropriate” sexual roles for women and men; consequently, the motivation and ability to engage in safer sex may be different for adolescent girls and boys. The aim of this study was to explore how social–psychological resources influence the behavior of girls and boys within the highly gendered and inequitable domain of sexual relationships. I used data from the National Longitudinal Study of Adolescent Health (Add Health) to examine whether personal control and self-efficacy in sexual negotiation are associated with contraceptive risk (engaging in sexual intercourse or not using condoms) among adolescents and whether these associations differ for adolescent boys and girls. Results indicate that personal control and self-efficacy in sexual negotiation are significantly associated with safer sex behavior, and are often more important for girls than for boys in predicting contraceptive risk.     

青少年特发性脊柱侧凸患者生存质量和心理特征的分析与对策

青少年特发性脊柱侧凸患者是个特殊的患病群体,患者的心理健康状况和躯体受到显著影响,青少年患者对其自身形象更为关注,心理焦虑和障碍表现更为明显。脊柱外科医生需要明确脊柱侧凸程度对患者生存质量及心理的影响,能明确其风险因素,针对不同畸形程度的患者采取个体化诊疗方案,以期最终能改善患者的疗效。     

Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences

Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of “high-risk” individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their “low-risk” counterparts.     

Effect of sex education on the sexual and contraceptive practices of female teenagers in Mexico City

After reviewing the literature on the relationship between sex education and sexual and contraceptive behavior, the National Research Council (1987) recently concluded that the existing evaluation of the effects of sex education on sexual and contraceptive practice is helpful but not sufficient. 1 possible explanation for the different results obtained are the diverse sociodemographic characteristics of the sample(s) of teens under consideration. Another aspect which might account for the differences seen in the literature focuses on the areas covered in the course. In Mexico, no studies have been undertaken which deal with the relationship between sex education and sexual and contraceptive behaviors. A study carried out with 392 adolescent females ages 16-17 of lower and middle lower socioeconomic status showed that merely attending a sex education course did not affect the initiation or continuation of sexual activity, contraceptive behavior, or even the perception of accessibility to contraception. Providing information on sexuality, partner relationships, and where contraception can be obtained does not appear to have any effect on sexual activity. Receiving information on pregnancy prevention and obtaining contraceptives was found to be related to contraceptive use. Although less dramatic, information about partner relationships and sexuality produced increases in contraceptive use.     

Unwanted teenage pregnancies: incidence, interpretation, and intervention.

North American and western European cultures are more permissive than they were before World War II about the increased incidence of teen sexual activity. Societies may be more open and teens are having more premarital sex than they used to, but they surely are not using contraception as often as they should. As such, there is a great deal of unintended and unwanted teenage pregnancies, especially in the US. Even the threat of contracting and/or transmitting HIV has not caused heterosexual youths to change their sexual or contraceptive behaviors. The authors conceptualize explanations for this lack of adolescent behavioral change, including procedures designed to identify deficiencies and to bring about necessary changes in contraception-relevant information, motivation, behavioral skills, and situational constraints. Examples of successful intervention programs are outlined. Sections consider the incidence of premarital intercourse, contraceptive use, and unwanted pregnancies; contraceptive neglect; unintended and unwanted pregnancies; and why teenagers have unprotected sexual intercourse. The conceptual framework of intervening to prevent unwanted teenage pregnancies is presented in sections on providing improved contraceptive information, increasing precontraceptive motivation, improving contraceptive skills, altering situational factors which inhibit contraception, and evaluation research.     

Parenting attitudes of adolescent and older mothers

The parenting attitudes of adolescent and older mothers were assessed at 1 and 12 months postpartum to explore group differences and determine if these attitudes predicted quality of home environment and parenting behaviors at 12 months. Adolescent mothers scored significantly lower than did older mothers in empathy toward children's needs, but there were no significant group differences on three other parenting attitude constructs. There were no significant correlations between parenting attitudes at 1 month and parenting behaviors at 12 months for either group. For adolescent mothers at 12 months postpartum, the only attitude construct that was significantly related to concurrent quality of parenting was developmental expectations of the child. These and other findings are discussed in the context of current theory and intervention related to adolescent parenting.     

Cognitive development in children of adolescent mothers: The impact of socioeconomic risk and maternal sensitivity

BackgroundAdolescent motherhood is accompanied by a constellation of risk factors that translate into developmental risk for the off-spring. Socioeconomic risk that is associated with adolescent motherhood as well as maternal interactive behaviors may contribute to the impact of adolescent motherhood on children’s developmental outcome.ObjectiveTherefore, the aim of the current study was to investigate differences in children’s cognitive development between children of adolescent and adult mothers in their first two years of life and to examine whether socioeconomic risk (e.g. such as educational and financial problems) and/or maternal sensitivity mediate developmental differences between children of adolescent and adult mothers.MethodsAdolescent mothers (<21 years; N = 64) and adult mothers (>25 years; N = 34) and their infants were included in the current study. Child cognitive development and maternal sensitivity were assessed at three different time points (T1: mean child age 5.26 months; T2: mean child age 14.69 months; T3: mean child age 21.16 months).ResultsChildren of adult mothers showed better cognitive performance at T3 compared to children of adolescent mothers but not at T1 and T2. A multiple mediation model including socioeconomic risk and maternal sensitivity as serial mediators demonstrated that the effect of adolescent motherhood on cognitive development was mediated in a causal effect chain with socioeconomic risk negatively affecting maternal sensitivity and maternal sensitivity affecting children’s cognitive development.DiscussionThe present findings demonstrate that maternal interactive behaviors are not only a simple predictor of cognitive development but may also act as a mediator of the association between more distal variables such as socioeconomic risk and cognitive development in adolescent mothers. This supports the need to promote prevention and intervention programs for adolescent mothers during the early postpartum period to reduce socioeconomic problems and enhance maternal interactive behaviors.     

Cognitive Behavior Therapy for Anxious Adolescents: Developmental Influences on Treatment Design and Delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the ‘why’ and the ‘how’ of developmentally appropriate CBT for anxious adolescents. ‘Why’ it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. ‘How’ clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents.     

The Relation Between Eating- and Weight-Related Disturbances and Depression in Adolescence: A Review

Depression often emerges during adolescence and persists into adulthood. Thus, it is critical to study risk factors that contribute to the development of depression in adolescence. One set of risk factors that has been recently studied in adolescent depression research is eating- and weight-related disturbances (EWRDs). EWRDs encompass negative cognitions related to one’s body or physical appearance, negative attitudes toward eating, and unhealthy weight control behaviors. However, there have been no comprehensive reviews of EWRDs and depression research that are contextualized within developmental frameworks of adolescent depression. Thus, this review will summarize research findings on the relation between EWRDs and depression in adolescence using a cognitive vulnerability developmental framework. First, a brief overview of epidemiological findings on depression is provided in order to highlight the importance of examining depression in adolescence. Second, a cognitive vulnerability developmental framework that can be used to conceptualize depression in adolescence is described. Next, theories and findings on EWRDs and depression in adolescence are summarized within this framework. Research limitations and suggestions for future research are provided. Finally, implications of this review related to the assessment, intervention, and prevention of depression in adolescence are provided.