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Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be "eat better, not more." This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake than the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report "prudent" or "health-conscious" eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained healthcare providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain predicts adverse perinatal outcomes among women with normal weight, the degree of prepregnancy obesity predicts adverse perinatal outcomes to a greater degree than gestational weight gain among women with obesity. Furthermore, low body mass index and insufficient gestational weight gain are associated with poor perinatal outcomes. Observational data have shown that first-trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or preconception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants. [ABSTRACT FROM AUTHOR]

Homeless female adolescents in the United States have disproportionately high rates of pregnancy compared to general population youth. Little is known about how homeless youth decide whether to use birth control and which birth control method to select. The current study explores how homeless female youth participating in a holistic sexual health program called Wahine ("woman") Talk experience this process, using data from in-depth interviews (N = 3) with 11 homeless adolescent girls. Data were analyzed using Interpretative Phenomenological Analysis, proceeding through reading and re-reading, initial noting, forming emergent and super-ordinate themes, repeating steps for each interview, and developing final themes and subthemes. Four final themes emerged, which, for most participants, were experienced sequentially: Getting Acclimated, Becoming Close and Building Trust, Addressing Fear, and Making the Choice. Study findings suggest that for homeless female youth, basic needs and relationship building must be addressed prior to the delivery of trauma-informed birth control-related content and effective linkage to (sexual) healthcare. Implications for practice, policy, and future research are discussed. • The rate of homeless teen pregnancy is five times greater than the general youth population. • Little is known about how homeless youth experience accessing and selecting birth control. • For study participants, accessing and selecting birth control contains four steps experienced sequentially. • Homeless youth perceive risk of sexual assault/unwanted pregnancies, which motivates accessing birth control. • Meeting basic needs and building a trusted relationship is critical for trauma-informed healthcare for homeless youth. [ABSTRACT FROM AUTHOR]

Abstract Rationale Rates of adolescent pregnancy and sexually transmitted infections (STIs) in the United States remain high. Norms and beliefs about sex and the use of contraception have been identified as potential contributors to these. Objective The current study examined multi-contextual links between norms and beliefs about sex and contraception, and adolescent pregnancies and STIs. Method Hierarchical linear modeling (HLM) was used to test the study questions in the historical data from Add Health dataset (Wave I, 1994–1995, and Wave II, 1995–1996). Measures of beliefs about sex and contraception were administered to adolescents and their caregivers; pregnancies and STIs were reported by adolescents (N = 13,568; level 1). School-reported data (N = 132; level 2) included sexuality education and prevalence of pregnancies at schools. Community data included the density of family planning providers in each county. Results Adolescents negative beliefs about contraception were associated with a higher likelihood of pregnancies and STIs via their association with contraception use. The opposite effect was found for negative beliefs about sex. Parental disapproval of contraception was associated with a decreased likelihood of STIs, but with an increased likelihood of pregnancies. A greater number of pregnancies at school was associated with a greater likelihood of STIs. Unexpectedly, the number of county-level family planning providers was associated with a higher likelihood of STIs. Conclusion Adolescent individual beliefs emerged as the most salient predictors of both pregnancies and STIs. Highlights • Beliefs about sex and contraception predicted adolescent pregnancies and STIs. • The most salient predictors were adolescents' individual beliefs. • Some unexpected findings on effects by parental and contextual beliefs. • No effects by school-level predictors were found. • Predictors of pregnancies and STIs were related to their impact on contraceptive use. [ABSTRACT FROM AUTHOR]

Objective: This study investigated: (1) differences by generational status in the risk of early childbearing; (2) to what extent observed differences reflected timing of sexual onset versus postonset proximate determinants like contraceptive use; and (3) the influence of individual‐, family‐, and neighborhood‐level social factors. Background: Although U.S. rates of early fertility have declined, they remain high relative to other high‐income countries, and disparities by population group persist. The share of the youth population with immigrant parents has expanded greatly, yet relatively little is known about generational variations in early fertility. Method: This study used Wave 1–4 data from the National Longitudinal Study of Adolescent to Adult Health (N=8,777 women). To distinguish between the sexual onset and fertility processes, a sequential hazard framework modelled: 1) the transition to sexual activity, and 2) the transition to first birth among women who had initiated sexual activity. Results: Foreign‐born and second‐generation young women initiated both sexual activity and childbearing later than those with U.S.‐born parents. Sequential hazard models revealed the importance of later sexual onset in explaining delayed fertility among the foreign‐born, and of family attributes for their later sexual onset. Postonset behaviors were essential to the delayed childbearing observed among the second generation. Conclusion: Important differences by generational status exist in both the proximate determinants and the social factors underlying children of immigrants' lower risk of early fertility. [ABSTRACT FROM AUTHOR]

From a neoliberal perspective, young women are free to make autonomous choices and are personally responsible for the outcomes of these choices. Neoliberal ideals may appear to empower women as free sexual agents; however, an individualistic focus on self-sufficiency and personal responsibility may lead to harsh, decontextualized responses to those who experience unintended outcomes. We hypothesized that observers with stronger neoliberal beliefs would show more stigmatizing responses to an unintentionally pregnant adolescent. We also explored whether these expected associations would be moderated by whether or not the young woman chose to consent to sex. U.S. undergraduate students (n = 200) completed a measure of neoliberal beliefs and were randomly assigned to read one of two scenarios in which an adolescent became pregnant after either consensual or forced sex. As expected, participants with stronger neoliberal beliefs were more blaming toward the adolescent for becoming pregnant, felt less sympathy toward her, and had less positive attitudes about her receiving help. These associations remained after controlling for general political ideology and regardless of whether the pregnancy was due to consensual or forced sex. Our results suggest that, for the neoliberal observer, young women are held personally responsible for even uncontrollable sexual and reproductive outcomes. [ABSTRACT FROM AUTHOR]

The current study examined mothers' reports of coparenting relationship dynamics (i.e., conflict, communication) within and between mother–father and mother–grandmother subsystems from 10 months postpartum to 5 years postpartum among 178 Mexican‐origin teen mothers (M age = 16.78 years; SD = 1.00). Within subsystems, more frequent mother–father coparenting conflict was associated with less frequent mother–father coparenting communication from 10 months to 5 years postpartum, and more frequent mother–father coparenting communication was associated with less frequent mother–father conflict from 3 to 4 years postpartum. Furthermore, more frequent mother–grandmother coparenting communication was associated with less frequent mother–grandmother conflict from 10 months to 2 years postpartum. Regarding relations across subsystems, more frequent mother–father coparenting conflict was associated with more frequent mother–grandmother conflict from 10 months to 2 years postpartum, as well as from 3 to 4 years postpartum. Findings have implications for future interventions focused on coparenting relationships within the context of adolescent parenthood. [ABSTRACT FROM AUTHOR]

Objective To determine how an adolescent's risk of cesarean varies by maternal age and race/ethnicity, and evaluate the contribution of obstetric and sociodemographic factors to mode of delivery. Study Design This is a retrospective cohort study of 604,287 births to women aged 13 to 23 years. Regression techniques were used to determine maternal ages at lowest risk of primary cesarean in each major racial/ethnic group before and after adjustment for various cesarean risk factors. Results Adolescent age was associated with lower risk of cesarean compared with young adults (17.2% at age 13 years vs 24.8% at age 23 years, p < 0.05). After stratification by race/ethnicity, Non-Hispanic Black women had the highest probability of cesarean, while Asian/Pacific Islanders had the lowest probability across all ages. When compared with young adults of the same race/ethnicity, young adolescents continued to have a lower risk of cesarean, decreased by at least 30% until age 18 years (White) and 17 years (other racial/ethnic groups). These associations persisted after adjustment for obstetric and sociodemographic risk factors. Conclusion Young maternal age is protective against cesarean delivery in all racial/ ethnic groups. Adolescents also experience racial/ethnic disparities in mode of delivery similar to those observed in adults, which were unexplained by either obstetric or sociodemographic factors. [ABSTRACT FROM AUTHOR]

Background: Although substantial efforts have been made to reduce the rates of adolescent pregnancy, the United States continues to have higher rates than other industrialized countries. Research and reporting usually focus on adolescents aged 15 to 19 years. Although less common, there are pregnant young adolescents that are ≤15 years of age, with developmental and social differences from older, high school-aged adolescents., Objective: Because adolescent pregnancies are of particular concern because of long-term socioeconomic consequences to parent and child, we sought to determine whether young adolescents (≤15 years old) had worse perinatal outcomes than older adolescents (16-19 years old) and older parents (≥20 to 34 years old) among those living in an urban inner city., Study Design: This was a study of pregnant individuals who delivered a singleton pregnancy without evidence of chronic hypertension or pregestational diabetes mellitus at a safety net hospital from January 2010 to May 2021. Parents were grouped by age at the time of delivery into young adolescents (≤15 years old) and older adolescents (16-19 years old). For a comparison group, nulliparous older parents aged 20 to 34 years with singleton pregnancies were analyzed for perinatal outcomes and compared with the adolescent cohorts. When analyzing baseline parental characteristics, a preponderance of obesity was noted in the young adolescent cohort. An analysis of parental characteristics and perinatal outcomes among young adolescents with obesity vs young adolescents without obesity ≤15 years old was performed. Statistical analysis included χ 2 and Student t test with P values of <.05 considered significant. Logistic regression analysis was performed to control for potentially confounding demographic variables., Results: Overall, 10,894 adolescent women delivered, with 868 young adolescents and 10,026 older adolescents. Pairwise comparisons showed young adolescents had a different race distribution than older adolescents (P=.006) and older parents (P<.001). Young adolescents were more likely to be Hispanic or non-Hispanic Black (P<.001) and accessed prenatal care at a later gestational age (19.7±8.9 weeks) compared with older adolescents (16.7±8.6 weeks) and the comparison older cohort of parents (15.7±8.7 weeks) (P<.001) and less frequently in pregnancy (P<.001) compared with older parents. Young adolescents were more likely to have preterm birth at <37 weeks of gestation (P<.001) and eclampsia (0.5% vs 0.1%) (P=.01) than older adolescents. Therefore, low birthweights of ≤2500 g (P=.02) and neonatal intensive care unit admission (P=.048) were also increased in adolescents. When adjusted for race, ethnicity, and body mass index, preeclampsia with severe features (P<.001) and preterm birth at <37 weeks of gestation (P=.048) remained significant. Young adolescents with obesity were more likely to have preeclampsia with severe features (odds ratio, 1.81; 95% confidence interval, 1.22-2.68) and be delivered via cesarean delivery (odds ratio, 2.71; 95% confidence interval, 1.85-3.99) than adolescents without obesity., Conclusion: In an urban inner city, young adolescent parents were more likely to be women of color, have later presentations to prenatal care, and have increased rates of preterm birth. Young adolescents had high rates of obesity, which was associated with increased rates of hypertensive disorders of pregnancy and cesarean delivery, than adolescents without obesity., (Copyright © 2022 Elsevier Inc. All rights reserved.)

ABSTRACT BACKGROUND Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. METHODS Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants after Wave I and before age 20, were still in secondary school while pregnant, and had complete data (N = 402) were included. Mothers reported infants' birthweight and gestational age. School administrators reported whether family planning counseling, diagnostic screening (including sexually transmitted diseases [ STDs]), STD treatment, and prenatal/postpartum health care were provided on-site at school at Wave I. Multilevel models adjusted for individual and school characteristics were conducted. RESULTS Few schools offered reproductive health care services on-site. In multilevel analyses, availability of family planning counseling (Est. β = 0.21, 95% confidence interval [ CI] 0.04-0.38 p < 0.05) and prenatal/postpartum health care (Est. β = 0.21, 95% CI 0.02-0.40 p < 0.05) were significantly associated with increased infant birthweight. No services examined were significantly associated with increased gestational age. CONCLUSIONS Some school-based reproductive health services may improve subsequent birth outcomes among adolescent mothers. Future analyses should examine the mechanisms by which services impact birth outcomes. [ABSTRACT FROM AUTHOR]

Study Objective In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. Design, Setting, Participants, Interventions, and Main Outcome Measures We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130). Results After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring ( P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01). Conclusion Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates. [ABSTRACT FROM AUTHOR]

Through considerable efforts and investments of resources, adolescent pregnancy and birth rates in the United States have decreased significantly over the past two decades. Nonetheless, large disparities persist for many populations of youth. Reducing unintended adolescent pregnancies is considered a "winnable public health battle," but one that will require innovative thinking and continued persistence. This paper reviews the recent research literature and innovative programmatic efforts to identify six promising strategies that address the challenge of adolescent pregnancy in new ways. These strategies aim to: (1) understand and address the complexity of adolescent lives; (2) expand the provision of quality sexual health education; (3) engage youth through technology and media; (4) increase access to contraceptives and other sexual health services; (5) create tailored interventions for populations with special needs; and (6) create a supportive policy environment. By building upon lessons learned from past efforts, we can move the field toward the development, strengthening, and promotion of future strategies that enhance the sexual well-being of all adolescents. [ABSTRACT FROM AUTHOR]

The study purpose was to use recursive partitioning analysis (RPA) to identify factors that, when clustered, are associated with a high prevalence of pregnancy involvement among US adolescent males. The National Survey of Family Growth is a nationally representative survey of individuals 15-44 years old. RPA was done for the 2002 and 2006-2010 cycles to identify factors which, when combined, identify adolescent males with the highest prevalence of pregnancy involvement. Pregnancy-involvement prevalence among adolescent males was 6 %. Two clusters of adolescent males have the highest pregnancy-involvement prevalence, at 84-87 %. In RPA, the highest pregnancy-involvement prevalence (87 %) was seen in adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment of <11th grade, and had ≤2 sexual partners in the past 12 months. Adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment ≥11th grade, were >17 years old, and had their first contraceptive education ≥10th grade, had a pregnancy-involvement prevalence of 84 %. Pregnancy-prevention efforts among adolescent males who have been involved in a pregnancy may need to target risk factors identified in clusters with the highest pregnancy prevalence to prevent subsequent pregnancies in these adolescent males and improve their future outcomes. [ABSTRACT FROM AUTHOR]

Housing instability is an understudied social condition that may be a severe stressor during pregnancy. Aims of this study are to identify correlates of housing instability and to explore the association between housing instability and birth weight among pregnant teens and young mothers. Participants included pregnant women ages 14-21 from seven community hospitals and health centers in New York City ( N = 623). Data were collected via structured surveys during the second trimester of pregnancy (14 to 24 weeks gestation, M = 19.35, SD = 3.20). Birth weight was obtained through labor and delivery logs. Housing instability was operationalized as two or more moves within the past year. More than one in four (28.5 %) pregnant teens and young women in this sample reported housing instability. Women who reported housing instability were less likely to be enrolled in school, have parents as main source of financial support, live in a single-family home or apartment, or be food secure; they were more likely to smoke (all p < 0.05). After adjusting for important clinical, behavioral, and demographic factors typically associated with lower birth weight, housing instability remained a significant predictor of lower birth weight ( B (SE) = −83.96(35.47), p = 0.018). Results highlight the importance of housing stability during pregnancy for infant health. Future interventions and policies should ensure that women are housing stable before, during, and after pregnancy. [ABSTRACT FROM AUTHOR]

Although the rate of adolescent childbearing in the USA continues to decline, and its consequences increasingly found to be equivocal, a persistent discourse of teen pregnancy as pathology structures public health responses. Foucault’s concepts of biopower and governmentality are useful to understand and critically analyze the operation of power in discourses related to adolescent childbearing; specifically, how power over life is simultaneously exercised at the level of the body and the population through self-governance. By conducting a situational analysis using health promotion materials and policy documents from a national, non-governmental teen pregnancy prevention organization, I identify two strategies through which the management of bodies and populations emerges in relation to teen pregnancy: the production of risky bodies and subjectivities and the deployment of a regulatory regime of heterosexuality. While the pregnant teenage subject is produced through public health discourses of normalizing judgment, risk, and deference to experts, the pregnant teen body is regulated through abjection and rites of redemption. At the same time, the expansive scope of the teen pregnancy ‘problem’ requires increasing forms of self-governance and rational behaviors from across diverse populations. This analysis enables us to challenge deeply entrenched assumptions guiding teen pregnancy prevention efforts and explore the possibility that the stigmatization and regulation of young women’s reproduction reinforce and reproduce existing health and social inequalities. [ABSTRACT FROM PUBLISHER]

Study Objective To identify factors associated with a positive pregnancy attitude among sexually active US teen females. Design Secondary database analysis of the National Survey of Family Growth. Participants Adolescent females 15-19 years old. Setting Nationally representative sample. Methods Bivariate and multivariable analyses were performed of the 2002 and 2006-08 cycles to examine whether sociodemographic factors, contraceptive history, sexual education and behavior history, medical services history, and family and sexual attitudes were associated with a positive pregnancy attitude among sexually active teen females. Results Among the 975 sexually active US adolescent females surveyed, 15% reported a positive pregnancy attitude. Compared with adolescent females with a negative pregnancy attitude, those females with a positive pregnancy attitude were significantly ( P < .05) more likely to have public insurance (43% vs 20%), to be poor (33% vs 10%), to have reached menarche at an earlier age (12 years old vs 13 years old), ever have HIV tested (35% vs 23%), but less likely to have ever been forced to have sex (1% vs 10%). In multivariable analyses, Latino race/ethnicity was associated with triple the odds, and African-American double the odds, of a positive pregnancy attitude. Older age of menarche and higher family income were associated with reduced odds of a positive pregnancy attitude. Conclusions One in 7 sexually active US adolescent females had a positive pregnancy attitude. Minority race/ethnicity was associated with greater odds of a positive pregnancy attitude, whereas older age of menarche and a higher family income were associated with lower odds of a positive pregnancy attitude. Assessing pregnancy attitudes for these groups of adolescent females might prove useful to decrease adolescent pregnancy rates. [ABSTRACT FROM AUTHOR]

Background: Although marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls (< 18 years). The contribution of girl child marriage (< 18 years) to perinatal health is understudied in the Americas., Methods: National singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011-2018, N = 23,117,661), Ecuador (2014-2018, N = 1,519,168), the USA (2014-2018, N = 18,618,283) and Canada (2008-2018, N = 3,907,610). The joint associations between marital status and maternal age groups (< 18, 18-19 and 20-24 years) with preterm birth (< 37 weeks), small-for-gestational age (SGA < 10 percentile) and repeat birth were assessed with logistic regression., Results: The proportion of births to < 18-year-old mothers was 9.9% in Ecuador, 8.9% in Brazil, 1.5% in the United States and 0.9% in Canada, and marriage prevalence among < 18-year-old mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In fully-adjusted models, marriage was associated with lower odds of preterm birth and SGA among 20-24-year-old mothers in the four countries. Compared to unmarried 20-24-year-old women, married and unmarried < 18-year-old girls had higher odds of preterm birth in the four countries, and slightly higher odds of SGA in Brazil and Ecuador but not in the USA and Canada. In comparisons within age groups, the odds of repeat birth among < 18-year-old married mothers exceeded that of their unmarried counterparts in Ecuador [AOR: 1.99, 95%CI: 1.82, 2.18], the USA [AOR: 2.96, 95%CI: 2.79, 3.14], and Canada [AOR: 2.17, 95%CI: 1.67, 2.82], although minimally in Brazil [AOR: 1.09, 95%CI: 1.07, 1.11]., Conclusions: The prevalence of births to < 18-year-old mothers varies considerably in the Americas. Girl child marriage was differentially associated with perinatal health indicators across countries, suggesting context-specific mechanisms., (© 2022. The Author(s).)

Many different definitions of the construct of motivational ambivalence have appeared in the literature on reproductive health. Using a theoretical framework in which motivational ambivalence is defined as an interaction between positive and negative pregnancy desires, we propose two hypotheses. The first is that positive and negative pregnancy desires independently predict the risk of an unplanned pregnancy. The second is that ambivalence and three related constructs that are also based on the interaction between positive and negative desires are each important predictors of pregnancy risk. We use weekly journal data collected from a US sample of 1,003 women aged 18–19 years and conduct hazard model analysis to test our hypotheses. Using both dummy and continuous predictors, we report results that confirm both hypotheses. The proposed interaction framework has demonstrated validity, compares favourably with previously reported alternative approaches, and incorporates a set of constructs that have potential importance for further research directed at the prevention of unplanned pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To identify markers that, when clustered, are associated with the highest and lowest pregnancy prevalence among US adolescent females. Design: Secondary database analysis of the National Survey of Family Growth. Participants: Adolescent females 15–19 years old. Setting: United States. Methods: Bivariate analyses were performed of the 2002 and 2006-08 cycles to identify markers associated with pregnancy in females 15–19 years old. Recursive partitioning analysis (RPA) was done to identify markers which, when combined, identify adolescent females with the highest and lowest pregnancy prevalence. Results: Pregnancy prevalence in 2,528 adolescent females was 14%. In RPA, females who ever HIV tested had a 48% pregnancy prevalence vs 4% in those never tested. The highest pregnancy prevalence (78%) was associated with the combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, and age of sexual debut ≤14 years old. Adolescent females with a combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, age of sexual debut at 15–16 years old, and the adolescent''s father not having a high-school diploma had a pregnancy prevalence of 75%. Conclusions: Two clusters of markers yield adolescent females with a very high adolescent pregnancy prevalence, at 75%–78%. Pregnancy prevention efforts might be especially effective when targeting combinations of HIV-testing history, never living away from home before 18 years old, adolescent age, age of sexual debut, and paternal educational attainment. [Copyright &y& Elsevier]

Purpose: To provide a comprehensive assessment of maternal and neonatal complications associated with teen pregnancies in the United States., Methods: Retrospective analysis of the Centers for Disease Control and Prevention natality live births database (2016-2019). Singleton births to women younger than 35 years from the following racial/ethnic groups were included: non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic. The risks of various complications were compared between teen patients (<20 years old) and nonteen patients (20-35 years old) using Pearson's chi-square test with the Bonferroni correction. Multivariate logistic regressions were used to adjust outcomes for potential confounders, including body mass index, race/ethnicity, payment method, prenatal care, parity, and the presence of chronic comorbidities., Results: Teen pregnancies comprised approximately 6% of the study population (661,062 of 11,038,489). Teen pregnancies were associated with increased odds of several maternal complications, such as hypertensive disorders of pregnancy, eclampsia, preterm birth, blood transfusion, and chlamydial and gonorrheal infections. Teen pregnancies were also associated with increased odds of several neonatal complications, including congenital birth defects, low 5-minute Apgar score, suspected neonatal sepsis, and assisted ventilation. Conversely, teen pregnancies were associated with decreased odds of gestational diabetes, unplanned hysterectomy, macrosomia, low birth weight, and neonatal intensive care unit admission., Discussion: Teen pregnancies in the United States are associated with increased risks of multiple adverse outcomes. This information should inform clinicians and policy makers about the unique risks of this highly vulnerable patient population and provide further knowledge for the important efforts to reduce teen birth rates in the United States., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Abstract: Although the socioeconomic impact of school desegregation in the U.S. has been well documented, little is known about the health consequences of this policy. The purpose of this study was to quantify the associations between school desegregation and adolescent births among black and white females. We compared the change in prevalence of adolescent births in areas that implemented school desegregation plans in the 1970s with areas that implemented school desegregation plans in other decades, using difference-in-difference methods with 1970 and 1980 Census microdata. School desegregation policy in the U.S. in the 1970s was associated with a significant reduction of 3.2 percentage points in the prevalence of births among black female adolescents between 1970 and 1980. This association was specific to black female adolescents and was not observed among white adolescents. [Copyright &y& Elsevier]

OBJECTIVE: Emergency contraception (EC) is an effective pregnancy prevention strategy. EC is available without a prescription to those aged 17 years or older. The objective of this study was to assess the accuracy of information provided to adolescents and their physicians when they telephone pharmacies to inquire about EC. METHODS: By using standardized scripts, female callers telephoned 943 pharmacies in 5 US cities posing as 17-year-old adolescents or as physicians calling on behalf of their 17-year-old patients. McNemar tests were used to compare outcomes between adolescent and physician callers. RESULTS: Seven hundred fifty-nine pharmacies (80%) indicated to adolescent callers, and 766 (81%) to physician callers, that EC was available on the day of the call. However, 145 pharmacies (19%) incorrectly told the adolescent callers that it would be impossible to obtain EC under any circumstances, compared with 23 pharmacies (3%) for physician callers. Pharmacies conveyed the correct age to dispense EC without a prescription in 431 adolescent calls (57%) and 466 physician calls (61%). Compared with physician callers, adolescent callers were put on hold more often (54% vs 26%) and spoke to self- identified pharmacists less often (3% vs 12%, P < .0001). When EC was not available, 36% and 33% of pharmacies called by adolescents and physicians respectively offered no additional suggestions on how to obtain it. CONCLUSIONS: Most pharmacies report having EC in stock. However, misinformation regarding who can take EC, and at what age it is available without a prescription, is common. Such misinformation may create barriers to timely access. [ABSTRACT FROM AUTHOR]

We sought to evaluate the impact of obesity on the risk of spontaneous and medically indicated preterm birth in young women compared to adult women. Florida vital records from 2004 to 2007 were used to obtain data. The study sample consisted of 290,807 mothers of whom 4,739 were adolescent girls ≤15 years old: 23,228 were girls 16–17 years old; 58,196 were women 18–19 years old; and 204,644 were women 20–24 years old. Adjusted estimates for spontaneous and medically indicated preterm birth were determined based on maternal BMI and weight gain during pregnancy. Subjects were categorized by BMI as follows: class I obesity (30.0 ≤ BMI ≤ 34.9), class II obesity (35.0 ≤ BMI ≤ 39.9), class III obesity (40 ≤ BMI ≤ 49.9), and super-obese (BMI ≥ 50.0). Obese mothers had elevated risk for medically indicated preterm birth and lower risk for spontaneous preterm birth compared to non-obese mothers. Overall, the risk for spontaneous preterm birth increased in a dose-dependent fashion with younger age but no age-dependent trend was observed for medically indicated preterm birth ( P < 0.0001). Very low weight gain (<0.12 kg/week) during pregnancy was associated with a higher risk of spontaneous preterm birth among both non-obese and obese teenagers. Preterm birth is a heterogeneous entity that is mediated by obesity status and maternal age. Obesity among pregnant teenagers increases the risk for medically indicated preterm birth but not the risk for spontaneous preterm birth. [ABSTRACT FROM AUTHOR]

Despite the substantial amount of literature focusing on social support for pregnant and parenting adolescents, few studies have directly examined the relationships among stress and social support across their transition to parenting. The present study investigates the nature of the relationship between stress and support both before and after the birth of the baby. Two groups of adolescent females (one group facing parenthood and one not) completed measures of support and stress across a 7-month period ( N = 231) to coincide with the transition to parenthood. In general, support and stress were negatively related when measured concurrently and positively related over time for parenting adolescents but not the non-parenting group. Understanding how long social support impacts stress will enable practitioners to identify when best to provide interventions for pregnant and parenting adolescents. [ABSTRACT FROM AUTHOR]

Certified childbirth educators have the ideal preparation for prenatal education, but they likely need to enhance their approach for adolescent clients. First, young mothers in the United States are presenting with increasingly diverse backgrounds, requiring cultural awareness of childbirth educators and others who wish to effectively meet their prenatal health care and education needs. In addition, adolescents who become pregnant are an extremely vulnerable group and, therefore, require special concern. Pregnant adolescents are unique from other groups of pregnant women in all major aspects of assessment: their social environment; their personal, social, and psychological development; and their physical response. Therefore, prenatal care and childbirth education designed for the typical population are unlikely to best serve the pregnant adolescent. [ABSTRACT FROM AUTHOR]

To evaluate: change in Body Mass Index (BMI) of adolescent mothers (14–19 years of age) from pre-pregnancy to 36 months postpartum; BMI of their children age 2 or older; relationship between maternal BMI and children’s BMI. Retrospective medical record abstraction of adolescent mothers attending a medical program in Massachusetts between 2001 and 2005 who had self-reported pre-pregnancy BMI data at first prenatal visit, at least one BMI measure 12 or more months postpartum, and who did not experience a repeat pregnancy ( n = 52). Children of adolescent mothers were included if they had received their 2 ( n = 41) and/or 3 ( n = 28) year physical. Adolescent mothers: overweight increased from 25% pre-pregnancy to 33% at 24–36 months postpartum; obesity more than doubled in the same time period, from 15% to 36%. Those with BMI data available pre-pregnancy and postpartum had an increase in mean BMI from 25 pre-pregnancy to 29 at 24–36 months postpartum ( P < 0.001). Two-year-old children: About 5% were at risk for overweight and 12% were overweight. Three-year-old children: About 18% were at risk for overweight and 18% were overweight. When BMI categories of children were compared to BMI categories of their mothers, there was a trend for adolescent mothers with overweight/obesity at 24–36 months postpartum to have 3-year-old children at risk for overweight or overweight ( P = 0.092). There was a significant increase in overweight/obesity in this cohort of adolescent mothers and their children followed 36 months postpartum. The long-term sequelae of overweight/obesity indicates a need for effective interventions. [ABSTRACT FROM AUTHOR]

Adolescent pregnancy and parenting remains a pressing social and public health concern because the United States continues to have the highest teen pregnancy rate among Western developed nations and because of the attendant social, psychological, and physical problems for young parents and their children. Prevention efforts to reduce the incidence of pregnancy and parenting among all teens continue to be critical. Even though funding constraints may limit the number of programs, it is possible to maximize the effectiveness of those that do exist or are developed. The most effective prevention programs are those based on theoretical models. This paper focuses on common theoretical models in four areas (developmental, perceived control, attitudes/intentions, and social learning) that can be easily applied to pregnancy prevention program development. After a short description of the theory and a discussion of its use in the literature, the theory's relevance to pregnancy/parenting prevention program development is discussed. [ABSTRACT FROM AUTHOR]

Teen birth rates in the United States have declined during the last decade but remain much higher than rates in other developed countries. Reduction of unintended pregnancy during adolescence and the associated negative consequences of early pregnancy and early childbearing remain public health concerns. Emergency contraception has the potential to significantly reduce teen-pregnancy rates. This policy statement provides pediatricians with a review of emergency contraception, including a definition of emergency contraception, formulations and potential adverse effects, efficacy and mechanisms of action, typical use, and safety issues, including contraindications. This review includes teens' and young adults' reported knowledge and attitudes about hormonal emergency contraception and issues of access and availability. The American Academy of Pediatrics, as well as other professional organizations, supports over-the-counter availability of emergency contraception. In previous publications, the American Academy of Pediatrics has addressed the issues of adolescent pregnancy and other methods of contraception. [ABSTRACT FROM AUTHOR]

This article describes the incorporation of a service-learning project in a maternal-infant health course in a baccalaureate nursing program. Partnership goals between university faculty and project Early Head Start were to develop and implement a clinical education experience that not only enhanced services to teenage mothers, but also taught students key elements in the delivery of community services to this vulnerable population. This article examines the impact of the service-learning experience on students' understanding of diversity, perceptions of social responsibility in community service, and health care issues. Implications for faculty investment of time and resources are also explored. [ABSTRACT FROM AUTHOR]

Probes into the efforts to reduce incidents in pediatric HIV-1 infections in the United States. Phases in the perinatal HIV-1 epidemic in the country; Risk assessment of the HIV-1 epidemic in New York City; Impact of HIV-1 seroprevalence and change in seroprevalence in young age groups of child-bearing women on the true change in incidents of the epidemic; Effectiveness of the opt-out approach as a prenatal testing.

Background: Adolescent pregnancy is associated with increased school dropout rates. Dropping out amplifies the probability of persistent social and economic disadvantage. Whether school-based health centers might help reduce school absenteeism and dropout rates in this group has not been well studied. Objective: To examine the association of school-based prenatal services on school attendance and dropout rates. Methods: In this retrospective cohort study, using school rosters from an alternative school, we identified adolescents aged 18 years or younger who delivered a baby between July 1, 1995, and August 30, 1997, in Baltimore, Md. We linked school records spanning 3 years with medical records and birth certificates. School variables such as attendance and dropout rates were examined in relation to the teen's year of pregnancy and prenatal care setting (school-based vs non-school-based). Hierarchical logistic regression was used to examine effects of school-based prenatal care on dropout and promotion or graduation rates, with adjustment for baseline group differences. Results: We identified 431 predominantly African American, low-income adolescents who attended the alternative school in their pregnancy school year. In the year prior to pregnancy, most performed poorly in school and had significant absenteeism. During their pregnancy school year, teens receiving school-based prenatal care were absent 12 fewer days, as compared with those receiving non-school-based care (P=.001), and their dropout rate was half that of those receiving non-school-based care (6% vs 15%; P=.02). Hierarchical logistic regression analyses, with adjustment for baseline prepregnancy differences, demonstrated that teens receiving school-based prenatal care were less likely to drop out of school during the pregnancy year (adjusted odds ratio, 0.39; 95% confidence interval, 0.15-0.99; P=.048). Conclusions: Absenteeism and dropout rates were reduced for pregnant adolescents receiving prenatal care at a school-based health center in an urban alternative school. Findings underscore the importance of funding and evaluating school-based health centers and other interventions that may ameliorate negative outcomes among childbearing adolescents. [ABSTRACT FROM AUTHOR]

The central purpose of this research was to discover, using Bronfenbrenner's conceptual framework of an ecological systems model, the combination of factors that successfully predicted pregnancy and parenting status in a convenience sample of 105 teenagers attending pregnancy prevention programs across a state in the southwestern United States. Nonpregnant or nonparenting teenagers were compared with pregnant and or parenting teenagers by factors organized by the following three main systems of interacting categories of variables, as explicated by Bronfenbrenner: (1) the microsystem, consisting of the psychological variables of self-esteem, depression, and stress levels experienced and the social psychological variables of alcohol and drug abuse; (2) the mesosystem, consisting of family structure, family functioning, problems with friends, the neighborhood, and the school, as well as enacted social support; and (3) the macrosystem, consisting of household income, parents' occupations, and race. [ABSTRACT FROM AUTHOR]

The incidence of pregnancy during adolescence has escalated dramatically in recent years, with an estimated half a million infants born to teenagers each year in the United States. A disproportionately high amount of child abuse and/or neglect is encountered among adolescent parents, underscoring the need for an effective intervention strategy. Short-term psychotherapy may be beneficial in these cases for forging a therapeutic alliance expeditiously and rigorously challenging the patient's resistance. The case described involves alleged abuse by a 16-year-old mother. An intervention was designed to clarify the allegations surrounding the abusive incident, help the mother confront episodes of loss in her own life and overcome feelings of hopelessness engendered by separation from her infant. [ABSTRACT FROM AUTHOR]

Objectives: To compare perceptions of the motivators and barriers to obtaining public prenatal care from the perspectives of pregnant adolescents coming for first-time and follow-up appointments, as well as among those of their prenatal care providers. Method: The patient sample consisted of 250 consecutive, adolescent, public prenatal patients coming to one of the 5 prenatal clinics in one county in Arkansas. Patient responses were analyzed by appointment status (first-time vs. follow-up visitors). Sixteen providers at the same public prenatal clinics were also interviewed using the same survey instrument. Results: We observed striking differences between patients and providers with respect to their perceptions of both the motivators and barriers to prenatal care. Adolescents reported “concern over the health of their baby” as a primary motivation, while providers identified adolescents' “concern over their own health” as the most important reason. With regard to barriers, adolescents were more likely to identify system-related barriers (e.g., lack of finances and transportation, and waiting time for appointments), while providers were more likely to identify personal barriers (e.g., feeling depressed, fear of procedures, and needing time to deal with problems at home). Patients and providers agreed, however, that fear of procedures and not wanting to be pregnant were important barriers to care. Conclusions: The differences in perceptions between adolescents and their prenatal care providers suggest that poor patient–provider communication may represent one of the single most important nonfinancial barriers to care. Possible explanations for inadequate patient–provider communication as well as solutions to improve their clinic interactions are discussed. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of adolescent birth on the health and wellness of these infants within their first year of life., Methods: Our study focused on 2011 Medicaid births nationwide. The study group (infants born to adolescents, aged 10 to 19 at time of birth) was matched with infants born to adults (aged 20 to 44 at time of birth), based on demographics. Statistical tests (proportion test and Poisson test) were used to compare the outcomes of these two groups to determine if differences were significant., Results: The outcomes assessed were: low birth weight (LBW), substance exposure, foster care, health status, infant mortality, emergency department (ED) visits, and wellness visits. Of the 68,562 infant pairs included in the study, we found statistically significant higher rates of LBW (P ≤ 0·005), infant mortality (P = 0·05), and ED visits (P ≤ 0·005) for infants born to adolescents at the 95% confidence interval. The rate of wellness visits for all infants was well below the recommended amount. Additional differences were found at the race/ethnicity and urbanicity levels., Conclusion for Practice: Infants born to adolescents had a higher rate of ED visits within the first year of life, however, the increased rates of LBW and mortality for the Medicaid population are not as significant as previous national studies suggest. Analysis of outcomes across stratification helped identify vulnerable populations (i.e. urban infants). Public health programs are urged to examine ED visits in infants born to adolescents among the Medicaid population. Improved health education or phone-based resources could help reduce unnecessary visits and reduce cost.

Background: In the USA, 12-14% have type 2 diabetes mellitus and the incidence is rising. Adolescent birth has been shown to be associated with significant gestational weight gain and obesity in adulthood. Objective: We sought to evaluate the association between the history of adolescent birth and diabetes in adulthood. Study design: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) data, examining 2-year cycles from 2005 to 2014. In a population of adult women who had experienced at least one live birth and who were not currently pregnant, we examined the prevalence of type 2 diabetes mellitus by the history of adolescent birth (live birth prior to 20 years of age). Sample characteristics were compared using survey-weighted chi-square tests. Multivariate logistic regression was used to examine the association between diabetes mellitus and adolescent birth history, with progressive adjustments for birth cohort, race/ethnicity, education level, and body mass index (BMI). Results: In a survey sample of 6507 individuals, we found that 38% of the women had experienced adolescent birth. Significant differences were found between those who had experienced adolescent birth and those who had not by birth cohort, race/ethnicity, federal poverty level, education attainment, parity, and BMI ( p  < .001 for all). The prevalence of type 2 diabetes was higher in women with a history of adolescent birth in adulthood than in women without a history of adolescent birth (17.2 versus 12.1%, p  < .001; BMI-adjusted odds ratio = 1.27; 95% confidence interval, 1.03-1.58, p  = .03). Conclusion: American women with a history of adolescent birth are at a significantly higher risk of type 2 diabetes mellitus in adulthood. Greater attention must be paid to preventing metabolic disease in women who experience early parity.

Adolescent females are disproportionately at risk for depression, which is expected to represent the leading cause of disability in 2030 (National Institute of Mental Health [NIMH] 2019). Although prior research has suggested that both child maltreatment and adolescent pregnancy increase the risk for depressive symptoms, less is known about how these two interact to influence depression in late adolescence. The present study tested the unique and interactive effects of adolescent pregnancy and child maltreatment on late-adolescent depressive symptomatology (N = 186) with a prospective, longitudinal design that utilized documented records of maltreatment and included demographically comparable (i.e., economically disadvantaged), nonmaltreated and non-pregnant comparisons. Participants were assessed at ages 10-12 and 18-21. Structural equation modeling was used to test whether adolescent pregnancy amplified the effect of child maltreatment on late-adolescent depressive symptoms. In the context of economic disadvantage, results indicated that the effect of child maltreatment on late-adolescent depressive symptoms was significantly enhanced for those who experienced an adolescent pregnancy. This effect remained after controlling for prior depressive symptoms, peer and maternal relationship quality, and romantic relationship violence. The findings are translated to preliminary guidance for practitioners regarding precision depression screening and tailored preventive interventions.​.

Study Objective: To determine the association of postpartum contraceptive use with repeat deliveries among adolescents and youth., Design: Retrospective, observational analysis of electronic health record data., Setting: Single, urban facility in Denver, Colorado, United States., Participants: Women aged 10-24 years who gave birth between January 1, 2011 and December 31, 2015., Interventions and Main Outcome Measures: Postpartum contraceptive use and time to subsequent delivery., Results: Among 4068 women, 1735 (43%) used postpartum contraception. In adjusted analyses, characteristics associated with contraceptive use included Hispanic ethnicity (relative risk [RR], 1.1; P = .03), incremental prenatal visits (RR, 1.01; P = .047), and attendance at postpartum care (RR, 1.60; P < .001). Long-acting reversible contraceptive (LARC) use was higher among women younger than 15 years (reference: 20-24 years; RR, 1.12; P < .001) and lower among women aged 18-19 years (RR, 0.93; P = .009). Hispanic women had higher rates of LARC use than non-Hispanic women (RR, 1.07; P = .02). Compared with inpatient LARC placement, outpatient placement (1-4 weeks and 5 or more weeks) rates were lower (RR, 0.77 and RR, 0.89, respectively; P < .001). Time to subsequent delivery was shorter in non-LARC users (median, 659 days) and contraception nonusers (median, 624 days) compared with LARC users (median, 790 days; P < .001); non-LARC postpartum contraceptive use did not significantly alter time to repeat delivery compared with that in women who used no method (P = .24)., Conclusion: Postpartum LARC use reduced the risk of repeat pregnancy with a significant increase in time to the next delivery. Non-LARC use was not different from no contraceptive use in terms of time to repeat delivery., (Copyright © 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day., (Copyright © 2019. Published by Elsevier Inc.)

The current rates of adolescent pregnancy in the United States and associated costs are reviewed. Better empirical and theoretical bases for intervention programs are needed in the future. Much could be gained from high quality evaluations of the many current intervention programs. However, the political climate often influences program development because ot the sensitive issues surrounding adolescent pregnancy. Studies included in this collection are previewed. [ABSTRACT FROM AUTHOR]

Objective: The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder., Methods: This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis., Results: The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001)., Conclusions: Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.

Purpose: The purpose of this study was to describe adolescents' and young adults' concerns about confidential reproductive health care and experience with time alone with a provider, and examine the association of these confidentiality issues with receipt of contraceptive services., Methods: Data from the 2013 to 2015 National Survey of Family Growth were analyzed using Poisson regression to describe 15- to 25-year-olds' confidential reproductive health-care concerns and time alone with a provider at last health-care visit according to sociodemographic characteristics. We also assessed whether confidentiality issues were associated with obtaining contraceptive services among females., Results: Concerns about confidential reproductive health care were less common among 15- to 17-year-olds who were covered by Medicaid compared to their parents' private insurance (adjusted risk ratio [ARR] = .61, confidence interval [CI] .41-.91) and had high-school graduate mothers compared to college-graduate mothers (ARR = .68, CI .47-.99), and were more common among those who lived with neither parent compared to living with both parents (ARR = 2.0, CI 1.27-3.16). Time alone with a provider was more common among black girls than white girls (ARR = 1.57, CI 1.11-2.22) and less common among girls covered by Medicaid than those with parents' private insurance (ARR = .72, CI .56-.92). Time alone was less common among boys living with neither parent compared to living with two parents (ARR = .48, CI .25-.91) and with high-school graduate mothers compared to college-graduate mothers (ARR = .59, CI .42-.84). Among sexually experienced girls and women, confidentiality concerns were associated with a reduced likelihood of having received a contraceptive service in the past year., Conclusions: Greater efforts are needed to support young Americans in receiving confidential care., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Although teenage birth rates in America have fallen to a historic low of 26.2 births per 1,000 teenagers, the U.S. remains behind the rest of the industrialized world. Adolescent pregnancy is relatively well discussed in today's literature, with ever more detailed estimates constantly emerging to quantify the cost of children born to America's teenagers. This study, however, describes the financial cost of childbirth in the U.S. with a specific focus on understanding the impact of adolescent childbirth in comparison to that of adult women and of annual childbirth as a whole., Methods: This retrospective cohort study used data from the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), a uniform, multistate database containing information regarding approximately 8 million hospital inpatient stays per year of data. Data were analyzed involving payment type, length of stay, and aggregate cost of all childbirths to adolescent girls (under 18 years of age) and to adult women., Results: This study found that Medicaid pays for the majority (70%) of births to adolescent girls, whereas private insurance pays for the majority (53%) of births to adult women. This was in contrast to the Medicaid coverage of 41% of all childbirths within the study time frame. Furthermore, the aggregate cost of childbirths to adolescent girls paid for by Medicaid was $670 million., Conclusions: Beyond their social impact, births to adolescent mothers place a financial burden on the national economy. Stronger efforts must be made to decrease adolescent childbirth., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Teen pregnancy and childbearing have declined over the past two decades to historic lows. The most recent declines have occurred during a time of coordinated national efforts focused on teen pregnancy. This article highlights a federal partnership to reduce teen pregnancy through the implementation of innovative, evidence-based approaches in affected communities, with a focus on reaching African-American and Latino/Hispanic youth. This initiative has the potential to transform the design and implementation of future teen pregnancy prevention efforts and provide a model that can be replicated in communities across the nation., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy., Design and Methods: This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7+1.5years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes., Results: These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners., Conclusions and Practice Implications: Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: The United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates., Methods: We carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates., Results: The state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different-for sex education policies, 39.8 of 1000 vs 45.1 of 1000 (P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent (P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 (P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P < .0001) and ethnic distribution of the population were the only variables associated with a difference between mean teen births. Lower teen abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent., Conclusion: While teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates., (Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Purpose: The impact of pregnancy on the health and livelihood of adolescents aged 15-19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings., Methods: The Well-Being of Adolescents in Vulnerable Environments study used respondent-driven sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), New Delhi (500), and Shanghai (438). RDS-II and poststratification age weights were used to explore the odds associated with "ever had sex" and "ever pregnant"; adjusted odds of pregnancy and 95% confidence interval were developed by site and gender., Results: Among the sexually experienced, pregnancy was most common in Baltimore (females, 53% and males, 25%) and Johannesburg (females, 29% and males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, New Delhi, and Shanghai. Current schooling and condom use at the first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were early sexual debut (Johannesburg participants and Baltimore females) being raised by someone other than the two parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males and Johannesburg participants)., Conclusions: The reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, and differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside with particular attention to neighborhood-level factors., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine the Institute of Medicine (IOM) guidelines for gestational weight gain in adolescents. Study Design: We studied a retrospective cohort using the Missouri Birth Certificate Registry and included subjects who were primiparous, who had singleton gestations, who were <20 years old, and who delivered at 24-44 weeks gestation. The exposure was defined as weight gain less than, within, or greater than IOM recommendations. Outcomes that were examined were small-for-gestational-age (SGA) infants, large-for-gestational age (LGA) infants, preterm delivery, infant death, preeclampsia, cesarean delivery, and operative vaginal delivery. The analysis was stratified by body mass index category. Results: In any body mass index category, inadequate weight gain was associated with increased odds of SGA infants, preterm delivery, and infant death. When subjects gained more than the IOM recommendations, the number of SGA infants decreased, with slight increases in the number of LGA infants, preeclampsia, and cesarean delivery. Conclusion: Adolescents should be counseled regarding adequate weight gain in pregnancy. Further research is necessary to determine whether the IOM recommendations recommend enough weight gain in adolescents to optimize pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a novel approach to adolescent pregnancy prevention through scheduled educational clinic visits, focusing to retain patients within the clinic system., Methods: This is a retrospective chart review conducted at the Center for Adolescent Pregnancy Prevention, a privately funded clinic located in an urban setting serving only adolescents and young adults. Subjects included adolescent patients aged 11-18 years who were seen between January 2007 and December 2010. The primary outcomes studied were 12- and 24-month continuation rates of birth control options, total length of follow-up, time until gaps in follow-up, and any incident pregnancies. Results were stratified based on age at initial visit: early adolescents (aged 11-15 years) or late adolescents (aged 16-18 years)., Results: There were 121 patients who met inclusion and had more than one visit. There were seven incident pregnancies over the study period, all in the late adolescent group. The relative risk of pregnancy among those with a gap in follow-up of >12 months compared with those without a gap was 4.63 (95% confidence interval [CI] 1.1-19.4). The early adolescents had a greater rate of continuation of birth control at 12 months compared with late adolescents (66.6% vs. 42.2%, relative risk [RR] 1.57, 95% CI 1.12-2.20) and had higher rates of continuation at 24 months (41.6% vs. 18.3%, RR 2.27, 95% CI 1.25-4.11)., Conclusions: The educational approach at Center for Adolescent Pregnancy Prevention may decrease adolescent pregnancy among high-risk adolescents that stay within the clinic system. This educational model may be more effective for early adolescents than late adolescent patients., (Published by Elsevier Inc.)

Purpose: Although a purported risk factor for early pregnancy is abuse history, the strength of this association has been inconsistent across studies and may vary as a function of abuse type. The purpose of this meta-analysis was to examine the extent to which sexual, physical, and emotional abuse, as well as neglect, increased the risk of adolescent pregnancy., Methods: A search of studies through MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, and Web of Science was conducted. Studies were retained if they included (1) women who became pregnant before 20 years of age; (2) a comparison group of nonpregnant adolescents; and (3) abuse experience (<18 years of age)., Results: Thirty-eight independent samples provided 70 estimates of effect sizes, derived from 75,390 participants. Both sexual and physical abuse were associated with an increased risk of adolescent pregnancy (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.75-2.38 and OR, 1.48; CI, 1.24-1.76, respectively). The strongest effect was for the co-occurrence of sexual and physical abuse (OR, 3.83; CI, 2.96-4.97]). Nonsignificant effect sizes were found for emotional abuse (OR, 1.01; CI, .70-1.47) and neglect (OR, 1.29; CI, .77-2.17]), although these were moderated by journal impact factor, that is, greater effect sizes were reported in higher impact journals., Conclusions: The results of this meta-analysis reveal that the strength of the association between abuse and adolescent pregnancy varies as a function of abuse subtype. Sexual and physical abuse were associated with increased risk for adolescent pregnancy, whereas emotional abuse and neglect were not., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Study Objective: To identify factors associated with a positive pregnancy attitude among sexually active US teen females., Design: Secondary database analysis of the National Survey of Family Growth., Participants: Adolescent females 15-19 years old., Setting: Nationally representative sample., Methods: Bivariate and multivariable analyses were performed of the 2002 and 2006-08 cycles to examine whether sociodemographic factors, contraceptive history, sexual education and behavior history, medical services history, and family and sexual attitudes were associated with a positive pregnancy attitude among sexually active teen females., Results: Among the 975 sexually active US adolescent females surveyed, 15% reported a positive pregnancy attitude. Compared with adolescent females with a negative pregnancy attitude, those females with a positive pregnancy attitude were significantly (P < .05) more likely to have public insurance (43% vs 20%), to be poor (33% vs 10%), to have reached menarche at an earlier age (12 years old vs 13 years old), ever have HIV tested (35% vs 23%), but less likely to have ever been forced to have sex (1% vs 10%). In multivariable analyses, Latino race/ethnicity was associated with triple the odds, and African-American double the odds, of a positive pregnancy attitude. Older age of menarche and higher family income were associated with reduced odds of a positive pregnancy attitude., Conclusions: One in 7 sexually active US adolescent females had a positive pregnancy attitude. Minority race/ethnicity was associated with greater odds of a positive pregnancy attitude, whereas older age of menarche and a higher family income were associated with lower odds of a positive pregnancy attitude. Assessing pregnancy attitudes for these groups of adolescent females might prove useful to decrease adolescent pregnancy rates., (Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)