Ecological Contexts in Adolescent Pregnancy: The Role of Individual, Sociodemographic, Familial and Relational Variables in Understanding Risk of Occurrence and Adjustment Patterns

Trauma Informed Care in the Prevention of High-Risk Sexual Behaviors and Unplanned Pregnancy in Adolescents with Mental Health Disorders

Although teen pregnancy and birth rates have declined over the decades, all adolescentpopulations are at risk. Disparities among adolescent pregnancies still exist, including increased risk and rates of unplanned pregnancy among vulnerable adolescents, including those with a mental health diagnosis.Adolescent girls with mental health disorders are notably at higher risk and are three timesmore likely to become pregnant than those without a mental illness. Adolescents who have experienced trauma and have a mental health diagnosis are much more likely to engage in high-risk sexual activity, to not participate in contraceptive use, and to become pregnant than their counterparts.Using Trauma Informed Care (TIC) to assess mental health diagnoses, high-risk sexual behaviors, and risk for unplanned pregnancy among adolescent populations can be an effective approach for primary prevention. There is increased expectation for clinicians to practice TIC and to establish relationships with patients while understanding how mental health diagnoses can impact health behaviors. The focus of this paper is to examine the effects of adolescent unplanned pregnancy, identify the increased risk for adolescents with mental health disorders, and discuss general methods for TIC in clinical practice.

Incident pregnancy and mental health among adolescent girls and young women in rural KwaZulu-Natal, South Africa: an observational cohort study

Pregnancy can place adolescent girls and young women (AGYW) at risk of poor mental health. However, evidence linking youth pregnancy to mental health in resource-limited settings is limited, especially where HIV incidence is high. We analysed a population-representative cohort of AGYW aged 13-25 in rural KwaZulu-Natal to assess how adolescent pregnancy predicts subsequent mental health. Among 1851 respondents, incident pregnancy (self-reported past-12-month) rose from 0.7% at age 14 to 22.1% by 18. Probable common mental disorder (CMD; 14-item Shona Symptom Questionnaire) prevalence was 19.1%. In adjusted Poisson regression recent pregnancy was associated with slightly higher probable CMD (adjusted prevalence ratio [aPR] 1.19, 95%CI 0.96-1.49), and stronger association among 13-15 year-olds (aPR 3.25, 95%CI 1.50-7.03), but not with HIV serostatus. These findings suggest a possible incremental mental health impact of being pregnant earlier than peers, pointing to the need for age-appropriate mental health interventions for AGYW in resource-limited settings.

How Can Unintended Pregnancies Be Prevented among Adolescents Who Engaged in Sexual Intercourse at Earlier Ages? The Role of Female Education and Partner Age Difference

Several studies have identified explicative factors for adolescents' sexual risk behaviors and related outcomes such as unintended pregnancy; however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1-6 years after first sexual intercourse by increasing the adolescents' likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.

Understanding the association between exposure to family planning messages and consistent condom use among never married men in Ghana

BACKGROUND

Despite considerable efforts to promote condom use, sexually active people in sub-Sahara Africa still engage in risky sexual behaviours, with condom use relatively low. With this high vulnerability of these persons to HIV and sexually transmitted infections, research related to exposure to family planning messages to help curb this trend remains sparse. This study examined how exposure to family planning messages in the midst of some socio-demographic factors is associated with consistent condom use among sexually active never married men in Ghana.

METHODS

Data were obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. Only never married men (15-64 years) who have had sexual experience in the last 12 months were included in the analysis (N = 971). Frequencies, percentages, chi-square tests and binary logistic regression analyses were carried out. Results of the binary logistic regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR).

RESULTS

The results showed that only 26.15% of sexually active never married men in Ghana consistently used condom during sex. Men who were exposed to family planning messages were 51% more likely use condom consistently compared to those who are not exposed [aOR = 1.51, CI = 1.04-2.18]. In terms of the covariates, the likelihood of consistent condom use among men in Ghana was lower among those aged 35 years and above compared to those aged 15-24 [aOR = 0.46 CI = 0.21-0.99]. The odds of consistent condom use among men increased with level of education, with men with higher level of education having the highest odds of consistent condom use compared to those with no formal education [aOR = 9.98, CI = 2.05-48.46]. Men of the richest wealth quintile were more likely to use condom consistently compared to those of the poorest wealth quintile [aOR = 2.62, CI = 1.30-5.27]. Higher odds of consistent condom use was found among men who dwelled in the Central, Northern, and Upper East regions compared to those of the Western region.

CONCLUSION

Our findings have established a strong association between exposure to family planning messages alongside age, educational level, wealth, and region of residence and consistent condom use. Men exposed to family planning messages were more likely to use condoms consistently. Designed programs should use intervention strategies that focus on interactive and participatory educational activities to improve sexually active men's interpersonal communication on family planning messages, especially on consistent condom use with their sexual partners.

Sociodemographic, sexual, and reproductive variables associated with pregnancy among adolescents from low socioeconomic background

Adolescent pregnancy remains a public health concern in both developed and developing countries. Portugal and Brazil represent some of the best examples of this phenomenon. The present study aimed to identify sociodemographic, sexual, and reproductive health-related variables associated with adolescent pregnancy among students from low socioeconomic backgrounds in both countries. The sample included 984 female adolescents, among whom 215 became pregnant. Living with a partner and lack of information about sex and contraception from the family were the best explicative factors for pregnancy occurrence in both countries. Country-specific variables were also identified. Our results may contribute to developing global preventive interventions, addressing the school as an ideal setting for primary intervention and considering culture-specific characteristics of high-risk populations.

JE, Seidu AA, Mintah JK, Sambah F, Schack T, Hormenu T. Examining Pregnancy Related Socio-Cultural Factors Among Adolescent Girls in the Komenda-Edina-Eguafo-Abrem Municipality in the Central Region of Ghana: A Case-Control Study

Background and Purpose: Given that Ghana continues to record higher rates of adolescent pregnancy among rural dwellers, notably, those living in the Brong Ahafo, Central and Volta regions, it is surprising that scholarly information related to socio-cultural determinants of this sequel in these mentioned areas of the country is limited. This study sought to examine the socio-cultural factors associated with pregnancy among adolescent girls in Komenda-Edina-Eguafo-Abrem (KEEA) Municipality in the Central Region of Ghana. Methods and results: Using a matched case-control design with a 1:1 ratio, a facility-based sampling approach was used to select 400 adolescent females aged between 15 and 19 years. Chi-square analyses on the strictness level of rules and regulations in family [χ2 (1) = 62.010, p < 0.05], freedom within the family to discuss issues related to sexuality [χ2 (1) = 9.600, p < 0.05], religious support of sex before marriage [χ2 (1) = 4.312, p < 0.05], peer influence to engage in sexual intercourse [χ2 (1) = 7.793, p < 0.05], reaction of parents toward pregnancy [χ2 (1) = 70.064, p < 0.05], and reaction of siblings toward pregnancy [χ2 (1) = 66.702, p < 0.05] were significantly related to adolescents' pregnancy status. Additionally, binary logistic regression analysis also showed that non-pregnant adolescents were seven times more likely to belong to families with strict rules and regulations compared to pregnant adolescents [OR = 0.14, 95% CI = (0.07-0.25), p ≤ 0.01]. Non-pregnant adolescents were 3 times more likely to have freedom within the family to discuss issues related to sexuality compared to pregnant adolescents [OR = 0.33, 95% CI = (0.18-0.59), p ≤ 0.01]. However, pregnant adolescents were 3 times more likely to be influenced by their peers to engage in sexual intercourse [OR = 2.63, 95% CI = (1.46-4.74), p ≤ 0.001] and 3 times more likely to have parents with positive reaction toward adolescent pregnancy compared to non-pregnant adolescents [OR = 2.97, 95% CI = (1.15-7.70), p ≤ 0.05]. Additionally, these pregnant adolescents were eight times more likely to have siblings with positive reaction toward adolescent pregnancy [OR = 7.74, 95% CI = (2.59-21.4), p ≤ 0.001] compared to their non-pregnant counterparts. Conclusion: Adolescent pregnancy heightens the risk of negating birth outcomes that is independent of recognized confounding variables. Therefore, adolescent girls in the KEEA Municipality are likely to experience continuous exposure to the risk of pregnancy with the existence of negative socio-cultural norms. Specific strategies need to involve multifaceted interventions that include education, competency-based skill training and support for young people, especially pregnant adolescents. Further research ought to determine which other factors would help us better understand circumstances that may lead to adolescent pregnancies in other areas of the region and perhaps among other subgroups.

The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?

In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.

Stress in the City: Influence of Urban Social Stress and Violence on Pregnancy and Postpartum Quality of Life among Adolescent and Young Mothers

Adolescent and young mothers transitioning from pregnancy to postpartum need to maintain an optimal quality of life. Stress and exposure to violence (e.g., intimate partner violence (IPV), nonpartner violence) are predictors of poor quality of life for adult women; however, these associations remain understudied among adolescent and young mothers in urban areas. Guided by the social ecological model, the current study created a latent variable, urban social stress, to examine the impact of the urban social environment (i.e., stressful life events, discrimination, family stress, and neighborhood problems) on the quality of life of adolescent and young mothers during both pregnancy and postpartum. The current study is a secondary data analysis of a prospective cohort study of 296 expectant young mothers recruited at obstetrics and gynecology clinics. Results from structural equation and multigroup models found that higher urban social stress predicted lower mental and physical quality of life during pregnancy, but these associations were significantly stronger for IPV-exposed and nonpartner violence-exposed mothers. In the postpartum period, higher urban social stress predicted lower mental and physical quality of life, but these associations were significantly stronger for IPV-unexposed and nonpartner violence-exposed mothers. Stress reduction programs need to help adolescent and young mothers in urban areas develop stress management skills specific to urban social stress. Pregnancy and parenting programs need to be tailored to the specific needs of young mothers in urban areas by becoming sensitive to the role of IPV and nonpartner violence in these young women's lives.

Translating group programmes into online formats: establishing the acceptability of a parents' sex and relationships communication serious game

Background

With ongoing concerns about the sexual health and wellbeing of young people, there is increasing need to innovate intervention approaches. Engaging parents as agents to support their children, alongside capitalising on increasingly sophisticated technological options could jointly enhance support. Converting existing programmes into interactive game based options has the potential to broaden learning access whilst preserving behaviour change technique fidelity. However the acceptability of this approach and viability of adapting resources in this way is yet to be established. This paper reports on the process of converting an existing group programme (“What Should We Tell the Children?”) and tests the acceptability within a community setting.

Methods

Translation of the original programme included selecting exercises and gathering user feedback on character and message framing preferences. For acceptability testing, parents were randomised to either the game (n = 106) or a control (non-interactive webpage) condition (n = 76). At time 1 all participants completed a survey on demographics, computer literacy and Theory of Planned Behaviour (TPB) items. Post intervention (time 2) users repeated the TPB questions in addition to acceptability items. Interviews (n = 17) were conducted 3 months post intervention to gather qualitative feedback on transfer of learning into real life.

Results

The process of conversion identified clear preferences for first person role play, home setting and realistic characters alongside positively phrased feedback. Evaluation results show that the game was acceptable to parents on cognitive and emotional dimensions, particularly for parents of younger children. Acceptability was not influenced by baseline demographics, computer skills or baseline TPB variables. MANOVA analysis and qualitative feedback suggest potential for effective translation of learning into real life. However attrition was more likely in the game condition, potentially due to feedback text volume.

Conclusions

A manualised group programme can be viably converted into a serious game format which is both cognitively and emotionally acceptable. The intervention may be more effectively targeted at parents with younger children, and further game developments must particularly address information dosing. Establishing the viability of digitally converting a group programme is a significant step forward for implementation focused research.

Maternidade na adolescência: indicadores emocionais negativos e fatores associados em mães de 14 a 16 anos em Porto Alegre, RS, Brasil

Verificou-se a prevalência de indicadores emocionais negativos e fatores associados em 430 mães adolescentes de 14 a 16 anos de Porto Alegre, RS. Foram estudadas variáveis sociodemográficas, relações sociais e familiares, aspectos reprodutivos, abuso e violência. As razões de prevalência (RP) foram obtidas por regressão de Poisson mediante análise hierarquizada. A prevalência de sofrimento psíquico intenso foi 32,6%, estando associado à baixa classe social, à não repetência escolar, ao relacionamento ruim com a mãe, à não aceitação da gestação pelo parceiro e à falta de apoio da família frente à gestação. A prevalência de autovalorização negativa foi 15,4%, permanecendo associada ao relacionamento ruim com a mãe e a não possuir uma pessoa confidente. Pouca ou nenhuma expectativa em relação ao futuro foi encontrada em 7,5% das adolescentes, estando associada à repetência escolar, à criação pela mãe biológica, à idade precoce da primeira relação sexual e à ocorrência de abuso físico. A alta prevalência de sofrimento psíquico, encontrada nas mães adolescentes, merece atenção especial das políticas públicas de saúde para a inclusão de profissionais habilitados ao manejo dos aspectos emocionais no atendimento da maternidade precoce.

Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda

Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers.

Qualitative evaluation of the Teenage Mothers Project in Uganda: a community-based empowerment intervention for unmarried teenage mothers

Background

A large proportion of unmarried teenage mothers in Uganda face physical, psychological, and social problems after pregnancy and childbirth, such as obstetric complications, lack of education, and stigmatisation in their communities. The Teenage Mothers Project (TMP) in Eastern Uganda empowers unmarried teenage mothers to cope with the consequences of early pregnancy and motherhood. Since 2000, 1036 unmarried teenage mothers, their parents, and community leaders participated in economic and social empowerment interventions. The present study explored the changes resulting from the TMP as well as factors that either enabled or inhibited these changes.

Methods

Semi-structured interviews (N = 23) were conducted with former teenage mothers , community leaders, and project implementers, and lifeline histories were obtained from former teenage mothers (N = 9). Quantitative monitoring data regarding demographic and social characteristics of teenage mother participants (N = 1036) were analysed.

Results

The findings suggest that, overall, the TMP seems to have contributed to the well-being of unmarried teenage mothers and to a supportive social environment. It appears that the project contributed to supportive community norms towards teenage mothers’ position and future opportunities, increased agency, improved coping with early motherhood and stigma, continued education, and increased income generation by teenage mothers. The study findings also suggest limited change in disapproving community norms regarding out-of-wedlock sex and pregnancy, late active enrolment of teenage mothers in the project (i.e., ten months after delivery of the child), and differences in the extent to which parents provided support.

Conclusions

It is concluded that strengths of the community-based TMP seem to be its socio-ecological approach, the participatory planning with community leaders and other stakeholders, counselling of parents and unmarried teenage mothers, and the emphasis on education and income generation. The project can improve by earlier active participation of unmarried pregnant adolescents and increased support for parents.