Violence in the lives of young women: clinical care and management.

Millions of female children, adolescents, and young adults from all socioeconomic segments of society will experience physical or sexual violence perpetrated by someone close to them at some point in their lives. Knowledge of risk factors and sequelae associated with interpersonal violence, and of specific screening tools and procedures designed to detect violence, can help clinicians identify potential victims of assault. Careful management and referral of victims is critical. The use of anticipatory guidance to prevent physical and sexual violence is also advised.

Pregnant adolescents: experiences and behaviors associated with physical assault by an intimate partner.

OBJECTIVE: To better understand the experiences and behaviors of battered pregnant adolescents and the characteristics of their intimate partners. METHODS: As part of a longitudinal multiracial/ethnic study of drug use among pregnant and parenting adolescents, 724 adolescents < or = 18 years of age completed face-to-face interviews on the postpartum unit between April 1994 and February 1996. Adolescent mothers reported on demographic characteristics, social support and peer contact, level of substance use before and during pregnancy, nonconforming behaviors, and both lifetime and concurrent exposure to violence. Information about the father of her baby included his level of substance use, gang and police involvement, and intimate partner violence. Chi-square and Student's t tests were used to identify victim, partner, and relationship characteristics associated with being assaulted by the father of her baby during the preceding year. RESULTS: Eighty-six (11.9%) adolescents reported being physically assaulted by the fathers of their babies. Assaulted adolescents were significantly more likely than nonassaulted adolescents to have been exposed to other forms of violence over the same 12-month period, including verbal abuse, assault by family members, being in a fight where someone was badly hurt, reporting fear of being hurt by other teens, witnessing violence perpetrated on others, and carrying a weapon for protection. A history of nonconforming behavior and frequent or recent substance use was more common among both battered adolescents and their perpetrator partners. The age and race/ethnicity of the pregnant adolescent and the length of her relationship with the father of her baby were not associated with assault status. CONCLUSIONS: Pregnant adolescents who are assaulted by intimate partners appear to live in violence-prone environments and to have partners who engage in substance use and other nonconforming behaviors. Comprehensive assessments are critical for all adolescent females at risk of assault, and direct questions about specific behaviors or situations must be used.

Racial/ethnic differences in the decision to breastfeed among adolescent mothers.

OBJECTIVE: To identify racial/ethnic differences in prevalence and the factors that influence decisions to breastfeed among adolescent mothers. METHODS: A total of 696 Mexican-American, African-American, and Caucasian adolescent mothers

Factors associated with adolescents' risk for late entry into prenatal care.

Risk factors for late entry into prenatal care were examined among 533 pregnant adolescents younger than 18. Forty-seven percent entered prenatal care after 12 weeks' gestation. Logistic regression analysis indicated that adolescents who no longer had contact with their baby's father were 4.2 times as likely as those who did to enter prenatal care after the first trimester. Adolescents with no history of abortion were 3.2 times as likely to enter care late as those who had had an abortion. Young women who had not used alcohol in the last 30 days and those with only one sex partner in the last 12 months were more likely than adolescents exhibiting riskier behavior to receive care late (odds ratios of 2.7 and 1.6, respectively). Odds of late entry into care were also elevated for those who were unemployed (1.9), black or white (1.9 and 1.7, respectively) and less educated (1.2).

PIP: As many as 55% of pregnant US adolescents enter prenatal care late or not at all. This study investigated the risk factors associated with delayed entry into prenatal care in 533 low-income pregnant adolescents under 18 years of age (mean age, 15.9 years) who presented to a hospital-based adolescent obstetric clinic in Galveston, Texas, in 1992-94. 24% reported a previous pregnancy and 6% had had an abortion. The average gestational age at presentation for prenatal care was 14.6 weeks. 280 adolescents (53%) entered care at 12 weeks or earlier; the remaining 253 (47%) initiated care in the second (n = 199) or third trimester (n = 54). Logistic regression analysis indicated that adolescents who no longer had contact with the baby's father were 4.2 times (95% confidence interval (CI), 2.0-8.6) as likely as those with such contact to enter prenatal care after the first trimester. Those with no history of abortion were 3.2 times (95% CI, 1.7-6.0) as likely to enter care late as those with an abortion history. Teens who had not used alcohol in the 30 days preceding the survey were 2.7 times (95% CI, 1.3-5.7) while those with only 1 sex partner in the last 12 months were 1.6 times (95% CI, 1.1-2.4) more likely than those with riskier behaviors to receive care late. The odds of late entry were also elevated among unemployed teens (1.9; 95% CI, 1.1-3.5) and those with lower educational attainment (1.2; 95% CI, 1.04-1.4). Finally, compared with Mexican Americans, Blacks were 1.9 times (95% CI, 1.2-3.2) and Whites were 1.7 times (95% CI, 1.1-3.0) as likely to enter care late. The need for early entry to prenatal care should be stressed whenever adolescents come into contact with the health care system as well as in school-based health education courses.

Prevalence and correlates of psychopathology in pregnant adolescents.

PURPOSE: To investigate the prevalence and correlates of psychopathology, as measured by the Youth Self-Report Scale, in pregnant adolescents so that interventions during pregnancy may be tailored to treat the psychopathology and thereby improve maternal and child outcomes. METHODS: Scores on seven psychologic syndromes (withdrawn, delinquent, aggressive behaviors; anxiety/depression; and social, thought, and attention problems) were compared for groups of pregnant adolescents (n = 185), never pregnant teenagers (n = 126), and previously published normative samples of clinically referred (n = 518) and nonreferred (n = 518) female adolescents using chi-square, Student's t-tests, analysis of covariance, or multiple logistic regression. Correlates of psychopathology were identified for the pregnant sample using odds ratios and 95% confidence limits. RESULTS: Pregnant adolescents exhibited less serious or lower rates of psychopathology than groups against which they were compared. Correlates of psychopathology included substance use during pregnancy, prior assault, maternal childbirth before age 18 years, ethnicity, > or = 3 sexual partners, and absence of a relationship with the baby's father. CONCLUSIONS: Although the prevalence of psychopathology was lower among pregnant patients, those who exhibit psychopathology are likely to engage in risky health behaviors that contribute to poor perinatal outcome.