The Impact of Childhood Adversity on Life Course Alcohol Use Patterns and Health Status Among People Living with HIV.

Adverse childhood experiences (ACEs) and financial hardship are associated with increased likelihood of heavier alcohol use and health challenges in adulthood among persons living with HIV (PWH). We examined whether retrospectively captured lifetime drinking trajectories are a pathway through which childhood hardships affect current health in a sample of 365 adult PWH. Childhood economic hardship and ACEs were used as main predictors. Measures of alcohol use included age at first drink and lifetime drinking trajectories. Health indicators included health-related quality of life, frailty, number of comorbidities, and symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). Structural equation modeling (SEM) was applied to estimate both direct and indirect pathways between childhood hardship and physical and mental health. Participants were mostly male; Black (84%); and averaged 48 years of age. SEM results supported both direct and indirect pathways between childhood experiences and adult health. ACEs were connected to physical health directly and mental health both directly and indirectly through age at first drink and drinking heaviness during ages 10-20. Childhood economic hardship related to mental health indirectly through higher drinking levels during ages 10-20. Childhood adverse experiences, economic hardship, and early drinking patterns appear to accumulate, resulting in later life physical and mental health concerns for PWH. Findings support taking a life course approach to health. This includes considering individual trauma histories in HIV care engagement and taking preventative approaches which support the economic and social well-being of vulnerable children to improve health in subsequent decades.

Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial.

BACKGROUND: Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. METHODS: Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. RESULTS: Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. CONCLUSION AND RELEVANCE: The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.

Patterns and correlates of substance use among young adult African American women.

Patterns and correlates of substance use among urban African American young women (ages 18-19, n = 459) were examined. Four patterns were identified: no/infrequent alcohol and marijuana use (64.9%); recent alcohol only use (18.2%); recent marijuana only use (7.9%); and recent alcohol and marijuana use (9.0%). Having a recent male sexual partner and a history of sexual coercion were associated with increased odds of marijuana-only and dual use. Greater family support and childhood sexual abuse were associated with increased odds of alcohol-only use. Results suggest that sexual relationships and history of abuse/coercion are important factors in young African American women's substance use.

HIV Stigma, Mental Health, and Alcohol Use Disorders among People Living with HIV/AIDS in New Orleans.

Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use disorders among PLWH. Furthermore, no studies have examined this relationship within the larger context of urban life stressors. The purpose of this study was to examine associations of an overall HIV-related stigma measure and four HIV stigma subscales on depression, anxiety, and hazardous drinking among a sample of 380 PLWH in New Orleans. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by urban life stressors. Overall, higher levels of HIV-stigma were associated with depressive symptoms (RR 1.67, 95% CI 1.25, 2.23), anxiety symptoms (RR 1.91, 95% CI 1.17, 3.12), and hazardous drinking (RR 1.45, 95% CI 1.02, 2.05). Internalized HIV-stigma (measured using the negative self-image subscale) was associated with all three outcomes and had the highest magnitude point estimates across the four stigma subscales. Urban life stressors, measured by the Urban Life Stressors Scale (ULSS), modified the association between HIV-related stigma and mental health and alcohol use disorders (P < 0.2), highlighting the importance for examining the larger urban environmental context. Findings from this study may inform interventions to reduce HIV-related stigma operating at the individual and structural level.

Latent Alcohol Use Typologies and Health Status Among a Cohort of Adults Living with HIV.

AIMS: To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. METHODS: Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heavy drinking, intoxication, withdrawal and dependence symptoms, alcohol-related problems and past contact with alcohol use treatment were drawn from validated scales. Physical and mental health measures included SF-36 subscales, medication non-adherence and anxiety, depressive and post-traumatic stress disorder symptoms. Latent class analysis was conducted to characterize alcohol drinking typologies. Logistic and ordinary least-squares regression were employed to test associations between alcohol use and health status. RESULTS: Four latent classes were identified: heavy drinkers (36%), former heavy drinkers (14%), heavy drinkers with problems (12%) and low-risk drinkers/abstainers (38%). Controlling for background characteristics, low-risk drinkers/abstainers showed significantly better health compared to heavy drinkers with problems across most domains. Although current and former heavy drinkers without alcohol-related problems were similar to heavy drinkers with problems in most health domains, they presented worse mental health and energy compared to low-risk drinkers/abstainers. CONCLUSIONS: Heavy drinkers with alcohol-related problems evidenced the worst health status among PLWH, and should be considered for mental and physical health interventions. However, interventions to improve physical and mental health of PLWH should consider history of heavy alcohol use, as current alcohol use status alone may be insufficient for identifying groups at increased risk.

Tobacco advertising/promotions and adolescents' smoking risk in Northern Africa.

BACKGROUND: Comprehensive tobacco advertising/promotion bans are effective against adolescent smoking but many developing countries have implemented only partial bans. This study examines the association between advertising/promotions exposure and adolescent cigarette smoking risk in North Africa, and possible mediation of this association by parent and peer smoking. METHODS: Adolescent data (n=12 329) from the Global Youth Tobacco Survey were analyzed (Libya, 2007; Egypt, 2005; Morocco, 2006; Tunisia 2007; and Sudan, 2005). Current smoking (any cigarette use in the past 30 days) and never-smokers' initiation susceptibility (composite of openness to accepting a cigarette from a friend and intention to start smoking in the next year) outcomes were examined. Advertising/promotion exposures included media and in-person contacts. Weighted univariate, bivariate and multivariable analyses were conducted. RESULTS: Current smoking prevalence ranged from 5.6% (Egypt) to 15.3% (Tunisia) among boys, and 1.1% (Libya and Egypt) to 2.0% (Morocco and Sudan) among girls. Initiation susceptibility ranged from 14.1% (Sudan) to 25.0% (Tunisia) among boys, and from 13.3% (Sudan) to 15.0% (Libya) among girls. Ninety-eight percent of adolescents reported exposure to at least one type of advertising/promotion. In multivariable analyses adjusting for demographics, each type of advertising/promotion was significantly and positively associated with boys' current smoking status; most advertising/promotion exposure types were also positively associated with initiation susceptibility among boys and girls. Peer smoking only partially mediated these associations. CONCLUSIONS: Tobacco advertising/promotion exposure was highly prevalent and associated with adolescents' smoking risk in these countries. The comprehensiveness and enforcement of advertising/promotion bans needs to be enhanced.

Academic performance, educational aspiration and birth outcomes among adolescent mothers: a national longitudinal study.

BACKGROUND: Maternal educational attainment has been associated with birth outcomes among adult mothers. However, limited research explores whether academic performance and educational aspiration influence birth outcomes among adolescent mothers. METHODS: Data from Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) were used. Adolescent girls whose first pregnancy occurred after Wave I, during their adolescence, and ended with a singleton live birth were included. Adolescents' grade point average (GPA), experience of ever skipping a grade and ever repeating a grade, and their aspiration to attend college were examined as predictors of birth outcomes (birthweight and gestational age; n = 763). Univariate statistics, bivariate analyses and multivariable models were run stratified on race using survey procedures. RESULTS: Among Black adolescents, those who ever skipped a grade had higher offspring's birthweight. Among non-Black adolescents, ever skipping a grade and higher educational aspiration were associated with higher offspring's birthweight; ever skipping a grade was also associated with higher gestational age. GPA was not statistically significantly associated with either birth outcome. The addition of smoking during pregnancy and prenatal care visit into the multivariable models did not change these associations. CONCLUSIONS: Some indicators of higher academic performance and aspiration are associated with better birth outcomes among adolescents. Investing in improving educational opportunities may improve birth outcomes among teenage mothers.

Neighborhood disadvantage, racial concentration and the birthweight of infants born to adolescent mothers.

To study the relationship between neighborhood demographic characteristics (disadvantage, racial concentration) and the birthweight of infants born to adolescent mothers, potentially as mediated by smoking, prenatal care use, or perceptions of neighborhood safety. Data from Waves I and IV of the National Longitudinal Survey of Adolescent Health were analyzed. Birthweight (continuous) and low birthweight (<2.5 kg) of singleton infants born to non-Hispanic Black and non-Hispanic White adolescent mothers (<20 years) after Wave I were examined as outcomes. Neighborhood demographic characteristics included Census Block Group socioeconomic disadvantage and Black racial concentration. Possible mediators (smoking during pregnancy, early initiation of prenatal care, and perceptions of safety) were also examined. Controls for adolescent baseline age, age at pregnancy, body mass index (BMI) and parental education were included. Analyses were run stratified on race. Baseline continuous birthweight, BMI and neighborhood demographics varied significantly between non-Hispanic Black and White adolescent mothers, with Black adolescent mothers evidencing lower birthweight and higher BMI, neighborhood disadvantage and Black racial concentration. In multivariable analyses among Black adolescent mothers, Black racial concentration was positively associated with birthweight, and negatively associated with low birthweight; no mediators were supported. Neighborhood disadvantage and Black racial concentration were unassociated with birthweight outcomes among White adolescent mothers. Infants born to Black adolescent mothers evidenced higher birthweight with increasing Black neighborhood concentration. Further exploration of mechanisms by which Black racial concentration may positively impact birthweight is warranted.

Predictors of birth weight and gestational age among adolescents.

Although pregnant adolescents are at high risk of poor birth outcomes, the majority of adolescents go on to have full-term, healthy babies. Data from the National Longitudinal Study of Adolescent Health, a longitudinal study of a nationally representative sample of adolescents in grades 7-12 in the United States who were surveyed from 1994-1995 through 2008, were used to examine the epidemiology of preterm birth and low birth weight within this population. Outcomes of pregnancies were reported by participants in the fourth wave of data collection (when participants were 24-32 years of age); data were compared between female participants who reported a first singleton livebirth at less than 20 years of age (n = 1,101) and those who were 20 years of age or older (n = 2,846). Multivariable modeling was used to model outcomes; predictors included demographic characteristics and maternal health and behavior. Among black adolescents, low parental educational levels and older age at pregnancy were associated with higher birth weight, whereas low parental educational levels and being on birth control when one got pregnant were associated with higher gestational age. In nonblack adolescents, lower body mass index was associated with lower birth weight, whereas being unmarried was associated with lower gestational age. Predictors of birth outcomes may differ by age group and social context.

Lifetime Alcohol Use Trajectories and Health Status Among Persons Living with HIV (PLWH).

OBJECTIVE: We characterized lifetime drinking trajectories among persons living with HIV (PLWH) and examined how trajectories are related to health. METHOD: Adults (ages 20-71) were recruited between 2015 and 2017 for a cohort study examining the impact of alcohol use on geriatric comorbidities in PLWH in New Orleans. The New Orleans Alcohol Use in HIV (NOAH) Study (n = 356; 68.8% male) included in-person interviews, anthropometric measurements, and biospecimen collection. Average monthly drinks per decade of life was derived from participants' reported average quantity and frequency of alcoholic beverages for each decade. Health indicators included CD4 count, viral load, health-related quality of life, frailty, comorbidities, body mass index, heavy drinking, anxiety, depression, and posttraumatic stress disorder. Participants also reported lifetime experiences with homelessness and incarceration. Latent curve modeling was applied in MPlus to derive lifetime drinking trajectories. Latent trajectory parameters were modeled as predictors of physical, mental, and social health, controlling for demographics. RESULTS: Alcohol consumption increased significantly between the teen years and midlife (31-40), declining thereafter through ages 50-60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10-20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking. CONCLUSIONS: Understanding lifetime alcohol consumption patterns is important in addressing physical and mental health among adult PLWH.

Early adolescent sexual initiation and physical/psychological symptoms: a comparative analysis of five nations.

Although most people in developed countries experience sexual initiation during adolescence, little is known about inter-country variability in the psychosocial correlates of early initiation. Population-based samples of 15-year-olds (n = 6,111, 52% female) who participated in the Health Behaviors in School-Aged Children Study (Finland, Scotland, France and Poland, 1997/1998) or the National Longitudinal Study of Adolescent Health (United States, 1996) self-reported sexual intercourse experience and physical (headaches, trouble sleeping) or psychological (unhappiness, loneliness, sadness, moodiness) symptoms. Analyses were conducted stratified by gender. Sexual initiation prevalence and symptoms scores varied significantly across nations. In adjusted models, sexual initiation was not related to symptoms among boys in any nation, but significantly positively related to symptoms among girls in Poland and the US. Results support variability by gender and nation in the relationship between adolescents' sexual initiation and physical/psychological symptoms. Empirically investigating specific features of national contexts that generate these differences should be explored further.

Area disadvantage and intimate partner homicide: an ecological analysis of North Carolina counties, 2004-2006.

Using data from the North Carolina Violent Death Reporting System and other sources, we examined ecologic relationships between county (n = 100) disadvantage and intimate partner homicide (IPH), variability by victim gender and county urbanicity, and potential mediators. County disadvantage was related to female-victim homicide only in metropolitan counties (incidence rate ratio [IRR] 1.25); however, disadvantage was associated with male-victim IPH regardless of county urbanicity (IRR 1.17). None of the potential intervening variables examined (shelter availability, intimate partner violence services' funding) was supported as a mediator. Results suggest disparities across North Carolina counties in IPH according to county disadvantage. Future research should explore other potential mediators (i.e., service accessibility and law enforcement responses), as well as test the robustness of findings using additional years of data.

Sources of Help for Dating Violence Victims: A Qualitative Inquiry Into the Perceptions of African American Teens.

Although teen dating violence victims' reticence in seeking help from adults is well documented, little is known about youths' comparative perceptions of the types of help offered by and effectiveness of various sources. This qualitative study solicited teens' perceptions of sources of help for victims using in-depth interviews with African American youth (ages 13-18) in two public high schools in New Orleans (N = 38). Participants were recruited purposively by researchers during lunchtime and via referral by school personnel. Interviews were transcribed verbatim and coded independently by two study team members. Thematic content analyses were conducted. Teens reported that victims were most likely to seek help from friends, who were largely expected to provide advice and comfort. Nearly half reported that teens would be likely to seek help from family, who would provide more active responses to dating violence (i.e., reporting to authorities, confronting the abuser). Fewer respondents believed teens would seek help from other adults, such as school personnel, who were also perceived as likely to enlist outside authorities. Fears about lack of confidentiality and over-reaction were the main perceived barriers to accessing help from adults. Furthermore, although respondents believed teens would be less likely to seek help from adults, adults were perceived as more effective at stopping abuse compared with peers. Interventions that train peer helpers, explain confidentiality to teens, increase school personnel's ability to provide confidential counseling, and promote use of health services may improve access to help for teen dating violence victims.

Parental Influences on Heavy Episodic Drinking Development in the Transition to Early Adulthood.

PURPOSE: The purpose of this study was to examine how parental relationship quality (communication frequency, time spent together, and closeness) during early adulthood is related to heavy episodic drinking (HED) during this developmental period and whether effects vary according to age, youth sex, or parent sex. METHODS: National data from the Panel Study of Income Dynamics-Transition to Adulthood Study were analyzed. Youth participated in up to four interviews (2005, 2007, 2009, and 2011; n = 1,320-1,489) between ages 18-25 years. At each wave, respondents reported past-year HED and their communication frequency, time spent, and closeness with each parent (items combined into an index). We tested differences in parental effects by age, parent sex, and youth sex using multigroup latent curve models. RESULTS: Paternal relationship quality was negatively associated with HED for both males and females at each age; associations did not vary by respondent age or sex (odds ratio [OR] = .73, 95% confidence interval [CI]: .63-.85). Maternal relationship quality was significantly negatively associated with HED at ages 18-19 years among both sexes equally (OR = .50, 95% CI: .41-.61). Although protective associations continued until the age of 25 years for males, they weakened and became nonsignificant at ages 20-25 years for females (OR = .87, 95% CI: .72-1.04). Findings were robust to inclusion of multiple covariates associated with both parenting and alcohol use. CONCLUSIONS: Having close, communicative parental relationships seems protective against HED in early adulthood, although for females maternal effects appear limited to late adolescence. Programs to improve relationship quality between young adults and their parents may help curb problematic drinking during this vulnerable period.

Preconception Nutrition, Physical Activity, and Birth Outcomes in Adolescent Girls.

STUDY OBJECTIVE: Recommendations for preconception care usually include optimal nutrition and physical activity, but these have not been tested extensively for their relationship with birth outcomes such as low birth weight and preterm birth. DESIGN: Data from Waves I, II, and IV of the National Longitudinal Study of Adolescent Health (Add Health) contractual dataset were used. METHODS: In Wave I in-home interview, participants were asked to recall their frequency of having 5 types of food on the previous day, including milk, fruit, vegetables, grains, and sweets. At Wave II, participants reported the previous day's intake of 55 items, and results were categorized into high-calorie sweet, high-calorie nonsweet, and low-calorie food. At Wave I in-home interview, participants were also asked how many times in a week or during the past week they were involved in types of physical activity. At Wave IV, female participants reported pregnancies and birth outcomes. Multivariable linear regression analysis with survey weighting was used to predict birth weight and gestational age. RESULTS: There were no associations between reported food intake and birth outcomes. Girls who engaged in more episodes of active behavior had higher birth weights (P < .01), but hours of sedentary behavior was not associated with birth weight. Multivariable analysis also indicated a U-shaped association between BMI and birth weight (P for quadratic term = .01). CONCLUSION: Adolescents who are more physically active before pregnancy have more positive birth outcomes as represented by birth weight.

Perceived Discrimination and Heavy Episodic Drinking Among African-American Youth: Differences by Age and Reason for Discrimination.

PURPOSE: The purpose of this study was to examine whether associations between perceived discrimination and heavy episodic drinking (HED) vary by age and by discrimination type (e.g., racial, age, physical appearance) among African-American youth. METHODS: National data from the Panel Study of Income Dynamics Transition to Adulthood Study were analyzed. Youth participated in up to four interviews (2005, 2007, 2009, 2011; n = 657) between ages 18 and 25 years. Respondents reported past-year engagement in HED (four or more drinks for females, five or more drinks for males) and frequency of discriminatory acts experienced (e.g., receiving poor service, being treated with less courtesy). Categorical latent growth curve models, including perceived discrimination types (racial, age, and physical appearance) as a time-varying predictors of HED, were run. Controls for gender, birth cohort, living arrangement in adolescence, familial wealth, parental alcohol use, and college attendance were explored. RESULTS: The average HED trajectory was curvilinear (increasing followed by flattening), whereas perceived discrimination remained flat with age. In models including controls, odds of HED were significantly higher than average around ages 20-21 years with greater frequency of perceived racial discrimination; associations were not significant at other ages. Discrimination attributed to age or physical appearance was not associated with HED at any age. CONCLUSIONS: Perceived racial discrimination may be a particularly salient risk factor for HED around the ages of transition to legal access to alcohol among African-American youth. Interventions to reduce discrimination or its impact could be targeted before this transition to ameliorate the negative outcomes associated with HED.

Pre-Pregnancy Dating Violence and Birth Outcomes Among Adolescent Mothers in a National Sample.

Although infants born to adolescent mothers are at increased risk of adverse birth outcomes, little is known about contributors to birth outcomes in this group. Given past research linking partner abuse to adverse birth outcomes among adult mothers, we explored associations between pre-pregnancy verbal and physical dating violence and the birth weight and gestational age of infants born to adolescent mothers. Data from the National Longitudinal Study of Adolescent Health Waves I (1995/1996), II (1996), and IV (2007/2008) were analyzed. Girls whose first singleton live births occurred after Wave II interview and before age 20 (N = 558) self-reported infants' birth weight and gestational age at Wave IV. Dating violence victimization (verbal and physical) in the 18 months prior to Wave II interview was self-reported. Controls included Wave I age, parent education, age at pregnancy, time between reporting abuse and birth, and childhood physical and sexual abuse. Weighted multivariable regression models were performed separately by race (Black/non-Black).On average, births occurred 2 years after Wave II interview. Almost one in four mothers reported verbal dating violence victimization (23.6%), and 10.1% reported physical victimization. Birth weight and prevalence of verbal dating violence victimization were significantly lower in Black compared with non-Black teen mothers. In multivariable analyses, negative associations between physical dating abuse and birth outcomes became stronger as time increased for Black mothers. For example, pre-pregnancy physical dating abuse was associated with 0.79 kilograms lower birth weight (p< .001) and 4.72 fewer weeks gestational age (p< .01) for Black mothers who gave birth 2 years post-reporting abuse. Physical dating abuse was unassociated with birth outcomes among non-Black mothers, and verbal abuse was unassociated with birth outcomes for all mothers. Reducing physical dating violence in adolescent relationships prior to pregnancy may improve Black adolescent mothers' birth outcomes. Intervening on long-term violence may be particularly important.

Parent-child relationships, parental attitudes towards sex, and birth outcomes among adolescents.

STUDY OBJECTIVE: To examine how parent-child relationships, parental control, and parental attitudes towards sex were related to pregnancy outcomes among adolescent mothers. DESIGN: Prospective cohort study. Parental report of relationship satisfaction, disapproval of adolescent having sex, discussion around sexual health, and sexual communication attitudes, and adolescent report of relationship satisfaction, parental control, and parental disapproval of sex were examined as predictors of self-reported birth outcomes. Weighted multivariable linear regression models were run incorporating interactions by race. SETTING: United States. PARTICIPANTS: 632 females who participated in Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health), a nationally-representative sample of students enrolled in grades 7-12 in 1994-95 and followed up in 2007-2008. MAIN OUTCOME MEASURES: Birthweight and gestational age. RESULTS: For Black adolescents, better parent-child relationship was associated with higher birthweight (0.14 kg, P < .05) and gestational age (0.75 weeks, P < .01), while higher parental disapproval of having sex (adjusted beta 0.15 kg, P < .05) were associated with higher birthweight. For non-Black adolescents, a moderate amount of discussion of birth control was associated with higher birthweight (0.19 kg, P < .01 and lower child-perceived parental disapproval of having sex was associated with higher birthweight (0.08 kg, P < .05) and gestational age (0.37 weeks, P < .05). Higher parental control was associated with a reduced likelihood of smoking during pregnancy and a greater likelihood of early prenatal care. CONCLUSION: Parent-child relationships and attitudes about sex affect outcomes of pregnant adolescents.

Macro-level age norms for the timing of sexual initiation and adolescents' early sexual initiation in 17 European countries.

PURPOSE: To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. METHODS: Nationally representative data from 17 countries that participated in the 2006/2007 European Social Survey (ESS-3, n = 33,092) and the 2005/2006 Health Behaviour in School-Aged Children Study (HBSC, n = 27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16 years) self-reported age at sexual initiation, which we defined as early (<15 years) or not early (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. RESULTS: In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR .60, 95% CI .45-.79); associations with ESI were stronger for parent cohort (ages 31-65 years) norms (AOR .37, 95% CI .23-.58) than for peer cohort (ages 15-20 years) norms (AOR .60, 95% CI .49-.74). For boys, overall norms were also significantly negatively associated with ESI (AOR .68, 95% CI .46-.99), as were parent cohort norms (AOR .66, 95% CI .45-.96). Peer cohort norms were not significantly related to boys' ESI. CONCLUSION: Macrolevel cultural norms may impact adolescents' sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted.

The association between prepregnancy parental support and control and adolescent girls' pregnancy resolution decisions.

PURPOSE: To examine the influence of prepregnancy parental support and control on adolescent girls' pregnancy resolution decisions. METHODS: Data from the National Longitudinal Study of Adolescent Health were analyzed. Girls whose first pregnancy reported in wave IV occurred after wave I and before age 20 were included (n = 1,107). Participants self-reported pregnancy disposition (abortion, ectopic or tubal pregnancy, miscarriage, stillbirth, live birth) for each pregnancy; responses were dichotomized as abortion versus other. Girls' perceptions of parental support and control were measured at wave I. Controls were included for wave I age, age at pregnancy, year at the end of pregnancy, race/ethnicity, and parent characteristics (i.e., education, religious affiliation, age at first marriage, and educational expectations). Weighted multivariable logistic regression models were performed. RESULTS: Approximately 18% of girls reporting a teen pregnancy reported having an abortion. In crude analyses, parental support was marginally negatively related to abortion (odds ratio [OR] = .83, p = .06) and parental control was significantly negatively related to abortion (OR = .78, p = .02). In multivariable analyses, higher parental control was significantly negatively related to abortion versus other pregnancy outcomes (adjusted OR .80, 95% confidence interval .66-.98). Perceived parental support was unassociated with pregnancy resolution decisions. The only other factor associated with abortion decisions was parent education: odds of choosing abortion versus other pregnancy outcomes were significantly higher for adolescent girls whose parents had a bachelor's degree or greater versus those with lower educational attainment. CONCLUSIONS: Pregnant adolescents with less educated parents or parents exercising greater control were less likely to have an abortion.