Early maternal depressive symptom trajectories: Associations with 7-year maternal depressive symptoms and child behavior.

This study examines potential mechanisms linking maternal depressive symptoms over 2 years postpartum with child behavior problems at school-age in a sample of adolescent mothers and their first-born child. Potential mechanisms include: mother-reported caregiving engagement at 6 months; observed parental nurturance and control, and child competence and affect at 24 months; and mother-reported resilience at 7 years based on achievement of adult developmental tasks. One hundred eighteen low-income African American adolescent mothers were recruited at delivery and followed through child age 7 years. Maternal depressive symptom trajectories over 24 months were estimated (low, medium, and high) based on mother-reported depressive symptoms. Direct and indirect associations between depressive symptom trajectories with 7-year maternal depressive symptoms and child behavior problems were examined. The high maternal depressive symptom trajectory was associated with 7-year maternal depressive symptoms (b = 5.52, SE = 1.65, p < .01) and child internalizing problems (b = 7.60, SE = 3.12, p = .02) and externalizing problems (b = 6.23, SE = 3.22, p = .05). Caregiving engagement among high depressive symptom trajectory mothers was significantly associated with observed child affect (b = -0.21, SE = 0.11, p = 0.05). Parental nurturance in toddlerhood mediated the association between high maternal depressive symptom trajectory and child internalizing problems at 7 years (indirect effect b = 2.33, 95% CI: 0.32-5.88). Findings suggest that family based interventions to promote parenting and adolescent resiliency strengthening may be beneficial in this population. (PsycINFO Database Record

Prenatal drug exposure and peer victimization in early adolescence: testing childhood anxiety/depression and aggression as possible mediators.

OBJECTIVE: Children who are prenatally exposed to drugs may be at risk for emotion dysregulation, including childhood anxiety/depression and aggression, potentially increasing their risk for peer victimization. The objectives of this study were to investigate how prenatal drug exposure relates to adolescent peer victimization and the mediating effects of childhood anxiety/depression and aggression. METHODS: Seventy-six prenatally drug exposed (PDE) and 38 nonexposed (NE) adolescent-caregiver dyads followed since birth and middle childhood, respectively, participated in an evaluation during adolescence. In middle childhood, caregivers reported on their child's anxiety/depression and aggression, and children reported on violence exposure. In adolescence, caregivers and adolescents responded to a parallel single-item measure of peer victimization. Analyses were conducted using multivariate linear and logistic regression models, adjusting for covariates, including violence exposure. RESULTS: One-third (33.3%, n = 35) of the sample endorsed peer victimization: 40.8% PDE and 17.6% NE, p = .01. In middle childhood, PDE youth had more aggressive behaviors (11.92 vs 7.45, p < .01) and anxiety/depression symptoms (3.43 vs 1.76, p < .01) than NE youth. Anxious/depressed behavior during childhood mediated the association between prenatal drug exposure and adolescent peer victimization. Aggression was not a significant mediator. CONCLUSIONS: The consequences of prenatal drug exposure extend into adolescence. Prenatal drug exposure may interfere with emotion regulation, resulting in anxious/depressed behavior during childhood and significantly increasing the risk for peer victimization during adolescence, even in the presence of violence exposure. Strategies to reduce anxious/depressed behavior among children with a history of prenatal drug exposure may reduce adolescent peer victimization.

African American adolescent mothers' early caregiving involvement and childrens' behavior and academic performance at age 7.

The United States continues to have the highest incidence of adolescent births among industrialized nations. This study used transactional and life span theories of development to examine whether caregiving patterns assessed over the first 24 months postpartum predicted children's behavior and academic achievement at 7 years. Participants included 120 primiparous, urban, low-income, African American adolescent mothers who participated in a randomized controlled trial of home intervention. Group-based trajectories were used to examine the pattern of caregiving involvement over time. Two distinct, consistent trajectories of caregiving involvement were found: maternal and shared. Maternal caregiving involvement over the first 24 months postpartum predicted positive child behavior and academic achievement at 7 years. In keeping with both transactional and life span theories, findings suggest that adoption of the parent role may lead to positive long-term outcomes for children of adolescent mothers.

Childhood maltreatment, emotional distress, and early adolescent sexual intercourse: multi-informant perspectives on parental monitoring.

This prospective investigation used multi-informant models to examine whether parental monitoring moderated associations between child maltreatment and either emotional distress or sexual intercourse. Data included 637 youth in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Child maltreatment was determined by lifetime Child Protective Service records and youth self-report and included sexual, physical, psychological abuse, and neglect (age 12). The moderating variable was youth- and caregiver-reported parental monitoring (age 12). Outcome variables were emotional distress (age 12) and sexual intercourse (age 14). Analyses included multi- and individual-informant models, adjusting for age, ethnicity/race, family income, and study site. Rates of parental monitoring did not differ by gender, but gender-specific analyses found that among girls, but not boys, youth-reported parental monitoring buffered the effect of maltreatment on emotional distress. Subtype analyses found that the buffering effects of monitoring on emotional distress were strongest for sexual and physical abuse and when youth experienced multiple subtypes of maltreatment. Caregiver-reported monitoring was not associated with reduced emotional distress. Youth and caregiver reports of parental monitoring were inversely associated with sexual intercourse, regardless of maltreatment history. Findings suggest that promoting parental monitoring among caregivers, and perceptions of monitoring among youth, may prevent early sexual intercourse regardless of maltreatment history. Promoting parental monitoring among youth with a history of maltreatment, especially girls or those who have experienced sexual or physical abuse or multiple subtypes of abuse, may reduce the likelihood of emotional distress.

Trajectories of adolescent mother-grandmother psychological conflict during early parenting and children's problem behaviors at age 7.

This study extends the determinants of parenting model to adolescent mothers by examining how adolescent mother-grandmother psychological conflict and perceptions of infant fussiness from birth through age 2 years relate to children's problem behaviors at age 7. Participants were 181 adolescent mother, child, and grandmother triads living in multigenerational households and recruited at delivery. Psychological conflict was characterized by two stable trajectories. In multivariate models that included maternal depression, both psychological conflict and perceptions of infant fussiness predicted externalizing behavior at age 7. Perceptions of infant fussiness, but not psychological conflict, predicted internalizing behavior at age 7.

Adolescent mothers' relationships with their own mothers: impact on parenting outcomes.

This study examined the relationship between mother-grandmother relationship quality and adolescent mothers' parenting behaviors using longitudinal multimethod, multi-informant data. Participants were 181 urban, African American adolescent mothers. Self-report data on mother-grandmother relationship conflict and depressive symptoms were collected after delivery and at 6-, 13-, and 24-month follow-up visits. Videotaped observations were used to measure mother-grandmother relationship quality at baseline. Mother-child interactions were videotaped at 6, 13, and 24 months to operationalize parenting. Mixed-model regression methods were used to investigate the relation between mother-grandmother relationships and mother-child interactions. Mother-grandmother relationship quality predicted both negative control and nurturing parenting. Mothers whose own mothers were more direct (both demanding and clear) and who reported low relationship conflict demonstrated low negative control in their parenting. Mothers who demonstrated high levels of individuation (a balance of autonomy and mutuality) and reported low relationship conflict showed high nurturing parenting. The implications of these findings for adolescent health and emotional development are discussed.

A seven-year investigation of marital expectations and marriage among urban, low-income, African American adolescent mothers.

Welfare reform has targeted marriage promotion among low-income women. This study explores patterns of marital expectations and marriage among 181 urban, low-income, African American adolescent mothers and their mothers. Using PROC TRAJ to analyze developmental trajectories of adolescent mother-grandmother relationship quality over 24 months, we categorized relationships as either high or low support. We examined the effects of intergenerational marriage models and adolescent mother-grandmother relationship quality on marital expectations and marriage over the first 7 years postpartum. At 24 months, half (52%) of adolescent mothers expected to marry, but marital expectations did not predict marriage. Marital expectations were associated with concurrent involvement in a romantic relationship, not intergenerational marriage models or a supportive adolescent mother-grandmother relationship. After 7 years, 14% of adolescent mothers were married. Married mothers lived in families characterized by the joint effects of intergenerational marriage models and supportive adolescent mother-grandmother relationships. They were older and had more children than did single mothers, suggesting that they were in a family formation phase of life. Policies that promote the education and employment opportunities necessary to support a family are needed.

Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers.

BACKGROUND: Maternal depressive symptomatology is an important public health issue with negative consequences for both mothers and infants. METHODS: This study examined prevalence and patterns of depressive symptoms among 181 urban, low-income, first-time, African American adolescent mothers recruited from urban hospitals following delivery. Follow-up evaluations were conducted at 6 (N=148; 82%) and 24 (N=147; 81%) month home visits. Depressive symptoms were measured with Beck Depression Inventory (BDI). RESULTS: Half of mothers (49%) had BDI scores >9 at baseline, with significant correlations between BDI scores across all visits (r=0.28-0.50). Depressive symptom trajectories analyzed using group-based trajectory modeling revealed three trajectories of depressive symptoms: Low (41%), Medium (45%), and High (14%). The high depressive symptom group reported lower self-esteem, more negative life events, and lower parenting satisfaction than the low and moderate depressive symptoms groups. LIMITATIONS: Depressive symptoms were self-reported and not verified with a clinical interview. Findings are limited to urban, low-income, African American adolescent mothers and may not be generalizable to other populations. CONCLUSIONS: The high prevalence and relative stability of depressive symptoms through 2years of parenting suggest the need for early identification and treatment of maternal depressive symptoms. Brief screening for maternal depressive symptoms conducted during pediatric well-child visits is a feasible and effective method for identifying mothers with depressive symptoms, however, screening measures can not differentiate between high and low levels of depressive symptoms. Brief intervention may be an effective treatment for mothers with mild symptoms of depression; mothers with moderate to severe symptoms may require more intensive intervention.

Sexual intercourse among adolescents maltreated before age 12: a prospective investigation.

OBJECTIVE: To examine whether child maltreatment (physical, emotional, and sexual abuse, and neglect) predicts adolescent sexual intercourse; whether associations between maltreatment and sexual intercourse are explained by children's emotional distress, and whether relations among maltreatment, emotional distress, and sexual intercourse differ according to gender. METHODS: The Longitudinal Studies of Child Abuse and Neglect was a multisite, longitudinal investigation. Participants ranged from at-risk to substantiated maltreatment. Maltreatment history was assessed through Child Protective Service records and youth self-report at age 12. Youth reported emotional distress by using the Trauma Symptom Checklist at the age of 12 years and sexual intercourse at ages 14 and 16. Logistic and multiple regressions, adjusting for gender, race, and site, were used to test whether maltreatment predicts sexual intercourse, the explanatory effects of emotional distress, and gender differences. RESULTS: At ages 14 and 16, maltreatment rates were 79% and 81%, respectively, and sexual initiation rates were 21% and 51%. Maltreatment (all types) significantly predicted sexual intercourse. Maltreated youth reported significantly more emotional distress than non-maltreated youth; emotional distress mediated the relationship between maltreatment and intercourse by 14, but not 16. At 14, boys reported higher rates of sexual intercourse than girls and the association between physical abuse and sexual intercourse was not significant for boys. CONCLUSIONS: Maltreatment (regardless of type) predicts sexual intercourse by 14 and 16. Emotional distress explains the relationship by 14. By 16, other factors likely contribute to intercourse. Maltreated children are at risk for early initiation of sexual intercourse and sexually active adolescents should be evaluated for possible maltreatment.

Low-income, African American adolescent mothers and their toddlers exhibit similar dietary variety patterns.

OBJECTIVE: To examine the relationship between maternal and toddler dietary variety. DESIGN: Longitudinal; maternal and toddler dietary data were collected at 13 months; anthropometry was collected at 13 and 24 months. SETTING: Data were collected in homes. PARTICIPANTS: 109 primiparous, low-income, African American adolescent mothers and toddlers. MAIN OUTCOME MEASURES: Maternal and toddler dietary variety and toddler obesity at 24 months. ANALYSIS: Correlations were computed to estimate associations between maternal and toddler dietary variety at 13 months; multiple logistic regression analyses were conducted to estimate associations between maternal and toddler diet and toddler growth. RESULTS: Maternal and toddler fruit, vegetable, snack, meat, dairy, and soda variety were significantly correlated. There was no association between maternal and toddler dietary variety and obesity at 24 months. Adolescent mothers who purchased groceries consumed more fruits and vegetables and provided more variety for their toddlers than those who relied on others to purchase groceries. CONCLUSIONS AND IMPLICATIONS: Adolescent mothers and toddlers exhibited similar dietary patterns; consuming more sweets and less fruits and vegetables than recommended. Toddlerhood is an optimal time to address healthful dietary patterns and to help adolescent mothers influence grocery purchasing decisions. Goals are to establish healthful dietary patterns and reduce pediatric obesity.

Adolescent mothers leaving multigenerational households.

This study examined how the developmental processes of autonomy and relatedness are related to changes in the residential status of 181 first-time, adolescent, urban, low-income, African American mothers over the first 24 months postpartum. Although adolescent mothers were eager to live independently, few made a clear transition out of the multigenerational household; 56% lived in the household of origin continuously (IN), 21% left and never returned (OUT), and 23% had multiple moves in and out of the household (IN/OUT). Older adolescent maternal age, less supportive adolescent mother-grandmother relations, and high household density were associated with leaving the household of origin. The IN/OUT group had difficulty adopting the roles of adult and parent. Helping adolescent mothers and grandmothers negotiate roles to reduce conflict may promote autonomy and relatedness, allowing mothers to learn parenting skills, qualify for public assistance, and continue their education.

The healthy eating index and youth healthy eating index are unique, nonredundant measures of diet quality among low-income, African American adolescents.

Chronic disease is related to poor diet quality. The Healthy Eating Index (HEI) was developed to assess diet quality. The Youth HEI (YHEI) is an adaptation of the HEI for use with children and adolescents. The objectives were to compare HEI and YHEI scores among adolescents at risk for chronic disease and to compare associations between the scores and health indicators. This cross-sectional study included 2 low-income, urban African American adolescent samples (Challenge, n = 196; Three Generation, n = 121). HEI and YHEI scores were calculated from a FFQ and compared with BMI, body composition, and micronutrient, energy, and dietary intakes. YHEI scores were lower than HEI scores across both adolescent samples (Challenge, 48.94 +/- 9.31 vs. 62.83 +/- 11.75; Three Generation, 47.08 +/- 9.65 vs. 59.93 +/- 11.27; P < 0.001). Females (64.47 +/- 11.70) had higher HEI scores than males (61.15 +/- 11.61) (P < 0.05), but there was no gender difference in YHEI scores. HEI and YHEI scores were associated with higher micronutrient and total energy intakes (r = 0.19-0.76; P < 0.05). Higher percent body/abdominal fat was associated with lower HEI scores (r = -0.17 to -0.19; P < 0.05) but not with YHEI scores. BMI was not associated with either HEI or YHEI scores. In conclusion, many adolescents were consuming diets that placed them at risk for developing chronic disease. Although both the HEI and YHEI are useful in assessing diet quality, the HEI is inversely associated with body composition, a predictor of chronic disease, and accounts for gender differences in the Dietary Guidelines, whereas the YHEI discounts nutrient-poor, energy-dense foods.

Participants' comments on changes in the revised special supplemental nutrition program for women, infants, and children food packages: the Maryland food preference study.

The Institute of Medicine recommended changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages to help families from diverse populations establish more healthful dietary patterns. A cross-sectional study conducted during summer 2007 included interviews and focus groups with 223 WIC participants throughout Maryland. The objectives were to examine participants' responses to food package changes, to identify racial/ethnic differences, and to assess costs. All participants (100%) consumed fruits and vegetables. They preferred fresh for taste, but many endorsed canned and frozen for convenience and cost. Most women (56%) and children (69%) consumed whole milk and did not want reduced-fat milk. Few participants (13%) consumed soy products and most were uninterested in future consumption. Participants endorsed whole-wheat bread as more healthful and reported that they (59%) and their children (51%) would increase consumption if provided by WIC. Non-Hispanic participants preferred peanut butter over beans, Hispanic participants reported that they (44%) and their children (57%) would consume more beans (substituting for peanut butter) if provided by WIC. There were few differences in preferences between African-American and white participants. Hispanics differed from non-Hispanics in preference for beans and dislike of frozen and canned vegetables, suggesting the importance of choices. The proposed food packages were cost-neutral, except when extensive substitutions with soy products were allowed. By providing fruits and vegetables, reduced-fat options, and increased opportunities for nutrition education, the revised food packages may reduce the risk of obesity among low-income women, infants, and children.

African American adolescent mothers and grandmothers: a multigenerational approach to parenting.

This study is an adaptation and extension of Apfel and Seitz's (Family Relations, 40(4), 421-429, 1991) models of adolescent parenting and adolescent-grandmother relationships to a sample of 148 African American, first-time adolescent mothers and their 6-month-old infants. The Parental Supplemental model, in which adolescent mothers and grandmothers shared caregiving, described 63% of Apfel and Seitz's (1991) sample and 66% of the current sample. Shared caregiving was not associated with conflict in the adolescent mother-grandmother relationship. Adolescent mothers who had caregiving responsibilities and a supportive adolescent-grandmother relationship also reported competence in their parenting role. Findings provide support for Apfel and Seitz's Parental Apprentice model, in which young mothers gain competence through direct caregiving experience in the context of a supportive relationship.