New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women.

OBJECTIVES: To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner. METHODS: Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner. RESULTS: The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% CI 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78) CONCLUSIONS: Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.

A profile of adolescent females with a history of sexual assault in texas: familial environment, risk behaviors, and health status.

STUDY OBJECTIVE: To describe the prevalence and correlates of sexual assault among adolescent females. DESIGN: A cross-sectional study. SETTING: A university family planning clinic in south Texas. PARTICIPANTS: Female adolescents <18 years who initiated care at a university family planning clinic in south Texas between June 28, 1992, and April 28, 1994. The adolescents' lifetime sexual assault experience. MAIN OUTCOME MEASURES: Of the 791 adolescents interviewed, 167 (21%) reported a history of sexual assault. Sexual assault was found to be highly associated with multiple risky behaviors and depressive symptoms. Among assaulted adolescents, nonsexual risk behaviors (e.g., substance use) were more common among those who also experienced physical assault than among those who did not. Sexual risk behaviors (e.g., earlier age at sexual debut) and related gynecological infections (e.g., STDs) were more prevalent among women reporting forced sexual intercourse than in those who reported molestation only. Furthermore, adolescents assaulted by a stranger had participated in the most risky behaviors and reported the worst health status, while those assaulted by a date/acquaintance reported higher rates of inconsistent condom use and gynecological infections but lower rates of substance use and depressive symptoms than those assaulted by a family member. CONCLUSION: A deeper understanding of the links between the characteristics of assault, risk behaviors, and health conditions may provide opportunities to design more individualized interventions.

Exposure to violence and associated health-risk behaviors among adolescent girls.

OBJECTIVE: To examine the relationship between exposure to violence and health-risk behaviors. DESIGN: Cross-sectional survey. SETTING: University-based outpatient family planning clinic. PATIENTS: Sexually active adolescent girls younger than 18 years (N = 517) who presented for contraceptive care. MAIN OUTCOME MEASURES: Prevalence of witnessing or experiencing violence and the associations with health-risk behaviors, including high-risk sexual behaviors, substance use, and self-injury. RESULTS: Compared with adolescents who had not been exposed to violence, those who had only witnessed violence were 2 to 3 times more likely to report using tobacco and marijuana, drinking alcohol or using drugs before sex, and having intercourse with a partner who had multiple partners. Those who had experienced, but not witnessed violence were at increased risk of these same behaviors and were 2 to 4 times more likely than those who had neither witnessed nor experienced violence to report early initiation of intercourse, intercourse with strangers, multiple partners, or partners with multiple partners, tobacco, alcohol and drug use, or to have positive test results for a sexually transmitted disease. Individuals who had both witnessed and experienced violence demonstrated the greatest risk of adverse health behaviors. These adolescents demonstrated 3 to 6 times greater risk of suicidal ideation (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.2-4.0) or suicide attempts (OR, 4.5; 95% CI, 2.2-9.4), self-injury (OR, 5.8; 95% CI, 2.6-12.9), and use of drugs before intercourse (OR, 6.2; 95% CI, 3.0-12.9) than those who had neither witnessed nor experienced violence. CONCLUSIONS: Adolescents exposed to violence are at increased risk of multiple adverse health behaviors. Programs designed to improve health outcomes should target this high-risk group.

The behavioral risks and life circumstances of adolescent mothers involved with older adult partners.

OBJECTIVE: To investigate behavioral risks and life circumstances of adolescent mothers with older (> or =5 years) adult (> or =20 years old) vs. similar-aged (+/-2 years) male partners at 12 months' postpartum. METHODS: Nine hundred thirty-one adolescent females were interviewed after delivery and were mailed surveys to complete at 12 months' postpartum. Analysis by chi(2) and t test was used to identify differences in behavioral risks (planned repeated pregnancy, substance use, and intimate partner violence) and life circumstances (financial status, school enrollment, and social support) for adolescent mothers with older adult vs similar-aged partners. Additional stratified analyses were conducted to evaluate the extent to which living with an adult authority figure or being with the father of her infant born 12 months previously might alter observed relationships. RESULTS: At 12 months following delivery, 184 adolescent mothers (20%) reported having an older adult partner, whereas 312 (34%) had a similar-aged partner. The remaining adolescent mothers (n = 239) were excluded from further analyses. Adolescent mothers with older adult partners were significantly less likely to be employed or enrolled in school and were more likely to report planned repeated pregnancies. These adolescent mothers also received less social support. No differences were observed in intimate partner violence or the mother's substance use. Adolescent mothers with older adult partners who did not live with an adult authority figure seemed to be at greatest risk. CONCLUSIONS: The negative educational and financial impact of coupling with an older vs. similar-aged partner seems greater for those mothers who no longer reside with an adult authority figure. These adolescent mothers are also at greater risk of planned rapid repeated pregnancy. Given their limited educational attainment and family support, a subsequent pregnancy may place these young women at considerable financial and educational disadvantage.

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.

A case-control study of anatomic changes resulting from sexual abuse.

OBJECTIVE: Our goal was to identify vulvar and hymenal characteristics associated with sexual abuse among female children between the ages of 3 and 8 years. STUDY DESIGN: Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetration and 200 children who denied prior abuse. Bivariate analyses were conducted by chi(2), the Fisher exact test, and the Student t test to assess differences in vulvar and hymenal features between groups. RESULTS: Vaginal discharge was observed more frequently in abused children (P =.01). No difference was noted in the percentage of abused versus nonabused children with labial agglutination, increased vascularity, linea vestibularis, friability, a perineal depression, or a hymenal bump, tag, longitudinal intravaginal ridge, external ridge, band, or superficial notch. Furthermore, the mean number of each of these features per child did not differ between groups. A hymenal transection, perforation, or deep notch was observed in 4 children, all of whom were abused. CONCLUSION: The genital examination of the abused child rarely differs from that of the nonabused child. Thus legal experts should focus on the child's history as the primary evidence of abuse.

Flunitrazepam: more than a date rape drug.

STUDY OBJECTIVE: To evaluate the independent relationship between depressive symptoms. self-esteem. and drug resistance self-efficacy, and future intentions to use flunitrazepam. DESIGN: Cross-sectional survey. SETTING: Community-based family planning clinics. PARTICIPANTS: 865 sexually active women who self-identified as Caucasian. African-American. or Mexican American. denied using flunitrazepam in the last 12 months and reported intentions to use or not use this substance in the next 12 months. INTERVENTIONS: None. MAIN OUTCOME MEASURE: An anonymous self-report measure assessed the patient's intentions to use flunitrazepam in the next 12 months: other lifetime drug use: and standardized measures of depression. self-esteem, and drug resistance self-efficacy. We hypothesized that future potential users of flunitrazepam would exhibit an increased number of depressive symptoms, lowered self-esteem, and limited drug resistance self-efficacy. RESULTS: Of the 865 subjects. 16 (1.8%) reported using flunitrazepam in their lifetime but not in the last 12 months. and 46 (5.3%) were identified as potential users. Logistic regression analyses controlling for confounding factors found that potential to use flunitrazepam was significantly associated with limited drug resistance self-efficacy (adjusted odds ratio [AOR] = 9.3) and the presence of both severe depressive symptoms and lowered self-esteem (AOR = 3.2). CONCLUSIONS: These data suggest that young women with severe depressive symptoms and diminished self-esteem are at high risk for future flunitrazepam use and may use this drug to self-medicate psychological distress.

Ethnic differences in depressive symptomatology among young women.

OBJECTIVE: To examine racial and ethnic differences in moderate to severe depressive symptoms among young women seeking reproductive health care. METHODS: Nine hundred four white, black, or Hispanic women between 14 and 26 years of age completed an anonymous questionnaire that assessed demographic and reproductive characteristics; recent substance use, including binge drinking; sexual behaviors; occurrence of assault; and depressive symptoms. Logistic regression analysis was used to develop adjusted odds ratios (OR) and 95% confidence intervals for correlates of depressive symptomatology for each racial or ethnic group. RESULTS: Twenty-one percent (68 of 321) of whites, 28% (88 of 316) of blacks, and 29% (77 of 267) of Hispanics reported moderate to severe depressive symptoms. White females with moderate to severe depressive symptoms were more likely to report sexual assault (OR = 3.1); being a high school dropout (OR = 2.6); unemployment (OR = 2.4); two or more episodes of binge drinking (OR = 2.1); and having a mother with less than a high school education (OR = 2.4). Black females with depressive symptoms were more likely to report smoking one to nine cigarettes per day (OR = 3.5); sexual assault (OR = 3.2); and unemployment (OR = 2.1). Hispanic females with depressive symptoms were more likely to report adolescent age (OR = 3.5); physical assault (OR = 3.2); and smoking one or more cigarettes per day (OR = 2.4). CONCLUSION: Twenty to 25% of young women, regardless of race or ethnicity, have moderate to severe depressive symptoms, and behavioral markers vary according to ethnicity.

Immediate recall of oral contraceptive instructions: implications for providers.

OBJECTIVE: The object of the study was to determine the patient characteristics associated with inadequate recall of oral contraceptive pill-taking instructions. STUDY DESIGN: Sexually active women aged 13 to 40 years (n = 150) attending university-based family planning clinics completed anonymous self-report measures that assessed demographic and reproductive characteristics, understanding of pill-taking instructions, and contraceptive compliance. Logistic regression was used to determine factors associated with inadequate recall for the sample, stratified by minority versus nonminority women. RESULTS: Minority women with inadequate recall were almost 6 times more likely than minority women with adequate recall not to know the name of the prescribed oral contraceptive and were 3 times more likely to have less than a high school education. In addition there were 1-fold and 2-fold increases in likelihood of inadequate recall as certainty of pill-taking instructions and general oral contraceptive knowledge, respectively, decreased. Inadequate recall was associated with poor compliance. CONCLUSION: Women with inadequate recall may be identified at the conclusion of their visit so that interventions to enhance their pill-taking skills can be provided.

PIP: This study was conducted to determine the demographic, reproductive, and behavioral characteristics associated with inadequate recall of oral contraceptive (OC) pill-taking instructions among sexually active women aged 13-40 years who received care from a community-based family planning clinic in Galveston, Texas. Preliminary analyses revealed that factors associated with inadequate recall differed according to patients' race or ethnicity. Specifically, the pattern of significant demographic and reproductive characteristics, as well as pill-taking instruction behaviors did not differ when women of Black, Mexican American, and other non-White race or ethnicity were compared with each other. However, minority women with inadequate recall were almost 6 times more likely than minority women with adequate recall not to know the name of the prescribed OC and were 3 times more likely to have less than a high school education. Furthermore, there were one- and two-fold increases in likelihood of inadequate recall as certainty of pill-taking instructions and general OC knowledge decreased. Inadequate recall was associated with poor compliance. However, these findings suggest that poor compliance with OCs may be linked to the immediate recall of pill-taking instructions. Intensive specialized patient education is needed to improve these women's abilities to adequately understand how to take OCs.

Prevalence, patterns, and correlates of voluntary flunitrazepam Use.

OBJECTIVE: To determine prevalence, patterns, and correlates of voluntary flunitrazepam use in a sample of sexually active adolescent and young adult women 14 to 26 years of age. DESIGN: Cross-sectional survey. SETTING: University-based ambulatory reproductive health clinics. PATIENTS OR OTHER PARTICIPANTS: There were 904 women self-identified as white, African-American, or Mexican-American. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Lifetime, frequency, patterns, and physical effects of flunitrazepam use. RESULTS: Lifetime use was reported by 5.9% (n = 53) of subjects, with frequency of use ranging from 1 to 40 times. Flunitrazepam was taken most often with alcohol (74%), and 49% took this substance with other illicit drugs. Logistic regression analyses controlling for age and race/ethnicity found that users were significantly more likely than were nonusers to report lifetime use of marijuana (odds ratio [OR] = 3.6) or LSD (OR = 5.2), having a peer or partner who used flunitrazepam (OR = 21.7), pressure to use flunitrazepam when out with friends (OR = 2.7), and a mother who had at least a high school education (OR = 2.6). Finally, 10% of voluntary users reported experiencing subsequent physical or sexual victimization. CONCLUSIONS: Voluntary use of flunitrazepam is becoming a health concern to sexually active young women who reside in the southwestern United States. Young women who have used LSD or marijuana in the past or who have a peer or partner who used this drug appear to be at the greatest risk.

Date rape among adolescents and young adults.

BACKGROUND: Adolescents and young adults are four times more likely to be victims of sexual assault than women in all other age groups. In the vast majority of these cases, the perpetrator is an acquaintance of the victim. Date rape is a subset of acquaintance rape where nonconsensual sex occurs between two people who are in a romantic relationship. METHODS: We conducted a MEDLINE and Current Concepts search for articles relating to date rape and then systematically reviewed all relevant articles. RESULTS: Lifetime prevalence of date or acquaintance rape ranges from 13% to 27% among college-age women and 20% to a high of 68% among adolescents. Demographic characteristics that increase vulnerability to date rape include younger age at first date, early sexual activity, earlier age of menarche, a past history of sexual abuse or prior sexual victimization, and being more accepting of rape myths and violence toward women. Other risk factors include date-specific behaviors such as who initiated, who paid expenses, who drove, date location and activity, as well as the use of alcohol or illicit drugs such as flunitrazepam (Rohypnol). Alcohol use that occurs within the context of the date can lead to: the misinterpretation of friendly cues as sexual invitations, diminished coping responses, and the female's inability to ward off a potential attack. CONCLUSIONS: Longitudinal research designs are needed to further our understanding of sexual violence among adolescents and young adults and the most effective ways to eliminate it. Understanding and comparing research findings would be easier if consensus regarding the definitions of date rape, sexual aggression, and sexual assault was obtained. Finally, primary and secondary date and acquaintance rape prevention programs must be developed and systematically evaluated.

The rise and fall of levonorgestrel implants: 1992-1996.

OBJECTIVE: To assess shifts over a 4-year period in attitudes of low-income US women regarding use of levonorgestrel implants. METHODS: An anonymous questionnaire was administered at two different points in time to English-speaking women of reproductive age seeking gynecologic or obstetric care in southeast Texas. The first survey, administered to 762 women in 1992, elicited information on demographic and reproductive characteristics, as well as exposure to information on implants and attitudes regarding use of this method. This same survey was administered again in 1995-1996 to 502 women. chi2, Student t, or Kruskal-Wallis nonparametric tests were used to evaluate shifts in attitudes and perceived barriers to use across the 4-year period. RESULTS: Women portrayed less positive attitudes about levonorgestrel implants when surveyed in 1995-1996 as compared with 1992. Most notably, they appeared less appreciative of the convenience associated with implant use and more concerned with potential side effects. Nulliparous and parous women surveyed in 1995-1996 were significantly less likely than those surveyed in 1992 to state that they would consider using this method for birth control (P < .001) and were more likely to state that their partner, friends, and family would object to their use of levonorgestrel implants. CONCLUSION: This study documents the decline in popular perceptions of levonorgestrel implants among low-income English-speaking women over the 4-year period following the introduction of this contraceptive method to the US market.

Strategies to promote breast-feeding among adolescent mothers.

OBJECTIVE: To identify characteristics of adolescent mothers who bottle-feed who considered breast-feeding their infants and strategies to promote breast-feeding within this special group. DESIGN: Adolescents completed an hour-long interview within 48 hours of delivery that elicited factors considered important to the mother's feeding decision and indices of mental health. SETTING: Postpartum ward of university hospital. SUBJECTS: A total of 693 adolescents 18 years old or younger (mean age, 16.7 years) from African American, Mexican American, or white race or ethnicity; 27% of Mexican American participants spoke little or no English. MAIN OUTCOME MEASURES: Factors associated with breast-feeding decision. RESULTS: Those who chose bottle-feeding (hereafter, bottle-feeders) who had considered breast-feeding were first compared with bottle-feeders who had not considered breast-feeding and then with adolescents who breast-fed. After controlling for ethnicity, bottle-feeders who had considered breast-feeding were more likely than those who had not considered breast-feeding to be impoverished (adjusted odds ratio [AOR] = 4.8), to have delayed their feeding decision until the later stages of pregnancy (AOR = 4.6), to have been encouraged to breast-feed (AOR = 4.5), to have friends who breast-fed (AOR = 2.3), and to have experienced low financial, tangible, emotional, or informational support from their families (AOR = 1.6). They were more likely to cite barriers associated with breast-feeding while returning to school or work (AOR = 2.0) and less likely to state that bottle-feeding was healthier (AOR = 0.3) as reasons for bottle-feeding. Compared with those who chose breast-feeding (hereafter, breast-feeders), this group was more likely to have made the feeding decision alone rather than relying on advice (AOR = 4.6), to have made this decision in the later stages of pregnancy (AOR = 4.4), to report fewer breast-feeding role models (AOR = 1.8) and fewer significant others who encouraged breast-feeding (AOR = 2.8), and to report at least 2 significant others who encouraged bottle-feeding (AOR= 3.2). They were also less likely to have attempted to breast-feed a previous child (AOR = 3.3). CONCLUSIONS: A subgroup of adolescent mothers who had considered breast-feeding but ultimately chose to bottle-feed may be identified in the late stages of gestation by collecting information on financial status, family support, perceived barriers to breast-feeding and attending school or working, timing of the feeding decision, prior breast-feeding experience, breast-feeding role models, and encouragement to breast-feed. We speculate that strategies to promote breast-feeding should focus on role modeling and facilitation.

Prevalence and risk factors of chorioamnionitis among adolescents.

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.

Use of video eyeglasses to decrease anxiety among children undergoing genital examinations.

OBJECTIVE: Our purpose was to compare three techniques in their ability to decrease anxiety induced by the pelvic examination among children of different races. STUDY DESIGN: Eighty-nine subjects between 3 and 8 years old of white, African-American, and Hispanic race or ethnicity were randomly assigned to one of three distraction techniques that was used during the genital examination: passive play (being read to), active play (singing, blowing bubbles), or viewing a movie through video eyeglasses. Levels of vocalized distress, as well as distress expressed by physical behavior and emotional support requested, were directly observed and recorded. Children also reported their level of satisfaction at the end of the examination. Multivariate analysis of covariance was used to evaluate the independent effects of each technique and race while we controlled for confounding variables. RESULTS: Levels of physical distress were lowest among children who used video glasses and highest among those randomly assigned to passive play (p = 0.02). Children randomized to video glasses also expressed higher levels of satisfaction than those randomized to active (p = 0.001) or passive (p = 0.05) play. No differences associated with race or ethnicity were detected. CONCLUSION: This study demonstrates that video glasses are more effective than active or passive play in reducing anxiety and improving satisfaction levels among children undergoing a genital examination.

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

Employment and health-risk behaviors among pregnant adolescents.

STUDY OBJECTIVE: To compare health-risk behaviors, maternal, and neonatal outcomes of pregnant adolescents less than 18 years old who reported employment more than 15 hours per week with those who did not report working. We hypothesized that working teens compared with nonworking adolescents would report higher rates of health-risk behaviors. METHODS: A structured interview was conducted at the first prenatal visit and the medical chart was reviewed to extract pregnancy (pregnancy-induced hypertension, preterm labor with hospitalization, and preterm delivery) and neonatal outcomes (low birthweight, small for gestational age, and admission to the neonatal intensive care unit). The study was conducted at an outpatient maternal and child health clinic at a university teaching hospital. A total of 384 white (n=111), African American (n=151), and Mexican American (n=99) adolescents, aged 12 to 17 years, who initiated care between January 2, 1992, and December 31, 1994, and delivered an infant at our institution were consecutively sampled. A structured interview assessed various health-risk behaviors including age at first intercourse, substance use (tobacco, alcohol, and other illicit drug use), and number of sexual partners. Medical records were reviewed to obtain information on pregnancy complications (pregnancy-induced hypertension, preterm delivery, and preterm labor with hospitalization) and negative birth outcomes (infant birthweight and neonatal intensive care admission). RESULTS: Controlling for chronological age, logistic regression analyses found that adolescents reporting employment at their first prenatal visit (n=40) compared with those not employed at this visit (n=331) were more likely to be characterized by school enrollment, higher economic status, partner employment, partner alcohol use, and a longer relationship with the father of their baby. Multivariate logistic regression found that employed females were 4.6 times more likely to deliver a small-for-gestational-age infant. CONCLUSIONS: Employment reported at the time of the first prenatal visit does not appear to be associated with an increase in health-risk behaviors or obstetric complications, but a relationship between working more than 15 hours and small-for-gestational-age delivery was detected.

Factors associated with recent and discontinued alcohol use by pregnant adolescents.

PURPOSE: To determine easily identifiable risk factors that differentiate pregnant adolescents who report recent (past 30 days) alcohol use and those who discontinue use by their first prenatal visit from those who deny consuming alcohol altogether. METHODS: A structured interview was completed by 378 adolescents < or = 17 years of age as part of standard care at our institution's adolescent obstetric clinic between July 7, 1992, and December 28, 1994. Using Chi-square or Student's t-tests, unique risk factors associated with recent or discontinued alcohol use in pregnancy were separately identified by comparing demographic, reproductive, behavioral, and environmental factors among recent users (n = 43), discontinued users (n = 48), and adolescents who denied ever using alcohol (n = 108). Significant indicators were then entered into stepwise logistic regression analyses to determine the most efficient models for predicting alcohol use. RESULTS: Partner alcohol use and use of alcohol during sexual activities were important risk factors for alcohol use by pregnant adolescents. Recent alcohol users were also more likely to be Mexican-American, to have quit school, and to report recent tobacco use, while adolescents who stopped using alcohol during pregnancy were significantly more likely to have witnessed or been a victim of or known a victim of violence. CONCLUSIONS: Screening at the first prenatal visit for these unique and easily assessed factors will help clinicians identify adolescents at greatest risk for alcohol use during pregnancy.

Adverse perinatal outcomes in young adolescents.

OBJECTIVE: To determine whether pregnant adolescents < or = 15 years of age developed more perinatal complications than older adolescents or adult women. STUDY DESIGN: We conducted a study of 147 nulliparous adolescents < or = 15 years of age who initiated prenatal care at the University of Texas Medical Branch at Galveston between January 1, 1992, and April 27, 1994. For purposes of analyses, these patients were then compared to two groups: (1) all nulliparas between the ages of 16 and 17 (n = 287) and (2) those 20-22 years old (n = 107) who delivered an infant of > or = 20 weeks' gestation and initiated care during the same interval at this same facility. Chi-square, Kruskall-Wallis or Student's t test initially was used to identify differences between groups in demographic characteristics and perinatal complications. Logistic regression analyses were then performed to determine whether observed differences in outcomes remained while controlling for potentially confounding variables. RESULTS: Adolescents < or = 15 years of age were more likely to develop anemia and less likely to deliver an infant who required admission to the intensive care unit. No differences were observed between groups in the prevalence of pregnancy-induced hypertension, preterm labor, preterm premature rupture of membranes, chorioamnionitis, meconium staining, endometritis, preterm delivery, low birth weight, low Apgar score or fetal demise. CONCLUSION: Adolescents < or = 15 years of age experience perinatal outcomes similar to those of older adolescents and young adult women.

PIP: A study of 147 nulliparous adolescents 15 years of age or younger who sought prenatal care at the University of Texas Medical Branch at Galveston during 1992-94 investigated whether young adolescents were more likely to develop perinatal complications than older adolescents and adult women. 287 adolescents 16-17 years of age and 107 women 20-22 years old who delivered at the same facility during the study period were used for the comparison. Younger adolescents were significantly more likely to develop anemia and less likely to deliver an infant who required admission to the intensive care unit than their older counterparts. There were no differences between the three groups, however, in terms of the prevalence of pregnancy-induced hypertension, preterm labor, preterm premature rupture of membranes, chorioamnionitis, meconium staining, endometritis, preterm delivery, low birth weight, low Apgar score, or fetal death. This study suggests that young age is not an independent risk factor for most perinatal complications.