Adolescent childbearing ambivalence: is it the sum of its parts?

Background: This study was conducted to compare the utility of methods of assessing ambivalent attitudes about childbearing that require deductive reasoning by the subject to methods that do not. The goal was to predict the intent to use a noncoital method of contraception during adolescence.

Design: Participants (N=340) in a racially and ethnically diverse population (white 20%, black 25%, Hispanic 55%) completed two scales concerning attitudes toward childbearing-a traditional Likert scale and a scale with positive, negative, and "I go back and forth" response choices.

Depression, weight gain, and low birth weight adolescent delivery: do somatic symptoms strengthen or weaken the relationship?

Objective: To determine if omission of the Center for Epidemiologic Studies Depression Scale (CES-D) items that assess the somatic symptoms of depression improves the psychometric properties of the scale and utility of the CES-D diagnosis of depression for predicting four adverse obstetrical outcomes that have been tentatively linked to maternal depression.

Methods: A cohort of 1684 13-21-year-old participants in an adolescent-oriented maternity program completed the CES-D at enrollment. Chi-square analyses were used to compare the predictive capacity of depression diagnosed by the full CES-D and the 14-item non-somatic subscale of the CES-D.

Trends in illness severity and length of stay in inner-city adolescents hospitalized for pelvic inflammatory disease.

Background: In 1998, the Centers for Disease Control and Prevention (CDC) changed their guidelines for treatment of adolescents with pelvic inflammatory disease (PID), no longer recommending hospitalization of all teenagers.

Study Objectives: (1) To determine the proportion of adolescents with PID who were admitted for failed outpatient treatment after the CDC guideline change. (2) To determine if adolescents admitted for PID after the guideline change needed longer hospital stays and/or were more likely to be "very ill" [as measured by inflammation markers, e.

Age at menarche and first pregnancy among psychosocially at-risk adolescents.

We sought to determine which factors influence the association between menarche and conception among adolescent study participants (n = 1030), who demonstrated an earlier age of menarche than did national samples. Age at first sexual intercourse (coitarche) mediated the relationship between age at menarche and first pregnancy among White girls, whereas gynecologic age at coitarche (age at coitarche minus age at menarche) and age at menarche explained the timing of the first pregnancy among Black and Hispanic girls. Pregnancy prevention interventions to delay coitarche should also include reproductive education and contraception.

Association of conventional goals and perceptions of pregnancy with female teenagers' pregnancy avoidance behavior and attitudes.

Context: Fostering conventional goals is a key component of pregnancy prevention interventions for teenagers. However, research has not shown whether having goals independently influences sexual behavior, or whether the perception that pregnancy represents an impediment to achieving goals mediates any association.

Methods: In 1999-2001, a racially mixed group of 351 sexually experienced female teenagers who were inadequate contraceptive users completed surveys about goals, the anticipated impact of childbearing on these goals, and protective behaviors and attitudes.

Reasons for ineffective contraceptive use antedating adolescent pregnancies: part 2: a proxy for childbearing intentions.

Purpose: Compare the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes in a group of early/middle adolescents versus a group of late adolescents (specifically high school seniors, high school graduates, and GED certificate recipients).

Methods: The reasons given by a racially/ethnically diverse group of 1,568 pregnant 13-18 year olds for not using contraception were used to classify their pregnancies as intended or unintended. Proportion comparison tests and stepwise logistic regression analyses were used to study the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes.

Reasons for ineffective contraceptive use antedating adolescent pregnancies part 1: an indicator of gaps in family planning services.

Purpose: Identify new ways to increase the impact of pregnancy prevention interventions on the number of children born to adolescents.

Methods: The study participants, a racially/ethnically diverse group of 1,568, pregnant 13-18 year olds, reported why they had not used contraception at the time of conception. Their explanations were sorted into categories.

Feasibility and utility of screening adolescent mothers for Chlamydia at their children's health care visits.

Purpose: Assess the feasibility of offering and barriers to accepting urine-based screening for Chlamydia trachomatis (CT) among asymptomatic adolescent mothers during their children's health care visits.

Method: Providers were automatically cued to offer CT-screening to 13 through 21 year old mothers when they opened the child's medical record. Recording the mothers' screening decisions removed the flag for 6 months.

Characteristics of adolescent women who stop using contraception after use at first sexual intercourse.

Study Objective: Identify correlates of contraceptive discontinuation, which if modified, might make teenagers more, not less, effective contraceptors as they age.

Setting: Teen clinic.

Participants: Teenagers who used contraception at first intercourse (N = 120).

Maternal age and the size of White, Black, Hispanic, and mixed infants.

Objective: To clarify the interaction between maternal age and race in the prediction of infant size at birth.

Methods: Birth certificate data was used to study the relationship between maternal age, race/ethnicity, and the size of term, singleton infants born to 91,061 healthy, non-smoking, non-substance using, primigravidas.

Results: Maternal race/ethnicity (Black race: OR: 1.

Cervicitis: to treat or not to treat? The role of patient preferences and decision analysis.

Purpose: Mucopurulent cervicitis is neither a sensitive nor a specific indicator of antibiotic sensitive infection. This analysis examines the positive and negative ramifications of treating cervicitis empirically as a Chlamydial (CT) infection. It begins where prior analyses leave off, with the number of cases of pelvic inflammatory disease (PID) prevented.

Having the best intentions is necessary but not sufficient: what would increase the efficacy of home visiting for preventing second teen pregnancies?

Objective: Identify ways to increase the impact a well-known home-based intervention--the Nurse Family Partnership (NFP)--has on conception rates among teenage mothers.

Methods: Secondary analysis of data collected on 111, 13-to-19 years old, primiparas who were visited in their homes by nurses during, and for 2 years after pregnancy. Data bearing on assistance with family and career planning were culled from the nurses' records.

Teen contraceptive decisions: childbearing intentions are the tip of the iceberg.

Objective: To validate a model we developed while trying to understand why pregnant teens so often report that they did not want to become pregnant and could have obtained contraceptives before they conceived.

Method: The study enrolled a racially/ethnically diverse group of 351 teenagers. Participants completed a questionnaire that asked about teen pregnancy risk factors, the expected effects of childbearing, the desire to remain non-pregnant, deterrents to contraceptive use, and contraceptive plans.

Why lightning strikes twice: postpartum resumption of sexual activity during adolescence.

Purpose: To describe the circumstances surrounding the postpartum resumption of sexual activity in a cohort of teenage mothers. The goal was to shed new light on the reasons why teenagers who have just given birth put themselves at risk for conception.

Methods: A racially and ethnically diverse group of 267 poor, predominantly unmarried, primiparous, 13-21 year olds was enrolled consecutively at delivery and followed through the third postpartum month.

Adolescent pregnancy: do expectations affect intentions?

Objective: To establish the relationship between expectations about the effects of childbearing on specific aspects of life and the strength of the desire to remain nonpregnant during adolescence. We hypothesized that the absence of negative childbearing expectations is associated with an increase in the odds that sexually active, inadequately contracepting teenage girls are cognitively susceptible to conception.

Method: A racially and ethnically diverse group of 351 nulligravida, inadequately contracepting teenagers was studied.

The Electronic Report on Adolescent Pregnancy (ERAP).

Purpose: To create a data management system that: (1) standardizes antecedent, program, and outcome variables relevant to the shared goals of adolescent-oriented maternity programs while allowing users to add variables pertaining to unique aspects of their work; (2) cues providers to physiologic and psychosocial characteristics that predispose teenagers to adverse pregnancy and parenting outcomes, (3) standardizes patient care by guiding providers through adolescent-oriented prenatal, postpartum, and well baby visits, and (4) establishes the infrastructure to collect data from a nationally representative sample of pregnant and parenting teens.

Method: We adapted a powerful, state-of-the-art relational database framework (Microsoft Access 2000) to create an easy-to-use data management system-The Electronic Report on Adolescent Pregnancy (ERAP)-that requires minimal training to use on a personal computer.

Results: ERAP is designed to meet the administrative and analytic needs of adolescent-oriented maternity programs.

Paradoxical adolescent reproductive decisions.

Objective: To determine why teenagers who say they do not plan to parent if they become pregnant fail to use contraceptives consistently enough to avoid conceiving by default.

Methods: A racially diverse group of 333 inadequately contracepting, nulligravida teens, 45 (13.5%) of whom did not plan to parent if they became pregnant was studied.

Teen home pregnancy test takers: more worried or more wishful?

Objective: To test the hypothesis that teenagers who have taken home pregnancy tests are more ambivalent about remaining nonpregnant than those who have not and, for this reason, use contraceptives less consistently.

Methods: A racially diverse group of 340 inadequately contracepting, nulligravida teens, 94 (28%) of whom had taken a home pregnancy test, was studied. At enrollment, participants completed a self-administered questionnaire, were counseled about contraceptive options, and were given the opportunity to initiate their method of choice.

Is this patient insulin resistant? How much does it matter?

Alex was an obese 10-year-old girl with a family history of type 2 diabetes, hypertension, and perhaps polycystic ovarian syndrome. Her physical examination was significant for a central accumulation of body fat and acanthosis nigricans. Although the laboratory studies indicated that Alex was not diabetic and probably not glucose intolerant, she could be insulin resistant (IR).