Amy Lewin

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment.

Prevalence of Obesity among Young Asian-American Children

BACKGROUND Asian-American children are considered to be at low risk of obesity, but previous estimates have not distinguished between children from different Asian countries. We estimate the prevalence of obesity among Asian-American children by mothers country of origin, generational status, and family socioeconomic factors using a secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) wave III (children ∼4 years old) dataset. METHODS The ECLS-B is a nationally representative study of children born in 2001 that oversampled births to Asian mothers. Asian ethnic categories included Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, and Other Asian/Pacific Islander. The primary outcome variable was weight status; overweight = BMI ≥85(th) and obese = BMI ≥95(th) percentile for age and gender. RESULTS Twenty-six percent [95% confidence interval (CI) 23.6-29.1] of Asian-American 4 year olds were overweight or obese, and 13% (95% CI 10.2-15.2) were obese. Chinese-American children were at lower risk of overweight or obesity (23.5%, 95% CI 18.4-29.5 ) compared to whites (36%, 95% CI 34.3-37.7); Asian-Indian 4 year olds had the lowest rates of overweight or obesity (15.6%, 95% CI 8.0-28.2) and were most likely to be underweight (10%, 95% CI 4.9-19.4). Among Asians,Vietnamese-American children had the highest rate of overweight or obesity (34.7%, 95% CI 0.6-52.3). CONCLUSIONS Vietnamese-American children are at elevated risk of obesity and overweight, whereas Chinese and Asian-Indian children are at low risk. After controlling for Asian ethnicity, maternal education, and household poverty status, Asian-American children whose mothers were born outside the United States were less likely to be obese [odds ratio = 0.55 (0.32-0.95), p = 0.03].

Developmental Differences in Parenting Behavior: Comparing Adolescent, Emerging Adult, and Adult Mothers

The nationally representative Early Childhood Longitudinal Study-Birth cohort data set was used to compare parenting behaviors of adolescent mothers (<19 years old), emerging adult mothers (19-25 years old), and adult mothers (>25 years old) when their children were 2 years old. Regression models controlling for socioeconomic differences indicate that adolescent mothers exhibited less supportiveness, sensitivity, and positive regard than emerging adult mothers, who exhibited less than adults. Adolescent and emerging adult mothers reported comparable frequencies of spanking and use of time out but significantly more than adults. Age differences in coparenting were largely accounted for by different rates of father coresidence. These finding suggest that age differences in parenting behaviors are not solely explained by sociodemographic factors, and that mothers who gave birth during the emerging adult period are a developmentally distinct group; overall, they are not as prepared for optimal parenting as older mothers but are better equipped than adolescent mothers.

Do Human and Social Capital Protect Young African American Mothers From Depression Associated With Ethnic Discrimination and Violence Exposure

Young minority mothers are particularly vulnerable to depression associated with community-level or contextual stressors such as violence exposure and ethnic discrimination. This study explores whether human and social capital act as buffers of the associations between such stressors and maternal depression. Among a sample of 230 urban, African American mothers, who were teenagers when their preschool-age children were born, both being a victim of violence and experiencing ethnic discrimination predicted increased depressive symptoms, and higher educational attainment predicted fewer symptoms. Ethnic identity moderated the association between witnessed violence and maternal depression, and community cohesion moderated the association between ethnic discrimination and depression. Social support protected against depressive symptoms associated with witnessed violence but seemingly exacerbated depression associated with victimization. The specific roles that forms of human and social capital play in moderating the effects of contextual stressors suggest the need for nuanced programmatic efforts to reduce maternal depression among young African American mothers living in violence-prone, urban neighborhoods.

Maternal Distress Explains the Relationship of Young African American Mothers’ Violence Exposure With Their Preschoolers’ Behavior

Adolescent mothers and their children are particularly susceptible to witnessing or directly experiencing violence. Such violence exposure predicts maternal distress, parenting, and child behavior problems. The current study examined how mothers’ depressive symptoms, aggression, harsh disciplinary practices, and home environment independently explain the association between mothers’ violence exposure and children’s externalizing and internalizing behavior, controlling for their children’s violence exposure. Data were collected from 230 African American mothers living in Washington, DC who gave birth as adolescents and whose children were 3 to 5 years old. Path analysis revealed that the effect of mothers’ experienced violence on children’s externalizing and internalizing behavior was mediated by mothers’ depressive symptoms and aggression. However, neither harsh discipline nor stimulation in the home environment acted as significant mediators, and there were no direct or indirect effects of mothers’ witnessed violence on child behavior. This study builds on previous work by identifying an association between maternal violence exposure and children’s behavior, independent of children’s own violence exposure that is explained by mothers’ increased distress but not their parenting. These findings suggest that a potential means of preventing behavior problems in minority children born to adolescent mothers is to identify mothers who have been directly exposed to violence and treat their depressive symptoms and aggressive behaviors.

Patterns and Predictors of Involvement Among Fathers of Children Born to Adolescent Mothers

Father involvement may be an important support for children born to adolescent mothers. This study examines patterns and predictors of father involvement, as reported by adolescent mothers, from their childs infancy through toddlerhood. Data were collected from urban, primarily African American, adolescent mothers (N = 138) in four interviews, over a 24-month period. The percentage of fathers categorized as “highly involved” decreased significantly from baseline to 12-month follow-up and was stable through 24 months. The romantic status of the mother–father relationship was the strongest predictor of whether father involvement was consistently high, consistently low, or decreased over time.

Strengthening Positive Coparenting in Teen Parents: A Cultural Adaptation of an Evidence-Based Intervention

Teen childbearing is associated with a range of adverse outcomes for both mothers and children, and perpetuates an intergenerational cycle of socioeconomic disadvantage. Fathers may be an underappreciated source of support to teen mothers and their children. The strongest and most consistent predictor of positive father involvement is a positive coparenting relationship between the mother and father. Thus, strengthening the coparenting relationship of teen parents may be protective for both parents and children. This paper describes the rationale, the intervention model, and the cultural adaptation of Strong Foundations, an intervention designed to facilitate and enhance positive coparenting in teen parents. Adapted from an evidence-based coparenting program for adult, cohabiting parents, this intervention was modified to be developmentally and culturally appropriate, acceptable, and feasible for use with urban, low-income, minority expectant teen mothers and their male partners. The authors present lessons learned from the cultural adaptation of this innovative intervention. Pilot testing has shown that this model is both acceptable and feasible in this traditionally hard to reach population. Although recruitment and engagement in this population present specific challenges, young, urban minority parents are deeply interested in being effective coparents, and were open to learning skills to support this goal.

Coparenting in Teen Mothers and Their Children's Fathers: Evidence From the Early Childhood Longitudinal Study–Birth Cohort

OBJECTIVE (1) To describe coparenting among adolescent mothers and the biological fathers of their children. (2) To examine the effects of coparenting on young childrens social-emotional development and whether these effects vary by fathers residence status, parental education, and child characteristics. METHODS Secondary analysis was conducted with the Early Childhood Longitudinal Study-Birth Cohort, which is a nationally representative sample of U.S. children born in 2001. The subsample used in this study includes 400 children whose biological mothers, aged 15-19, participated when their children were 2 years and 4 years old and whose biological fathers (residential and nonresidential) participated at 4 years. Cooperative coparenting and coparenting conflict were measured at child age 2 years. Childrens social skills and problem behavior were measured at child age 4 years. RESULTS Mother- and father-reported coparenting conflict were associated with child behavior problems, more strongly among boys (b = 1.31, P < .01) than girls (b = -0.13, P > .05). Mother-reported coparenting conflict also predicted lower child social skills (b = -1.28, P < .05); the association of father-reported coparenting conflict with social skills was moderated by child race and father education. CONCLUSIONS Coparenting conflict between adolescent parents influences child adjustment. Practitioners working with teen mothers should encourage father participation at medical visits and other clinical contacts and should address the relationship between the parents, whether or not they are living together, as part of routine care.

Parental Nurturance and the Mental Health and Parenting of Urban African American Adolescent Mothers

This study examined the relationship between a teen mothers perceptions of nurturance from her mother and father and her mental health and parenting attitudes. One-hundred and thirty-eight urban, primarily African American adolescent mothers were interviewed. Multivariate results indicate that teen mothers who felt nurtured by their mothers had greater empathy toward their own children, and those who felt nurtured by their fathers reported greater parenting satisfaction. These findings support the importance of interventions that include supporting nurturing parenting of adolescent mothers by their mothers and their fathers.

Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting

Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.