Mary Jane Lohr

Drug use among adolescent mothers: prepregnancy to 18 months postpartum.

PURPOSE Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

Substance use and other factors associated with risky sexual behavior among pregnant adolescents.

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.

Repeat pregnancies among adolescent mothers.

To better understand the factors associated with rapidly repeated pregnancies among teenagers who experience nonmarital births the authors estimated a multivariate event history model containing both proximate and distal determinants of repeated pregnancies. 170 young women who had had repeated nonmarital pregnancies within the span of 18 months participated in the study. Subjects were under age 18 years at enrollment and from lower- to middle-income families recruited from social and health services agencies in an urban area of the Northwest. 49% were White 29% were Black and 22% were from other racial groups including Native American Asian American and Latina. The women were interviewed at 5 points from pregnancy through 18 months postpartum. Contraceptive use and frequency of intercourse were important predictors of repeated pregnancy in both univariate and multivariate models. A history of school problems drug use fighting living with parents length of relationship with boyfriends best friends experiencing pregnancies and age at first birth were also significant determining factors.

Original articleDrug use among adolescent mothers: Prepregnancy to 18 months postpartum

PURPOSE Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers. METHODS A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews. RESULTS Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use. CONCLUSIONS The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

Impact of childhood trauma on the outcomes of a perinatal depression trial

Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment‐seeking, pregnant, low‐income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT‐B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow‐up time points for women within UC, but not for those within IPT‐B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure.

The Prevalence and Correlates of Depressive Symptoms Among Adolescent Mothers: Results from a 17-Year Longitudinal Study

The objective of the authors in this study was to examine the prevalence and correlates of elevated depressive symptoms in a 17-year cohort study of 173 women who were unmarried, pregnant adolescents between June 1988 and January 1990. Multiple logistic regression was used to estimate the associations between correlates and elevated depressive symptoms during five distinct developmental periods of the life course. Depressive symptoms were measured by the Brief Symptom Inventory depression subscale. The prevalence of elevated depressive symptoms in adolescent mothers significantly increased over the 17 years of the study from 19.8% to 35.2%. In adjusted analyses, antenatal depressive symptoms were positively and significantly associated with elevated depressive symptoms at every developmental period. Intimate partner violence was positively and significantly associated with elevated depressive symptoms during all but one developmental period. Other significant correlates of elevated depressive symptoms included welfare receipt, smoking, and parity, all of which were significant at some, but not other, developmental periods. Antenatal depressive symptoms and intimate partner violence were positively and significantly associated with elevated depressive symptoms. Given the public health consequences associated with maternal depression, clinical and community-based interventions should be developed to identify and to treat adolescent mothers at-risk for antenatal depression and intimate partner violence.

Factors related to substance use by pregnant, school-age adolescents

This study provides information on substance use among pregnant adolescents, and examines social influence, intrapersonal, and environmental factors associated with substance use during pregnancy in adolescence. The sample consists of premaritally pregnant adolescents (N = 241), who were interviewed as part of a longitudinal study of patterns of drug use among pregnant and parenting school-age adolescents. The findings indicate that, although the sample demonstrated a high rate of prepregnancy substance use, a significant drop in use occurred during pregnancy. Logistic regression analysis indicated that perceived harm of using substances while pregnant, best friends substance use, boyfriends substance use, and school status were related to substance use during pregnancy, even after controlling for the effects of prepregnancy substance use. The findings have implications for substance use prevention and intervention programs for pregnant and parenting adolescents.

Methods for Tracking Pregnant and Parenting Adolescents

This article provides descriptive information on procedures used to successfully follow a sample of 241 premaritally pregnant urban adolescents participating in a longitudinal study of drug use patterns. Respondents were interviewed once during pregnancy, with subsequent interviews at 1 month, 6 months, 12 months, and 18 months after pregnancy resolution. Only 1 respondent refused to continue in the study, and temporary attrition due to inability to locate respondents was only 1% to 3% at each wave of data collection. Successful methods for sample recruitment and retention are discussed, emphasizing a multimethod approach.

COLLABORATIVE CARE FOR PERINATAL DEPRESSION IN SOCIOECONOMICALLY DISADVANTAGED WOMEN: A RANDOMIZED TRIAL

Both antenatal and postpartum depression have adverse, lasting effects on maternal and child well‐being. Socioeconomically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence‐based depression care. The authors evaluated whether “MOMCare,”a culturally relevant, collaborative care intervention, providing a choice of brief interpersonal psychotherapy and/or antidepressants, is associated with improved quality of care and depressive outcomes compared to intensive public health Maternity Support Services (MSS‐Plus).

Psychological distress and substance use by adolescent mothers: associations with parenting attitudes and the quality of mother-child interaction.

Abstract This study examines associations between psychological distress and alcohol and drug use across the first five years of raising a child and parenting quality at child age six for 185 adolescent mothers. Overall, alcohol and other drug use in this sample was relatively low, but drug use was associated with more mother-reported unrealistic expectations of child behavior and more attributions of child intent to annoy parent by misbehaving. Maternal psychological distress was associated with maternal reports of negative control (yelling, pushing, spanking, etc.), and alcohol use moderated the association between psychological distress and negative control. At low levels of alcohol use, more maternal distress was associated with greater negative control; at higher levels of alcohol use, maternal distress was not related to negative control, but the absolute level of negative control was similar to that reported by more distressed mothers. Neither psychological distress nor alcohol and other drug use were related to maternal behavior during an interaction task. Overall, much stronger associations with parenting outcomes were found for an index of maternal vocabulary, compared with maternal psychological distress or maternal alcohol and other drug use.