Sarah E. Oberlander

Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

CONTEXT. Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES. There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mothers first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. DESIGN. We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infants first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as “big sisters.” The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. METHODS. Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers (<18 years of age); 82% (149 of 181) completed the 24-month evaluation. RESULTS. Intent-to-treat analyses revealed that control mothers were more likely than intervention mothers to have a second infant. The complier average causal effect was used to account for variability in intervention participation. Having ≥2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed ≥6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infants father. At 24 months, there were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). CONCLUSIONS. A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended ≥8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6–8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.

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.

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 childrens 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.

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.

Graduate Students and the Culture of Authorship

In the last 50 years, multiauthored publications have become more prevalent, given the increasing number of collaborative, interdisciplinary, multicenter research studies. The determination of authorship credit and order is a difficult process, especially for graduate students, whose disadvantaged power position in research settings increases their vulnerability to exploitation. The American Psychological Association has published ethical standards for determining authorship credit, but the power difference inherent in the student–faculty relationship may complicate this ethical dilemma. The authors reviewed a number of previously recommended strategies and proposed that determining authorship credit is most effectively facilitated through professional development.

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.

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.

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.

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 childrens 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.