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Objectives Originally developed to assess emergency preparedness, evidence suggests the Social Vulnerability Index (SVI) may also be useful to investigate multilevel environmental and social influences on health risk behaviors and outcomes. This ecological study explores the application of the SVI as a predictor of teen pregnancy rates across counties in the United States (U.S.) and identifies areas with greatest need for community-based interventions. Methods County-level SVI and teen birth rate data were obtained from the Centers for Disease Control and Prevention. Regression analysis was conducted to examine associations between teen birth rates and social vulnerability, geographic region, and the four themes which compromise the index: socioeconomic status, household composition, minority status, and housing. Dot maps of teen birth rates and SVI by quartiles were used to examine spatial distribution across counties. Results Each increase in SVI quartile was associated with an additional 11.5 births per 1000 females ages 15-19. Higher social vulnerability was significantly associated with higher teen birth rates to varying degrees across the U.S., with largest effect sizes observed in East South Central ([beta] = 62.56; SE = 6.28; p < 0.001) and West South Central ([beta] = 66.75; SE = 5.33; p < 0.001) Census divisions. Among index themes, socioeconomic status ([beta] = 25.56; SE = 1.16; p < 0.001), household composition ([beta] = 23.49; SE = 1.00; p < 0.001), and minority/language status ([beta] = 10.99; SE = 0.83; p < 0.001) were positively associated with teen birth. No association was observed with housing/transportation. Conclusions The SVI offers a novel tool for identifying at-risk populations most in need of resources and guiding community-based teen pregnancy interventions across the U.S., Author(s): Chloe W. Yee [sup.1] , Shayna D. Cunningham [sup.2] , Jeannette R. Ickovics [sup.2] Author Affiliations: (Aff1) grid.47100.32, 0000000419368710, Department of Health Policy, Yale School of Public Health, , [...]

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care., Author(s): Shayna D. Cunningham [sup.1] , Stephanie Grilo [sup.1] , Jessica B. Lewis [sup.1] , Gina Novick [sup.2] , Sharon Schindler Rising [sup.3] , Jonathan N. Tobin [sup.4] [sup.5] [sup.6] [...]

Relationships influence sexual risk and maternal-child health. Few studies have assessed relationship dissolution and its association with sexually transmitted diseases (STD) among adolescent parents. Our study aimed to describe relationship dissolution among 295 parenting and non-parenting adolescents over an 18-month period and how it related to STD incidence. Results showed that nonparenting adolescents in a relationship with someone other than their baby's father were more likely to have a relationship dissolution over an 18-month period compared to those in a relationship with the baby's father (OR = 1.69, P < .05). Parenting adolescents who ended their relationship with their baby's father were 3 times more likely to get an STD over the course of the study compared to parenting adolescents who remained with their baby's father (39% vs. 13%). Comparatively, non-parenting adolescents who ended their relationship were only 1.4 times more likely to get an STD compared to non-parenting adolescents who remained with their partner (44% vs. 32%). Our results suggest that prevention programs that incorporate male partners and components that strengthen relationship skills may reduce HIV/STD risk and help adolescents adapt during times of transition such as parenthood. Keywords Relationship dissolution * STDs * Pregnancy * Adolescent relationships, Introduction Over 480,000 adolescent women in the United States have a child each year (Henshaw and Finer 2003). Pregnancy during adolescence has been linked to a variety of adverse consequences [...]

Objectives. We assessed the impact of parity on tooth loss among American women and examined mediators of this relationship. Methods. The study sample comprised 2635 White and Black non-Hispanic women who had taken part in the third National Health and Nutrition Examination Survey. We examined the relationship between parity and tooth loss, by age and by socioeconomic position, and tested a theoretical model focusing on direct and indirect influences of parity on dental disease. Robust regression techniques were used to generate path coefficients. Results. Although parity was associated with tooth loss, the relationship was not moderated through dental care, psychosocial factors, or dental health-damaging behaviors. Conclusions. Parity is related to tooth loss among American women, but the mechanisms of the association remain undefined. Further investigation is warranted to determine whether disparities in dental health among women who have been pregnant are caused by differences in parity or to physiological and societal changes (e.g., factors related to pregnant women's access to care) paralleling reproductive choices.

Urban teens face many traumas, with implications for potential growth and distress. This study examined traumatic events, posttraumatic growth, and emotional distress over 18 months among urban adolescent girls (N = 328). Objectives were to (a) describe types of traumatic events, (b) determine how type and timing of events relate to profiles of posttraumatic growth, and (c) prospectively examine effects of event type and posttraumatic growth on short- and long-term emotional distress with controls for pre-event distress. Results indicate that type of event was related to profiles of posttraumatic growth, but not with subsequent emotional distress. When baseline emotional distress was controlled, posttraumatic growth was associated with subsequent reductions in short- and long-term emotional distress. Implications for future research and clinical practice with adolescents are addressed. Keywords: adolescents, posttraumatic growth, emotional distress, multilevel modeling, hierarchical linear modeling

This article examines whether the frequency, dyadic nature, and potential implications of relationship violence differ in parenting (n = 168) and nulliparous (i.e., never given birth; n = 165) adolescent females from low-income, urban communities. We found the frequency and dyadic nature of violence did not differ between parental status groups. Over half of the adolescents in both groups reported relationship violence in the past year, with female-enacted violence more common than male-enacted violence. However, significant group differences emerged in the relationship between violence and subsequent relationship dissolution and mental health. Higher levels of female-enacted violence predicted relationship dissolution among nulliparous adolescents but predicted increases in depression in parenting adolescents. Findings highlight the need for violence prevention programs tailored specifically to the developmental and contextual needs of adolescent mothers.

Behaviors that lead to teen pregnancy also place young women at risk for STDs and repeat pregnancy. Compared to the broad literature on adolescent sexual risk behavior, our understanding of sexual risk in pregnant/mothering teens lags far behind. Primary objectives of this systematic review (1981-2003) of pregnant/mothering teens were to: (1) document rates of STD, repeat pregnancy, condom use, and contraception; (2) identify correlates of these biological and behavioral outcomes; (3) review sexual risk reduction interventions; and (4) discuss directions for future research and implications for clinical care. Fifty-one studies met inclusion criteria. Rates of STD and repeat pregnancy were high, with the majority of teens engaging in unprotected sex during and after pregnancy. An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989) Ecological Systems Theory, was proposed to organize findings on correlates of sexual risk. Improvements in research, including integration of outcomes and risk factors, stronger methodologies, and standardized assessments, are essential. Results suggest that teen pregnancy is a marker for future sexual risk behavior and adverse outcomes, and that pregnant/mothering teens need hybrid interventions promoting dual use of condoms and hormonal contraception. Pregnancy may provide a critical 'window of opportunity' for sexual risk reduction. Keywords: Teen mothers; Pregnant teens; Sexual risk behavior; STD; Repeat pregnancy; Review; USA

Byline: Trace S. Kershaw (1,2), Jeannette R. Ickovics (1), Jessica B. Lewis (1), Linda M. Niccolai (1), Stephanie Milan (1), Kathleen A. Ethier (3) Keywords: STDs; adolescents; condom use; behavior change Abstract: The purpose of this study is to assess changes in sexual risk behaviors, attitudes toward using condoms, and perceived susceptibility to future STDs for adolescent females who recently were diagnosed with an incident STD compared to those who were not diagnosed with an incident STD. Adolescent females (N=308) were assessed at two time points, 6 months apart. Ninety-two participants were diagnosed with an STD, and 216 were not diagnosed with an STD in between the two time points. Results indicated that adolescents did not significantly change their behaviors, attitudes, or perceptions following the diagnosis of an incident STD compared to those who were not diagnosed with an incident STD. This suggests that an STD diagnosis alone is not sufficient to motivate adolescent females to reduce their sexual risk behavior and change their sexual risk attitudes and perceptions. Author Affiliation: (1) Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut (2) Center for Interdisciplinary Research on AIDS Yale University, New Haven, Connecticut (3) Division of STD Prevention, Behavioral Interventions and Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia Article History: Registration Date: 30/12/2004

Using attachment theory as a framework, this paper examines how pregnant adolescents' experiences of physical maltreatment during childhood influence the subsequent mother-infant relationship in 203 low-income adolescents followed from the 3rd trimester of pregnancy through the 1st year of parenthood. The relation between physical maltreatment history and early difficulty in the mother-infant relationship was mediated by adolescents' evaluations of the relationship with their primary caretaker and the feelings they associated with motherhood measured prior to childbirth. In addition, a supportive romantic relationship during pregnancy acted as a protective factor by moderating the impact of maltreatment history on the quality of the subsequent mother-infant relationship. Findings support the importance of assessments and interventions that consider the social context and relational history of pregnant and parenting adolescents. KEY WORDS: adolescent mothers: attachment; maltreatment; mother-infant relationship.

This study examines trajectories and correlates of emotional distress symptoms in pregnant adolescents (n = 203) and nulliparous adolescents (n = 188) from economically disadvantaged communities over an 18-month period. For both groups, the prevalence of significant emotional distress exceeded expectation based on adolescent norms; however, the severity of symptoms did not differ between the 2 groups. Results from growth curve modeling revealed a significant decline in symptoms during the study period for both groups, but pregnant adolescents experienced a different pattern of decline. Also, certain interpersonal factors (e.g., history of physical maltreatment, partner support) appeared to play a more important role in the emotional well-being of pregnant and parenting adolescents relative to nulliparous adolescents. Implications for early identification and intervention are discussed.

Research has been conducted on adherence to HIV treatment regiments during pregnancy. The patterns of adherence to zidovudine during prenatal period have been investigated and the results demonstrate that the adherence to zidovudine taken during the last 3 weeks of pregnancy was low and declined the last 3 weks postpartum.

The availability of interventions to reduce perinatal HIV transmission has led to nationwide efforts to encourage pregnant women to learn their HIV status. (1-3) The challenge has been to provide […]

This article examines the relationships between subjective and objective measures of social status and health indicators in Caucasian women. Results indicate that perceptions of social status are more closely associated with health indicators like heart rate, body fat, and stress than objective measures of status like education or income level.

This study examined how women in a clinic-based sample in New Haven, Connecticut, (N = 168), have been affected by the AIDS epidemic. The aims of this study were to (a) document the proportion of women who knew individuals who were HIV positive, who were symptomatic with AIDS, or who had died from AIDS; (b) compare the demographics of women who knew someone infected with HIV with those of women who did not know anyone infected with HIV; and (c) examine prospectively the effects of the number of AIDS related losses on women's mental health. Many women have been deeply affected by the AIDS epidemic: Nearly 3/4 of the women in this study knew at least 1 person who had died of AIDS. Women who experienced multiple AIDS-related losses over the course of the study were significantly more anxious than those who experienced no loss or 1 loss. Implications for clinical interventions are discussed.

Women of diverse backgrounds from 4 community health clinics in southern Connecticut were involved in a longitudinal, prospective study (n = 189). Data from interviews 3 months apart were used for the current analyses. The purpose of this study was to develop predictive models of safer sexual behavior among heterosexual women. Specifically, there was an interest in identifying factors to predict the maintenance or initiation of safer behavior over time. Relationship involvement and attitudes toward condoms were important in both models. Beyond this, differences in explanatory models emerged, reflecting the importance of examining behavior maintenance and change independently. Depression, health locus of control, and outcome efficacy belief made significant contributions to understanding the maintenance of safer sexual behavior. HIV counseling and testing, partner risk, and optimism helped to explain the initiation of safer sexual behavior. Implications for future interventions are discussed.

HIV testing and counseling appear to have little effect on the sexual behavior of heterosexual women. A total of 152 women seeking counseling and testing were compared with 78 women who visited health clinics for other reasons. Women who were tested appeared to engage in less-risky sexual behavior, but their behavior was probably altered prior to testing rather than because of it. The level of risky behavior in both groups remained largely unchanged after counseling and testing. Increasingly risky behavior was as likely to be noted as decreasingly risky behavior. Women who were tested appeared more concerned about AIDS and their relative risk of infection at the time of testing, but such thoughts apparently subsided three months after testing. HIV counseling and testing appears to be ineffective at promoting less-risky sexual behavior.

A path analytic model was used to examine the impact of three domains of life satisfaction and three employment-related variables on general well-being in a sample of 1,145 Army wives. The life domains included marital, financial, and role satisfaction. The employment-related variables included: (a) time spent employed (none, part, or full); (b) role fit; and (c) satisfaction with overall career development prospects. The employment-related variables were hypothesized to impact on general well-being both directly and indirectly through their relationship to role satisfaction. Time spent employed and role fit were found to be significantly related to role satisfaction, which in turn, was significantly related to general well-being. One variable--satisfaction with overall career development prospects--had a significant direct impact on general well-being.

The risk factors for teenage pregnancy are investigated. Findings showed that daughters of teenage mother are 66% more in risk of teenage childbearing. Other factors that predicted childbearing in teenagers are also analyzed.

The urban female adolescents' sexual risk behavior is related to their perceived risk for HIV/AIDS. Accurate and inaccurate risk perceivers are compared with respect to psychological maintenance variables, relationship context variables, and risk knowledge of different levels of sexual risk.

Objectives. We determined rates of prenatal HIV testing and investigated barriers to testing. Methods. We surveyed 1362 representative parturient women from 7 hospitals in 4 locations of the United States. Results. Overall, 89.9% of women reported being offered HIV testing and 69.6% reported being tested. Proportions of women not offered testing differed by location (range = 5.2%-16.3%), as did proportions not tested (range = 12:2%-54,4%). Among women who perceived that their clinicians had not recommended testing, 41.7% were tested, compared with 92.8% of women who perceived a strong recommendation (P [is less than] .05). Private insurance for prenatal care was also associated with not being tested. Women gave multiple reasons for not being tested, most commonly not being at risk, having been tested recently, and the test's not being offered or recommended, cited by 55.3%. 39.1% and 11.1% of women, respectively, Conclusions. Although most parturient women were offered a prenatal HIV test and got tested testing proportions did not reach national goals and differed significantly by location and payment status. Concern about testing consequences was not a major barrier. Perception of clinicians' recommendations strongly influenced testing. Changing provider practices will be essential to implementing universal prenatal HIV testing. (Am J Public Health. 2001;91: 727-733)

Women with HIV infection have a worse prognosis if they are also depressed, according to a study of 765 HIV-infected women. Not only did those who were depressed have higher death rates, their infection progressed more quickly than non-depressed women.

Objectives. Efforts to prevent perinatal transmission of HIV include implementation of prenatal counseling and testing programs. The objective of this study was to assess organizational predictors of HIV counseling and testing. Methods. Surveillance records were collected on 5900 prenatal patients from 9 hospital and community clinics in Connecticut. Results. Some organizational factors (e.g., type of clinic, dedicated staff) that enhanced counseling rates had the opposite effect on test acceptance. For instance, patients were more likely to be counseled when counseling was conducted by providers; however, test acceptance was more likely when dedicated counselors were available. Conclusions. These results provide important information concerning clinic resources needed as HIV counseling and testing services continue to be incorporated into prenatal care. (Am J Public Health. 2000;90:1448-1451)

In addition to the context of psychological health, thriving can be measured in the context of physical health. Moreover, thriving may be operationalized at a macro level (e.g., improved functional health status following acute illness or injury) or at a micro level (e.g., hormonal balance). The goal of this article is to examine physical thriving at the micro level, by investigating hormonal responses to stressful situations. In addition, we examine the role that psychological factors play in this relationship. Although stress-induced arousal has traditionally been viewed as negative, certain endocrine responses to stress can be health enhancing. Specifically; we propose that physical thriving results when there is a greater amount of growth promoting or anabolic hormones (e.g., growth hormone) than catabolic hormones (e.g., cortisol). Characteristics of the stressor (duration, frequency, and controllability) as well as psychological moderators such as one's cognitive appraisal of the stressor (threat versus challenge) play a role in determining the profile of response to stress. When an individual appraises intermittent stressors as controllable, she or he may display a resilient profile of stress hormone responding - rapid cortisol responses with quick recovery, and more importantly, cortisol adaptation when faced with similar stressors over time. This stress response is in turn related to better health. To substantiate some of these issues, we present data from a study examining women's cortisol reactivity in response to a repeated laboratory stressor and their self-reported growth from facing trauma. The results suggest that women who have grown psychologically from trauma may show quicker cortisol habituation to other stressors. Cortisol adaptation to stress may serve as one potential marker of resilient psychological and physical functioning.