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Romantic relationships and leisure play significant roles in adolescents’ lives. However, heterosexual romantic relationships can negatively constrain women’s leisure, particularly with regard to ‘...

Though declining since the 1990s, adolescent pregnancy remains common in the United States. Social supports appear to improve outcomes for pregnant teens; however, teen pregnancy introduces social obstacles, such as stigma. This study investigates how currently or previously pregnant teens’ friendship networks differ from nonpregnant girls using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) and multilevel regression models. To mitigate concerns that background differences contribute to both pregnancy risk and social networks, girls who experience a pregnancy prior to one data collection time point are compared girls who experience their first pregnancy after this time point. This group who become pregnant after the time point is presumably more similar to already pregnant teens than those never experiencing teen pregnancy. When compared to these girls who become pregnant in the future, those who have already experienced a teen pregnancy report similar numbers of friends (out-nominations) and perceived social acceptance, but are predicted to have fewer peers reporting them as friends (in-nominations) and fewer reciprocated friendships. This suggests that pregnant teens may face stigmatization, of which they may be unaware. It further highlights a new comparison group to account for selection in studies of adolescent pregnancy.

Objectives To examine the risk of premature delivery (PD) and small for gestational age (SGA) among pregnant teens with depressive disorders (DD), and the impact of race/ethnicity on these birth outcomes. Design/Methods We examined the hospital discharge records of pregnant mothers between the age of 13–18 year old who gave birth in the years 1994, 2000, 2006, and 2012 in the National Inpatient Sample database. We calculated the risk for PD and SGA among pregnant teens with and without DD in the overall population and within each race/ethnicity. Results Weighted sample included 1,023,586 pregnant teenage women. Prevalence of DD among teens was 0.93%, with a significantly increasing trend from 0.29% in 1994 to 2.01% in 2012 (p

Pregnant teens often feel uncertain in the last trimester about their ability to take care of their baby. At this time, maternal confidence in the ability to care for the baby is an important step in the preparation for becoming a mother. The purpose of this study was to examine the validity and reliability of an Indonesian version of the Young Adult Maternal Confidence Scale (YAMCS) as an instrument to measure maternal self-efficacy of pregnant teens in the last trimester. The study consisted of 90 pregnant teens, age of respondents less than 19 years and living in 1 of 3 sub-districts: Cilember, Sukamanah and Megamendung, Bogor Regency. West Java. All the participants completed a questionnaire based on the YAMCS to assess maternal self-efficacy. The YAMCS consists of 3 dimensions (perception of ability, uncertainty, and mothering behaviors) and 10 items. All items of the YAMCS had corrected item-total item correlation more than 0.3 and had 0.859 Cronbach's α scores. Based on the findings of this study, this questionnaire is a valid and reliable measure of maternal self-efficacy of pregnant teens in Indonesia. Health workers can use the questionnaire to assess the confidence of pregnant women, especially that of adolescents, in caring for their baby and being a good mother.

IntroductionExpectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children’s healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents’ self-sufficiency by promoting their educational outcomes and healthy birth spacing.MethodsWe conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review’s eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies’ findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence.ResultsWe identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs.DiscussionEffective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens’ education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness.

espanolEste estudio tiene como proposito analizar los significados alrededor del embarazo como una situacion social de alto impacto individual, familiar y cultural, desde el punto de vista de las propias adolescentes. Con un enfoque cualitativo, se entrevisto a 16 mujeres adolescentes con una edad promedio de 15 anos, de la ciudad de Bucaramanga, Colombia, en situacion de embarazo. Se destaca el peso del embarazo como una representacion conflictiva ligada a los procesos de inicio de la sexualidad, pero ademas como un dispositivo de autoafirmacion y proyeccion de las mujeres en una sociedad que no ofrece oportunidades de desarrollo personal, especialmente para las adolescentes en condiciones economicas desfavorables. EnglishThis study has the purpose to analyze the meanings of the teenagers pregnancy as a social situation of high individual, family and cultural impact, from the point of view of the teenagers themselves. Following a qualitative approach, 16 pregnant teens living in the city of Bucaramanga, Colombia with an age average of 15 years were interviewed. Pregnancy is highlighted as a conflicting representation linked to the processes of initiation of sexuality, but also as a device of self-affirmation and projection of women in a society that does not offer opportunities for personal development, especially for adolescents in adverse economic conditions.

Previous studies have proved that therapeutic rehabilitation is an effective intervention for reducing recidivism among delinquent children. The programme involves attempts to bring about behavioural changes by facilitating personal development through improved skills, social relationships, social perceptions, etc. This paper, however, focuses only on one of the main characteristics of the therapeutic rehabilitation which is the restorative programme. Ten pregnant teenagers who are currently enrolled in the rehabilitation and protection programme in the Garden of the Princess, Cheras (Taman Seri Puteri, Cheras) involved voluntarily in the study. To gain the primary data, the researcher performed series of in-depth interviews with the ten respondents. Using the interview protocol, the researchers assessing the implementation of the programme based on three main features of restorative practices; the inculcation of responsibility, facilitation of competence skill and the practice of communities reconciliation. The study found that the institution failed to implement the components of the effective restorative programme. The existing programme is generic in its characteristic; not specialised and not- peculiar to the needs of the pregnant teens. As the intervention to the problem, few suggestions are proposed for improving and enhancing the quality of existing programmes of the institution. Keywords: restorative programme, rehabilitation, pregnant girls

Background Interventions to prevent sudden unexpected infant death (SUID) typically include education to increase knowledge, thereby improving parenting practice. However, health decision-making is based on a complex interplay of knowledge, attitudes, and beliefs related to intent to initiate behaviors. Further, based on the Health Belief Model, self-efficacy and locus of control are also linked to behavior change. Objective: This study examined the link between pregnant teens’ report on several safe sleep constructs thought to influence parent’s safe sleep behaviors and prenatal knowledge of safe sleep practices. Design/methods We recruited pregnant teens (13–19 years old) into a trial of an educational intervention for safe sleep during second trimester in a US state with high sleep-related SUID rates. A self-administered survey was completed before intervention. The survey included safe sleep constructs: attitudes (3 items), beliefs (4), self-efficacy (3), intentions (4), knowledge (3), and a standardized measure of knowledge of infant development (KIDI). Results 115 subjects completed baseline surveys, including 27 white (20%), 103 black (76%), and 5 other (4%) teens with median age 18 y±2. In regression analyses, the KIDI predicted safe sleep knowledge (R2=0.05, F(1, 112)=6.24, p Conclusions The prenatal period presents an important opportunity for educational intervention, as women develop knowledge and form beliefs that may shape early parenting behavior. The link between key safe sleep-related constructs may inform interventions before the birth. Our results suggest that safe sleep knowledge is associated with both key beliefs and with knowledge of general infant development. Interventions that target these beliefs may be more successful.

Objectives Previous research suggests that, in general, youth who become pregnant during their teenage years tend to report elevated levels of substance use prior to conception and substantial reductions in use during pregnancy. While such studies provide insight into aggregate patterns of adolescent substance use in relation to pregnancy, they may have the unintended effect of masking the behavioral heterogeneity of pregnant teens. Methods The present study employs data from a large, population-based study of adolescents in the United States. We employ latent class analysis to identify subgroups of pregnant adolescents (ages 12–17; n = 810) on the basis of variables measuring the past 12-month and past 30-day use of an extensive array of substances. Results Results revealed a four class solution. Classes were identified as Class 1: Abstainers (n = 344, 42.47 %), Class 2: Drinkers (n = 303, 37.41 %), Class 3: Alcohol and Cannabis Users (n = 77, 9.51 %), and Class 4: Polydrug Users (n = 86, 10.62 %). The Abstainers class had the highest proportion of Hispanic youth (34.3 %) as well as the highest proportion of youth residing in households earning less than $20,000 per year (44.2 %). The Polydrug Users class had the highest proportion of youth who were in late adolescence (75.58 %), non-Hispanic white (54.65 %), high-income (13.95 %), and in their first trimester of pregnancy (58.33 %). Conclusions for Practice Findings point to an important degree of heterogeneity among pregnant teens and may have implications for the development of interventions designed for youth exhibiting disconcerting patterns of substance use prior to pregnancy.

Este estudio analiza cómo las adolescentes de niveles socioeconómicos bajos en la ciudad de Cartagena, Colombia, han construido sus creencias y prácticas sobre la sexualidad. El diseño de la investigación es de tipo cualitativo, específicamente con un enfoque etnográfico centrado en lo que las participantes expresaron en cuanto a sus experiencias, actitudes, valores, roles, tradiciones y creencias. Igualmente, se analizó la apropiación de conductas que generan estilos de vida y formas de relacionamiento que inciden sobre la presencia del embarazo a temprana edad. Se observó que las creencias y prácticas de sexualidad de estas jóvenes adolescentes se han construido de lo que culturalmente se ha transmitido de generación en generación, ejerciendo una gran influencia la dinámica social, los mecanismos de ocio y esparcimiento. This study analyzes the way teenagers from low socio-economic levels construct their beliefs and practices on sexuality. The research is qualitative, and specifically designed with an ethnographic approach, which is centered on the participants' description of their experiences, attitudes, values, roles, traditions, and beliefs. Also analyzed was the adoption of lifestyle-forming behaviors that construct relationships and affect the teenage pregnancy rate. That the teenagers' beliefs and practices on sexuality are the result of their cultural and traditional knowledge, the prevalence of their social dynamics, and their leisure and recreation activities was also observed.

A diagnosis of pregnancy is fraught with overwhelming and conflicting emotions for teen girls. These young women have to consider various options such as continuing pregnancy and parenting, adoption, or termination. Healthcare providers have a significant role to play in providing nonjudgmental and inclusive counseling options for pregnant teens. Through a clinical vignette, these options will be reviewed as well as an overview of teen pregnancy statistics and complications in addition to prevention of rapid repeat pregnancy.

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data from a demonstration project which took place in the residential program of a New York City foster care agency, with an approach that addressed the developmental needs of adolescents and the practical needs of parenting. Inwood House’s experience provided insights into the role of a theory of change focused on the development of young people, not only their protection, to improve the health...

The purpose of this study was to evaluate the efficacy of a school-based case management intervention in reducing teen-pregnancy. A nonrandomized intervention/comparison schools mixed-method evaluation design was employed. Participants included 203 pregnant and parenting teens with annual follow-up over a 3-year period. The results indicated that the time to repeat pregnancy was delayed among pregnant teens, high school drop-out rates were reduced among parenting teens, and pregnant teens were less likely to deliver before 36 weeks in the intervention versus the comparison school. Case management at a school setting is a promising approach to decrease repeat teen pregnancy.

This study aimed to determine whether perceived self-efficacy and healthy lifestyle behaviors were associated with global quality of life in adolescent mothers. Sixty-two participants completed the General Self-Efficacy Scale (GSES), the Health-Promoting Lifestyle Profile II (HPLP-II), and the Cantril’s Self-Anchoring Striving Scale (Cantril’s Ladder) that measures global quality of life. The results indicated moderate to high correlations between the GSES and the Cantril’s Ladder as well as between the HPLP–II and the Cantril’s Ladder. The study yielded evidence supporting the importance of interventions that promote self-efficacy and healthy lifestyle as they relate to quality of life of adolescent mothers.

Teens in foster care give birth at over twice the rate of other teens. Unique challenges exist for these vulnerable teens and babies, yet research on such populations, particularly within the systems that serve them, is limited. A demonstration project at Inwood House, a residential foster care agency in New York City, from 2000 to 2005, at the same time that the Administration for Children's Services was exploring policy and practice changes for this population, is described. Research design and implementation issues, descriptive data, and experiences provide lessons for improving the evidence base to meet the needs of pregnant teens in care.

Zika infection in pregnant women is associated with an elevated probability of giving birth to a child with microcephaly and multiple other disabilities. Public health messaging on Zika prevention has predominantly targeted women who know they are pregnant or intend to become pregnant, but not teenage females for whom unintended pregnancy is more likely. Vulnerabilities among this population to reproductive risks associated with Zika are further amplified by restrictive abortion laws in several Zika-impacted states. Key to prevention is enhanced, targeted public health messaging centered on teens nationally and particularly in certain high-risk regions.

Among pregnant youth, relationships with parents and romantic partners are correlated with overall wellbeing; however, this relationship does not exist with friends. Friends who have also experienced a pregnancy, however, may offer more effective support than friends who have not. One way that pregnant and mothering adolescents can connect is through online message boards. We hypothesized that adolescents would use these sites primarily to establish friendships and develop a supportive community, rather than simply to solicit pregnancy-related advice. We randomly selected 200 threads from four message boards for pregnant and mothering teens and performed a mixed-methods content analysis of the original posts and responses. Most original posts were categorized as ''Community Oriented Posts,'' rather than ''Soliciting Pregnancy or Motherhood Advice.'' Furthermore, qualitative analysis revealed frequent instances of emotional support, instrumental support, and informational support in both categories. In message board communities where pregnant teens and teen mothers were in the majority, messages were predominantly positive. In sharp contrast, in the one message board in which they were in the minority, as they are in the adolescent community at large, messages were significantly more negative. The dynamics of these message boards indicate the possibility that social support from other pregnant or mothering teens may enhance the wellbeing of pregnant teens and explain why peer ''support'' from teens who have not had this experience may often have a negative influence on wellbeing.

After years of high teen birth rates, there is currently a decline in U.S. pregnancy and birth rates among teens. Nevertheless, these rates continue to be higher than those of most global counterparts, and psychosocial and physical adversities still occur for pregnant teens and their children. The declining birth rates may be due to teens making better choices about contraceptive use and sexual behaviors. Psychiatric–mental health nurses are in key positions to enhance pregnancy prevention for teens. [ Journal of Psychosocial Nursing and Mental Health Services , 54 (2), 25–28.]

Objective: To identify the feeding habits of pregnant adolescents in four different civil status: married, cohabiting with a partner, single with no partner and single with a partner. Methods: In a cross-sectional study, 321 pregnant adolescents aged 13 to 19 years old who attended the Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, Mexico) were included. They were healthy, in any trimester of pregnancy and had either a low or medium-low socioeconomic status. The civil status of adolescents was stratified into: a) married, b) cohabiting with a partner, c) single with a partner and d) single without a partner. Socio-demographic, economic and feeding habits data were included. ANOVA, post-hoc tests for Chi², odds ratio and logistic regression models were used. Results: The frequency of married adolescents was 9.3%; 59.8% of the adolescents were cohabiting, 15.3% of the adolescents were single without a partner and 15.6% of the adolescents were single with a partner. Low schooling (OR 2.6 [1.5-4.4]) and occupation in housework (OR 4.47 [1.99-10.0]) predominated among adolescents in cohabitating with a partner; an occupation at home (OR 0.28 [0.127 to 0.61]) and unaccompanied dining (OR 4.12 [1.62-10.8]) were the factors with the most epidemiological significance in single without a partner adolescents. The consumption of vegetables was significantly lower in married adolescents and cohabiting-with-partner adolescents; consumption of beans and sweet bread was significantly lower in pregnant married adolescents. Conclusion: Because some variables and eating habits depended on civil status, it is pertinent to analyze them in each group of pregnant teenagers separately. Objetivo: identificar los hábitos alimentarios de adolescentes embarazadas en cuatro estados civiles diferentes: casada, cohabita con una pareja, soltera sin pareja y soltera con una pareja. Métodos: en estudio transversal, se incluyeron 321 adolescentes embarazadas de 13-19 años que acudieron al Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, México). Se encontraban sanas, en cualquier trimestre del embarazo y pertenecían a un nivel socioeconómico bajo o medio-bajo. El estado civil se estratificó en: casadas; en unión libre; soltera con una pareja y soltera sin pareja. Se incluyeron datos socio-demográficos, económicos y de hábitos de alimentación. Se utilizaron pruebas de ANOVA, pruebas post-hoc para Chi², razón de momios y modelos de regresión logística. Resultados: la frecuencia de las adolescentes casadas fue de 9,3%, 59,8% en unión libre, 15,3% eran solteras sin pareja y 15,6% solteras con pareja. La baja escolaridad (RM 2,6 [1,5-4,4]) y la ocupación en el hogar (RM 4,47 [1,99-10,0]) predominaron entre las adolescentes en unión libre; la ocupación en el hogar (RM 0,28 [0,127-0,61]) y cenar sin compañía (RM 4,12 [1,62-10,8]) fueron significativamente más frecuentes en adolescentes sin pareja. El consumo de verduras fue menor en las adolescentes casadas y en quienes cohabitaban con pareja; el consumo de frijoles y pan dulce fue menor en adolescentes embarazadas casadas. Conclusión: debido a que ciertas variables y hábitos de alimentación mostraron diferencias entre los grupos es pertinente analizar las adolescentes embarazadas de acuerdo a su estado civil.

En los últimos años se han presentado estadísticas alarmantes de embarazos adolescentes, en Honduras se estima que el 30% de los partos ocurren entre jóvenes de 13 a 19 años. En el departamento de Intibucá, de enero a junio del 2010, se han atendido en promedio mensual 77 adolescentes embarazadas entre edades de 10 a 19 años. El embarazo en la adolescencia no sólo representa un problema de salud, también tiene una repercusión en el área social, afectiva y económica. En el caso de los municipios de Intibucá se identifican factores socioculturales que condicionan el embarazo entre las adolescentes entre ellas el machismo, los tabúes alrededor de la educación sexual, el hacinamiento, la falta de espacios de recreación y redes de jóvenes que permitan socializar sus inquietudes y fortalecer la educación sexual. DOI: http://dx.doi.org/10.5377/pdac.v7i0.691 Revista Población y Desarrollo: Argonautas y Caminantes, Vol. 7, No. 7, 2011 pp.47-55

This article describes the lessons learned in the process of implementing a 13-year project that teaches pregnant teens about pregnancy childbirth and parenting using evaluative feedback to adapt the project to more closely meet their needs.

Obtaining funding to support community-based childbirth education programs can be a challenge for childbirth educators who may have little grant-writing experience. This article was written by two nurse educators/nurse-midwives who have been involved for over 10 years with a grant-funded parenting and childbirth education program for pregnant teens. It reviews the background of the Resource Center for Young Parents-To-Be, suggests grant-funding sources, and explains the building of partnerships in the community. The basic steps involved in the grant-writing process are presented as well as the importance of follow-up evaluations and reports. Grant-writing skills and the ability to forge partnerships with other community organizations can be important tools for childbirth educators and health-care professionals.

Background Teens and racial and ethnic minority women are less likely to initiate prenatal care (PNC) in the first trimester of pregnancy than their counterparts. Objective This study examines the impact of Medicaid program changes in the late 1990s on the timing of Medicaid enrollment and PNC initiation among pregnant teens by race and ethnicity. Research design Using Medicaid enrollment and claims data and a difference-in-differences method, we examine how the patterns of prepregnancy Medicaid enrollment, PNC initiation, and racial and ethnic disparities in PNC changed over time after controlling for person- and county-level characteristics. Subjects We included 14,089 teens in Florida with a Medicaid-covered delivery in fiscal years 1995 and 2001. Measures Prepregnancy enrollment was defined as enrollment 9 or more months before delivery; late or no PNC was defined as initiation of PNC within 3 months of delivery or not at all. Results For teens enrolled in traditional welfare-related categories, the proportion with prepregnancy Medicaid enrollment increased and the proportion with late or no PNC declined from 1995 to 2001. Teens enrolled under the Omnibus Budget Reconciliation Act (OBRA) expansion category in 2001 were less likely than welfare-related teen enrollees to have prepregnancy coverage but were more likely to initiate PNC early. Racial disparities were found in PNC initiation among the 1995 welfare-related group and the 2001 expansion group but were eliminated or greatly reduced among the 2001 welfare-related group. Conclusions Providing public insurance coverage improves access to care but is not sufficient to meet Healthy People 2010 goals or eliminate racial and ethnic disparities in PNC initiation.

Teen pregnancy is an important public health issue for all teens, but particularly for low-income teens who rely on the public health safety net for services. Medicaid pays for more than two-thirds of deliveries among teenagers in the USA. To discern how this public program serves pregnant teens (aged 11-19 years), the authors used Medicaid enrollment and claims data for Florida, Georgia and New Jersey in 1995 to examine teens' enrollment duration, service use and average payments relative to 20-24-year-olds on Medicaid. Teens were more likely than the older women to have been enrolled in Medicaid before pregnancy and to have maintained coverage through the third month following delivery. If not enrolled prepregnancy, teens were more likely than older women to enroll later in pregnancy. Teens were less likely to receive early prenatal care and more likely to be hospitalized during pregnancy, usually for preterm labor. While total Medicaid payments for routine prenatal and delivery-related care were equivalent between teens and older women, payments for nonroutine care during pregnancy were modestly higher for teens in Florida and Georgia. Thus, only modest cost savings can accrue from lower average costs per pregnancy and delivery among teens who delay pregnancy. Additional and larger cost savings to the Medicaid program from preventing teen pregnancy would accrue from the expected lower enrollment in Medicaid among the teens as they age.

Since adoption can solve both personal and societal problems, it is important to identify salient variables related to the perceptions of pregnant adolescents while in the process of deciding to keep or place their baby. An anonymous questionnaire administered at a residential facility for pregnant, unmarried persons in a Southwestern metropolitan area was the basis for this investigation of 178 teens who placed their baby for adoption. A number of contextual variables appear to influence the choice of adoption: family background and interaction patterns, religious values, cognitive factors, and peer relations.

Youth may be particularly attuned to social evaluation during the teen years with implications for physical and mental health. Negative attitudes and stereotypes constitute an important type of social evaluative threat. Pregnant and parenting teens not only encounter challenges associated with their early transition to parenthood, but also are confronted with unfavourable attitudes of others. A university sample of 255 men and women responded to surveys targeting their feelings and beliefs about pregnant teens, teen mothers and teen fathers. Teen mothers were generally perceived more positively than pregnant teens who were perceived more positively compared to teen fathers. Social evaluations were generally unrelated to respondents' sex or race, but respondents who had contact with a friend or family member who had experienced a teen pregnancy were selectively more positive, as were freshmen compared to seniors. Risks attributed to early childbearing may be exacerbated by negative social evaluations.

Part I: Sexuality, Pregnancy and Schooling 1. Separate and Unequal 2. Shame, Blame and the Stigma Wars Part II: Pregnant With Meaning 3. Self Portraits: From Girlhood to Motherhood 4. Making the "Self-Which-I-Might-Be" 5. Showing and Telling Pregnancy Stories 6. Representing Youth Worlds, Identities and Relationships Part III: Notes to and from the Field 7. Entering Girls' Worlds 8. Split at the Roots: Re-thinking Educational Practice

The perinatal program for urban youth at The Door, located in New York City, provides accessible, comprehensive, high-quality prenatal services to pregnant teens. Through a holistic, family-centered, youth-development approach, the program seeks to counteract the adverse medical risks and psychosocial consequences of early childbirth and child rearing in order to improve the immediate and long-term futures of the mother and her new family. The Door's services are presented, along with a description of the agency's service model and an analysis of 100 pregnant teens enrolled in its perinatal program.

Valerie is a typical 17-year-old girl--active in high school sports and very social with a large group of friends. She became sexually active when she was 15, and, like many of her friends, occasionally smoked at parties or after school. After she missed two periods in a row, Valerie thought she should call a health care provider. When she learned she was pregnant, she was forced to face another challenge: could she quit smoking?

Youth development emerged in part as a reaction against approaches to working with youth that identify specific youth as being in need or at risk and try to meet the need or reduce the risk. One of the central insights underlying youth development is that different youth problems have spawned separate systems of theory, research, funding, and programs, yet often different problems result from the same conditions and respond to the same treatments. Moreover, some of the same youth have multiple problems (Dryfoos, 1990). A pregnant teenager who drops out of school should not be divided between a program for dropouts and another for pregnant teens. This insight has led some youth development advocates and practitioners to portray prevention programs as an inferior alternative.

Miscarriage, even if biologically random, is not socially random. Willingness to abort reduces miscarriage risk. Because abortions are favorably selected among pregnant teens, those miscarrying are less favorably selected than those giving birth or aborting but more favorably selected than those giving birth. Therefore, using miscarriage as an instrument is biased towards a benign view of teen motherhood while OLS on just those giving birth or miscarrying has the opposite bias. We derive a consistent estimator that reduces to a weighted average of OLS and IV when outcomes are independent of abortion timing. Estimated effects are generally adverse but modest.

The Teenage Mothers-Grandmothers (TAM-GM) program was developed at a hospital in the Bronx, New York, to help the adolescents' mothers understand and communicate with their pregnant daughters. Eligible adolescents were no more than 32 weeks pregnant, had no previous live birth, would be aged 17 or younger at due date, and maintained an ongoing relationship with their mother or mother surrogate (their grandmother or the mother of the adolescent's boyfriend). The TAM-GM program consisted of a series of structured, hour-long sessions coinciding with prenatal visits. During sessions one, two, and four, a social worker met with the adolescent's mother alone; the adolescent joined them for the third session. Additional sessions occurred after the birth. An evaluation was undertaken in 1993 to determine if program participation improved school completion, reduced repeat pregnancy rates, and improved the adolescent-mother relationship. The grandmothers reported that participation in the program helped them deal with the situation and improved their relationships with their daughters. Adolescents and their mothers reported improved communications. Program participants suggested that the program be extended beyond clinic hours, possibly using a hotline approach. The adolescents who participated in the program were less likely to drop out of school and had a lower repeat pregnancy rate and significantly higher self-esteem than those who did not participate. High self-esteem was a significant predictor of staying in school.

Purpose: Our study investigates the factors associated with length of time to referral appointments for pregnant teens diagnosed in a hospital-based adolescent clinic. Methods: Ninety-six pregnancies diagnosed during a six-month period at a hospital-based adolescent clinic were followed prospectively. Demographic data, plans for pregnancy, last menstrual period (LMP), and who accompanied patient to the appointment were recorded by providers. Appointment at referral site was confirmed by the patients' primary provider, contact with the patient, and/or referral site. The time from first positive pregnancy test to kept referral appointment was determined. Results: Of the 96 diagnosed pregnancies, data were available for 94 patients. The mean age was 17.6 ± 2.0 years. The average gestation was 7.4 ± 4.2 weeks (range 4–27 weeks) at initial visit and 11.7 ± 4.9 weeks (5–30 weeks) at referral site. The time to referral appointment was significantly shorter for patients who planned to terminate compared with those who planned to continue with the pregnancy (22.4 ± 16.6 vs. 35.7 ± 24.5 days, P = 0.0042). However, the final decision to continue vs. terminate the pregnancy was a stronger predictor of the interval to kept referral appointment ( R 2 = 0.177) than the initial plan. Those who planned to tell more people about their pregnancy had a significantly higher rate of continuing the pregnancy than those terminating. Conclusion: Pregnant teens may need multiple follow-up appointments to facilitate connection to referral care. Close follow-up and communication with referral sites needed to optimize care of pregnant teens because of the delay until teens access pregnancy services.