The Association Between Adverse Childhood Experiences and Adolescent Pregnancy, Long-Term Psychosocial Consequences, and Fetal Death

Hillis, Susan D.; Anda, Robert F.; Dube, Shanta R.; Felitti, Vincent J.; Marchbanks, Polly A.; Marks, James S.

doi:10.1542/peds.113.2.320

Cited by 548 publications

(371 citation statements)

References 56 publications

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“…In 2008, more than 435,000 infants were born to adolescent mothers, age 15-19 years, in the U.S. with a rate of 41.5 births/1,000 women [2]. Compared to adult mothers, adolescent mothers have higher rates of poverty, single parenthood, abuse and victimization and lower levels of education [3,4]. Adolescent mothers also may have inadequate social support [3,[5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Study of Depressive Symptoms and Social Support in Adolescent Mothers

Brown¹,

Harris

Woods

et al. 2011

Matern Child Health J

109

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Previous studies have suggested that adolescent mothers with higher social support have lower depressive symptoms. This is a longitudinal study of adolescent mothers to examine the association of social support and depressive symptoms over one year postpartum. This was a prospective study of adolescent mothers (N at baseline = 120, N at 1 year = 89; age \ 19 years) enrolled in a teen tot program. Participants completed the Center for Epidemiological Studies Depression Scale for children (CES-DC) and the Duke-UNC Functional Social Support Questionnaire at baseline, 12 weeks, and 1 year. A score of C 16 on the CES-DC was suggestive of major depression. The mean CES-DC scores of the adolescent mothers were C16 points at all three time points (baseline: mean = 18.7 ± 10.3; 53% C 16; 12 weeks: mean = 18.4 ± 11.4, 57% C 16; one year: mean = 20.0 ± 11.4; 57% C 16). Social support had a significant, inverse association with depressive symptoms for all participants from baseline to 12 weeks with a stronger association for those with more depressive symptoms (score C 16) at baseline (beta = -0.030 ± 0.007; P \ 0.001) than for those with fewer depressive symptoms (score \ 16) at baseline (beta = -0.013 ± 0.006; P = 0.021). From 12 weeks to one year, increased social support was only significantly associated with decreased depressive symptoms for those with a higher baseline level of depressive symptoms (beta = -0.039 ± 0.009; P \ 0.001). Depressive symptoms were prevalent among adolescent mothers. For more depressed adolescent mothers, higher levels of social support were associated with less depressive symptoms over the 1 year follow-up. Effective long-term interventions are needed to lessen depression and enhance social support.

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Section: Introductionmentioning

confidence: 99%

Longitudinal Study of Depressive Symptoms and Social Support in Adolescent Mothers

Brown¹,

Harris

Woods

et al. 2011

Matern Child Health J

109

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“…Scores of articles have long demonstrated a relationship between exposure to childhood adversity and a range of negative outcomes throughout the life span. [1][2][3][4][5][6][7][8] The disproportionate exposure of low-income children to abuse, neglect, and other adversities 9,10 has been implicated as an important contributor to health disparities. 11,12 Preventing and mitigating the impact of ACEs is critical to decreasing health disparities.…”

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confidence: 99%

“…Additional research has further substantiated the tie between childhood adversity and negative outcomes, including poor academic achievement, incarceration, unemployment, poverty, disability, and early death. 1,3,4,[13][14][15][16][17][18][19][20][21][22][23][24] The original ACE questionnaire assessed childhood exposure to physical abuse, psychological abuse, and sexual abuse, as well as household mental illness, substance abuse, domestic violence, and incarceration. 1 Subsequent ACE studies incorporated physical/emotional neglect and parental separation/divorce into the ACE index.…”

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confidence: 99%

Adverse Childhood Experiences of Low-Income Urban Youth

Wade¹,

et al. 2014

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BACKGROUND AND OBJECTIVE: Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area. METHODS: Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains. RESULTS: Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination. CONCLUSIONS: Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults.

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“…Recent retrospective studies in primarily middle-class, white participants have compared adverse childhood experiences with adolescent risk behavior. 31,32 The Adverse Childhood Experience (ACE) score assessed past exposure to 8 ACEs, including exposure to violence and home environment factors. Statistically significant associations were shown between higher ACE scores and adolescent drug use and teen pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Follow-up of Poor Inner-city Youth Between Ages 8 and 18: Intentions Versus Reality

Handzel¹,

Brodsky

Betancourt

et al. 2012

Pediatrics

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OBJECTIVES: (1) To document, at ages 8 to 10, children’s perceptions of their future and, at ages 16 to 18, youth outcomes; and (2) to assess early childhood factors associated with trajectory-altering events (TAEs), defined as youth risk behaviors that may modify developmental trajectories. METHODS: A prospective longitudinal study of 97 poor, inner-city, African American youth followed since birth who completed (1) early childhood environment, cognitive, and social-emotional evaluations, as well as an inventory at ages 8 to 10 of perceptions of their futures; and (2) evaluation for presence or absence of 4 TAEs documented at ages 16 to 18: drug use, adjudication, school failure, and teen parenthood. RESULTS: At age 9.4 ± 0.5, 94% of participants felt it unlikely they would try marijuana; 93% felt they were unlikely to get arrested; 92% felt they were likely to attend college or trade school; 81% did not know one could become pregnant with first-time sex. Age 18.1 ± 0.8 outcomes showed that 33% had used drugs, 33% had been adjudicated, 19% had school failure, and 20% had become parents. Fifty-six percent had ≥1 TAE. No relationship was found between childhood perceptions and intentions and documented outcomes. Odds of having a TAE increased with greater exposure to violence and poorer home environment. CONCLUSIONS: Young inner-city children are idealistic regarding their future. By ages 16 to 18 however, more than half of this cohort had a TAE. Factors most strongly associated with a TAE were greater exposure to violence and poorer home environment.

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The Association Between Adverse Childhood Experiences and Adolescent Pregnancy, Long-Term Psychosocial Consequences, and Fetal Death

Abstract: The relationship between ACEs and adolescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se.

Cited by 548 publications

References 56 publications

Longitudinal Study of Depressive Symptoms and Social Support in Adolescent Mothers

Longitudinal Study of Depressive Symptoms and Social Support in Adolescent Mothers

Adverse Childhood Experiences of Low-Income Urban Youth

Longitudinal Follow-up of Poor Inner-city Youth Between Ages 8 and 18: Intentions Versus Reality

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