Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Characteristic | % Excluded, n = 235 (13.7%) | % Included, n = 1482 (86.3%) |
---|---|---|
Age | ||
18–25 | 32.8 | 32.0 |
26–30 | 27.6 | 28.8 |
31–35 | 19.5 | 20.4 |
>35 | 20.1 | 18.9 |
Educational attainment * | ||
HS degree or less | 35.4 | 47.4 |
Above HS degree | 64.6 | 52.6 |
Household income | ||
<$15,000 | 47.4 | 46.2 |
$15,000–<$35,000 | 31.6 | 34.2 |
≥$35,000 | 21.1 | 19.7 |
Marital Status | ||
Married | 26.4 | 23.8 |
Living with partner | 17.8 | 15.2 |
Separated/Widowed/Never married | 55.8 | 61.0 |
Race * | ||
Black | 52.3 | 63.0 |
White | 29.4 | 27.6 |
Neither Black nor White | 18.3 | 9.4 |
Currently Pregnant | ||
Yes | 32.9 | 27.3 |
Gravidity * | ||
Nulligravid | 4.9 | 2.9 |
Primigravid | 38.7 | 24.1 |
2 | 23.2 | 25.1 |
3+ | 33.1 | 47.9 |
Parity | ||
Nulliparous | 13.2 | 10.1 |
Parous | 86.8 | 89.9 |
Trouble getting pregnant | ||
Yes | 12.4 | 12.0 |
No | 85.0 | 84.9 |
Don’t Know | 2.7 | 3.1 |
Miscarriage history | ||
Yes | 16.8 | 18.3 |
Depressive symptoms * | ||
Yes | 21.7 | 15.1 |
PTSD-like symptoms | ||
Yes | 10.4 | 8.6 |
Exposure | Not Sure to Wanting Future Children 1 | ||||
---|---|---|---|---|---|
HS or Below (n = 580) | Above HS (n = 546) | ||||
Overall ACE | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
High | 2.19 | (1.73–2.78) * | 1.11 | (0.87–1.41) | 0.07 |
Low | 1.12 | (0.84–1.49) | 0.72 | (0.54–0.97) * | 0.44 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
ACE by Age Period | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
Childhood | |||||
High | 2.03 | (1.60–2.58) * | 1.86 | (1.45–2.38) * | 0.44 |
Low | 1.72 | (1.35–2.18) * | 1.06 | (0.81–1.37) | 0.34 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Adolescence | |||||
High | 2.08 | (1.63–2.64) * | 1.20 | (0.94–1.54) | 0.09 |
Low | 1.60 | (1.26–2.03) * | 0.85 | (0.67–1.08) | 0.18 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
ACE Sub-Type | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
Physical Abuse | |||||
High | 2.22 | (1.77–2.78) * | 1.28 | (0.99–1.66) | 0.14 |
Low | 1.87 | (1.49–2.35) * | 1.04 | (0.83–1.31) | 0.17 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Emotional Abuse | |||||
High | 1.28 | (1.04–1.58) * | 0.99 | (0.77–1.27) | 0.30 |
Low | 1.09 | (0.85–1.40) | 1.84 | (1.45–2.32) * | 0.46 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Substance Abuse | |||||
High | 1.12 | (0.81–1.56) | 0.47 | (0.29–0.75) * | 0.21 |
Low | 2.10 | (1.67–2.63) * | 1.08 | (0.85–1.36) | 0.24 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Sexual Abuse | |||||
1+ ACE | 0.33 | (0.23–0.49) * | 0.56 | (0.41–0.77) * | 0.58 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Neglect | |||||
1+ ACE | 0.73 | (0.58–0.93) * | 0.63 | (0.48–0.83) * | 0.45 |
None | 1.00 | (Ref) | 1.00 | (Ref) |
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Characteristic, n (%) | Sample | Reproductive Plans | Adolescent Pregnancy | |||
---|---|---|---|---|---|---|
Total n = 1482 | Yes n = 640 | Not Sure n = 107 | No n = 735 | Yes n = 276 | No n = 1206 | |
Age | ||||||
18–25 | 473 (32) | 291 (46) | 37 (35) | 145 (20) | 97 (35) | 376 (31) |
26–30 | 426 (29) | 181 (28) | 40 (37) | 205 (28) | 69 (25) | 357 (30) |
31–35 | 301 (20) | 108 (17) | 20 (19) | 173 (24) | 50 (18) | 251 (21) |
>35 | 279 (19) | 58 (9) | 10 (9) | 211 (29) | 58 (22) | 221 (18) |
Educational attainment | ||||||
HS degree or less | 780 (53) | 327 (51) | 56 (52) | 397 (54) | 195 (71) | 585 (49) |
Above HS degree | 702 (47) | 313 (49) | 51 (48) | 338 (46) | 81 (29) | 621 (52) |
Household income | ||||||
<$15,000 | 654 (46) | 296 (49) | 43 (43) | 315 (44) | 141 (53) | 513 (45) |
$15,000–<$35,000 | 484 (34) | 204 (34) | 31 (31) | 249 (35) | 82 (31) | 402 (35) |
≥$35,000 | 279 (20) | 105 (17) | 27 (27) | 147 (21) | 42 (16) | 237 (21) |
Marital Status | ||||||
Married | 351 (24) | 117 (18) | 28 (26) | 206 (28) | 47 (17) | 304 (25) |
Living with partner | 224 (15) | 120 (19) | 20 (19) | 84 (12) | 45 (16) | 179 (15) |
Separated/Widowed/Never married | 898 (61) | 401 (63) | 58 (55) | 439 (60) | 183 (67) | 715 (60) |
Race | ||||||
Black | 934 (63) | 386 (60) | 61 (57) | 487 (66) | 188 (68) | 746 (62) |
White | 409 (28) | 186 (29) | 37 (35) | 186 (25) | 71 (26) | 338 (28) |
Neither Black nor White | 139 (9) | 68 (11) | 9 (8) | 62 (8) | 17 (6) | 122 (10) |
Currently Pregnant | ||||||
Yes | 404 (27) | 167 (26) | 44 (41) | 193 (26) | 65 (24) | 339 (28) |
Gravidity | ||||||
Nulligravid | 41 (3) | 33 (5) | 2 (2) | 6 (1) | 0 (0) | 41 (4) |
Primigravid | 344 (24) | 245 (40) | 19 (19) | 80 (11) | 21 (8) | 323 (28) |
2 | 357 (25) | 165 (27) | 35 (35) | 157 (22) | 47 (17) | 310 (27) |
3+ | 683 (48) | 164 (27) | 44 (44) | 475 (66) | 206 (75) | 477 (41) |
Parity | ||||||
Nulliparous | 144 (10) | 103 (17) | 14 (14) | 27 (4) | 5 (2) | 139 (12) |
Parous | 1279 (90) | 495 (83) | 85 (86) | 699 (96) | 270 (98) | 1009 (88) |
Trouble getting pregnant | ||||||
Yes | 157 (12) | 103 (19) | 10 (10) | 44 (7) | 25 (10) | 132 (12) |
No | 1113 (85) | 436 (78) | 84 (87) | 593 (90) | 213 (86) | 900 (85) |
Don’t Know | 41 (3) | 17 (3) | 3 (3) | 21 (3) | 9 (4) | 32 (3) |
Miscarriage history | ||||||
Yes | 257 (18) | 98 (17) | 27 (28) | 132 (18) | 54 (20) | 203 (18) |
Depressive symptoms | ||||||
Yes | 224 (15) | 103 (17) | 12 (11) | 109 (15) | 53 (19) | 171 (14) |
PTSD-like symptoms | ||||||
Yes | 120 (9) | 55 (9) | 4 (4) | 61 (9) | 32 (13) | 88 (8) |
Exposure | ACEs Prevalences | Wanting Future Children 1 | Adolescent Pregnancy 2 | |||||
---|---|---|---|---|---|---|---|---|
Yes (n = 640) | Not Sure (n = 107) | Yes (n = 276) | ||||||
Overall ACE | n | (%) | OR | (95% CI) | OR | (95% CI) | OR | (95% CI) |
High | 771 | (52.0) | 1.87 | (1.69–2.06) * | 1.58 | (1.34–1.87) * | 1.45 | (1.28–1.63) * |
Low | 365 | (24.6) | 1.31 | (1.17–1.47) * | 0.93 | (0.76–1.14) | 1.21 | (1.05–1.38) * |
None | 346 | (23.4) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
ACE by Age Period | n | (%) | OR | (95% CI) | OR | (95% CI) | OR | (95% CI) |
Childhood | ||||||||
High | 539 | (36.4) | 2.04 | (1.85–2.25) * | 1.95 | (1.64–2.31) * | 1.30 | (1.15–1.46) * |
Low | 522 | (35.2) | 1.43 | (1.30–1.58) * | 1.38 | (1.16–1.64) * | 1.17 | (1.05–1.32) * |
None | 421 | (28.4) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Adolescence | ||||||||
High | 517 | (34.9) | 1.97 | (1.79–2.18) * | 1.59 | (1.34–1.88) * | 1.41 | (1.25–1.59) * |
Low | 541 | (36.5) | 1.31 | (1.19–1.44) * | 1.19 | (1.01–1.41) * | 1.39 | (1.24–1.56) * |
None | 424 | (28.6) | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) | |
ACE Sub-Type | n | (%) | OR | (95% CI) | OR | (95% CI) | OR | (95% CI) |
Physical Abuse | ||||||||
High | 319 | (21.5) | 1.91 | (1.73–2.10) * | 1.72 | (1.45–2.03) * | 1.21 | (1.08–1.36) * |
Low | 354 | (23.9) | 1.23 | (1.12–1.36) * | 1.36 | (1.16–1.60) * | 1.11 | (1.00–1.24) |
None | 809 | (54.6) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Emotional Abuse | ||||||||
High | 432 | (29.2) | 1.99 | (1.82–2.17) * | 1.16 | (0.99–1.36) | 0.90 | (0.81–1.01) |
Low | 272 | (18.4) | 1.21 | (1.09–1.34) * | 1.41 | (1.19–1.67) * | 0.94 | (0.83–1.06) |
None | 778 | (52.5) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Substance Abuse | ||||||||
High | 151 | (10.2) | 1.74 | (1.53–1.97) * | 0.80 | (0.61–1.04) | 1.38 | (1.20–1.59) * |
Low | 268 | (18.1) | 1.24 | (1.12–1.38) * | 1.47 | (1.25–1.73) * | 1.08 | (0.96–1.22) |
None | 1063 | (71.7) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Sexual Abuse | ||||||||
1+ ACE | 234 | (15.8) | 1.41 | (1.27–1.57) * | 0.46 | (0.36–0.59) * | 1.54 | (1.37–1.74) * |
None | 1248 | (84.2) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Neglect | ||||||||
1+ ACE | 323 | (21.8) | 1.20 | (1.10–1.32) * | 0.70 | (0.59–0.83) * | 1.30 | (1.17–1.45) * |
None | 1159 | (78.2) | 1.00 | (Ref) | 1.00 | (Ref) | 1.00 | (Ref) |
Exposure | Yes to Wanting Future Children 1 | Interaction p-Value | |||
---|---|---|---|---|---|
HS or Below (n = 780) | Above HS (n = 702) | ||||
Overall ACE | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
High | 2.40 | (2.10–2.75) * | 1.40 | (1.21–1.61) * | <0.01 |
Low | 1.69 | (1.45–1.97) * | 0.95 | (0.80–1.13) | 0.04 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
ACE by Age Period | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
Childhood | |||||
High | 2.53 | (2.20–2.90) * | 1.61 | (1.39–1.85) * | 0.01 |
Low | 1.73 | (1.51–1.98) * | 1.14 | (0.99–1.32) | 0.07 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Adolescence | |||||
High | 2.18 | (1.90–2.50) * | 1.77 | (1.52–2.05) * | 0.06 |
Low | 1.40 | (1.23–1.60) * | 1.19 | (1.03–1.37) * | 0.21 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
ACE Sub-Type | OR | (95% CI) | OR | (95% CI) | Interaction p-value 2 |
Physical Abuse | |||||
High | 2.01 | (1.75–2.30) * | 1.81 | (1.56–2.08) * | 0.34 |
Low | 1.76 | (1.54–2.01) * | 0.90 | (0.79–1.03) | <0.01 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Emotional Abuse | |||||
High | 1.97 | (1.74–2.23) * | 2.05 | (1.79–2.34) * | 0.67 |
Low | 1.28 | (1.11–1.47) * | 1.13 | (0.97–1.33) | 0.24 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Substance Abuse | |||||
High | 1.85 | (1.56–2.20) * | 1.61 | (1.33–1.94) * | 0.42 |
Low | 1.53 | (1.32–1.77) * | 1.02 | (0.89–1.18) | 0.30 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Sexual Abuse | |||||
1+ ACE | 1.57 | (1.36–1.81) * | 1.25 | (1.07–1.45) * | 0.22 |
None | 1.00 | (Ref) | 1.00 | (Ref) | |
Neglect | |||||
1+ ACE | 1.23 | (1.09–1.40) * | 1.18 | (1.03–1.36) * | 0.50 |
None | 1.00 | (Ref) | 1.00 | (Ref) |
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Flaviano, M.; Harville, E.W. Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort. Int. J. Environ. Res. Public Health 2021, 18, 165. https://doi.org/10.3390/ijerph18010165
Flaviano M, Harville EW. Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort. International Journal of Environmental Research and Public Health. 2021; 18(1):165. https://doi.org/10.3390/ijerph18010165
Chicago/Turabian StyleFlaviano, Megan, and Emily W. Harville. 2021. "Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort" International Journal of Environmental Research and Public Health 18, no. 1: 165. https://doi.org/10.3390/ijerph18010165