MCH Student:

Annie Fedorowicz

Date of Defense:

February 27, 2012

Abstract:

Purpose: Adolescent pregnancy has declined over the past decade but the United States still has the highest rate of adolescent pregnancy in the developed world, with approximately 750,000 women younger than 20 becoming pregnant each year. Adolescent childbearing disproportionally affects minority youth in the United States, with 60 percent of adolescent live births being African-American or Hispanic/Latino. Our study examined the association between feelings of hopelessness and low self-worth, and feelings about pregnancy that may lead to future adolescent pregnancy and childbearing.

Methods: Our cross-sectional sample was 3,139 sexually active, 9 –19 year-old adolescents who completed the Mobile Youth Survey (MYS) in Mobile and Prichard, Alabama between the years of 2006 and 2009. The MYS is a community-based, multiple cohort longitudinal study developed to examine the environmental and psychosocial factors associated with risk behaviors and negative health outcomes in adolescents living in poverty. We used age and sex-stratified multivariate logistic regression to examine the association between hopelessness and low self-worth, and two potential correlates of pregnancy risk (i.e. trying for pregnancy and feelings toward being involved in a future pregnancy).

Results: Fifty percent of participants reported they would be ambivalent or happy about being involved in a future pregnancy within the next year, while only 13 percent of participants reported they were currently trying for pregnancy. More males than females reported that theywould be happy or ambivalent about a future pregnancy. Similarly, more males reported they were currently trying to get someone else pregnant as compared with females reporting they were trying to get pregnant. Hopelessness was inconsistently related to our pregnancy outcomes and the strongest findings were for 17 –19 year-olds: females and males who reported moderate or high feelings of hopelessness were 2 –3 times more likely to report they were trying for pregnancy as compared to same-age adolescents who reported low hopelessness. Further, 17 –19 year-old females and males who reported moderate feelings of hopelessness were 1.5 –1.75 times more likely to report ambivalent or happy feelings about a future pregnancy as compared with those who reported low hopelessness. Self-worth was only associated with trying for pregnancy in females: 9 –14 year-old females who reported low self-worth were 6.6 times more likely to report they were trying to get pregnant as compared to same-age females who reported high self-worth. For adolescent females older than 15 years, those who reported moderate or low self-worth were 2 –3 times more likely to report trying to get pregnant than those with high self-worth.

Conclusions: While our findings were inconsistent across age and sex strata, hopelessness and low self-worth were associated with pregnancy feelings and reports of pregnancy trying for some youth.This suggests that youth living in poverty may view potential early pregnancy as less

burdensome if they are uncertain about their future prospects or do not value their lives as being important. Our findings support a youth development approach to pregnancy prevention programming, which expands targeting behavioral change and access to family planning services to include addressing adolescents’ psychological feelings that inform their pregnancy attitudes.

Keywords: adolescent pregnancy, pregnancy feelings, hopelessness, self-worth