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Purpose This study aimed to examine whether the timing of depression onset relative to age at sexual debut is associated with teenage pregnancy. Methods Using data from 1,025 adolescent girls who reported having had sex in the National Comorbidity Survey—Adolescent Supplement, we applied cox proportional hazards models to test whether depression onset before first sex, at the same age as first sex, or after first sex compared with no depression onset was associated with experiencing a first teenage pregnancy. We examined the unadjusted risk by depression status as well as risk adjusted for adolescents' race/ethnicity, marital status, poverty level, whether the adolescent lived in a metropolitan area, living status, age at first sex, parental education, and age of mother when the adolescent was born. Results In both unadjusted and adjusted models, we found that adolescents with depression onset at the same age as having initiated sex were at an increased risk of experiencing a teenage pregnancy (unadjusted hazard ratio [HR] = 2.5, 95% confidence interval [CI]: 1.08–5.96; adjusted HR = 2.7, 95% CI: 1.15–6.34) compared with those with no depression onset. Moreover, compared with those with no depression onset, the risk of pregnancy for girls experiencing depression onset before first sex also increased but was not significant (adjusted HR = 1.5, 95% CI: .82–2.76). Conclusions Timing of first depressive episode relative to age at first sexual intercourse plays a critical role in determining the risk of teenage pregnancy. Timely diagnosis and treatment of depression may not only help adolescents' mental well-being but may also help them prevent teenage pregnancy.

Severe maternal morbidity continues to be on the rise in the US. Short birth spacing is a modifiable risk factor associated with maternal morbidity, yet few studies have examined this association, possibly due to few available data sources to examine these rare events. To examine the association between interpregnancy interval (IPI) and severe maternal morbidity using near‐national birth certificate data and account for known under‐reporting using probabilistic bias analysis. We used revised 2014‐2017 birth certificate data, restricting to resident women with a non–first‐born singleton birth. We examined the following: (a) maternal blood transfusion, (b) admission to intensive care unit (ICU), (c) uterine rupture (among women with a prior caesarean delivery) and (d) third‐ or fourth‐degree perineal laceration (among vaginal deliveries) by IPI categories (<6, 6‐11, 12‐17, 18‐23, 24‐59 and 60+ months). Risk ratios and 95% confidence intervals were estimated using log‐binomial regression, adjusting for select maternal characteristics. Probabilistic bias analyses were performed. Compared with IPI 18 to 23 months, adjusted models revealed that the risk of maternal transfusion followed a U‐shaped curve with IPI, while risk of ICU admission and perineal laceration increased with longer IPI. Risk of uterine rupture was highest among IPI <6 months. With the exception of maternal transfusion, these findings persisted regardless of the extent or type of misclassification examined in bias analyses. Associations between IPI and maternal morbidity varied by outcome, even after adjusting for misclassification of SMM. Differences across maternal health outcomes should be considered when counselling and making recommendations regarding optimal birth spacing.

Objectives To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria. Methods A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations. Results Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3). Conclusions Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.

Background Recognizing that quality family planning services should include services to help clients who want to become pregnant, the objective of our analysis was to examine the distribution of services related to achieving pregnancy at publicly funded family planning clinics in the United States. Methods A nationally representative sample of publicly funded clinics was surveyed in 2013–2014 (n = 1615). Clinic administrators were asked about several clinical services and screenings related to achieving pregnancy: basic infertility services, reproductive life plan assessment, screening for body mass index, screening for sexually transmitted diseases, provision of natural family planning services, infertility treatment, and primary care services. The percentage of clinics offering each of these services was compared by Title X funding status; prevalence ratios (PR) and 95% confidence intervals (CIs) were estimated after adjusting for clinic characteristics. Results Compared to non-Title X clinics, Title X clinics were more likely to offer reproductive life plan assessment (adjusted PR [aPR], 1.62; 95% CI, 1.42–1.84), body mass index screening for men (aPR, 1.10; 95% CI, 1.01–1.21), screening for sexually transmitted diseases (aPRs ranged from 1.21 to 1.37), and preconception health care for men (aPR, 1.10; 95% CI, 1.01–1.20). Title X clinics were less likely to offer infertility treatment (aPR, 0.55; 95% CI, 0.40–0.74) and primary care services (aPR, 0.74; 95% CI, 0.68–0.80) and were just as likely to offer basic infertility services, preconception health care services for women, natural family planning, and body mass index screening in women. Conclusions The availability of selected services related to achieving pregnancy differed by Title X status. A follow-up assessment after publication of national family planning recommendations is underway.

Materials and Methods:  Using data on 245 women who were attending an urban hospital abortion clinic, we assessed whether women had ever experienced emotional, physical, or sexual IPV. Effectiveness of women's post-abortion contraceptive method selection was categorized into high (intrauterine device [IUD] and implant), moderate (pill, patch, ring, and shot), and low (condoms, emergency contraception, and none) effectiveness. Using multinomial logistic regression, we examined the relationship between number of types of IPV experienced and post-abortion contraceptive method effectiveness, adjusting for sociodemographics, prior abortion, having children, abortion trimester, importance of avoiding pregnancy in the next year, pre-abortion psychological distress, and effectiveness level of the contraceptive method women were planning to use before contraceptive counseling. Results:  Twenty-seven percent (27%) of women experienced two or three types of IPV, 35% experienced one IPV type, and 38% experienced no IPV. Compared to women with no histories of IPV, women who experienced two or more types of IPV during their lifetimes were more likely to choose contraceptive methods with moderate effectiveness (adjusted odds ratio [AOR] = 5.23, 95% confidence interval [CI]: 1.13–24.23, p = 0.035) and high effectiveness (AOR = 5.01, 95% CI: 1.12–22.39, p = 0.035) than those with low effectiveness. Conclusion:  Women who experienced two or more types of lifetime IPV selected more effective contraceptive methods post-abortion. Access to contraceptives that are not partner dependent, including long-acting reversible contraceptives (LARC), may be particularly important for women who have experienced multiple types of IPV.

Purpose This study aimed to examine whether the timing of depression onset relative to age at sexual debut is associated with teenage pregnancy. Methods Using data from 1,025 adolescent girls who reported having had sex in the National Comorbidity Survey—Adolescent Supplement, we applied cox proportional hazards models to test whether depression onset before first sex, at the same age as first sex, or after first sex compared with no depression onset was associated with experiencing a first teenage pregnancy. We examined the unadjusted risk by depression status as well as risk adjusted for adolescents' race/ethnicity, marital status, poverty level, whether the adolescent lived in a metropolitan area, living status, age at first sex, parental education, and age of mother when the adolescent was born. Results In both unadjusted and adjusted models, we found that adolescents with depression onset at the same age as having initiated sex were at an increased risk of experiencing a teenage pregnancy (unadjusted hazard ratio [HR] = 2.5, 95% confidence interval [CI]: 1.08–5.96; adjusted HR = 2.7, 95% CI: 1.15–6.34) compared with those with no depression onset. Moreover, compared with those with no depression onset, the risk of pregnancy for girls experiencing depression onset before first sex also increased but was not significant (adjusted HR = 1.5, 95% CI: .82–2.76). Conclusions Timing of first depressive episode relative to age at first sexual intercourse plays a critical role in determining the risk of teenage pregnancy. Timely diagnosis and treatment of depression may not only help adolescents' mental well-being but may also help them prevent teenage pregnancy.

The majority of research on African American adolescents raised in single-mother homes has focused on externalizing problems, with less attention to other facets of socio-emotional functioning. Using a compensatory resilience approach, the current study examined risk and protective factors at the family (maternal warmth, monitoring, psychological control) and youth (ethnic identity and religiosity) levels as predictors of depressive symptoms, hopelessness, and self-esteem among African American adolescents from single-mother homes ( n  = 193). Lower levels of psychological control, higher levels of monitoring, and higher levels of youth ethnic identity were associated with at least one of the outcomes, depressive symptoms, hopelessness, and self-esteem. In addition, self-esteem, but not hopelessness, mediated the associations between the family- and youth-level factors and youth depressive symptoms. The importance of targeting maternal psychological control and youth ethnic identity, as well as self-esteem, in intervention programs for African American youth from single-mother families is discussed.

Research has documented a negative association between women’s educational attainment and early sexual intercourse, union formation, and pregnancy. However, the implications that school progression relative to age may have for the timing and order of such transitions are poorly understood. In this article, I argue that educational attainment has different implications depending on a student’s progression through school grades relative to her age. Using month of birth and age-at-school-entry policies to estimate the effect of advanced school progression by age, I show that it accelerates the occurrence of family formation and sexual onset among teenage women in Mexico. Focusing on girls aged 15–17 interviewed by a national survey, I find that those who progress through school ahead of their birth cohort have a higher probability of having had sex, been pregnant, and cohabited by the time of interview. I argue that this pattern of behaviors is explained by experiences that lead them to accelerate their transition to adulthood compared with same-age students with fewer completed school grades, such as exposure to relatively older peers in school and completing academic milestones earlier in life. Among girls who got pregnant, those with an advanced school progression by age are more likely to engage in drug use, alcohol consumption, and smoking before conception; more likely to have pregnancy-related health complications; and less likely to attend prenatal care visits. Thus, an advanced school progression by age has substantial implications for the health and well-being of young women, with potential intergenerational consequences.

We examine change across U.S. cohorts born between 1920 and 2000 in their probability of having had sex with same-sex partners in the last year and since age 18. Using data from the 1988–2018 General Social Surveys, we explore how trends differ by gender, race, and class background. We find steep increases across birth cohorts in the proportion of women who have had sex with both men and women since age 18, whereas increases for men are less steep. We suggest that the trends reflect an increasingly accepting social climate, and that women’s steeper trend is rooted in a long-term asymmetry in gender change, in which nonconformity to gender norms is more acceptable for women than men. We also find evidence that, among men, the increase in having had sex with both men and women was steeper for black than for white men, and for men of lower socioeconomic status; we speculate that the rise of mass incarceration among less privileged men may have influenced this trend.

We advance current knowledge of school punishment by examining (1) the prevalence of exclusionary discipline in elementary school, (2) racial disparities in exclusionary discipline in elementary school, and (3) the association between exclusionary discipline and aggressive behavior in elementary school. Using child and parent reports from the Fragile Families Study, we estimate that more than one in ten children born between 1998 and 2000 in large US cities were suspended or expelled by age nine, when most were in third grade. We also find extreme racial disparity; about 40 percent of non-Hispanic black boys were suspended or expelled, compared to 8 percent of non-Hispanic white or other-race boys. Disparities are largely due to differences in children’s school and home environments rather than to behavior problems. Next, consistent with social stress and strain theories, we find suspension or expulsion associated with increased aggressive behavior in elementary school. This association does not vary by race but is robust to a rich set of covariates, within-individual fixed effects, and matching methods. In conjunction with what we find for racial disparities, our results imply that school discipline policies relying heavily on exclusionary punishment may be fostering childhood inequality.