1. Adverse Childhood Experiences and Teen Pregnancy Hillary Turner, MPH 1, Christina Harris, BA 2, Adebowale Popoola, MD 3, Nicholas Ialongo, PhD 4, Harolyn Belcher, MD 4,5,6 1 University of Illinois at Chicago School of Public Health, Chicago, IL 2 Howard University College of Medicine, Washington, DC 3 Washington Adventist Hospital, Rockville, MD 4 Johns Hopkins University Bloomberg School of Public Health 5 Johns Hopkins School of Medicine 6 Kennedy Krieger Institute, Baltimore, MD Adverse childhood experiences (ACE) including child physical, sexual, and emotional abuse, experiencing or witnessing community violence and having a caregiver with mental health disorder, substance abuse problems, and/or incarceration have been associated with poor physical and mental health outcomes. This study was designed to examine the association between ACE and teen pregnancy in urban youth. Several studies have documented that stressful events frequently accompany pregnancy and parenthood for adolescents 2006 marked the first year in over a decade that the National teenage pregnancy rate increased, increasing by 3% after a 32% drop in rate between 1991-2005 When compared to other larger cities in the US, Baltimore has one of the highest percentages of all births to mothers under the age of 20 years Baltimore City shares the highest teen pregnancy rate in Maryland with Dorchester County at 7% In urban areas, it is estimated that 80% of youth have been exposed to violence in the neighborhood In 2008, Baltimore's homicide rate was the highest among US cities with populations over 500,000 (37 per 100,000) Both adolescent pregnancy and homicide rates among Hispanics and Blacks are disproportionately higher when compared to other ethnicities As hypothesized, increased ACE exposures increased the odds of experiencing an adolescent pregnancy in a dose-response manner. Consistent with previous research, sexual abuse had the greatest odds of teen pregnancy, only second to witnessing violence. Due to the small number of subjects with ACE > 6, it may be reasonable to combine ACE scores > 6. When ACE> 6 was used in the model, dose response and statistical significance was preserved (OR: 4.545, p<0.001). This study suggests that interventions and supportive services to address ACEs might decrease teen pregnancy outcomes in youth. Studies should continue to look at the impact of violence exposures on youth outcomes in order to have a better understanding of their progression. Research suggests the use of public surveillance mechanisms for long-term monitoring (Kracke and Hahn, 2008). Limitations Questions asked directly to adult participants may have caused underreporting of socially undesirable life experiences. Also, violence variables captured frequent exposures, which might have yield even stronger results had we allowed for one single exposure to count as a defining response. Lastly, results are specific to Baltimore City thus are not generalizable to all populations. Special thanks to my research team, especially my research mentor Dr. Harolyn Belcher and partner Christina Harris. Also, thank you to my capstone readers, Dr. Michele Kelley and Dr. Laurie Ruggiero. This research was supported by a Centers for Disease Control and Prevention grant (U50/CCU325127). The original study was funded by a National Institute of Health grant. Methods Discussion & Implications Acknowledgements Results Hypothesis The hypothesis for this study was that increased exposure to ACEs will result in increased odds of teen pregnancy. Specifically, exposures to violence, both experiencing and witnessing, will increase the odds of experiencing an adolescent pregnancy Randomized school-based preventative trials consisted of 2,311 children from 43 first grade classrooms in 19 Baltimore City elementary schools. Participants originated from two consecutive cohorts of first graders from the 1985-86 and 1986-87 school year. Baseline behavior and demographic information was collected from the child’s caregivers. Follow up interviews were completed at age 19 with the adult child. For the purposes of this study, data was only used from those that were a part of the longitudinal cohort (N=1715) that completed the follow-up interview (mean age 19+-, SD 1.1). Descriptive statistics summarized the characteristics of the study population. Multivariate analyses were performed to measure the association between ACE and teen pregnancy in urban youth. Logistical regression analyses were used to measure exposures to individual ACE variables and the risk of experiencing an adolescent pregnancy. TABLE 1. Characteristics of Study Population (N=1715) Adolescent Pregnancy N (%)n (%) YesNo Gender Male671 (44.14)259 (36.27)412 (51.12) Female849 (55.86)455 (63.73)394 (48.88) Race Black1063 (69.93)580 (81.23)483 (59.93) White433 (29.14)130 (18.21)313 (38.83) Asian3 (0.20)0 (0)3 (0.37) American Indian7 (0.46)3 (0.42)4 (0.5) Hispanic4 (0.26)1 (0.14)3 (0.14) Education Less than 12 th grade349 (23.69)240 (34.38)109 (14.06) Diploma503 (34.15)231 (33.09)272 (35.10) GED127 (8.62)70 (10.03)57 (7.35) Some college494 (33.54)157 (22.49)337 (43.48) Parental Marital Status Married567 (51.97)256 (46.97)311 (56.96) Single/Widowed524 (48.03)289 (53.03)235 (43.04) Income At of below poverty line1048 (77.63)501 (81.33)547 (74.52) Above poverty line302 (22.37)115 (18.67)187 (25.48) Depression189 (12.44)88 (12.34)101 (12.53) Arrested/night in jail406 (28.55)251 (37.63)155 (20.53) Sexual History Sex by age 13170 (11.24)111 (15.57)59 (7.38) Sex by age 14337 (22.27)218 (30.58)119 (14.88) Ever had an STD277 (18.34)198 (27.85)79 (9.89) Traded sex for money42 (2.86)28 (4.11)14 (1.78) Total sample size decreased due to missing data TABLE 3. ACE Exposures and Risk of Adolescent Pregnancy Adolescent Pregnancy UnadjustedAdjusted* n (%) ORP-ValueORP-Value Household Substance Use Yes260 (36.98)1.7810.0001.7070.000 No443 (63.01)1 (Referent) 1 Household Mental Illness Yes107 (16.74)1.2360.1581.4410.024 No532 (83.26)1 (Referent) 1 Incarcerated Caregiver Yes229 (32.71)1.6960.0001.6540.000 No471 (67.29)1 (Referent) 1 Emotional Abuse Yes343 (50.29)1.1230.2711.0870.453 No339 (49.71)1 (Referent) 1 Physical Abuse Yes192 (28.15)1.5110.0011.5010.002 No490 (71.85)1 (Referent) 1 Sexual Abuse Yes82 (12.06)2.6260.0002.2920.000 No598 (87.94)1 (Referent) 1 Witnessed Violence Yes470 (65.83)1.5620.0001.7620.000 No244 (34.17)1 (Referent) 1 Experienced Violence Yes135 (18.91)1.1580.2721.6090.002 No578 (81.09)1 (Referent) 1 *Adjusted for Race, Age, Gender Total sample size decreased due to missing data on ACE exposures and adolescent pregnancy FIGURE 1. Definitions of ACEs Questions Defining Responses Household Substance Use: How many of the people that took care of you growing up used drugs such as marijuana, cocaine or methamphetamine? “very few of them," "a few of them," "some of them," "many of them," or "all of them" Household Mental Illness: Have any of your caregivers ever had a serious mental illness or emotional problems? "yes" Incarcerated Caregiver: How many people who took care of you growing up were ever put in jail or prison? “very few of them," "a few of them," "some of them," "many of them," or "all of them" Emotional Abuse: How often did your caregivers insult, swear or yell at you? "sometimes," "often," "most of the time," or "always" Physical Abuse: How often did your caregivers push, grab, shove or slap you? "sometimes," "often," "most of the time," or "always" Sexual Abuse: In your entire life, has anyone ever used physical or verbal force to make you have sex with them? "yes" Witnessed Violence: How many time have you ever seen someone 1.) being beaten up, robbed or mugged 2.) shot, stabbed or killed in your lifetime? "a few time," "sometimes," "many times," or "everyday" to at least one of the questions Experienced Violence: How many time have you ever been 1.) beaten up, robbed or mugged 2.) shot or stabbed in your lifetime? "a few time," "sometimes," "many times," or "everyday" to at least one of the questions Introduction TABLE 2. ACE score and Adolescent Pregnancy Adolescent Pregnancy UnadjustedAdjusted* ACE Scoren (%)** ORP-ValueORP-Value 0 ACEs77 (12.13)1 (Referent) 1 1 ACE126 (19.84)1.1220.4901.1490.470 2 ACEs111 (17.48)1.5820.0181.7320.007 3 ACEs112 (17.64)1.6220.0131.7340.008 4 ACEs97 (15.28)2.0480.0012.1190.001 5 ACEs59 (9.29)2.0280.0032.1290.003 6 ACEs37 (5.83)3.4140.0004.0340.000 7 ACEs13 (2.05)5.6980.0036.8680.002 8 ACEs3 (0.47)5.2590.1544.9020.178 *Adjusted for Race, Age, Gender **Of those that experienced an adolescent pregnancy Total sample size decreased due to missing data on ACE exposures and adolescent pregnancy