Victimization, Mental Distress, Crime, and Substance Use among Pregnant Adolescent Girls

1. Figure 1: Mean scale scores reported by pregnancy Ever Pregnant (n=567) General Victimization* 5.43 Never Pregnant (n=3465) 3.67 * p < 0.05. General Crime* 2.86 1.79 Behavior Complexity** 12.42 11.64 Internal Mental Distress* 14.91 12.05 Substance Problems* 7.85 7.10 0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 Figure 2: Percent “High” Scores by pregnancy Ever Pregnant (n=567) General Victimization* 68% Never Pregnant (n=3465) 50% * p < 0.05. General Crime* 31% 20% Behavior Complexity** 29% 23% Internal Mental Distress* 24% 15% Substance Problems* 41% 35% 0% 10% 20% 30% 40% 50% 60% 70% 80% Severity of Victimization Table 2 Percent High Scores Among Pregnant Adolescents by Severity of Victimization High Some None (n=384) (n=44) (n=134) General Crime* (high score range) 38% 25% 10% Substance Problems in past year* (high score range) 49% 23% 27% Internal Mental Distress* (high score range) 34% 11% 3% Behavior Complexity* (high score range) 39% 14% 6% * p < 0.05 Victimization, Mental Distress, Crime, and Substance Use among Pregnant Adolescent Girls Victoria H. Coleman-Cowger, Ph.D. & Michael L. Dennis, Ph.D. Chestnut Health Systems, Normal, IL Introduction Purpose of Study Methods Results References • Approximately 750,000 adolescent girls aged 15-19 become pregnant each year (The Alan Guttmacher Institute, 2006). Though the adolescent pregnancy rate had been declining since 1990, it rose 3.4 percent from 2005 to 2006 and an additional 1 percent from 2006 to 2007(National Center for Health Statistics, 2009). • The increasing rate of adolescent pregnancy over the past two years is a concern given that babies born to adolescent mothers are at elevated risk of poor birth outcomes, including higher rates of low birthweight, preterm birth, and death in infancy (National Center for Health Statistics, 2009). • Pregnant adolescents (aged 15-17) report a higher rate of current illicit drug use (22.6%) than non-pregnant adolescents (13.3%), which is a trend that is reversed for women aged 18-44 (SAMHSA, 2008). • Several adolescent pregnancy risk factors have been identified in the literature, including cognitive vulnerabilities, romantic partner characteristics, and familial and contextual factors (Noll, Senk, & Putnam, 2009), making it possible to identify girls with a greater likelihood of becoming pregnant. • Adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy (Rainey, 1995). Childhood sexual abuse (CSA) has been found to significantly increase the odds of experiencing an adolescent pregnancy by 2.21 (Noll, Shenk, & Putnam, 2009). • Adolescent girls who report either physical or sexual dating violence are significantly more likely to use alcohol, tobacco, and cocaine, to have been pregnant, and to seriously consider or attempt suicide (Silverman, Raj, Mucci, & Hathaway, 2001). Frequent or recent substance use is more common among abused adolescents and their perpetrator partners (Wiemann, Agurcia, Berenson, Volk, & Rickert, 2000). • The themes of victimization and substance use, and to a lesser extent mental health and crime, thread through many discussions of adolescent pregnancy; therefore, it is important to examine the prevalence of these in all adolescent girls, particularly at entry to substance abuse treatment. • Comprehensive assessment and targeted interventions for adolescent girls are warranted because this population may be at greater risk of becoming pregnant due to prior victimization and are at greater risk of having more substance use, mental health, and environmental problems. The purpose of this study is to examine Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) data collected from adolescents upon entry into substance abuse treatment, in an effort to: Compare ever-pregnant adolescent girls with never-pregnant girls on levels of victimization, mental distress, crime, and substance use. Determine if level of victimization reported by pregnant adolescents is associated with mental distress, crime and violence, and substance use. Dennis, M.L., Titus, J.C., White, M., Unsicker, J., & Hodgkins, D., Webber. R. (2003). Global Appraisal of Individual Needs: Trainer’s Training Manual and Resources. Bloomington, IL: Chestnut Health Systems. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2007. National vital statistics reports, Web release; vol 57 no 12. Hyattsville, MD: National Center for Health Statistics. Released March 18, 2009. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7. Hyattsville, MD: National Center for Health Statistics. 2009. Noll, J.G., Shenk, C.E., & Putnam, K.T. (2009). Childhood sexual abuse and adolescent pregnancy: A meta-analytic update. Journal of Pediatric Psychology, 34, 366-378. Rainey, D.Y., Stevens-Simon, C., & Kaplan, D.W. (1995). Are adolescents who report prior sexual abuse at higher risk for pregnancy? Child Abuse and Neglect, 19, 1283-1288. Silverman, J.G., Raj, A., Mucci, L.A., & Hathaway, J.E. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA, 286, 572-579. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (December 4, 2008). The NSDUH Report: Trends in Substance Use, Dependence or Abuse, and Treatment among Adolescents: 2002 to 2007. Rockville, MD. Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD. Wiemann, C.M., Agurcia, C.A., Berenson, A.B., Volk, R.J., & Rickert, V.I. (2000). Pregnant adolescents: Experiences and behaviors associated with physical assault by an intimate partner. Maternal and Child Health Journal, 4, 93-101. • Data are from 4032 females presenting to treatment, including 308 who were pregnant in the past year and 259 who were pregnant before that. • Table 1 shows their characteristics. Trained and certified GAIN administrators collected intake data from treatment clients at 10 sites during a one-on-one interview. Individual sites sent data to a central data management system at Chestnut Health Systems. • Data analysis was conducted utilizing SPSS version 17.0. High victimization was defined as having a scale score of 4 or higher on the general victimization scale (GVS). Analysis 1. Analysis of data by pregnancy status revealed significant difference in substance problems, mental distress, victimization, and general crime in the past year. Girls who had ever been pregnant were significantly more likely to report having been victimized, higher levels of mental distress, more substance problems, and more involvement in illegal activities (see Figure 1). Pregnant adolescent girls were also significantly more likely to score in the high range for substance problems, internal mental distress, problems controlling external behavior, involvement in criminal activities, and victimization (see Figure 2). Data Set Used • Data used in this study is from a collection of 10 adolescent treatment CSAT grant programs. • All data reported is intake data collected with the GAIN instruments (Dennis et al., 2003). • The dataset was limited to cases for which pregnancy status was available. Information from 4,032 adolescent girls (ages 13-19) was used for the analyses. Of these, 567 (14%) reported having ever been pregnant. Analysis 2. A further analysis was conducted within the pregnant sample of adolescent girls. It was found that those with high levels of victimization were also significantly more likely to report the highest levels of internal mental distress, difficulty controlling external behaviors, criminal involvement, and substance use problems. Ever Pregnant Never Pregnant Table 1. Characteristics (n=567) (n=3465) Mean Age 15.5 16.1 Race White 52% 40% Mixed 17% 22% GAIN Instruments & Scales Hispanic 17% 14% Summary and Implications African-American 10% 17% The GAIN is a collection of comprehensive bio- psychosocial assessments used in substance abuse treatment. Native American 3% 4% • Adolescent girls who have ever been pregnant are more likely to report having experienced: > Victimization at higher levels; > Greater involvement in illegal activities; > Higher levels of internal mental distress; > Greater difficulty controlling external behaviors; > More problems associated with substance use. • Pregnant adolescents have tremendous need for intervention for mental health, criminal, and substance issues. • Targeted interventions to identify girls who have been victimized may help prevent pregnancy in this population, which would in turn lower the national trend of increasing pregnancy rates and improve public health. Asian 0.7% 1% • Staff-administered in about 60-90 minutes • Yield DSM/ICD diagnostic impressions and ASAM/other treatment planning information • Strong history of psychometric integrity Other 1% 2% High severity victimization (past year)** 50% 68% Measures at Intake • Substance Problems Scale (SPSy) – count of the number of problems related to substance use during the past year (i.e, physiological, psychological, and social). • Internal Mental Distress Scale(IMDS) – count of symptoms including somatic, depression, anxiety, traumatic stress, and suicide/homicide in the past year. • Behavior Complexity Scale(BCS) – count of external behavioral problems in the past year. • General Crime Scale (GCS) – count of number of different types of illegal activities endorsed in the past year. • General Victimization Scale (GVS) – count of types of victimization experienced and number of traumagenic factors involved. Victimized in past 90 days 23% 23% Current criminal justice sys. Involve.** 60% 70% Weekly any drug use 49% 51% Acknowledgement Weekly alcohol use 14% 13% Weekly tobacco use** 53% 62% Analysis of the GAIN data reported in this presentation was supported by Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts 207-98-7047, 277-00-6500, 270-03-00006, and 270-07-0191 using data provided by 10 grantees. The opinions expressed here belong to the author and are not official positions of the government. For more information, please contact Victoria H. Coleman, Ph.D. * Chestnut Health Systems * 448 Wylie Drive * Normal, IL 61761 * 309-451-7797 * E-mail: vhcoleman@chestnut.org Weekly marijuana use 34% 35% Any past year substance dependence* 49% 54% Any past year substance abuse 28% 24% Any mental health disorder* 74% 78% *Significant difference at p < 0.05 **Significant difference at p < 0.001