Adolescent pregnancy and substance use.

The question of just what is the relationship of early pregnancy and childbearing and substance use among adolescents remains unanswered. From a public health perspective, both behaviors are unwanted, and populations that are at risk are often at high risk for both. Perhaps prevention of one behavior may be expected to prevent the other. This, however, may be too simplistic a notion, grounded in misconception of the role of early pregnancy and specific cultural context. Furthermore, several studies have documented a decline of drug use during pregnancy and just after delivery among adolescent mothers. Does this trend continue through the parenting years? If so, for whom? What are the individual maternal, child, and family environmental characteristics that predict a decline in use or continued abstinence after early childbearing? Within the context of poverty, lower educational attainment, minority status, and high prevalence of alcohol and drug use, pregnancy may play a positive role. With a change in role, young women may be less likely than nonparenting peers and less likely than prior to their own pregnancy to become deeply involved in the negative behaviors, such as smoking, drinking, and substance use. Perhaps this is a potential opportunity to intervene. To summarize, the health risk behaviors of substance use and adolescent pregnancy and childbearing appear to be linked. Youths who become pregnant before they complete high school represent a particular group of young women who may be at higher risk than the general population for substance use, at least cigarettes, alcohol, and marijuana. Yet, most pregnant teenagers are not substance users. Among those who are, frequency and amounts of use in most samples were low compared with adult samples of pregnant women. Furthermore, there is evidence that teenagers perceive substance use as a risk to their pregnancies and their unborn children. Among users, there is a decrease in use and increase in quit rates during pregnancy and early childrearing years. Many of these young people are embedded in an environment with very high rates of use among family, partners, and peers. There appears to be strong evidence of covariation of risk behaviors. It is possible that for some youths, pregnancy can be viewed as an opportunity and a chance to intervene to decrease risks for initiating and decrease use among adolescents already using substances. It may be a natural touch point, and pregnancy and parenthood may transition youths out of a high-risk experimentation phase of their adolescence. Further research, especially that of a longitudinal nature, is needed to address the complex issues of adolescent pregnancy and substance use.