Barnet B, Duggan A K, Wilson M D, Joffe A
University of Maryland School of Medicine, Department of Family Medicine, Baltimore, USA.
Pediatrics. 1995 Oct;96(4 Pt 1):659-66.
Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics.
Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated.
Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery.
This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.
怀孕青少年的物质使用是一个重要的公共卫生问题，但关于育有子女青少年的酒精和非法药物使用的已发表数据几乎不存在。本研究确定了产后前4个月青少年母亲中酒精和药物使用的患病率，并探讨了相关的心理社会特征。
在常规孕晚期产前检查期间，连续招募参加综合青少年怀孕和育儿项目的青少年。产后4个月时通过自我报告来确定自分娩以来的酒精使用情况，使用的是为1984年马里兰州青少年药物滥用调查开发的工具。产后2个月和4个月时通过匿名定量尿液药物筛查来测量非法药物使用情况。产后2个月和4个月时使用经过验证的自我管理工具评估抑郁症状、压力和社会支持情况。评估了物质使用者和非使用者在人口统计学特征、同伴群体影响和心理社会变量方面的差异。
参与者（129名符合条件者中的125名）主要是非洲裔美国人，平均年龄16.3岁。产后2个月时从110名参与者、产后4个月时从105名参与者那里获得了完整评估。42%的参与者在产后访视时非法药物筛查呈阳性，或报告自分娩后使用过酒精，被归类为物质使用者。31%的受试者报告自分娩后使用过酒精。大麻是最常见的非法药物（14%），其次是阿片类药物（5%）和可卡因（4%）。将物质使用者与非使用者进行比较时，44%对24%的人抑郁得分较高（P = 0.02），62%对43%的人压力较大（P = 0.04），62%对44%的人报告非常需要社会支持（P = 0.07）。在控制年龄后进行的逻辑回归结果表明，抑郁者非法物质和/或酒精使用的可能性高3.3倍，报告朋友使用非法药物者高2.8倍，自分娩后吸烟的青少年高6.7倍。
本研究表明，在这个产后青少年母亲样本中，酒精和药物使用很常见，抑郁、压力、高支持需求和同伴群体药物使用是相关因素。尽管本研究无法确定抑郁和压力是在物质使用之前还是之后出现，但在照顾青少年母亲时关注这些因素似乎是有必要的。
