Adverse Childhood Experiences, Adolescent Unintended Pregnancy, and Perceived Stress Levels in Adolescence 公开

Abstract

Background: Stress is a serious public health issue that can result in severe health consequences. Potential precursors to stress include social stressors and stressful life events. One such social stressor, adverse childhood experiences, has primarily been examined as a specific type of abuse or neglect without considering the effect of more than one type, of abuse and neglect intensity, or of the number of types of abuse and neglect experienced. We examined all of these classifications and hypothesized that 1) adverse childhood experiences increase perceived stress levels in adolescence, 2) adverse childhood experiences are associated with adolescent unintended pregnancy, and 3) an adolescent unintended pregnancy increases perceived stress levels in adolescence.

Methods: The parent study consisted of a convenience sample of 199 young women aged 15-24 living in the metro-Atlanta area. Young women were interviewed between February and December 2017 regarding their personal and health history. 146 young women from this study were included in the final analytic sample. We conducted multivariable logistic and linear regression to address the three hypotheses of the study.

Results: In total, ninety-two (63.0%) young women reported having ever been victim to an adverse childhood event and thirty-three (22.6%) women reported a history of adolescent unintended pregnancy. Average perceived stress scores were highest among women victim to an adverse childhood experience (mean 24.7, SD 8.1) and among those with a history of adolescent unintended pregnancy (mean 24.7, SD 9.2). Through multivariable linear regression, we found modest evidence that an increase in the number and severity of adverse childhood experiences was associated with an increase in perceived stress score. We observed a slightly protective, though non-significant, effect or adverse childhood experience on adolescent unintended pregnancy and of adolescent unintended pregnancy on perceived stress level. 

Conclusions: Results suggest a dose-response relationship between adverse childhood events and level of perceived stress in adolescence. The high level of educational attainment in our sample, possibly due to oversampling in areas frequented by university and college students, may help explain paradoxical findings between adverse childhood experiences and adolescent unintended pregnancy as well as adolescent unintended pregnancy and perceived stress level.

Table of Contents

INTRODUCTION.......................................................................................................................... 1

 

Adolescence as a Critical Development Period.............................................................................. 1

 

Stress Definitions and Measurements............................................................................................. 1

 

The Effect of Stress on Mental & Physical Health......................................................................... 3

 

Perceived Stress as a Public Health Issue....................................................................................... 3

 

The Role of Adverse Childhood Experiences as Social Stressors...................................................4

 

The Role of Unintended Pregnancy as a Potential Unique Stressor................................................6

 

Adverse Childhood Experiences, Unintended Pregnancy, and Adolescent Stress Perception..... 10

 

Importance and Implications ...................................................................................... …………..10

 

BACKGROUND...........................................................................................................................13

 

METHODS....................................................................................................................................17

 

Study Sample and Design.............................................................................................................17

 

Measures........................................................................................................................................18

 

Adverse Childhood Experiences..............................................................................................18

 

Unintended Pregnancy............................................................................................................20

 

Psychosocial Stress.................................................................................................................20

 

Background Characteristics....................................................................................................21

 

Data Analysis.................................................................................................................................22

 

Descriptive Statistics................................................................................................................23

 

Bivariate Analysis....................................................................................................................24

 

Multivariable Analysis.............................................................................................................25

 

RESULTS......................................................................................................................................27

 

Participant Descriptive Statistics...................................................................................................27

 

Covariates.....................................................................................................................................28

 

Models Considered........................................................................................................................29

 

Question 1: Adverse Childhood Experiences and Perceived Stress..............................................30

 

Question 2: Adverse Childhood Experiences and Adolescent Unintended Pregnancy.................31

 

Question 3: Adolescent Unintended Pregnancy and Perceived Stress..........................................33

 

DISCUSSION................................................................................................................................35

 

Strengths........................................................................................................................................37

 

Limitations.....................................................................................................................................38

 

Conclusion.....................................................................................................................................39

 

IMPORTANCE AND IMPLICATIONS......................................................................................41

 

Extended Results and Discussion..................................................................................................41

 

Importance of Studying Adolescence..........................................................................................41

 

Prevalence of Adverse Childhood Experiences...........................................................................41

 

Inverse Relationship Between Adverse Childhood Experiences and Unintended Pregnancy.... 42

 

Adverse Childhood Experiences and Perceived Stress in Adolescence..................................... 45

 

Public Health Implications............................................................................................................46

 

Costs to the Individual and Society..............................................................................................46

 

Public Health Surveillance of Adverse Childhood Experiences..................................................47

 

The Impact of Stress on Health and Health Behavior...................................................................47

 

Future Directions..........................................................................................................................49

 

Raising Awareness of Adverse Childhood Experiences...............................................................49

 

Clinical Interventions for Victims of Adverse Childhood Experiences.......................................50

 

Future Research............................................................................................................................51

 

REFERENCES.............................................................................................................................53

 

TABLES........................................................................................................................................59

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health Health Sciences, Epidemiology
关键词	Stress Adverse childhood experiences Adolescence
Committee Chair / Thesis Advisor	Kramer, Michael, Emory University
Committee Members	Stidham Hall, Kelli, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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