Psychosocial stressors of drug-abusing disadvantaged adolescent mothers.

Scafidi, Frank A. ; Field, Tiffany ; Prodromidis, Margarita 等

Adolescence is a time of physical, psychological, and social change and generally is considered a stressful period during normal development. Additional psychosocial stressors such as pregnancy may predispose some adolescents to poorer functioning (Ensminger, 1990). In fact, adolescent pregnancy has been associated with increased depression and lower self-esteem (Bolton, 1980), more disadvantaged socioeconomic backgrounds (Barnett, Papini, & Gbur, 1991), and poorer family communication (Lewis, 1978; Shah, Zelnik, & Kantner, 1975). The constellation of psychosocial problems facing the adolescent mother also places her at risk for illicit drug use. For example, disadvantaged socio-economic backgrounds frequently are associated with increased drug use, and adolescent girls have been noted to self-medicare for depression. Peer and family systems also play an important role in the onset of drug use. For example, the strongest single predictor of current and future drug use is whether an adolescent's friends use drugs. Similarly, familial use and their attitudes toward drugs and alcohol are highly correlated with adolescent drug use. Adolescents living in dysfunctional family systems including poor family cohesion, negative communication patterns, unrealistic parental expectations, and parental disengagement are at increased risk for drug use (Andrews et al., 1991; Friedman & Utada, 1992; Swadi, 1992; Wills, Vacarro, & McNamara, 1992). Poor academic achievement, poor sense of competence, low self-concept, and nonconforming behaviors such as sexual activity and rebelliousness also have been associated with early drug use (Andrews et al., 1991).

Prevention and intervention programs for drug abuse could benefit from evaluations of potential psychosocial stressors in many aspects of the adolescent's life. Since poor mental health, dysfunctional family and peer relationships, poor social skills, low educational and vocational achievement, and inappropriate use of leisure time have been related to early drug use (Andrews et al., 1991; Swadi, 1992; Willis et al., 1992), it is important that these potentially problematic areas be evaluated.

The present study attempted to identify the psychosocial stressors associated with adolescent pregnancy and drug abuse. The sample consisted of economically disadvantaged adolescent mothers classified as drug abusing and nondrug abusing during pregnancy. The primary question was whether drug-abusing mothers experienced more psychosocial stressors than did the nondrug-abusing mothers from the same low socioeconomic background. A secondary question was whether there was a cluster of psychosocial stressors that differentiated the two groups of young mothers.

METHOD

Sample

The sample consisted of 104 adolescent mothers between 13 and 21 years of age (M = 18) who received their obstetrical care at a large inner-city university hospital. The young women were primarily single, African-American, and Hispanic, with a tenth grade education (see Table 1).

Table 1

BDI PBF and Sociodemographic Variables for Drug Abusing and
Non-Drug Abusing Adolescent Mothers

Variables Drug-using Non-drug-using
 (N = 55) (N = 49)
 Mean (sd) Mean (sd) p

BDI 14.0 (9.2) 6.0 (2.4) .001
PBF 6.8 (3.0) 5.8 (3.2) .15
Age 18.6 (1.9) 18.2 (2.1) .31
Education 10.3 (1.6) 10.6 (1.5) .29
Socioeconomic Status 4.4 (0.8) 4.4 (0.6) .64

Measures

In order to identify adolescents who abused drugs during pregnancy the following measures were conducted:

Urine toxicology. A urine toxicology screen was conducted on all adolescent mothers upon admission to labor and delivery. Specific immunoassays (EMIT, Syva) were performed for cocaine metabolite (benzoylecgonine), opiates, and marijuana. In addition, urine toxicology screens were performed on the infants' urine as soon as possible after delivery.

Drug/alcohol history. A maternal history of substance abuse and medication usage was completed during the admission history and physical examination by the labor and delivery staff as per hospital protocol. In addition, a separate interview was subsequently conducted after delivery by a trained research associate. Mothers were asked to identify substances used immediately prior to or during each trimester of pregnancy. The list included caffeine, nicotine, alcohol (e.g., beer, wine, liquor), nonprescription medications used for nonindicated reasons, prescription medications used in a nonprescribed manner (e.g., valium, codeine), and illicit drugs (e.g., marijuana, cocaine, heroin, methadone). Mothers were asked to estimate the day they last used any of the substances and the frequency of use (daily, weekly).

Inclusion criteria for the drug-abusing group included: a positive toxicology screen for the mother or the infant or maternal reports of: (a) 15 or more alcoholic drinks, (b) any marijuana use, or (c) any cocaine use during pregnancy. Inclusion criteria for the nondrug-abusing group included a negative toxicology screen and a history of not using drugs; a history of less than 15 alcoholic drinks during pregnancy; or a history of drug experimentation that occurred more than six months before pregnancy).

Within 24 hours after delivery each mother was administered a social history, the Beck Depression Inventory (BDI), the Paranoid-Borderline Features Scale (PFB) adapted from the Millon Clinical Multiaxial Inventory, and the Problem Oriented Screening Instrument for Teenagers (POSIT). All scales were administered in an interview format to control for differences in reading levels and were given in the order described below.

Demographic data. This information was obtained by a brief interview and included age, ethnicity, marital status, and education and employment histories. Socioeconomic status was determined by the Hollingshead two-factor index of social status.

Beck Depression Inventory. The revised Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979; Beck & Steer, 1987) is a 21-item self-report inventory that assesses a wide range of symptoms associated with depression. The items reflect affective, cognitive, motivational, and vegetative symptoms and are based on a 4-point scale ranging from 0 to 3. The BDI is scored by summing the ratings on all the items (scores can range from 0 to 63). Total scores above 13 are indicative of depression. This instrument is applicable for use with adolescents as young as 13 years (Steer & Beck, 1988).

Paranoid-Borderline Features (PBF). To determine the presence of paranoid and borderline features, a subset of 15 questions from the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1982) were administered. These questions reflect paranoid ideation, dependency, and lack of trust, and require "true" or "false" responses. A total score is obtained by summing the items (scores can range from 0 to 15). Higher scores represent greater paranoid and borderline characteristics.

Problem Oriented Screening Instrument for Teenagers. The POSIT is a validated 139-item screening instrument developed by the National Institute of Drug Abuse (Rahdert, 1991) to aid in the identification of adolescent problem behaviors. This questionnaire utilizes a yes/no response format and identifies social, familial, educational, physical, and psychological stressors in ten functional areas: Substance Use/Abuse, Mental Health, Physical Health, Family Relations, Peer Relations, Educational Status, Vocational Status, Social Skills, Leisure and Recreation, and Aggressive Behavior/Delinquency which was used to screen for social, emotional and behavioral problems. A total adjusted mean score is calculated on each of the 10 problem or potentially stressful areas represented on the POSIT questionnaire. The POSIT is a good measure for differentiating adolescents with and those without known problems (Rahdert, 1991; Babor et al., 1991).

RESULTS

No significant differences were noted between the groups (drug versus nondrug) on any of the sociodemographic variables except on the BDI (see Table 1). Drug-abusing mothers were more depressed than nondrug-abusing mothers (t (102) = 6.18, p [less than] .001).

Drug-abusing mothers received higher (less optimal) Total scores on the POSIT than nondrug-abusing mothers (t (94) = 7.29, p [less than] .001). In addition, drug-abusing mothers obtained higher adjusted total scores on every scale: Substance Use/Abuse (t (102) = 3.92, p [less than] .001); Physical Health (t (102) = 2.40, p [less than] .02); Mental Health (t (192) = 6.67, p [less than] .001); Family Relations (t (102) = 5.39, p [less than] .001); Peer Relations (t (102) = 6.07, p [less than] .001); Educational Status (t (102) = 6.76, p [less than] .001); Vocational Status (t (102) = 3.41, p [less than] .001); Social Skills (t (102) = 5.29, p [less than] .001); Leisure/Recreation (t (102) = 3.96, p [less than] .001); and Aggressive Behavior (t (102) = 4.66, p [less than] .001).

A stepwise multiple regression analysis was performed to determine the relative contribution of each POSIT subscale to adolescent mother drug abuse. The regression analysis yielded a three-variable model that accounted for 40% of the variance and included Mental Health (30%), Leisure and Recreation (6%) and Peer Relationships (5%).

Table 2

Means and Standard Deviations for Drug Abusing and Non-Drug
Abusing Adolescent Mothers on Adjusted Total Subscale Scores of
the POSIT

Measures(1) Drug-using Nondrug
 (N = 55) (N = 49)
 Mean (sd) Mean (sd) p

POSIT Total score 50.84 (17.8) 28.60 (11.6) .001
Substance Use 0.10 (0.2) 0.00 (0.0) .001
Physical Health 0.40 (0.2) 0.32 (0.1) .01
Mental Health 0.41 (0.2) 0.18 (0.2) .001
Family Relations 0.32 (0.2) 0.11 (0.1) .001
Peer Relations 0.39 (0.2) 0.19 (0.2) .001
Educational Status 0.38 (0.1) 0.20 (0.1) .001
Vocational Status 0.34 (0.1) 0.14 (0.2) .001
Social Skills 0.36 (0.1) 0.20 (0.1) .001
Leisure and Recreation 0.48 (0.2) 0.35 (0.2) .001
Aggressive Behavior 0.33 (0.2) 0.18 (0.2) .001

1 Lower scores are optimal

A discriminant function analysis was then conducted to determine how well the POSIT scales classified drug-abusing and nondrug-abusing mothers. The discriminant function consisting of Mental Health, Leisure and Recreation, Peer Relationships, Physical Health and Social Skills, respectively, correctly classified 75% of the drug-abusing mothers and 84% of the nondrug-abusing mothers (Lambda (102) = .55, p [less than] .0001). The function loaded most heavily on the Mental Health subscale.

DISCUSSION

In the present study drug-abusing adolescent mothers experienced more psychosocial stressors than did nondrug-abusing mothers, suggesting several factors that might lead to, maintain, or be the consequence of drug abuse. Studies of adolescents have associated several factors with early drug use including peer pressure, a dysfunctional family system, poor academic achievement, and low self-esteem (Friedman & Utanda, 1992; Wills et al., 1992). The findings from this study suggest that similar factors are predictive of drug abuse during adolescent pregnancy. Targeting this specific population is important since previous research has demonstrated that the adolescent mother is at risk for poorer psychosocial functioning (Ensminger, 1990; Prodromidis et al., 1993).

Drug-abusing adolescent mothers reported poorer physical and mental health, lower vocational and educational status, more family and peer relations problems, less constructive use of leisure time, poorer social skills, and more aggressive behavior than did nondrug-abusing adolescent mothers. Mental Health was the most important factor associated with drug abuse in adolescent mothers. This finding is not surprising since the BDI indicated that drug-abusing adolescent mothers were more likely to be depressed than were the nondrug-abusing mothers. Further, depressed adolescent girls are known to self-medicate for depression (Adams & Adams, 1991). A recent study noted that 14% of adolescents attending a family planning clinic reported using drugs. Infants exposed to drugs in utero are at greater risk for developmental problems including low birthweight, smaller head circumference, increased irritability, motor deficits, and long-term neurological sequalae (Chasnoff, Lewis, Griffith, & Wiley, 1989; Eisen et al., 1991; Scafidi et al., 1996; Young, Vosper, & Phillips, 1992).

Identification of specific problem areas is essential for developing additional assessment strategies and individualized intervention plans for preventing drug abuse in pregnant adolescents. The POSIT, a comprehensive screening instrument designed to evaluate potential problem areas for the teenager, is a useful screening instrument both for identifying problem areas and identifying pregnant adolescents who are at risk for drug abuse.

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Frank Scafidi, Ph.D., Assistant Research Professor, Touch Research Institute, University of Miami School of Medicine.

Margarita Prodromidis, Ph.D., Research Associate, Touch Research Institute, University of Miami School of Medicine.

Elizabeth Rahdert, Ph.D., Project Officer, National Institute on Drug Abuse.