Men who were exposed to abuse or domestic violence in childhood are significantly more likely than others to be involved in a teenage pregnancy, according to a cohort study conducted at a San Diego primary care clinic.1 Nineteen percent in this population have impregnated a teenager at some point in their lives. Forty-three percent report having experienced physical or sexual abuse, or having witnessed the physical abuse of their mother, during their preteen or teenage years. Compared with men without exposure to abuse, men who frequently experienced one type of childhood abuse are about twice as likely, either during adolescence or as adults, to have engaged in sex leading to a teenage pregnancy. Furthermore, men who endured a combination of physical abuse, sexual abuse and exposure to maternal battery before adulthood are more than twice as likely as other men to have been involved in the pregnancy of a teenager.

Although previous studies have reported a correlation between a female's adverse childhood experiences and her risk of teenage pregnancy, it has not been known whether a similar correlation exists for males. To assess this issue, researchers analyzed the responses of 4,127 men on a questionnaire used in a study of the effect of adverse childhood experiences on health outcomes and behaviors. On the questionnaire, each man was asked about his reproductive history, as well as his exposure to and frequency of childhood abuse.

At the time of the survey, the men were, on average, 58 years old. Eighty-one percent were white, and the vast majority were either currently married (78%) or living with a partner (4%). Forty-nine percent had graduated from college, and only 6% had not graduated from high school.

Nineteen percent of respondents reported involvement in at least one teenage pregnancy. The men were, on average, 21 years of age at the time of their first involvement in teenage pregnancy. At the time the pregnancy occurred, 59% were 20 or older, and at least 56% were not married. The females whom these men impregnated were, on average, 17.8 years old at the time of pregnancy. Sixteen percent were 12-16 years old, 16% were 17 years old, 32% were 18 years old and 36% were 19 years old.

Of the men surveyed, 32% reported having been physically abused by age 18, 15% reported having been sexually abused and 11% reported having had a battered mother. Overall, 43% reported exposure to at least one type of abuse (31% one type, 10% two types and 2% all three types).

The researchers used logistic regression analysis to determine the relationship between the three types of abuse and men's involvement in teenage pregnancy, controlling for the potentially confounding effects of age, race and education. An increased risk of involvement in teenage pregnancy was found in men with a history of childhood exposure to physical abuse (odds ratio, 1.3), sexual abuse (1.5) or maternal battery (1.5).

Moreover, as the frequency of abuse increased, the odds of involvement in a teenage pregnancy rose significantly. Men who said that they had often or very often been physically abused or witnessed various types of maternal battery were about twice as likely as those with no such history to have impregnated a teenager (odds ratios, 1.7-2.4). Similarly, men who reported having been abused sexually at age 10 or earlier, and those whose abuse involved physical force or the threat of harm, were significantly more likely than men who had not been abused to have impregnated a teenager (1.8 and 2.1, respectively).

Further analysis of the data found a dose-dependent relationship between a man's exposure to adverse childhood experiences and his risk of involvement with teenage pregnancy. Men who experienced two types of abuse were significantly more likely than men not abused to have been involved in a teenage pregnancy (odds ratio, 1.7). Those men who endured all three types of boyhood abuse were more than twice as likely as men with no history of abuse to have engaged in sexual intercourse leading to the pregnancy of a teenager (2.2).

In light of the relationship found between adverse childhood experiences and the risk of involvement in teenage pregnancy, the researchers call for pediatricians to increase efforts to screen male and female patients for signs of abuse. They urge that "continued vigilance on the part of pediatricians to identify both boys and girls exposed to abuse or domestic violence seems to be a vital component of teen pregnancy prevention." The researchers also conclude that since "children of teenage mothers are more likely to be abused or neglected because of the social, financial, and emotional stressors of teenage motherhood," intervention by physicians in cases of childhood abuse could also help decrease "intergenerational transmission of abuse and domestic violence."--J. Rosenberg

=subhead =subhead REFERENCE

1. Anda RF et al., Abused boys, battered mothers, and male involvement in teen pregnancy, Pediatrics, <http:// 2/e19>. 33183

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