 

:88 : illlllllllWlllHlllllllllllllHlllllllilllllHllllllillllllﬂ

31293 01716 419

This is to certify that the

dissertation entitled
The Relationship of Age, Religiosity, and
Depression on Risk Related Behaviors Among
African American Mothers

presented by

Averetta Elizabeth Lewis

has been accepted towards fulﬁllment
of the requirements for

PhD degree in E'amj 1L&_Chi 1d Ecology

 

   

[U .1 " /7
(luv (k; '

 

Major protessor

Date 12-18-97

 

MSU is art Afﬁrmative Action/Equat Opportunity Institution 0- 12771

 

 

LIBRARY

Michigan State
University

 

 

PLACE IN RETURN BOX
to remove this checkout from your record.
TO AVOID FINE return on or before date due.

 

DATE DUE

DATE DUE

 

 

 

meme
JU 5593193

 

.nﬁ n ”A”
%l3 0" H 9 {LUV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1!” Wm“

THE RELATIONSHIP OF AGE,
RELIGIOSITY, AND DEPRESSION
ON RISK RELATED BEHAVIORS
AMONG AFRICAN AMERICAN MOTHERS

By

Averetta E. Lewis

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

College of Human Ecology

1997

ABSTRACT

THE RELATIONSHIP OF AGE, .
RELIGIOSITY, AND DEPRESSION ON
RISK RELATED BEHAVIORS AMONG

AFRICAN AMERICAN MOTHERS
By

Averetta E. Lewis

The purpose of this study was to compare the relationship of age, religiosity, and
depression on risk related behaviors among African American mothers. An aspect of risk
behaviors that has gained increased attention is sexual risk behavior. The rise of sexually
transmitted diseases (STDs), human immunovirus (HIV), and acquired
immunodeﬁciency syndrome (AIDS) are rising in the African American female
population. However, missing in the literature are studies that correlate the risk related
behaviors, religiosity, and depression in adolescent and adult African American mothers.

An integrated framework derived from the Health Belief Model and the Social
Control Theory was used to guide the study. It is believed that adult mothers being more
mature, are less likely to engage in risk related behaviors than are adolescent mothers. In
a retrospective, exploratory study, using secondary analysis of data, a data set of 127, (78
adolescent African American mothers - ages 12-17) and (49 adult African American
mothers ages 18 and older) was analyzed. This data set was obtained from the Ethnic

Families Research Project (EFRP) of HP. McAdoo, PhD conducted in 1994-1997. Three

areas were examined: First, age, as it relates to risky behaviors, is explored using ﬁve
risk-related indicators: a) the inconsistent or lack of use of birth control; b) the non use of
condoms or abstinence (as compared to all of those not using birth control other than
condoms and all of those who are not using birth control); c) experienced an unwanted
pregnancy and birth; (I) experienced an unwanted miscarriage or abortion; and e) the use
of illicit drugs. Second, the relationship of depression to risky sexual behaviors is
examined through the use of the ﬁve risk-related indicators and responses from the Beck
Depression Index. Lastly, the relationship of religiosity to risky sexual behaviors is
explored using the ﬁve risk-related indicators.

The independent variables for this study were: age, religiosity, and depression.
Dependent variables consisted of ﬁve risk-related indicators: a) the inconsistent or lack
of use of birth control; b) the non use of condoms or abstinence as compared to all of
those not using birth control other than condoms and all of those who are not using birth
control; c) experienced an unwanted pregnancy and birth; (I) experienced an unwanted
miscarriage or abortion; and e) the use of drugs.

Findings revealed that there was no signiﬁcant differences in the age of the
mothers, level of religion, depression, and risky sexual behaviors. The practical and

policy implications of this study were also examined.

In honor of and dedicated to, my mother, Nelia Hamlin Lewis...a truly virtuous woman.
In loving memory of my father, Napoleon Lewis, Sr. and my brother
Napoleon Lewis, Jr. You are forever in my heart.

iv

ACKNOWLEDGMENTS

This work would not be possible without the grace and mercy of God, from whom
all of my blessings come. I thank Him for allowing me to complete this journey in my
life. I thank my parents for their constant support and encouragement along the way. To
my father, my greatest supporter, who passed away in 1995, I love you and keep your
spirit with me always. My mother, Nelia Hamlin Lewis, my friend, advisor, conﬁdante
throughout my life. Thank you for your sacriﬁces, your time, listening ear, your constant
love, devotion and assistance. You’ve been a blessing all of my life and I thank you for
being an example of a virtuous woman and mother. I also thank my siblings who have
shared in my educational struggles and endeavors. To Albert and Rosie for always
encouraging me. To Debbie for sticking by me during my rough times and nursing me
back to health during that really rough time. Thank you Alberta and Cecil for opening
your home to me during the winter semesters when commuting home was treacherous. A
special thanks to OJ. and Cameron for keeping me entertained during those winter days
and nights. Thanks to my brother David for your constant support - both loving and
ﬁnancial. You’ve made this journey easier.

I would also like to thank my dissertation committee chair, Dr. H.P. McAdoo, and

my committee: Dr. Georgia Padonu, Dr. Larry Schiamberg, and Dr. Carl Taylor. Thank

you for your support and expert guidance during this process in my professional career.
You have been wonderful.

A special thanks to Dr. Dozier Thornton and Mr. James P. Dwyer who assisted
my work ﬁnancially and supported and encouraged me throughout my doctoral studies.
A special heartfelt thanks to my colleagues Dr. Sally Decker, Dr. Joseph Ofori-Dankwa,
and Dr. Robin McKinney. You have been my backbone and support through these last
few months, it would have been near impossible without your help and encouragement
along the way. Thank you very much.

Finally, I would like to acknowledge my other friends and colleagues, (Linda
McWright and Maureen Kozumplik) my church family, my understanding and supportive
Pastor, Robert B. Corley, Jr., and his wife, my closest friend, J annis. Thanks for your
prayers and understanding during this time of my life. A special acknowledgment to my
dear friend the late Dr. Granville Smith, Jr. who believed in me and encouraged me to
continue when times were difﬁcult. Thank you. To my committee member, Dr. John
McAdoo, who passed away during my third year at Michigan State University. I have
missed an opportunity to work with a gifted expert in the ﬁeld of adolescence. Thank
you for sharing a brief time with me. And to my mentor, the late Dr. Roosevelt Rufﬁn,
God Bless You and thank you for everything. Last, but not least to my brother, Louie,
who passed away in 1994. Thanks for being you, no one else could keep me laughing
like you. I cherish those memories - always. I love you and miss you very much.

Peace.

vi

TABLE OF CONTENTS

LIST OF TABLES. ..................................................... ix

LIST OF FIGURES ..................................................... .x

CHAPTER 1

OVERVIEW OF STUDY. ................................................. 1
Introduction. ...................................................... 1
Signiﬁcance of Study. .............................................. 2
Signiﬁcance to Nursing ........ p ...................................... 3
Theoretical Framework. ............................................. 4
Social Control Theory. .............................................. 5
Health Belief Model. ............................................... 6
Integrated Ecological Framework. ..................................... 7
Deﬁnitions ....................................................... 10

CHAPTER 2

REVIEW OF LITERATURE. ............................................. 13
Adolescent Growth and Development Characteristics. 13
Characteristics of Adult Women ...................................... l4
Adolescent and Adult Mothers. ...................................... 16
The Meaning of Motherhood in African American Women. ............... 18
Literature on Risk Related Behaviors in African Americans. ............... 19
Risk Related Behaviors. ............................................ 21
Elective Abortions ............................................... .23
Non-Use of Contraceptives ........................................ .23
Drug Use ...................................................... .26
Religiosity-Historical Perspective and Inﬂuence. ........................ 28
Depression ....................................................... 32
Summary. ....................................................... 35
Research Questions. ............................................... 37
Hypotheses. ..................................................... 38

CHAPTER 3

METHODS. ........................................................... 40
Sample and Materials. ............................................. 40
Variable Speciﬁcation .............................................. 41

vii

Instrumentation and Measures. ...................................... 44

Data Analysis. ................................................... 45
Limitations of Secondary Analysis. ................................... 45
Summary. ....................................................... 46

CHAPTER 4

RESULTS. ............................................................ 48
The Inﬂuence of Religion and Depression. ............................. 48
Condom Use. .................................................... 51
Birth Control Methods. ............................................ 51
Unwanted Pregnancies, Births, and Abortions. ......................... 56
Drug Use. ....................................................... 59
Depression ....................................................... 59
Religiosity. ...................................................... 61
Summary. ....................................................... 62

CHAPTER 5

SUMMARY AND CONCLUSIONS. ....................................... 65
Implications for Research. .......................................... 68
Implications for Practice. ........................................... 69

BIBLIOGRAPHY. ...................................................... 71

viii

LIST OF TABLES

Table 1 - Demographics of African American Mothers. ......................... 42

Table 2 - Correlations of Religiosity, Depression, and risk Related
Behaviors in Aﬁican American Mothers. ............................ 49

Table 3 - Chi-Square of Birth Control Methods Used By African
American Mothers. ............................................. 53

Table 4 - Chi-Square of Unwanted Pregnancy and Birth in Aﬁican
American Mothers. ............................................. 57

Table 5 - Chi-Square of Unwanted Abortions and Miscarriages in

African American Mothers. ....................................... 58
Table 6 - Chi-Square of Drug Use in African American Mothers. ................. 60
Table 7 - Chi-Square of Level of Depression in Aﬁican American Mothers. ......... 62
Table 8 - Chi-Square of Importance of Religion in African American Mothers ...... .63
Table 9 - Chi-Square of Level of Religiosity in Aﬁican American Mothers. ......... 64

ix

LIST OF FIGURES

Figure 1.1- Integrated Ecological Framework ................................. .9

Chapter 1

OVERVIEW OF STUDY

Introduction

The purpose of this study was to examine the inﬂuence of age, religiosity, and
depression on risk related behaviors, of African American mothers. In recent years, there
has been an increase interest in the study of risk related behaviors particularly with regard
to sexually transmitted diseases (STDs). High risk sexual behaviors especially with the
increased incidences of multiple partners and unprotected sexual intercourse has
dramatically increased the prevalence of STDs.

The increasing percentage of adolescents having sex at earlier ages has a
collective inﬂuence on number of sex partners the person has. The earlier that sexual
activity is begun, the longer the interval of exposure to different sex partners.
Adolescence represents a time of sexual inquisitiveness and experimentation. The 15-19
year age interval appears to be the highest risk interval for exposure to multiple sex
partners (CDC, 1990). Greater than twenty-ﬁve percent of women who began sexual
activity prior to or by age 15 had 10 or more lifetime partners, compared to less than six
percent of those beginning sexual activity at 20 years. It is important to question whether

risk related behaviors continue as mothers grow older and mature.

2

Religiosity is a signiﬁcant factor in determining risk because of its importance in
the lives of African Americans. It has been reported that African American mothers rely
on a spiritual association and the church as a source of strength and guidance for their
families. It is believed that the more “religiously” involved one is, the less likely one is
to engage in risky behaviors.

Depression as a factor in determining risk behaviors is linked to the vulnerability
of the person experiencing at the time of the behavior. Persons with low levels of
depression are presumed less likely to engage in risky behaviors because they are
perceived as less vulnerable than persons with high levels of depression and vulnerability.

Practical implications for the study pertain to the reported increased incidence of
STDS and AIDS in adolescent populations with high risk behaviors. Nursing
implications include the policies and treatment regarding health and reproductive
education for adolescent and adult African American mothers. Theoretical implications

for this study are explored in a later section.

Signiﬁcance of the Study

There is a considerable amount of existing literature comparing adolescents with
other adolescents regarding risks (J essor, 1991) and risk related behaviors and outcomes
(Cates, 1991; Feldman, et al., 1995). Literature exists comparing attitudes and beliefs
(including religious beliefs) of adolescent and adult mothers (Baranowski, Schimoeller,
& Higgins, 1990, 1991). There is also a myriad of studies on postpartum depression

(Logsdon, McBride, & Birkimer, 1994; Auerbach & Jacobi, 1990). However, there is a

3

paucity of literature addressing the inﬂuence of age, religiosity, and depression on risk
related behaviors in African American mothers. This study examined and the
relationship of age, religiosity, and depression on risk related behaviors among this

population of African American women.

Signiﬁcance to Nursing

Risk related behaviors lead to a hostvof problems for adolescents and adults.
African American adolescent females and mothers are particularly vulnerable to the
consequences of engaging in these types of behaviors. When adolescent choices include
engaging in sexual activity, the adolescent is at risk for various health problems. The
nurse can work effectively with the sexually experienced adolescent to achieve optimal
health outcomes. According to Wong and Perry (1998) this can be accomplished by
using the nursing process.

Nurses must be knowledgeable of the developmental attributes of adolescents, as
well as attributes of women in risk related situations. They must also be cognizant of the
unique characteristics inherent in the African American culture (values, kinship network,
family, etc.). Nurses must be knowledgeable of their responsibilities which encompass
all aspects of sexually transmitted disease education, conﬁdentiality, prevention and
treatment. When educating these women and adolescents about sex education,
information about these diseases, symptoms, and treatment needs to be included. Most
persons in the vulnerable adolescent population are uninformed or misinformed about the

severity of these diseases.

4

The major effort of nurse counseling should be toward prevention. This would
include the avoidance of many of these risky behaviors. The school nurse may be
involved in developing preventive programs and interventions for adolescents at risky for
risk related behaviors- including depression, for adolescent mothers and their signiﬁcant
others, and the children of these teen mothers as well.

The nurse must be aware of the inﬂuence of religion and culture with regard to
health care and perceived health outcomes. Culturally competent care is a must with
clients of diverse cultures and beliefs. Perceptions of what is risky and what is not may
be contingent on beliefs inherent in religions and cultures. These possibilities must be
properly assessed by the nurse.

Assessment for depression in the client is a must for the nurse. Both subjective
and objective data may be obtained to complete this assessment. Depression may be a
contributing factor in adherence to prevention programs involving education on risk
related behaviors. Proper assessment for depression is essential so that appropriate

treatment is prescribed for the client.

_T_heoreticgl Frmewog

There are several models and theories that have been used to examine risk
behaviors. For the purpose of this study, using strengths and attributes of the Health
Belief Model developed by Marshall Becker (1974) and the Social Control Theory
(Hirschi, 1969), an integrated framework was developed to help compare and explain the

relationship of age, religiosity, and depression on risk related behaviors. From these two

5

major models, an integrated ecological framework was developed. A brief explanation of
the models are included . Collectively meshed, using the strengths of these models, an
integrated ecological framework was developed that is applicable for the study of the
relationship of age, religiosity, and depression on risk related behaviors among African
American mothers.

In the Social Control Theory, the human context is examined through four
elemental bonds to one’s society, using these bonds as motivators for participation in
behaviors. Although similar to the Social Control Theory, the Health Belief Model
examines the perceptions of individuals as motivators for engaging in certain behaviors.
In both models motivation is a factor, however, while the Social Control Theory also
examines what motivates one not to engage in a said behavior, the Health Belief Model
only considers the perceptions of individual regarding engaging in a behavior. Both
motivation for and perceptions of risk related behaviors are Signiﬁcant to the study,

therefore, both models combined, were used.

Social Control Theory

The Social Control Theory examines what factors prevent individuals from
participating in nonnorrnative behavior and explicitly ignores variations in frustration or
motivation to deviate or change (Hirschi, 1969). This theory assumes that there is always
“adequate motivation for any individual to deviate and that the great diversity in the
motivations of persons resists useful classiﬁcation” (Hirschi, 1969, p. 862). Many forms

of deviance, such as drinking, truant behaviors, and sexual activity are believed to be

6

attractive and appealing to the vast majority of adolescents (as well as adults). Therefore,
the social control theory argues that variations in motivation levels are not necessary to
the explanation of deviance. Control theorists do not want to know what motivates
participation in risk behaviors, instead, what factors prevent the engaging of these types
of behaviors (Hirschi, 1969; Moore, Sims, & Betsey, 1986).

To test this social control framework, one must examine the effects of four
elemental bonds to one’s society - attachment, commitment, involvement, and belief
(Hirschi, 1969). Attachment refers to the internalization of norms, caring, respect,
affection, and sensitivity to the beliefs of others. Attachments are to family, teachers,
friends, and are positively correlated to decreased deviance. “Commitment refers to an
individuals investment in conformity” (Hirschi, 1969, p. 862). Persons committed to
jobs, completing high school or college are likely to examine the costs and beneﬁts of
engaging in risk behaviors. Involvement denotes that persons who are involved in
conventional activities within the family or community, are to busy to participate in
deviant or nonconventional risk behaviors. Belief is how strongly one believes in the

conventional order of society (Hirshci, 1969).

The Health Belief Model

The Health Belief Model (HBM) provides a theoretical approach to the issue of
promoting positive health practices. This model investigates the individual perceptions
as motivators of health related behaviors - including depression. These motivators

include perceived susceptibility, deﬁned as “individual’s perceived vulnerability or

7

personal risk to the health threat” (Brown, O’Clemente, & Reynolds, 1991, p.63). Also,
perceived severity deﬁned as the perceived implications of the health threat (Becker,
1974). The individual must weigh the perceived beneﬁts, which are the believed
effectiveness of the strategies to prevent the illness, against the negative consequences of
taking prescribed health actions (Brown, O’Clemente, & Reynolds, 1991).

A weakness of this model is that culture is not included as in inﬂuence of health
perceptive motivators. In Spector (1995) cultural concepts relating to women’s health is
explored with regard to health-promoting behaviors. Concepts of heritage consistency,
traditional beliefs, and traditional health-promoting behaviors based on one’s culture is

discussed. Those concepts are lacking in the HBM.

Integrated Ecological Framework

The intent of the integrated ecological framework builds from the Social Control
Theory and the Health Belief Model and aid in explaining the relationship of age,
religiosity, and depression on sexual risk behaviors in the study population. Adult and
adolescent African American mothers are engaging in risk related behaviors.

From the Social Control Theory, age is examined with regard to it’s inﬂuence on
risk related behaviors. Maturity is believed to be a factor in the engaging of risk related
behaviors. Religiosity is also examined through the use of the Social Control Theory.
Religiosity is based on commitment, attachment, and belief, which coincide with some
measure of appraisal or thought when participating is risk related behaviors. From the

Health Belief Model, depression is studied. Depression is part of the perception or

8

“perceived susceptibility” and “perceived threat” of engaging in risk related behaviors.
The level of depression determines the perception of the person. The integrated model
will allow for the meshing and examination of the variables age, religiosity, and
depression and their relationship to risk related behaviors in a population of African
American mothers.

Explanation of Framework Design. Both adolescent and adult African
American mothers are motivated to engage in risk related behaviors which can lead to
states of depression. These mothers base their motivations and perceptions on levels of
attachment, commitment, beliefs and involvement in society, family, and community.
These factors (attachment, commitment, beliefs (including religious beliefs), and
involvement) contribute to their level of religiosity (importance of religion, and meaning
of religion to mother) and this in turn relates to motivation and types of behaviors the
mothers will participate in. Levels of religiosity (low) are also factors contributing to
depression.

This framework reﬂects the inﬂuence of age, religiosity, and depression of the
individual and the individual’s perception of risk related behavior - its cost and beneﬁt.
Motivators for the engagement in risk related behaviors are also examined using an

integrated ecological framework (Figure 1.1).

V9553“— SGOJOOM amps-GNP:- ...v 952“—

 

biig .. .3...

Z

3:252:
Q nae—.33 be 8.. .82 .
3:
.9550 5...: 2.3338..— .
5...:
.3 qua—=35: 3:555 .
53.3.7. 93:55.5 .
on: was: .

 

 

 

 

 

 

 

 

 

 

 

 

5.8:...— 35. m
22:92
coke =2: e
«gonna—25‘
8.82%: 26:59.".— _\/ 38.3.:
9535,52 ESE<

 

 

 

 

 

10

The purpose of this research was to examine the relationship of age, religiosity,

and depression on risk related behaviors in adolescent and older Aﬁican American

mothers. Deﬁnitions (conceptual and operational) inherent in this study are listed below.

Deﬁnitions
Conceptual Deﬁnitions:
Age:

Religiosity:

Depression:

Risk Related Behaviors:

Beck Depression Index:

Operational Deﬁnitions:

Age:

Religiosity:

The length of time a person has lived.

The beliefs of a person, generally centered on a
supernatural power or being. Degree of belief
pertains to signiﬁcance of belief.

A psychological decline of deep dejection.
Engaging in chance or hazardous endeavors which
negatively affect the reproductive health of the
mother and/or her offspring.

Index used to measure levels of depression.

For the purpose of this study, age is deﬁned by age
of mother at birth of her ﬁrst child and
corresponding categories adolescent mother, age 17
and under, and adult mother, age 18 and Older.

For the purpose of this study, religiosity is deﬁned

by the scores to responses to questions pertaining to

Depression:

Risk Related Behaviors:

Depression:

11

the signiﬁcance of religion: How religious are you?
(Not religious, Somewhat religious, and Very
religious). and How important is religion to you?
(Not important, Somewhat important, and Very
Important).

For the purpose of this study, depression is deﬁned
as the score of responses to questions from the Beck
Depression Index. The scores are categorized into
levels Of depression: Low 0-20, Moderated 21-39,
and Severe 40-100.

For the purpose of this study, risk related behaviors
are operationalized as the risk behavior indicators:
Birth control method used or not used, unwanted
miscarriage, unwanted abortion, unwanted
pregnancy, unwanted birth, drug use, inconsistent
condom use, and utilization or non utilization of
abstinence as a birth control method.

The Beck Depression Index is deﬁned as the scores
of the responses of the mothers for measuring
levels of depression. Scores of 0-20 indicates low

levels of depression; 21-39 indicates moderate

12

levels of depression; and 40-100 indicates high

levels of depression.

Chapter 2

REVIEW OF LITERATURE

For the purpose of this study, the literature review was discussed in two sections.
The ﬁrst section overviews the literature on the growth and development of females, and
the meaning of motherhood in African American women. The next section pertains to
risk related behaviors in women, and the inﬂuence of age, religiosity, depression and

risky related behaviors. A summary concludes this chapter.

Adolescent Growth and Development Characteristics

In most girls the initial indication of puberty is the appearance of breast buds, an
event known as thelarche. This generally occurs between the ages of 9 and 13.5 years.
Thelarche is then followed by the growth of pubic hair, known as adrenarche (Wong &
Perry, 1998).

The initial appearance of menstruation, or menarche, usually occurs about 2 years
after the ﬁrst prepubescent changes, 3 months after attainment of peak height velocity,
and 3 months after attainment of peak weight velocity. The average age of menarche in
the United States is 12.8 years, and ovulation and regular menstruation usually occur up

to approximately 14 months later (Wong & Perry, 1998).

13

14

At age 15 to 17 years, growth decelerating occurs in girls. They have reached
95% of their adult height and secondary sex characteristics are well advanced.
Cognitively, adolescents age 12-14 years have limited abstract thought, and normality is
compared with their peers; while adolescents 15 to 17 begin to develop a greater capacity
for abstract thinking. These teens also tend to enjoy intellectual powers - and often think
in idealistic terms. In the late adolescent/young adult stage, abstract thought is
established and long range options are perceived. Problems are viewed comprehensively
and intellectual and functional identity is established (Wong & Perry, 1998).

Sexuality development in adolescents ages 12 to 14 years tends to be a
“self-exploring” and “self-evaluation” phase. They usually have limited dating
experiences with limited intimacy. As teens mature (ages 15 to 17) multiple (plural)
relationships occur. This is the usual period of “sex appeal” exploration and the feelings
of “being in love” are realized. Tentative relationships are also established. At ages 18
and older, stable relationships and attachments to one another occur. Dating as a male
and female pair is the norm. Intimacy at this stage involves commitment rather than

exploration and romanticism (Wong & Perry, 1998).

Characteri_sﬁcs of Adult Women
In the mid 1990's, the average American woman is 34 years of age and is more
likely to be college educated than the average American man. American women outlive

their male counterparts by approximately seven years. Despite these advantages,

15

American women are disproportionately represented among the poor, single, heads of
households, and the chronically ill and disabled (Allen & Phillips, 1997).

Today’s average woman is approximately 34 years old. By the middle of the next
century, however, the average American woman could be approximately 45 years of age.
The average age hides much of the diversity and disparity among American women.
Among 100 women today, 84 are Caucasian, 13 are Aﬁican American, 3 are other races,
and 8 are of Hispanic origin. By the middle of the next century, projections indicate that
among 100 women, 75 will be Caucasian, 16 will be African American, 9 will be other
races, and 17 will be of Hispanic culture (Allen & Phillips, 1997).

Educational status is positively correlated with health status regardless of gender.
Over the past 20 years, there has been a marked increased in the number of women
college graduates. Asian American women are reportedly most likely to be college
educated (27%), Caucasian women (13%), and African American women (8%)
(Taeubner, 1991).

Employment status of women vary with regard to race. Female African
American teenagers are reportedly less likely to be in the labor force than Caucasian
teenagers. In a 1987 report, 39.6% of female African American teenagers were in the
work force compared to 56.5% of Caucasian teenagers. However, adult African
American women (ages 20 and older) tended more likely to be employed (60%) than
adult Caucasian women (55.6%) (Taeubner, 1991).

Earnings for women have consistently been lower than that of men (the same age

and comparable education). In a study conducted in 1986, men with a college education

16

aged 25-34 years averaged $28,000, while women of the same education and age group
averaged $22,000. Education positively correlates with earnings. Women tended to have
lower educational levels than men. In 1987, a study revealed than 13.4% of all women
were below the poverty line, compared with 9.1% of all men (Taeubner, 1991).

Over the past 20 years, marital status for women has declined. In comparison to
1970 statistics when 11% of women reported never married, in 1993, 30% of women
aged 25 to 29 reported never married. (Taeubner, 1991).

Childbearing for adult women differ by races, particularly for women age 25 and
younger. African American women under age 25, tend to have a higher fertility rate than
Caucasian women of the same age. After age 35, there is much less difference reported
between the two groups of races (Taeubner, 1991).

Health status and life expectancy of women varies between the races with
Caucasian women (79.3 years) and African American women (73.6 years). Women of
both races (African American and Caucasian) suffer from conditions found in both races:
cardiovascular disease, cerebrovascular disease, and cancer. However, more Aﬁican
American women tend to die from these conditions due to lack prevention and treatment
measures which are more commonly accessible to and adhered to by Caucasian women

(Mastroianni, Faden, & F ederman, 1994; CDC, 1993).

Adolescent and Adylt Mothers
One common standard for becoming a woman that is accepted by a majority of

people in the community was the time when girls gave birth to their ﬁrst child. This

17

“milestone” was identiﬁed as the demarcation line that separated girls from women. The
child-bearing experience enhances maturity.

Differences in older and younger mothers with regard to parenting are noted in a
study by Chase-Lansdale, Brooks-Gunn, and Zamsky (1994). In this study, it was found
that multi-generational families most likely to provide positive parenting examples were
those where older mothers did not live with the grandmothers. “Whereas, in families
with very young mothers co-residing with grandmothers showed higher quality of
parenting than did non-co-residing ones” (p. 127).

To reinforce what has been taught schools pertaining to sex education and sex
information has been cited as an issue of concern (Hockenberry-Eaton, Richman, Dilorio,
Rivero, & Maibach, 1996). In their study, the impact of personal and family
characteristics on adolescent’s HIV risk and risk reduction is discussed. Findings
revealed that mothers were not able to deﬁne sexual development terms to adequately
teach their children about sex. Adolescents tend to lack accurate knowledge regarding
reproductive physiology, especially in the timing of fertility awareness about birth control
pills may be greater today than it was a decade ago, ignorance remains about most other
forms and methods of birth control (Panzarine & Gould, 1988). Green, Johnson, and
Kaplan (1992) examined the relationship of cognitive capacity, cognitive egocentrism,
and experience factors to decision-making in contraceptive usage. In this study, it is
proposed that as one ages, cognitive capacity increases. This theory, however, conﬂicts

with the study conducted by Hockenberry-Eaton, et al. (1996), where mothers lacked the

18

knowledge to adequately educate their children regarding sexual development and sexual
education.

In efforts to work to try and understand adolescent risk, J essor (1991) sketched a
conceptual framework which examines lifestyle risks ﬁom socio/developmental and
psychological perspectives. J offe and Radius (1992) used a self-efﬁcacy theory to
explain adolescent condom use. As one becomes older, one is more able to use
self-efﬁcacy regarding risk related behaviors.

Wayland and Rawlins (1997) discussed teens general lack of knowledge with
regard to childbearing and information about their children’s normal growth and
development and safety issues. Adolescents are less likely to have information on normal
growth and development because of their cognitive development and level of readiness

for parenthood.

The Meaning of Motherhood in African American Women

Historically, childbearing has been revered as the most signiﬁcant role in a
female’s life. Procreative powers, possessed by women and girls have important value in
the African American culture. Children are greatly valued and a strong emphasis is
placed on one’s being able to give birth (Ladner, 1971). Therefore, the true conﬁrmation
of womanhood is one’s ability to bring forth life.

The ability to bear children also represents (for girls) a maturity that they feel

19

cannot be gained any other way. Rainwater (1965) asserts that “it would seem that for
girls, pregnancy is the real measure of maturity, the dividing line between adolescence
and womanhood” (p. 216 in Ladner, 1971).

Harrison (1977) reports that African American women have always valued the
role of mother. Motherhood is an important dimension of their sex-role identity. It has
also been reported that African American women have been known to give the mother
role priority over the wife and worker roles (Blood & Wolfe, 1971; Harrison & Minor,

1978).

Age Related Literature ontRisk Related Beh_aviors ir_r African Amerigra

Speciﬁc information on risk related behaviors in younger and older mother needs
further exploration. The following section will speak to literature related to age and risk
related behaviors in African Americans.

Currently, there has been an increased focus on age speciﬁc risk related behaviors.
Especially with the increased onset of STDS in the adolescent population. African
American adolescents are likely to be at an elevated risk for STDS give the
disproportionately high incidence of AIDS and HIV infection among Aﬁican Americans
and other minorities (Lawrence, Brasﬁeld, Jefferson, Allyene, & Shirley, 1994).

One of the oldest and most widely accepted beliefs regarding sexual risk
behaviors is that adolescents are high risk takers. In a longitudinal study conducted by
Feldman, Rosenthal, Brown, and Canning (1995) that focused on the relationship

between peer relationships in sixth grade and the number of sexual partners in the tenth

20

grade. Low self-restraint led to increased misconduct which led to increased
opportunities for sexual intercourse with multiple partners. Likewise, in a study
conducted on a convenience sample of 250 African American males ages 12 to 70, the
mean age was 24 years, the mean age at ﬁrst intercourse was 13.4 years. Only one-fourth
of the sample used a method of birth control at ﬁrst intercourse. After ﬁrst coitus, only
34.3% reported using any form of contraception with regularity. One hundred percent of
this sample reported receiving information about sex and 83.3% stated they had received
medium to large amounts of information on birth control (Tucker, 1991).

In 1988, African American women ages 15-19 years continued to have the highest
rate of sexual activity. F iﬂy-eight percent of these sexually active females reported
having sex with two or more partners. Younger Aﬁican American teens are at risk for
early parenthood (Pitman, Wilson, Adams-Taylor, & Randolph, 1992). Nearly 6 of 10
births to teens younger than age 15 were to Aﬁican American teens. Fiﬂ'y-two percent of
children under age 14 who have AIDS are African American (CDC, 1990).

Early sexual activity and risk related beh_a_viors. Young adolescent girls who
participate in early sexual activity are at a greater risk of becoming pregnant than are
older counterparts. Young adolescents are less knowledgeable about reproduction and
contraception use (Marsiglio & Mott, 1986). These teens may not have the cognitive
ability to perceive that they are at risk of becoming pregnant if they are sexually active.
Because they are younger and have less information, they are not always aware of the
repercussions of their actions, and they are less likely to use contraceptives to prevent

pregnancy and or STDS (Zelnik & Shah, 1985).

21

Many studies have been done comparing mother/teen dyads and risk behaviors.
In these studies teens were pregnant and non-pregnant (Rogers & Lee, 1992). Family
structure has been examined using two-parent family households and black and white
teens, male and female teens who where virgins and non-virgins (Young, Jensen, Olsen,
& Cundick, 1991). This report indicated that white females, with two-parent households,
tended to remain virgins, however, once the white adolescent female became sexually
active, she had more sexual encounters than the black adolescent female. The number of
parents n the household was not a positive indicator for the black adolescent female in
maintaining virginity. Social support and teen parenting has been studied (Lawrence,
Brasﬁeld, Jefferson, Allyene, & Shirley, 1994). Findings here noted that adolescents
with fewer social supports were more likely to engage in casual sex and have higher
levels of STDS.

Resnick and Burt (1996) report that a number of behavioral traits most
consistently identiﬁed in the literature as being indicative of serious problems of risk in
adolescents include: early sexual behavior, school truancy, running away from home,

early use of tobacco, alcohol, and other drugs as well as delinquent peers.

Risk Rehrted Belgviors

 

Inconsistent use or 1% of birth control. Hormonal contraceptives are
indicated for pregnancy prevention or birth control. The mechanism of action in
ovulation is inhibited by suppression follicle-stimulating hormone (FSH) and luteinizing

hormone (LH). These contraceptives may alter cervical mucus and endometrial

22

environment, preventing penetration by sperm and implantation of egg. Biphasic Oral
contraceptives inhibit ovulation by suppressing the FSH and LH. It may also alter
cervical mucus and the endometrial environment, prevention of penetration by sperm and
implantation of the egg. In addition, there is a smaller dosage of progestin in phase I
which allows for proliferation of the endometrium. Larger amounts of progestin are
noted in phase II which allows for secretory development. Triphasic Oral contraceptives
again, inhibits the suppression of F SH and LH. The cervical mucus and endometrial
environment which prevents the penetration of sperm and implantation of the egg. There
are varying doses of estrogen/progestin and may more closely mimic natural hormonal
ﬂuctuations. Progestin-Only contraceptives and Contraceptive Implants mechanism of
action is not clearly known. These contraceptives may alter cervical mucus and
endometrial environment, preventing penetration by sperm and implantation of the egg.
Ovulation may also be suppressed. Medroxyprogesterone Injection inhibits gonadotropin
secretion, follicle maturation, and ovulation. It also produces endometrial thinning
(Deglin & Vallerand, 1995).

Contraindications and precautions for these medicinal contraceptives include
thromboembolic disorders, cardiovascular disease, and cerebrovascular disease. Caution
is to be taken in clients with a history of cigarette smoking and also in clients with the
presence of other cardiovascular risk factors and a history of diabetes mellitus, bleeding
disorders or headaches. Adverse reactions and side effects noted with the use of
contraceptive hormones include: migraine headaches; depression; contact lens

intolerance; pulmonary embolism; coronary thrombosis; cerebral thrombosis; cerebral

23

hemorrhage; thrombophlebitis; thromboembolic phenomenon; Raynaud’s disease;
hypertension; edema; nausea; vomiting; rash; bloating; dysmenorrhea; and weight

changes (Deglin & Vallerand, 1995).

Elective Abortioaa

Elective abortion is the intentional interruption of a viable pregnancy. The
indication for an elective abortion is by request of the mother but not for reasons of
maternal risk or fetal disease (Wong & Perry, 1998).

Many women report that there is more than one factor contributing to the decision
to abort (Thompson & Thompson, 1990). Most of the women in the United States who
have had abortions are white and younger than age 24 (CDC, 1994). One-fourth of all

abortions are obtained by married women (Wallach & Zacur, 1995).

Non-Use of Contraceptives

The highest risk for adolescents begins with sexual intercourse, without the use of
contraception at the initial intercourse. This action sets the adolescent up for a possible
unintended pregnancy, sexually transmitted diseases, and other possible reproductive
infections (Dryfoos, 1990).

Once adolescents become sexually active, the usage of contraceptives becomes
important. The inconsistent use of condoms and other forms of birth control have
resulted in over one million pregnant teens and increasing incidences of STDS (Cates,

1991). The need for behavioral change of risk related practices has been of the highest

24

priority since the onset of the AIDS epidemic. The major focus of education has been
emphasis on condom use (Kramer, 1991) . Increasing the use of condoms by adolescents
is an important public health goal. Although this protective behavior is beginning to be
adopted by increasing numbers of sexually active adolescents, many of them still do not
use them, and consistently using condoms remains inﬁequent (Sonnestein, Pleck, & Ku,
1989; Hingson, Strunin, & Berlin, 1988, 1990; Shafer & Boyer, 1991; Weisman, Plichta,
& Natheson, 1991). i

m There have been a great number of studies related to risk related
behavior and its outcomes. One result of risk related behavior is STDS including HIV
and AIDS. An alarming number of the studies relate to the prevalence and incidences of
sexually transmitted diseases (STDS) and AIDS which is now in epidemic proportion in
some African third world countries. However, few if any of these studies compare risk
related behavior of older and younger African American mothers.

One of the most serious consequences of STDS, particularly syphilis, is the
increased likelihood of HIV infection (Ofﬁce of Technology Assessment, 1991). AIDS is
now the leading killer of adults aged 24—44, many of who were infected as adolescents
(CDC, 1996). The number of AIDS cases is growing faster among African American
women than any major race-gender group.

STDS are a major health concern of the 1990's as the incidences of these diseases
increases (Ament & Whalen, 1996). High risk sexual behaviors such as multiple partners
and unprotected sexual intercourse has dramatically increased the prevalence of STDS in

the United States (Cates, 1991). Nearly 75% of college students have reported that they

25

have engaged in unprotected sexual activity with multiple partners. Rates of reported
AIDS cases are seven times higher among African-Americans, and three times higher
among Hispanics than for whites. AIDS is now the leading cause of death among all
Americans aged 25-44, accounting for 19% of the deaths in this age group (CDC, 1996).
Half of all AIDS cases among women are African American women, and is the third
leading cause of death for women aged 15 to 44 (Jenkins, 1992; CDC, 1996). For the
researcher, these statistics are alarming. Risk related behavior is proving to be a fatal
encounter of many Aﬁican American women. As these Aﬁican American mothers age,
they are engaging in risk related behaviors? What is accounting for the incidences of
STDS, HIV infections, and AIDS for mothers greater than 18 years of age? Is there a
difference in the average age of younger African American mothers who engage in risk
related behaviors versus those who do not? The purpose of this study is to compare the
risk related behaviors, religiosity, and depression in younger and older Aﬁican American
mothers.

The likelihood of engaging in risk related behaviors is based on differences in age,
culture, and decision—making (Pittman, Wilson, Adams-Taylor, & Randolph, 1992).
Additionally it is believed that attitudes and cultural values related to identity, self-image,
gender/role socialization, and contraception have a role in the increased widespread of
HIV/AIDS in African American youth (Pittman, et al., 1992).

Diseases related to risk related behavior, AIDS and STDS, are growing at
astonishing rates. Females, particularly African American females are those reported to

be most affected by this epidemic. African American females are at a greater risk for

26

early initiation of intercourse, inconsistent contraceptive use, which leads to unplanned

pregnancy or worse - HIV infection and AIDS.

Drug Use

Alcohol. In the United States, it is estimated that 50% to 80% of all pregnant
women use alcohol. Data are difﬁcult to obtain because alcohol is so rapidly absorbed in
the small intestine and is metabolized in the‘liver. A major concern of health care
providers is the under reporting of alcohol use in pregnancy. It is estimated that 1% to
55% of pregnant women meet diagnostic criteria] for alcoholism. Predisposing factors
for alcohol abuse in pregnancy include the following: women who smoke, who are
unmarried, less educated, and younger than age 25. Alcohol abuse during pregnancy is
the leading cause of fetal retardation in the US. (National Organization on Fetal
Alcoholism, 1995).

Marijuana. Marijuana smoke has the characteristics of tobacco smoke and has
similar dangers (Cook, et al., 1990). Marijuana easily crosses the placenta. Both
cigarettes and marijuana increases carbon monoxide levels in the mother’s blood, and this
reduces oxygen to the fetus.

Research ﬁndings report some inconsistencies with regard to marijuana. It is been
reported that marijuana use may cause spontaneous abortions and stillbirths. Effects on
the neonate varies and may include altered sleep and arousal patterns and tremulousness.
Women who abuse marijuana are more likely to bear children with features similar to

Fetal Alcohol Syndrome. These ﬁndings support the theory that marijuana may have a

27

synergic effect on alcohol and other substances (Cook, et al., 1990). Marijuana rapidly
passes into breast milk.

Cocaine. The increase use of cocaine and even more addictive “crack” among
childbearing women has been great in the past few years (Glantz & Woods, 1993;
Vaughn, 1993). Cocaine is used in all cultures, however, its low cost and availability
makes it the drug of choice among the economically disadvantaged.

In the US, it is estimated that 10% to 15% of all pregnant women use cocaine
(Glantz & Woods, 1993; Lynch & McKeon, 1990). Cocaine affects fetal movement and
development , cause premature birth, and cocaine addiction in the neonate.

m The incidence of heroin use in pregnancy is unknown, however, persons
with a heroin dependency may use multiple drugs. Opiods, such as heroin are the most
commonly abused by those in their late teens and early twenties. Studies report that
approximately 0.7% of the adult population uses heroin (American Psychiatric
Association, 1994).

Medical complications of heroin use include an increased risk for bloodbome
pathogens such as HIV or hepatitis B. Narcotics may depress fetal movement. The most
common effect is interference with fetal growth and increased incidence of prematurity
(Ney, 1990).

Methamphetamine. Approximately 2% of the adult population experience
methamphetamine abuse at some time during their lives. It is most commonly abused in

the 18 to 30 year-old age group. Most of the complications of methamphetarnines are

28

similar to those of cocaine. However, fewer maternal-neonate complications are noted
with these drugs.

Methamphetamine-exposed pregnant women have higher rates of preterm births
and more neonates with intrauterine growth restriction and smaller head circumferences.
Neonatal behavioral patterns are characterized by abnormal sleep patterns, poor feeding,

tremors, and hypertonia (Cook, et al., 1990).

Religiosity-Historical Perspective and Inﬂuence

From an historical perspective, the African American church, as it is known
today, was evolving into its own pattern long before ofﬁcial efforts were made to
Christianize the New World African. In the seventeenth century, slaves were considered
inﬁdels; and because of this belief, the slaves were allowed to have “secret religious
meetings” to promote their practices of beliefs held dear (Carter, Walker, & Jones, 1991 ).

“Slaves, not masters, took the initiative to translate their Aﬁican beliefs into
English and into inescapably Christian terms. They also sorted through the Christian
bible and selected ideas useful to them in the new slave experience. By the time the
masters were willing to concede souls to Slaves, satisﬁed that Christian faith could be
used to enforce obedience and increase market value, the slaves had long since
established their underground version of the true faith; and they were well along in their
own ‘individual institution’, or underground church” (Carter, et al., 1991, p. 196).

Foremost in the unrecorded religious beliefs of the African slaves in the later

seventeenth and early in the eighteenth century were the absolute belief in the Supreme

29

God and the absolute acceptance of Jesus as the Son of God. They believed that God’s
grace was sufﬁcient and it could save a sinner from destruction. The concept of hell was
embraced and often used by white preachers as a form of ﬁery symbolism to control
slaves (Carter, et al., 1991).

The Praise House. The Praise House was the hut or building used by slaves for

 

their nightly meetings of prayer and song. At times, these meetings were held in secret,
in open ﬁelds, and at other times, they were held with permission from the master. These
meetings served as a safe place for the slave to vent their emotions and feelings about
their life’s condition under an attitude free of a restrictive boss. It was in the Praise
House that the slave got religion and his soul was converted (Carter, et al., 1991). In
Carter, et al., it is further stated that: “These meetings celebrated life under the harshest
human conditions, and afﬁrmed the slave’s personhood in a world where he was sold as a
piece of property. Everyone in this setting was somebody. He could sing, dance, pray, or
shout with fervor as life permitted” (p. 8).

In the Aﬁican American church, the vision of a nobler life is lifted up. It views
life as a perennial struggle by people in pilgrimage. Because the Aﬁican American
church is nondependent on the greater society, it is free to be prophetic. There are

distinct differences between the white church and the African American church:

30

African American Church
Church of the oppressed
Theology of survival
Theology of Irnmanence
Prophetic/ Free Pulpit
Spontaneity in worship
Social ferment
Activistic Afﬂiction
Substance

Heterogeneous

(Carter, etal., 1991, pp. 96-97).

White Church

Church of the oppressor
Theology of success
Theology of Transcendence
Priestly/Restricted Pulpit
Rigidity in worship

Status quo oriented

Apathy

Shadow

Homogeneous

Religion and risk behaviors. Historically, the African American church and

faith have remained strong and powerful in the lives of African American people. In the

church, kinship structures have been a key in holding and keeping the family together. It

represents a sanctuary for the family which stresses family values and responsibility, and

there is still a continued tendency for the church to provide direction and psychological

support for dealing with the stressors of everyday existence. The church, and religion

have been an essential staple for the African American in society, particularly, the

Aﬁican American mother.

The many functions of the African American church were described by Benjamin

Mays and Joseph Nicholson: “Despite its problems and failures, there was a certain

‘genius’ of the soul of the black church that gives it life and vitality, that makes it stand

31

out signiﬁcantly above its buildings, creeds, rituals, and doctrines; something like that
makes the institution unique” (Billingsley, 1992, p. 354).

At the apex of this “genius” was the notion of complete ownership and control by
the African American people. It (the church) represented freedom, independence, and
respect for its leadership, as well as opportunity for self-esteem, self-development,
leadership, and relaxation. It also serves as a community center as well as a recreational
center which encourages education, business development, and democratic fellowship
(Billingsley, 1992). Further, Blackwell (1991) reports that the black church is a basis for
citizenship training and community social action; it provides educative and social roles;
it is an agency for the development of black business; it is an instrument for black
leadership; and an index of social class. The church is critical, especially for Aﬁican
American families undergoing transformation crises such as poverty and inadequate
health care that plague society today.

A study reported at the 1991 meeting of the Association of Black Sociologists
revealed that the strongly held belief in God, apart ﬁ'om religious participation, had a
positive effect on the outcome of pregnancies in low- and moderate-income of Aﬁican
American unmarried women. Women with strongest beliefs were more likely to have
healthy babies. Families and individuals actively involved in a religious life also tend to
have more positive life outcomes than those who are not actively involved. In addition,
McAdoo (1983) reports in a study conducted on women and stress that, women under the
most stress tended to be the most religious. These women attended church more

frequently and tended to have more of a religious orientation.

32

In the National Survey of Black Americans (1980), 86% of the African American
females considered themselves religious, 72% considered religion to be very important
when they were young and 80% considered the church as very important to them now.
Eighty-four percent of the women report that they pray daily.

Moore (1977) found in a self-rating inventory and religiosity index study which
correlated these two categories, that in the male students there was signiﬁcant correlation
between self-rating and religiosity and with the females there was no correlation.
McAdoo (1995) reports in a study conducted on stress in single African American
mothers, that religion provides emotional support, however, women who are not
religious, tended to have lower stress levels. In a study of 251 college students asked to
describe their own degree of religiousness, this self report study revealed that 75% of the
students believed they were more religious now than they had ever been, and this
correlated positively with GPAs above the sample mean (Zorn, 1989). Based on the
literature reviewed, one would anticipate that older women are more religious than
younger women. There is a scarce amount of literature pertaining to adolescent African
American females regarding religiosity and its inﬂuence on motherhood status and

depression.

Depression

Depression is one of the most prevalent disorders and has been recognized since
the time of the early Egyptians. It may be a cause of risk related behavior or depression

may be the result of risk related behavior. Regardless, depression is a common thread

33

inherent in postpartum women of all races and ethnicity. It is also exhibited in females
throughout the lifespan and may be exhibited in a host of ways Anxiety is one of the
primary features of depression in adolescents (Goldman, 1988).

Depression and Ris_k Belgvior. In a study conducted by Culp, Clyman, and
Culp (1995), it is reported that adolescents who have symptoms of depressed mood and
who believe they must care for their own problems are over represented among teenagers
who think of attempting suicide. In another study conducted on 455 adolescents to
determine the relationship between depression and parental happiness, social support,
intimate relationships, self-esteem, and risk-taking behaviors, ﬁndings revealed that
adolescents with depressed moods were less intimate with both parents, felt less social
support and had lower self esteem than peers. Adolescents who perceived their mother or
father as unhappy also reported less intimacy with both parents and less social support
(Lasko, Field, Gonzalez, Harding, Yando, & Bendell, 1996).

The incidence of postpartum depression without psychotic features is 10% to 15%
in all childbearing women. Predisposing factors of postpartum depression may be
hormone-related or infant related. Environmental and family stress issues may also be
connected to postpartum depression (Gotlib, 1991). In general, women who experience
depression often have fewer personal support systems, more stressful life events, and
fewer personal resources to combat these events. Women with feelings of postpartum
closeness to their husbands or partners report fewer cases of depressive signs and

symptoms (Logsdon, McBride, & Birkimer, 1994).

34

Predictive factors for postpartum depression that may assist the nurse in assessing
potential problems include a previous history of mood disorder, meager or absent social
support, and stressﬁrl life events (e.g., single parent, divorce, or recent death of parent or
child (Auerbach & Jacobi, 1990; Stein, et al., 1989)).

Clinical manifestations of postpartum depression are severe anxiety, panic attacks,
spontaneous crying long after the usual one to four days of postpartum blues. Alterations
in matemal-infant attachment may result from postpartum depression and infant
separation from the mother (American Psychiatric Association, 1994).

There is substantial literature on the relationship between maternal depression and
child adjustment (Downey & Coyne, 1990). Mothers diagnosed with major depressive
disorder have been found to have children with higher rates of psychiatric disorders in
general (Orvaschel, Walsh-Allis, & Ye, 1988); cognitive deﬁcits (Kaplan, Beardslee, &
Keller, 1987); and a ﬁrll range of adjustment problems (Downey & Coyne, 1990). Even
less severe forms of maternal depression have been associated with difﬁculties in child
function. Thus, parental depression, whether deﬁned as a disorder or simply as a mood
predicts child adjustment.

A study, reported by O’Hara, Neuraber, and Zekoski (1984), found maternal
depression to range from 25-30% during the ﬁrst three months after delivery. Even mild
depression may effect a new mother’s relationship with her child. For example, in one
study, postpartum depressed mothers demonstrated less rocking, gaze, and positive regard
toward the infants than did nondepressed mothers (Livingood, Dean, & Smith, 1983).

Others have reported less frequent positive and more frequent negative states among

35

depressed mother-infant dyads (Cohn, Campbell, Matias, & Hopkins, 1990; Field, 1992;
Healy, Goldstein & Guthertz, 1990).

Finally, in a study conducted by Hubbs-Tait and Garmon (1995), moral reasoning
and risk related behaviors were found to be inversely correlated as was the relationship
between AIDS knowledge and sexual behaviors. AIDS knowledge and risk related
behaviors are inversely correlated for higher-level moral reasoners and not for lower level
reasoners. There tends to be more literature on self-esteem, early motherhood, locus of
control and violence in Aﬁican American adolescents. These issues are considered
contributing factors to depression, however, there is a lack of information on depression

itself in this particular population of women.

Summagy

The theoretical framework for this study is an integrated ecological framework
using strengths of the Social Control Theory and the Health Belief Model. From this
perspective, this framework served as a guide for this study of age, religiosity, and
depression on risk related behaviors in African American mothers.

Age is a signiﬁcant variable in the study which discems older and younger
mothers and their level of engagement in risky behaviors. Adolescent females,
expectantly, will be the greater risk takers with regard to sexual behavior. Reportedly,
Aﬁican American adolescent females engage in sexual behaviors earlier than other
adolescents. With the increase incidences of AIDS and unplanned pregnancies,

adolescent African American women tend to be the most critically affected. Abortions

36
(elective) are also used as a form of birth control in some instances. The most widely
represented group of women engaging in abortions are single and under the age of 24 .

African American adult women and Caucasian women vary in areas of
employment, fertility, and life expectancy. It has been reported that adult Caucasian
women have lower employment status, lower fertility level at earlier ages, and longer life
expectancies than adult African American women. Caucasian women are more educated,
and Asian women surpass them with regard to college and advanced degree obtainment.
However, all women, are at greater risk for being at the poverty level or below the
poverty level regardless of race.

Lack of knowledge regarding sexual risk behavior is believed to be related to
increased risk taking. In fact, because of a lack of knowledge and maturity (including
physical maturity), risks are engaged in without knowing that they are indeed risky
behaviors. An example of this is consistent condom usage. The pill or foam or Norplant
may protect the adolescent from and unwanted pregnancy, however, it will not protect
them from sexually transmitted diseases, only adding condoms or abstinence will prevent
this.

Drug use while pregnant has implications for both the health of the mother and
the fetus. Children born to mothers who are abusers and users of alcohol, marijuana,
cocaine, amphetamines, and heroin have negative health outcomes with regard to
physical and cognitive development.

The inﬂuence of religion on risky behaviors is particularly important with regard

to African Americans. For the Aﬁican American, the church and religion have long

37

served as the backbone and roots of cultural and moral development. This inﬂuence
dates back to the African ancestry, and still serves as an inﬂuence in the lives of many
African Americans.

Depression is noted as a variable of inﬂuence or it may serve as a result for risk
related behavior. Depression more speciﬁcally, postpartum depression, affects mothers
of all cultures, however, little research has been noted on depression and it’s inﬂuence on
age with regard to risk related behaviors in Aﬁican American mothers. This study will
examine the inﬂuence of age on risk related behaviors in adolescent and adult Aﬁican

American mothers.

Research Questions

Based on a review of the aforementioned literature the following research

questions are posed:

Question 1: Does religion and depression inﬂuence engagement in risk related
behaviors in African American women?

Question 2: Are adolescent African American mothers less likely to use condoms than
adult African American mothers?

Question 3: Are adolescent African American mothers less likely to use birth control
methods than adult African American mothers?

Question 4: Are adolescent Aﬁican American mothers less likely to abstain from

sexual activity than adult mothers?

Question 5:

Question 6:

Question 7:

Question 8:

Question 9:

Hypotheses

38

Are adolescent Aﬁican American mothers more likely to experience more
unwanted pregnancies and births than adult Aﬁican American mothers?
Are adolescent African American mothers more likely to have undesired
miscarriages and abortions than adult African American mothers?

Are adolescent African American mothers more likely to use drugs than
adult African American mothers?

Are adolescent African American mothers more likely to have higher
levels of depression than adult Aﬁican American mothers?

Do adolescent Aﬁican American mothers have lower degrees of religiosity

than adult African American mothers?

From the aforementioned research questions, the following hypotheses were proposed:

Hypothesis 1: Religion and depression positively inﬂuence engagement of risk related

behaviors in African American mothers.

Hypothesis 2: Adolescent African American mothers are less likely to use condoms than

older African American mothers.

Hypothesis 3: Adolescent African American mothers are less likely to use birth control

methods than are older African American mothers.

Hypothesis 4: Adolescent Aﬁican American mothers are less likely to abstain from

sexual activity than are older mothers.

Hypothesis 5:

Hypothesis 6:

Hypothesis 7:

Hypothesis 8:

Hypothesis 9:

39

Adolescent African American mothers are more likely to experience more
unwanted pregnancies and births than are older African American
mothers.

Adolescent African American mothers are more likely to have more
undesired miscarriages and abortions than older Aﬁican American
mothers.

Adolescent Aﬁican American mothers are more likely to use

drugs than are older African American mothers.

Adolescent African American mothers are more likely to have

higher levels of depression than older Aﬁican American mothers.
Adolescent African American mothers have a lower degrees of religiosity

than older African American mothers.

Chapter 3

METHODS

This section of the study includes the sample, a description of the sample,
variable speciﬁcation, information on and data analysis and limitations of secondary

analysis.

Sample and Materials

The sample for this study was obtained from the Ethnic Families Project data set
which was collected in 1996 by HP. McAdoo, PhD entitled: The Family Dynamics of
African American and Mexican American Children With Learning Disabilities. This
Midwestern regional sample consisted of the 127 African American mothers. Subjects
were a convenience sample selected based on the acknowledgment that they were Aﬁican
American, female, and mothers.

Mothers ranged in age from 20 to 60. The mean age of the mothers at the birth
of their ﬁrst child was 19 years. Sixty-three percent (63%) of the mothers gave birth
when they were between the ages of 13 and 19 years while 37% were between 20 and 38
years of age.

Fifty-three percent (53%) of the women had never been married, while 47% were
married at one time in their life or lived as a “common law couple”. The mean

40

41

educational level for this population of mothers was 12.44 years. The income levels were
very low, with average income of less than $12,000 annually. The mean number of

children living in the household was three (Table 1).

Ya_riable Speciﬁcaﬂrp

Measurement of the Variables. The variables in this study were selected from
self-report measures obtained from the original 1994-1996 interview schedules. The
individual items were selected for the collective list of questions in the Health Status
section; Life Events Section; Feelings Section; and the Stress Section using the BDI. The
responses were recoded into appropriate categories for analysis.

Independent Va_ri_aarl_ea. As stated earlier, age was operationalized as the age of
the mother at the birth of her ﬁrst child. Age was then ﬁrrther broken down into two
categories. These categories were recoded into dichotomous variables for analysis using
the two categories (groups) 0 (group 1) were younger mothers (ages 13-17), and 1 (group
2) were older mothers (ages 18 and older).

Religiosity was deﬁned as the degree to which religion inﬂuences ones life. It
was measured by using the Likert-like scale (1-3) responses to: How religious are you?
1) Not religious; 2) Somewhat religious; and 3) Very religious. How important is
religion to you? was also used to measure religiosity. The responses to this question
were: 1) Not religious; 2) Somewhat religious; and 3) Very religious. These responses

were recoded for analysis.

42

Table 1 - Demographics of African American Mothers

 

 

Variables Adolescent Mothers Adult Mothers
Age at First Birth 53 71
Income <$12,000 <$12,000
Educational Level 12 years 12 years
Number of Children Mean = 3 Mean = 3
Mother’s Religion
Catholic 1 l 3
Protestant 1 5
Baptist 35 32
Jewish 0 l
Methodist 0 4
Other 8 19
No Religion 5 l

 

43

For the purpose of this study, depression is deﬁned by the Beck Depression
Inventory (BDI) indicated by scores reported in study which depict level of depression
reﬂected in responses. The BDI, developed in 1967, is the most frequently cited
self-report measure of depression. It contains 21 items (13 in the short version) which
encompasses four major components of depression: affective; cognitive; behavioral; and
physiological. This tool is applicable in measuring the intensity of depressive symptoms
as well as a screening tool for determining the presence or absence of depression
(Robinson, Shaver, & Wrightrnan, 1991). Depression was operatonalized by the scores
from the BDI. Scores between the ranges of 0-20 represented mild levels of depression;
scores of 21-39 were considered moderate levels of depression; and scores of 40-100
represented severe levels of depression.

Dependent variables. The dependent variable for this study was: Risk related
behaviors which were deﬁned by the following ﬁve risk indicators: 1) condom use or
abstinence; 2) birth control usage; 3) unwanted abortion or miscarriage; 4) unwanted
pregnancy or birth; and 5) drug use.

Condom use or abstinence was operationalized as birth control used compared to
all of those using birth control other than condoms and all of those who are not using
birth control. Birth control usage was deﬁned as the non use or inconsistent use of any
birth control method. Experienced an unwanted pregnancy was an unplanned pregnancy,
followed by the birth of an undesired child. Experienced an unwanted miscarriage or

abortion was deﬁned as a mother who had been pregnant and either lost her child or was

44

coerced into having an abortion. Use of drugs was operationalized as maternal use of
alcohol or other non-prescribed chemical substances within the last month.

The following questions representing the ﬁve risk-related indicators from the
study were derived from the Health Status, Life Events, Religion, and Depression

sections of the Family Environment Survey:

1) Are you using any birth control methods now such as:
a) Pills _ b) Diaphragm _ c) IUD _ d) Condoms _
e) Foam _ f) Abstinence _ g) Norplant _ h) Depo Provera _
I) Tubal ligation/vasectomy _ j) Other: (specify) __

2) Have you used drugs not for a medical reason (in the last month)?

3) Do you have problems getting pregnant?.

Instrumentation and Measures

The principle instrument of the original study was a semi-structured interview
schedule (McAdoo & Villaruel, 1996). This instrument (Ethnic Families Research
Project Instrument) consisted of two questionnaires (including the Families
Environmental Scale survey) with multiple sections including: general demographic
information, health status section, life events section, stress scale indicator and feelings,

child’s health and education, and depression section.

45

Data Analysis

Variables related to risks from responses to surveys from these mothers were
analyzed. Age, as a variable, examined adolescent African American mothers and adult
African American mothers with regard to risk related behaviors. Religiosity and
depression were also addressed in both adolescent and adult African American mothers
and further examined with regard to risk related behaviors.

Descriptive statistics were presented on the sample. The statistics used to test the
hypotheses were Chi-square (Cross- tabs). Fisher’s Exact Test (One-Tail) was used
primarily due to the direction of the hypotheses. Adolescent African American mothers
are less likely to use birth control, more likely to use drugs, and have a greater likelihood
of being depressed than are adult Aﬁican American mothers. Fisher’s Exact Test has
level of signiﬁcance p<.05. This test was used to test hypotheses: 1, 2, 3, 4, 5, and 6.
Chi-square ( p<.05 level of signiﬁcance) test was used to test hypotheses: 6 and 7.
Chi-square is a nonparametiric test of statistical signiﬁcance used to assess the

relationship between risk related behaviors and all independent variables.

Limitations of Secondaﬂ Analysis

A key issue associated with the use of secondary analysis of data involves the
question of validity (Babbie, 1983). The concern being that researchers who collect
original data for one particular purpose may not include speciﬁc questions that will
measure what another researcher is particularly interested in studying. However,

questions of the original study may come close to measuring what he or she is interested

46

in or related questions from the study can often be used. The question becomes: “Do
these questions provide a valid measure of the variables to be analyzed?”

This study examined the relationship of age, religion, and depression on risk
related behaviors among Aﬁican American mothers. This retrospective, exploratory
study did pose a few problems in the original data, the researchers did not compare the
aforementioned variables for adolescent and adult mothers to risk related behaviors; nor
did they examine the relationships of religion and depression with regard to risk related
behaviors among Aﬁican Americans. Interpretation and presentation of the data was
contingent upon the original researchers’ display of the data; accurate and consistent
description of the sample; methodology, results, and accurate, appropriate statistical
measures (Stewart, 1987). Secondary analySis and retrospective studies tend to limit the
researcher to data that cannot be easily manipulated and/or compared over a period of

time.

Summag

In summary, this study examined 127 African American mothers. The
relationship of age, religion, and depression on risk related behaviors was studied in this
population. The population is a sample from a larger sample of African American and
Mexican American families. The original study The Ethnic Family Research Project, was
conducted by HP. McAdoo, PhD, and F. Villaruel, PhD (1994-1996). Interviews were

conducted using interview schedules. Each semi-structured interview lasted

47

approximately three hours. The mothers were given $25 for participation. Interviews
were held in the homes of the families or in a community agency.

Limitations of secondary analysis of data include the concern that questions may
not reﬂect what the current researcher is seeking from the data. Validity of original study

is also considered a limitation when using this type of analysis.

Chapter 4

RESULTS

A descriptive breakdown utilizing percentages, means, and frequencies of
mothers’ risk factors, levels of depression, and levels of depression, and hypotheses
testing were discussed in this section. The results and a summary of the hypothesis

testing are also included in this section.

Inﬂuence of Religion and Depression

Hypotheses 1: Religion and depression positively inﬂuence the engagement of

risk related behaviors in African American mothers.

It had been hypothesized that religion and depression positively inﬂuenced the
engagement of risk related behaviors in African American mothers. Using Fisher’s Exact
Two Tail Test, ﬁndings revealed that severe levels of depression and unwanted
pregnancies and births were signiﬁcantly correlated, p = .04, n=121. Findings also noted
that the inconsistent use of abstinence and or condoms as a form of birth control was
signiﬁcantly correlated with severe depression, p=.021, n=120. Results also indicated
that use of or inconsistent use of an IUD signiﬁcantly correlated with severe depression,

13:002. n=l 19 (Table 2).

48

49

Table 2 - Correlations of Religiosity, Depression, and Risk Related
Behaviors in African American Mothers

 

Variable N Value Signiﬁcance

 

Risk Related Behaviors
and Religiosity

Drug Use 127 .1137 .203
Depoprovera 122 .2134 .018*
Pills 123 -.0209 .819
IUD 122 .0554 .545
Condoms 122 .0194 .832
Foam 123 .0096 .916
Abstinence 123 .1 140 .209
Norplant 122 -.0621 .497
Unwanted Abortion

or Miscarriage 124 .0826 .362
Unwanted Pregnancy

or Birth 124 .1020 .260

50

 

 

Table 2 (cont’d)
Variable N Value Signiﬁcance
Risk Related Behaviors
and Depression

Drug Use 122 -.0152 .868
IUD 119 .2805 .002**
Abstinence 120 .2099 .021 *
Unwanted Pregnancy

or Birth 121 -.1872 .040*
Pills 120 .0306 .740
Condoms 119 -.1285 .164
Foam 120 .0104 .911
Norplant 119 -.0034 .971
Depoprovera l 19 .0738 .425
Unwanted Abortion

or Miscarriage 121 -.1151 .209

 

*p<.05 **p<.01

51

Use of certain types of birth control was also signiﬁcantly correlated with level of
religiosity. The more religious one reported to be, the more likely they were to use

Depoprovera as a form of birth control p=.018, n=122. This hypothesis was accepted.

Condom Use

Hypotheses 2: Adolescent Aﬁican American mothers are less likely to use

condoms than older Aﬁican American mothers.

It has been hypothesized that adolescent African American mothers are less likely
to use condoms than adult Aﬁican American mothers. Findings reveal that there was no
signiﬁcant difference noted. Adolescent Aﬁican American mothers are just as likely to
use or not use condoms as adult African American mothers. Fourteen percent (8)
adolescent mothers reported “Yes” to using condoms, while, 10% (10) adult mothers
responded “Yes” to condom use. The level of signiﬁcance was .43. This hypothesis was

not supported. (See Table 3.)

Birth Coatrol Methods
Hypothesis 3: Adolescent African American mothers are less likely to use birth
control methods than are adult Aﬁican American mothers.
There was no signiﬁcant difference noted the use of birth control pills, foam, IUD,
and Norplant. With the use of Depoprovera, adult Aﬁican American mothers were more
likely to use as a birth control method, however, ﬁndings were not statistically signiﬁcant

with the exception of other methods of birth control. Other methods of birth control not

52

noted in the questionnaire, were found to be used more by adolescent African American
mothers. This hypothesis is not supported. (See Table 3.)
Birth control methods were tested using Fisher’s Exact Test (one-tail) and

Pearson’s. The methods used were not consistent among both adolescent and adult

53

Table 3 - Chi-Square of Birth Control Methods Used

By African American Mothers

 

 

Birth Control Adolescent Adult % Yes % No %Total
Method f f
Pills 5 4 7.4 92.6 100%
IUD** 0 2 1.7 98.3 100%
Condoms 8 10 15 .0 85 .0 100%
Foam 2 2 3.3 96.7 100%
Abstinence 4 6 8.3 91 .7 100%
Norplant 2 2 3.3 96.7 100%
Depoprovera 1 7 6.7 93 .3 100%
Other Methods 1 2 2.5 97.5 100%

Signiﬁcance (p=.35 and above) ns

 

*p<.05 “Only adult mothers utilized this form of birth control.

n=121

54

mothers. Birth control pills were reportedly used more by adolescent mothers with 14%
(5) “Yes” responses and 86% (44) “No” responses. Adult mothers reported 5.5% (4)
“Yes” and 94.5% (68) ‘No” responses. The level of signiﬁcance for the Fisher’s Exact
Test (one-tail) was p<.05. The level of signiﬁcance for birth control pills usage by these
mothers was .27, which is not statistically signiﬁcant.

IUD use was tested using Fisher’s Exact Test (one-tail) p<.05. Adolescent
mothers reported no utilization of this form of birth control. The total 11 for adolescent
mothers responding to this question was forty-nine, each responded “No” to the use of
IUD as a method of birth control. Only 2.3% (2) adult mothers responded “Yes” to the
use of IUD as a birth control method, while 97.7% (69) reported “No”. The level of
signiﬁcance for this response was .35 for the adult mothers only. This was not
statistically signiﬁcant although more adult mothers used this form of birth control.

Foam as a method of birth control was tested using Fisher’s Exact Test (one-tail)
pg .05. Adolescent mothers and adult mothers both had 2 .3% (2) respondents to “Yes”
as using foam as a method of birth control. Adolescent mothers who reported “No”
totaled 97.7% (48) and 97.7% (70) adult mothers reported “No” to this birth control
method as well. The level of signiﬁcance was .53 which is not statistically signiﬁcant.

Depoprovera use was tested using Fisher’s Exact Test (one-tail) pg .05.
Adolescent mothers had 2% (1 )“Yes” response to this birth control method and 98% (47)
“No” responses. Adult mothers reported 9.7% (7) “Yes” responses and 91.3% (65) “No”
responses. The level of signiﬁcance for this method was .10, which is not statistically

signiﬁcant in spite of number of older mothers using this form of birth control.

55

Norplant was tested using Fisher’s Exact Test (One-tail) p<.05. Both adolescent
and adult mothers had 4.1% (2 )“Yes” responses. Adolescent mothers had 95.9% (46)
“No” responses and older mothers yielded 95.9 (70)“No” responses to using Norplant as
a method of birth control. The level of signiﬁcance was .53 which is not statistically
signiﬁcant.

Other methods of birth control was tested using Fisher’s Exact Test (one-tail) p_<_
.05. Adolescent mothers were the only “Yes” respondents to this method of birth control
with 8.7% (4 ) and 91.3% (42) “No”responses. Adult mothers (with n= 71) all reported
“No” to other methods of birth control. The level of signiﬁcance for this method of birth
control was .02 which is statistically signiﬁcant, however, n is too small for actual
signiﬁcance to be warranted.

Hypothesis 4: Adolescent African American mothers are less likely to abstain

from sexual activity than adult African American mothers.

It was hypothesized that adolescent African American mothers would be less
likely to use abstinence as a birth control method than would adult African American
mothers. Findings reported that 8.1% (4) adolescent mothers responded “Yes” to
abstinence and 91.9% (45) responded “No”. Adult mothers responded with 8.4% (6)
“Yes” and 91.6% “No”. The ﬁndings were not statistically signiﬁcant. Level of

signiﬁcance .42. This hypothesis was not supported. (See Table 3.)

56

Unwanted Pregnancies, Births, and Abortions

 

Hypothesis 5: Adolescent African American mothers are more likely to
experience unwanted pregnancies and births than are adult Aﬁican
American mothers. This hypothesis was not supported.

Using Fisher’s Exact Test (one-tail) there was no signiﬁcant level
of difference noted in the ﬁndings p = .48 .

Unwanted pregnancies, births, and abortions were tested using Fisher’s Exact Test
(one-tail) p<.05. Adolescent and adult mothers alike reported 3 “Yes” responses to
having had unwanted pregnancies and births. Forty-seven (47) adolescent mothers
reported “no” as did sixty-eight (68) adult mothers. The level of signiﬁcance for this
factor was .48 which is not statistically signiﬁcant. (See Table 4.)

Hypothesis 6: Adolescent Aﬁican American mothers are more likely to have
undesired miscarriages and abortions than adult Aﬁican American
mothers.

Unwanted abortions and miscarriages was tested using Fisher’s Exact Test (one-
tail) pg .05. Both adolescent and adult mothers reported 3.3 % (2) “Yes” responses to
this question. Forty-eight (96.7%) adolescent mothers responded and 96.7% (69) adult
mothers responded “No”. The level of signiﬁcance was .55, which is not statistically

signiﬁcant. (See Table 5.) This hypotheses was not supported.

57

Table 4 - Chi-Square of Unwanted Pregnancy and Birth
in African American Mothers

 

 

Variable f

Unwanted Pregnancy & Birth Yes No Total
Adolescent Mothers 3.0 47.0 50
Adult Mothers 3 .0 68 .0 71
Total 6 115 121
Total % 5.0 95.0 100.0

 

*p<.05 n = 121

58

Table 5 - Chi-Square of Unwanted Abortions and Miscarriages
in African American Mothers

 

 

Variable f

Unwanted Abortions & Miscarriages Yes No Total
Adolescent Mothers 2.0 48.0 50
Adult Mothers 2.0 69.0 71
Total 4 117 121
Total % 5.0% 95.0% 100%

Signiﬁcance (p=.53) ns

 

*p<.05 n = 121

59

Drug Use

Hypothesis 7: Adolescent African American mothers are more likely to
use drugs than are adult African American mothers.
Adolescent mothers reported 11.3% (6) “Yes” responses, and 88.7 (47) “No”
responses. Adult mothers responses were 21.9% (16) “Yes” and 78.1% (57) “No”.
Findings indicated that there was no level of signiﬁcance noted p=.09. (See Table 6.)

This hypothesis was not supported.

Depression

Hypothesis 8: Adolescent African American mothers are more likely to be

depressed than adult African American mothers.

Levels of depression was tested using Pearson’s Test where pg .05. Depression
level was determined using the BDI. Scores for the BDI were interpreted by the use of
total scores derived from the Family Ethnic Studies questionnaire section on depression
and feelings. Since the lowest score for each question was zero, the lowest possible score
is zero. The higher the score, the more severe the depression. Ranges for levels of
depression were reported as follows: Mild Depression - 0-20; Moderated Depression -
21-39; and Severe Depression - 40-100.

Adolescent mothers reported as follows: Mild Depression - 76.4% (39);
Moderate Depression - 15.7% (8); and Severe Depression - 7.9% (4). Adult mothers
reported: Mild Depression - 80.2% (5 8); Moderate Depression - 10.7% (5); and Severe

Depression - 9.1% (7). The level of signiﬁcance was .32 which is not statistically

60

Table 6 - Chi-Square of Drug Use in African American Mothers

 

 

Adolescent Mothers Adult Mothers
Variable f % f %
Drug Use
Yes 6 9.3 47 21.9
No 16 88.7 57 78.1
Total 22 100.0 104 100.0

Signiﬁcance (p=.09) ns

 

*p<.05 n = 126

61

signiﬁcant, although, adult mothers reported more severe levels of depression. (See Table

7.) This hypothesis was not supported.

Religiosity

Hypothesis 9: Adolescent African American mothers have a lower degree

of religiosity than adult African American mothers.

Levels of religiosity were tested using Pearson’s Test p<.05. The questions How
religious are you? and How important is religion to you? were tested. Responses were
categorized as: not religious; somewhat religious; very religious; and I don’t know.
Adolescent mothers reported: not religious - 7.5% (4); somewhat religious - 64.1% (33);
very religious - 28.4% (14), and don’t know - 0. Adult mothers reported: not religious -
10.9% (8); somewhat religious - 46.5% (34); very religious - 42.3% (30); and don’t know
- 1.3% (1). The level of signiﬁcance was .22, which is not statistically signiﬁcant. (See
Tables 8 and 9.) This hypothesis was not supported.

Using Pearson’s Test pg .05, there was no signiﬁcance noted in the ﬁndings. It
was noted that there tended to be a trend in the results reﬂecting religion being more
important in the adult Aﬁican American mothers, however, the ﬁndings were not

statistically signiﬁcant p = .22. This hypothesis was not supported.

62

Table 7 - Chi-Square of Level of Depression in African American Mothers

 

 

Variable Adolescent Mothers Adult Mothers Total
Depression Level f % f % f
Mild Depression 39 72.5 58 83.0 97
Moderate Depression 8 15.6 5 7.0 13
Severe Depression 4 7.9 7 10.0 11
Totals 51 100.0 70 100.0 121

Signiﬁcance (p=.32) ns

 

*p<.05 n = 121

Summagy

The tests used for analysis of data were Fisher’s Exact Test (one-tail) and

Pearson’s Test. With regard to methods of birth control, no signiﬁcant level of difference

was noted between adolescent and adult mothers with the exception of “other methods of

birth control” utilized by adolescent mothers. Depression and religiosity both reported

trends in favor of adult mothers being more depressed and more religious. However

ﬁndings were not statistically Signiﬁcant. These may be due to low number of

participants.

63

Table 8 - Chi-Square of Importance of Religion in African American Mothers

 

 

Variable Not Important Somewhat Important Very Important

Religion f f f %
Adolescents 1 21 29 41.1
Adults 2 18 53 58.9
Total 3 _ 39 82 1 00.0
Total % 2.4 31.5 66.1 100.0

Signiﬁcance (p=.22) ns

 

*p<.05 n = 124

64

Table 9 - Chi-Square of Level of Religiosity in African American Mothers

 

 

Variable Not Religious Somewhat Very DK
How religious are you? f % f % f % f %
Adolescent Mothers 4 3.1 33 26.2 14 5.0 0 0
Adult Mothers 8 6.6 34 27.8 30 30.5 8
Total 12 9.7 67 54.0 44 35.5 8

Total % = 100.0

Signiﬁcance (p=.22) ns

 

*pg .05 n = 124

Chapter 5

SUMMARY AND CONCLUSIONS

This study examined the effects of age, religion, and depression on risk related
behaviors in a group of Aﬁican American mothers. It was hypothesized that adolescent
African American mothers were more likely to engage in risk related behaviors than were
adult African American mothers; and mothers with lower levels of religiosity would be
more likely to participate in risk related activity. Lastly, it was believed that mothers
with high levels of depression were more likely to partake in risk related behaviors.

When run as a group, there was a signiﬁcant correlation noted between level of
religiosity and depression on risk related behaviors. It was noted that as a group, the
Aﬁican American mothers who were suffering from severe depression, tended to be
inconsistent with birth control methods particularly abstinence. Level of religiosity
(“very important”) revealed that mothers who viewed religion as very important tended to
use Depoprovera consistently as a birth control method. Positive correlation existed
between Depoprovera and the signiﬁcance of religiosity to the mother.

Possible explanations for these ﬁndings include the fact that mothers who are
more depressed or who suffer from severe depression, tend to be less motivated to
consistently use birth control methods. Depression affects all women and presents itself
in a multitude of manners. Lack of appropriate decision-making by the mother is a strong

65

66

likelihood when levels are severe. When levels of depression are minimized, or when
mothers are able to positively recognize and afﬁrm that they are depressed, and seek
appropriate therapy, effective management of a severe depressed state can be obtained.

African Americans women reportedly, are less likely to seek assistance when they
are depressed. Historically, African American mothers have borne the brunt of society.
They have been subjugated to severe levels of scorn and oppression. Long periods of this
type of treatment and “way of life” is essentially “second nature” to many Aﬁican
American mothers. Depression may almost be an expectation for Aﬁican American
women.

Depression, in the form of feelings of oppression, and low, altered self-esteem,
make recognition of depression difﬁcult to recognize in the Aﬁican American mother,
thereby making it difﬁcult to treat. Nursing implications for African American mothers
and women who are depressed would include: seeking out positive attributes of
themselves, positive activities, reporting feelings of depression - anorexia, fatigue,
listlessness, malaise, anger, anxiety, and mood swings to their physician or nurse
practitioner. If the client has been diagnosed with depression, encourage them to follow
the therapeutic regimen outlined by their health care provider for treatment. The nurse
may be accessible to or provide a 24-hour crisis hotline number for the depressed client in
case of a crisis or emergency.

For many African Americans, particularly young adult and adolescents, religion
has rejuvenated itself for the 21St century. Historically, the church and its precepts, have

served as an undergirding for the foundation of the Aﬁican American mother and her

67
family. African American mothers have relied on the church as a method of support and
guidance in the rearing of children, and the establishment of values and norms. Over the
last two decades, the signiﬁcance of the historical, traditional Aﬁican American church
has waned. Young adults and adolescent African Americans have pulled away from the
traditional “ﬁre and brimstone”, “hell and damnation for sins”. These attributes
prevailed historically in the traditional African American Pentecostal, Baptist, and some
Methodist churches. This type of traditional worship does not hold the interest of the
younger adult and adolescent.

A new, up and coming trend of sorts in the area of religion and religious music are
the young African American artists who haVe blended the rhythm of R&B with the lyrics
of gospel music to create a sound and message that appeals to young adults, adolescents,
and many older adults. Artists such as “Take 6", Kirk Franklin, and the Winans are
upbeat gospel groups who mix the sound of R&B with the message and lyrics of gospel
music. Kirk Franklin includes “gospel rap” in his musical repertoire, making worship
and praise for young adults and adolescents, in particular, popular and exciting. The
lyrics are positive and uplifting, and present God and Jesus as tangible deity, worthy of
everyone’s praise. It was stated earlier, that when one is involved in the church, or
actively practicing one’s faith, they are less likely to engage in risk related behaviors, and
have more positive life outcomes.

Music is a tremendous motivator. Just as gospel music steers adolescents in a
positive path, “Gangsta Rap” or “Hardcore” rap tends to lead adolescents down a risky

path. Rap artists such as the late Tupac Shakur, and the late Notorious B.I.G., Lil’ Kim,

68

and Snoop Doggy-Dog ﬁll the airwaves and Music Television Videos with lyrics of
explicit sex acts, violence, and belittling women (referring to them as “bitches and
whores”). Graphic videos and concerts portray the artists in suggestive poses and acts.
This music revolution has captured the minds and the spirits of adolescents across
culture, gender, and socio-economic lines. Music such as “Gangsta Rap” has been linked
with violent, brutal crimes, and as an instigator and motivator for stimulating sex and or
acting out sexual fantasies in adolescents.

When analyzed by groups as adolescent and adult mothers, results indicated no
Si grriﬁcant differences between adolescent and adult mothers with regard to engaging in
risk related behaviors. Findings also indicated that degrees of religion and levels of
depression have no effect on participating in risk related behaviors.

What needs do be done then, is an examination of these results for the purpose of
research and practice. I will discuss implications for research ﬁrst, then discuss

implications for practice.

Implications for Research

In the past, literature pertaining to younger mothers, especially adolescent mothers
have been plentiful. Very little research had been done on comparing adolescent and
adult mothers with regard to religiosity, depression, and it’s effects on risk related
behavior. This study sheds light on both populations and ﬁnds that there is no signiﬁcant
difference in the two. Where should research focus? Further exploration using the other

variables inherent in the Social Control and Health Belief models could be a start.

69

In this research, only three areas were examined using these frameworks. Age
and religion were examined using the Social Control Theory. Depression was examined
as it relates to the Health Belief Model. A suggestion would be to examine other factors
possibly related to risk related behaviors.

Findings were interesting in that, it was an assumption that age was an inﬂuence
on engaging in risk related behaviors, as it had been reﬂected in the literature. There may
be a need to rethink this belief. This ﬁnding may lend itself to the development of a new
theory which the researcher will not embark on at this time. However, the notion of when

is age a factor or important? When is age not a factor?

Implications for Practice

Implications for nursing practice are three-fold. First, based on the ﬁndings, the
nurse must address the readiness level of all clients. In the past, when caring for mothers,
especially with regard to education, nursing has focused on being assured that the
younger/adolescent mother have a clear understanding of what is being taught.

As stated earlier in the literature, repeated STDS predispose women to higher
incidences of cervical cancer. Cervical cancer is particularly prevalent in young Aﬁican
American women and is generally diagnosed in very late stages. The unfortunate reality
of cervical cancer is, when it is diagnosed via a positive pap smear, the cancer is in an
advanced stage, and often times more challenging to treat, manage, or cure. Cervical

cancer is a serious complication directly linked to engaging in unprotected sex, with

70

multiple partners, and repeated STDS. Education with regard to this disease and others
(like HIV) is imperative.

Remedial education and often re—educating young mothers was a basic
expectation of the nurse. Nursing must now be prepared to take the same precaution and
educational approach with adult mothers to be assured that they too, understand what is
being taught with regard to reproductive health education.

Secondly, although, religion and depression were not signiﬁcant, culturally
speciﬁc norms are to be recognized and considered when caring for clients of diverse
cultures and backgrounds. There is a need for age, religiosity, depression and culturally
competent care (Andrews & Boyle, 1995).

Lastly, there is a need for follow-up on teaching regarding reproductive health in
younger and older mothers. The rates of sexually transmitted disease in the United States
is a alarming. As a profession, nurses must stand watch as protectors and providers of
quality and prudent health education. Nurses must be knowledgeable and maintain an
objective, non-judgmental point of view when working with adolescents. Society and the
public must be involved in positively educating adolescent and adult women toward a
healthy, holistic lifestyle. A method of follow-up and continued education needs to be in

place to assure optimal health for these mothers.

Bibliography

Bibliography

Allen, K.M., & Phillips, J .M. (1997). Womens lmlth care across the lifespan: A
comprehensixﬁperspective. Philadelphia, PA: Lippincott.

Ament, L.A. & Whalen, E. (1996). Sexually transmitted diseases in pregnancy:
Diagnosis, impact and intervention. Journal of Gypecological Nursing, 2_5, 657-666.

Andrews, M., & Boyle, J. (1995). Transcultural Nursing Care, St. Louis: Mosby.

Baranowski, M.D., Schimoeller, G.L., & Higgins, BS. (1990). Parenting
attitudes of adolescent and older mothers. Adolescence. 25 (100), 781-790.

Blackwell, J .E. (1991). The black communig. New York: Harper Collins.

Chase-Lansdale, P.L., Brooks-Gunn, J ., & Zamsky, ES. (1994), Young Aﬁican-
American multi generational families in poverty: Quality of mothering and
grandmothering. Child Development. ﬂ, 373-393.

Carter, H. A., Walker, W.T., & Jones, W.A. (1991). The Aﬁican American
church: Past, present, and ﬁrture. Martin Luther King fellows Press: New York, New
York.

Cates, W. (1991). Teenagers and sexual risk taking: The best of times and the
worst of times. Journal of Adolescent Healﬂ, Q, 84-94.

Centers for Disease Control (1990). Update: Acquired immunodeﬁciency
syndrome - United States. Morbidity and Mortality Weekly Report.

Centers for Disease Control and Prevention (1993). Priorities for women’s heaily
Atlanta, GA: Author.

Centers for Disease Control (1994). Division of STD/HIV prevention annua_l
report. Atlanta: US. Department of Health & Human Services.

Centers for Disease Control (1994). Abortion surveillance. United States.
Morbidity Mortality Weekly Report. Q, 42.

71

72

Deglin, J .H., & Vallerand, AH. (1995). _D_avis’s Drug Guide For Nurses (4th
Edition). F .A. Davis Co.: Philadelphia.

F eldman, S.S., Rosenthal, D.R., Brown, N.L., & Canning, RD. (1995).
Predicting sexual experience in adolescent boys from peer rejection and acceptance
during childhood. Journal of Research on Adolescence. 5 (4), 387-411.

Green, V., Johnson, S., & Kaplan, D. (1992). Predictions of adolescent female
decision making regarding contraceptive usage. Adolescence 21 (107), 615-629.

 

Hingson, R. Strunin, L., & Berlin, B. (1990). Acquired immunodeﬁciency
syndrome transmission: Changes in knowledge and behaviors among teenagers.
Massachusetts State Surveys. Pediatrics 8_5, 24-9.

 

Handler, A. (1990). The correlates of the initiation of ﬁrst intercourse among
young urban Black females. Journal of Youth and Adolescence 12 (2), 159-170.

 

 

Hirschi, T. (1969). Causes of delinguency. University of California Press.

Hockenberry-Eaton, M., Richman, M..J., Dilorio, C., Rivero, T., & Maibach, E.
(1996). Mother and adolescent knowledge of sexual development: The effects of gender,
age, and sexual experience. Adolescence, 31 (121), 35-46.

 

Hofferth, S.L., Kahn, J .R. & Baldwin, W. (1987). Premarital sexual activity
among US. teenage women over the past three decades. Family Planning Perspectives,
ﬂ (2), 46-53.

Hubbs-Tait, L., & Garmon, LC. (1995). The relationship of moral reasoning and
AIDS knowledge to risky sexual behavior. Adolescence. $2 (119), 549-563.

J essor, R. (1991). Risk behavior in adolescence. A psychosocial framework for
understanding and action. Journal of Adolescent Health, 12, 597-605.

Joffe, A., & Radius, SM. (1993). Self-efﬁcacy and intent to use condoms among
entering college freshmen. Jorﬂal of Adolescent Hem ﬂ, 262-268.

Ladner, J .A. (1971). Tomorrow’s tomorrow: The BlackWomap, Doubleday &
Company, Inc.: Garden City, New York.

Lawrence, J.S., Brasﬁeld, T.L., Jefferson, K.W., Allyene, E., & Shirley, A.
(1994). Journal of Adolescent Research 2 (3), 292-310.

 

73

Levinson, RA (1995). Reproductive and contraceptive knowledge, contraceptive
self-efﬁcacy, and contraceptive behaviors among teenage women. Adolescence. _3_Q
(117), 64-83.

Marsiglio, W., & Mott, F .L. (1986). The impact of sex education on sexual
activity, contraceptive use, and premarital pregnancy among American teenagers. Family

Planning Perspectives, 1_8 (4), 151-162.

Mastroianni, A.C., Fader, R.L., & Federman, D. (1994). Women and hem

research: Ethical and legal issues of including women in clinical studies. _1_. Washington
DC: National Academy Press.

 

McAdoo, HP. (1983). Levels of stress and family support in Black families. In
H. McCubbin, E. Cauble & J. Patterson (Eds), Family stress, coping and social support.
Springﬁeld, IL: Charles C. Thomas.

McAdoo, HP. (1995). Stress levels, family help patterns, and religiosity in
middle and working class Aﬁican American single mothers. Journal of Black
Psychology, _21 , 424-449.

Moore, K.A., & Glei, D. (1995). Taking the plunge: An examination of positive
youth development. Journaliof Adolescent Research, m (1), 15-40.

Moore, K.A., Simms, M., & Betsey, C. (1986). Choice and Circumstance: Racial
differences in adolescent sexuality and fertility. Transactions Books.

National Center for Health Statistics advance report of ﬁnal natality statistics
1988. Monthly Vital Statistics Report. Washington, DC. US. Department of Health
and Human Services. August 1990.

National Research Council (1987). _Rﬁring the future: Volume 1. Adolescent
Sexualig, Pregaancy, and Childbearing. National Academy Press: Washington, DC.

Panzarine, S., & Gould, CL. (1988). Knowledge about contraceptive use and
conception among a group of urban black adolescent mothers. Journal of Obstetrics apd

Gypecological Nursing, July/August.

 

Pittman, K.J., Wilson, P.M., Taylor, S., & Randolph, S. (1992). Making sexuality
education and prevention programs relevant for African American youth. Journal of
School Health Q (7), 339-341.

 

Porter, L. (1984). Parenting enhancement among high-risk adolescents. Nursing
Clinics of North America. _12 (1), 89-102.

74

Rainwater, L. (1965). The crucible of identity: The Neggo lower-class family.
Houghton Mufﬂin Company: Boston.

Richardson, R.A., Barbour, N.E., & Bubenzer, BL. (1995). Peer relationships as
a source of support for adolescent mothers. Journal of Adolescent Research, _1_Q_(2), 278-
290.

Robinson, J.P., Shaver, P.R., Wrightsman, LS. (1991). Measures of personality
and social psychological attitudes. Harcourt Brace Jovanovich: San Diego, CA.

Rogers, E., & Lee, H. (1992). A comparison of the perceptions of the mother-
daughter relationship of black pregnant and nonpregnant teenagers. Adolescence ﬂ
( 107), 555-564.

 

Schimoeller, G.L., Baranowski, M.D., & Higgins, BS. (1991). Long-terrn
support and personal adjustment of adolescent and older mothers. Adolescence 26
(104), 787-793.

 

Shafer, M., & Boyer, CB. (1991). Psychosocial and behavioral factors associated
with risk of sexually transmitted diseases, including human immunodeﬁciency virus
infection, among urban high school students. Journal of Pediatrics, _1_1_9, 826-33.

Sonnenstein, F .L., Pleck, J .H., & Ku, LC. (1989). Sexual activity, condom use,
and AIDS awareness among adolescent males. Family Planning Perspectives, 21, 152-8.

Spector, R. (1995). Cultural concepts of women’s health and health promoting
behaviors. Journal of Gyaecological Nursing, 25(3), 241-245.

Stevens-Simon, C., Kelly, L., & Singer, D. (1996). Absence of negative attitudes
toward childbearing among pregnant teenagers. Archives of Pediatric Adolescent
Medicine. 150. 1037-1043.

Teuber, C. (1991). Statistical handbookLon women in Ameripa Phoenix, AZ:
Oryx Press.

Thompson, J ., & Thompson, H. (1990). Ethical considerations in high risk
pregnancies. In K. Buckley and N. Kulb (Eds), High risk matemitv nursing manual.
Baltimore: Williams and Wilkins.

Tucker, SK. (1991). The sexual and contraceptive socialization of Black
adolescent males. Public Health Nursing. 8 (2), 105-112.

Wallach , E., & Zauer, H. (1995). Reproductive medicine and surgegy. St. Louis:
Mosby.

75

Wayland, J ., & Rawlins, R. (1997). Aﬁican American teen mothers perceptions
of parenting. Jourmll of Pediatric Nursing. Q (1), 13-20.

Weisman, C.S., Plichta, S., & Natheson, CA. (1991). Consistency of condom use
for disease prevention among adolescent users of oral contraceptives. Family Planning

Perspectives, 23, 71-4.

Wong, D.L. & Perry, SE. (1998). Maternal child nursing care. Mosby: St. Louis.

Young, E.W., Jensen, L.C., Olsen, J.A., & Cundick, RP. (1991). The effects of
family structure on the sexual behavior of adolescents. Adolescence 26_ (104), 977-986.

 

Zelnik, M., & Shah, F .K. (1983). First intercourse among young Americans.
Family Planning Perspectives, Q (2), 64-72.

MICHIGAN STATE UNIV. LIBRARIES
lll111111"11111111111111ll1111111111lllllllllllllllll
31293017164199