Substance use among pregnant adolescents: A comparison of self-reported use and provider perception

Purpose: This study describes, from both client and provider perspectives, the ethnic differences (African-American and white) in cigarette, alcohol, marijuana, and other drug (cocaine and crack) use among pregnant adolescents attending public prenatal clinics in one county. Methods: Client information was based on a cross-sectional survey of 248 consecutive adolescent, public prenatal clients. The sample represented 79% of pregnant adolescents in the country at the time of the study. Ethnic groups were compared through the use of appropriate bivariate statistics regarding (a) number, type(s), and frequency of substance(s) used; (b) mean age of first use; (c) change in use 6 months prior to pregnancy and first trimester; and (d) use among family and friends. Provider information was based on open-ended interviews among 23 individuals (91% of all providers) covering the same themes. Results: The majority of clients were African-American (61%), single (81%), and primaparous (72%). Many reportedly used at least one substance prior to pregnancy (79%) and during their first trimester (49%). The most common substances were cigarettes and alcohol. Overall, use of each substance during both time periods was higher among whites; yet African-Americans were more likely to report discontinued use. Substance use was common among adolescents' family members and friends. The provider survey revealed a wide range of perceptions about substance use among pregnant adolescents. Conclusions: Pregnant adolescents' self-reported substance use patterns differed by ethnicity, and providers' perceptions of substance use among their adolescent prenatal population differed from what was obtained from patients' self-reports. Additional research is needed to understand the role ethnicity plays in high-risk behaviors among adolescent prenatal clients, as well as its role in client-provider communication. (C) Society for Adolescent Medicine, 1998.