ABSTRACT
Background
Teen pregnancy and psychoactive substance use represent some of the factors that can have a negative impact on children's development.
Objetives
To explore the effect of the prevalence of drug, alcohol and tobacco use in the different federative entities in Mexico and children with adolescent mothers on the early childhood development (ECD).
Methods
Observational study. ECD was evaluated with the Early Childhood Development Index (ECDI) using the 2015 National Survey of Boys, Girls and Women. The prevalence of psychoactive substance use was estimated using the 2016 National Survey of Drug, Alcohol and Tobacco use. Association of ECD with different characteristics of the environment where the children resided was explored using a multilevel logistic regression model.
Results
The average age for an adolescent mother was 18 years and for an adult mother it was 28 years. The population is characterized by a higher percentage of children who attend early education, have support for learning, have three or more books and receive adequate care. The children with adolescent mothers (aOR = 1.54, 95% CI: 1.03–2.31) the prevalence of ilegal drug use use (aOR = 1.16, 95% CI: 1.02–1.32) and number of homicides (aOR = 1.18, 95% CI: 1.03–1.36) were factors associated with inadequate ECD. Finally, population density was negatively associated with inadequate ECD (aOR = 0.91, 95% CI: 0.88–0.95).
Conclusion
In Mexico, children with adolescent mothers and children with inadequate ECD prevail in populations in a situation of vulnerability. These findings can be useful to design public policies that consider the individual and social context of children and their mothers.
Keywords: alcohol consumption, child development, illegal drug use, Mexico, neighborhood, Teen pregnancy, tobacco use
1. Introduction
Teenage pregnancy is a serious public health problem. Socieconomic impacts associated with this condition are usually high, especially when associated with poverty [1]. Teenage pregnancy can profoundly impact the health of mothers, as well as that of their sons or daughters [2, 3]. According to the Organization for Economic Cooperation and Development (OECD), the teenage pregnancy rate in Mexico ranks first in the occurrence of pregnancies in women between 15 and 19 years of age [4].
Several studies displayed evidence regarding the impact of teenage pregnancy on the development of capabilities, observing a significant association between early motherhood with lower educational achievements and greater difficulties in accessing the labor market [5, 6].
On the other hand, children of adolescent mothers may not achieve adequate early childhood development (ECD), which is associated with health, well‐being, and appropriate care [1]. ECD was defined as cognitive, social, emotional and physical development from conception to 8 years [7]. Previous studies analyzed the ECD of children of adolescent mothers, who presented fewer socio‐emotional, cognitive and language skills, as well as more violent behaviors, than children of adult mothers [8, 9].
The neighborhood environment has been identified as key for supporting families to overcome adversities that could constrain child development [10, 11]. Children living in these environments are at greater risk of developing anxiety disorders, depression, and behavioral problems [12]. Factors such as poverty, inequality, malnutrition, reproductive immaturity, addictions, violence and crime can affect the well‐being of a family. In Mexico, the use of psychoactive substances has increased by 32% between 2011 and 2016, mainly among those under 25 years of age. The largest increase in this period has been detected in marijuana use. The use of these substances during adolescence is associated with risk behaviors, including unprotected sex and potential impacts on fetal development, among pregnant women and children born from these pregnancies [10]. Exposure to environments where psychoactive substances use is prevalent affects children's mental health and is associated with adolescent pregnancy, crimes and violence ref [13]. Children living in these environments are at greater risk of developing anxiety disorders, depression, and behavioral problems ref [14, 15]. Therefore, it is important to explore the linkage between the environment where children reside and ECD, with the use of psychoactive substances and violence being some of the problems with multiple causes [16].
The objective of this study was to evaluate the impact of the prevalence of drug, alcohol and tobacco consumption in the different states in Mexico and children with adolescent mothers on ECD. Psychosocial adversity refers to a set of stressful, traumatic, or difficult experiences that a person encounters throughout their life, and that can have a negative impact on their psychological, emotional, and social development. We hypothesize that children residing in environments with high levels of psychosocial adversity and/or with a adolescent mother could be associated with inadequate ECD.
2. Materials and Methods
2.1. Study Design
This is an observational cross‐sectional study based on secondary information sources. Data from the National Survey of Children and Women (ENIM) 2015 were analyzed, which has a probabilistic design and national representativeness. ENIM 2015 is Mexico's adaptation of UNICEF's MICS (Multiple Indicator Cluster Survey) [17]. Methodological details have been published previously [18]. In this study, information from the individual questionnaires of women and children between 36 and 59 months, and from the household questionnaire, was used. The final sample included 3292 boys and girls aged 36–59 months who lived with their mother and who had completed questionnaires for boys and girls under 5 years of age.
This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cross‐sectional studies.
2.2. Primary Outcome: Early Childhood Development
The dependent variable of the study is ECD, which was measured through the early childhood development index (ECDI). The ECDI is a global indicator developed and validated by the United Nations Children's Fund (UNICEF) that consists of 10 questions answered by the mother and organized around four domains (literacy and numeracy, physical, socio‐emotional and learning) [7]. This index identifies children aged 36–59 months with adequate ECD, if they have adequate development in at least three of the four domains considered (literacy‐numeracy, physical, socio‐emotional, and learning). This was re‐coded as adequate ECD and inadequate ECD.
For the literacy‐numeracy domain (three items), a child was considered to have adequate development if he or she could perform at least two of the following tasks: identify or name at least ten letters of the alphabet; read at least four common simple words; and/or recognize the symbols of all the numbers from 1 to 10. Socioemotional development (three items) was considered adequate if the child met at least two of the following: the child gets along well with other children; does not kick, bite or hit other children; and/or does not to get distracted easily. Physical development (two items) was assessed as adequate if a child could pick up small objects (rock, stick) with two fingers from the ground, and/or if the mother/primary caregiver indicated that the child was well enough to play. Learning (two items) was rated as adequate if he/she could follow simple instructions on how to do things, and/or if a child could independently follow an instruction given by an adult. Every surveyed child was identified first as being on track in each of the four domains. The ECDI was then built as the percentage of children aged 36–59 months who were developmentally on track in at least three of these four domains (or ECDI = 1) [7]. The ECDI was then constructed, which identifies children aged 36–59 months who were developmentally on track in at least three of the four domains. This index was re‐coded as adequate ECD and inadequate ECD [7].
2.3. Covariates at the Child Level
In our analysis, child, maternal, and household characteristics, as well as indicators of well‐being, were included as covariates. The child's characteristics included sex, age in months, and whether he or she lived with the biological father. For the mother, information was available on age, education, marital status and depressive symptoms. The seven‐item version of the Center for Epidemiological Studies Depression Scale (CESD‐7) was used to measure depressive symptoms. The CESD‐7 used in the survey measures the frequency with which depressive symptoms are experienced during the week before the interview. Considering a total score between 0 and 21 points, the cut‐off points to identify the presence of moderate or severe depressive symptoms are nine points for adults aged 20–59 years and five points for older adults ( ≥ 60 years) [19, 20, 21]. Regarding household characteristics, information on socioeconomic level, indigenous status, area of residence and region was explored. The well‐being indicators considered in the study were whether the child attended early education (percentage of children aged 36–59 months who attend preschool education programs), had learning support (percentage of children aged 36 to 59 months with whom household members participated in four or more activities in the 3 days before the interview), had three or more children's books at home (percentage of children aged 36 to 59 months with at least three children's books at home), and whether the care was inadequate (percentage of children under 5 years of age who were left alone and/or in the care of another child under 10 years of age for at least 1 h in the week, prior the survey).
Finally, to identify women who had their child in adolescence, the “age group” variable was constructed to classify them as adult mothers (if they were 20 years old or older) and adolescent mothers (if they were between 15 and 19 years old).
2.4. Exposure of Environmental Variables
The influence of environmental factors on EDC in children from 36 to 59 months was obtained through different sources of information. These variables were measured at the level of federal entities, and were linked to the information of children at the individual level through the geocodes of each federal entity.
Consumption of psychoactive substances: The use of illegal drugs and non‐prescribed medical drugs, as well as alcohol consumption and tobacco use were estimated at the federal entity level. This utilized data from the National Survey on Drug, Alcohol and Tobacco Consumption, which is a probabilistic survey with representativeness at the federal level, national and federal entity.
Additionally, we included other covariates that may be related to psychoactive substance use and EDC. These were the population density (inhabitants per km2) [22], the marginalization index [23] and the number of reported homicides [24].
2.5. Statistical Analysis
First, considering the sampling design of the 2015 National Survey of Children and Women in Mexico, the sample was described in terms of child, maternal, and household characteristics, as well as well‐being indicators. Additionally, the prevalence of EDC and its domains were estimated. Categorical variables were presented as percentages with 95% confidence intervals (95% CI), while continuous variables were summarized as means with standard deviations (SD). Second, a bivariate analysis of the environmental variables was carried out with means and SD according to the EDC and the mother's age group (adolescent vs. adult). Comparisons were conducted using chi‐square tests of independence for categorical variables and independent‐samples t‐tests for continuous variables. Finally, a multilevel logistic regression model was fitted with the ECDI variable (non‐adequate EDC vs. adequate EDC) as the dependent variable, controlling for individual‐level variables and environmental variables [25]. Level 1 comprised individual‐level variables, whereas level 2 included variables related to the federal entities. In the multilevel model, those significant individual‐level variables that were selected in a previously published study were introduced [26]. A null model was estimated to calculate the Median Odds Ratio (MOR), which quantifies the unexplained variation in early childhood development (ECD) between federal entities [27]. An MOR equal to 1 suggests no variability between federal entities. Values greater than 1 indicate increasing differences in ECD outcomes across federal entities. Results from multilevel model were reported as adjusted odds ratio (aOR) with 95% confidence intervals (CI).
For all statistical analyses, the complex design of the survey was taken into account using the corresponding weights. All p values were two‐sided, and the significance threshold was set at 0.05. All estimates were performed using Stata statistical software version 16.0 (Stata, Stata Corp, College Station).
2.6. Ethics
This study is based on publicly available secondary data from the 2015 National Survey of Children and Women (ENIM), which was conducted by national health authorities following ethical standards. Informed consent was obtained by the original survey administrators. As this study involved secondary analysis of anonymized data, no additional ethical approval was required.
3. Results
Most of the children (57.41%) were between 48 and 59 months, and 54.62% were female (Table 1). In general, the majority of children lived with their biological father (73.72%), in homes with low socioeconomic status (48.34%) and in urban areas (74.74%). The average age for a teenage mother was 18 years (SD = 1.34) and for an adult mother it was 28 years (SD = 5.39). The majority of the children's mothers had secondary education or more (79.53%), were married (78.92%) and did not present depressive symptoms (82.09%). Additionally, 21% of the sample were adolescent mothers. Finally, around 25% of the children did not have support for learning at home, 49.77% did not have three or more children's books at home, 40.34% did not attend early education and 6.57% had inadequate care.
Table 1.
Sociodemographic characteristics of the population. According to the mother's age group.
| Total (n = 3292) | Children with adult mother (n = 2601) | Children with adolescent mothers (n = 691) | ||
|---|---|---|---|---|
| % (95% CI) | % (95% CI) | % (95% CI) | p value | |
| Child characteristics | ||||
| Sex | ||||
| Male | 45.38 (40.33–50.53) | 45.22 (39.22–51.37) | 45.99 (39.11–53.02) | 0.868 |
| Female | 54.62 (49.47–59.67) | 54.78 (48.63–60.78) | 54.01 (46.98–60.89) | |
| Age group (months) | ||||
| 36–47 | 42.59 (37.93–47.38) | 41.38 (35.96–47.02) | 47.13 (40.41–53.96) | 0.192 |
| 48–59 | 57.41 (52.62–62.07) | 58.62 (52.98–64.04) | 52.87 (46.04–59.59) | |
| Lives with biological father | ||||
| No | 26.28 (22.7–30.2) | 23.84 (19.96–28.2) | 35.46 (28.82–42.72) | 0.003 |
| Yes | 73.72 (69.8–77.3) | 76.16 (71.8–80.04) | 64.54 (57.28–71.18) | |
| Characteristics of the Mother | ||||
| Mother's age, mean (SD) | 25.79 (6.31) | 27.91 (5.39) | 17.96 (1.34) | < 0.001* |
| Mother's education | ||||
| Primary or less | 20.47 (17.24–24.12) | 21.43 (17.73–25.67) | 16.9 (12.9–21.83) | < 0.001* |
| Middle School | 40.01 (35.14–45.08) | 35.49 (30.26–41.09) | 56.73 (49.5–63.69) | |
| High School | 22.39 (19.18–25.97) | 22.53 (18.8–26.75) | 21.88 (17.34–27.2) | |
| College/University | 17.13 (10.47–26.76) | 20.55 (12.39–32.11) | 4.49 (2.51–7.91) | |
| Mother's marital status | ||||
| Married | 78.92 (75.4–82.05) | 81.09 (77.38–84.32) | 70.84 (62.9–77.67) | 0.023* |
| Previously married | 13.11 (10.72–15.93) | 11.46 (9.09–14.35) | 19.24 (13.44–26.77) | |
| Never married | 7.97 (6.08–10.39) | 7.45 (5.58–9.87) | 9.92 (5.69–16.74) | |
| Depressive symptoms | ||||
| No | 82.09 (78.94–84.85) | 83.05 (79.75–85.9) | 78.53 (69.96–85.17) | 0.254 |
| Yes | 17.91 (15.15–21.06) | 16.95 (14.1–20.25) | 21.47 (14.83–30.04) | |
| Characteristics of the Home | ||||
| Socioeconomic level | ||||
| Lower | 48.34 (42.7–54.02) | 47.1 (40.56–53.75) | 52.99 (45.39–60.46) | 0.149 |
| Middle | 37.31 (32.61–42.26) | 36.93 (31.61–42.59) | 38.73 (31.38–46.64) | |
| Upper | 14.35 (7.96–24.51) | 15.97 (8.25–28.64) | 8.28 (4.95–13.53) | |
| Indigenous status | ||||
| No | 91.25 (88.02–93.66) | 90.90 (87.68–93.35) | 92.53 (87.40–95.67) | 0.363 |
| Yes | 8.75 (6.34–11.98) | 9.10 (6.65–12.32) | 7.47 (4.33–12.60) | |
| Region | ||||
| Northwest | 17.40 (13.61–21.97) | 17.07 (13.06–22) | 18.63 (13.59–25.01) | 0.815 |
| Northeast | 22.88 (19.26–26.96) | 22.84 (18.86–27.39) | 23.03 (17.97–29.01) | |
| Central | 19.77 (13.24–28.47) | 20.6 (12.84–31.37) | 16.65 (10.68–25.02) | |
| Mexico City | 19.3 (15.8–23.35) | 18.93 (15.07–23.5) | 20.67 (14.32–28.9) | |
| South | 20.65 (17.13–24.68) | 20.55 (16.93–24.72) | 21.02 (15.17–28.37) | |
| Residence area | ||||
| Urban | 74.74 (69.87–79.05) | 74.26 (68.85–79.02) | 76.52 (70.67–81.52) | 0.439 |
| Rural | 25.26 (20.95–30.13) | 25.74 (20.98–31.15) | 23.48 (18.48–29.33) | |
| Well‐being Indicators | ||||
| Early education attendance | ||||
| No | 40.34 (35.49–45.39) | 37.96 (32.63–43.6) | 49.27 (41.59–56.99) | 0.015* |
| Yes | 59.66 (54.61–64.51) | 62.04 (56.4–67.37) | 50.73 (43.01–58.41) | |
| Learning support | ||||
| No | 23.87 (20.65–27.42) | 23.48 (19.84–27.56) | 25.35 (18.95–33.04) | 0.647 |
| Yes | 76.13 (72.58–79.35) | 76.52 (72.44–80.16) | 74.65 (66.96–81.05) | |
| With three or more children's books at home | ||||
| No | 49.77 (44.24–55.31) | 47.81 (41.36–54.33) | 57.16 (49.84–64.17) | 0.058 |
| Yes | 50.23 (44.69–55.76) | 52.19 (45.67–58.64) | 42.84 (35.83–50.16) | |
| Inadecuate care | ||||
| No | 93.43 (91.57–94.9) | 92.96 (90.73–94.68) | 95.2 (91.57–97.32) | 0.227 |
| Yes | 6.57 (5.1–8.43) | 7.04 (5.32–9.27) | 4.8 (2.68–8.43) | |
| ECDI | ||||
| Inadequate | 17.95 (15.49–20.71) | 16.08 (13.70–18.79) | 24.98 (18.68–32.56) | 0.010* |
| Adequate | 82.05 (79.29–84.51) | 83.92 (81.21–86.30) | 75.02 (67.44–81.32) |
Note: Continuous variables were presented as mean with standard deviation, and categorical variables were presented as the frequency (N) and 95% CI.
Abbreviations: CI, confidence Interval; ECDI, early childhood development index; SD, standard deviation.
Statistically significance at p < 0.05.
Adult mothers had an average age of 28 years (5.4), while adolescent mothers averaged 18 years (1.3). The percentage of children who do not live with their biological father is higher when the mother is an adolescent (35%) compared to when the mother is an adult. Adult mothers also had a higher level of education than adolescent mothers (High School/College/University: 43.1% vs. 26.3%, respectively). Additionally, a greater percentage of adult mothers (81.1%) are married compared to their adolescent counterparts (70.8%). Children of adult mothers have higher early education attendance percentage (62.0%) than those of adolescent mothers (50.7%). Finally, children of adult mothers have lower inadequate ECD percentage (16.1%) than those of adolescent mothers (25.0%) (Table 1). Finally, children of adult mothers have higher early education attendance percentages (62.0%) than those of adolescent mothers (50.7%), as well as a higher percentage of adequate ECD (adequate ECD = 83.92% vs. inadequate ECD = 75.02%)
Eighty‐two point zero five percentof the children showed adequate ECD, with a higher proportion in physical development (98.12%) and learning (97.37%) (Table 2). On the other hand, the lowest prevalence of adequate development was observed in literacy and numerical knowledge (23.63%).
Table 2.
Early childhood development by domain and Early Childhood Development Index.
| Total (n = 3292) | |
|---|---|
| % (95% CI) | |
| Literacy and numerical knowledge | |
| Inadequate | 76.37 (72.76–79.64) |
| Adequate | 23.63 (20.36–27.24) |
| Physical development | |
| Inadequate | 1.88 (1.42–2.51) |
| Adequate | 98.12 (97.49–98.58) |
| Socio‐emotional development | |
| Inadequate | 21.36 (18.55–24.47) |
| Adequate | 78.64 (75.53–81.45) |
| Learning | |
| Inadequate | 2.63 (2.04–3.39) |
| Adequate | 97.37 (96.61–97.96) |
| ECDI | |
| Inadequate | 17.95 (15.49–20.71) |
| Adequate | 82.05 (79.29–84.51) |
Abbreviations: CI, confidence Interval; ECDI, Early Childhood Development Index. *Statistically significance at p < 0.05.
The characteristics of the Mexican states where the children reside according to whether they presented adequate or inadequate ECD are available on Table 3. The prevalence of the use of illegal drugs and non‐prescribed medical drugs and the number of homicides were higher in the states where children with inadequate ECD lived compared to those states where children with adequate ECD lived. Furthermore, population density was smaller in areas where children with inadequate ECD lived.
Table 3.
Characteristics of the federal entities where the children reside, according to whether they have inadequate or adequate early childhood development.
| Inadequate ECD | Adequate ECD | ||
|---|---|---|---|
| Mean (SD) | Mean (SD) | p value | |
| Prevalence of illegal drug use | 2.74 (0.98) | 2.57 (0.85) | 0.009* |
| Prevalence of non‐prescribed medical drug use | 0.5 (0.24) | 0.45 (0.25) | 0.030* |
| Drug prevalence | 3 (1) | 2.82 (0.88) | 0.014* |
| Prevalence of tobacco use | 6.12 (2.91) | 6.11 (2.97) | 0.950 |
| Prevalence of alcohol consumption | 48.4 (7.07) | 48.14 (6.19) | 0.492 |
| Marginalization index | 19.03 (3.23) | 19.2 (3.13) | 0.296 |
| Number of homicides | 1712.47 (1134.58) | 1534.09 (1026.21) | 0.017* |
| Population density (inhabitants/km2) | 399.88 (1186.21) | 616.56 (1505.5) | 0.015 |
Abbreviations: ECD, early childhood development; SD, standard deviation.
Statistically significance at p < 0.05.
The characteristics of the Mexican states where children with inadequate ECD reside, according to the mother's group (adolescent vs. adult), can be seen in Table 4. Children with inadequate ECD and adolescent mothers lived more frequently in entities with lower population density (population density 238.5 inhabitants/km2 vs. 466.54 inhabitants/km2 in the inadequate ECD group). Although they did not turn out to be significant, the prevalence of illegal drug use and non‐prescribed medical drug use was higher in the states where children with a teenage mother lived compared to those states where children with an adult mother lived.
Table 4.
Characteristics of the federal entities where children with inadequate early childhood development reside, according to the mother's age group.
| Children with adult mother | Children with adolescent mothers | ||
|---|---|---|---|
| Mean (SD) | Mean (SD) | p value | |
| Prevalence of illegal drug use | 2.70 (0.98) | 2.83 (0.80) | 0.260 |
| Prevalence of non‐prescribed medical drug use | 0.50 (0.25) | 0.53 (0.19) | 0.319 |
| Drug prevalence | 2.96 (1.00) | 3.09 (0.82) | 0.294 |
| Prevalence of tobacco use | 6.2 (2.96) | 5.92 (2.26) | 0.261 |
| Prevalence of alcohol consumption | 48.75 (7.22) | 47.57 (5.38) | 0.148 |
| Marginalization index | 19.09 (3.3) | 18.89 (2.49) | 0.450 |
| Number of homicides | 1719.03 (1153.57) | 1696.59 (884.74) | 0.854 |
| Population density (inhabitants/km2) | 466.54 (1289.83) | 238.5 (670.41) | 0.021* |
Abbreviation: SD, standard deviation.
Statistically significance at p < 0.05.
From the null model, the median odds of inadequate ECD in a higher‐risk federal entity were estimated to be approximately 1.26 times those in a lower‐risk entity (MOR = 1.26; 95% CI: 1.05–1.47), indicating modest heterogeneity across federal entities. After adjusting for individual‐ and federal entity–level variables, the MOR increased to 1.62 (95% CI: 1.27–1.97), suggesting that these factors account for part of the variability, although notable differences between federal entities remain. Adjusted multilevel model shows that children of adolescent mothers (aOR = 1.54, 95% CI: 1.03–2.31), children who resided in areas with prevalence of illegal drug consumption (aOR = 1.16, 95% CI: 1.02–1.32) and number of homicides (aOR = 1.18, 95% CI: 1.03–1.36) were positively associated with inadequate ECD, while greater population density was negatively associated with inadequate ECD (aOR = 0.91, 95% CI: 0.88–0.95) (Table 5).
Table 5.
Adjusted odds ratios for the association between inadequate ECD and ilegal drug use.
| Variables | aOR | 95% CI | p value |
|---|---|---|---|
| Adolescent mothers (Ref. = Adult mothers) | 1.541 | 1.028–2.309 | 0.036* |
| Attend early education (Ref. = No) | 1.006 | 0.758–1.336 | 0.966 |
| With learning support (Ref. = Without support) | 0.356 | 0.234–0.542 | < 0.001* |
| With three or more children's books at home (Ref. = Without three or more books) | 0.849 | 0.639–1.127 | 0.258 |
| Male (Ref. = Female) | 1.497 | 1.127–1.989 | 0.005* |
| Child's age (months) | 0.939 | 0.914–0.965 | < 0.001* |
| Mother's education (Ref. = Primary or less) | |||
| Middle School | 1.295 | 0.836–2.008 | 0.247 |
| High School | 1.325 | 0.825–2.129 | 0.244 |
| College/University | 0.825 | 0.432–1.577 | 0.561 |
| With depressive symptoms (Ref. = Without symptoms) | 1.612 | 1.085–2.394 | 0.018* |
| Socioeconomic level (Ref. = Upper) | |||
| Middle | 1.309 | 0.810–2.116 | 0.272 |
| Lower | 1.293 | 0.785–2.127 | 0.313 |
| Prevalence of illegal drug use | 1.161 | 1.019–1.323 | 0.025* |
| Prevalence of nonprescribed medical drug use | 1.085 | 0.680–1.731 | 0.732 |
| Number of homicides | 1.183 | 1.028–1.360 | 0.019* |
| Population density | 0.914 | 0.880–0.948 | < 0.001* |
Note: Null model: MOR = 1.261 (1.053–1.469); adjusted model: MOR = 1.621 (1.272–1.969).
Abbreviations: aOR, adjusted odds ratio; CI, confidence Interval.
Statistically significance at p < 0.05.
4. Discussion
This study evaluated the association of inadequate ECD with the prevalence of psychoactive substance use and children with adolescent mothers, as well as other environmental characteristics. Our main findings show that the factors associated with inadequate ECD were: (1) children with adolescent mothers; (2) residing in a federal entity with a high prevalence of illegal drug use; (3) residing in states with the highest number of homicides; (4) living in areas with lower population density.
These findings suggest that an adverse environment and adolescent pregnancy could influence in development of children [28, 29]. The family environment plays a relevant role in the ECD process. Variables such as family socioeconomic status, family composition and home environment, parenting behaviors and interaction styles, parental mental health and functioning, and parental substance use, were considered key elements to fully understand ECD. Family environments with the varied opportunities, challenges, and experiences they provide, impact critically on ECD process [30, 31]. However, the family can also become a risk environment due to drug use, which is associated with psychosocial adversity [32]. In this way, children and adolescent mothers who live in areas characterized by violence, crime or marginality have a high probability of presenting health problems, such as depression and psychopathological disorders [33, 34]. Therefore, it is important to reduce and prevent the social damage associated with the drug phenomenon, such as violence and crime, especially in vulnerable areas, to guarantee adequate ECD and the development of communities affected by such phenomenon.
Substance use is frequently linked with a higher risk of starting sexual life at an early age, which can contribute to higher rates of adolescent pregnancy. Furthermore, adolescent mothers usually belong to poor, dysfunctional families with low education [24]. While our study does not include specific data on illicit drug use during pregnancy, prior literature highlights important connections. For instance, Baird et al. [25] reported that pregnant adolescent women exhibited higher prevalences of substance use, particularly cocaine and marijuana, compared to their nonpregnant counterparts. These findings suggest that substance use may play a role in risk‐taking behaviors, such as unprotected sex, that increase the likelihood of adolescent pregnancy. However, it is important to note that our study is observational and evaluates the association of inadequate ECD with substance use and adolescent pregnancy; that is, it does not assess the association between substance use and adolescent pregnancy.
On the other hand, previous studies observed higher rates of prenatal and postpartum depression for the group of adolescent mothers compared to the group of adult mothers [35]. Furthermore, maternal depression is associated with increased use of non‐prescribed medical drugs [36, 37] and with negative developmental outcomes in children, which affects children's emotional and social development [38]. However, our results did not show a significant association between ECD and the prevalence of non‐prescribed medical drugs, although the analysis suggests that a higher prevalence of the use of these drugs is less likely to obtain an adequate ECD.
Our results showed that living in less densely populated areas is associated with higher odds of having inadequate ECD. Large cities allow greater access to services and better opportunities for the development of boys and girls [39, 40]. Typically, the highest rates of teenage pregnancy are found in populations living in more marginalized areas where residents have a lack of information and restricted access to services [41].
This study has some limitations that must be considered when interpreting the results. Due to the cross‐sectional nature of the data, causality between the observed associations cannot be established. The results are based on the information offered by the mother, which may be affected by information bias. Since the interviewers were trained at the beginning of the work, the possibility of measurement error is considered low. On the other hand, environmental factors were measured at the federal entity level, which was the geographic level that was available for the National Survey on Drug, Alcohol and Tobacco Consumption. Nonetheless, it has the strength of showing representative information at the national and state level. This approach does not take into account the important role of children's exposure to psychoactive substances within the home, so future work could analyze these variables individually. However, our study allows us to identify factors associated with adequate ECD, which allows us to improve the targeting of social programs towards this population.
5. Conclusions
Our findings suggest that children of adolescent mothers and/or children who resided in areas with a greater prevalence of illegal drug consumption and a higher number of homicides were associated with greater likelihood of obtaining inadequate ECD. Given the future implications for health and human development, it is of utmost importance to strengthen public policies focused on preventing adolescent pregnancies and to reduce the risks of inadequate ECD, especially in populations with greater social deprivation.
Author Contributions
Francisco‐Javier Prado‐Galbarro: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing. Carlos Sanchez‐Piedra: conceptualization, methodology, supervision, writing – original draft, writing – review and editing. Ana‐Estela Gamiño‐Arroyo: writing – review and editing, conceptualization. Jasmine‐Rena Baldwin: writing – review and editing, conceptualization. Juan‐Manuel Martinez‐Nuñez: conceptualization, writing – review and editing.
Conflicts of Interest
The authors declare no conflicts of interest.
Transparency Statement
The lead author Carlos Sanchez‐Piedra affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data Availability Statement
The authors confirm that the data supporting the findings of this study are publicly available. Data from the 2015 National Survey of Children and Women (ENIM) can be accessed at: https://mics.unicef.org/surveys. Data from the 2016 National Survey on Drug, Alcohol and Tobacco Consumption in Mexico are available at: https://www.gob.mx/salud/conadic.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors confirm that the data supporting the findings of this study are publicly available. Data from the 2015 National Survey of Children and Women (ENIM) can be accessed at: https://mics.unicef.org/surveys. Data from the 2016 National Survey on Drug, Alcohol and Tobacco Consumption in Mexico are available at: https://www.gob.mx/salud/conadic.