Strengthening Positive Coparenting in Teen Parents: A Cultural Adaptation of an Evidence-Based Intervention

A perinatal coparenting intervention: Effects of a randomized trial on parent cardiometabolic risk and self-reported health

BACKGROUND

The transition to parenthood is a common yet stressful experience faced by many young and midlife adults, and the risk of cardiometabolic conditions also begins to rise at this time. Consequently, parenthood represents an opportune time to intervene with adults to support their psychological and physical health.

PURPOSE

We examined whether the benefits of the Family Foundations program, a perinatal preventative intervention promoting positive coparenting, extend beyond documented mental health and family relationship outcomes to better cardiometabolic risk factors among parents.

METHODS

We analyzed data from 183 couples (n = 366 participants) who, eight years prior, were randomly assigned to the 9-session perinatal preventative intervention program or a control condition. We collected dried blood spots to measure C-reactive protein (CRP), interleukin-6 (IL-6), and cholesterol; parents also reported on their self-rated health.

RESULTS

Randomization to the intervention condition was associated with lower cholesterol (B=-.081, p = .049). Among parents who demonstrated more negative communication styles at pretest (during pregnancy), the intervention was further associated with better self-rated health (B=.181, p = .018). Participation in the intervention program was also marginally associated with lower CRP (B=-.261, p = .077), particularly among mothers (B=-.428, p = .076).

CONCLUSIONS

These findings indicate that coparenting-focused interventions, such as Family Foundations, can lead to benefits beyond psychosocial and behavioral outcomes, and suggest that Family Foundations may improve parents' longer-term physical health, with potentially more benefits among couples who demonstrated more negative communication styles during pregnancy.

Adapting a Coparenting-Focused Prevention Program for Latinx Adolescent Parents in a School Context

The current study utilized a three-step cultural adaptation process to adapt a universal-coparenting program for Latinx adolescent parents in a school-based setting. First, focus groups were conducted with adolescent parents (n = 13; 100% Latinx; 69% female), their parents (n = 17; 94% Latinx; 82% female), and school staff (n = 7; 71% White; 100% female) to identify unique needs faced by this population. Second, the program was adapted to include new lesson modules (e.g., coparenting with grandparents, coparenting after breakups) and structural reformatting to fit a school schedule. Third, selected lessons from the adapted program were piloted in four schools with 32 Latinx adolescent parents (97% Latinx; 78% female). Lesson evaluation surveys and focus group data assessed the feasibility and acceptability of the service delivery method and content to show the program was well received. However, implementation challenges emerged when attempting to provide services to adolescent fathers and Spanish-speaking adolescents. This manuscript provides an example of how to use this cultural adaptation process to tailor prevention programs, highlights a new prevention program that can serve as a resource for adolescent parents, and provides several recommendations for working with Latinx adolescent parents.

Culturally Sensitive Interventions in Pediatric Primary Care Settings: A Systematic Review

CONTEXT

Culturally sensitive interventions in the pediatric primary care setting may help reduce health disparities. Less is known on the development of these interventions, their target groups, and their feasibility, acceptability, and impact on health outcomes.

OBJECTIVE

We conducted a systematic review to describe culturally sensitive interventions developed for the pediatric primary care setting.

DATA SOURCES

PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (January 2000 to July 2020).

STUDY SELECTION

Studies were eligible for inclusion if they were (1) original research on an intervention with an evaluation, (2) within a pediatric primary care setting, (3) not limited to education for providers, (4) not limited to interpreter use, and (5) based in the United States.

DATA EXTRACTION

The following were extracted: study topic, study design, intervention, cultural sensitivity strategies and terminology, setting, target group, sample size, feasibility, acceptability, and health outcomes.

RESULTS

Twenty-five studies described 23 interventions targeting a variety of health topics. Multiple cultural sensitivity strategies were used, most commonly sociocultural (83%). Most interventions (57%) were focused on Hispanic/Latino families. Interventions were generally reported as being feasible and acceptable; some also changed health outcomes.

LIMITATIONS

Small samples and heterogenous methods subject to bias were used. Relevant articles may have been missed because of the variety of terms used to describe cultural sensitivity.

CONCLUSIONS

The included articles provide preliminary evidence that culturally sensitive interventions can be feasible and effective and may help eliminate disparities for patients from communities with barriers to equitable care.

Parental Factors as Predictors of Dating Violence Among Latinx Adolescent Mothers

The purpose of our study was to examine how parental stress and coparenting relationship quality were related to dating violence perpetration and victimization among 114 Latinx adolescent mothers. We hypothesized that higher levels of parental stress and lower coparenting quality would be associated with increased dating violence perpetration and victimization. Prior to running a path analysis to test our hypotheses, we examined how frequently the Latinx adolescent mothers in our sample reported perpetrating at least one act of psychological or physical abuse against their partner in the past month. We found that 84.3% of the mothers in our study had perpetrated at least one act of violence against their partner in the past month and 74.7% reported they had been the victim of at least one act of violence by their partner in the past month. After accounting for frequency of contact with the father of their child, we found Latinx adolescent mothers were more likely to perpetrate abuse against, as well as be the victim of abuse by, their partner if they had a lower quality coparenting relationship. However, parental stress was not associated with dating violence perpetration or victimization after accounting for frequency of contact. Our findings show the importance of the quality of the coparenting relationship, above and beyond parental stress, as a predictor of dating violence victimization and perpetration, thus highlighting the importance of educating adolescent parents about how to navigate the coparenting relationship.

Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico

Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9-14 years (N = 43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents' positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.

Adolescent Fathers' Perceptions and Experiences of Fatherhood: A Qualitative Exploration with Hispanic Adolescent Fathers

PURPOSE

The purpose of this secondary analysis of qualitative data was to understand the multifactorial influences that impact the health and health behaviors of Hispanic adolescent fathers DESIGN & METHODS: Qualitative description was the method used for this secondary analysis. The theoretical domains of the Vulnerable Populations Conceptual Framework were used to guide this study. The semi-structured interviews of 17 participants were analyzed using qualitative content analysis. Participants were Hispanic adolescent fathers, between the ages of 16 and 23 years, who were attending a fatherhood program.

RESULTS

Most participants came from socioeconomically disadvantaged backgrounds and unstable families. Additionally, their exposure to widespread neighborhood and domestic violence resulted in gang involvement and illegal activities. The cumulative impact of adverse childhood events resulted in substance use and psychological distress. However, becoming a father was transformative, motivating adolescents to stop engaging in destructive, unhealthy behaviors.

CONCLUSION

Adolescent fathers' well-being is an important component of perinatal health because it affects family functioning and health outcomes in their children. The perinatal period presents a "golden" opportunity to promote health and should be leveraged by nurses to allow adolescent fathers to become involved during the perinatal period.

PRACTICE IMPLICATIONS

A family-centered approach is critical in addressing the complex needs of this population. An assessment of their psychosocial environment, including childhood trauma, is necessary to help nurses identify at-risk fathers. Additionally, trauma informed care is a valuable tool that nurses can utilize to foster trust in Hispanic adolescent fathers.

Caregiver and family factors promoting child resilience in at-risk families living in Lima, Peru

BACKGROUND

Child victimization is one of the most serious, preventable threats to child health and wellbeing around the world. Contemporary research has demonstrated that polyvictimization, or children's experience of multiple types of victimization, is particularly detrimental.

OBJECTIVE

The current study aims to evaluate relationships between child victimization and child resilience with a particular focus on caregiver and family promotive factors.

PARTICIPANTS AND SETTING

Participants included N = 385 caregiver-child dyads from a high-risk neighborhood in San Juan de Lurigancho district in Lima, Peru.

METHODS

Data were collected in the context of a representative survey of houses in the neighborhood; an index child (ages 4-17) was randomly selected for each household and caregivers provided reports on core study constructs.

RESULTS

Child victimization (β = .35, p < .001) and harsh punishment (β = .17, p < .001) were associated with higher levels of child adjustment problems. Caregiver depression was associated with both higher adjustment problems (β = .22, p < .001) and higher prosocial skills (β = .14, p = .003). Caregiver resilience was associated with lower adjustment problems (β = -.15, p = .01) and higher prosocial skills (β = .14, p = .04). Positive parenting was associated with lower adjustment problems (β = -.15, p < .001) and higher prosocial skills (β = .20, p < .001). Family cohesion (β = .23, p = .001) was positively associated only with children's prosocial skills.

CONCLUSIONS

Findings suggest that caregiver resilience and positive parenting are consistent promotive factors for child resilience across indicators, including both adjustment problems and prosocial skills. These promotive factors may therefore be promising potential targets address in the context of interventions aimed at promoting child resilience.

Increasing condom usage for African-American and hispanic young fathers in a community based intervention

Objectives: This paper investigates a community-based intervention for young fathers, FatherWorks, compared to care-as-usual, 24/7 Dads. We hypothesized that utilizing the FatherWorks intervention (a 15 session parenting intervention, 13 session employment class, paid internship, case management, and access to behavioral health services) will assist in readiness to use condoms and increase condom usage, which may differ by race/ethnicity.Methods: Eligible males (n = 328) were enrolled into a Randomized Control Trial. Participants were 15-24 years old and had fathered one or more children with a female under the age of 21. A survey was taken at baseline and at 15 weeks following the intervention.Results: Analyses of changes indicated that intervention participants improved from the pre-contemplation stage of condom usage towards contemplation, and from preparation to action. The pattern of improvement in the condom use stage of change was different in African-American versus Hispanic participants. Changes in condom use during last intercourse were not significant.Conclusions: Study findings indicate that FatherWorks is successful in increasing the intent to use condoms, with the effect manifesting differently in African-American and Hispanic young fathers. Future work with minority fathers indicates a need for cultural adaptation of the intervention.

Maternal Engagement in a Home Visiting Program as a Function of Fathers' Formal and Informal Participation

Home visiting programs support new and expecting parents by strengthening parenting practices, improving parental and child health and well-being, and preventing child maltreatment. Participant retention is often a challenge for home visitation, particularly for young families, potentially reducing program impact. Father engagement in services may be one avenue for supporting continued program take-up for young parents. The current study examined associations between fathers' formal and informal participation in an infant home visiting program and mothers' take-up of home visits and whether these associations differed depending on mothers' relationship status at enrollment or timing of enrollment. Results showed that fathers' participation in home visiting supported maternal retention, particularly when fathers were formally enrolled. These associations depended on mothers' relationship status at enrollment but not on whether they enrolled pre- or postnatally. These findings have direct implications for home visiting programs, both in supporting maternal retention and in informing the recruitment and engagement of fathers.

African-American, Puerto-Rican, and Other Hispanic Fathers' Differential Responses to a Parenting Intervention

Despite the recognized importance of fathers to children's well-being, there is a lack of research exploring the impact of parenting interventions on young fathers. Further, little work has been done to identify whether fatherhood interventions differentially benefit specific subgroups of fathers, including Hispanic subgroups.This research examines a 15-week fatherhood intervention for African American, Puerto Rican, and non-Puerto Rican Hispanic young fathers. Data were collected from 312 fathers ages 15-24 at baseline, post-intervention (15 weeks), and at 8 months, 12 months, and 16 months post-baseline follow-up. Latent growth models were used to examine differential shapes of change for the three groups. Results suggest different intervention responses across the three groups on risky parenting attitudes, African American fathers in the study indicated more risky parenting attitudes than Hispanic and Puerto Rican fathers. The practice and research implications of disaggregating data for minority fathers, particularly for Latino subgroups, are discussed.

Promoting Father Involvement for Child and Family Health

Paternal involvement in children's lives is associated with a variety of child outcomes, including improved cognition, improved mental health, reduced obesity rates, and asthma exacerbation. Given this evidence, the American Academy of Pediatrics has promoted actions by pediatricians to engage fathers in pediatric care. Despite these recommendations, the mother-child dyad, rather than the mother-father-child triad, remains a frequent focus of care. Furthermore, pediatric care is often leveraged to improve maternal health, such as screening for maternal depression, but paternal health is infrequently addressed even as men tend to exhibit riskier behaviors, poorer primary care utilization, and lower life expectancy. Therefore, increasing efforts by pediatric clinicians to engage fathers may affect the health of both father and child. These efforts to engage fathers are informed by currently used definitions and measures of father involvement, which are discussed here. Factors described in the literature that affect father involvement are also summarized, including culture and context; interpersonal factors; logistics; knowledge and self-efficacy; and attitudes, beliefs, and incentives. Innovative ways to reach fathers both in the clinic and in other settings are currently under investigation, including use of behavior change models, motivational interviewing, mobile technologies, peer support groups, and policy advocacy efforts. These modalities show promise in effectively engaging fathers and improving family health.

Health and Social Needs of Young Mothers

PURPOSE

Teen parenting rates are disproportionately high among minority youth in the Southern United States. We explored barriers and unmet needs relating to medical and social support as perceived by these teen mothers, and elicited suggestions for improving their healthcare through the medical home.

STUDY DESIGN AND METHODS

We conducted four focus groups of 18- to 24-year-old mothers in New Orleans with questions designed to prompt discussions on young motherhood and healthcare. All 18 participants identified as African American, became mothers when <20, and their children were <5 at the time of the study. Two researchers independently analyzed focus group transcripts and coded them thematically, revealing various unmet social and health needs.

RESULTS

Seven main themes emerged, which revealed a concerning lack of mental healthcare, few with consistent medical homes, inadequate contraceptive knowledge and access, and a desire for parenting education and support groups. Suggestions for improving care largely centered around logistical and material support, such as extended clinic hours, transportation, and baby supplies.

CLINICAL IMPLICATIONS

Findings suggest a need for improved medical knowledge, healthcare access, and social support for teen mothers. This may be provided through a multidisciplinary medical home model, such as a Teen-Tot clinic, where the unique challenges of adolescent parenting are continuously considered.

Annual Research Review: Interparental conflict and youth psychopathology: an evidence review and practice focused update

The quality of the interparental relationship is recognized as an important influence on child and adolescent psychopathology. Historically, clinically oriented research on this topic has focused on the impacts of parental divorce and domestic violence as primary interparental relationship influences on child outcomes, to the relative neglect of dimensional or qualitative features of the couple/interparental relationship for youth (child and adolescent) psychopathology. Recent research has highlighted that children are affected by attributes of interparental conflict, specifically how parents express and manage conflicts in their relationship, across a continuum of expressed severity and negativity - ranging from silence to violence. Furthermore, new evidence highlights that children's emotional, behavioral, social, academic outcomes, and future interpersonal relationships are adversely affected by conflict between parents/carers whether adults are living together or not (i.e. married or separated), or where children are or are not genetically related to their rearing parents (e.g. adoption). We review evidence and present an integrated theoretical model, highlighting how children are affected by interparental conflict and what this evidence base means for effective intervention and prevention program development, as well as the development of possible cost-benefit models. Additionally, we review policy implications of this research and highlight some very recent examples of UK-based policy focusing on addressing the interparental relationship and its impact on youth psychopathology.

MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

Stress in the City: Influence of Urban Social Stress and Violence on Pregnancy and Postpartum Quality of Life among Adolescent and Young Mothers

Adolescent and young mothers transitioning from pregnancy to postpartum need to maintain an optimal quality of life. Stress and exposure to violence (e.g., intimate partner violence (IPV), nonpartner violence) are predictors of poor quality of life for adult women; however, these associations remain understudied among adolescent and young mothers in urban areas. Guided by the social ecological model, the current study created a latent variable, urban social stress, to examine the impact of the urban social environment (i.e., stressful life events, discrimination, family stress, and neighborhood problems) on the quality of life of adolescent and young mothers during both pregnancy and postpartum. The current study is a secondary data analysis of a prospective cohort study of 296 expectant young mothers recruited at obstetrics and gynecology clinics. Results from structural equation and multigroup models found that higher urban social stress predicted lower mental and physical quality of life during pregnancy, but these associations were significantly stronger for IPV-exposed and nonpartner violence-exposed mothers. In the postpartum period, higher urban social stress predicted lower mental and physical quality of life, but these associations were significantly stronger for IPV-unexposed and nonpartner violence-exposed mothers. Stress reduction programs need to help adolescent and young mothers in urban areas develop stress management skills specific to urban social stress. Pregnancy and parenting programs need to be tailored to the specific needs of young mothers in urban areas by becoming sensitive to the role of IPV and nonpartner violence in these young women's lives.