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Tinago CB, Frongillo EA, Warren AM, Chitiyo V, Cifarelli AK, Fyalkowski S, Pauline V. Development and assessment of feasibility of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe. Pilot Feasibility Stud 2021; 7:110. [PMID: 34001288 PMCID: PMC8127315 DOI: 10.1186/s40814-021-00832-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Adolescent mothers in Zimbabwe often experience stigma, isolation, and lack coping skills and resources to successfully navigate motherhood. Social isolation and stigma are linked to poor mental health outcomes. No interventions currently address mental health of adolescent mothers in Zimbabwe. Peer support groups in other contexts have been effective at increasing social connectedness, self-esteem, and self-efficacy, providing coping mechanisms to manage stigma experiences, in addition to empowering and improving mental health of adolescents and adolescent mothers. To develop a community-based peer support intervention, we aimed to understand the unique needs of adolescent mothers, how peer support groups could address those needs, and the feasibility of implementing the intervention. Methods Focus group discussions were conducted with 86 adolescent mothers aged 14–18 years, 24 community health workers, and 25 key community stakeholders in a low-income high-density community in Harare. Data were analyzed thematically using NVivo 12 software. Results Participants described adolescent mother experiences with stigma and social isolation, in addition to challenges including gossip, lack of employment and educational opportunities, and gaps in services and programming. Peer support groups for adolescent mothers were welcomed to improve mental health, social support, knowledge sharing, and skills building. Participants identified varying preferred frequency and duration of group sessions addressing topics including income generation, mental health, and gossip, facilitated by community health workers at health and community centers. The use of WhatsApp Messenger to support intervention efforts was welcomed as an affordable and user-friendly platform to share information. Implementation (i.e., training, supervision, frequency, location, and co-facilitation) was feasible. Conclusions Adolescent mothers, community health workers and key community stakeholders welcomed the peer support groups as a feasible way to address the mothers’ needs.
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Affiliation(s)
- Chiwoneso B Tinago
- Department of Health, West Chester University of Pennsylvania, 855 S. New Street, West Chester, PA, 19383, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC, 29208, USA
| | - Andrea M Warren
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC, 29208, USA.
| | - Vivian Chitiyo
- The Organization for Public Health Interventions and Development (OPHID), 20 Cork Road, Belgravia, Harare, Zimbabwe
| | - Ashley K Cifarelli
- Department of Health, West Chester University of Pennsylvania, 855 S. New Street, West Chester, PA, 19383, USA
| | - Shannon Fyalkowski
- Department of Health, West Chester University of Pennsylvania, 855 S. New Street, West Chester, PA, 19383, USA
| | - Victoria Pauline
- Department of Health, West Chester University of Pennsylvania, 855 S. New Street, West Chester, PA, 19383, USA
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Maslowsky J, Hendrick CE, Stritzel H. Mechanisms linking teenage mothers' educational attainment with self-reported health at age 50. BMC WOMENS HEALTH 2021; 21:15. [PMID: 33407362 PMCID: PMC7789595 DOI: 10.1186/s12905-020-01150-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022]
Abstract
Background Early childbearing is associated with adverse health and well-being throughout the life course for women in the United States. As education continues to be a modifiable social determinant of health after a young woman gives birth, the association of increased educational attainment with long-term health for women who begin childbearing as teenagers is worthy of investigation. Methods Data are from 301 mothers in the National Longitudinal Survey of Youth 1979 who gave birth prior to age 19. We estimated path models to assess women’s incomes, partner characteristics, and health behaviors at age 40 as mediators of the relationship between their educational attainment and self-rated general health at age 50. Results After accounting for observed background factors that select women into early childbearing and lower educational attainment, higher levels of education (high school diploma and GED attainment vs. no degree) were indirectly associated with higher self-rated health at age 50 via higher participant income at age 40. Conclusions As education is a social determinant of health that is amenable to intervention after a teen gives birth, our results are supportive of higher educational attainment as a potential pathway to improving long-term health outcomes of women who begin childbearing early.
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Affiliation(s)
- Julie Maslowsky
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto D3700, Austin, TX, 78712, USA. .,Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA. .,Population Research Center, University of Texas at Austin, Austin, TX, USA.
| | - C Emily Hendrick
- School of Community Health Sciences, University of Nevada Reno, Reno, NV, USA
| | - Haley Stritzel
- Population Research Center, University of Texas at Austin, Austin, TX, USA
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Aslam RW, Hendry M, Booth A, Carter B, Charles JM, Craine N, Edwards RT, Noyes J, Ntambwe LI, Pasterfield D, Rycroft-Malone J, Williams N, Whitaker R. Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. BMC Med 2017; 15:155. [PMID: 28806964 PMCID: PMC5557469 DOI: 10.1186/s12916-017-0904-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/27/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Unintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions. METHODS We conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. We searched 20 electronic databases, including MEDLINE, Excerpta Medica database, Applied Social Sciences Index and Abstracts and Research Papers in Economics, to cover a broad range of health, social science, health economics and grey literature sources. Searches were conducted between May 2013 and June 2014 and updated in August 2015. RESULTS Twelve randomised controlled trials (RCTs), two quasi-RCTs, 10 qualitative studies and 53 other quantitative studies were identified. The RCTs evaluated psychosocial interventions and an emergency contraception programme. The primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control group, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78-1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with an RR of 0.60 (95% CI 0.39-0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. Qualitative and realist evidence highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions. CONCLUSIONS Little or no evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce unintended repeat pregnancy in young women. TRIAL REGISTRATION PROSPERO, CRD42012003168 . Cochrane registration number: i = fertility/0068.
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Affiliation(s)
- Rabeea'h W Aslam
- Department of Biostaistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - Maggie Hendry
- North Wales Centre for Primary Care Research School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluations, School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluations, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | | | - Diana Pasterfield
- North Wales Centre for Primary Care Research School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Jo Rycroft-Malone
- Centre for Health-Related Research School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nefyn Williams
- North Wales Centre for Primary Care Research School of Healthcare Sciences, Bangor University, Bangor, UK
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Whitaker R, Hendry M, Aslam R, Booth A, Carter B, Charles JM, Craine N, Tudor Edwards R, Noyes J, Ives Ntambwe L, Pasterfield D, Rycroft-Malone J, Williams N. Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. Health Technol Assess 2016; 20:1-214. [PMID: 26931051 DOI: 10.3310/hta20160] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. OBJECTIVES To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. DATA SOURCES We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association's electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. REVIEW METHODS To address the topic's complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. RESULTS We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. LIMITATIONS Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. CONCLUSIONS We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Maggie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rabeea'h Aslam
- Liverpool Review and Implementation Group, University of Liverpool, Liverpool, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ben Carter
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Noel Craine
- Microbiology Department, Public Health Wales, Ysbyty Gwynedd, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | | | - Diana Pasterfield
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | | | - Nefyn Williams
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.,North Wales Organisation for Randomised Trials in Health (& Social Care), School of Healthcare Sciences, Bangor University, Bangor, UK
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Cecil DK, McHale J, Strozier A, Pietsch J. Female inmates, family caregivers, and young children's adjustment: A research agenda and implications for corrections programming. JOURNAL OF CRIMINAL JUSTICE 2008; 36:513-521. [PMID: 19884977 PMCID: PMC2641026 DOI: 10.1016/j.jcrimjus.2008.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Attendant to the exponential increase in rates of incarceration of mothers with young children in the United States, programming has been established to help mothers attend to parenting skills and other family concerns while incarcerated. Unfortunately, most programs overlook the important, ongoing relationship between incarcerated mothers and family members caring for their children-most often, the inmates' own mothers. Research reveals that children's behavior problems escalate when different co-caregivers fail to coordinate parenting efforts and interventions, work in opposition, or disparage or undermine one another. This article presents relevant research on co-caregiving and child adjustment, highlights major knowledge gaps in need of study to better understand incarcerated mothers and their families, and proposes that existing interventions with such mothers can be strengthened through targeting and cultivating functional coparenting alliances in families.
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Affiliation(s)
- Dawn K Cecil
- Department of Criminology, University of South Florida, 140 Seventh Avenue South, St. Petersburg, FL 33701
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Sadler LS, Swartz MK, Ryan-Krause P, Seitz V, Meadows-Oliver M, Grey M, Clemmens DA. Promising outcomes in teen mothers enrolled in a school-based parent support program and child care center. THE JOURNAL OF SCHOOL HEALTH 2007; 77:121-30. [PMID: 17302854 DOI: 10.1111/j.1746-1561.2007.00181.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. METHODS A volunteer sample of 65 adolescent mothers enrolled in the parent support program and their children were interviewed, surveyed, and assessed. Fifty-three mothers had children enrolled in the school-based child care center and 12 mothers had their children cared for by family members. Maternal characteristics assessed included self-esteem and depressive symptoms, social stressors and support, self-perceived parental competence, parent-child teaching interactions, and subsequent childbearing and maternal educational outcomes. Child outcomes included child developmental assessments and health outcomes. RESULTS About 33% of teen mothers were mildly to moderately depressed and 39% of the sample had experienced transitional homelessness. Social support networks were small; in the past 12 months, mothers experienced a mean number of 13.2 +/- 11.9 negative life events. Maternal self-report measures and mother-child observation measures indicated positive levels of parental competence. Maternal educational outcomes were positive, and only 6% of mothers had subsequent childbirths within 2 years. The mean scores on developmental assessments of children fell within the normal range, although there were 7 children identified with developmental delays. CONCLUSIONS For at-risk teen mothers, this parent support program and school-based child care setting appears to offer promising opportunities to help young mothers with parenting, avoid rapid subsequent pregnancies, and stay engaged with school, while their children are cared for in a close and safe environment.
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Affiliation(s)
- Lois S Sadler
- Yale University School of Nursing, 100 Church St South, PO Box 9740, New Haven, CT 06536, USA.
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Kennedy AC. Urban adolescent mothers exposed to community, family, and partner violence: prevalence, outcomes, and welfare policy implications. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2006; 76:44-54. [PMID: 16569126 DOI: 10.1037/0002-9432.76.1.44] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The federal welfare reforms of 1996 mandated that all minor adolescent mothers receiving cash assistance must attend school and live at home to receive their cash grant. Though this law has been in place for over 8 years, little research has been done that explores the barriers facing adolescent mothers who try to attend school and live at home. Anecdotal and qualitative evidence from welfare reform evaluation studies suggests that violence may be just such a barrier. This article reviews the recent empirical literature on urban adolescent mothers' exposure to multiple forms of violence. The author delineates and critiques the existing research on the prevalence of and outcomes linked with exposure to community violence, witnessed parental violence, physical abuse within the family, and partner violence among this population. The article concludes with recommendations for researchers, practitioners, and policy makers in light of the reviewed findings.
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Affiliation(s)
- Angie C Kennedy
- Michigan State University, School of Social Work, East Lansing, MI 48824, USA.
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Sadler LS, Cowlin A. Moving into Parenthood: a program for new adolescent mothers combining parent education with creative physical activity. J SPEC PEDIATR NURS 2003; 8:62-70. [PMID: 12875174 DOI: 10.1111/j.1744-6155.2003.tb00188.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ISSUES AND PURPOSE To describe a school-based program combining traditional parent education with creative physical activity classes to assist newly delivered adolescent mothers to develop positive parenting behaviors while remaining in school. CONCLUSIONS The program contains sessions on parenting information, creative coping strategies, fitness, and role modeling of positive parenting behaviors to help young mothers learn healthy parenting skills as they continue in their own adolescent development. PRACTICE IMPLICATIONS The content and teaching strategies can be adapted for individual or group clinical work with teen mothers and their infants in a variety of community settings as well as in school-based healthcare programs.
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Affiliation(s)
- Lois S Sadler
- Yale University School of Nursing, New Haven, CT, USA.
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Koniak-Griffin D, Turner-Pluta C. Health risks and psychosocial outcomes of early childbearing: a review of the literature. J Perinat Neonatal Nurs 2001; 15:1-17. [PMID: 12095025 DOI: 10.1097/00005237-200109000-00002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article presents a review of the literature on the obstetric, medical, and neonatal health risks as well as psychosocial outcomes associated with early childbearing. An important concern in adolescent pregnancies is the increased risk for infant morbidity and mortality as a result of higher incidence of preterm births and low-birthweight infants. Implications for prenatal and postpartum nursing care are discussed. Promising new models to improve care of young mothers and their children, such as home visitation by public health nurses, are presented and features of successful intervention programs outlined.
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