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Levey EJ, Rodriguez AEM, Chang AR, Rondon MB, Sanchez MLJ, Harrison AM, Gelaye B, Becker AE. A qualitative analysis of adolescent motherhood within the broader family context in Peru. FAMILY RELATIONS 2024; 73:1046-1066. [PMID: 38523658 PMCID: PMC10957107 DOI: 10.1111/fare.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/24/2023] [Indexed: 03/26/2024]
Abstract
Objective The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets. Background Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group. Method This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed. Results The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy. Conclusion Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy. Implications Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.
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Affiliation(s)
- Elizabeth J. Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Andrew R. Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | | | - Alexandra M. Harrison
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
| | - Bizu Gelaye
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anne E. Becker
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
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Merriman B, Jarmoc G, van der Rijn M, Pierre-Joseph N. Impact of COVID-19 on Mental Health and Resiliency of Pregnant and Parenting Adolescents and Young Adults: A Qualitative Study. J Pediatr Health Care 2023; 37:484-491. [PMID: 36973102 PMCID: PMC10008786 DOI: 10.1016/j.pedhc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION This study aimed to understand the impacts the COVID-19 pandemic has on the mental health and well-being of pregnant and parenting adolescents and young adults (AYA) to identify unique challenges they faced. METHOD Pregnant and parenting AYA from a teen and tot program at a safety-net hospital in the northeast participated in semistructured qualitative interviews. Interviews were audio-recorded, transcribed, and coded. Analysis was conducted using modified grounded theory and content analysis. RESULTS Fifteen pregnant and parenting AYA participated in interviews. Participants were aged 19-28 years (mean age, 22.6). Participants reported adverse mental health experiences, namely increased loneliness, depression, and anxiety, engagement in preventive measures to protect their children's health, positive attitudes toward telemedicine because of efficiency and safety, delayed attainment of personal and professional goals, and increased attitudes of resilience. DISCUSSION Health care professionals should offer expanded screening and support resources to pregnant and parenting AYA during this time.
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Affiliation(s)
- Bridgette Merriman
- Bridgette Merriman, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Grace Jarmoc
- Grace Jarmoc, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA.
| | - Madeleine van der Rijn
- Madeleine van der Rijn, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Natalie Pierre-Joseph
- Natalie Pierre-Joseph, Clinical Associate Professor of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Alukagberie ME, Elmusharaf K, Ibrahim N, Poix S. Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reprod Health 2023; 20:95. [PMID: 37355659 PMCID: PMC10290377 DOI: 10.1186/s12978-023-01629-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is a global public health and social problem that affects both developed and developing countries. Reducing adolescent pregnancy is central to achieving sustainable development goals. In 2021 Nigeria's Adolescent pregnancy was 106 per 1000 and showed an increasing rate. This study, therefore, aims to explore the literature to map the risk factors and interventions against adolescent pregnancy in Nigeria. METHOD A scoping review of studies published between January 2007 and December 2022 using PubMed, Web of Science and Africa Journals Online were searched using the keywords' adolescent pregnancy' AND 'Nigeria'. Studies were screened using the eligibility criteria. RESULTS A total of 241 articles, of which 229 were identified through the databases and 12 were identified through hand search. After the full-text review, 28 studies met the inclusion criteria and were included in the final review. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Still, the policies need more sponsorship, implementation, and monitoring, while only some interventions on adolescent pregnancy majorly based on contraceptives and education of health providers are available in Nigeria. CONCLUSION Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy. Thus, policies on sexual, reproductive, and mental health development specifically targeting adolescents to reduce the cycle of societal dependence by empowering this group economically and educationally are justifiably warranted.
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Affiliation(s)
- Majesty Enaworoke Alukagberie
- School of Medicine, University of Limerick, Limerick, Ireland
- Public Health Master Programme, University of Limerick, Limerick, Ireland
| | | | - Nuha Ibrahim
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Sébastien Poix
- School of Medicine, University of Limerick, Limerick, Ireland
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Ambia AM, Pruszynski JE, Fairchild E, McIntire DD, Nelson DB. Perinatal outcomes of young adolescent pregnancies in an urban inner city. Am J Obstet Gynecol MFM 2023; 5:100843. [PMID: 36572108 DOI: 10.1016/j.ajogmf.2022.100843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although substantial efforts have been made to reduce the rates of adolescent pregnancy, the United States continues to have higher rates than other industrialized countries. Research and reporting usually focus on adolescents aged 15 to 19 years. Although less common, there are pregnant young adolescents that are ≤15 years of age, with developmental and social differences from older, high school-aged adolescents. OBJECTIVE Because adolescent pregnancies are of particular concern because of long-term socioeconomic consequences to parent and child, we sought to determine whether young adolescents (≤15 years old) had worse perinatal outcomes than older adolescents (16-19 years old) and older parents (≥20 to 34 years old) among those living in an urban inner city. STUDY DESIGN This was a study of pregnant individuals who delivered a singleton pregnancy without evidence of chronic hypertension or pregestational diabetes mellitus at a safety net hospital from January 2010 to May 2021. Parents were grouped by age at the time of delivery into young adolescents (≤15 years old) and older adolescents (16-19 years old). For a comparison group, nulliparous older parents aged 20 to 34 years with singleton pregnancies were analyzed for perinatal outcomes and compared with the adolescent cohorts. When analyzing baseline parental characteristics, a preponderance of obesity was noted in the young adolescent cohort. An analysis of parental characteristics and perinatal outcomes among young adolescents with obesity vs young adolescents without obesity ≤15 years old was performed. Statistical analysis included χ2 and Student t test with P values of <.05 considered significant. Logistic regression analysis was performed to control for potentially confounding demographic variables. RESULTS Overall, 10,894 adolescent women delivered, with 868 young adolescents and 10,026 older adolescents. Pairwise comparisons showed young adolescents had a different race distribution than older adolescents (P=.006) and older parents (P<.001). Young adolescents were more likely to be Hispanic or non-Hispanic Black (P<.001) and accessed prenatal care at a later gestational age (19.7±8.9 weeks) compared with older adolescents (16.7±8.6 weeks) and the comparison older cohort of parents (15.7±8.7 weeks) (P<.001) and less frequently in pregnancy (P<.001) compared with older parents. Young adolescents were more likely to have preterm birth at <37 weeks of gestation (P<.001) and eclampsia (0.5% vs 0.1%) (P=.01) than older adolescents. Therefore, low birthweights of ≤2500 g (P=.02) and neonatal intensive care unit admission (P=.048) were also increased in adolescents. When adjusted for race, ethnicity, and body mass index, preeclampsia with severe features (P<.001) and preterm birth at <37 weeks of gestation (P=.048) remained significant. Young adolescents with obesity were more likely to have preeclampsia with severe features (odds ratio, 1.81; 95% confidence interval, 1.22-2.68) and be delivered via cesarean delivery (odds ratio, 2.71; 95% confidence interval, 1.85-3.99) than adolescents without obesity. CONCLUSION In an urban inner city, young adolescent parents were more likely to be women of color, have later presentations to prenatal care, and have increased rates of preterm birth. Young adolescents had high rates of obesity, which was associated with increased rates of hypertensive disorders of pregnancy and cesarean delivery, than adolescents without obesity.
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Affiliation(s)
- Anne M Ambia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Ambia, Pruszynski, McIntire, and Nelson).
| | - Jessica E Pruszynski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Ambia, Pruszynski, McIntire, and Nelson)
| | | | - Donald D McIntire
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Ambia, Pruszynski, McIntire, and Nelson)
| | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Ambia, Pruszynski, McIntire, and Nelson)
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Boateng AA, Botchwey COA, Adatorvor BA, Baidoo MA, Boakye DS, Boateng R. A phenomenological study on recurrent teenage pregnancies in effutu municipality- Ghana.the experiences of teenage mothers. BMC Public Health 2023; 23:218. [PMID: 36726092 PMCID: PMC9890793 DOI: 10.1186/s12889-023-15074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Generally, recurrent teenage pregnancies are public health menaces that impede the quality of life of teenage mothers, their offspring, and society as a whole. However, there is paucity of information regarding factors influencing this social issue especially, in developing countries where Ghana is no exception. Moreover, this menace has been least investigated from the perspective of the teenager with multiple pregnancies. Hence, this study aimed at identifying the factors influencing recurrent teenage pregnancies and the challenges confronted by these teenage mothers. METHOD This study is a phenomenological qualitative study that was conducted in the Effutu Municipality in the Central Region of Ghana. Employing convenience and snowball sampling, 40 participants who were residents of the study area, had a child each, and were pregnant at the time of the study were included. Other participants included teenage mothers who had at least two (2) children. A face-to-face in-depth interview with the help of an interview guide was conducted. Proceedings were recorded, transcribed, and analysed using thematic analysis. Quotations were used in the result presentation. RESULTS The results of the study revealed that factors influencing recurrent teenage pregnancies are multifactorial. It includes peer pressure, parental neglect, poverty, living with a partner, and inadequate knowledge of family planning. The teenager with recurrent pregnancy is confronted with financial difficulties and is faced with stigmatisation in the society where she finds herself. CONCLUSION To this effect, it is important to intensify education on family planning and good parental practices among parents with teenage mothers while providing a similar form of sensitization for members of the society about the harmful effects of stigmatisation on the teenage mother and her children. Again, a social support network for teenagers with recurrent pregnancies could be formed to help curb this public health menace.
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Affiliation(s)
- Agartha Afful Boateng
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region, Winneba, Ghana.
| | - Charles Owusu-Aduomi Botchwey
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | | | - Michael Afari Baidoo
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Dorothy Serwaa Boakye
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
| | - Richard Boateng
- grid.442315.50000 0004 0441 5457Department of Health Administration and Education, Faculty of Science Education, University of Education, Post Office Box 25, Central Region Winneba, Ghana
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Prevalence and risk factors for female and male adolescents involved in pregnancy and abortion: a population-based cross-sectional study in Taiwan, 2006–2016. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Meek JY, Carmona CA, Mancini EM. Problems of the Newborn and Infant. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Canlı A, Demirtaş B. Prenatal Attachment and the Relationship With Body Self-Perception. J Obstet Gynecol Neonatal Nurs 2021; 51:e1-e12. [PMID: 34592162 DOI: 10.1016/j.jogn.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore prenatal attachment by sociodemographic and obstetric characteristics and to determine the relationship between prenatal attachment and body self-perception among pregnant women. DESIGN Descriptive correlational. SETTING The obstetrics and gynecology outpatient clinic of a university hospital in Ankara, Turkey. PARTICIPANTS One hundred eighty-three healthy pregnant women at 20 weeks or more of pregnancy who visited the obstetrics and gynecology outpatient clinic of the university hospital between April 3 and July 6, 2019. METHODS We collected data using a personal data collection form, the Prenatal Attachment Inventory (PAI), and the Multidimensional Body Self Relations Questionnaire. RESULTS Participants' mean PAI score was 67.74 (SD = 9.98). Participants younger than 20 years had the lowest mean PAI score of 57.20 (SD = 10.66). The level of prenatal attachment decreased as the number of pregnancies increased (p < .05). Participants' mean PAI score had a weak positive relationship with their total body self-perception score (r = .226) and the Appearance Evaluation, Fitness Evaluation, Health Orientation, Fitness Orientation, and Body Areas Satisfaction subscales (p < .05). CONCLUSION Prenatal attachment levels were greater if participants were pleased with their appearances and bodies, approached their physical fitness positively, and engaged in practices to increase their health and physical capacity. We recommend conducting education programs concentrating on adaptation to pregnancy that enable women to evaluate their bodies more positively during pregnancy, to adopt behaviors to improve their health in pregnancy, and to increase prenatal attachment.
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Weiss SJ, Leung C. Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely. Infant Ment Health J 2021; 42:586-602. [PMID: 34021614 PMCID: PMC8453766 DOI: 10.1002/imhj.21924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire‐9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers’ family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.
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Affiliation(s)
- Sandra J. Weiss
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Cherry Leung
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Abstract
Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
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Affiliation(s)
- Makia E Powers
- Children's Healthcare of Atlanta and Morehouse School of Medicine, Atlanta, Georgia; and
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Using Social Network Analysis to Strengthen Organizational Relationships to Better Serve Expectant and Parenting Young People. Matern Child Health J 2020; 24:232-242. [PMID: 32889682 PMCID: PMC7497387 DOI: 10.1007/s10995-020-02992-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Expectant and parenting young people (young parents) need a range of supports but may have difficulty accessing existing resources. An optimally connected network of organizations can help young parents navigate access to available services. Community organizations participating in the Pathways to Success (Pathways) initiative sought to strengthen their network of support for young parents through social network analysis (SNA) undertaken within an action research framework. Method Evaluators and community partners utilized a survey and analysis tool to map and describe the local network of service providers offering resources to young parents. Respondents were asked to characterize their relationship with all other organizations in the network. Following survey analysis, all participants were invited to discuss and interpret the results and plan the next actions to improve the network on behalf of young parents. Results Scores described the diversity of organizations in the network, density of connections across the community, degree to which the network was centralized or decentralized, which organizations were central or outliers, frequency of contact, levels of collaboration, and levels of trust. Findings were interpreted with survey participants and used by Pathways staff for action planning to improve their network. Discussion SNA clarified complex relationships and set service providers on a path toward optimizing their network. The usefulness of SNA to impact and improve a network approach to supporting young parents is discussed, including lessons learned from this project.
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Harding JF, Zief S, Farb A, Margolis A. Supporting Expectant and Parenting Teens: New Evidence to Inform Future Programming and Research. Matern Child Health J 2020; 24:67-75. [PMID: 32860585 PMCID: PMC7497376 DOI: 10.1007/s10995-020-02996-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Until recently, federal programs had not explicitly focused on improving the outcomes of highly vulnerable teen parents. Established in 2010, the Pregnancy Assistance Fund (PAF) aims to improve the health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families, through providing grants to states and tribes. This article introduces the Maternal and Child Health Journal supplement “Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund,” which draws together the perspectives of researchers and practitioners to provide insights into serving expectant and parenting teens through the PAF program. The articles in the supplement include examples of programs that use different intervention strategies to support teen parents, with programs based in high school, college, and community settings in both urban and rural locations. Some of the articles provide rigorous evidence of what works to support teen parents. In addition, the articles demonstrate key lessons learned from implementation, including allowing some flexibility in implementation while clearly outlining core programmatic components, using partnerships to meet the multifaceted needs of young parents, hiring the right staff and providing extensive training, using strategies for engaging and recruiting teen parents, and planning for sustainability early. The studies use a range of qualitative and quantitative methods to evaluate programs to support teen parents, and three articles describe how to implement innovative and cost effective methods to evaluate these kinds of programs. By summarizing findings across the supplement, we increase understanding of what is known about serving expectant and parenting teens and point to next steps for future research.
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Affiliation(s)
| | - Susan Zief
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543-2393, USA
| | - Amy Farb
- Office of Population Affairs, Washington, DC, USA
| | - Amy Margolis
- Office of Population Affairs, Washington, DC, USA
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Purington A, Stupp E, Sebuharara D, Maley B, Henderson SB, Powers J. Creating Systems-Level Change to Better Support Expectant and Parenting Young People: A Case Study. Matern Child Health J 2020; 24:171-177. [PMID: 32889683 PMCID: PMC7497379 DOI: 10.1007/s10995-020-02991-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Expectant and parenting young people (young parents) require diverse services to support their health, educational success, and family functioning. Rarely can the needs of young parents be met by a single school or service provider. This case study examines how one large school district funded through the pathways to success initiative was able to facilitate systems change to increase young parents' access to and use of supportive services. METHODS Data sources include a needs and resources assessment, quarterly reports documenting grantee effort, sustainability plans, social network analysis, and capstone interviews. All data sources were systematically reviewed to identify the existing context prior to the start of the initiative, the changes that resulted from the initiative, and efforts that could potentially be maintained beyond the grant period. RESULTS The community context prior to Pathways implementation was one of disconnected services and missed opportunities. The full-time program coordinator hired by the district focused on systems-level change and facilitated connections between organizations. This greater connectivity contributed to increased collaboration with the goal of producing lasting benefits for young parents. DISCUSSION Promoting sustainable connections and collaboration at the systems level can help dismantle barriers to service access and benefit young parents.
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Affiliation(s)
- Amanda Purington
- Bronfenbrenner Center for Translational Research, Cornell University, 35 Thornwood Drive Suite 200, Ithaca, NY, 14853, USA.
| | - Erica Stupp
- Bureau of Women, Infant & Adolescent Health, New York State Department of Health, Albany, NY, USA
| | - Divine Sebuharara
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, USA.,State University of New York at Binghamton, Binghamton, NY, USA
| | - Brian Maley
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, USA
| | - Sara Birnel Henderson
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, USA.,Planned Parenthood Federation of America, New York, NY, USA
| | - Jane Powers
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY, USA
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Pressfield L, Campa M, Ramstrom K, Kabadi S, Lopez C. Translating Theory into Practice: Lessons Learned from Developing a Program Model to Foster Resiliency in Expectant and Parenting Youth. Matern Child Health J 2020; 24:132-140. [PMID: 32065336 PMCID: PMC7497358 DOI: 10.1007/s10995-020-02890-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This paper describes the approach used to develop the Adolescent Family Life Program (AFLP) Positive Youth Development (PYD) Model within the structure of an existing state government-run program. DESCRIPTION The California Department of Public Health, Maternal, Child and Adolescent Health (CDPH/MCAH) Division undertook an innovative approach to develop a program model to help expectant and parenting youth build resilience. CDPH/MCAH started by assessing existing program efforts and theory to develop and test new strategies in the field, structure a program model, and build toward broader expansion and sustainability. CDPH/MCAH engaged local organizations from across the state, their staff and enrolled youth, experts, and evaluators in an iterative program development process to standardize an effective model that could be replicated and evaluated. ASSESSMENT Key lessons for program developers and administrators are to ensure adequate staffing with diverse expertise related to the topic and content to support the multiple components of program development and implementation, evaluation, and training; identify the guiding theory and framework early and link them with clearly articulated core components to ensure the final model reflects the intended purpose and is structured to support implementation; engage implementation staff on the ground and focus early and often on processes for supporting people through change. CONCLUSION The lessons learned can guide others working with existing programs to develop standardized program models or translate new science and theory into practice.
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Affiliation(s)
- Lissa Pressfield
- California Department of Public Health, Maternal, Child and Adolescent Health Division, PO Box 997377, MS 0510, Sacramento, CA, 95899, USA.
| | - Mary Campa
- California Department of Public Health, Maternal, Child and Adolescent Health Division, PO Box 997377, MS 0510, Sacramento, CA, 95899, USA
| | - Karen Ramstrom
- Shasta County Health and Human Services Agency, 2650 Breslaur Way, Redding, CA, 96001, USA
| | - Sangi Kabadi
- California Department of Public Health, Maternal, Child and Adolescent Health Division, PO Box 997377, MS 0510, Sacramento, CA, 95899, USA
| | - Catherine Lopez
- California Department of Public Health, Women, Infants and Children (WIC) Division, 3901 Lennane Drive, Sacramento, CA, 95834, USA
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SmithBattle L, Loman DG, Cibulka NJ. Family-Centered Primary Care for Teen Parents and Their Children. J Pediatr Health Care 2020; 34:204-211. [PMID: 31859135 DOI: 10.1016/j.pedhc.2019.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Although the teen birth rate in the United States continues to decline, births remain disproportionately high among disadvantaged teens and teens of color. The vulnerabilities and resilience of teen parents are described from a historical context, with recommendations for advancing primary care of these families. We endorse comprehensive primary care and clinical practices that capitalize on the strengths and resilience of these families while recognizing the social inequities that compromise their health and development. To strengthen the bonds among young mothers, fathers, and children, we recommend family-centered primary care services that are of a youth- and father-friendly, nonstigmatizing, strength-based, and trauma-informed nature.
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Grubb LK, Powers M. Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics 2020; 145:peds.2020-0627. [PMID: 32341182 DOI: 10.1542/peds.2020-0627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
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Affiliation(s)
- Laura K Grubb
- Departments of Adolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and
| | - Makia Powers
- Departments of Pediatrics and Public Health and Community Medicine, Morehouse School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Li Z, Patton G, Sabet F, Zhou Z, Subramanian SV, Lu C. Contraceptive Use in Adolescent Girls and Adult Women in Low- and Middle-Income Countries. JAMA Netw Open 2020; 3:e1921437. [PMID: 32074290 DOI: 10.1001/jamanetworkopen.2019.21437] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Preventing unwanted pregnancy through adequate use of contraceptives among adolescent girls is essential for improving maternal and child health and social well-being. OBJECTIVE To estimate the levels and trends of contraceptive use in adolescent girls (age 15-19 years) compared with adult women (age 20-34 years). DESIGN, SETTING, AND PARTICIPANTS This survey study used data from 261 Demographic and Health Surveys or Multiple Cluster Indicator Surveys conducted in 103 low- and middle-income countries between 2000 and 2017. Modern contraceptive use in 90 countries and unmet need for family planning in 73 countries for adolescent girls and adult women were assessed at country and aggregate levels. Data analyses for this study were conducted between March 2019 and December 2019. MAIN OUTCOMES AND MEASURES Modern contraceptive use and unmet need for family planning, estimated between adolescent girls and adult women for absolute inequality and relative inequality (defined as the ratio in service use between adult women and adolescent girls). Inequalities by wealth and place of residence in each age group were also assessed. RESULTS A total of 832 673 adolescent girls and 2 156 268 adult women were included in the analysis. Adolescent girls were significantly less likely to use modern contraceptives (31.6% [95% CI, 30.3% to 32.8%] vs 43.5% [95% CI, 42.4% to 44.7%]; absolute inequality, 11.9 percentage points [PPs] [95% CI, 11.7 to 12.1 PPs]; relative inequality, 1.38 PPs [95% CI, 1.36 to 1.40 PPs]) and more likely to have an unmet need for family planning (50.8% [95% CI, 49.0% to 52.5%] vs 36.4% [95% CI, 34.9% to 35.8%]; absolute inequality, -14.4 PPs [95% CI, -15.8 to -15.0 PPs]; relative inequality, 0.72 PPs [95% CI, 0.69 to 0.75 PPs]). Contraceptive use generally improved over time (aggregate-level use of contraceptives increased from 17.8% [95% CI, 16.6% to 19.0%] in 2000-2006 to 27.2% [95% CI, 26.6% to 27.8%] in 2013-2017 for adolescents and from 30.9% [95% CI, 29.8% to 32.0%] in 2000-2006 to 40.3% [95% CI, 39.8% to 40.8%] in 2013-2017 for adult women), but inequalities between adolescents and adult women persisted. Aggregate-level prevalence of unmet need for family planning decreased only among adult women (from 45.8% [95% CI, 44.9% to 46.7%] in 2000-2006 to 38.0% [95% CI, 37.3% to 38.7%] in 2013-2017). For adolescents, the prevalence remained at approximately 52% over time. The inequality between the 2 age groups therefore significantly increased from 7.5 PPs (95% CI, 6.5 to 8.4 PPs) in 2000 to 2006 to 14.0 PPs (95% CI, 13.4 to 14.6 PPs) in 2013 to 2017. An increasing gap between adolescent girls and adult women was found in 18 countries for modern contraceptive use and in 20 countries for unmet need for family planning. In India, for example, both age groups had increased percentage of unmet need for family planning over time, from 16.2% (95% CI, 15.9% to 16.6%) in 2006 to 29.8% (95% CI, 29.6% to 30.1%) in 2015 for adult women and from 23.9% (95% CI, 23.0% to 24.9%) to 64.5% (95% CI, 63.3% to 65.7%) among adolescents. Thus, inequality increased from 7.7 PPs (95% CI, 7.2 to 8.2 PPs) in 2006 to 34.7 PPs (95% CI, 34.2 to 35.1 PPs) in 2015. CONCLUSIONS AND RELEVANCE Despite a growing focus on contraception in the past decade with initiatives such as Family Planning 2020, adolescent girls continue to lag behind adult women in contraceptive use. There is a pressing need to develop age-appropriate strategies for increasing access and maintaining contraceptive use in sexually active adolescent girls.
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Affiliation(s)
- Zhihui Li
- Department of Global Health and Population, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - George Patton
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Farnaz Sabet
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Zhiying Zhou
- Xi'an Jiaotong University School of Public Policy and Administration, Xi'an, Shaanxi, China
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chunling Lu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Problems of the Newborn and Infant. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Meek JY, Carmona CA, Mancini EM. Problems of the Newborn and Infant. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee HY, Edwards RC, Hans SL. Young First-Time Mothers’ Parenting of Infants: The Role of Depression and Social Support. Matern Child Health J 2019; 24:575-586. [DOI: 10.1007/s10995-019-02849-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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The paradox of acceptance: A content analysis of Iranian married female adolescent in confronting pregnancy. PLoS One 2019; 14:e0216649. [PMID: 31075136 PMCID: PMC6510424 DOI: 10.1371/journal.pone.0216649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/25/2019] [Indexed: 11/19/2022] Open
Abstract
Adolescent pregnancy is a major health problem significantly associated with adverse effects on the health of both adolescents and their newborns. However, there is a lack of clarity over adolescent pregnancy from adolescents' perspective, particularly in the low- and middle income countries including Iran. This study aimed to explore the experiences of Iranian married female adolescent in confronting pregnancy. This qualitative research was conducted using conventional content analysis approach. Unstructured interviews with 24 female adolescents (aged 14–18 years) were used for data collection, and data analysis was done simultaneously. In this study, the participants were recruited from urban and rural primary healthcare centers (PHCs). The PHCs were selected randomly from several towns and villages of Guilan Province, Iran. The participants were recruited through a purposive sampling method. After data analysis, four categories were extracted from 24 interviews, including "actively accepting pregnancy", "passively accepting pregnancy", "hope and satisfaction" and "frustration and regret". These categories formed the main theme of "paradox of acceptance" in confronting pregnancy. The concepts that have emerged based on the results of the study can potentially help develop comprehensive and age-tailored health promotion programs to confront pregnancy more successfully for female pregnant adolescents. Further research, particularly on the long-term effects of teenage motherhood is suggested.
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Govender D, Naidoo S, Taylor M. Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal. Afr J Prim Health Care Fam Med 2019; 11:e1-e11. [PMID: 31038339 PMCID: PMC6489148 DOI: 10.4102/phcfm.v11i1.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes. AIM The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children. SETTING The study was conducted in a local district hospital in Ugu, KwaZulu-Natal. METHODS An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis. RESULTS Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers. CONCLUSION In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, Ugu District, South Africa; and, School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban.
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Cox JE, Harris SK, Conroy K, Engelhart T, Vyavaharkar A, Federico A, Woods ER. A Parenting and Life Skills Intervention for Teen Mothers: A Randomized Controlled Trial. Pediatrics 2019; 143:peds.2018-2303. [PMID: 30755464 DOI: 10.1542/peds.2018-2303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5985300176001PEDS-VA_2018-2303Video Abstract BACKGROUND: Teen mothers often present with depression, social complexity, and inadequate parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes. We conducted a randomized controlled trial of a parenting and life skills intervention for teen mothers aimed at impacting parenting and reproductive outcomes. METHODS Teen mothers were recruited from a teen-tot clinic with integrated medical care and social services. Participants were randomly assigned 1:1 to receive (1) teen-tot services plus 5 interactive parenting and life skills modules adapted from the Nurturing and Ansell-Casey Life Skills curricula, delivered by a nurse and social worker over the infant's first 15 months or (2) teen-tot services alone. A computerized questionnaire was self-administered at intake, 12, 24, and 36 months. Outcomes included maternal self-esteem, parenting attitudes associated with child maltreatment risk, maternal depression, life skills, and repeat pregnancy over a 36-month follow-up. We used generalized linear mixed modeling and logistic regression to examine intervention effects. RESULTS Of 152 invited, 140 (92%) participated (intervention = 72; control = 68). At 36 months, maternal self-esteem was higher in the intervention group compared with controls (P = .011), with higher scores on preparedness for mothering role (P = .011), acceptance of infant (P = .008), and expected relationship with infant (P = .029). Repeat pregnancy by 36 months was significantly lower for intervention versus control participants. CONCLUSIONS A brief parenting and/or life skills intervention paired with medical care for teens and their children has positive effects on maternal self-esteem and repeat pregnancy over 36 months.
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Affiliation(s)
- Joanne E Cox
- Divisions of General Pediatrics and .,Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sion Kim Harris
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Kathleen Conroy
- Divisions of General Pediatrics and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | - Elizabeth R Woods
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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Harrison ME, Obeid N, Haslett K, McLean N, Clarkin C. Embodied Motherhood: Exploring Body Image in Pregnant and Parenting Youth. J Pediatr Adolesc Gynecol 2019; 32:44-50. [PMID: 30193969 DOI: 10.1016/j.jpag.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/19/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE There is a paucity of research on body image in pregnant and parenting youth (PPY). Study objectives were to examine: (1) profiles of PPY regarding body image, depression, and eating behaviors and any effects of age and pregnancy status on results; and (2) PPY perceptions of body image. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Demographic data and scores from measures related to self-esteem, body esteem, eating behaviors, and depression were collected from 101 PPY from 2 urban centers. Two focus group sessions were held to further explore survey findings. Sessions were audio-recorded and transcribed verbatim for analysis. RESULTS Participants (mean age, 19.8 years) reported a history of depression (79/101; 78.2%), anxiety (75/101; 74.3%), drug/alcohol abuse (45/101; 44.6%), and eating disorder (32/101; 31.7%). Parenting (nonpregnant; n = 64) participants had lower body esteem (P = .041) and more eating disorder behaviors (P = .026) compared with pregnant (n = 37) participants. A history of depression or eating disorder both independently increased risk for lower body esteem and self-esteem and higher depressive symptoms in pregnant youth. Four dominant themes emerged from qualitative data: (1) adapting to rapidly changing bodies; (2) inter-relationship between body image and mood; (3) added attention and perceptions of pressure to return to prepregnancy body size; and (4) reconciling change and striving to find a new normal. CONCLUSION This study highlights the importance of exploring past and current body image, mood, and eating disorder behavior in PPY for risk of current mental health issues. Future research exploring prepregnancy depression, eating disorder, body esteem, and depression in pregnant youth are needed.
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Affiliation(s)
- M E Harrison
- Division of Adolescent Medicine, Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Regional Eating Disorders Program, University of Ottawa, Ottawa, Ontario, Canada.
| | - N Obeid
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Regional Eating Disorders Program, University of Ottawa, Ottawa, Ontario, Canada
| | - K Haslett
- Rideauwood Addiction and Family Services, Ottawa, Ontario, Canada
| | - N McLean
- Dave Smith Youth Treatment Centre, Carleton Place, Ontario, Canada
| | - C Clarkin
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
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Pearce LD, Hayward GM, Chassin L, Curran PJ. The Increasing Diversity and Complexity of Family Structures for Adolescents. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2018; 28:591-608. [PMID: 30197489 PMCID: PMC6124501 DOI: 10.1111/jora.12391] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
The structure of adolescents' families, and thus parental forms, in the United States, have become more heterogeneous and fluid over the past several decades. These changes are due to increases in never-married, single parents, divorce, cohabitation, same-sex parenting, multi-partnered fertility, and co-residence with grandparents. We document current diversity and complexity in adolescents' families as important context for rethinking future parenting theory and research. We also discuss how understandings of adolescents' families are somewhat limited by current methods used to measure characteristics of families. We recommend social network and profile-based methods as alternatives to capturing key dimensions of family structure and processes. Understanding the diversity of households and families in which adolescents are raised can improve theory and research on parenting.
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Govender D, Naidoo S, Taylor M. Scoping review of risk factors of and interventions for adolescent repeat pregnancies: A public health perspective. Afr J Prim Health Care Fam Med 2018; 10:e1-e10. [PMID: 29943611 PMCID: PMC6018382 DOI: 10.4102/phcfm.v10i1.1685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/03/2018] [Accepted: 05/19/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adolescent repeat pregnancy is of importance in public health because the birth of a second child to an adolescent mother compounds the adverse medical, educational, socioeconomic and parenting outcomes. Repeat pregnancy in adolescence is not only an international phenomenon but also a local concern as it also occurs in South Africa. The prevalence of adolescent repeat pregnancy in Durban, KwaZulu-Natal, was reported as 17.6% in 2013. AIM This review aimed to gather relevant information from national and international sources to inform practice and to provide an understanding of what is known about the risk factors of and the interventions for adolescent repeat pregnancy. METHODS A scoping review was undertaken using the Arksey and O'Malley framework. An electronic search was conducted using PubMed, Medline, Science Direct, Ebscohost, Sage and Wiley Online and Google Scholar. RESULTS The search identified 3032 citations. After a review of the full text articles, 26 articles met the inclusion criteria. Risk factors pertaining to adolescent repeat pregnancy are categorised according to individual factors, partner relationship factors, family factors, peer factors, and social and community factors. Interventions to reduce adolescent repeat pregnancy have been largely influenced by the ecological framework. Across studies, adolescent mothers who received medical, psychosocial, educational, and family planning support experienced lower rates of repeat pregnancy. CONCLUSION A single 'one-size-fits-all' intervention for adolescent repeat pregnancy prevention is unlikely as different strategies were employed by the intervention programmes in this scoping review.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, South Africa, Discipline of Public Health, University of KwaZulu-Natal.
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27
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Xavier C, Benoit A, Brown HK. Teenage pregnancy and mental health beyond the postpartum period: a systematic review. J Epidemiol Community Health 2018; 72:451-457. [DOI: 10.1136/jech-2017-209923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/16/2022]
Abstract
BackgroundTeenage mothers are at increased risk for adverse social outcomes and short-term health problems, but long-term impacts on mental health are poorly understood. The aims of our systematic review were to determine the association between teenage pregnancy and mental health beyond the postpartum period, critically appraise the literature’s quality and guide future research.MethodsWe systematically searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus and Web of Science from inception to June 2017 for peer-reviewed articles written in English or French. Data were collected using a modified Cochrane Data Extraction Form. Study quality was assessed using the Effective Public Health Practice Project critical appraisal tool. Heterogeneity of studies permitted only a qualitative synthesis.ResultsNine quantitative studies comprising the results from analyses of 11 cohorts met our criteria and were rated as strong (n=5), moderate (n=2) or weak (n=2). Three cohorts found a statistically significant association between teenage pregnancy and poor long-term mental health after adjustment, three found a statistically significant association before but not after adjustment and five did not find a statistically significant association. Studies observed varying degrees of attenuation after considering social context. Studies with statistically significant findings tended to comprise earlier cohorts, with outcomes measured at older ages.ConclusionsThe association between teenage pregnancy and mental health beyond the postpartum period remains unclear. Future studies should employ age–period–cohort frameworks to disentangle effects of normative patterns and stress accumulation. Social factors are important in determining long-term mental health of teenage mothers and should be prioritised in prevention and intervention strategies.
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Exploring young mothers' experiences with postpartum contraception in Ottawa: results from a multimethods qualitative study. Contraception 2018; 97:434-438. [PMID: 29326036 DOI: 10.1016/j.contraception.2017.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Postpartum contraception plays a significant role in reducing subsequent pregnancy. However, young mothers in Ottawa, the capital of Canada, face various barriers when trying to access contraception after delivery. Through this project, we aimed to explore these barriers and understand the decision-making processes of young mothers surrounding postpartum contraception. STUDY DESIGN We conducted 10 semistructured in-depth interviews with young mothers living in Ottawa who had experienced a subsequent pregnancy within 24months of their first childbirth. In addition, we interviewed 10 key informants who work with teenage mothers. We audio-recorded and transcribed all interviews and analyzed them using inductive and deductive techniques. We used ATLAS.ti software to manage our data. RESULTS Both young mothers and key informants report that teen mothers in Ottawa often do not use postpartum contraception or inconsistently use their chosen contraceptive method. Many factors, including cost, personal beliefs, personal priorities and knowledge, influence young mothers' decision making surrounding contraception. CONCLUSIONS Our study suggests that when young mothers do not use postpartum contraception, the reasons are complex; for some, this is a choice, and for others, this is the result of systems-level, service delivery and information barriers. Supporting policies to ensure that a full range of contraceptive methods are available and affordable and developing educational programs in Ottawa that are sex-positive and nonjudgmental appear warranted. IMPLICATIONS Ensuring that a full method mix, including contraceptive implants, is available to and affordable for young mothers in Ottawa could meet significant needs. Addressing existing systems-level, service delivery and information barriers through supporting evidence-based policies and sex-positive and nonjudgmental educational programs appears warranted.
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Wilson D, Gross D, Hodgkinson S, Deater‐Deckard K. Association of teen mothers' and grandmothers' parenting capacities with child development: A study protocol. Res Nurs Health 2017; 40:512-518. [PMID: 29130503 PMCID: PMC5690830 DOI: 10.1002/nur.21839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/29/2017] [Indexed: 11/27/2022]
Abstract
Children born to teen mothers may experience less responsive and supportive parenting and are at heightened risk for a range of social, developmental, and health issues. There is literature to support the positive impact of grandmothers on teen parents and their children. However, what if the teen's mother is also limited in her parenting capacities? How do parenting capacities across these two generations of mothers affect the developing child? In this ongoing study we are examining two important aspects of parenting capacities, attachment quality and executive functioning, in teen mothers (TM) and their biological, co- residing mothers or grandmothers (GM or GGM). Both are essential components of effective parenting, but little is known about their impact on young children's development when raised by two generations of parents. In a cross- sectional, descriptive design, a convenience sample of 50 TM/GM dyads with children 1 to 3 years old is being recruited from two urban teen-tot clinics. Participants complete a paper-and-pencil measure of attachment quality and a computerized measure of multiple aspects of executive function (working memory, inhibitory control, cognitive flexibility). A standardized maternal report measure is used to assess child developmental status. The biggest challenges of the study thus far include recruitment and transience of the study population. Progress to date and experiences from recruitment and data collection are discussed, as well as successful strategies to address challenges.
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Affiliation(s)
- Damali Wilson
- Johns Hopkins University School of NursingBaltimoreMaryland
| | - Deborah Gross
- Johns Hopkins University School of NursingBaltimoreMaryland
| | - Stacy Hodgkinson
- Generations Program, Children's National Health SystemWashington, DC
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Maravilla JC, Betts KS, Couto e Cruz C, Alati R. Factors influencing repeated teenage pregnancy: a review and meta-analysis. Am J Obstet Gynecol 2017; 217:527-545.e31. [PMID: 28433733 DOI: 10.1016/j.ajog.2017.04.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus. DATA SOURCES We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews. STUDY ELIGIBILITY CRITERIA Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention. STUDY APPRAISAL AND SYNTHESIS METHODS We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity. RESULTS Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14-1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08-2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk. CONCLUSION Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings.
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Marcell AV, Burstein GR, Braverman P, Adelman W, Alderman E, Breuner C, Hornberger L, Levine D. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics 2017; 140:peds.2017-2858. [PMID: 29061870 DOI: 10.1542/peds.2017-2858] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.
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Affiliation(s)
- Arik V. Marcell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine and
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
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Nolan S, Hendricks J, Williamson M, Ferguson S. Using narrative inquiry to listen to the voices of adolescent mothers in relation to their use of social networking sites (SNS). J Adv Nurs 2017; 74:743-751. [PMID: 28910502 DOI: 10.1111/jan.13458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022]
Abstract
AIM This article presents a discussion highlighting the relevance and strengths of using narrative inquiry to explore experiences of social networking site (SNS) use by adolescent mothers. BACKGROUND Narrative inquiry as a method reveals truths about holistic human experience. Knowledge gleaned from personal narratives informs nursing knowledge and clinical practice. This approach gives voice to adolescent mothers in relation to their experiences with SNS as a means of providing social support. DESIGN Discussion paper. DATA SOURCES This paper draws and reflects on the author's experiences using narrative inquiry and is supported by literature and theory. The following databases were searched: CINAHL, Cochrane Library, Medline, Scopus, ERIC, ProQuest, PsychINFO, Web of Science and Health Collection (Informit). Key terms and Boolean search operators were used to broaden the search criteria. Search terms included: adolescent mother, teenage mother, "social networking sites", online, social media, Facebook, social support, social capital and information. Dates for the search were limited to January 1995-June 2017. IMPLICATIONS FOR PRACTICE/RESEARCH Narrative research inherently values the individual "story" of experience. This approach facilitates rapport building and methodological flexibility with an often difficult to engage sample group, adolescents. CONCLUSION Narrative inquiry reveals a deep level of insight into social networking site use by adolescent mothers. The flexibility afforded by use of a narrative approach allows for fluidity and reflexivity in the research process.
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Affiliation(s)
- Samantha Nolan
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Joyce Hendricks
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Moira Williamson
- School of Nursing, Midwifery & Social Sciences, CQ University, Brisbane, QLD, Australia
| | - Sally Ferguson
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Lee JO, Gilchrist LD, Beadnell BA, Lohr MJ, Yuan C, Hartigan LA, Morrison DM. Assessing Variations in Developmental Outcomes Among Teenage Offspring of Teen Mothers: Maternal Life Course Correlates. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2017; 27:550-565. [PMID: 28776838 DOI: 10.1111/jora.12293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study investigated potential heterogeneity in development among offspring (age 17) of teen mothers and maternal life course as correlates of variation. Using latent class analysis, subgroups of developmental outcomes were identified. Maternal standing in two life course realms (i.e., socioeconomic and domestic) was considered as a potential explanation for heterogeneity in offspring's development. Offspring reported on measures assessing their psychological, academic, and behavioral development. Teen mothers reported on measures of life course realms. Three subgroups of developmental outcomes were identified: on track (52%), at risk (37%), and troubled (11%). Findings suggest that economic hardship and number of pregnancies among teen mothers distinguish developmental patterns among teenage offspring, whereas teen mothers' educational attainment and marital status do not.
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Fortier E, Foster AM. “It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, Canada. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Young mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa, explore young mothers’ subsequent pregnancy experiences, and identify how services could be improved in Canada’s capital. In 2016, we conducted in-depth interviews with 10 young mothers and semi-structured interviews with 10 key informants working with pregnant and parenting youth. We analyzed interviews for content and themes using a multi-phased, iterative process. Four major themes emerged: (1) young mothers often plan their pregnancies actively or passively; (2) violence before, during, and after pregnancy is common; (3) mental health and substance abuse issues shape pregnancy risk; and (4) becoming pregnant often serves as a source of motivation for young mothers. Our results further indicate that young mothers have difficulty finding youth-friendly, non-judgmental support services and that integrated, multidisciplinary services offering individually tailored support and building on women’s strengths will likely be more successful in helping young mothers prevent subsequent pregnancies. Increasing awareness about existing services and supporting efforts that approach teen pregnancy comprehensively and holistically appear warranted.
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Affiliation(s)
- Elyse Fortier
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient. Pediatrics 2017; 140:peds.2017-2273. [PMID: 28827383 DOI: 10.1542/peds.2017-2273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics policy statement "Options Counseling for the Pregnant Adolescent Patient" recommends the basic content of the pediatrician's counseling for an adolescent facing a new diagnosis of pregnancy. However, options counseling is just one aspect of what may be one of the more challenging scenarios in the pediatric office. Pediatricians must remain alert to the possibility of pregnancy among their adolescent female patients. When discovering symptoms suggestive of pregnancy, pediatricians must obtain a relevant history, perform diagnostic testing and properly interpret the results, and understand the significance of the results from the patient perspective and reveal them to the patient in a sensitive manner. If the patient is indeed pregnant, the pediatrician, in addition to providing comprehensive options counseling, may need to help recruit adult support for the patient and should offer continued assistance to the adolescent and her family after the office visit. All pediatricians should be aware of the legal aspects of adolescent reproductive care and the resources for pregnant adolescents in their communities. This clinical report presents a more comprehensive view of the evaluation and management of pregnancy in the adolescent patient and a context for options counseling.
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Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
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Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Options Counseling for the Pregnant Adolescent Patient. Pediatrics 2017; 140:peds.2017-2274. [PMID: 28827379 DOI: 10.1542/peds.2017-2274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Each year, more than 500 000 girls and young women younger than 20 years become pregnant. It is important for pediatricians to have the ability and the resources in their offices to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental pregnancy options counseling. Counseling includes an unbiased discussion of the adolescent's legal options to either continue or terminate her pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.
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Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
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Shah S, Bernstein J, Moore AM, Thompson G, Sohail S, Ford-Jones L, Vandermorris A. Three hundred babies born to underhoused mothers in Toronto-understanding the problem and how we can help. Paediatr Child Health 2017; 22:282-284. [PMID: 29479235 PMCID: PMC5804840 DOI: 10.1093/pch/pxx061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Little is known about pregnancy in underhoused women, possibly because the number of underhoused mothers with babies in Toronto has been significantly underestimated. Using a novel data collection method, it has been found that there are approximately 300 babies being born each year to underhoused women in Toronto. This finding has significant public health implications, as these women are at increased risk of multiple issues related to physical health, mental health, child protection, poverty and safety. This commentary presents a new data collection strategy, highlights the importance of accurate data collection and offers suggestions for supports for this over-looked population.
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Affiliation(s)
- Sonam Shah
- University of Toronto Faculty of Medicine, Toronto, Ontario
| | | | | | | | - Sadia Sohail
- The Hospital for Sick Children, Toronto, Ontario
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Hughes LP, Austin-Ketch T, Volpe EM, Campbell-Heider N. Identification and Treatment of Adolescents With Perinatal Anxiety and Depression. J Psychosoc Nurs Ment Health Serv 2017; 55:23-29. [PMID: 28585664 DOI: 10.3928/02793695-20170519-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
Abstract
Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.].
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Queiroz MVO, Menezes GMD, Silva TJP, Brasil EGM, Silva RMD. Pregnant teenagers' group: contributions to prenatal care. Rev Gaucha Enferm 2017. [PMID: 28640332 DOI: 10.1590/1983-1447.2016.esp.2016-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To describe changes in nurses' care following the implementation of a group of pregnant teenagers in prenatal care based on the expectations and experiences of pregnant teenagers. Method Qualitative and descriptive study conducted from February to November 2013 at a Primary Care Unit in Fortaleza, Ceará, Brazil, through focus groups with 16 adolescents from the group of pregnant women in the second or third trimester of pregnancy. The analysis identified central ideas and units of meanings that formed the categories. Results The strategy of a group of pregnant teenagers, which provides a space for coexistence and the establishment of ties encourages these individuals to talk about their needs, re-signifying their ties. Educational strategies to promote self-care of pregnant teenagers and care for their babies involve the sharing of experiences, doubts and beliefs. Conclusion Considerations and suggestions of the adolescents contributed to guide nurses' practice and provide a strategic space of care and support for pregnant adolescents in primary care.
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Tabet M, Jakhar S, Williams CA, Rawat U, Hailegiorgis YD, Flick LH, Chang JJ. Racial/Ethnic Differences in Correlates of Spontaneous and Medically-Indicated Late Preterm Births among Adolescents. J Pediatr Adolesc Gynecol 2017; 30:63-70. [PMID: 27543000 DOI: 10.1016/j.jpag.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/03/2016] [Accepted: 08/06/2016] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To investigate the racial/ethnic differences in the correlates of spontaneous and medically-indicated late preterm birth (LPTB), defined as deliveries between 34 0/7 and 36 6/7 weeks gestation, among US adolescents. DESIGN Population-based, retrospective cohort study. SETTING Births in the United States to adolescents in 2012. PARTICIPANTS Adolescents (younger than 20 years; n = 171,573) who delivered nonanomalous singleton first births between 34 and 44 weeks of gestation. INTERVENTIONS AND MAIN OUTCOME MEASURES Bivariate and multivariable logistic regression were used to evaluate the associations between maternal risk factors and spontaneous and medically-indicated LPTB, stratified according to maternal race/ethnicity. RESULTS Risk factors for spontaneous LPTB included single marital status among Asian adolescents; no insurance coverage among whites, Asian, and Hispanic adolescents; inadequate prenatal care among all racial/ethnic groups except American Indian, and adequate plus prenatal care among all races/ethnicities; prenatal smoking among whites and black adolescents; insufficient gestational weight gain among all racial/ethnic groups except American Indian; and prepregnancy underweight among white, black, and Hispanic adolescents. Risk factors for medically-indicated LPTB included inadequate prenatal care among white, black, and Hispanic adolescents, and adequate plus prenatal care among all racial/ethnic groups except Asian; insufficient gestational weight gain among white, black, and Hispanic adolescents; and prepregnancy overweight and obesity among white, black, and Hispanic adolescents. CONCLUSION Our results show racial/ethnic differences in the correlates of spontaneous and medically-indicated LPTB among US adolescents and support the need for risk-specific interventions among different racial/ethnic groups.
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Affiliation(s)
- M Tabet
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - S Jakhar
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - C A Williams
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - U Rawat
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Y D Hailegiorgis
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - L H Flick
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - J J Chang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri.
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Tabet M, Flick LH, Cook CA, Xian H, Chang JJ. Age at First Birth and Psychiatric Disorders in Low-Income Pregnant Women. J Womens Health (Larchmt) 2016; 25:810-7. [PMID: 27248210 PMCID: PMC6037188 DOI: 10.1089/jwh.2015.5236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young maternal age at first birth has been associated with poor mental health. However, few studies directly compared the prevalence of psychiatric disorders among adolescent versus adult mothers at first birth using a comprehensive diagnostic tool. This study examined the association between age at first birth and 22 current and lifetime psychiatric disorders in a cohort of low-income pregnant women. METHODS The sample consisted of 744 low-income currently pregnant women who were Medicaid-eligible and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Saint Louis City and 5 rural counties in Southeastern Missouri. Current (previous 12 months) and lifetime psychiatric disorders were assessed using the Diagnostic Interview Schedule IV (DIS-IV). Logistic regression analyses tested the association between women's age at first birth and psychiatric disorders, controlling for potential confounders, including relative poverty. RESULTS When adjusting for confounders, mothers giving birth in their teens had 2.5 times the odds of having a lifetime behavior disorder (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.35-5.24) and current posttraumatic stress disorder (PTSD) (OR 2.54, 95% CI 1.38-4.70) and almost twice the odds of having at least one anxiety disorder compared to older women at first birth (OR 1.78, 95% CI 1.10-2.85). CONCLUSION Low-income women who have their first birth in adolescence have higher odds of psychiatric disorders and should be the target of psychiatric screening during their pregnancy. Mothers beginning childbearing before age 19 should be screened during pregnancy for anxiety disorders, including PTSD, and behavior disorders.
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Louise H. Flick
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Cynthia A.L. Cook
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Hong Xian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Jen Jen Chang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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Ngui EM, Greer DM, Bridgewater FD, Salm Ward TC, Cisler RA. Trends and Progress in Reducing Teen Birth Rates and the Persisting Challenge of Eliminating Racial/Ethnic Disparities. J Racial Ethn Health Disparities 2016; 4:615-622. [PMID: 27440119 DOI: 10.1007/s40615-016-0265-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/14/2016] [Accepted: 07/05/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE We examined progress made by the Milwaukee community toward achieving the Milwaukee Teen Pregnancy Prevention Initiative's aggressive 2008 goal of reducing the teen birth rate to 30 live births/1000 females aged 15-17 years by 2015. We further examined differential teen birth rates in disparate racial and ethnic groups. METHOD We analyzed teen birth count data from the Wisconsin Interactive Statistics on Health system and demographic data from the US Census Bureau. We computed annual 2003-2014 teen birth rates for the city and four racial/ethnic groups within the city (white non-Hispanic, black non-Hispanic, Hispanic/Latina, Asian non-Hispanic). To compare birth rates from before (2003-2008) and after (2009-2014) goal setting, we used a single-system design to employ two time series analysis approaches, celeration line, and three standard deviation (3SD) bands. RESULTS Milwaukee's teen birth rate dropped 54 % from 54.3 in 2003 to 23.7 births/1000 females in 2014, surpassing the goal of 30 births/1000 females 3 years ahead of schedule. Rate reduction following goal setting was statistically significant, as five of the six post-goal data points were located below the celeration line and points for six consecutive years (2010-2014) fell below the 3SD band. All racial/ethnic groups demonstrated significant reductions through at least one of the two time series approaches. The gap between white and both black and Hispanic/Latina teens widened. CONCLUSION Significant reduction has occurred in the overall teen birth rate of Milwaukee. Achieving an aggressive reduction in teen births highlights the importance of collaborative community partnerships in setting and tracking public health goals.
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Affiliation(s)
- Emmanuel M Ngui
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA. .,Center for Urban Population Health, Milwaukee, WI, USA.
| | - Danielle M Greer
- Center for Urban Population Health, Milwaukee, WI, USA.,Aurora Health Care, Inc., Milwaukee, WI, USA
| | - Farrin D Bridgewater
- Center for Urban Population Health, Milwaukee, WI, USA.,College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA
| | - Trina C Salm Ward
- Center for Urban Population Health, Milwaukee, WI, USA.,Health Promotion & Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Ron A Cisler
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA.,Center for Urban Population Health, Milwaukee, WI, USA.,Aurora Health Care, Inc., Milwaukee, WI, USA.,College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA.,School of Medicine and Public Health, University of Wisconsin, Madison, USA
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Thompson G. Répondre aux besoins des parents adolescents et de leurs enfants. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.5.273a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RésuméLes parents adolescents et leurs enfants sont deux patients d’âge pédiatrique pour les dispensateurs de soins, et ont chacun leurs propres besoins de santé. Les jeunes parents et leur enfant peuvent être à risque de voir leur santé en souffrir, non pas directement à cause de l’âge de la mère, mais de la pauvreté et des autres inégalités en matière de déterminants sociaux de la santé. Pour bien évaluer les besoins de santé de l’enfant et de sa mère, il faut privilégier une approche objective, des outils de dépistage appropriés et des questions ouvertes qui tiennent compte à la fois de la prévention et des problèmes de santé aigus. Il est possible d’anticiper les besoins coexistants de cette dyade, car ils portent sur la croissance et le développement, la santé mentale du nourrisson et de l’adolescente, l’alimentation et la sécurité alimentaire, la sécurité, les relations, les pratiques parentales, l’éducation, la santé sexuelle et l’aide à trouver du soutien et des ressources. Les dispensateurs de soins qui comprennent le développement des adolescentes et intègrent des éléments du « foyer médical » axé sur les patients à leur pratique sont les mieux placés pour favoriser des résultats de santé positifs, tant pour la mère que pour son nourrisson.
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Abstract
Adolescent parents and their children present to health care practitioners as two paediatric patients, each with unique health care needs. Young parents and their children may be at risk for negative health outcomes, not directly as a consequence of maternal age but because of poverty and other inequities in the social determinants of health. The health needs of child and mother are best assessed using a nonjudgmental approach, appropriate screening tools and open questions that address both preventative and acute health issues. The dyad's coexisting needs may be anticipated as they relate to growth and development, infant and adolescent mental health, nutrition and food security, safety, relationships, parenting, education, sexual health and the facilitation of supports and resources. Care providers who understand adolescent development and integrate medical home elements of a patient-centred 'medical home' into their practices are ideally positioned to facilitate positive health outcomes for both mother and child.
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Harrison ME, Clarkin C, Worth K, Norris ML, Rohde K. But We’re Not Like the People on TV: A Qualitative Examination of How Media Messages are Perceived by Pregnant and Parenting Youth. Matern Child Health J 2015; 20:684-92. [DOI: 10.1007/s10995-015-1868-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Umaña-Taylor AJ, Updegraff KA, Jahromi LB, Zeiders KH. Trajectories of Ethnic-Racial Identity and Autonomy Among Mexican-Origin Adolescent Mothers in the United States. Child Dev 2015; 86:2034-50. [PMID: 26450526 DOI: 10.1111/cdev.12444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined trajectories of ethnic-racial identity (ERI) and autonomy development among Mexican-origin adolescent females in the United States (N = 181; M(age) at Wave 1 = 16.80 years, SD = 1.00) as they transitioned through the first 5 years of parenthood. Trajectories of ERI and autonomy also were examined in relation to psychosocial functioning. Unconditional latent growth models indicated significant growth in autonomy, ERI resolution, and ERI affirmation from middle to late adolescence. Conditional latent growth models indicated that autonomy and ERI exploration growth trajectories were positively associated with psychosocial adjustment. Although adolescent mothers are experiencing transitions that are not normative during adolescence, they also engage in normative developmental processes, and their engagement in such processes is linked with better adjustment.
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Trotman G, Chhatre G, Darolia R, Tefera E, Damle L, Gomez-Lobo V. The Effect of Centering Pregnancy versus Traditional Prenatal Care Models on Improved Adolescent Health Behaviors in the Perinatal Period. J Pediatr Adolesc Gynecol 2015; 28:395-401. [PMID: 26233287 DOI: 10.1016/j.jpag.2014.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 11/25/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE To determine if the CenteringPregnancy model of prenatal care improves maternal health behaviors in adolescent pregnancy. DESIGN We conducted a retrospective chart review comparing 150 pregnant adolescents who received prenatal care between 2008 to 2012 with CenteringPregnancy to those receiving care in traditional prenatal care models with either multiprovider or single-provider visits. Outcome measures included weight gain during pregnancy, compliance to prenatal care appointments, infant feeding method, postpartum follow up and contraceptive use postpartum. A χ(2) analysis was used to compare outcomes between the 3 groups at a 2-tailed α of .05. RESULTS Fifty individuals were evaluated in each group. Adolescents in the CenteringPregnancy group were more likely to comply with prenatal and postpartum visits and to meet the 2009 Institute of Medicine gestational weight guidelines for weight gain in pregnancy than were adolescents in either multiprovider (62.0% vs 38.0%, P = .02) or single-provider (62.0% vs 38.0%, P = .02) groups. The CenteringPregnancy group was also more likely to solely breastfeed compared with adolescents in the multiprovider group (40.0% vs 20.0%, P = .03) and include breastfeeding in addition to bottle-feeding compared with both multiprovider (32.0% vs 14.0%, P = .03) and single-provider (32.0% vs 12.0%, P = .03) patient groups. Additionally, the CenteringPregnancy group had increased uptake of long-acting reversible contraception and were less likely to suffer from postpartum depression. CONCLUSIONS CenteringPregnancy Prenatal Care program aids in compliance to prenatal visits, appropriate weight gain, increased uptake of highly effective contraception, and breastfeeding among adolescent mothers.
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Affiliation(s)
- Gylynthia Trotman
- MedStar Washington Hospital Center, Department of Women and Infants' Services, Washington, DC.
| | - Gayatri Chhatre
- MedStar Washington Hospital Center, Department of Women and Infants' Services, Washington, DC
| | - Renuka Darolia
- MedStar Washington Hospital Center, Department of Women and Infants' Services, Washington, DC
| | | | - Lauren Damle
- MedStar Washington Hospital Center, Department of Women and Infants' Services, Washington, DC
| | - Veronica Gomez-Lobo
- MedStar Washington Hospital Center, Department of Women and Infants' Services, Washington, DC
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Grossman JM, Tracy AJ, Richer AM, Erkut S. Comparing Sexuality Communication Among Offspring of Teen Parents and Adult Parents: a Different Role for Extended Family. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2015; 12:137-144. [PMID: 27499816 PMCID: PMC4972327 DOI: 10.1007/s13178-015-0183-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This brief report examined teenagers' sexuality communication with their parents and extended families. It compared who teens of early parents (those who had children when they were adolescents) and teens of later parents (those who were adults when they had children) talk to about sex. Eighth grade students (N=1281) in 24 schools completed survey items about their communication about sex. Structural equation modeling was used to predict communication profiles, while adjusting for the nesting of students within schools. After controlling for teens' age, gender, race/ethnicity, grades, parent/guardian closeness, and social desirability of survey responses, as well as family status and median family income, results showed that teens of early (teen) parents were more likely than teens of later (adult) parents to talk with both parents and extended family about sex and less likely than later parents to talk only with parents. These findings indicate that realities of teen sexuality communication for teens of early parents may extend beyond a parent-teen model to include extended family. Extended family involvement in educational outreach is a potential untapped resource to support sexual health for teens of early parents.
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Affiliation(s)
- Jennifer M. Grossman
- Cheever House/Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA 02481, USA
| | - Allison J. Tracy
- Cheever House/Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA 02481, USA
| | - Amanda M. Richer
- Cheever House/Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA 02481, USA
| | - Sumru Erkut
- Cheever House/Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA 02481, USA
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Rosenberg M, Pettifor A, Miller WC, Thirumurthy H, Emch M, Afolabi SA, Kahn K, Collinson M, Tollman S. Relationship between school dropout and teen pregnancy among rural South African young women. Int J Epidemiol 2015; 44:928-36. [PMID: 25716986 DOI: 10.1093/ije/dyv007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa. METHODS Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday. RESULTS School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)].This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)]. CONCLUSIONS Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Center for Population and Development Studies, Harvard University, Cambridge, MA USA,
| | - Audrey Pettifor
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - William C Miller
- Department of Epidemiology, Division of Infectious Diseases in the Department of Medicine, University of North Carolina-Chapel Hill, NC, USA
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Health Policy and Management
| | - Michael Emch
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Geography, and
| | - Sulaimon A Afolabi
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Demography and Population Studies, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
| | - Mark Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
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