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Connor KA, Spin P, Smith BM, Marshall BR, Calderon GV, Prichett L, Jones VC, Connor R, Cheng TL, Klein LM, Johnson SB. Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students. Acad Pediatr 2024:S1876-2859(24)00116-5. [PMID: 38588789 DOI: 10.1016/j.acap.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE School-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism. METHODS Participants were students enrolled in 2 co-located Title I schools from 2015-19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends. RESULTS More than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]). CONCLUSIONS SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.
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Affiliation(s)
- Katherine A Connor
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Paul Spin
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, EVERSANA (P Spin), Milwaukee, Wis.
| | - Brandon M Smith
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Beth R Marshall
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Department of Population, Family, and Reproductive Health (BR Marshall), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Gabriela V Calderon
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Laura Prichett
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Vanya C Jones
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Department of Health, Behavior, and Society (VC Jones), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Ryan Connor
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Tina L Cheng
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Pediatrics (TL Cheng), University of Cincinnati, Ohio.
| | - Lauren M Klein
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Sara B Johnson
- Johns Hopkins University School of Medicine Division of General Pediatrics, Department of Pediatrics, Ruth and Norman Rales Center for the Integration of Health and Education (KA Connor, P Spin, BM Smith, BR Marshall, GV Calderon, L Prichett, VC Jones, R Connor, TL Cheng, LM Klein, and SB Johnson), Baltimore, Md; Division of General Pediatrics (KA Connor, P Spin, BM Smith, GV Calderon, L Prichett, R Connor, TL Cheng, LM Klein, and SB Johnson), Johns Hopkins University School of Medicine, Baltimore, Md.
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Itriyeva K. Improving Health Equity and Outcomes for Children and Adolescents: The Role of School-Based Health Centers (SBHCs). Curr Probl Pediatr Adolesc Health Care 2024:101582. [PMID: 38490819 DOI: 10.1016/j.cppeds.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
School-based health centers (SBHCs) provide a critical point of access to youth in low-resource communities. By providing a combination of primary care, reproductive health, mental health, vision, dental, and nutrition services, SBHCs improve the health, wellbeing, and academic achievement of the students they serve. SBHCs operate in collaboration with schools and community primary care providers to optimize the management of chronic health conditions and other health concerns that may result in suboptimal scholastic achievement and other quality of life measures. Conveniently located in or near school buildings and providing affordable, child- and adolescent-focused care, SBHCs reduce barriers to youth accessing high quality health care. SBHCs provide essential preventive care services such as comprehensive physical examinations and immunizations to students without a primary care provider, assist in the management of chronic health conditions such as asthma, and provide reproductive and sexual health services such as the provision of contraceptives, screening and treatment for sexually transmitted infections (STIs), and management of pregnancy. Additionally, some SBHCs provide vision screenings, dental care, and nutrition counseling to students who may not otherwise access these services. SBHCs have been demonstrated to be a cost-effective model of health care delivery, reducing both health care and societal costs related to illness, disability, and lost productivity.
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Affiliation(s)
- Khalida Itriyeva
- Cohen Children's Medical Center, Division of Adolescent Medicine, Northwell, New Hyde Park, NY.
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Hirose N, Sanmei C, Okamoto M, Madeni FE, Madeni N, Teshima A, Ando Y, Takahama K, Yoshikawa M, Kunimoto Y, Shimpuku Y. Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: a cross-sectional study. Reprod Health 2023; 20:44. [PMID: 36918903 PMCID: PMC10012580 DOI: 10.1186/s12978-023-01583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is a serious reproductive health problem in Tanzania. However, the risk factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy in Tanzanian adolescents remain unexplored. METHODS We collected baseline characteristics and information on attitudes and behaviors of reproductive health from 4161 Tanzanian adolescents in all 54 primary and secondary schools in the Korogwe district. We applied mixed effect multiple regression analyses stratified by sex to find the factors related to reproductive health attitudes and behaviors toward pregnancy. RESULTS In female students, regarding the attitudes of reproductive health, higher age, hope for marriage in the future, a talk with a parent about sex or pregnancy, and a higher hope score were significantly associated with a lower score. For the behaviors of reproductive health, higher age, a talk with a parent about sex or pregnancy, time to talk with a parent about daily life, and a higher hope score were significantly associated with a lower score. In male students, regarding the attitudes of reproductive health, a higher hope score was significantly associated with a lower score. For the behaviors of reproductive health, higher age, time to talk with a parent about daily life, and a higher hope score was significantly associated with a lower score. CONCLUSIONS The heterogeneous factor-outcomes association between female and male students suggested that sex-specialized interventions may be required to change their risky attitudes or behaviors of reproductive health. Although we cannot conclude as points of intervention, our study suggested that it may be practical to improve parent-adolescents communication about sex or reproductive health and change adolescents' views of pregnancy or marriage for gaining financial or social status.
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Affiliation(s)
- Naoki Hirose
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan.
| | - Chen Sanmei
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | | | | | | | - Ayaka Teshima
- Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Yasunobu Ando
- National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | | | | | - Yu Kunimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8553, Japan
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Jochim J, Meinck F, Toska E, Roberts K, Wittesaele C, Langwenya N, Cluver L. Who goes back to school after birth? Factors associated with postpartum school return among adolescent mothers in the Eastern Cape, South Africa. Glob Public Health 2023; 18:2049846. [PMID: 35388739 DOI: 10.1080/17441692.2022.2049846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/19/2022] [Indexed: 11/04/2022]
Abstract
Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high . This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Optentia, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Elona Toska
- Department of Sociology, University of Cape Town, Cape Town, South Africa
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Kathryn Roberts
- Institute for Global Health, University College London, London, United Kingdom
| | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Melander K, Kortteisto T, Hermanson E, Kaltiala R, Mäki-Kokkila K, Kaila M, Kosola S. The perceptions of different professionals on school absenteeism and the role of school health care: A focus group study conducted in Finland. PLoS One 2022; 17:e0264259. [PMID: 35226678 PMCID: PMC8884500 DOI: 10.1371/journal.pone.0264259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose of the study School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. Materials and methods Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. Results Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. Conclusion Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.
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Affiliation(s)
| | | | - Elina Hermanson
- Pikkujätti Medical Center for Children and Youth, Helsinki, Finland
| | | | | | - Minna Kaila
- University of Helsinki /Public Health Medicine, Helsinki, Finland
| | - Silja Kosola
- Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Finland
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Sobngwi-Tambekou JL, Tsague-Agnoux M, Fezeu LK, Ndonko F. Teenage childbearing and school dropout in a sample of 18,791 single mothers in Cameroon. Reprod Health 2022; 19:10. [PMID: 35033103 PMCID: PMC8761331 DOI: 10.1186/s12978-021-01323-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Adolescent childbearing increases the risk of adverse health and social consequences including school dropout (SDO). However, it remains unclear why some teenage mothers drop out of school and others do not, especially in sub-Saharan Africa settings. We aimed to investigate the background and behavioral characteristics of single mothers, associated with school dropout in a sample of 18,791 Cameroonian girls, who had their first child during adolescence. Methods We used data from a national registry of single mothers, collected during the years 2005–2008 and 2010–2011. Both bivariate analysis and logistic binary regression models were used to explore the relationship between adolescence motherhood and SDO controlling for a range of socio-economic, family, sexual and health seeking behavior characteristics. Results Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. The multivariable regression model showed that SDO was more common in those who were evicted from their parental home (aOR: 1.85; 95% CI: 1.69–2.04), those who declared having other single mothers in their family (aOR: 1.16; 95% CI 1.08–1.25) and in mothers who had their first child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout. Conclusions Strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies. There is compelling, worldwide evidence that pregnancy and birth during teenage years are significant contributors to high school dropout rates, especially in developing countries. Research has also shown that education continuity of teenage mothers can lessen the long term negative social consequences of teenage pregnancies and childbearing. In this study, we investigated the factors associated with school dropout in a sample of Cameroonian teenage mothers. The information collected included socio-economic, family, sexual characteristics, and health-seeking behavior. Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. School dropout was more common in those who were evicted from their parental home, those who declared having other single mothers in their family and in mothers who had their 1st child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout. In conclusion, strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies.
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Affiliation(s)
- Joëlle L Sobngwi-Tambekou
- RSD Institute, Rue de l'Université, Po Box 7535, Yaoundé, Cameroon. .,Université Catholique d'Afrique Centrale (UCAC), Yaoundé, Cameroon. .,London School of Economics and Political Science, London, UK.
| | | | - Léopold K Fezeu
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), 93017, Bobigny, France
| | - Flavien Ndonko
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Yaoundé, Cameroon
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Harper J, Hopper D, Keating B, Harding J. NM GRADS: Lessons Learned from Implementing a School-Based Program for Young Parents Across New Mexico. Matern Child Health J 2020; 24:163-170. [PMID: 32860586 PMCID: PMC7497359 DOI: 10.1007/s10995-020-02993-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The New Mexico Graduation Reality and Dual-role Skills (GRADS) program provides services for expectant and parenting students at high schools. The GRADS program has operated since 1989, serving more than 17,000 youth. This study summarizes the GRADS program model and program administrators' lessons learned from implementing this comprehensive, large-scale program. DESCRIPTION The GRADS program is a multicomponent intervention that can include a classroom intervention, case management, linkages to child care and health care, and support for young fathers. The program aims to support expectant and parenting youth in finishing high school, delaying a repeat pregnancy, promoting health outcomes for their children, and preparing for college and career. This study presents program administrators' lessons learned to increase understanding of how to implement a statewide program to support expectant and parenting students. ASSESSMENT During the 2010-2017 school years, the GRADS program operated in 26-31 sites each year, serving a total of 2691 parenting youth. Program administrators identified lessons learned from implementing the GRADS program during that period of expansion, including allowing variation across sites based on resources and needs, providing centralized implementation support, fostering buy-in from school and district leaders, and collecting consistent data to better understand participant outcomes. CONCLUSIONS Although not based on a rigorous impact or implementation study, this article provides lessons learned from a statewide, school-based program that may be a promising way to serve a large number of expectant and parenting youth and help them overcome challenges for completing high school.
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Affiliation(s)
- Jessica Harper
- New Mexico Public Education Department, 120 South Federal Place, Room 206, Santa Fe, NM, 87501, USA.
| | - Dean Hopper
- New Mexico Public Education Department, 120 South Federal Place, Room 206, Santa Fe, NM, 87501, USA
| | - Betsy Keating
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543, USA
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Laurenzi CA, Gordon S, Abrahams N, du Toit S, Bradshaw M, Brand A, Melendez-Torres GJ, Tomlinson M, Ross DA, Servili C, Carvajal-Aguirre L, Lai J, Dua T, Fleischmann A, Skeen S. Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review. Reprod Health 2020; 17:65. [PMID: 32410710 PMCID: PMC7227359 DOI: 10.1186/s12978-020-00913-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/24/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents. METHODS We used the standardized systematic review methodology based on the process outlined in the World Health Organization's Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence. RESULTS We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries. CONCLUSION Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Nina Abrahams
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Stefani du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Melissa Bradshaw
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Amanda Brand
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - David A Ross
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Liliana Carvajal-Aguirre
- Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring, UNICEF Headquarters, New York, USA
| | - Joanna Lai
- Maternal, Newborn and Adolescent Health Unit, Health Section, UNICEF Headquarters, New York, USA
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alexandra Fleischmann
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
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The multigenerational effects of adolescent motherhood on school readiness: A population-based retrospective cohort study. PLoS One 2019; 14:e0211284. [PMID: 30726256 PMCID: PMC6364914 DOI: 10.1371/journal.pone.0211284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022] Open
Abstract
Background Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by testing whether the grandchildren of adolescent mothers also have lower school readiness scores than their peers; we further assessed if this relationship was moderated by whether the child’s mother was an adolescent mother. Methods We used population-based data to conduct the retrospective cohort study of children born in Manitoba, Canada, 2000–2009, whose mothers were born 1979–1997 (n = 11,326). Overall school readiness and readiness on five domains of development were analyzed using logistic regression models. Results Compared with children whose mothers and grandmothers were both ≥ 20 at the birth of their first child, those born to grandmothers who were < 20 and mothers who were ≥ 20 years old at the birth of their first child had 39% greater odds of being not ready for school (95% CI: 1.22–1.60). Children whose grandmothers were ≥ 20 and mothers were < 20 at the birth of their first child had 25% greater odds of being not ready for school (95% CI: 1.11–1.41), and children born to grandmothers and mothers who were both <20 at the birth of their first child had 35% greater odds of being not ready for school (95% CI: 1.18–1.54). Conclusions These findings suggest a multigenerational effect of adolescent motherhood on school readiness.
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Allison MA, Attisha E, Lerner M, De Pinto CD, Beers NS, Gibson EJ, Gorski P, Kjolhede C, O’Leary SC, Schumacher H, Weiss-Harrison A. The Link Between School Attendance and Good Health. Pediatrics 2019; 143:peds.2018-3648. [PMID: 30835245 DOI: 10.1542/peds.2018-3648] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students' physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.
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Affiliation(s)
- Mandy A. Allison
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, and Children’s Hospital Colorado, Aurora, Colorado; and
| | - Elliott Attisha
- Detroit Public Schools Community District, Detroit, Michigan
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Reese BM, Halpern CT. Attachment to Conventional Institutions and Adolescent Rapid Repeat Pregnancy: A Longitudinal National Study Among Adolescents in the United States. Matern Child Health J 2017; 21:58-67. [PMID: 27475827 PMCID: PMC5233596 DOI: 10.1007/s10995-016-2093-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction There is limited research on rapid repeat pregnancies (RRP) among adolescents, especially using nationally representative samples. We examine distal factors-school, family, peers, and public/private religious ties-and their associations with RRP among adolescent mothers. Methods Guided by social development theory, we conducted multivariate logistic regression analyses, adjusted for sociodemographic characteristics, to examine associations between RRP and attachment to school, family, peers, and religion among 1158 female respondents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who reported at least one live birth before age 20. Results Attachments to conventional institutions were associated with lower likelihood of RRP. Adolescent mothers who had a stronger relationship with their parents had reduced odds of RRP (adjusted odds ratio [aOR] 0.83, 95 % CI 0.71-0.99). Increased odds of RRP were associated with anticipating fewer negative social consequences of sex (aOR 1.18, 95 % CI 1.02-1.35), never praying (versus praying daily; aOR 1.47, 95 % CI 1.10-1.96), and never participating in church-related youth activities (versus participating once a week; 1.04, 95 % CI 1.01-1.07). Discussion After an adolescent birth, social support from family, peers, and the community can benefit young mothers. Private aspects of religiosity may be especially important. Understanding the processes by which these distal factors are linked to the likelihood of RRP is needed to create multifaceted intervention programs that provide diverse methods of support customized to specific circumstances of adolescent mothers.
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Affiliation(s)
- Bianka M Reese
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, 206 West Franklin St., Rm 208, Chapel Hill, NC, 27516, USA.
| | - Carolyn T Halpern
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, 206 West Franklin St., Rm 208, Chapel Hill, NC, 27516, USA
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Abstract
OBJECTIVE To assess whether geographic access to family planning services is associated with a reduced female high school dropout rate. METHODS We conducted a retrospective cross-sectional study. We merged the location of Planned Parenthood and Title X clinics with microdata from the 2012-2013 American Community Surveys. The association between female high school dropout rates and local clinic access was assessed using nearest-neighbor matching estimation. Models included various covariates to account for sociodemographic differences across communities and male high school dropout rates to account for unmeasured community characteristics affecting educational outcomes. RESULTS Our sample included 284,910 16- to 22-year-old females. The presence of a Planned Parenthood clinic was associated with a decrease (4.08% compared with 4.83%; relative risk ratio 0.84, P<.001) in female high school dropout rates. This association was consistent across several model specifications. The presence of a Title X clinic was associated with a decrease (4.79% compared with 5.07%; relative risk ratio 0.94, P=.03) in female high school dropout rates, an association that did not remain significant across model specifications. CONCLUSION Local access to Planned Parenthood is associated with lower high school dropout rates in young women.
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Knopf JA, Finnie RKC, Peng Y, Hahn RA, Truman BI, Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC, Phyllis Jones C, Fullilove MT. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med 2016; 51:114-26. [PMID: 27320215 PMCID: PMC5759331 DOI: 10.1016/j.amepre.2016.01.009] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. EVIDENCE ACQUISITION A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. EVIDENCE SYNTHESIS Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. CONCLUSIONS Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.
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Affiliation(s)
- John A Knopf
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Yinan Peng
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Robert A Hahn
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
| | - Benedict I Truman
- Office of the Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia
| | | | - Veda C Johnson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | | | | | - Carles Muntaner
- University of Toronto, Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | | | - Camara Phyllis Jones
- Satcher Health Leadership Institute at the Morehouse School of Medicine, Atlanta, Georgia
| | - Mindy T Fullilove
- Columbia University Mailman School of Public Health, New York, New York
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14
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Shaw SY, Metge C, Taylor C, Chartier M, Charette C, Lix L, Santos R, Sarkar J, Nickel NC, Burland E, Chateau D, Katz A, Brownell M, Martens PJ. Teen clinics: missing the mark? Comparing pregnancy and sexually transmitted infections rates among enrolled and non-enrolled adolescents. Int J Equity Health 2016; 15:95. [PMID: 27328711 PMCID: PMC4915138 DOI: 10.1186/s12939-016-0386-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/16/2016] [Indexed: 11/17/2022] Open
Abstract
Background In Manitoba, Canada, school-based clinics providing sexual and reproductive health services for adolescents have been implemented to address high rates of sexually transmitted infections (STIs) and pregnancies. Methods The objectives of this population-based study were to compare pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school. Data were from the PATHS Data Resource held in the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy. Adolescents aged 14 to 19 between 2003 and 2009 were included in the study. Annualized rates of pregnancies and positive STI tests were estimated and Poisson regression models were used to test for differences in rates amongst the three groups. Results As a proportion, pregnancies among non-enrolled female adolescents accounted for 55 % of all pregnancies in this age group during the study period. Pregnancy rates were 2–3 times as high among non-enrolled female adolescents. Compared to adolescents enrolled in schools without school-based clinics, age-adjusted STI rates were 3.5 times (p < .001) higher in non-enrolled males and 2.3 times (p < .001) higher in non-enrolled females. Conclusions The highest rates for pregnancies and STIs were observed among non-enrolled adolescents. Although provision of reproductive and health services to in-school adolescents should remain a priority, program planning and design should consider optimal strategies to engage out of school youth. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0386-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Souradet Y Shaw
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Colleen Metge
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Catherine Charette
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Rob Santos
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.,Healthy Child Manitoba, Winnipeg, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
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Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health 2016; 58:3-10. [PMID: 26707224 PMCID: PMC4693147 DOI: 10.1016/j.jadohealth.2015.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Since the founding of the first school-based health centers (SBHCs) >45 years ago, researchers have attempted to measure their impact on child and adolescent physical and mental health and academic outcomes. A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales. A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York; School Based Health Centers, New York-Presbyterian Hospital, New York, New York
| | - Jennifer Heitel
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Kathryn Martin
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah A Fisher
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
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16
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Abstract
School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health.
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17
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Sámano R, Martínez-Rojano H, Godínez Martínez E, Sánchez Jiménez B, Villeda Rodríguez GP, Pérez Zamora J, Casanueva E. Effects of breastfeeding on weight loss and recovery of pregestational weight in adolescent and adult mothers. Food Nutr Bull 2013; 34:123-30. [PMID: 23964385 DOI: 10.1177/156482651303400201] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss. OBJECTIVE To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children. METHODS A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months. RESULTS Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 +/- 1,060 vs 6,096 +/- 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (-2.9 kg, 95% interquartile range, -5.7 to 0.8 kg, vs -1.8 kg 95% interquartile range -2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance (F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% (F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life. CONCLUSIONS EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.
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Affiliation(s)
- Reyna Sámano
- Instituto Nacional de Perinatología, Mexico City
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18
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Gentry QM, Nolte KM, Gonzalez A, Pearson M, Ivey S. "Going beyond the call of doula": a grounded theory analysis of the diverse roles community-based doulas play in the lives of pregnant and parenting adolescent mothers. J Perinat Educ 2013; 19:24-40. [PMID: 21886419 DOI: 10.1624/105812410x530910] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article presents some of the most salient qualitative results from a larger program evaluation of pregnant and parenting adolescents who participated in a community-based doula program. Using grounded theory analysis, seven problem-solving strategies emerged that doulas apply in helping pregnant and parenting adolescents navigate multiple social and health settings that often serve as barriers to positive maternal- and child-health outcomes. The ethnographic findings of this study suggest that the doulas provide valuable assistance to pregnant and parenting adolescents by addressing social-psychological issues and socio-economic disparities. "Diverse role-taking" results in doulas helping pregnant adolescents navigate more successfully through fragmented social and health service systems that are less supportive of low-income adolescents, who are often perceived to be draining scarce resources. The findings have implications for the roles of community-based doulas assigned to low-income adolescents of color seeking to overcome obstacles and attain better educational and economic opportunities.
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Affiliation(s)
- Quinn M Gentry
- QUINN M. GENTRY is a postdoctoral fellow at Johns Hopkins School of Public Health's Urban Health Institute and serves as a program evaluator for Messages of Empowerment Productions, LLC. KIM M. NOLTE is the vice-president of training and programs for The Georgia Campaign for Adolescent Pregnancy Prevention, Inc. AINKA GONZALEZ is an evaluation coordinator for Messages of Empowerment Productions, LLC. MAGAN PEARSON is an evaluation coordinator for Messages of Empowerment Productions, LLC. SYMEON IVEY is an assistant data manager for Messages of Empowerment Productions, LLC
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A Response to Intervention Model to Promote School Attendance and Decrease School Absenteeism. CHILD & YOUTH CARE FORUM 2013. [DOI: 10.1007/s10566-013-9222-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barnet B. Supporting adolescent mothers: a journey through policies, programs, and research. Am J Public Health 2012; 102:2201-3. [PMID: 23078502 DOI: 10.2105/ajph.2012.300936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lachance CR, Burrus BB, Scott AR. Building an evidence base to inform interventions for pregnant and parenting adolescents: a call for rigorous evaluation. Am J Public Health 2012; 102:1826-32. [PMID: 22897541 PMCID: PMC3490682 DOI: 10.2105/ajph.2012.300871] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2012] [Indexed: 11/04/2022]
Abstract
Adolescent parents and their children are at increased risk for adverse short- and long-term health and social outcomes. Effective interventions are needed to support these young families. We studied the evidence base and found a dearth of rigorously evaluated programs. Strategies from successful interventions are needed to inform both intervention design and policies affecting these adolescents. The lack of rigorous evaluations may be attributable to inadequate emphasis on and sufficient funding for evaluation, as well as to challenges encountered by program evaluators working with this population. More rigorous program evaluations are urgently needed to provide scientifically sound guidance for programming and policy decisions. Evaluation lessons learned have implications for other vulnerable populations.
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Affiliation(s)
- Christina R Lachance
- Office of Adolescent Pregnancy Programs, US Department of Health and Human Services, Rockville, MD 20852, USA.
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Fredriksen AM, Lyberg A, Severinsson E. Health supervision of young women during pregnancy and early motherhood: a Norwegian qualitative study. Nurs Health Sci 2012; 14:325-31. [PMID: 22950614 DOI: 10.1111/j.1442-2018.2012.00724.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes and interprets midwives' and public health nurses' perceptions of their experiences of caring for young women during pregnancy and early motherhood. A number of studies suggest that teenage pregnancy is associated with many adverse psychological, physical, social, and financial outcomes. Multistage focus group interviews were conducted with six professionals, and a qualitative content analysis was performed. The result of this descriptive and explorative study comprised one main theme, creating a trusting and committed relationship to support immature young women, characterized by two themes: searching for security and love in daily life and active involvement with "the children of their hearts". In summary, in order to support the young women, the informants used modeling as a strategy to achieve self-esteem, thus helping them to cope with daily life. Continuity of team supervision should be improved to enhance midwives' and public health nurses' professional roles.
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Affiliation(s)
- Anne Mari Fredriksen
- Centre for Women's, Family and Child Health, Vestfold University College, Tønsberg, Norway.
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23
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Padin MDFR, Silva RDSE, Mitsuhiro SS, Chalem E, Barros MM, Guinsburg R, Laranjeira R. Repeat pregnancies among adolescents in a tertiary hospital in Brazil. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.677139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Basch CE. Teen pregnancy and the achievement gap among urban minority youth. THE JOURNAL OF SCHOOL HEALTH 2011; 81:614-618. [PMID: 21923873 DOI: 10.1111/j.1746-1561.2011.00635.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To outline the prevalence and disparities of teen pregnancy among school-aged urban minority youth, causal pathways through which nonmarital teen births adversely affects academic achievement, and proven or promising approaches for schools to address this problem. METHODS Literature review. RESULTS In 2006, the birth rate among 15- to 17-year-old non-Hispanic Blacks (36.1 per 1000) was more than three times as high, and the birth rate among Hispanics (47.9 per 1000) was more than four times as high as the birth rate among non-Hispanic Whites (11.8 per 1000). Compared with women who delay childbearing until age 30, teen mothers' education is estimated to be approximately 2 years shorter. Teen mothers are 10-12% less likely to complete high school and have 14-29% lower odds of attending college. School-based programs have the potential to help teens acquire the knowledge and skills needed to postpone sex, practice safer sex, avoid unintended pregnancy, and if pregnant, to complete high school and pursue postsecondary education. Most students in US middle and high schools receive some kind of sex education. Federal policies and legislation have increased use of the abstinence-only-until-marriage approach, which is disappointing considering the lack of evidence that this approach is effective. CONCLUSIONS Nonmarital teen births are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on educational attainment, and effective practices are available for schools to address this problem. Teen pregnancy exerts an important influence on educational attainment among urban minority youth. Decisions about what will be taught should be informed by empirical data documenting the effectiveness of alternative approaches.
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Affiliation(s)
- Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA.
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Martinez EZ, Roza DLD, Caccia-Bava MDCGG, Achcar JA, Dal-Fabbro AL. Gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil: análise espacial. CAD SAUDE PUBLICA 2011; 27:855-67. [DOI: 10.1590/s0102-311x2011000500004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 02/24/2011] [Indexed: 11/22/2022] Open
Abstract
A gravidez na adolescência é um problema de saúde pública comum em todo o mundo. O objetivo deste estudo ecológico é estudar o padrão espacial da associação entre os percentuais de gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil. Para isso, foi utilizado um modelo bayesiano com uma distribuição espacial que segue uma estrutura condicional autorregressiva (CAR), baseado em algoritmos Monte Carlo em cadeias de Markov (MCMC). Foram usados dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Verificou-se que a ocorrência de gravidezes precoces apresentou-se maior nos municípios de menor produto interno bruto (PIB) per capita, com maior incidência de pobreza, de menor tamanho populacional, menor índice de desenvolvimento humano (IDH) e maior percentual de indivíduos com índice paulista de vulnerabilidade social (IPVS) igual a 5 ou 6, ou seja, mais vulneráveis. O estudo demonstra uma estreita associação entre gravidez na adolescência e indicadores econômicos e sociais.
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Career aspirations and pregnancy intentions in pregnant teens. J Pediatr Adolesc Gynecol 2011; 24:e11-5. [PMID: 21256777 DOI: 10.1016/j.jpag.2010.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 12/01/2010] [Accepted: 12/03/2010] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To quantify the association between career aspirations and pregnancy intention in a cohort of pregnant adolescents seeking prenatal care. DESIGN Pregnant adolescents presenting for their first prenatal visit between March 2002 and February 2005 participated in a 30-minute interview as part of a larger cohort study addressing pregnancy attitudes and outcomes. Pregnancy intention was assessed through direct questioning and career aspirations were assessed by categorizing career goal responses into three categories: those requiring less than a college education, those requiring at least a college education, and undecided. Associations between pregnancy intention and career aspirations were quantified using cross tabulations and multivariable logistic regression. SETTING Hospital based prenatal clinic. PARTICIPANTS Women aged 12 to 19 seeking prenatal care. MAIN OUTCOME MEASURE Pregnancy intention. RESULTS Of the 257 pregnant adolescents included in the study, 20% were 12-15 years old, 39% were 16-17 years old and 41% were 18-19 years old. The majority (85%) of the adolescents reported their pregnancies were unintended; 59% reported a career that requires at least a college education; 28% reported a career that requires less than a college education; and, 13% were undecided. Intended pregnancy was observed in 15% of those with career aspirations not requiring college and 17% of those with career aspirations and requiring college. CONCLUSIONS The majority of adolescents in this study reported their pregnancy was unintended, had career aspirations requiring at least a college education, and reported plans to go back to school after the baby was born. Understanding pregnant adolescents' career aspirations may help inform pregnancy prevention and parenting support programs.
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Casares WN, Lahiff M, Eskenazi B, Halpern-Felsher BL. Unpredicted trajectories: the relationship between race/ethnicity, pregnancy during adolescence, and young women's outcomes. J Adolesc Health 2010; 47:143-50. [PMID: 20638006 DOI: 10.1016/j.jadohealth.2010.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents who become pregnant in the United States are at higher risk for a myriad of health concerns. One would predict even more adverse health outcomes among pregnant adolescents who are from disadvantaged racial/ethnic groups; however, previous studies indirectly suggest the opposite. This study examines whether adolescents from racial/ethnic minority groups are less affected by adolescent pregnancy compared to white adolescents. METHODS We used data from 1,867 adolescents participating in the National Longitudinal Study of Adolescent Health (1995-2001). Our predictor variable was self-reported race/ethnicity. Self-perception of health, educational attainment, and public assistance use in young adulthood were outcome measures. We conducted weighted multivariate logistic regressions and analyzed how adolescent pregnancy modified the relationship between our predictor and outcome variables. RESULTS Black and American Indian young women had significantly higher odds than white young women of receiving public assistance (OR, 2.6 and 2.7, respectively; p <.01) and even higher odds if ever pregnant in adolescence (OR, 4.2 and 19.0, respectively; p = .03). White young women had significantly lower odds of high educational attainment if they had a live birth in adolescence as compared to those who had not (OR, 0.1; CI = 0.1-0.4). CONCLUSIONS These findings support studies that found adolescent pregnancy increases the risk of public assistance use and low educational attainment. The study shows that, for educational attainment, black young women who become pregnant may not be as disadvantaged as their peers, whereas white young women who become pregnant are more disadvantaged.
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Affiliation(s)
- Whitney N Casares
- Pediatrics Residency Program, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94304, USA.
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James S, Montgomery SB, Leslie LK, Zhang J. Sexual Risk Behaviors Among Youth in the Child Welfare System. CHILDREN AND YOUTH SERVICES REVIEW 2009; 31:990-1000. [PMID: 23606780 PMCID: PMC3628813 DOI: 10.1016/j.childyouth.2009.04.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to provide estimates of sexual risk behaviors for 877 youth, age 11-14 at baseline, in the child welfare system. It examines the association between baseline psychosocial risk and protective factors on engagement in sexual risk behaviors after 36 months. It further compares rates of sexual risk behaviors between youth placed in out-of-home care and those who remained with their biological family. Key findings include a high rate of pregnancy, a high percentage of youth who initiated sexual activity at or before age 13 as well as a limited role of protective factors in moderating sexual risk behaviors. A history of placement into out-of-home care is not significantly associated with greater engagement in sexual risk behaviors. Implications for intervention development and child welfare policy for this population are discussed.
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Affiliation(s)
- Sigrid James
- Loma Linda University, Loma Linda, CA ; Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, CA
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de Fátima Rato Padin M, de Souza e Silva R, Chalem E, Mitsuhiro SS, Barros MM, Guinsburg R, Laranjeira R. Brief report: A socio-demographic profile of multiparous teenage mothers. J Adolesc 2009; 32:715-21. [PMID: 19261325 DOI: 10.1016/j.adolescence.2009.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 01/08/2009] [Accepted: 01/25/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Delineate a socio-demographic profile of multiparous teenage mothers at a public hospital in Brazil. METHOD This is a cross-sectional study consisting of 915 interviews with teenage girls, including 170 multiparous subjects whose babies were born alive. RESULTS The multiparous teenage mothers had the following average characteristics: 17.8 years old; first pregnancy at 16 years; beginning of sexual life at 14.2 years; dropped out of school at 13.6 years; attended school for 6 years with only 10% still attending school when they were interviewed; 87.4% had prenatal exams; monthly income was reported to be 0.3% less than the national minimum salary. CONCLUSION Teenage mothers are in need of better social, educational, and health care in order to have a greater chance of a positive motherhood experience, thereby creating a better, healthier environment for their children.
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Teenage pregnancy—New tools to support local health campaigns. Health Place 2009; 15:300-7. [DOI: 10.1016/j.healthplace.2008.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 05/23/2008] [Accepted: 06/15/2008] [Indexed: 11/24/2022]
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Kearney CA. An Interdisciplinary Model of School Absenteeism in Youth to Inform Professional Practice and Public Policy. EDUCATIONAL PSYCHOLOGY REVIEW 2008. [DOI: 10.1007/s10648-008-9078-3] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: an integrated literature review. J Sch Nurs 2008; 24:13-20. [PMID: 18220451 DOI: 10.1177/10598405080240010301] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Teenage pregnancy outcomes have become an increasing concern in the United States. Education and support of pregnant teens are critical factors that may determine good or poor pregnancy outcomes. Poor outcomes may include low birth weight, developmental delays, and poor academic performance. Although the number of teenagers experiencing pregnancy and parenting has declined in the U.S., school-based health clinics can be used to provide support and guidance designed to avoid the negative outcomes associated with teenage pregnancy and parenting. By having school-based health clinics, nurse practitioners and school nurses can provide much needed services to pregnant and parenting teens. These services should include educational support, counseling, and community resources. This inquiry provides a metasynthesis of the literature and will review, examine, and summarize the literature relating to the effect of school-based clinics on teenage pregnancy and parenting outcomes.
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Chalem E, Mitsuhiro SS, Ferri CP, Barros MCM, Guinsburg R, Laranjeira R. [Teenage pregnancy: Behavioral and socio-demographic profile of an urban Brazilian population]. CAD SAUDE PUBLICA 2007; 23:177-86. [PMID: 17187116 DOI: 10.1590/s0102-311x2007000100019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 05/18/2006] [Indexed: 11/21/2022] Open
Abstract
To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3% of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9%) lived near the hospital. 930 (93%) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3% of the total. 80.1% of the subjects were giving birth for the first time. 81.2% had not planned the pregnancy, and 23.8% had been using some contraceptive method. 67.4% had vaginal deliveries. Some 13.3% of the newborns were premature and 15.9% had low birth weight. 17.3% of these adolescent mothers reported smoking during pregnancy, with 2.8% reporting alcohol and 1.7% illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.
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Affiliation(s)
- Elisa Chalem
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brasil.
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Barnet B, Liu J, DeVoe M, Alperovitz-Bichell K, Duggan AK. Home visiting for adolescent mothers: effects on parenting, maternal life course, and primary care linkage. Ann Fam Med 2007; 5:224-32. [PMID: 17548850 PMCID: PMC1886481 DOI: 10.1370/afm.629] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care. METHODS Pregnant adolescents aged 12 to 18 years, predominantly with low incomes and of African American race, were recruited from urban prenatal care sites and randomly assigned to home visiting or usual care. Trained home visitors, recruited from local communities, were paired with each adolescent and provided services through the child's second birthday. They delivered a parenting curriculum, encouraged contraceptive use, connected the teen with primary care, and promoted school continuation. Research assistants collected data via structured interviews at baseline and at 1 and 2 years of follow-up using validated instruments to measure parenting (Adult-Adolescent Parenting Inventory) and depression (Center for Epidemiologic Studies Depression). School status and repeat pregnancy were self-reported. We measured program impact over time with intention-to-treat analyses using generalized estimating equations (GEE). RESULTS Of 122 eligible pregnant adolescents, 84 consented, completed baseline assessments, and were randomized to a home-visited group (n = 44) or a control group (n = 40). Eighty-three percent completed year 1 or year 2 follow-up assessments, or both. With GEE, controlling for baseline differences, follow-up parenting scores for home-visited teens were 5.5 points higher than those for control teens (95% confidence interval, 0.5-10.4 points; P = .03) and their adjusted odds of school continuation were 3.5 times greater (95% confidence interval, 1.1-11.8; P <.05). The program did not have any impact on repeat pregnancy, depression, or linkage with primary care. CONCLUSIONS This community-based home-visiting program improved adolescent mothers' parenting attitudes and school continuation, but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care. Coordinated care may require explicit mechanisms to promote communication between the community program and primary care.
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Affiliation(s)
- Beth Barnet
- Department of Family Medicine, University of Maryland School of Medicine, Baltimore, Md 21201, USA.
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Raneri LG, Wiemann CM. Social ecological predictors of repeat adolescent pregnancy. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2007; 39:39-47. [PMID: 17355380 DOI: 10.1363/3903907] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CONTEXT Women with multiple pregnancies in adolescence may experience medical, psychological and social complications. Improved understanding of the individual-, dyad-, family-, peer/community- and social system-level risk factors for repeat pregnancy may lead to the development of more effective prevention strategies for adolescent mothers in a variety of settings. METHODS Between 1993 and 1996, white, black and Mexican American adolescent mothers at a labor and delivery unit in Texas were interviewed after delivery and completed written surveys prospectively for up to 48 months. Logistic regression analyses were used to determine predictors of repeat pregnancy within 24 months, using social ecological theory as a guide. RESULTS Forty-two percent of adolescent mothers experienced a repeat pregnancy within 24 months; 73% of these delivered a second child. Individual-level predictors were planning to have another baby within five years (odds ratio, 1.6) and not using long-acting contraceptives within three months of delivery (2.4). Dyad-level predictors were not being in a relationship with the father of the first child three months after delivery (2.0), being more than three years younger than the first child's father (1.6) and experiencing intimate partner violence within three months after delivery (1.9). Peer/community-level predictors were not being in school three months postpartum (1.8) and having many friends who were adolescent parents (1.5). CONCLUSION Adolescent mothers are at high risk for a rapid subsequent pregnancy. Interventions that address the complex and multifaceted aspects of the lives of adolescent mothers are needed to prevent repeat pregnancy.
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Affiliation(s)
- Leslie G Raneri
- Office of Adolescent Pregnancy Programs, Office of Population Affairs, U.S. Department of Health and Human Services, Rockville, MD, USA.
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Abstract
Health-care providers need to recognize that not all adolescent pregnancies occur as a result of error. A small subset of adolescents intentionally plan their pregnancy. The purpose of this phenomenological study was to describe the experiences of 14- to 17-year-old pregnant females who had planned their pregnancies. Participants were recruited from one prenatal clinic at a large tertiary medical center in the eastern region of the United States. Three themes emerged from participant interviews that were related to the adolescents' pregnancies. Themes included living environment issues, adjustment to the pregnancy, and an increased motivation to do well in school and work to provide a good life for their infants. Understanding the phenomena of planned adolescent pregnancy can provide a basis for health-care providers to provide support to adolescent females in this life transition. Understanding the common experience of these adolescents can assist health-care providers to develop individualized interventions to best meet these young women's needs and to improve birth outcomes among this population.
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Affiliation(s)
- Kristen S Montgomery
- K risten M ontgomery is an assistant professor in the College of Nursing at the University of South Carolina in Columbia, South Carolina
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Mitsuhiro SS, Chalem E, Barros MCDM, Guinsburg R, Laranjeira R. Prevalence of cocaine and marijuana use in the last trimester of adolescent pregnancy: socio-demographic, psychosocial and behavioral characteristics. Addict Behav 2007; 32:392-7. [PMID: 16814936 DOI: 10.1016/j.addbeh.2006.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 03/31/2006] [Accepted: 05/24/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the prevalence of cocaine and marijuana use during the third trimester of pregnancy in a population of 1000 teenage women of a public hospital in São Paulo, Brazil using hair analysis in order to avoid underestimation of data that could happen by the use of self-report questionnaires and describe socio-demographic, psychosocial and behavioral characteristics of the drug users. RESULTS Hair analysis has detected use of cocaine and/or marijuana in the third trimester of pregnancy in 6% of the patients: 4.0% used marijuana, 1.7% used cocaine and 3% used both drugs. They were about 17 years old, from low-income, poorly educated, unemployed, financially dependent and they had not planned the pregnancy. 10% of miscarriages have occurred in this population. CONCLUSION This study shows the psychosocial impairment associated to teenage pregnancy and use of cocaine and marijuana during gestation by this low-income population with reliable data of prevalence obtained through hair analysis.
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Affiliation(s)
- Sandro Sendin Mitsuhiro
- Alcohol and Drug Research Unit (Uniad), Psychiatry Department, Federal University of São Paulo, Rua Botucatu, 394, 04023 061, Brazil.
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Brown MB, Bolen LM. The school-based health center as a resource for prevention and health promotion. PSYCHOLOGY IN THE SCHOOLS 2007. [DOI: 10.1002/pits.20276] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Because the success of teen mothers is enhanced by completing high school, school districts should give high priority to supporting teen mothers to remain in school and to graduate. This article reviews the literature on the educational attainment of these students, their school aspirations, and the policies affecting their education. Although teens often begin mothering with a range of educational and social disadvantages, many teen mothers recommit to school to enhance their future opportunities. Unfortunately, rising school aspirations among teen mothers often are undermined by competing demands and the lack of consistent family and school support. School nurses can support teen mothers' aspirations and contribute to their long-term success by linking them to resources and advocating for policies and practices that promote high school graduation.
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Affiliation(s)
- Lee Smithbattle
- School of Nursing, Saint Louis University, St. Louis, MO, USA
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Mitsuhiro SS, Chalem E, Barros MM, Guinsburg R, Laranjeira R. Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders. REVISTA BRASILEIRA DE PSIQUIATRIA 2006; 28:122-5. [PMID: 16810395 DOI: 10.1590/s1516-44462006000200009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the prevalence of psychiatric disorders during pregnancy, the prevalence of cocaine and marijuana use during the third trimester of gestation and the socio-demographic characteristics of a population of low-income teenagers. METHOD One thousand pregnant teenagers were evaluated using the Composite International Diagnostic Interview, and a socio-demographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was collected for analysis. RESULTS Of the 1000 pregnant teenagers interviewed, 53.6% were poor, 90.4% were unemployed, 92.5% were financially dependent and 60.2% dropped out of school. Those using drugs during the third trimester of pregnancy were equal to 6% (marijuana: 4%, cocaine: 1.7%, both: 0.3%). Those having at least one psychiatric disorder equaled 27.6%. The most frequent diagnoses were depression (12.9%), posttraumatic stress disorder (10.0%) and anxiety disorders (5.6%). DISCUSSION Unstructured families, dropping out of school, unemployment and a low level of professional training are all contributing factors to the maintenance of an unfavorable socio-economic environment in which there is a high prevalence of cocaine and marijuana use during the third trimester of pregnancy and an abnormally high incidence of psychiatric disorders.
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Affiliation(s)
- Sandro Sendin Mitsuhiro
- Research Unit of Alcohol and Drugs, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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