Deborah Koniak-Griffin

A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum.

BACKGROUND Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.

Health risks and psychosocial outcomes of early childbearing: a review of the literature.

This article presents a review of the literature on the obstetric, medical, and neonatal health risks as well as psychosocial outcomes associated with early childbearing. An important concern in adolescent pregnancies is the increased risk for infant morbidity and mortality as a result of higher incidence of preterm births and low-birthweight infants. Implications for prenatal and postpartum nursing care are discussed. Promising new models to improve care of young mothers and their children, such as home visitation by public health nurses, are presented and features of successful intervention programs outlined.

Nurse visitation for adolescent mothers: two-year infant health and maternal outcomes.

BackgroundChildren of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers. ObjectiveThe purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs). MethodsIn a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP, n = 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC, n = 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions. ResultsThe total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not. ConclusionsThe EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.

Health Disparities Among Vulnerable Populations: Evolution of Knowledge Over Five Decades in nursing Research Publications

BackgroundConsiderable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge. PurposeThe purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made. MethodsCriteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year’s bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles. ResultsSeventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time. ConclusionsNursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.

LINKAGES BETWEEN SEXUAL RISK TAKING, SUBSTANCE USE, AND AIDS KNOWLEDGE AMONG PREGNANT ADOLESCENTS AND YOUNG MOTHERS

This survey examined the relationships of sexual risk taking to substance use and AIDS knowledge in pregnant adolescents (n = 58) and nonpregnant young mothers (n = 93). Subjects were from predominantly minority backgrounds, were single, and ranged in age from 12 to 20 years (M = 16.64). A number of high-risk behaviors were reported, including substance use during pregnancy and early parenthood, unprotected sexual relations, and multiple (lifetime) sex partners. Current pregnancy status, history of marijuana use, and ethnicity were strong predictors of having bad multiple sex partners. Odds ratios suggested that Black adolescents were many times more likely than Whites to have had multiple sex partners. Pregnant adolescents were less likely than young mothers (nonpregnant) to have had multiple sex partners but more likely to have unprotected sex (i.e., without use of a condom). Conversely, young mothers were more likely to have multiple sex partners and less likely to have unprotected sex than were pregnant adolescents. Those with a history of marijuana use were more likely to have had multiple sex partners than were adolescents who had never used this drug. AIDS knowledge was not a significant predictor of high-risk sexual behavior.

Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth.

PURPOSE To compare effects of an early intervention program (EIP) of intense home visitation by public health nurses (PHNs) with effects of traditional public health nursing care (TPHN) on infant health and selected maternal outcomes of adolescent mothers. METHODS EIP adolescents (N = 102) received preparation-for-motherhood classes and individual home visits (from pregnancy through 1 year postpartum) from PHNs employed in a county health department. Participants were predominantly Latina (64%) and African-American (11%) and from impoverished backgrounds. Infant health outcomes were determined based on medical record data; interviews and standardized questionnaires evaluated other program effects (e.g., maternal educational achievement and psychological status). Data were analyzed using Chi-square and repeated measures ANOVA. RESULTS Infants of EIP mothers experienced significantly fewer total days (n = 74) and actual episodes (n = 14) of hospitalization during the first year of life than those receiving TPHN (n = 154, n = 24, respectively). Similarly, positive program effects were found for immunization rates. There were no group differences in emergency room visits or repeat pregnancy rates. Alcohol, tobacco, and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy (lifetime rates). CONCLUSIONS These findings demonstrate the positive effects of a PHN home visitation program on health outcomes for children of adolescent mothers. Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers. Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers.

Project CHARM: an HIV prevention program for adolescent mothers.

Effects were examined of a human immunodeficiency virus (HIV) prevention program for adolescent mothers offered in pregnant minor and parenting programs in Los Angeles County. The sample included young women (N = 497) of predominantly poor, Latina backgrounds who had complete data from baseline to the one-year follow-up. The treatment group demonstrated statistically significant improvements in AIDS knowledge and intentions to use condoms, and fewer sex partners at the six-month follow-up as compared to the control group. Findings related to the effects of the intervention on theoretical variables provide some support for selected concepts from Social Cognitive Theory and the Theory of Reasoned Action.

Relationship, Power, and Other Influences on Self-Protective Sexual Behaviors of African American Female Adolescents

This study examined risky sexual behaviors, gender, and power issues affecting risk taking, and factors most likely to promote self-protection among female African American adolescents. A cross-sectional design was used for data collection. The sample included 130 adolescents ranging from 14 to 20 years of age, who completed questionnaires. Multiple regression analysis resulted in two models that accounted for 23% and 37% of the variance. Behavioral intention, partner age, pregnancy status, current substance use, and length of sexual relationship were statistically significant predictor variables. Behavioral intentions, in particular, were found to be a strong predictor of condom use among African American youth.

Using videotape instruction and feedback to improve adolescents' mothering behaviors

The effects of videotape instruction and feedback (videotherapy) on mothering behaviors were evaluated in this longitudinal study. In this study, 31 adolescents and their healthy infants were randomly assigned to experimental and control groups. All subjects were videotaped during structured mother-infant teaching episodes in their homes at 1 and 2 months postpartum. Experimental group subjects reviewed the videotaped 1-month teaching episode and received feedback from a specially trained professional nurse who emphasized positive aspects of maternal behavior. Instruction was individualized according to the mothers needs. Results of a repeated measures MONOVA revealed significant differences in the pattern of change over time between subjects in the experimental and control groups on a measure of actual maternal behaviors. Adolescents receiving videotape instruction and feedback obtained significantly higher maternal behavior scores at 1 and 2 months postpartum.

A Community‐Based Parish Nurse Intervention Program for Mexican American Women with Gestational Diabetes

OBJECTIVE To examine the effects of a Parish Nurse Intervention Program (PNIP) on maternal health behaviors, glycemic control, and neonatal outcomes among Mexican American women with gestational diabetes. DESIGN A randomized controlled trial comparing care as usual (CAU) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse. SETTING An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care, non-profit hospital with a Parish Nurse partnership. PARTICIPANTS One hundred Mexican American women were included in the study with randomization into Parish Nurse Intervention Program (n=49) and care as usual (n=51) groups. MAIN OUTCOME MEASURES The Health Promoting Lifestyle Profile II (HPLP II) and two measures of glycemic control pre- and post-intervention, as well as newborn size, and days of maternal and neonatal hospitalization. RESULTS Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group. No significant differences between groups regarding glycemic control, macrosomia, or days of maternal or neonatal hospitalization were found. CONCLUSIONS A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors.