Janna Lesser

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.

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.

Childhood Predictors of Daily Substance Use among Homeless Women of Different Ethnicities

The objective of this study was to describe associations between childhood factors and adult daily substance use profiles among homeless women and to identify independent predictors of daily substance use for the overall sample and for ethnic/acculturation subgroups. Structured surveys were administered to 1,331 homeless women in Los Angeles who were either daily drug and alcohol users for the past 6 months or nondaily substance users. Physical abuse and parental drug abuse predicted daily drug use in the whole sample and selected subgroups, whereas parental alcohol abuse predicted daily alcohol use in the whole sample. Teen self-esteem was also found to have a protective effect on daily alcohol use for the sample and for African American women. Negative peer influence in adolescence predicted daily drug use among high-acculturated Latinas. In summary, childhood abuse, parental substance use, and negative peer influence affect important roles in homeless womens daily substance use.

HIV prevention for Latino adolescent mothers and their partners.

This study evaluates the outcomes of a theory-based, couple-focused HIV prevention program for Latino adolescent mothers and their male partners. The sample includes 49 couples (98 individuals) who receive either the intervention or only an HIV information session (comparison). The six-session, culturally appropriate intervention was developed through a community—academic partnership. Findings at the 6-month evaluation show that the probability of unprotected sex is significantly reduced and intentions to use condoms increase over time for participants in the experimental group, compared with the comparison group (p < .001), although AIDS knowledge improves for participants in both groups. Females in both groups have higher intentions of using condoms (p < .01) and lower probability of unsafe sex (p < .05) at baseline and over time, compared with their male partners. The intervention is well accepted by the inner-city adolescents and is realistic for implementation in a community setting.

Young Latino Fathers’ Perceptions of Paternal Role and Risk for Hiv/Aids

This study explored young Latino fathers’ feelings about their fathering role and perceptions of risk for HIV. Many teen parents have engaged in activities that place them at risk for exposure to HIV. Compared with young mothers, little is know about teen fathers. Young Latino fathers (N = 45) living in the inner-city participated in focus group interviews; 10 also completed individual interviews. Participants provide an account of the influence of lifelong poverty/social oppression on their worldviews and life choices, describing experiences with community violence, substance abuse, and risky sexual activity. Findings illustrate the profound change that some young men make after becoming fathers, including an understanding of the importance of relationships based on equality. Because of these youths’ ability to make difficult behavioral changes for the sake of their children, young Latino fathers are excellent candidates for intervention programs, such as HIV prevention.

Community-academic research partnerships with vulnerable populations.

Community-academic research partnerships have evolved as a multidisciplinary approach to involve those communities experiencing health disparities in the development, implementation, and evaluation of health interventions. Community-academic partnerships are intended to bring together academic researchers and communities to share power, establish trust, foster colearning, enhance strengths and resources, build community capacity, and address community-identified needs and health problems. The purpose of this chapter is to review the current state of community-academic research partnerships in the United States and Canada. We discuss contextual issues; present a review of the current literature; identify the major strengths, challenges, and lessons learned that have emerged during the course of these research collaborations; and explore implications for future research and policy.

Tailoring STI & HIV prevention programs for teens

Successful HIV/sexually transmitted infection (STI) prevention programs are not “one size fits all.” To effectively meet the HIV/STI prevention needs of all adolescents, programs should be developmentally and gender specific, should integrate an understanding of racial/ethnic culture, and should be open to variations in sexual expression. Nurse researchers have demonstrated the importance of these differences in programs, and this article offers concrete suggestions for ways to apply this knowledge in community programs.

Parental protectiveness and unprotected sexual activity among Latino adolescent mothers and fathers

Latino pregnant and parenting adolescents living in inner cities are one of the populations at risk for acquiring HIV. Although teen parenthood has been predominantly looked at with a focus on potential adverse physical, emotional, and socioeconomic outcomes for the mother and child; a growing body of literature has documented the strengths and resiliency of young parents. Respeto/Proteger: Respecting and Protecting Our Relationships is a culturally rooted couple-focused and asset-based HIV prevention program developed for young Latino parents. In this program, parental protectiveness (defined as the parent-child emotional attachment that positively influences parental behavior) is viewed as an intrinsic and developing critical factor that supports resiliency and motivates behavioral change. The primary purpose of this article is to describe the longitudinal randomized study evaluating the effect of this intervention on unprotected vaginal sex 6 months post intervention and to determine whether parental protectiveness had a moderating effect on the intervention. The unique features of our database allow for examination of both individual and couple outcomes.