Mary Lou Balassone

Risk of contraceptive discontinuation among adolescents

This prospective study assesses a sample of adolescent oral contraceptive users for correlates of continued use of birth control. Data were collected by interview at both an initial family planning clinic visit and 3 months later. Half of the sample did not return to the clinic for follow-up. Among those contacted by phone, all had discontinued the use of a contraceptive, and 69% were at risk for an unintended pregnancy. Least likely to continue to use the pill were adolescents who perceived substantial health-related problems associated with oral contraceptive use, felt their own risk of pregnancy was less than that of other teenagers, and had poor problem-solving skills. Among the most common problems experienced were the side effects associated with oral contraceptive use and difficulty remembering to take a pill every day. Suggested interventions aimed at supporting continued and effective use of birth control are provided.

INTERGROUP DIALOGUES: AN INNOVATIVE APPROACH TO TEACHING ABOUT DIVERSITY AND JUSTICE IN SOCIAL WORK PROGRAMS

This article reports on intergroup dialogues, an innovative pedagogical method to address cultural diversity and social justice issues in social work curricula. Intergroup dialogues—facilitated face-to-face meetings of students from different social identity groups—are aimed at exploring cultural identities and differences, fostering deeper understanding about issues of oppression and privilege, and building alliances for social change. Intergroup dialogue can also serve as a foundation to prepare social workers for cultural ly competent and social justice-oriented practice. Results from a formative evaluation are included together with suggestions for social work programs interested in incorporating intergroup dialogues into their curricula.

A comparison of users and nonusers of a school-based health and mental health clinic

This study compares student health and mental health knowledge, behavior, and access to services for adolescents who used and did not use a school-based health and mental health clinic. Data were collected as part of an anonymous, self-administered survey completed by all students in a school housing a clinic that had been in operation for a school year. Comparisons of clinic users and nonusers revealed differences in health- and mental health-related knowledge and behavior and access to needed care. The clinic was found to be serving adolescents at high risk for a variety of psychosocial problems (e.g., drug use, depression, dropout).

A social learning model of adolescent contraceptive behavior.

Central to an understanding of adolescent pregnancy and sexually transmitted disease prevention is the study of birth control use among teenagers. This paper critically reviews both recent research findings and dominant theories regarding adolescent contraceptive use. An alternative theoretical framework, one that relies on social learning theory, is offered. This framework uses three major components — environmental context, cognitive influences, and behavior execution constraints — as the foundation for understanding the learning and maintenance of contraceptive behaviors. First, environmental factors, such as the availability of role models, accurate sexuality education, and birth control services, are seen as supporting or inhibiting birth control use. Second, the importance of cognitive functions through which the external environment is viewed and which influence the adolescents image of the consequences associated with contraceptive use are highlighted. Last, the actual behavioral skills teenagers need in order to use birth control successfully are considered.

Interventions to decrease the risk of HIV/AIDS and other sexually transmitted diseases among high-risk heterosexual adolescents☆

Abstract Sexually transmitted diseases (STDs), including HIV/AIDS, have become a major health concern for American adolescents, and professionals need to be knowledgeable about the interventions available to help teenagers decrease their risk of contracting these diseases. This paper provides an overview of the development and implementation of two theoretically and empirically grounded interventions intended for heterosexually active adolescents at high risk of contracting HIV/AIDS and other STDs. The interventions were developed using a process of feedback and revision that allowed for the tailoring of content to the specific target population. The steps in this process are reviewed and the specific content of each intervention is outlined. The interventions provide: basic information about HIV/AIDS and other STDs, information to counter negative beliefs about condom use, models that reinforce positive beliefs, examples of adolescents negotiating condom use with potential sexual partners, and a set of four skills steps for talking to partners about using condoms. The interventions are designed to be culturally sensitive, appropriate for both males and females, and relatively short and simple to administer so they can be delivered in a variety of settings. Preliminary data regarding the usefulness, accessibility, and acceptability of the interventions to the target population are reviewed.

Return for follow-up care and contraceptive continuation among adolescents.

Family planning service providers have noted a greater than 50% nonreturn rate among adolescent clients. Those who fail to return to the clinic are likely to discontinue their use of contraceptives and be at riskfor an unintendedpregnancy. Case record reviews of a random sample of adolescent oral contraceptive users were used to investigate variables correlated with nonreturn for follow-up care. Compared to adolescents who returned to the clinic, those least likely to return had a sexually transmitted disease, had irregular menstrual periods, had a pap smear over a year prior to the initial clinic visit, reported more general health problems, were referred for additional tests, and had waited longer since first coitus to obtain birth control. Implications for the development of a method to screen adolescents for risk of contraceptive discontinuation are drawn.

Book Reviews : Altered Loves: Mothers and Daughters During Adolescence. By Terri Apter. New York: St. Martins Press, 1990, pp. 231

Abel notes that &dquo;caregivers, like mothers, are simultaneously sentimentalized and devalued&dquo; (p. 8) and suggests that policymakers persist in holding up an inaccurate, idealized, and irrelevant version of the past as the model of contemporary family care. Her history, meticulously pieced from the admittedly thin scraps of available documentation, demonstrates the discrepancies between past and present conditions for caregiving. Thus, the myths on which policy is too often founded do not fit contemporary reality. The current research agenda, with its emphasis on the stress engendered by caregiving, also comes in for criticism. As Abel’s own research demonstrates, the realities of women’s caregiving experiences demand that feminists neither focus exclusively on the stresses