Naomi A. Schapiro

Separation and reunification: The experiences of adolescents living in transnational families

There are increasing numbers of mothers as well as fathers who engage in long-term migration to support their children and other family members in their home countries. In this article, the current state of the literature about children and adolescents left at home in these transnational families is surveyed and reviewed. The article reviews the effects on children of the process of separation from parents, the impact of gifts and remittances home, communication with distant parents and the quality of life with their substitute caregivers. The effects of immigration in late childhood or adolescence on these separated children are examined, as well as what is known about the processes of adaptation and family reunification, including migration traumas, impact of gender, and educational outcomes. Suggestions are given for pediatric clinicians working with reunifying families. Gaps in the literature are highlighted and the need for research into factors that promote successful family re-engagement and overall adaptation upon reunification.

Issues of separation and reunification in immigrant Latina youth

Latinos make up 12.5% of the total U.S. population, and the largest source of migration to the United States is from Mexico. The intersection of acculturation and risk for Latino immigrant youth is complex, with recent arrivals being protected in the context of strong family ties. Youth, and particularly young women who have been separated from their parents during migration and later reunited, face particular problems that have not been well studied. This article discusses possible stresses facing reunified families, with implications for nursing practice and suggestions for future research.

Condom Availability in Middle Schools: Evidence and Recommendations

Literature on condomavailability inmiddle schools is sparse, because most publications focus on high schools and colleges. However, the age of pubertal onset has continually decreased during the past several decades because of improvements in nutrition and overall health (Rosen, 2004). Early onset of puberty has been shown to be associated with a variety of risk-taking behaviors, such as alcohol and drug use before age 14 years and sexual debut and unprotected sex before age 16 years (Deardorff, Gonzales, Christopher, Roosa, & Millsap, 2005; Downing & Bellis, 2009). Sexualmaturation normally occurs before cognitive maturation. Thus early adolescents engaging in sexual activity are at risk for unwanted health outcomes, such as unintended pregnancy and sexually transmitted infections (STIs), which they are not cognitively mature enough to prevent or manage. This policy brief will examine the adolescent development trajectory, the context of early sexual debut, and current policies in some middle schools to address these issues. Evidence-based recommendations for stakeholders to consider in creating and revising policies on condom availability are then offered.

Confidentiality and Access to Adolescent Health Care Services

Adolescent birth rates in the United States declined steadily from the 1950s until 2005, but increased 3.5% in 2006. While multiple factors are at play in this reversal, the increases were largest in states with the most limited access to confidential adolescent health services and contraception (Child Trends Data Bank, 2007). Adolescent childbearing has been linked to poorer health outcomes for both mother and child, and maternal mortality is the third-leading cause of death for adolescents internationally (World Health Organization [WHO], 2009). Access to confidential reproductive

Interview With “Ms. Rob,” Health Educator at San Lorenzo High School Health Center

I can tell you why I decided to do this in the first place. So, in 1997, I was in the Welfare office with a friend of mine, she was down there to get MediCal. I overheard two social workers talking about a 9-year-old girl who was pregnant. At this time, I had left my 9-year-old daughter at home who was in the backyard making mud pies with rose petals and oranges, so it just totally floored me that this 9-year-old little baby was pregnant and that her parents wanted her to continue. I said, okay, something has to be done. So, I went in and started taking some classes with Girls Inc. and Planned Parenthood to get some information and I just started talking to parents. I noticed that parents were still filtering the information that the teen pregnancy rate in Alameda County was still growing. So I said, forget you, I’m going to talk right to your kids. And so in 1998, I just started with Girls Inc. exclusively and going out and talking mainly to mothers in domestic violence shelters, who had a lot of young daughters with them, and they themselves were single and it was information that they didn’t have either. So I started doing that and I registered my eldest daughter at San Lorenzo High School and I was approached by a woman who said, “How would you feel about a school-based health center on this campus?” I said, “That would be fabulous!” I said, “What type of services would you offer?” and she said, “What type of services would you like to have?” and I said, “Oh I’d like health education for teenagers in regards to self-esteem and pregnancy prevention and disease prevention,” and she said, “OK, well we’ll write that in the grant.” When I came here, there was no outline for health education. I applied for the job, and I basically wrote a letter that said, “I want this job” and sent it to the School District and everybody signed off on it, so I came in and I wrote an outline for what a health education visit should look like. And just started going in really by the skin of my teeth and with base knowledge of birth control methods and prevention skills and diseases signs, symptoms, you know, treatments outcomes and things like that and started sharing this information with kids. And I learned that—they are kids to me, everybody calls them youth and all that, and some of them are children, some of them are kids, some of them are youth, and some are young adults, there really is a range you can see in cognitive development. And so I had to learn to tailor it, to fit each of these age-groups, as well as to be able to work with children who were—what is the politically correct term for it now?—with some mental deficits and cognitive deficits. So I had to learn how to tailor it so all of them could get it, as they are all sexual beings. And they taught me how to do what I do, so I started to understand that this space that I was in was golden, and that I had in front of me a captive audience of up to 1300 potential youth who were at one point in their lives going to become sexual beings and they were right there. You know, I could bring them in and they could speak to me in whichever way they needed to get out what they needed to get out and I could filter it and send it back to them, properly and empowered for themselves. One thing that happened to me most recently was I ran into a student in East Oakland. I didn’t remember this girl from a can of paint when she walked up to me. And she says, “You’re that condom lady from San Lorenzo High, aren’t you?” And I say, “Yeah.” And she said, “I graduated from there in 2003.” And I said, “Oh really, what are you doing now?” And she says, “I‘m part owner of a beauty shop down here in East Oakland.” I said

Adolescent contraception. Foreword.

For far too long pregnancy prevention and reproductive health in general have been siloed into school-based interventions and teen clinics. In the recent past this was more understandable as testing adolescents for sexually transmitted infections required a genital or pelvic examination and Pap smears were recommended for all sexually active young women. In the current evidence-driven health environment with a urine DNA amplification test that can effectively screen for gonorrhea and chlamydia with recommendations to delay Pap smears to age 21 and with medical eligibility criteria that do not require a routine genital or pelvic examination before starting contraception there is no longer an evidence-based rationale for excluding pregnancy prevention from a pediatric practice. We know that the need is there. Up to 82% of teen pregnancies are unplanned with lifelong impact on educational and health outcomes. Early sexual activity and teen pregnancy are not equally distributed with higher rates among African American and Latino teens and in locations with high concentrations of poverty. The 2011 results of the biannual Centers for Disease Controls Youth Risk Behavior Surveillance System have just been released in which 47.3% of surveyed high school students reported that they have been sexually active a rate that has not changed significantly in the past 10 years. One-third of students reported sexual activity within the past 3 months and only 23.3% of these students reported using hormonal contraception at that time. Preventing adolescent pregnancy is the responsibility not only of public health and primary care providers but also for pediatric specialists who may be prescribing teratogenic medications for seizure control or maintaining organ transplants and whose patients are at high risk for pregnancy-related complications. In this issue authors Hartman Monasterio and Hwang provide a comprehensive and up-to-date guide to help pediatric clinicians address the gap between sexual activity and contraceptive use. They cover every method of pregnancy prevention from abstinence and condom use through a variety of hormonal contraception and long-acting reversible contraception such as subcutaneous implants and intrauterine devices. Hartman Monasterio and Hwang carefully review the efficacy contraindications medical benefits medical risks advantages disadvantages and adherence issues for each method of contraception. They also address medical eligibility criteria and risks and benefits of contraception for adolescents with chronic conditions. Ethical issues and dilemmas for the pediatric provider are thoroughly addressed in a companion piece by Gowda and Lantos. Access to contraception has been a controversial part of the Affordable Care Act and as we go to press we cannot predict the role this issue will play in the Presidential campaign of 2012. The excellent review by Hartman Monasterio and Hwang reminds us of the crucial roles that ongoing access to and delivery of contraception play in delivering effective and equitable pediatric and adolescent care. (full-text)