Effects of a skill-based intervention to encourage condom use among high risk heterosexually active adolescents.

OBJECTIVES: In this article we describe the development and testing of three behavioral interventions to reduce the risk of contracting HIV/AIDS and other sexually transmitted diseases among heterosexually active adolescents. METHODS: The interventions include a comic book, a videotape, and a group skill training curriculum that emphasize skill development--for communicating and negotiating condom use with partners, in addition to providing basic information. Participants included 228 youths sampled in juvenile detention and 168 youths sampled from public health STD and other similar clinics. The samples included both young men and women, and were comprised of African American and European American adolescents, ages 14-19. RESULTS: Examination of the relative efficacy of the interventions at three and six months following intervention show very few differences among conditions, despite the fact that the interventions contained most of the elements that previously have been defined as essential for effective interventions. CONCLUSIONS: In the discussion, we consider possible reasons for this outcome and make recommendations for future research.

The role of social workers in providing comprehensive health care to pregnant women.

Prenatal care is an important women's health care issue. Numerous studies have shown that early monitoring and continuous care during pregnancy is associated with more favorable birth outcomes. Using data from a survey of service providers, this paper describes innovative service delivery models that are a part of Washington state's new, comprehensive maternity care system. Washington's program departs from traditional medical prenatal care in making both support and case management services available to pregnant women. The services are described, highlighting the roles that social workers play in providing maternity services.

Prospects for national health care in the United States.

This paper provides an overview of both the current health care crisis in the United States and various reform proposals (some based on Canadian and British models) being considered at the federal and state levels. The proposals discussed fall into three categories--multiple payer national health insurance programs, one payer national health insurance programs, and a national health service program. The authors review four important criteria (cost, quality, access, and equity) that must be considered in evaluating the proposals for reform. Information is provided to assist health care professionals in understanding the various national health care proposals, applying evaluative criteria to these proposals, and advocating for needed changes.

A social learning model of adolescent contraceptive behavior.

PIP: Decision making and socialization models have advanced our knowledge of adolescent contraceptive behavior. They also show the vital role values, attitudes, and beliefs play in contraceptive use. A social work professor builds on these models and adds values, attitudes, and beliefs to a new social learning model of contraceptive behavior to improve on the weaknesses of those models. This new model considers contraceptive behavior an active response instead of a passive response. It uses 3 major components to explain how adolescents learn and preserve contraceptive behaviors. They include environmental context, cognitive influences, and behavior executive constraints. Accurate sexuality information, available contraceptive services, and availability of role models constitute the environmental context. These environmental factors either support or limit contraceptive use. Perception of need and consequences is a cognitive influence and embraces judgment of immediate and delayed consequences and probability and susceptibility to pregnancy and sexually transmitted diseases (STDs); perception of pregnancy/STD seriousness; and expectation regarding personal mastery. The other cognitive influence is decision making processed which involved generating, evaluating, and selecting alternatives. Advantages of this model are its flexibility to apply it to different groups of adolescents and its emphasis on reducing the risk of acquiring an STD as well as pregnancy prevention. Researchers of contraceptive behavior among adolescents should consider all 3 model components when designing research that aims to predict birth control behavior.^ieng

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).

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.

PIP: This prospective study assesses a sample of adolescent oral contraceptive users from 3 clinics run by a private family planning agency in Oakland, California 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. 1/2 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 include reassurance by staff, increased teaching of adolescents by practitioners to associate their pill-taking with another daily activity and to call the clinic should a side-effect occur. The typical medical protocol in family planning clinics requiring referral for additional tests may also interfere with some teenagers' continued use of birth control. Time spent in explaining the need for the tests and better follow-up will also enhance continuation.

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

PIP: Family planning clinic personnel have reported high rates of contraceptive discontinuation among adolescent clients and the majority of these teenagers fail to return for their 3-month and annual reproductive health examinations. To learn more about the characteristics of adolescents unlikely to return to family planning clinics for follow-up care, the medical history records of 218 adolescent oral contraceptive acceptors at 6 clinic sites in California's Bay Area were randomly selected from a sampling frame of all females 17 years of age and younger who received their initial OC prescription during the 22-month study period. The average age of study respondents was 15.4 years; 48% were black, 39% were white, 8% were Hispanic, and 4% were Asian. The average age at 1st intercourse was 14.3 years; only 9% of study subjects obtained contraception before becoming sexually active. Over half (110 adolescents) of the sample failed to return to the family planning clinic for follow-up care. Both bivariate and multivariate analyses were conducted to determine the correlates of nonreturn. There were no significant differences between adolescents were returned to the clinic and those who did not in terms of age, ethnicity, clinic where served, or other sources of medical care. In terms of reproductive history, adolescents who started having intercourse at younger ages and those who waited longest after the onset of intercourse to seek contraception were least likely to return to the clinic. 75% of the adolescents who had a sexually transmitted disease at the time of the initial visit did not return. Other factors significantly correlated with nonreturn for follow-up were irregular menstrual periods, referral for additional medical tests, failure to have obtained a pap smear in the year prior to the initial visit, and the presence of general health problems such as asthma.^ieng

Multiple pregnancies among adolescents: incidence and correlates.

The study of adolescent fertility traditionally has focused on understanding and predicting the occurrence of an initial adolescent pregnancy. The complex problem of multiple pregnancies among teenagers is explored. Current knowledge regarding the incidence and correlates of repeated pregnancy is summarized and reviewed. Intervention strategies and directions for further research are suggested.

PIP: Research on teen pregnancy has usually focused on causes, incidence, and strategies on reduction, but recently some work has been done on the complex problem of repeated pregnancies. Evidence shows increased health risks associated with repeated pregnancies. The number of these cases questions the validity of access to birth control information and the desire to prevent pregnancy as sufficient means to stop teen pregnancy. The rate of teen pregnancy is increasing as well as sexual activity, and the birth rate is increasing in relation to the increase in abortions. In 1981, 22% of teens who gave birth has a previous birth, and 13% of those having abortions had a previous birth. Recent studies, although not confirmed, estimate that repeated pregnancies range from 17% in the 1st year up to 38% within 2 years for teens. The earlier the 1st pregnancy, the more likely a 2nd pregnancy will occur and in 80% of the cases, an unintended one. Those with a lower educational status and especially high school dropouts tend to have multiple pregnancies. Higher rates of repeated pregnancies occur in Hispanic and black teens than in white teens, with Hispanic being the highest. Birth control use appears to decline after the 1st pregnancy due to side effects and health fears. Teens having abortions seem to receive little attention concerning prevention of future pregnancies. Any program that deals with teen pregnancies must pay special attention to teens under 15 and males.