The family as a protective asset in adolescent development.

Adolescents are considered at high risk for engaging in such negative health behaviors as drug and alcohol use, unprotected sexual intercourse, and violence. Conventional wisdom has long upheld the belief that the peer group exerts the strongest influence on adolescent behavior. However, recent research has shown that in fact the family remains a strong factor in moderating teen risk behavior. Holistic nursing acknowledges the crucial relationship between environment and health; the environment is composed of everything that surrounds the individual, which by definition includes the family. The purpose of this article is to examine the evidence supporting the concept of the family as a protective external asset in adolescent development, to explore the way the family helps defend young people from risk, and to review briefly the implications for nursing research, practice, advocacy, and education.

Preventing injuries to infants of adolescent mothers.

Infant injury prevention is an important issue for practitioners who work with adolescent mothers. Data are presented to examine the association between having a young mother and being injured as an infant. Prevention messages need to take into account that parents in general tend to minimize the magnitude of injury risk to their children. With careful documentation, using External Cause of Injury Codes, practitioners may be able to estimate the cost savings of prevention initiatives.

A randomized trial of a health care program for first-time adolescent mothers and their infants.

To test the effectiveness of a special health care program for adolescent mothers (17 years old or younger) and their infants, 243 mother-infant pairs were randomly assigned to one of two groups. All of the mothers were unwed, on Medicaid, and black. The control group received routine well-baby care. The experimental group received routine care and services that included rigorous follow-up, discussions with the mother about her plans for return to school and use of family planning methods, and extra health teaching. The dropout rate in the experimental group (60%) was significantly less after 18 months than the control group (82%). In spite of the high dropout rate, 91% of the mothers were located for the 18 month follow-up interview. The repeat pregnancy rate in the experimental group was 12% after 18 months, and 28% in the control group. There was no significant difference in the percentage returning to school. After 12 months, the infants in the experimental group were more likely to be fully immunized (33%) than the infants in the control group (18%). Mothers in the special care program who continued to attend clinic used the emergency room less than the mothers who continued to attend in the control group. These results suggest that a comprehensive health care program is one way to bring about better outcomes for both adolescent mothers and their infants.

PIP: 120 adolescent mothers who delivered at a large teaching hospital in Philadelphia, Pennsylvania, and their infants were assigned to an experimental group who had received special care which included rigorous follow-up, discussions with the mothers about plans to return to school and use of family planning, and additional health education. Another 123 mothers formed the control group and received only routine well-baby care. A nurse practitioner directed the experimental clinic. All the cases and controls were African American, on Medicaid, and unmarried. Mothers in the control group were more likely to return for all well-baby visits (at 2 weeks, 92% vs. 76%; at 18 months, 40% vs. 18%; p = 0.002). At 18 months, the dropout rate was high for both groups, but it was less for the experimental group than the control group (60% vs. 82%). Nevertheless, clinic staff were able to locate 91% of the mothers at 18 months postpartum. At 18 months, mothers in the experimental group had a lower repeat pregnancy rate than did those in the control group (12% vs. 28%; p = 0.003). More than 50% of mothers from both groups returned to school with no significant difference between the 2 groups. Children of mothers in the experimental group were more likely to be fully immunized at 18 months than those in the control group (33% vs. 18%; p 0.02). Experimental group mothers who still attended the clinic at 18 months were less likely to use the emergency room for infant care at least once than control group mothers who still attended the clinic (81% vs. 100%; p 0.03). These findings indicate that a comprehensive health care program improves outcomes for adolescent mothers and their infants. The high dropout rates from clinic attendance suggests a need for more research into developing programs targeting adolescent mothers.