Recruiting and enrolling pregnant adolescents for research.

Difficulty obtaining a sample is not justification for failure to study a hard-to-enroll population, particularly a vulnerable population such as pregnant adolescents. Recruitment of a representative, adequate sample of pregnant adolescents for a recent instrument development study provided multiple challenges. Although carefully developed, the sampling plan required several modifications to achieve the sample (n=145). Those challenges and the ensuing modifications to the sampling plan are discussed in relation to (a) access/institutional concerns, (b) the human subject's protection considerations, and (c) developmental/personal concerns of the pregnant adolescents. Recommendations for sampling strategies for future research are offered.

Health-risk behaviors in a sample of first-time pregnant adolescents.

OBJECTIVE: The purpose of this study was to assess the frequency of prenatal health-risk behaviors (substance use, sexual risk taking, and prenatal class attendance) among a nonrandom sample of first-time pregnant adolescents. DESIGN: The design is descriptive. SAMPLE: 145 ethnically diverse first-time pregnant adolescents aged 15-18 years. MEASUREMENT: Health behavior questions modified from the Center for Disease Control's Youth Risk Behavior Surveillance System. RESULTS: The health-risk behavior most modified during pregnancy was alcohol use (64/145 drank but quit and 1/145 did not quit). Of the 52/145 who used street drugs, nine continued despite pregnancy. Of the 75/145 who smoked early in pregnancy, 39 continued. The majority did not use a condom at last sexual intercourse. Approximately half attended a prenatal class and half attended a teen parenting class. CONCLUSION: Health-risk behaviors captured by birth certificate data are thought to be underreported for all age groups, and the prevalence of health-risk behaviors in this sample of pregnant teens was often greater than the most recent national trend data available. The magnitude of the effects of health-risk behaviors on pregnancy outcomes necessitates improved data gathering to enhance planning and evaluation of research and interventions at community, system, and individual/family levels.

Setting a new course for advanced practice community/public health nursing.

In recent years the changes in the organization and delivery of health care have created an environment that places great demands on nursing education at all levels. Determining a sound, responsive course of study in advanced practice community/public health nursing (C/PHN) is dependent on clear educational outcomes and competencies. Outcomes and competencies for C/PHN practice need to continue to be derived from the rich knowledge, experience, and research tradition with populations living in the community. However, in today's health care environment, these outcomes and competencies also must be integrated within the context of a very different health care system perspective. This article describes the outcomes and competency indicators developed to guide a curriculum designed to integrate traditional C/PHN and a health systems perspective for students seeking advanced practice education in C/PHN at the College of Nursing, University of Nebraska Medical Center.

Determinants of Medicare home healthcare service use among Medicare recipients.

BACKGROUND: Medicare reimbursement for home healthcare (HHC) services has changed dramatically in recent years. A clear understanding of the determinants of Medicare HHC services use is needed so that HHC agencies can meet the demand for services from an aging population while remaining financially sound. OBJECTIVES: The purpose of the study was to identify the determinants of Medicare HHC service within the framework of the Andersen Behavioral Model. METHODS: This cross-sectional secondary analysis used data from the 1996 Medical Expenditures Panel Survey to examine characteristics of 239 subjects who had received Medicare reimbursed HHC services. Predisposing characteristics, enabling resources, and need characteristics were examined to explain Medicare HHC service use. Two criterion measures, annual Medicare expenditures and days of care, were employed in hierarchical regression analyses. RESULTS: Variance in annual Medicare expenditures was explained by both the predisposing (R(2) =.16, <.001) and need characteristics (R(2) =.09, <.001). Variance in days of care was explained by predisposing characteristics (R(2) =.12, <.001) and need characteristics (R(2) =.15, <.001). The adjusted for the total model was.21 for annual Medicare expenditures and.25 for days of care. CONCLUSIONS: While Andersen's Behavioral Model is useful in explaining Medicare HHC service use, it may be important to use multiple measures as criterion variables since the amount and proportion of variance explained differs with the variable used.

Seniors' need for and use of Medicare home health services.

This study examined: (a) nature and extent of seniors' need for care both at time of admission to and discharge from Medicare home health services, and (b) relationships among admission need, service utilization, need at discharge, and discharge disposition for one episode of home care services. The sample of 195 was stratified by home health discharge disposition: (a) acute group, (b) chronic group, and (c) stable home group. Two classification systems were used to access the seniors' level of need, the mandated Medicare case-mix system (CMS) and a holistic intensity of need system. Findings show that there were no differences in services received by the three groups, that discharge did not mean seniors' need for home care services had been eliminated or reduced, and that caregiver support impacts seniors' need for home care.