Social support, resource utilization, and well-being: a survey of adolescent parents in Washington, DC.

BACKGROUND: Adolescent parents experience worse health and socioeconomic outcomes compared to older parents. Little is known about the factors that can lead to better health and well-being among teen-headed families. A city-wide collaborative conducted a comprehensive well-being assessment of expectant and parenting teens in Washington, DC. METHODS: An online, anonymous survey was conducted with adolescent parents in Washington, DC, using convenience sampling. The survey consisted of 66 questions adapted from validated scales of quality of life and well-being. Descriptive statistics were used to describe the data overall, by subgroups of mother and father, and by subgroups of parent age. Spearman's correlations were utilized to demonstrate associations of social supports with well-being metrics. RESULTS: A total of 107 adolescent and young adult parents from Washington, DC, completed the survey; 80% of respondents identified as mothers and 20% as fathers. Younger adolescent parents rated their physical health better compared to older adolescent and young adult parents. Adolescent parents reported accessing various governmental and community-based resources in the preceding 6 months. The most used resources were supplemental food programs, with 35% receiving Supplemental Nutrition Assistance Program benefits and 24% receiving support from the Special Supplemental Nutrition Program for Women, Infants and Children. There was no significant difference in health-related well-being metrics among those who did and did not receive resources. Having higher self-reported social support was positively correlated with higher self-rated physical health, mental health, and well-being, as well as experiencing positive emotions, and was negatively correlated with experiencing negative emotions. CONCLUSION: This snapshot of the well-being of expectant and parenting teens in Washington, DC, showed overall positive physical, mental, and emotional health. Greater social support was correlated with better outcomes in these areas. Future work will leverage the multidisciplinary collaborative to translate these findings into policies and programs that meet the needs of this population.

Adolescent Nocturnal Fears: a psychometric evaluation of the fear of sleep inventory (FoSI).

Objective: Nocturnal fears are associated with trauma-related sleep disturbance in adults, yet research is limited addressing this relationship in adolescents. This study evaluated the validity of the Fear of Sleep Inventory (FoSI) as a measure of nocturnal fears broadly and in relation to trauma exposure in adolescents. Participants: Students ages 14-18 from two urban school-based health centers were the participants. Methods: De-identified clinical data were utilized from a mental health screening battery. Two exploratory factor analyses (EFA) were conducted using the full 23-item FoSI and the 13-item short form. Cronbach's α and Pearson correlation coefficients were employed to examine the convergent and divergent validity of the total scores and the factors derived from the EFA with Insomnia Severity, probable PTSD, and parental monitoring respectively. Results: The 23-item FoSI showed high internal consistency (α = .84); however, EFA yielded an unclear factor structure. Further analysis indicated that an 11-item FoSI yielded a clear 2-factor structure with subscales conceptualized as (a) Fear of Sleep and (b) Vigilant Behavior. Conclusions: The FoSI-11 demonstrates promise as a measure of nocturnal fears in adolescents and can help reveal distinctions between trauma-related nocturnal fears and nocturnal fears associated with psychological or environmental factors. It can be utilized as a screener to highlight adolescent nocturnal fears in large group settings, while also identifying individuals in need of further assessment of trauma exposure. Future studies should include the FoSI-11 to provide a more thorough examination of the role of adolescent nocturnal fears in the relationship between trauma and sleep disturbance.

The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women.

BACKGROUND: African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format. METHODS: Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported. RESULTS: Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended > or = 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were fully completed (where all required risk content was covered). Ninety-three percent of the subsample of intervention women had a positive view of their relationship with their counselor. Most intervention women found the session content helpful. Implementation challenges of addressing multiple risk behaviors are discussed. CONCLUSION: While implementation adjustments and flexibility are necessary, multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services, and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions.

Prenatal care reduces the impact of illicit drug use on perinatal outcomes.

OBJECTIVE: To estimate the extent that prenatal care (PNC) retains its protective influence against prematurity, low birth weight (LBW), and small for gestational age (SGA) status in infants exposed to illicit drug use (IDU) in pregnancy. STUDY DESIGN: This was a prospective cohort analysis including 6673 women residents of the District of Columbia (Washington, DC, USA) delivering at four city hospitals. Women were screened in the immediate postpartum period. Levels of PNC were established according to American College of Obstetrics and Gynecology guidelines and the Kotelchuck index. PNC and IDU were compared between subgroups. Adjusted relative risks for prematurity, LBW and SGA, controlling for maternal and gestational ages, were calculated in different groups according to IDU and level of PNC. RESULTS: IDU was identified in 13% of mothers screened. PNC was classified as none (6%), inadequate (10%), intermediate (20%), and adequate (64%). The highest risk for prematurity, LBW, or SGA occurred in infants born to mothers with no PNC and positive IDU in pregnancy (prematurity OR=12.05, 95% CI: 8.99 to 16.16; LBW OR=14.76, 95% CI: 11.03 to 19.75; SGA OR=9.20, 95% CI: 5.32 to 15.92). As PNC levels increased, significant reductions in risk for prematurity and LBW (not for SGA) in IDU-exposed infants were observed. Risk for SGA in IDU-exposed infants reduced significantly when PNC was introduced. CONCLUSIONS: In infants exposed to IDU, a reduction in risk for prematurity, LBW, and SGA, was consistently demonstrated with improved levels of PNC. In high-risk populations, health care should seek to reach mothers early, especially those identified at risk for IDU, and deliver PNC to them effectively.

The effect of a parenting education program on the use of preventive pediatric health care services among low-income, minority mothers: a randomized, controlled study.

OBJECTIVE: To determine if a community-based intervention program focusing on parenting education will have an impact on preventive health care utilization behaviors among low-income, minority mothers in Washington, DC. DESIGN: The experimental design was a randomized, controlled study in which 286 mother-infant dyads were assigned to either the standard social services (control) group or to the intervention group. Women and their newborn infants were recruited during the immediate postpartum period in 4 Washington, DC, hospital sites from April 1995 to April 1997. The year-long multicomponent intervention included home visits and hospital-based group sessions in addition to the standard social services available at the hospital sites. A total of 286 postpartum women with inadequate prenatal care were assigned randomly to the control or the intervention group. Women and their infants were followed for 1 full year. Outcome measures included usage of preventive health care services including well care infant visits and adherence to immunization schedules during the first year of the infant's life. RESULTS: Infants in the intervention group initiated well care at an earlier age than controls (by 6 weeks, 62.5% vs 50% had received their first well infant visit). Infants in the intervention group had more frequent well visits (by 12 months of age, 3.5 vs 2.7 visits). Multivariate analyses showed infants in the intervention group to be more likely to complete their scheduled immunizations (by 9 months, odds ratio = 2.2, 95% confidence interval: 1.09-4.53). Those in the intervention group with more frequent contacts (30+ visits) with study personnel were most likely to have followed age-appropriate immunization schedules when compared with controls (at 9 months odds ratio = 3.63, 95% confidence interval: 1.58-8.33). CONCLUSIONS: It is possible to influence health care usage patterns of high-risk minority populations through public health interventions that are global in their perspective. Focusing on parental knowledge and beliefs regarding health-related issues and life skills in a self-efficacy model is associated with improved usage of infant health care resources.