Comprehensive School-Based Services for Pregnant and Parenting Adolescents in West Dallas, Texas

A cohort of 339 Black (n = 210), Hispanic (n = 118), and other (n = 11) adolescent mothers in Dallas, Texas, were followed from the start of their pregnancy through the school year of the delivery to assess differences in numbers of prenatal care visits, postpartum care, repeat deliveries, and school continuation rates. Approximately one-half the teens received reproductive services at a comprehensive, school-based clinic and one-half at a categorical (Title XX) family planning and prenatal care clinic. Adolescents attending the school-based clinic were more likely to be in school at conception and averaged more prenatal visits than those served by the categorical provider. However, during the pregnancy and following the delivery, school dropout rates for the two sets of teens converged. School continuation rates were higher among a subset of adolescents attending the Dallas Independent School District school for pregnant teens than among other teens. Hispanic teens were two times more likely than their Black counterparts to drop out of school. No differences were found in repeat birth rates, by ethnicity, clinic site, or school attended.     

Prenatal Care for Pregnant Adolescents in a Public High School

Two groups of pregnant adolescents enrolled in the St. Paul, Minnesota Maternal and Infant Care Project were involved in this study. A retrospective analysis of obstetrical summary sheets of delivered pregnant adolescents was conducted to demonstrate the relationship of the availiability of a comprehensive, interdisciplinary program of prenatal care in a regular public school setting to the achievement of early and continuous prenatal care and to the minimizing of obstetrical complications of the pregnant adolescents who were students in the school. A total sample of 36 students who received prenatal care in the school clinic (study group) from 1973 to 1976 was compared with a random sample of 36 adolescent patients (matched for race) who received care at a non-school clinic (comparison group). The data demonstrated that the study group initiated care earlier and had more total prenatal visits than did the comparison group. Also demonstrated were fewer obstetrical complications in the study group than in the comparison group. The comparison group had more low birth weight infants and more complicated deliveries than did the study group. Therefore, the results of this study support the initial objective and may have significance for educators and health personnel.     

Reduced low birth weight for teenagers receiving prenatal care at a school-based health center: effect of access and comprehensive care.

PURPOSE: To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based. METHODS: Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics. RESULTS: Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24). CONCLUSIONS: School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.     

Adolescent health care: improving access by school-based service

Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused on depression and feelings of uncertainty about the future.     

New Jersey School Nurses' Perceptions of School-Based, Prenatal Nutrition Education

ABSTRACT: This study used formative evaluation to identify channels and barriers to providing ongoing dietary guidance to pregnant teens in New Jersey. In phase one, 14 health and social service professionals participated in a focus group or interview about nutrition services for pregnant teens. Participants identified school nurses as potential providers of early and continuous dietary counseling to pregnant teen-agers, but delineated barriers to establishment and effectiveness of school-based, prenatal nutrition education. In phase two, school nurses were surveyed to assess their interest in, and perceptions of barriers to, providing nutrition education to pregnant adolescents. Two-hundred fifty-three nurses (71%) returned completed questionnaires. Results indicated that a significant proportion perceived a need for, and were interested in providing, nutrition education to pregnant students. Results from this formative research are being used to guide development of a school-based nutrition education program for pregnant teen-agers in New Jersey.     

Prenatal care in Finland: from primary to tertiary health care?

Traditionally, the Finnish prenatal care system has been based on special maternity centers outside hospitals. In recent years, however, the use of hospital outpatient clinics has increased. The purpose of this study was to describe the use of the clinics and to see whether clinics serve as an addition or as an alternative to maternity centers. We used several different data sources (statistics, documents, interviews, questionnaires). The main source was data on visits for all women who gave birth in Helsinki in a five-week period in 1987. The content of care and means of care delivery differ between clinics and maternity centers. Clinics are technologically and provider-oriented without continuity of care. Clinics are not just referral centers for high-risk mothers; at least half of pregnant women visit them. Ultrasound screening is an important reason for use of the clinic. Background characteristics as well as the outcome of pregnancy were similar among women visiting a hospital clinic a maximum of one time (low users), two to three times, or four times or more (high users). Standardizing for the length of gestation, high users made fewer visits to maternity centers than did low users. Hospital clinic care now seems to replace care in maternity centers, and we found a weak trend toward a pluralistic prenatal care.     

Characteristics of pregnant adolescents receiving prenatal care at school-based or hospital-based clinics

This study examines characteristics of adolescent females in prenatal care in a hospital-based teen clinic compared to a school-based teen clinic. Interviews were conducted during 1991-92 among 189 pregnant adolescents, whose mean age was 16.22 years. 48% were African American, 42% were Hispanic, and 2% were Asian or other. 75% of adolescents were single or without a spouse. 30% lived with siblings, 21% lived with their husband, 9% lived with their boyfriend, 10% lived with in-laws, 4% lived with a friend, and the rest lived with their mothers. 48% of adolescents' mothers helped with child care. 27% did not have any help. 57% were enrolled in school, 41% dropped out, and 4% graduated. 63% planned to continue their education. 75% had a parent who served as a mentor. Over 50% lived with someone who smoked cigarettes or drank alcohol. 75% had friends or relatives who smoked. Almost 25% had a sexual partner who sold drugs, and 25% had a sexual partner who had been in trouble with the law. 14% had a partner who used drugs. 62% of adolescents who had smoked before their pregnancy quit smoking. 79% of adolescents who had consumed alcohol before their pregnancy stopped consuming alcohol. Adolescents in both clinics showed no significant differences in family welfare status, initiation of prenatal care, parity, and number of living children. There were differences by clinic type for adolescent ethnic patterns of clinic use, educational status, financial and social support, and family setting. Hispanics and Whites and school dropouts were more likely to use hospital-based care. The school-based adolescents were more likely to be single; to receive support from parents, relatives, and a job; and to have higher exposure to alcohol and substance abuse. Hospital-based adolescents were more likely to live with relatives, not to have help, and to be Spanish speakers. It is recommended that services match the characteristics and needs of clients in each local setting.     

Interventions to improve diet and weight gain among pregnant adolescents and recommendations for future research

Pregnant adolescents are at particular risk for both inadequate and excessive gestational weight gain and for inadequate intake of micronutrients that support healthy fetal development. This article reviews the available literature on prenatal nutrition interventions intended to address such risks to identify effective strategies and needs for further research. A medical model providing enhanced prenatal care aimed at improved birth weight predominated. No studies rigorously evaluated the independent influence of nutrition education on prenatal dietary behaviors or outcomes; few applied a conceptual framework or targeted dietary attitudes, behaviors, skills, or self-efficacy. Positive effect on birth outcomes was evident, likely due to multidisciplinary teams supporting the special psychosocial needs of pregnant adolescents; individualized education and counseling encouraging optimal dietary choice and appropriate gestational weight gain; home visits providing prenatal education, support, and outreach to highest-risk teens; visual presentation and tracking of gestational weight gain; and support/discussion groups. Nevertheless, greater effects could likely be achieved by applying behavior-change strategies that have been implemented effectively with other, similar populations. Further research is needed to test such approaches with pregnant, high-risk teens.     

Different dental care setting: does income matter?

In this paper we consider the use of mobile dental clinics as a means of improving access to dental care among primary school children in Southern Thailand by reducing the opportunity cost of service use to parents. Parents' willingness to pay (WTP) is measured for three different services provided in a community hospital dental clinic and a school-based mobile clinic. Although the service setting does not affect significantly the WTP for treatment directly, the estimated positive association between WTP and income is modified by setting. The results indicate that the potential for mobile clinics to increase utilization of services among primary school children is associated with parents' income, with the difference in valuation of dental services between the two settings being less among lower income parents than higher income parents. However, even among lower income parents our results indicate that the potential for increasing service utilization among children depends on the improvements in access associated with the mobile clinic not being achieved at the opportunity cost of lower levels of effectiveness.     

Outcomes of enhanced prenatal services for Medicaid-eligible women in public and private settings.

OBJECTIVE: With changes in Medicaid, more low-income women are receiving prenatal care in private practice settings. The authors sought to determine whether private settings can provide the enhanced prenatal support services for low-income women that have been offered for decades in public settings. METHODS: The authors analyzed birth outcomes of Medicaid-eligible women receiving care from public and private providers certified to deliver enhanced prenatal care services, which included assessments of nutritional, psychosocial, and health educational risks and individualized counseling along with clinical care. Birth outcomes were compared by type of provider setting using multivariate logistic regression models to adjust for differences in risks and use of care. RESULTS: Among settings certified to deliver enhanced perinatal support services, private physicians'' offices had the best risk-adjusted birth outcomes and public health department clinics the worst, while public hospital clinics had outcomes no different from private physicians'' offices. Adjusted for prenatal care use, outcomes were still better for women seen in private physicians'' offices than for women seen in public health department clinics, community clinics, or private hospital clinics. CONCLUSIONS: The findings suggest that given a certification process, private providers can provide enhanced support services as effectively as providers in public practice settings.     

Utilization of Health Services in Physician Offices and Outpatient Clinics by Adolescents and Young Women in the United States: Implications for Improving Access to Reproductive Health Services

PurposeWe examined utilization patterns of adolescents and young women as they seek general and reproductive health services in physician offices and hospital outpatient clinics.MethodsWe analyzed physician office visits in the 2003–2006 National Ambulatory Medical Care Surveys, and hospital outpatient clinic visits in the National Hospital Ambulatory Medical Care Surveys, to examine utilization patterns of females aged 9–26 years by 2-year age intervals and other characteristics such as physician specialty or clinic type.ResultsThe number of visits to primary care physician offices increased with age, from 4.9 million for ages 9–10 years to 9.0 million for ages 25–26 years. The proportion of visits made to obstetrician-gynecologists and family practitioners increased with age, and by ages 15–16 years fewer than half of all visits to primary care providers were made to pediatricians. The proportion of visits to family practitioners increased from 25% at ages 9–10 years to 30% at ages 25–26 years. By ages 17–18 years, a larger proportion of visits were made to obstetrician-gynecologists (33% of 7.0 million visits) and to family practitioners (34%) than to pediatricians (23%). The proportion of visits for reproductive health services peaked at 53% of 7.5 million physician visits at ages 20–21 years. Similar utilization patterns were observed for the 11.0 million hospital outpatient visits to primary care providers.ConclusionsBecause adolescents and young women most commonly utilize healthcare services provided by obstetrician-gynecologists and family practitioners, these specialties should be priority targets for interventions to improve the quality and availability of reproductive health services.     

The effect of source of prenatal care on care-seeking behavior and pregnancy outcomes among adolescents

This study measured the extent to which pregnancy outcomes of adolescents are related to the environment of the prenatal clinic where they receive care. The study sample consisted of women aged 18 years and under living in a medium-sized urban city in the Northeast, and who delivered their babies during 1984 or 1985 (N = 466). Hypotheses were tested using multiple regression analysis. Findings support the study's hypotheses: adolescents are likely to obtain more adequate care if the prenatal site is attractive and inviting, and if special efforts are made to register and retain them in care, and adequate care results in better outcomes.     

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).     

Nutrition services for pregnant adolescents within a public high school.

The St. Paul Maternal and Infant Care Project (MIC) was begun in 1973 in response to the recognition that pregnant adolescents were medically, nutritionally, and socially at risk. The program provides prenatal care as well as adolescent health care and drug screening. It operates within 3 inner city public high schools and has a strong educational component for parents and for infants and children. Funds come from state-allocated Title V Maternal and Child Health funds, Title XIX EPSDT funds, and grants from the Minnesota Community Health Services Act and the St. Paul-Ramsey Hospital Medical Education and Research Foundation. Title XX monies are used to support the day care component. In-kind contributions from the St. Paul Schools provide physical facilities for the school health clinics and the day care center. Since implementation, the program has secured a 50% reduction in school fertility rates, there have been fewer obstetric complications, and a lower incidence of low-birth-weight infants compared with adolescents served by the MIC Project in non-school clinics. 85% have completed high school. The article then describes the nutritional problems of pregnant adolescents and the measures taken to deal with these.     

The community perinatal health care system of urban Cape Town, South Africa--II. Geographical patterns

Greater Cape Town has developed a geographical network of perinatal health care services for low-income mothers using community-based clinics with hospital referrals. This study analyzes 25,409 births recorded in 162 different urban residential areas during 1987. The data apply to two populations--black and mixed. Information on the mother, such as height, weight, education, parity, and prenatal visits is indicated by suburb, as well as birth outcomes such as gestational age, birthweight, and method of obstetrical delivery. Comparisons are drawn between black and mixed populations and among suburbs. High utilization rates and successful maternity and infant outcomes suggest that the outreach clinics of Cape Town could provide a model for urban agglomerations in other African countries.     

The community perinatal health care system of urban Cape Town, South Africa--I. Characteristics of mothers and birth outcomes

Greater Cape Town has developed a geographical network of perinatal health care services for low-income mothers using community-based clinics with hospital referrals. This study analyzes 25,409 births recorded in 162 different urban residential areas during 1987. The data apply to two populations--black and mixed. Information on the mother, such as height, weight, education, parity, and prenatal visits is indicated by suburb, as well as birth outcomes such as gestational age, birthweight, and method of obstetrical delivery. Comparisons are drawn between black and mixed populations and among suburbs. High utilization rates and successful maternity and infant outcomes suggest that the outreach clinics of Cape Town could provide a model for urban agglomerations in other African countries.     

Effects of an urban high school-based child care center on self-selected adolescent parents and their children

This study examined the effects of an urban high school-based child care center on parenting teens and their children enrolled during 1995-1998. Retrospective record review of 52 low-income, urban adolescent parents enrolled at the Celotto Child Care Center (CCCC) during the period of study was conducted from the CCCC and the high school records. Mean age of the student parents was 17 years (s.d. = 1.3) and mean grade level was 11.2 (s.d. = 1). Most parents were female (98%) and African American (62%). Children enrolled at CCCC had a mean age of 10 months (s.d. = 10.8). Students using the services of CCCC showed improvement in overall grade point averages, and 100% were educationally successful as defined by promotion to the next grade or graduating from high school. None of the students experienced a repeat childbirth during the period of CCCC enrollment. Ninety percent of children were up-to-date with pediatric health visits and immunizations. These results lend strong support to the importance of extending child care and social support services to teen parents, and for the implementation of high school-based child care centers as alternative sites for these critically important services.