Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens.

In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.

An Integrative Review of the Research on Teen Mothers' Resilience.

Greater attention to teen mothers' strengths and aspirations has generated interest in their resilience. An integrative review of the research was undertaken to determine how teen mothers' resilience, risks, and protective factors are conceptualized across methodological approaches. In total, 10 databases were searched in 2021 to identify relevant studies. Of the 32 studies meeting criteria, the majority were conducted in the United States. Qualitative studies mined teen mothers' accounts for resilient processes, adversities, and protective factors while quantitative studies operationalized variables based on the resilience framework. The studies in this review present a more balanced and contextual perspective on teen mothers and suggest broader notions of their competence, success, and vulnerabilities. Several studies draw attention to the potential costs of resilience and the heterogeneity of teen mothers. Unfortunately, this research shows little cross-fertilization across methods. Implications of the findings for future research, policy, and practice are described.

Adverse Childhood Experiences as Public Health Threat.

Toxic stress has long-term effects on health and well-being.

Evidence for Revising the Adverse Childhood Experiences Screening Tool: a Scoping Review.

The relationship between adverse childhood experiences (ACEs) and risky behavior, chronic illness, and premature mortality is well documented. Despite this evidence, screening for ACEs in primary care settings remains limited. Objections to widespread screening include concerns that the original ACE screening tool limited childhood adversities to family and household dysfunction. The purpose of this scoping review is to describe current knowledge for expanding ACEs categories and revising the formatting and scoring of the screening tool. With the assistance of a medical librarian, we used a two-step process to conduct a systematic search in three databases (CINAHL, OVID Medline, PsycINFO). Our aim was to focus on articles that expanded ACE categories and/or revised the scoring or formatting of the ACE tool. Eighteen articles (reporting 19 studies) met criteria. A minimum of two authors extracted the relevant characteristics of the studies independently and conferred to reach agreement. The majority of studies broadened ACEs to include community and systemic categories; three studies revised the formatting or scoring of the ACE tool. Exposure to community violence (ECV) was the most frequently added category (15), followed by economic hardship in childhood (EHC) (13); bullying (10); absence/death of parent or significant others (9); and discrimination (7). This evidence supports the expansion of ACE screening tools for assessment of childhood trauma and timely treatment.

An Umbrella Review of Qualitative Research on Teen Mothering.

The sheer volume of qualitative research on teen mothering over three decades has generated numerous scientific reviews. This umbrella review synthesizes the findings of these reviews and describes the utility of this evidence for improving clinical practice and policy. A comprehensive search of six electronic databases performed through October 2019 yielded 17 articles from 15 independent reviews. Data were extracted and key findings were synthesized to yield the following paradox: mothering has the potential for transforming and redirecting teens' lives in positive ways because of, and despite, difficult childhoods, constricted pathways to adulthood, fragile partner relationships, social inequities, and stigma. By bringing visibility to the paradox that teen mothering simultaneously transforms and imperils, this review extends the science on teen mothering and enhances the generalizability and utility of small-scale qualitative studies for reframing practice, policy, and behavioral interventions.

The quest for workload equity in nurse faculty teaching.

BACKGROUND: While nurse faculty may believe that they teach more than faculty in other academic departments, their perceptions are difficult to corroborate when workload policies are not transparent at institutions. PURPOSE: This descriptive study was designed to examine inequities in teaching workloads between nurse faculty and their academic colleagues from the perspectives of Deans and Directors of Nursing Programs. METHODS: A web-based, investigator-developed survey was emailed to Nurse Unit Leaders in spring, 2019. The final sample included 224 respondents. Data were analyzed with descriptive statistics. FINDINGS: Nurse Unit Leaders perceived that nurse faculty teach larger classes and more courses than their academic peers. Survey respondents attributed these and other variations at their institutions to the complexity of teaching responsibilities in nursing units and the limited understanding of these responsibilities by university administrators. DISCUSSION: Ensuring equitable teaching workloads requires transparent policies and an organizational culture committed to faculty governance.

Screening for Adverse Childhood Experiences: Literature Review and Practice Implications.

Adverse childhood experiences (ACEs) are linked with negatively impacting child and adult health outcomes. Clinicians are integral in identifying childhood adversities and offering supportive measures to minimize negative effects. This systematic literature review included 13 ACE studies that examined the acceptability, feasibility, and implementation of ACE screenings from the perspectives of clinicians and patients. The findings of this review can assist clinicians in considering the appropriateness of ACE screenings for their patients and the ethical and practical issues that must be addressed for effective screening implementation.

Walking on Eggshells: An Update on the Stigmatizing of Teen Mothers.

Teen mothers are stigmatized for violating age norms for parenting and for being members of devalued racial or socioeconomic groups. Stereotypes of young mothers perpetuate stigma by teen pregnancy prevention campaigns, television shows, sex education programs, professionals, and the general public. How teen mothers became a stigmatized group; updates on research about their experience of stigma; and resources for reducing stigma are presented. Because stigma is pervasive and has damaging effects, nurses are urged to reduce stigma and discrimination by assuring that health settings are safe and welcoming, and that pregnant and parenting teens are treated with respect and dignity. Doing so is consistent with our professional commitment to promote social justice and mitigate the social inequities that contribute to health disparities for all parents, irrespective of age, gender, ethnicity, immigration status, or income.

Navigating a Minefield: Meta-Synthesis of Teen Mothers' Breastfeeding Experience.

Teen mothers have lower rates of breastfeeding duration and exclusivity than older mothers. A growing body of qualitative research on teen mothers' experience helps to explain these disparities. Following a systematic search to identify relevant research, we synthesized the findings from 22 primary studies to conclude that teen mothers navigate a minefield that undermines their intention to breastfeed and their breastfeeding confidence and skill. This metaphorical minefield reflects competing norms for infant feeding and good mothering, as evident in mixed support from teens' social networks; fragmented and stigmatizing healthcare; and spaces that are inhospitable to teen mothers and breastfeeding mothers in general.In recognition of this minefield, we urge clinicians to: respect teen mothers' infant feeding decisions; develop collaborative relationships based on the principles of patient-centered and strength-based care; challenge stigmatizing healthcare practices; welcome teen mothers and their significant others to clinical settings; and press health systems to fully implement probreastfeeding policies. We also recommend further study to extend our knowledge about teen mothers' breastfeeding experiences.

Family-Centered Primary Care for Teen Parents and Their Children.

Although the teen birth rate in the United States continues to decline, births remain disproportionately high among disadvantaged teens and teens of color. The vulnerabilities and resilience of teen parents are described from a historical context, with recommendations for advancing primary care of these families. We endorse comprehensive primary care and clinical practices that capitalize on the strengths and resilience of these families while recognizing the social inequities that compromise their health and development. To strengthen the bonds among young mothers, fathers, and children, we recommend family-centered primary care services that are of a youth- and father-friendly, nonstigmatizing, strength-based, and trauma-informed nature.

Fathering on Tenuous Ground: A Qualitative Meta-Synthesis on Teen Fathering.

BACKGROUND: Although teen fathers are a vulnerable group of parents, they have received far less attention than teen mothers. PURPOSE: We conducted a systematic search of qualitative studies that examined their prenatal and postpartum experience to better understand teen fathers' concerns, strengths, and vulnerabilities. METHODS: We searched nine electronic databases through September 2017; 29 studies represented in 30 articles met study criteria. All authors independently extracted data from each article. Coding decisions were reviewed weekly and differences were settled by consensus. RESULTS: From pooling the results of 29 primary studies, we describe how a tenuous ground contributes to teen paternity and imperils young fathers' involvement with their children. In the best of circumstances, the ground begins to stabilize for teens who become involved parents despite significant challenges and hardships. CLINICAL IMPLICATIONS: Our results contribute to the visibility of teen fathers and the social disparities that imperil fathering. We provide clinical guidance for strengthening the ground for teen fathers and their families, recognizing that clinicians often encounter challenges such as interpersonal factors and sociocultural conditions that systematically erode fathers' ties to their children, partners, professional caregivers, and institutions.

Housing trajectories of teen mothers and their families over 28 years.

Housing has received little attention in the research on teen mothers. A qualitative longitudinal study presented a unique opportunity to examine how teen mothers house their families over time. The study began in 1988 and has followed teen mothers and family members for 7 waves over 28 years. The 7th wave began in 2016. The specific aims of this substudy were to describe the housing trajectories of teen mothers over 28 years and to explore how their housing trajectories were shaped by family resources, housing programs, and discrimination. Data from 9 families were analyzed using interpretive phenomenology. Housing instability was pervasive for Black mothers who were disadvantaged as children. Their stories included many moves, doubling up, sending children to live with others, depression, unreliable partners, and racism. Housing instability was a source of toxic stress, interrupted personal and family goals, undermined family routines, and reflected a legacy of discriminatory housing policies. In contrast, White advantaged mothers were stably housed as children and adults, which reflected longstanding family resources, stable marriages, husbands' steady employment, and tax deductions for homeownership. These stark differences in housing trajectories reflect and reproduce multigenerational social and health inequities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The past is prologue? The long arc of childhood trauma in a multigenerational study of teen mothering.

The purpose of this interpretive phenomenological study was to describe intergenerational patterns in adverse childhood experiences (ACE) and protective childhood experiences among teen mothers, their parents and children, and to include social disadvantage as a source of ACE. At the seventh wave of a study that has followed teen mothers and families beginning in 1988 for 28 years, 42 family members were reinterviewed in 2016. Adult participants also completed two tools that identify ACE and childhood family strengths. After narrative data were coded inductively, Interpretive Family Profiles were created to facilitate case and cross-case analysis. Of the 9 participating teen mothers at Time 7, 4 reported few ACE and many family strengths; their parents and children reported similar scores. Of the 5 mothers reporting high ACE, children's scores improved with one exception. Findings suggest that mothers' aspirations to shield their children from trauma was a fragile endeavor for mothers who faced ongoing trauma and economic hardships. Clinicians may facilitate intergenerational repair by capitalizing on mothers' aspirations with trauma-informed care and referrals to community resources. Trauma assessment should also include poverty-related ACE and experiences related to stigma and discrimination.

A methodological review of qualitative longitudinal research in nursing.

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients' and care-givers' experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR.

An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers.

The purpose of this study was to perform an umbrella review of meta-analyses of intervention studies designed to improve outcomes of pregnant or parenting teenagers. An extensive search retrieved nine reports which provided 21 meta-analyses analyses. Data were extracted by two reviewers. Methodological quality was assessed using the AMSTAR Instrument. Most effect sizes were small but high quality studies showed significant outcomes for reduced low birth weight (RR = 0.60), repeat pregnancies/births (OR = 0.47-0.62), maternal education (OR = 1.21-1.83), and maternal employment (OR = 1.26). Several parenting outcomes (parent-child teaching interaction post-intervention [SMD = -0.91] and at follow-up [SMD = -1.07], and parent-child relationship post-intervention [SMD = -0.71] and at follow-up [SMD = -0.90]) were significant, but sample sizes were very small. Many reports did not include moderator analyses. Behavioral interventions offer limited resources and occur too late to mitigate the educational and social disparities that precede teen pregnancy. Future intervention research and policies that redress the social determinants of early childbearing are recommended.

Moms growing together: Piloting action methods and expressive arts in a therapeutic group for teen mothers.

PURPOSE: The purpose of this pilot study was to test the safety, acceptability, feasibility, and effectiveness of Moms Growing Together (MGT), an intervention to prevent and reduce psychological distress in teen mothers. STUDY DESIGN AND METHODS: A mixed method design was used. The primary outcomes were reported satisfaction with MGT (acceptance); successful recruitment and retention of teen mothers (feasibility); and prevention or reduction of psychological distress (safety and effectiveness). Summary scores on each of three symptom measures operationally defined psychological distress. Sixteen African-American teen mothers participated in the study: eight in MGT and eight in a comparison group. RESULTS: MGT was considered safe and acceptable. MGT had a negative small effect (effect size [ES] = -0.028) on decreasing depression in participants and a moderate effect in reducing anxiety (ES = 0.395) and trauma symptoms (ES = 0.521-0.554) relative to the comparison group. Prolonged recruitment limited feasibility. CONCLUSION: Because psychological distress casts a long shadow on teen mothers' well-being, developing teen-friendly clinical programs that address their mental health is a high priority.