A qualitative study of the meaning of fatherhood among young urban fathers.

OBJECTIVE: To explore the beliefs, attitudes, and needs young men have regarding their role as a father. DESIGN AND SAMPLE: Exploratory, descriptive, qualitative design. Young fathers/young expectant fathers were recruited from service sites within a city in Massachusetts. Men were considered young fathers/young expectant fathers if they were or would be <20 years old at the birth of a first child or the mother of their baby was or would be <20 years old at the baby's birth and the young man was <25 years old. MEASURES: Participants were interviewed utilizing open-ended questions, which included the following: the characteristics of good fathers, goals/needs for self and child, and whether or not they planned to raise the child as their father raised them and why. RESULTS: Responses regarding fathering clustered into the following themes: being available; providing support; and self-improvement, including completing education and becoming a positive role model. Forty-seven percent believed that being employed or finishing school would help them be better fathers; 77% reported they would not raise their child as their own father had raised them, citing physical and/or emotional abuse/abandonment. CONCLUSIONS: Young men in this study identified several challenges to being "good" fathers. These included lack of employment, education, and positive role models.

Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

PROBLEM: Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. APPROACH: Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. OUTCOMES: This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. NEXT STEPS: The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

Adolescent mothers' attitudes toward contraceptive use before and after pregnancy.

STUDY OBJECTIVE: To understand attitudes and beliefs influencing use and nonuse of contraceptive methods pre- and postpartum among a group of adolescent mothers. DESIGN AND SETTING: Qualitative descriptive study utilizing focus groups conducted between May, 2005 and January, 2006 in Central Massachusetts. PARTICIPANTS: Adolescent mothers attending a federally funded multi-professional medical program. Inclusion criteria included being at least one year postpartum. Forty-six mothers were eligible; 34 were successfully contacted via telephone. Twenty-two agreed to attend; 15 adolescent mothers attended one of four groups. MAIN OUTCOME MEASURE: Emergent themes were identified concerning adolescent mothers' attitudes and beliefs regarding contraception pre and postpartum. RESULTS: Themes pertaining to nonuse of contraception prior to first pregnancy were: denial, not planning to have sex, not considering the consequences of unprotected sex, and wanting to become pregnant. Participants identified barriers to obtaining and utilizing contraception, including embarrassment discussing the topic, confidentiality, inability to obtain contraception without parental knowledge, and lack of knowledge regarding methods. Participants reported that convenience, perceived effectiveness, familiarity, and side effects were the primary reasons for selecting or changing a method of contraception postpartum and recommended several methods of promoting contraceptive use among adolescents. These included persuading health care providers to discuss the issue routinely with every adolescent patient, parental involvement, outreach by young mothers to at-risk teens, and media campaigns. CONCLUSIONS: Given the adverse consequences of adolescent pregnancy, understanding the attitudes and beliefs of postpartum adolescents regarding contraceptives is important for developing effective interventions. Focus groups conducted with adolescent mothers, a difficult population to engage, provide a venue for exploring this complex issue.

Multilevel Provider-Based Sampling for Recruitment of Pregnant Women and Mother-Newborn Dyads.

OBJECTIVE: In 2010, the National Children's Study launched 3 alternative recruitment methods to test possible improvements in efficiency compared with traditional household-based recruitment and participant enrollment. In 2012, a fourth method, provider-based sampling (PBS), tested a probability-based sampling of prenatal provider locations supplemented by a second cohort of neonates born at a convenience sample of maternity hospitals. METHODS: From a sampling frame of 472 prenatal care provider locations and 59 maternity hospitals, 49 provider and 7 hospital locations within or just outside 3 counties participated in study recruitment. During first prenatal care visits or immediately postdelivery at these locations, face-to-face contact was used to screen and recruit eligible women. RESULTS: Of 1450 screened women, 1270 were eligible. Consent rates at prenatal provider locations (62%-74% by county) were similar to those at birth locations (64%-77% by county). During 6 field months, 3 study centers enrolled a total prenatal cohort of 530 women (the majority in the first trimester) and during 2 months enrolled a birth cohort of an additional 320 mother-newborn dyads. As personnel became experienced in the field, the time required to enroll a woman in the prenatal cohort declined from up to 200 hours to 50 to 100 hours per woman recruited. CONCLUSIONS: We demonstrated that PBS was feasible and operationally efficient in recruiting a representative cohort of newborns from 3 diverse US counties. Our findings suggest that PBS is a practical approach to recruit large pregnancy and birth cohorts across the United States.

Adolescent pregnancy.

Teen birth rates have decreased steadily over the past decade, but the United States still has the highest birth rates among all developed countries. Young women who give birth as adolescents are likely to have poor school performance, and come from families with low socioeconomic status, a history of teen pregnancies, and low maternal education. The fathers of babies who are born to teen mothers are likely to be unsuccessful in school, have limited earnings, have high rates of substance use, and have trouble with the law. Infants who are born to teen mothers are at risk for low birth weight and physical neglect and abuse; at school age, these children are more likely than children born to adult women to have trouble with school achievement, and they are at risk for becoming teen mothers or fathers themselves. Programs that are successful in reducing teen birthrates are usually multifactorial and combine comprehensive sexuality education with youth development activities; reduction in repeat pregnancies is associated with home visits by nurses combined with long-acting contraceptive use.

Adolescent medicine training in pediatric residency programs.

OBJECTIVES: The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine. METHODS: We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents' ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience. RESULTS: Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues. Those least well covered concern the effects of violence, motor vehicle safety, sports medicine, and chronic illness. Shortages of adolescent medicine specialists, addictions counselors, psychiatrists, and other health professionals who are knowledgeable about adolescents frequently limit pediatric residency training in adolescent medicine. Considerable variation exists in the timing of the mandatory adolescent medicine block rotation, the clinic sites used for ambulatory care training, and the range of services offered at the predominant training sites. In addition, residents' continuity clinic experience often does not include adolescent patients; thus, pediatric residents do not have opportunities to establish ongoing therapeutic relationships with adolescents over time. Both program and rotation directors had similar opinions about adolescent medicine training. CONCLUSIONS: Significant variation and gaps exist in adolescent medicine ambulatory care training in pediatric residency programs throughout the United States. For addressing the shortcomings in many programs, the quality of the block rotation should be improved and efforts should be made to teach adolescent medicine in continuity, general pediatric, and specialty clinics. In addition, renewed attention should be given to articulating the core competencies needed to care for adolescents.

Vulnerability-based spatial sampling stratification for the National Children's Study, Worcester County, Massachusetts: capturing health-relevant environmental and sociodemographic variability.

BACKGROUND: The National Children's Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of > 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits. Worcester County, Massachusetts, like other sites, stratifies according to local conditions and local knowledge, subject to probability sampling rules. OBJECTIVES: We answer the following questions: How do we divide Worcester County into viable strata that represent its health-relevant environmental and sociodemographic heterogeneity, subject to sampling rules? What potential does our approach have to inform stratification at other sites? RESULTS: We developed a multivariable, vulnerability-based method for spatial sampling consisting of two descriptive indices: a hazards/stressors exposure index (comprising three proxy variables), and an adaptive capacity/sociodemographic character index (five variables). Multivariable, health-relevant stratification at the start of the study may improve detection power for environment-child health associations down the line. Eighteen strata capture countywide heterogeneity in the indices and have optimal relative homogeneity within each. They achieve comparable expected birth counts and conform to local concepts of space. CONCLUSION: The approach offers moderate to high potential to inform other sites, limited by intersite differences in data availability, geodemographics, and technical capacity. Energetic community engagement from the start promotes local stratification coherence, plus vital researcher-community trust and co-ownership for sustainability.

The body mass index of teen mothers and their toddler children.

OBJECTIVES: To evaluate: change in Body Mass Index (BMI) of adolescent mothers (14-19 years of age) from pre-pregnancy to 36 months postpartum; BMI of their children age 2 or older; relationship between maternal BMI and children's BMI. METHODS: Retrospective medical record abstraction of adolescent mothers attending a medical program in Massachusetts between 2001 and 2005 who had self-reported pre-pregnancy BMI data at first prenatal visit, at least one BMI measure 12 or more months postpartum, and who did not experience a repeat pregnancy (n = 52). Children of adolescent mothers were included if they had received their 2 (n = 41) and/or 3 (n = 28) year physical. RESULTS: Adolescent mothers: overweight increased from 25% pre-pregnancy to 33% at 24-36 months postpartum; obesity more than doubled in the same time period, from 15% to 36%. Those with BMI data available pre-pregnancy and postpartum had an increase in mean BMI from 25 pre-pregnancy to 29 at 24-36 months postpartum (P < 0.001). Two-year-old children: About 5% were at risk for overweight and 12% were overweight. Three-year-old children: About 18% were at risk for overweight and 18% were overweight. When BMI categories of children were compared to BMI categories of their mothers, there was a trend for adolescent mothers with overweight/obesity at 24-36 months postpartum to have 3-year-old children at risk for overweight or overweight (P = 0.092). CONCLUSIONS: There was a significant increase in overweight/obesity in this cohort of adolescent mothers and their children followed 36 months postpartum. The long-term sequelae of overweight/obesity indicates a need for effective interventions.

Sisters' and Girlfriends' Sexual and Childbearing Behavior: Effects on Early Adolescent Girls' Sexual Outcomes.

This study examined three key issues related to the effects of sisters' and girlfriends' sexual and childbearing behavior on early adolescent girls' sexual outcomes. Subjects were 455 girls from predominantly minority racial backgrounds. Results indicated that number of sexually active girlfriends, number of sexually active sisters, and presence of an adolescent childbearing sister were positively associated with permissive sexual attitudes, positive intentions for future sexual activity, and a greater likelihood of being a nonvirgin. The strength of these relationships did not vary by race, but there was a greater presence of permissive social influences for African American girls than for nonblack girls. Results from multiple hierarchical regression analyses indicated that having both many sexually active girlfriends and an adolescent childbearing sister had particularly strong effects on permissive sexual attitudes and a nonvirgin status.