Adolescent Health Care in the United States
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The Adolescent Client
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Trends in Adolescent Sexual Behavior, Pregnancy, and Childbearing
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Background Factors
- Sexual Activity and Use of Birth Control
- Peer Pressure and Partner Pressure
- Other Factors
Young Men and Parternity
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Early Identification of the Pregnant Teen
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Special Issues in Caring for the Pregnant Teen
Violence
Initiation of Prenatal Care
Low Birth Weight Infants and Preterm Delivery
Nutrition
Infant Care
Repeat Pregnancy
Schooling and Educational Needs
Teen Pregnancy and the Nurse
Home Based Interventions
Community Based Interventions
Discuss approaches that could be used in providing care to the adolescent client
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Identify trends in adolescent pregnancy, birth, abortions, and adoption in the United States
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Discuss reasons that may affect whether a teenager becomes pregnant.
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Explain some of the deterrents to the establishment of paternity among young fathers.
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Develop nursing interventions for the prevention of pregnancy problems that adolescents are at risk for experiencing.
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Identify nursing activities that may contribute to the prevention of adolescent pregnancy.
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True or False
Reasons for teenage pregnancy have remained the same.
The causes of teen pregnancy are diverse and affected by changing moral attitudes, sexual codes, and economic circumstances.
Social concern about teenage pregnancy includes
years of lost potential for teenage mom's.
Losses associated with pregnancy
academic and economic disadvantages that their children will experience.
The main cause of teen mortality is:
high risk behaviors
Why might adolescents not seek care?
(1) access to health care may be hindered due to a limited number of professionals with expertise in dealing with teenagers;
(2) costs of care or availability of insurance may limit services;
(3) adolescents need to believe that their visits are confident
What percentage of adolescents receive STDs every year?
25% of sexually experienced teenagers have STDs
Advantages of Using Neutral Terms
- provides a nurse with an opportunity to educate the client about normal anatomy and physiology
Ways for handling issues with STDs
- using neutral terms
"Has there been a change in your typical vaginal discharge?
Teenagers may be bashful about admitting issues with
STDs
It is most important for nurses to provide an environment where they feel
safe
A nurse's response may encourage the teen
to discuss concerns about family violence, alcohol, or dating
Preconception counseling
- fetal health and development
- consider lifetime goals and consider how pregnancy might impact you
An adolescent expresses a desire to become pregnant
the nurse can provide preconception counseling and emphasize the need to achieve good health and to establish a health-promoting lifestyle before pregnancy.
Notes about adolescent behavior towards the nurse
can range from mature and competent during one visit to hostile, rude, or distant at other times because behavior often reflects intense anxiety over what the teen is experiencing
What do adolescents seek health care for?
birth control
Nurses who want to promote the health of adolescents should provide:
anticipatory guidance about peer pressure, assertiveness, and future planning need to understand adolescent behaviors, health risks, and the social context in which they live.
Why is the adolescent at high risk for acquiring an STD?
Because they are not using protection (i.e. condoms)
What is a legal barrier for adolescences to achieve birth control?
most minor teens can consent to birth control services in the United States, there is great variability in who may access and release their medical records
Why aren't abortion services clearly defined?
No federal protection is extended to adolescents requesting abortion services, and the adolescent's right to privacy and ability to give consent varies by state
Confidential care to teenagers may
mean the difference in preventing an unwanted pregnancy, an abortion, and a birth.
Why do teen's pursue confidential care?
seeking independence as well as serious and well-founded concerns about a parent's potential reaction (
the nurse may need to honor the adolescent's need for confidentiality for an unknown period and proceed with the usual interventions, such as
pregnancy testing, options counseling, and referral for clinical care.
Abortion and Adolescent Rights
Parental consent laws:
One or both parents of a young woman who is under 18 years of age seeking an abortion must give permission to the abortion provider before the abortion is performed
Abortion and Adolescent Rights
25 states with mandated consent and notice laws:
Alabama, Arkansas, Arizona, California, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Tenn
Abortion and Adolescent Rights
Parental notification law
One or both parents of a young woman seeking an abortion must be notified by the abortion provider before the abortion is performed.
Abortion and Adolescent Rights
Parental notification and consent laws:
One or both parents of a young woman seeking an abortion must be notified and provide consent before the abortion is performed. These laws are enforced in five states: Oklahoma, Texas, Utah, Virginia, and Wyoming.
Abortion and Adolescent Rights
The following states (11) with parental notification or consent laws permit other trusted adults to stand in for a parent:
Arizona, Colorado, Delaware, Illinois, Iowa, Maine, North Carolina, Pennsylvania, South Carolina, Virginia, and Wisconsin.
Abortion and Adolescent Rights
The following states (four) have laws that have been found unconstitutional and unenforceable:
California, Nevada, New Jersey, and New Mexico.
Abortion and Adolescent Rights
Judicial bypass:
In a 1979 Supreme Court decision, it was ruled that any mandatory parental consent law must allow the young woman an opportunity to be granted an exception or waiver to the law. A young woman could appeal directly to a judge, who would decide either that
How many births were there in 2012 to teenage moms?
305,388 births to women under age 20.
Trends in teenage birth rates
Teen birth rates increase by age, with the highest rates occurring among 19-year-olds.
Decreases in pregnancy among teens ages 15 to 17 have been attributed to
reduced sexual activity (one fourth of the reduction) and the rest result from improved contraceptive use.
For teens ages 18 to 19 the reduction is entirely attributed to increased
contraceptive use, with evidence showing that the use of long-acting reversible contraceptives tripled among this age group from 2007 to 2009
This decrease was caused in part by decreases in the pregnancy rate, but may also have resulted from laws
that required parental notification or consent for minors requesting abortion services in some states
Healthy People 2020
Selected Objectives Related to Adolescent Reproductive Health
HIV-13: Increase the percentage of adolescents who have been tested for HIV.
Healthy People 2020
Objectives Related to Family Planning
� FP-12: Increase the proportion of adolescents who received formal instruction on reproductive health topics before they are 18 years old.
� FP-13: Increase the proportion of adolescents who talked to a parent or guardian about reproductive health topics
Healthy People 2020
topics before they are 18 years old.
Objectives Related to Maternal, Infant, and Child Health
� MICH-8.1: Reduce low birth weight (LBW) and very low birth weight (VLBW)
� MICH-10: Increase the proportion of pregnant women who receive early and adequate prenatal care.
sexual debut
or first experience with intercourse, for a teen has a significant impact on pregnancy risk.
The Healthy People 2020 goal is to
increase the proportion of adolescents who have never engaged in sexual intercourse by age 17
Which form of birth control is most often used by adolescents?
Condoms
Health People 2020 goals:
increase the proportion of 15- to 19-year-olds who use condoms and a hormonal contraceptive and increase the proportion of teens who receive reproductive health information through formal instruction as well as from their parents or guardians
The current recommended method of birth control
Oral Contraceptives;
i.e. long-acting reversible contraception (LARC), and a condom, referred to as dual protection.
Male teens use condoms with (more or less) frequency than female teens,
more frequency
African American males use condoms more often than any other group, male or female.
Hormone Birth Control Methods
alcohol and other substances is common among adolescents and can contribute to -- what?
unplanned pregnancy. Mood-altering effects may reduce inhibitions about engaging in intercourse and interfere with the proper use of a chosen birth control method.
Peer pressure among teens is not a new phenomenon, but many of the influences have become more serious.
Yet, why is it more of an issue currently?
Influence has expanded from fashion and language to cigarettes, substance abuse, sexuality, and pregnancy.
Influential Peer Behaviors
Teens are more likely to be sexually active if their friends are sexually active . -Peers reinforce teen parenting by exaggerating birth control risks, discouraging abortion and adoption, and glamorizing the impending birth of the child.
What is a romantic risk of peer influence?
young men and young women may think that allowing a pregnancy to happen verifies one's love and commitment for the other.
How can a nurse benefit a father?
Nurses can acknowledge and support the young man as he develops in the role of father. His involvement can positively affect his child's development and provide greater personal satisfaction for him and greater role satisfaction for the young mother.
Age discrepancy between the pregnant teen and her male partner
is an important consideration, even when it is 2 years. It raises concern about coercion, potential or actual violence, increased risk for STI, and exposure to greater substance and alcohol use
Swiss Cheese Model
theory for how errors occur.
Reproductive Health Care Rights
Can states prohibit an adolescent access to contraceptives?
No
Which Supreme Court Decision protect an adolescent's access to birth control?
1965: Griswold v. Connecticut
1972: Eisenstadt v. Baird
1977: Carey v. Population Services International
1965: Griswold v. Connecticut
the right to prevent pregnancy through use of contraceptives is protected by the right to privacy
1972: Eisentstadt
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