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Ezekiel Hill
Ezekiel Hill

Teen Model Sandra


An unacceptably high number of pregnant and parenting adolescent females smoke cigarettes, and the majority who quit during pregnancy relapse within six months postpartum. This dissertation examined measures from the Transtheoretical Model of Change (TMC) and variables associated with smoking behavior in a population of pregnant and parenting females 18 years-of-age and under. Data were from the baseline survey of 245 young women enrolled in a three-year randomized controlled trial through a teen parent program in Portland, Oregon. The objectives were: 1) to investigate whether factors identified in the literature as associated with initiating and quitting smoking were associated with never smokers and teens in the stages of change, 2) to determine whether stage effects (i.e., theoretically predicted associations between the stages and TMC measures) were exhibited for the TMC constructs of decisional balance, temptations to smoke, processes of change, and self-efficacy for the total sample and by pregnancy status.




teen model sandra



Significant associations by categories of never smokers and TMC stages of change were found for several psychosocial variables including pregnancy status, perceived wrong and harm of smoking, partner and friends' smoking, current alcohol and marijuana use, smoking self-efficacy, and smoking intention. Interactions between TMC measures and stages of change showed little influence for the role of peer pressure in smoking; rather, smoking as a means to deal with stress and frustration and to avoid unpleasant emotions were significant factors. Also, lack of use of stage-appropriate internal processes of change and coping methods may indicate that teens who have quit smoking are at high risk for relapse. Implications of these and other findings as well as recommendations for social work research, policy, and practice are discussed.


Early one Monday morning, a fifteen-year-old girl enters a yellow cinderblock classroom at Booker T. Washington High School in Atlanta's West End. Two months pregnant, she has hopes of someday becoming a lawyer, but the baby's father has vanished, and she knows she is not ready to raise a child alone. She also faces the daunting task of breaking the news of her pregnancy to her mother, who had her first child when she was only thirteen.


The Adolescent Health Station, a five-year program begun in January 1996, represents the Woodruff School of Nursing's efforts to strengthen its presence in the community and to explore the changing role of nurses in preventive health care. It also provides Emory with a laboratory and clinical site for an innovative model of health care delivery.


Nursing school Dean Dyanne Affonso, who worked for fifteen months with high school officials and community leaders to conceive the project, says the traditional medical model "is not good enough any more. It's not culturally sensitive; it has an imposing character to it. So as new paradigms emerge, we will be giving care in unfamiliar settings. Instead of hospitals and clinics and doctors' offices, we will be in the community, in places like Booker T. Washington High School, because that's where the action is in the life of a teenager."


Of the more than fourteen hundred students at Washington High School, the city's first public school to admit African-American students and the alma mater of Martin Luther King Jr., some 130 are pregnant or already parents. Twice a week, midday at the health station is set aside especially for students who are pregnant or new mothers. Daniels and Leonard, both advanced-practice nurses who launched the program, talk with forty to fifty of those young women about managing motherhood. They engage the group in a steady stream of chatter about due dates, ultrasounds, school assignments, child care, teachers, and their own parents.


While teen pregnancy is a significant concern at Washington High School, Daniels and Leonard also address issues of loss and grief among the students, whose urban lives are frequently disrupted by violence; students' interpersonal relationships; and problems related to the school's low retention rates, especially among ninth-graders. Ultimately, they hope to respond to early warning signs of depression, substance abuse, violence, and suicide.


The nurses address students' most pressing problems. A "Lunch and Learning" series offers the opportunity to discuss domestic violence, anger management, drug abuse among friends and family, and advice for teen fathers. One Saturday last fall, twenty female Washington High students and their mothers attended a half-day workshop to help improve their relationships. When a student was shot and killed on campus last year, Daniels and Leonard offered grief counseling and organized a memorial service. They have also begun to work with leaders in four public housing projects near the school to help parents develop a program to control truancy.


"They're supporting their future and their babies' future," says Leslie Brooks, an Emory senior who wants to pursue neonatal nursing. "If a pregnant teenager is not getting some essential nutrients, the baby will wind up in the neonatal intensive care unit [because of low birthweight], and the mother may get early-onset osteoporosis."


Another group taught a series of lessons to a Washington High class on how to gain access to health care. "We're helping teenagers get in the front door, utilize the free clinics, and stay away from the emergency room, and we're educating them on the various payment plans like Medicare, Medicaid, HMOs, and insurance," says Amy Thom, an Emory nursing senior. "Adolescents are traditionally an underserved population. We want them to know health care is available and within their reach; it just may take a little bit of know-how and some assertiveness." 041b061a72


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