Mary Ann Osuchowski-Sanchez PhD, RN, FNP-BC

1. Teen Pregnancy & Parenting: Attitudes and Behaviors of Teenaged Long-Term Hispanics in Northern New Mexico Mary Ann Osuchowski-Sanchez PhD, RN, FNP-BC

2. To explore and describe the attitudes and behaviors related to teen pregnancy and parenting in long-term Hispanic female teens in northern NM Purpose

3. Teen pregnancy assoc. w/ poverty, poor education, domestic violence, repeated cycles of teen pregnancy Over 800,000 U.S teens pregnant/year Hispanic teens amongst highest teen pregnancy rates in the US since 1995 (106/1,000 Vs. 58/1,000 non-Hispanic white) Some propose: Lack of knowledge re: sexual risk-taking/contraceptives Promotion/celebration of fertility vs. Marianismo (purity) in Hispanic communities Reality: research is sparse, findings discordant, Hispanics not sampled - influences on teen pregnancy and reproductive health largely unknown By 2025 ~ 25% of adolescents will be Hispanic The Problem

5. 1. What are the attitudes and behaviors of parenting long-term Hispanic teen females regarding sex, contraception, adolescent pregnancy, and parenthood? 2. What cultural and social influences guide the behavior and belief systems of long-term Hispanic teen females, in regards to sex, contraceptive use, adolescent pregnancy, and adolescent parenting? 3. What are the attitudes of Hispanic adults regarding teen sexuality and reproduction? Research Questions

6. Theoretical Lens: Symbolic Interactionism Method: Focused Ethnography: in-depth exploration into one of many interwoven and socioculturaly constructed behaviors and meanings Setting: Northern New Mexico Population: 76% - 81% Hispanic Rural: 8 to 14 persons/square mile Impoverished: annual household income $15K - $19K compared to $25K (NM), $31K (US) Design

7. Purposive sampling of self-identifying long-term Hispanics (at least 3 generations of family residence in NNM), reside in NNM, and English as primary language Primary Participants: Hispanic teen mothers aged 15-17 yrs, delivered baby past 12 months, not currently pregnant (N=10) Secondary Participants: Hispanic adults involved with the education/care of community adolescents (N=10) Sample

8. Interviews: Audio-taped, 1-2 hour, face-to-face, semi-structured, open-ended, loosely based on interview guides Participant observations to capture people’s interactions and practices that are unspoken Demographic data Field notes of impressions, observations, and research process Data Collection

9. Audiotapes transcribed, verified, and dimensionalized Line-by-line coding, Immersion and crystallization, Atlas Ti Observations to augment and validate Field notes document non-verbal data for contextual purposes and to detail research process Data Analysis

10. Demographics: Primary M = married, D = dating, S = single Median age = 16.6 yrs. SD = 0.69 40% lived with boyfriend’s family, 40% lived with own parent, 20% lived with other family

11. Demographics: Secondary

12. Teen pregnancy/parenting is demanding/stressful It’s frustrating, I’m just a kid, I don’t know these things Others need to help more and not judge Regrets: It’s not fun, it’s a big responsibility/I regret not waiting Becoming a mother has benefits It’s fun having a baby/Like, I love my baby! It’s given me a reason to try to do better It’s made me stronger/more mature Boys get to do what they want He gets to go out all the time Be a man and help your kid! Be careful, you could land up pregnant too! It’s too hard, be sure of your contraception I want better for him/her Findings: Research Question 1Attitudes and Behaviors of Teens

13. Teen pregnancy/parenting is isolating and a barrier to one’s education, career and having fun. Teens were ill-prepared for their role as parents which led to much frustration. Teens expressed feelings of entitlement for community assistance in their parenting role (rite-of-passage) and resentment when adults expected them to instead mature and take on responsibility of their actions. Teens regretted the ill-timing of their pregnancies and hardships it had created in their lives. It’s hard, real hard. I think it’s just hard to do everything by yourself. You are the only one and you have to do everything. If he (baby) needs something, there is only you and then like I see couples with their baby and it’s hard to be all alone. (Eve, lines 161-168) Teen Pregnancy/Parenting is Demanding/Stressful

14. The role transition from teen to teen mother led to positive emotions of love and fulfillment and newfound inner strength/maturity with dreams of education, careers, and financially and emotionally stable homes. Like, everything changes. Your whole life changes. You start seeing things different. People like really have to understand that when you become a mom, like you don’t see yourself changing, but like other people see it…and then I’m pretty sure you will come about it one day or another. You’ll see how you’ve changed…you just look at situations differently…You look at your friends…like sort of like from a mother’s point of view…You don’t take things as lightly as you used to…You are careful who you are around because the people you are around influence you in a big way…You just need to be careful. And you just think about your daughter. (Asabel, lines 326-345) Becoming a Mother has Benefits

15. Males were viewed as immature and whiny; many boys failed to acknowledge paternity and/or to take on the responsibility of parenting as the teen mothers had. Males continued to live their lives as they had before the pregnancy; this was unfair to both the teen mother and the child. Like one time I told him Change her diaper and he was all like I changed her yesterday! And I was all like What?! She peed today! And I was all like Okay?! She’s your daughter and you should change her whenever she needs it! (Roberta, lines 720-723) Boys Get to do What They Want

16. Contraception is seen as important in the prevention of “landing up” pregnant. Most teens had taken contraception lightly prior to their pregnancies, but now cautioned peers to avoid risky sexual behavior until they were older in order to avoid the hardships associated with pregnancy/parenting. Participants described sex and contraception as a taboo topic of discussion and hoped to have more open communication with their own children to avoid teen pregnancies for them. I would say You are crazy! And Take life slow cause it moves so fast. It moves so fast!...I would be like Stick on what you got (contraception) or switch to another birth control if you don’t like it. Just make sure what could happen…cause like when you get pregnant, you’re pregnant. I mean you can’t go back, you can’t switch plans. (Lola, lines 760-769) Be Careful, You Could Land up Pregnant Too!

17. We Really Didn’t Talk About it Chaotic/Unstable Environments My parents weren’t around Alcohol/Drug use Home is wherever you are tonight Disappointment Findings: Research Question 2Cultural and Social influences guiding behaviors and belief systems of teens

18. Discussions about sexual topics in families, sexual dyads, schools, and general community were rare and of limited content; taboo. Resulting sexual knowledge was sketchy and led to confusion/unknowing. An expectation existed for community change to more openly discuss reproductive issues to prevent teen pregnancy. That (sex) was like one of those things that is like awkward and we (family) didn’t talk about anything like that with each other. (Asabel, lines 205-207) I think that as adults, we need to open our eyes and realize that this is happening…a lot of adults don’t want this subject (sex) brought up. And you know, it is everywhere, it’s on TV, it’s on the radio, it’s everywhere. It’s happening. So, you know what I think, we just need to come to reality and help these kids. Educate them. Give them the tools they need. (Lorraine, lines 144-148) We Really Didn’t Talk About it

19. Home environments where teens engaged with their families, shared beliefs and attitudes and currently raised their own children were fragmented and unstable. Many homes were headed by grandparents as parents were addicted and/or emotionally/physically unavailable; a situation that was taxing for elderly adults. Many homes were simply a place; they lacked connectivity and support amongst its members. They were good parents. You know? And once my dad started going to work, he found a guy that had drugs and started him on it and got my mom on it…and it just started escalating, where things would get worse. You know what I mean? And one night, well one day, my dad picked me up from school and…my dad took me, my brother and my sister and just dropped us off…with our grandparents…he dropped my brother and sister there (at the paternal grandparents) and went to my mom’s mom and dad and left me there. And after a while the cops came and said that the grandparents on my dad’s side of the family were abusing my sister and brother. And so my grandpa had to get them…I looked at my parents and I didn’t see the good side of drugs. I saw everything that made it horrible. All my shit was pawned; my movies, my toys, everything that was valuable was gone. Things were broken down; TV was gone, radio was gone. It was so horrible. (Lola, lines 835-857) Chaotic/Unstable Environments

20. Teen pregnancies were met with disappointment and anger by families and boyfriends in private. Publicly, however, teen pregnancy was portrayed by acceptance. Teens dealt with fear of informing their families and the related embarrassment by justifying that they were not different (worse) from their own parents in repeating the cycle of pregnancy. So like no one would know that I was pregnant…She (mother) wouldn’t take me to town with her. I had to stay home so no one would see me pregnant. (Eve, 154-156) They (family) are just like I can’t believe this is happening! I can’t believe she’s pregnant!...and they are really pushing themselves, I think they are really pushing themselves, like forcing themselves to be happy about it…(Corrine, lines 108-111). Disappointment

21. What do you mean, you’re pregnant?! Say it isn’t So Keep it in the Family It has to change Above all, prevent it Earn the support you want Findings: Research Question 3Attitudes of Hispanic Adults

22. Teen pregnancy creates hardship, anger, and frustration for the families involved. Despite importance placed on traditions of baptism and baby showers, teen pregnancy is generally seen as disappointing. However, an unwillingness exists to allow the child to be raised outside of the biological realm despite associated financial and physical hardships for the family. There are some practices, like baptisms, especially if you are Catholic...that is really big. Especially the role of godparents and things like that are really important in this culture. But, I don’t think that we want our teens to be pregnant or to reproduce…(Bernice, lines 198-201). What do you Mean, You’re Pregnant?!

23. Breaking the cycle of teen pregnancy through community change is a global desire of the participants. School-based comprehensive education, recreational opportunities and family communication, are seen as important to affecting this change. Support for teen parents is viewed as a two-way street where teens are expected to mature and make gains in education and careers in return for community support and respect. Yes, they are mothers but they are also adolescents and I think it is important that we do not give up on them because it is going to cost us as a society. We do need to assist and support them, but is also brings accountability. They need to be accountable and responsible for their actions. They have to earn it. It is probably not in their best interest to turn around and have another pregnancy. They also need to go on with their education, help their baby and do right. (Bernice, lines 136-145). It Has to Change

24. Chaotic and unstable homes Communication Disappointment Futures Comparison to Literature

25. Hispanic households described in terms of familismo, respeto, and personalismo Differs from current study where fragmented homes appear to feed cycles of disconnectivity amongst family members and in turn teen pregnancy – Global hopes for change Socioeconomic and geographic factors important to consider for each community along with strengths and uniquities – interventions based upon these and not on presupposed values Chaotic and Unstable Homes

26. Current study found poor connectivity, low to no communication in homes, sexual dyads, and schools Communication accepted as a proxy for family relationships and overall home environment Teens desired increased communication = quality relationships with reliable, trustworthy, credible adults May be difficult for adults raised in same communities Communication

27. Literature depicts Hispanic culture as that which strongly values motherhood as an end in itself and celebrates and supports teen pregnancy. Current study found disappointment and anger in response to pregnancies with poor support of teen parenting role- parents not credible sources of information or support Dichotomy between private disappointment and public acceptance- socially correcting embarrassment Social unwillingness to speak badly about baby- celebrations around child- possible extension of public portrayal of happiness/acceptance May create environment inconducive to honest and supportive communication re: hardships/prevention Disappointment

28. Literature describes motherhood as a viable career choice in impoverished areas with limited life options Career choice accepted in current study as that which defines oneself and one’s life work, not necessarily financial/employment success Positive changes towards more mature/responsible seen as a career choice/self-define as mothers However, without support and positive role models, rewriting life script of repeated cycles of low education, poverty, broken adult relationships and pregnancies is unlikely Futures

29. Limitations Male participants Second interviews Strengths Prolonged engagement Persistent observations Triangulation of data sources Member checks Dependability of data Confirmability of data Support for the guiding theoretical influence Strengths and Limitations

30. Community Nursing Educate: reproduction/contraception, parenting skills for youth and adults Community action coalitions: promote social capital in educational and healthcare systems Nursing Research (Qualitative) Hispanic reproductive issues at community, family and individual levels Community uniquities, strengths, social networks that shape beliefs and practices Familial relationships, communication, connectivity, and expectations Male teens as half of the sexual dyad and teens’ peer influence Raise Hispanic health issues on state and federal research agendas Build collaborations within Hispanic research community and amongst all researchers to share information and fill gaps in knowledge base All Nurses/Social Workers/SBHC staff Role model effective communication and culturally competent advocacy Nursing Recommendations

31. Thanks for your attention! Questions?