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African American teen mothers' perceptions of parenting
African American Teen Mothers' Perceptions of Parenting Jan Wayland, PhD, RN Ruth Rawlins, RN, DSN, CS The purpose of this study was to describe the childbearing African American teens' perceptions of parenting based on their own experiences. Focus group discussions were held with 17 teens in their school setting for 50 minutes each week. Group discussions were audiotaped, tapes were transcribed, and then analyzed for common themes. The unmarried teens ranged in age from 15 to 18 years. Findings indicated that the teens depended on grandmothers to provide child care and for information about parenting. The teens identified parenting problems including crying, discipline, and conflicts dealing with grandmothers and the child's father. Teens wanted more information about breastfeeding and minor childhood diseases. The researchers identified that teens lacked information about their children's growth and development and safety issues. Findings have implications for nurses who care for childbearing teens and their children; and those involved in planning and implementing parent education programs for African American teen mothers and their families. Further research is indicated with larger samples of African American teens; and to explore the context of family relationships in which teen mothers and grandmothers share parenting for the teens' children. Copyright9 1997by W.B. Saunders Company
N THE UNITED STATES, more than 1 million teenagers become pregnant, and about 500,000 of these give birth each year (The Alan Guttmacher Institute, 1994a). Compared with babies born to older women, prematurity and low birth weight occur with greater frequency in babies born to teens (Brown, Fan & Gonsoulin, 1991; The Alan Guttreacher Institute, 1994b; Klerman, 1993). Children of teen mothers often display greater difficulties in physical, emotional, behavioral, and developmental areas than children of older parents (Kotagal, 1993). Finally, social and economic problems often occur with early child-bearing and child-rearing. The teenage mother is at increased risk for remaining poorly educated, having more children than desired, and having a lower family income, often supported by public funds (Horowitz, Klerman, Kuo & Jekel, 1991). Given the problems associated with early childbearing and child-rearing, teen parents need parenting information and support for parenting. Furthermore, teen mothers want information about their children's psychosocial needs and cognitive development (Degenhart-Leskosky, 1989; Epstein, 1980; Howard & Sater, 1985). Arecent study (Arenson, 1994) looked at perceptions of parenting among seven White and Hispanic teens. Although the birthrate for African American teens is three times higher than that of White teens (The Alan Guttmacher Institute, 1994a), studies of
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Journal of PediatricNursing, Vol 12, No 1 (February),1997
African American teen mothers' perceptions of parenting were not found. Identification of African American teen mothers' perceptions of parenting can help nurses and other health professionals in providing care for these young mothers and their children and in developing parenting education programs for teens. The purpose of this study was to describe African American teen mothers' perceptions of parenting based on discussions of their own experiences conducted in focus group sessions.
REVIEW OF THE UTERATURE In the past quarter-century many studies of teenage parents and children of teen parents were conducted. One of the first of these, examining interaction between adolescent mothers and their infants, found young parents to be generally intolerant, insensitive, impatient, irritable, and prone to
From the College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR and the Department of Nursing, University of Central Arkansas, Conway, AR. Supported by a University of Arkansas for Medical Sciences, College of Nursing, Intramural Grant No. 11740131. Address reprint requests to Jan Wayland, RN, PhD, Assistant Professor, University of Central Arkansas, Department of Nursing, 201 Donaghey Avenue, Conway, Arkansas 72035. Copyright 9 1997 by W.B. Saunders Company 0882-5963/97/1201-000353.00/0 13
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use physical punishment with their young children (Delissovoy, 1973). A number of subsequent studies compared teen mothers' parenting behaviors with those of adult mothers. These studies consistently found maternal age correlated with the quality of maternal nurturing. Relationships were found between older maternal age and greater responsiveness to one's infant (Jones, Green & Krauss, 1980; Roosa, Fitzgerald & Carson, 1982); more realistic developmental expectations and more desirable child rearing attitudes (Field, Widmayer, Stringer & Ignatoff, 1980); the provision of more audiovisually-stimulating toys for their infants (Roosa, Fitzgerald & Carson, 1982); and significantly greater knowledge about child development (Roosa, 1983). More recently, Fleming, Munton & Clark (1993) showed that teens, compared with older mothers, reacted to their older infants' behaviors more punitively, and with less verbal interaction. East, Matthews & Felice (1994) found that younger mothers had lower acceptance of their children than older mothers did, and teen and young adult mothers alike more often than older mothers advocated physical punishment for their children as a method of discipline. One study examined parenting from the teen mother's perspective or experience. Using a qualitative-descriptive approach, Arenson (1994) interviewed five White and two Hispanic teen mothers to identify their strengths in coping with parenthood. These teens said that having children improved their lives, reconnected them with their parents and siblings, established them as adults, and made them feel better about themselves. During the teenage years, African American mothers seldom marry or move away from the parental home after the birth of their children, but continue to reside with their families of origin, particularly with their mothers (The Alan Guttmacher Institute, 1994b). Mothers and grandmothers of African American teens often provide support and assistance with caregiving for the teens' children (Furstenberg & Crawford, 1978). The supportive environment offered in this living situation provides the motivation for the teen mother to continue her education, take a part-time job, and socialize with friends. These are activities important for the teen mother's own growth and development. In summary, studies have examined parenting behaviors of teen mothers. When parenting behaviors of teens are compared with those of older mothers, teens have not compared favorably. Only
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one study has examined teen mothers' own perceptions of parenting. Limitations of these studies include small sample size and inappropriate or missing comparison group. Another major problem with studies of parenting is the lack of appropriate tools to measure parenting abilities, particularly for measurement of teen mothers' parenting skills. Despite these limitations, there is little doubt that children of teen mothers are at greater risk for environmental deprivation. The teen mother's lack of maturity, knowledge, and life experiences may be contributing factors. These factors indicate a need for parenting education for teen mothers. The study described in this report identified childbearing African American teens' perceptions of parenting based on comments and descriptions of their own experiences that were obtained in focus group discussions held with their childbearing peers. The guiding research questions for this study were: (1) What are the parenting experiences of African American teenage mothers? and (2) What are African American teen mothers' perceptions about their parenting experiences?
METHODOLOGY A descriptive, qualitative design was used to gather information on African American teens' perceptions of parenting based on their own experiences. A series of 10 focus group discussions were conducted with 17 African American childbearing teenagers. All group sessions were audiotaped. Focus group discussions are conducted within a group of people to gather data on a topic supplied by the researcher, who typically takes the role of a moderator. Although focus groups, as a qualitative research method, began in social science research, the technique has been more widely used in the business community, particularly in marketing. The strength of using focus groups as an approach in data collection is in their ability to explore topics and generate hypotheses. Limitations of focus groups are that some topics may inhibit discussion, and there is some uncertainty about the accuracy of what participants say in a group situation as compared with individual interviews (Morgan, 1988). Although focus groups have been used with adults in social research as a technique for data collection, studies of focus groups with adolescents were not found. The researchers chose focus groups instead of individual interviews to facilitate verbal interaction among the teen participants.
TEENS" PERCEPTIONSOF PARENTING
SETrlNG For the study population, the researchers selected a senior high school and an adjacent junior high school where pregnant and parenting teens attend classes with nonchildbearing teens. The senior high school serves 10th through 12th grade students; the junior high school serves seventh through ninth grade students. These schools, composed of 65% to 75% African American students, were selected because of their higher rates of teen pregnancy.
PROCEDURES Permission was obtained from school officials and the city-county health department to conduct the study. The university's Human Research Advisory Committee and the city-county health department, which operates a school-based clinic in the high school, reviewed and approved the study's procedures. Before beginning the study, the researchers agreed to report any suspected abuse toward study teens or their children to the school nurse and school social worker. School officials identified 10 pregnant, and 18 parenting teens in the two schools. The school nurse and social worker sent letters explaining the study, with consent forms, to all known pregnant and parenting teens and their families. All students who volunteered and returned consent forms signed by both the students and parents were invited to participate. Of these, seventeen African American teens took part in discussions.
FOCUS GROUP DISCUSSIONS The focus groups were convened in the high school home economics room during the teens' 50-minute lunch period. Tables were placed in a circular arrangement to facilitate group discussions. Teens were encouraged to bring their lunches to the sessions. The focus group leaders provided juice, cookies, and health bars for all but the final session. After the final session the focus group leaders served pizza, a cake, and soft drinks and passed out movie passes to a local theatre. The focus group leaders consisted of the reseachers, both White, and an African American graduate nursing student. A different topic was introduced each week to initiate discussion. Topics reflected content from a teen parenting education program (Bavolek, 1984): (1) infant feeding, (2) comforting a crying infant and sleep routines, (3) bathing, diapering, and dressing an infant, (4) infant and child safety, (5) childhood illness, (6) an infant's need for play and stimulation, (7) an infant's need
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for cuddling and holding, (8) childhood discipline, and (9) identification of the teen mothers' needs. For the 10th session, the teens were asked to discuss whatever they wanted to talk about. The week after the 10th session, the focus group leaders held a party for the participants. Initially, the focus group leaders planned to introduce comforting a crying baby later in the sessions. However, at the conclusion of the first session, the teens all said they wanted to talk about crying (hollerin) for the second session. The teens completed a one-page demographic data collection form developed for the study during the first group session. The form asked for the teen's age, grade in school, number of children, ages of children, expected date of childbirth (if pregnant), listing of persons with whom she resided, and listing of persons who helped her with her children. The attendance at group sessions varied from 7 to 14 teen participants. Most teen participants attended a total of three or more sessions. A focus group team leader began each session with a question or the presentation of a situation followed by a question. For instance, a focus group leader began the first group session with the following. "Doctors and nurses say that it is best to begin solid foods for your baby about 4 to 6 months of age, and until that time your baby needs only breast milk or formula. What do you think about this?" The teens were encouraged to respond based on their own perceptions and experiences. To conclude each session, a focus group team leader addressed specific questions the teens had asked during the session and distributed parent education pamphlets supplied by the local city-county or state health department. For this study teen and mother refer to the participant. Child refers to the teen's infant or child. Grandmother refers to the child's grandmother.
DESCRIPTION OF THE SAMPLE Seventeen unmarried teens, 15 to 18 years old with a mean age of 16.76, participated in the focus group discussions. Twelve were senior high students and five were junior high students. Eight were pregnant, and nine were mothers. Most of the teen mothers had one child. Two teens had two children each, one of these had twins. The teens' children ranged in age from 3 months to 2 years. Sixteen teens lived with their families of origin. One teen lived with her boyfriend (not the child's father) and her child in their own apartment. Female family members, especially teens' mothers
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16 and grandmothers, most often helped with the teens' children. One teen wrote. "No one helps me."
ANALYSIS A woman of African American descent transcribed the audiotapes verbatim within a week after each session. The transcriptionist reported no difficulty understanding the dialogue and terms expressed by the teen participants. The authors reviewed the transcripts within 2 weeks after they were transcribed. The researchers held postfocus group conferences within 1 to 4 hours after each focus group session for the purpose of reviewing the teen participants' comments and descriptions of their parenting experiences, obtaining a general sense of the flow of the discussion, and for planning subsequent group sessions. The postfocus group conferences were also audiotaped and transcribed for use in analysis. The researchers read and reread the focus group narratives until themes from the data emerged. In addition, another researcher who holds recognized expertise in the design and analysis of qualitative research was consulted. The research consultant also reviewed the focus group transcriptions for verification of themes. Three women of African American descent, a graduate student, a school nurse, and a university secretary reviewed the themes along with the designated narrative. They were asked if, in their estimation, the narrative "fit" the themes. Each concluded that the narrative did indeed fit the themes as described. Finally, the graduate student whose first child was born when she was a teenager said the narrative was descriptive of her own experience of parenting while a teenager. A limitation of the study is that the teen participants were not asked to read the themes with the designated narrative.
Table I. ThemesWith Examples From Narratives Artifacts My momma told me to use um [cloth diapers] but if l run outof pampers, I'm goin to be goin to the store. She be liken the television remote, thatJswhat she like the best to play with. Sources of Information When she was a few weeks old she was real greedy, one bottle wouldn't hold her, so my mother told me to go ahead and start giving her cereal. When I did, she [infant] acted better. Sometimes they [grandmothers] tell you to use brown flour (for diaper rash). You put it in a pan and you just let it tam brown. Then cool it off and put it on their behinds. Problems With Parenting I don't like her [grandmother] tryin to tell me how to do my baby. I be wantin to do my baby the way I wanna do her, but she be trying to tell me h o w . . . I don't like that. My friends be wanting me to go places. The ones that don't have babies, they don't understand that you got a responsibility and you just can't up and go all the time now. Strategies or Remedies for Dealing With Problems I don't like arguing so I just told him {her child's father} if you want to keep them {twins) it's gonna have to be on a weekend or you can come after they come out of school. Like at Easter time, he wanted all of us to be together, but I wanted to be with my mama. So, I kept them half a day, and he kept them half a day. To me if a baby is hungry, if you stick your finger right there and they suck, then they might be hungry. If you have already fed them and they're just hollerin, and they're noddin off, they're sleepy. Unique Language hoggy/greedy (means) hungry whup (means) spank hollerin (means[ crying fallin out (means) child throwing self on floor throwin fits (means) temper tantrum showin out (means) showing off boo-boo (means) hurt or sore area posteria/bult (means) buttocks noddin off (means) falling asleep hold longer (means) last longer in stomach (food) Lack of Information Will breast milk hold longer than formula? What about this breast pump? What is it supposed to do? Don't that supposed to keep the milk coming? Misinformation I used to lay her down on her back and prop the bottle in her mouth, it didn't ever bother her. If she spill something on the floor, she's going to wipe it up.
FINDINGS The researchers identified seven themes from the narrative data: (1) artifacts, (2) sources of information, (3) problems with parenting, (4) strategies or remedies for dealing with problems, (5) unique language, (6) lack of information, and (7) misinformarion (Table 1). Artifacts are items or objects that participant teens considered important in parenting their children. Teens considered disposable diapers necessary items for parenting. Some teens said grandmothers wanted them to use cloth diapers; however, teens
clearly preferred the disposable ones. Teens did not view the expense of disposable diapers as a problem. Two teens said their children's fathers provided some disposable diapers. "I use pampers, I ' m not fixin to mess around with no cloth, that means washin." "I can see myself when he's first born, but now (that he's older) I can't wash no diapers up, the smell (laughs)." Another artifact described by the teens was the use of remote controls. Teens used the television remote control and played music on the radio to
TEENS' PERCEPTIONSOF PARENTING
amuse, distract, and comfort their children. "My baby loves those remote controls." "Yeah, they be amused by it, little stuff like that. They see the light, they point at the light, little buttons, they like to mash it, push, play, push, eject, push it back in. They be busy for a while." Sources o f information are those persons who are primary sources of parenting information to the teens. Teens said that although nurses, doctors, and friends gave them parenting information, grandmothers were their primary source of parenting information, followed by sisters and aunts. "Well, my morn always tell me, like, when he have his head against me and it be hot, and I say, he might have a fever, and she says the only way he has a fever is if you check up under his ann or in his butt." When professionals' advice on parenting differed from that of family members, teens said they took the advice of family members. Teens also depended heavily on grandmothers for assistance with child care. When asked how they managed at home when they had pressing school-work to be done, they said they "turned their children over to grandmothers." Problems are what the teens themselves identified as specific parenting events that caused them concern. Teens said relationships became strained when the child spent so much time with the grandmother that the child responded to the grandmother as "mother" and to the teen mother as "sister." Teen participants acknowledged that grandmothers spent more time with their children than they did; nevertheless, they wanted their children to respond to them (teens) as "the mother." "She (grandmother) hold him all the time, talking to him, playin with him, everything. Like when I talk to my baby she just don't act the same as when my grandmother is talkin to her. She be talkin back to me but she gets more excited when my grandmother is talkin to her. Sometimes, I get jealous." Teens viewed their relationships with grandmothers (teen's mothers and their grandmothers) as having both positive and negative aspects. Although the teens talked of "turning the child over to the grandmother" when they had homework or other things to do, they viewed grandmothers as "spoiling the child" by picking the child up and holding him or her too often. Coping with a crying baby was one of the problems all the participant teens wanted to talk about. "My baby hollers for no reason." " I f the baby could tell you what they want when they cry.
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You have to sit there and figure it out. I hate that. I get frustrated." Teen participants shared the problems of balancing school, homework, jobs, and relationships with caring for their children. They talked about the effects of parenthood on their lives. One teen said, "you don't have no more freedom to go as you please." Another said, "it's the same for me. I just take my baby where I go." Some talked about having more responsibilities. "I used to help my mom with her twins. It's more responsibility now, because it's mine. I have to do everything myself." Another said, " m y friends be wanting me to go places. The ones that don't have babies, they don't understand that you got a responsibility and you just can't up and go all the time now." One teen said, "it's fun to me to stay home and be with my baby. Another said, "it ain't too fun to me." In response to this discussion, another teen said, "its not really different, I like staying home with her." Two teens expressed dissatisfaction in not having the freedom to go out with friends, "to party," and "to go to movies." Strategies or remedies are the ways in which teens went about addressing or solving specific parenting events that caused them concern. To manage their children's crying, teen mothers used several strategies. "That's the only way mine will stop crying, if I pick him up or his grandmother picks him up. I'll put him in that walker or swing and walk on. Somebody there will hold him . . . they'll get tired of listenin. I ain't gonna be there to hold him." Other remedies for crying included: "playing music on the radio for the child," "talking to the child," "giving the child a bottle," "playing with the child," "sleeping with the child," "letting the child cry," "giving the child to the grandmother," or "spanking the child." All participant teens said they either slept in the same bed with their children or shared a room with them. Teens reported bedtime routines for their children that fit with their own schedules and needs. "Sometimes I make her go to bed, i f I get real busy. If I don't . . . she'll just stay up and go to sleep when I go." "My b a b y , . . , she be woke when I get home and I try to put her to sleep when I get home so I'll have time to do my homework. If she wakes up about six, I'll leave her up until it's time for me to go to sleep and then she'll go to sleep." "I would kind of like for my child to stay up late so she won't be getting me up in the morning." When their children did not sleep, teens said they used the following strategies: "allow the child to stay up," "feed the child cereal," "gave the child a warm
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bath," "give the child a bottle," "give the child to the grandmother," or "spank the child." The teen mothers disciplined their children in various ways, often using trial and error methods. "Well, my baby gets a spanking every now and then. I don't always whip her but she gets a spanking. Not with a belt, but I do threaten her with one." Sometimes I do what they do at the daycare she'll stand in the corner. .... . . . if they {twins} do something, I'll just sit them on the couch or I'll put them in the playpen." " I f I whip my little girl with my hand, my mom gets mad at me. She says, you may break something, stop hitting her like that. So what I started doing was popping her in her hand with a comb." During one discussion about discipline, one teen remarked "I don't beat my child, because someone might think I am abusing her." Another teen said that, "when it is your child, you do what you want." Teen participants did not spontaneously address concerns about their children's fathers. During one group session, a focus group team leader asked about fathers. In response, one teen turned her head away from the group and said, "We don't want to talk about that." Some said they didn't want the fathers to take the baby out alone without them (teen mothers) along. One said, "I don't trust him with my baby." Another said, "If she does go (with the father), I gotta know when she's goin, what she's gonna be doin, how they gonna do this, how they're gonna do that. If she comes back cryin, she ain't goin no more." Some teens talked of their children's fathers as "not serious" or "not accepting responsibility" for the child. One teen commented that her child's father acts "silly and he shows out." On the other hand, two teens said their children's fathers "visit and play with their children." One teen said, " . . . he pays child support once a week and when he gets paid, he buys diapers. I get a child support check from my dad too and when I get mine I still buy diapers." The teens expressed little desire to have additional children. "I ain't havin no more." "One is too many." "One is enough." "Right now at my age, no." "One is already expensive." When discussing the possibility of another pregnancy, some teens said they were using a method of birth control or planned to use a birth control method after childbirth. "As soon as I have it, I ' m going to get on birth control." " I ' m already taking them (birth control pills)." "I wanna get the implant." ' T m gettin a shot." Teens reported using several home remedies passed down through maternal family members in .
.
.
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caring for their children. Some home remedies were "olive oil for skin care," "browned flour, browned in a pan on top of the stove, for diaper rash," an "Irish potato tied around the child's neck for fever," and "blowing smoke on the child's soft spot for colic." Unique language consisted of terms consistently used among the teens that the researchers did not know or were unsure as to their meaning. When a teen participant used one of these terms the researchers asked her and the other teens to talk about what the term meant to them. These terms have been quoted in context within the teens' narratives and are listed with explanations of meanings in the table. Lack of information consisted of parenting areas or topics that participant teens identified about which they needed information. Several teens asked about breastfeeding. "So, if you don't breastfeed at all, how are you going to get the milk out of your breast? .... Don't you have to poke a hole in your, you know, thing to get the milk to come out?" "Will the milk make a difference in the baby's stomach, because he'll be taking two kinds of milk?" There were also comments about breastfeeding. "I wanna do it, but I don't want to do it every day." One teen showed an unusual practical sense. "I know I ' m going to do it (breastfeed). The first couple of weeks I can't go nowhere. I can't go to no WIC doctor for nothing. I gotta have some kind of milk. Hospital milk runs out." The teens said they knew when their children were ill, but did not know how to treat childhood illness such as fever, diarrhea, thrush, and eczema. The teens first mentioned the terms thrush and eczema. They wanted to know what these terms meant. Teens matter-of-factly reported that grandmothers told them how to care for their sick children. When seeking health care for their ill children, teens said they used emergency rooms rather than pediatric clinics. Some teen mothers said they knew how to "take" their children's temperatures with a thermometer whereas others admitted they did not. Misinformation consisted of those parenting areas or topics that the researchers identified in which the teens lacked information. The theme, misinformation differs from the theme, lack of information, in that participant teens did not seem to be aware that they lacked information or were misinformed about these parenting topics. One teen mother said, "My baby is already spoiled. She wants you to hold her all the time. She
TEENS' PERCEPTIONSOF PARENTING
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likes a lot of attention. If you don't give her a lot of attention, she just lay there and cry." Teens attributed their children's behaviors to purposeful actions. Sometimes, the teens thought their children behaved in ways to annoy their caregivers. "They know what they're doin, anybody that just sit there and pour pop on the floor, they know what they're doin." Teens expected grandmothers to take care of safety measures in the home. None of the teens said they used carseats when riding with their children in automobiles. Several teens said that they sometimes "propped the bottle" when feeding their children.
UMITATIONS There are several factors which limit the generalizability of the study findings. The population used in the study was restricted to a small number of African American childbearing teens. Therefore, the findings may not apply to other samples. The use of focus groups as a method for collecting data has limitations (Morgan, 1988). Studies using focus groups with teens were not found. Thus, it is not known how comfortable teens are in discussing their experiences in groups with adults and their peers. Sensitive topics may inhibit discussion, and there may be some question about the accuracy of the teen participants' comments when in the company of peers.
CONCLUSIONSAND IMPUCATIONS In comparing findings from this study with those of a sample of five white and two Hispanic teens, Arenson's (1994) teen participants similarly reported good family support with parenting. In addition, Arenson's participants reported that having a child had markedly improved their lives, helping them overcome "self-destructive behaviors." In contrast, the teens in this study did not express a sense that giving birth had improved their lives in any appreciable sense, nor did they talk about self-destructive behaviors either before or after giving birth. Findings from this study provide information about African American teens' perceptions of their experiences with parenting. The data are reflective of the social and cultural milieu of these young women. The information from this study may enhance clinicians' efforts to improve nursing care for teenage mothers and their children. The teens'
own perceptions add to the knowledge about teen parenting gained from other studies that have used structured questionnaires, observation methods, and individual interview formats. The findings from this study have implications for nurses and others whose practice includes development, implementation, and evaluation of parent education programs for African American teen mothers and their families. Teen mothers need information about all child-rearing topics, however, data from this study indicate that discipline, feeding methods, milestones in early child development, and child safety issues are critical areas in which childbearing teens need more guidance, information, and support. In addition, this study's findings may provide information about the social and cultural influences that affect African American teens' parenting styles and skills. The African American teen mothers in this study looked to their mothers and grandmothers for parenting information. Furthermore, grandmothers provided much of the child care for the teens' children. Nurses and others might consider including extended family members' participation when planning nursing care for childbearing African American teens and their children. Grandmothers could benefit from parenting education programs. They may also need more emotional and financial support for the additional responsibilities they carry. Studies with larger samples of African American childbearing teens are indicated. Some research exists on grandmothers who help in rearing their grandchildren when the parents of these children use and abuse alcohol and other drugs (Burton, 1992). Research on grandmothers who help with parenting their teens' children deserves attention. Further research is indicated to explore the context of family relationships in which teen mothers and grandmothers share parenting of the teens' children.
ACKNOWLEDGMENT The authors wish to acknowledge the following persons: Dr. Margarete Sandelowski, consultant in qualitative analysis for the study, Shelia Bivens and DanieUe Broadway for their insight in the analysis stage, and Dr. Patricia O'Sullivan, Dr. Cornelia Beck, Valerie Shue, and Teresa Ragland for their assistance in preparation of the manuscript.
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(1993). Assessing and promoting positive parenting in adolescent mothers. MCN, 18, 32-37. Furstenberg, EE & Crawford, A.G. (1978). Family support: Helping teenage mothers to cope. Family Planning Perspectives, 10(6), 322-333. Horowitz, S.M., Klerman, LV., Kuo, H.S., & Jekel, J.E (1991). School-age mothers: Predictors of long-term educational and economic outcomes. Pediatrics, 87(6), 862-868. Howard, J.S., & Sater, J. (1985). Adolescent mothers: selfperceived health education needs. JOGNN, 14(5), 399-404. Jones, EA., Green, V., & Krauss, D.R. (1980). Maternal responsiveness of primiparous mothers during the postpartum period: age differences. Pediatrics, 65(3), 579-587. Klerman, L.V. (1993). Adolescent pregnancy and parenting: Controversies of the past and lessons for the future. Journal of Adolescent Health, 14(7), 553-561. Kotagal, U.R. (1993). Newborn consequences of teenage pregnancies. Pediatric Annals, 22(2), 127-132. Morgan, D.L. (1988). Focus groups as qualitative research. Beverly Hills, CA: Sage University Paper Series on Qualitative Research Methods, Vol. 16. Roosa, M.W. (1983). A comparative study of pregnant teenagers' parenting attitudes and knowledge of sexuality and child development. Journal of Youth and Adolescence, 12(3), 213-223. Roosa, M.W., Fitzgerald, H.E., & Carlson, N.A. (1982). Teenage and older mothers and their infants: A descriptive comparison. Adolescence, 17(65), 1-17.
N THE UNITED STATES, more than 1 million teenagers become pregnant, and about 500,000 of these give birth each year (The Alan Guttmacher Institute, 1994a). Compared with babies born to older women, prematurity and low birth weight occur with greater frequency in babies born to teens (Brown, Fan & Gonsoulin, 1991; The Alan Guttreacher Institute, 1994b; Klerman, 1993). Children of teen mothers often display greater difficulties in physical, emotional, behavioral, and developmental areas than children of older parents (Kotagal, 1993). Finally, social and economic problems often occur with early child-bearing and child-rearing. The teenage mother is at increased risk for remaining poorly educated, having more children than desired, and having a lower family income, often supported by public funds (Horowitz, Klerman, Kuo & Jekel, 1991). Given the problems associated with early childbearing and child-rearing, teen parents need parenting information and support for parenting. Furthermore, teen mothers want information about their children's psychosocial needs and cognitive development (Degenhart-Leskosky, 1989; Epstein, 1980; Howard & Sater, 1985). Arecent study (Arenson, 1994) looked at perceptions of parenting among seven White and Hispanic teens. Although the birthrate for African American teens is three times higher than that of White teens (The Alan Guttmacher Institute, 1994a), studies of
I
Journal of PediatricNursing, Vol 12, No 1 (February),1997
African American teen mothers' perceptions of parenting were not found. Identification of African American teen mothers' perceptions of parenting can help nurses and other health professionals in providing care for these young mothers and their children and in developing parenting education programs for teens. The purpose of this study was to describe African American teen mothers' perceptions of parenting based on discussions of their own experiences conducted in focus group sessions.
REVIEW OF THE UTERATURE In the past quarter-century many studies of teenage parents and children of teen parents were conducted. One of the first of these, examining interaction between adolescent mothers and their infants, found young parents to be generally intolerant, insensitive, impatient, irritable, and prone to
From the College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR and the Department of Nursing, University of Central Arkansas, Conway, AR. Supported by a University of Arkansas for Medical Sciences, College of Nursing, Intramural Grant No. 11740131. Address reprint requests to Jan Wayland, RN, PhD, Assistant Professor, University of Central Arkansas, Department of Nursing, 201 Donaghey Avenue, Conway, Arkansas 72035. Copyright 9 1997 by W.B. Saunders Company 0882-5963/97/1201-000353.00/0 13
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use physical punishment with their young children (Delissovoy, 1973). A number of subsequent studies compared teen mothers' parenting behaviors with those of adult mothers. These studies consistently found maternal age correlated with the quality of maternal nurturing. Relationships were found between older maternal age and greater responsiveness to one's infant (Jones, Green & Krauss, 1980; Roosa, Fitzgerald & Carson, 1982); more realistic developmental expectations and more desirable child rearing attitudes (Field, Widmayer, Stringer & Ignatoff, 1980); the provision of more audiovisually-stimulating toys for their infants (Roosa, Fitzgerald & Carson, 1982); and significantly greater knowledge about child development (Roosa, 1983). More recently, Fleming, Munton & Clark (1993) showed that teens, compared with older mothers, reacted to their older infants' behaviors more punitively, and with less verbal interaction. East, Matthews & Felice (1994) found that younger mothers had lower acceptance of their children than older mothers did, and teen and young adult mothers alike more often than older mothers advocated physical punishment for their children as a method of discipline. One study examined parenting from the teen mother's perspective or experience. Using a qualitative-descriptive approach, Arenson (1994) interviewed five White and two Hispanic teen mothers to identify their strengths in coping with parenthood. These teens said that having children improved their lives, reconnected them with their parents and siblings, established them as adults, and made them feel better about themselves. During the teenage years, African American mothers seldom marry or move away from the parental home after the birth of their children, but continue to reside with their families of origin, particularly with their mothers (The Alan Guttmacher Institute, 1994b). Mothers and grandmothers of African American teens often provide support and assistance with caregiving for the teens' children (Furstenberg & Crawford, 1978). The supportive environment offered in this living situation provides the motivation for the teen mother to continue her education, take a part-time job, and socialize with friends. These are activities important for the teen mother's own growth and development. In summary, studies have examined parenting behaviors of teen mothers. When parenting behaviors of teens are compared with those of older mothers, teens have not compared favorably. Only
WAYLAND AND RAWUNS
one study has examined teen mothers' own perceptions of parenting. Limitations of these studies include small sample size and inappropriate or missing comparison group. Another major problem with studies of parenting is the lack of appropriate tools to measure parenting abilities, particularly for measurement of teen mothers' parenting skills. Despite these limitations, there is little doubt that children of teen mothers are at greater risk for environmental deprivation. The teen mother's lack of maturity, knowledge, and life experiences may be contributing factors. These factors indicate a need for parenting education for teen mothers. The study described in this report identified childbearing African American teens' perceptions of parenting based on comments and descriptions of their own experiences that were obtained in focus group discussions held with their childbearing peers. The guiding research questions for this study were: (1) What are the parenting experiences of African American teenage mothers? and (2) What are African American teen mothers' perceptions about their parenting experiences?
METHODOLOGY A descriptive, qualitative design was used to gather information on African American teens' perceptions of parenting based on their own experiences. A series of 10 focus group discussions were conducted with 17 African American childbearing teenagers. All group sessions were audiotaped. Focus group discussions are conducted within a group of people to gather data on a topic supplied by the researcher, who typically takes the role of a moderator. Although focus groups, as a qualitative research method, began in social science research, the technique has been more widely used in the business community, particularly in marketing. The strength of using focus groups as an approach in data collection is in their ability to explore topics and generate hypotheses. Limitations of focus groups are that some topics may inhibit discussion, and there is some uncertainty about the accuracy of what participants say in a group situation as compared with individual interviews (Morgan, 1988). Although focus groups have been used with adults in social research as a technique for data collection, studies of focus groups with adolescents were not found. The researchers chose focus groups instead of individual interviews to facilitate verbal interaction among the teen participants.
TEENS" PERCEPTIONSOF PARENTING
SETrlNG For the study population, the researchers selected a senior high school and an adjacent junior high school where pregnant and parenting teens attend classes with nonchildbearing teens. The senior high school serves 10th through 12th grade students; the junior high school serves seventh through ninth grade students. These schools, composed of 65% to 75% African American students, were selected because of their higher rates of teen pregnancy.
PROCEDURES Permission was obtained from school officials and the city-county health department to conduct the study. The university's Human Research Advisory Committee and the city-county health department, which operates a school-based clinic in the high school, reviewed and approved the study's procedures. Before beginning the study, the researchers agreed to report any suspected abuse toward study teens or their children to the school nurse and school social worker. School officials identified 10 pregnant, and 18 parenting teens in the two schools. The school nurse and social worker sent letters explaining the study, with consent forms, to all known pregnant and parenting teens and their families. All students who volunteered and returned consent forms signed by both the students and parents were invited to participate. Of these, seventeen African American teens took part in discussions.
FOCUS GROUP DISCUSSIONS The focus groups were convened in the high school home economics room during the teens' 50-minute lunch period. Tables were placed in a circular arrangement to facilitate group discussions. Teens were encouraged to bring their lunches to the sessions. The focus group leaders provided juice, cookies, and health bars for all but the final session. After the final session the focus group leaders served pizza, a cake, and soft drinks and passed out movie passes to a local theatre. The focus group leaders consisted of the reseachers, both White, and an African American graduate nursing student. A different topic was introduced each week to initiate discussion. Topics reflected content from a teen parenting education program (Bavolek, 1984): (1) infant feeding, (2) comforting a crying infant and sleep routines, (3) bathing, diapering, and dressing an infant, (4) infant and child safety, (5) childhood illness, (6) an infant's need for play and stimulation, (7) an infant's need
15
for cuddling and holding, (8) childhood discipline, and (9) identification of the teen mothers' needs. For the 10th session, the teens were asked to discuss whatever they wanted to talk about. The week after the 10th session, the focus group leaders held a party for the participants. Initially, the focus group leaders planned to introduce comforting a crying baby later in the sessions. However, at the conclusion of the first session, the teens all said they wanted to talk about crying (hollerin) for the second session. The teens completed a one-page demographic data collection form developed for the study during the first group session. The form asked for the teen's age, grade in school, number of children, ages of children, expected date of childbirth (if pregnant), listing of persons with whom she resided, and listing of persons who helped her with her children. The attendance at group sessions varied from 7 to 14 teen participants. Most teen participants attended a total of three or more sessions. A focus group team leader began each session with a question or the presentation of a situation followed by a question. For instance, a focus group leader began the first group session with the following. "Doctors and nurses say that it is best to begin solid foods for your baby about 4 to 6 months of age, and until that time your baby needs only breast milk or formula. What do you think about this?" The teens were encouraged to respond based on their own perceptions and experiences. To conclude each session, a focus group team leader addressed specific questions the teens had asked during the session and distributed parent education pamphlets supplied by the local city-county or state health department. For this study teen and mother refer to the participant. Child refers to the teen's infant or child. Grandmother refers to the child's grandmother.
DESCRIPTION OF THE SAMPLE Seventeen unmarried teens, 15 to 18 years old with a mean age of 16.76, participated in the focus group discussions. Twelve were senior high students and five were junior high students. Eight were pregnant, and nine were mothers. Most of the teen mothers had one child. Two teens had two children each, one of these had twins. The teens' children ranged in age from 3 months to 2 years. Sixteen teens lived with their families of origin. One teen lived with her boyfriend (not the child's father) and her child in their own apartment. Female family members, especially teens' mothers
WAYLAND AND RAWLINS
16 and grandmothers, most often helped with the teens' children. One teen wrote. "No one helps me."
ANALYSIS A woman of African American descent transcribed the audiotapes verbatim within a week after each session. The transcriptionist reported no difficulty understanding the dialogue and terms expressed by the teen participants. The authors reviewed the transcripts within 2 weeks after they were transcribed. The researchers held postfocus group conferences within 1 to 4 hours after each focus group session for the purpose of reviewing the teen participants' comments and descriptions of their parenting experiences, obtaining a general sense of the flow of the discussion, and for planning subsequent group sessions. The postfocus group conferences were also audiotaped and transcribed for use in analysis. The researchers read and reread the focus group narratives until themes from the data emerged. In addition, another researcher who holds recognized expertise in the design and analysis of qualitative research was consulted. The research consultant also reviewed the focus group transcriptions for verification of themes. Three women of African American descent, a graduate student, a school nurse, and a university secretary reviewed the themes along with the designated narrative. They were asked if, in their estimation, the narrative "fit" the themes. Each concluded that the narrative did indeed fit the themes as described. Finally, the graduate student whose first child was born when she was a teenager said the narrative was descriptive of her own experience of parenting while a teenager. A limitation of the study is that the teen participants were not asked to read the themes with the designated narrative.
Table I. ThemesWith Examples From Narratives Artifacts My momma told me to use um [cloth diapers] but if l run outof pampers, I'm goin to be goin to the store. She be liken the television remote, thatJswhat she like the best to play with. Sources of Information When she was a few weeks old she was real greedy, one bottle wouldn't hold her, so my mother told me to go ahead and start giving her cereal. When I did, she [infant] acted better. Sometimes they [grandmothers] tell you to use brown flour (for diaper rash). You put it in a pan and you just let it tam brown. Then cool it off and put it on their behinds. Problems With Parenting I don't like her [grandmother] tryin to tell me how to do my baby. I be wantin to do my baby the way I wanna do her, but she be trying to tell me h o w . . . I don't like that. My friends be wanting me to go places. The ones that don't have babies, they don't understand that you got a responsibility and you just can't up and go all the time now. Strategies or Remedies for Dealing With Problems I don't like arguing so I just told him {her child's father} if you want to keep them {twins) it's gonna have to be on a weekend or you can come after they come out of school. Like at Easter time, he wanted all of us to be together, but I wanted to be with my mama. So, I kept them half a day, and he kept them half a day. To me if a baby is hungry, if you stick your finger right there and they suck, then they might be hungry. If you have already fed them and they're just hollerin, and they're noddin off, they're sleepy. Unique Language hoggy/greedy (means) hungry whup (means) spank hollerin (means[ crying fallin out (means) child throwing self on floor throwin fits (means) temper tantrum showin out (means) showing off boo-boo (means) hurt or sore area posteria/bult (means) buttocks noddin off (means) falling asleep hold longer (means) last longer in stomach (food) Lack of Information Will breast milk hold longer than formula? What about this breast pump? What is it supposed to do? Don't that supposed to keep the milk coming? Misinformation I used to lay her down on her back and prop the bottle in her mouth, it didn't ever bother her. If she spill something on the floor, she's going to wipe it up.
FINDINGS The researchers identified seven themes from the narrative data: (1) artifacts, (2) sources of information, (3) problems with parenting, (4) strategies or remedies for dealing with problems, (5) unique language, (6) lack of information, and (7) misinformarion (Table 1). Artifacts are items or objects that participant teens considered important in parenting their children. Teens considered disposable diapers necessary items for parenting. Some teens said grandmothers wanted them to use cloth diapers; however, teens
clearly preferred the disposable ones. Teens did not view the expense of disposable diapers as a problem. Two teens said their children's fathers provided some disposable diapers. "I use pampers, I ' m not fixin to mess around with no cloth, that means washin." "I can see myself when he's first born, but now (that he's older) I can't wash no diapers up, the smell (laughs)." Another artifact described by the teens was the use of remote controls. Teens used the television remote control and played music on the radio to
TEENS' PERCEPTIONSOF PARENTING
amuse, distract, and comfort their children. "My baby loves those remote controls." "Yeah, they be amused by it, little stuff like that. They see the light, they point at the light, little buttons, they like to mash it, push, play, push, eject, push it back in. They be busy for a while." Sources o f information are those persons who are primary sources of parenting information to the teens. Teens said that although nurses, doctors, and friends gave them parenting information, grandmothers were their primary source of parenting information, followed by sisters and aunts. "Well, my morn always tell me, like, when he have his head against me and it be hot, and I say, he might have a fever, and she says the only way he has a fever is if you check up under his ann or in his butt." When professionals' advice on parenting differed from that of family members, teens said they took the advice of family members. Teens also depended heavily on grandmothers for assistance with child care. When asked how they managed at home when they had pressing school-work to be done, they said they "turned their children over to grandmothers." Problems are what the teens themselves identified as specific parenting events that caused them concern. Teens said relationships became strained when the child spent so much time with the grandmother that the child responded to the grandmother as "mother" and to the teen mother as "sister." Teen participants acknowledged that grandmothers spent more time with their children than they did; nevertheless, they wanted their children to respond to them (teens) as "the mother." "She (grandmother) hold him all the time, talking to him, playin with him, everything. Like when I talk to my baby she just don't act the same as when my grandmother is talkin to her. She be talkin back to me but she gets more excited when my grandmother is talkin to her. Sometimes, I get jealous." Teens viewed their relationships with grandmothers (teen's mothers and their grandmothers) as having both positive and negative aspects. Although the teens talked of "turning the child over to the grandmother" when they had homework or other things to do, they viewed grandmothers as "spoiling the child" by picking the child up and holding him or her too often. Coping with a crying baby was one of the problems all the participant teens wanted to talk about. "My baby hollers for no reason." " I f the baby could tell you what they want when they cry.
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You have to sit there and figure it out. I hate that. I get frustrated." Teen participants shared the problems of balancing school, homework, jobs, and relationships with caring for their children. They talked about the effects of parenthood on their lives. One teen said, "you don't have no more freedom to go as you please." Another said, "it's the same for me. I just take my baby where I go." Some talked about having more responsibilities. "I used to help my mom with her twins. It's more responsibility now, because it's mine. I have to do everything myself." Another said, " m y friends be wanting me to go places. The ones that don't have babies, they don't understand that you got a responsibility and you just can't up and go all the time now." One teen said, "it's fun to me to stay home and be with my baby. Another said, "it ain't too fun to me." In response to this discussion, another teen said, "its not really different, I like staying home with her." Two teens expressed dissatisfaction in not having the freedom to go out with friends, "to party," and "to go to movies." Strategies or remedies are the ways in which teens went about addressing or solving specific parenting events that caused them concern. To manage their children's crying, teen mothers used several strategies. "That's the only way mine will stop crying, if I pick him up or his grandmother picks him up. I'll put him in that walker or swing and walk on. Somebody there will hold him . . . they'll get tired of listenin. I ain't gonna be there to hold him." Other remedies for crying included: "playing music on the radio for the child," "talking to the child," "giving the child a bottle," "playing with the child," "sleeping with the child," "letting the child cry," "giving the child to the grandmother," or "spanking the child." All participant teens said they either slept in the same bed with their children or shared a room with them. Teens reported bedtime routines for their children that fit with their own schedules and needs. "Sometimes I make her go to bed, i f I get real busy. If I don't . . . she'll just stay up and go to sleep when I go." "My b a b y , . . , she be woke when I get home and I try to put her to sleep when I get home so I'll have time to do my homework. If she wakes up about six, I'll leave her up until it's time for me to go to sleep and then she'll go to sleep." "I would kind of like for my child to stay up late so she won't be getting me up in the morning." When their children did not sleep, teens said they used the following strategies: "allow the child to stay up," "feed the child cereal," "gave the child a warm
18
bath," "give the child a bottle," "give the child to the grandmother," or "spank the child." The teen mothers disciplined their children in various ways, often using trial and error methods. "Well, my baby gets a spanking every now and then. I don't always whip her but she gets a spanking. Not with a belt, but I do threaten her with one." Sometimes I do what they do at the daycare she'll stand in the corner. .... . . . if they {twins} do something, I'll just sit them on the couch or I'll put them in the playpen." " I f I whip my little girl with my hand, my mom gets mad at me. She says, you may break something, stop hitting her like that. So what I started doing was popping her in her hand with a comb." During one discussion about discipline, one teen remarked "I don't beat my child, because someone might think I am abusing her." Another teen said that, "when it is your child, you do what you want." Teen participants did not spontaneously address concerns about their children's fathers. During one group session, a focus group team leader asked about fathers. In response, one teen turned her head away from the group and said, "We don't want to talk about that." Some said they didn't want the fathers to take the baby out alone without them (teen mothers) along. One said, "I don't trust him with my baby." Another said, "If she does go (with the father), I gotta know when she's goin, what she's gonna be doin, how they gonna do this, how they're gonna do that. If she comes back cryin, she ain't goin no more." Some teens talked of their children's fathers as "not serious" or "not accepting responsibility" for the child. One teen commented that her child's father acts "silly and he shows out." On the other hand, two teens said their children's fathers "visit and play with their children." One teen said, " . . . he pays child support once a week and when he gets paid, he buys diapers. I get a child support check from my dad too and when I get mine I still buy diapers." The teens expressed little desire to have additional children. "I ain't havin no more." "One is too many." "One is enough." "Right now at my age, no." "One is already expensive." When discussing the possibility of another pregnancy, some teens said they were using a method of birth control or planned to use a birth control method after childbirth. "As soon as I have it, I ' m going to get on birth control." " I ' m already taking them (birth control pills)." "I wanna get the implant." ' T m gettin a shot." Teens reported using several home remedies passed down through maternal family members in .
.
.
WAYLAND AND RAWLINS
caring for their children. Some home remedies were "olive oil for skin care," "browned flour, browned in a pan on top of the stove, for diaper rash," an "Irish potato tied around the child's neck for fever," and "blowing smoke on the child's soft spot for colic." Unique language consisted of terms consistently used among the teens that the researchers did not know or were unsure as to their meaning. When a teen participant used one of these terms the researchers asked her and the other teens to talk about what the term meant to them. These terms have been quoted in context within the teens' narratives and are listed with explanations of meanings in the table. Lack of information consisted of parenting areas or topics that participant teens identified about which they needed information. Several teens asked about breastfeeding. "So, if you don't breastfeed at all, how are you going to get the milk out of your breast? .... Don't you have to poke a hole in your, you know, thing to get the milk to come out?" "Will the milk make a difference in the baby's stomach, because he'll be taking two kinds of milk?" There were also comments about breastfeeding. "I wanna do it, but I don't want to do it every day." One teen showed an unusual practical sense. "I know I ' m going to do it (breastfeed). The first couple of weeks I can't go nowhere. I can't go to no WIC doctor for nothing. I gotta have some kind of milk. Hospital milk runs out." The teens said they knew when their children were ill, but did not know how to treat childhood illness such as fever, diarrhea, thrush, and eczema. The teens first mentioned the terms thrush and eczema. They wanted to know what these terms meant. Teens matter-of-factly reported that grandmothers told them how to care for their sick children. When seeking health care for their ill children, teens said they used emergency rooms rather than pediatric clinics. Some teen mothers said they knew how to "take" their children's temperatures with a thermometer whereas others admitted they did not. Misinformation consisted of those parenting areas or topics that the researchers identified in which the teens lacked information. The theme, misinformation differs from the theme, lack of information, in that participant teens did not seem to be aware that they lacked information or were misinformed about these parenting topics. One teen mother said, "My baby is already spoiled. She wants you to hold her all the time. She
TEENS' PERCEPTIONSOF PARENTING
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likes a lot of attention. If you don't give her a lot of attention, she just lay there and cry." Teens attributed their children's behaviors to purposeful actions. Sometimes, the teens thought their children behaved in ways to annoy their caregivers. "They know what they're doin, anybody that just sit there and pour pop on the floor, they know what they're doin." Teens expected grandmothers to take care of safety measures in the home. None of the teens said they used carseats when riding with their children in automobiles. Several teens said that they sometimes "propped the bottle" when feeding their children.
UMITATIONS There are several factors which limit the generalizability of the study findings. The population used in the study was restricted to a small number of African American childbearing teens. Therefore, the findings may not apply to other samples. The use of focus groups as a method for collecting data has limitations (Morgan, 1988). Studies using focus groups with teens were not found. Thus, it is not known how comfortable teens are in discussing their experiences in groups with adults and their peers. Sensitive topics may inhibit discussion, and there may be some question about the accuracy of the teen participants' comments when in the company of peers.
CONCLUSIONSAND IMPUCATIONS In comparing findings from this study with those of a sample of five white and two Hispanic teens, Arenson's (1994) teen participants similarly reported good family support with parenting. In addition, Arenson's participants reported that having a child had markedly improved their lives, helping them overcome "self-destructive behaviors." In contrast, the teens in this study did not express a sense that giving birth had improved their lives in any appreciable sense, nor did they talk about self-destructive behaviors either before or after giving birth. Findings from this study provide information about African American teens' perceptions of their experiences with parenting. The data are reflective of the social and cultural milieu of these young women. The information from this study may enhance clinicians' efforts to improve nursing care for teenage mothers and their children. The teens'
own perceptions add to the knowledge about teen parenting gained from other studies that have used structured questionnaires, observation methods, and individual interview formats. The findings from this study have implications for nurses and others whose practice includes development, implementation, and evaluation of parent education programs for African American teen mothers and their families. Teen mothers need information about all child-rearing topics, however, data from this study indicate that discipline, feeding methods, milestones in early child development, and child safety issues are critical areas in which childbearing teens need more guidance, information, and support. In addition, this study's findings may provide information about the social and cultural influences that affect African American teens' parenting styles and skills. The African American teen mothers in this study looked to their mothers and grandmothers for parenting information. Furthermore, grandmothers provided much of the child care for the teens' children. Nurses and others might consider including extended family members' participation when planning nursing care for childbearing African American teens and their children. Grandmothers could benefit from parenting education programs. They may also need more emotional and financial support for the additional responsibilities they carry. Studies with larger samples of African American childbearing teens are indicated. Some research exists on grandmothers who help in rearing their grandchildren when the parents of these children use and abuse alcohol and other drugs (Burton, 1992). Research on grandmothers who help with parenting their teens' children deserves attention. Further research is indicated to explore the context of family relationships in which teen mothers and grandmothers share parenting of the teens' children.
ACKNOWLEDGMENT The authors wish to acknowledge the following persons: Dr. Margarete Sandelowski, consultant in qualitative analysis for the study, Shelia Bivens and DanieUe Broadway for their insight in the analysis stage, and Dr. Patricia O'Sullivan, Dr. Cornelia Beck, Valerie Shue, and Teresa Ragland for their assistance in preparation of the manuscript.
REFERENCES The Alan Guttmacher Institute. (1994a). Facts in brief: Teenage reproductive health in the United States. New York and Washington, DC:Author.
The Alan Guttrnacher Institute. (1994b). Sex and America's teenagers. New York and Washington, DC: Author. Arenson, J.D. (1994). Strengths and self-perceptions of
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parenting in adolescent mothers. Journal of Pediatric Nursing, 9(4), 251-257. Bavolek, S. (1984). Handbook for the Adult-adolescent parenting inventory (AAPI). Salt Lake City, Utah: Family Development Resources, Inc. Brown, H.L., Fan, Y., & Gonsoulin, W.J. (1991). Obstetric complications in young teenagers. Southern Medical Journal, 84(1), 46-48. Burton, L.M. (1992). Black grandparents rearing children of drug-addicted parents: stressors, outcomes, and social service needs. The Gerontologist. 32(6), 744-751. Degenhart-Leskosky, S.M. (1989). Health education needs of adolescent and nonadolescent mothers. JOGNN, 17(3), 238244. Delissovoy, V. (1973). Child care by adolescent parents. Children Today, 2(4), 22-25. East, EL., Matthews, K.L., & Felice, M.E. (1994). Qualities of adolescent mothers' parenting. Journal of Adolescent Health, 15(2), 163-168. Epstein, A.S. (1980). Assessing the child developmental information needed by adolescent parents with very young children. Final Report. Grant no. 90-3-1341. Ypsilanti, ME: High/Scope Educational Research Foundation. Field, T.M., Widmayer, S.M., Stringer, S., & Ignatoff, E. (1980). Teenage, lower-class Black mothers and their pre-term infants: an intervention and developmental follow-up. Child Development, 51,426-436. Fleming, B.W., Munton, M.T., Clarke, B.A., & Strauss, S.S.
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(1993). Assessing and promoting positive parenting in adolescent mothers. MCN, 18, 32-37. Furstenberg, EE & Crawford, A.G. (1978). Family support: Helping teenage mothers to cope. Family Planning Perspectives, 10(6), 322-333. Horowitz, S.M., Klerman, LV., Kuo, H.S., & Jekel, J.E (1991). School-age mothers: Predictors of long-term educational and economic outcomes. Pediatrics, 87(6), 862-868. Howard, J.S., & Sater, J. (1985). Adolescent mothers: selfperceived health education needs. JOGNN, 14(5), 399-404. Jones, EA., Green, V., & Krauss, D.R. (1980). Maternal responsiveness of primiparous mothers during the postpartum period: age differences. Pediatrics, 65(3), 579-587. Klerman, L.V. (1993). Adolescent pregnancy and parenting: Controversies of the past and lessons for the future. Journal of Adolescent Health, 14(7), 553-561. Kotagal, U.R. (1993). Newborn consequences of teenage pregnancies. Pediatric Annals, 22(2), 127-132. Morgan, D.L. (1988). Focus groups as qualitative research. Beverly Hills, CA: Sage University Paper Series on Qualitative Research Methods, Vol. 16. Roosa, M.W. (1983). A comparative study of pregnant teenagers' parenting attitudes and knowledge of sexuality and child development. Journal of Youth and Adolescence, 12(3), 213-223. Roosa, M.W., Fitzgerald, H.E., & Carlson, N.A. (1982). Teenage and older mothers and their infants: A descriptive comparison. Adolescence, 17(65), 1-17.