1
scriptions) and Medical Services Plan (MSP) (physician reim- bursement claims). An algorithm incorporating MSP diagnostic codes to identify non-EC uses of Ovral was developed, and EC prescriptions were retained. Results: During the pre-policy period from 1996 to 2000, 44,025 EC prescriptions were provided by physicians. Pre-policy annual utilization rates were 1.3/1000 women 10 –15 years, 20.8/1000 women 16 –24 years and 3.7/1000 women 25–59 years. In the post-policy 2001-2002 period, physicians and pharmacists pro- vided 33,833 EC prescriptions, representing an increase across all age groups in annual utilization rates to 1.9/1000 women 10 –15 years, 35.6/1000 women 16 –24 years and 7.6/1000 women 25–59 years. Physicians provided the Yuzpe EC regimen to women more commonly than pharmacists: 10-15 years (80% vs 61%), 16 –24 years (79% vs 43%) and 25–59 years (84% vs 36%). Compared with pre- and post-policy physician prescribing patterns, pharma- cists provided 10-15 and 16 –24 year olds EC more frequently on weekends. Repeat use was relatively infrequent. Of those 10 –15 years of age using EC, 90% used EC only a single time within one year, 8% used it twice and 2% more than twice. This pattern of repeat use was lower than among adolescents 16 –24 (85%, 12%, 3%) and women 25–59 (88%, 9% 3%) years of age. Physicians provided EC to women who required income assistance more often than did pharmacists. Conclusions: Authorization of pharmacists to provide EC in- creased utilization across all age groups throughout the province, with the highest utilization rate among adolescents 16 –24 years of age. Physicians provided the Yuzpe regimen to women more frequently than did pharmacists. Pharmacists improved timely ac- cess to EC on weekends for adolescents, and repeat use of EC was infrequent. Support: Research was funded in part by the BC Ministry of Health and the BC Medical Services Foundation, and with support from the Pharmacy Access Partnership funded by the David and Lucille Packard Foundation. PII: S1054-139X(04)00291-5 7. ADOLESCENT MOTHERS’ PERCEPTIONS AND MANAGEMENT OF STIGMA Kathryn Bondy Fessler, M.D., M.A. Division of Sociology, Horace H. Rackham School of Graduate Studies, University of Michigan, Ann Arbor, MI. Purpose: Young mothers must meet many challenges; effectively parenting their children, fulfilling their own developmental tasks, and interacting with other people in their environment who often disapprove of their “teen mom” status and who may judge them harshly. This study was undertaken in an attempt to understand the effect of the stigma of early childbearing on young mothers’ parenting and sense of self. Methods: Study Design: This is a qualitative study with a grounded theory design. Semi-structured open-ended interview transcripts were analyzed using a combination of thematic and line-by-line coding techniques. Setting: Interviews were conducted with young mothers recruited from an adolescent health center and an educational program for young mothers, both in small cities. Participants: 34 young women completed interviews. All had expe- rienced their first birth at age 19 or younger. Racial/ethnic background was as follows: 12 Caucasian, 7 African American, 10 Latina, 5 Native American. Most were from working families. Results: Several themes emerged from the data. 1) Young mothers do, in general, experience their status as “teen mothers” as a stigma- tized identity. 2) Many young mothers manage stigma with tech- niques of hypervigilance and avoidance. Young mothers describe a pattern of behavior in which they are always alert for judgment. They ascribe the actions of others as being related to their “teen mom” status i.e. “The grocery store clerk was rude to me because I’m a teen Mom” or “ When I was in labor, the nurse wouldn’t let me eat because I was so young.” Avoidance was described in an earlier paper from a related study. In summary, young women often go to great lengths to avoid situations in which they might encounter stigma, such as stop- ping prenatal care or dropping out of school. 3) Young mothers often respond to stigma by erecting protective barriers or by taking on a “good mother” identity. Barriers shield the young mother from po- tential sources of stigma and sometimes reaffirm social ties after a family or peer group initially responds negatively to the pregnancy i.e. “I went everywhere with my grandmother [when I was pregnant]. No one would dare say anything to me while she was there” or “When I felt my first contractions we were all so excited [mother, aunt, brother and 2 girlfriends] that we all piled into the car to go to the hospital together.” “The Good Mother,” as defined by the women with whom I spoke, never leaves her child with another caregiver, provides an exemplary level of material goods (i.e. never buying used baby cloth- ing) and denies her own needs in order to best care for her baby. By taking on this identity, young women “prove” that they can parent effectively, often at a great cost to themselves in terms of maternal stress. Conclusions: Health care providers sometimes note behaviors in young mothers that can make interactions difficult. These behav- iors may be better understood in terms of hypervigilance/avoid- ance or as protective/adaptive responses to stigma. It is hoped that better understanding will improve health care delivery. Support: NIMH Gender and Mental Health fellowship, Rackham dissertation support, Univ. of Mich. Division of General Pediatrics small grant program. PII: S1054-139X(04)00292-7 PLATFORM RESEARCH PRESENTATIONS: SESSION IV Parents, Providers and Patients 1. PARENT AND ADOLESCENT VIEWS OF RISK BEHAVIOR RESEARCH AND CONSENT Ryan H. Pasternak, M.D., M.P.H., Tina L. Cheng, M.D., M.P.H., Gail Geller, Sc.D., Catherine Parrish, M.D. Dept. of Ped., Johns Hopkins Sch. of Med., Baltimore, Maryland. Purpose: Data on adolescent risk behavior have frequently been obtained from surveys without parental consent. Legal challenges have led to increased scrutiny of adolescent research. There has been little study, however, on parent and youth perceptions of the need for this research, attitudes and expectations on confidentiality or disclosure, and views of the consent process. This study aims to assess parents’ views, compare their views with their adolescent, and identify predictors of these views. 104 Abstracts / 36 (2005) 95-110

Adolescent mothers’ perceptions and management of stigma

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scriptions) and Medical Services Plan (MSP) (physician reim-bursement claims). An algorithm incorporating MSP diagnosticcodes to identify non-EC uses of Ovral was developed, and ECprescriptions were retained.Results: During the pre-policy period from 1996 to 2000, 44,025EC prescriptions were provided by physicians. Pre-policy annualutilization rates were 1.3/1000 women 10–15 years, 20.8/1000women 16–24 years and 3.7/1000 women 25–59 years. In thepost-policy 2001-2002 period, physicians and pharmacists pro-vided 33,833 EC prescriptions, representing an increase across allage groups in annual utilization rates to 1.9/1000 women 10–15years, 35.6/1000 women 16–24 years and 7.6/1000 women 25–59years. Physicians provided the Yuzpe EC regimen to women morecommonly than pharmacists: 10-15 years (80% vs 61%), 16–24years (79% vs 43%) and 25–59 years (84% vs 36%). Comparedwith pre- and post-policy physician prescribing patterns, pharma-cists provided 10-15 and 16–24 year olds EC more frequently onweekends. Repeat use was relatively infrequent. Of those 10–15years of age using EC, 90% used EC only a single time within oneyear, 8% used it twice and 2% more than twice. This pattern ofrepeat use was lower than among adolescents 16–24 (85%, 12%,3%) and women 25–59 (88%, 9% 3%) years of age. Physiciansprovided EC to women who required income assistance more oftenthan did pharmacists.Conclusions: Authorization of pharmacists to provide EC in-creased utilization across all age groups throughout the province,with the highest utilization rate among adolescents 16–24 years ofage. Physicians provided the Yuzpe regimen to women morefrequently than did pharmacists. Pharmacists improved timely ac-cess to EC on weekends for adolescents, and repeat use of EC wasinfrequent.Support: Research was funded in part by the BC Ministry ofHealth and the BC Medical Services Foundation, and with supportfrom the Pharmacy Access Partnership funded by the David andLucille Packard Foundation.

PII: S1054-139X(04)00291-5

7.

ADOLESCENT MOTHERS’ PERCEPTIONS ANDMANAGEMENT OF STIGMAKathryn Bondy Fessler, M.D., M.A. Division of Sociology,Horace H. Rackham School of Graduate Studies, University ofMichigan, Ann Arbor, MI.

Purpose: Young mothers must meet many challenges; effectivelyparenting their children, fulfilling their own developmental tasks,and interacting with other people in their environment who oftendisapprove of their “teen mom” status and who may judge themharshly. This study was undertaken in an attempt to understand theeffect of the stigma of early childbearing on young mothers’parenting and sense of self.Methods: Study Design: This is a qualitative study with agrounded theory design. Semi-structured open-ended interviewtranscripts were analyzed using a combination of thematic andline-by-line coding techniques.Setting: Interviews were conducted with young mothers recruitedfrom an adolescent health center and an educational program foryoung mothers, both in small cities.

Participants: 34 young women completed interviews. All had expe-rienced their first birth at age 19 or younger. Racial/ethnic backgroundwas as follows: 12 Caucasian, 7 African American, 10 Latina, 5Native American. Most were from working families.Results: Several themes emerged from the data. 1) Young mothersdo, in general, experience their status as “teen mothers” as a stigma-tized identity. 2) Many young mothers manage stigma with tech-niques of hypervigilance and avoidance. Young mothers describe apattern of behavior in which they are always alert for judgment. Theyascribe the actions of others as being related to their “teen mom”status i.e. “The grocery store clerk was rude to me because I’m a teenMom” or “ When I was in labor, the nurse wouldn’t let me eat becauseI was so young.” Avoidance was described in an earlier paper from arelated study. In summary, young women often go to great lengths toavoid situations in which they might encounter stigma, such as stop-ping prenatal care or dropping out of school. 3) Young mothers oftenrespond to stigma by erecting protective barriers or by taking on a“good mother” identity. Barriers shield the young mother from po-tential sources of stigma and sometimes reaffirm social ties after afamily or peer group initially responds negatively to the pregnancy i.e.“I went everywhere with my grandmother [when I was pregnant]. Noone would dare say anything to me while she was there” or “When Ifelt my first contractions we were all so excited [mother, aunt, brotherand 2 girlfriends] that we all piled into the car to go to the hospitaltogether.” “The Good Mother,” as defined by the women with whomI spoke, never leaves her child with another caregiver, provides anexemplary level of material goods (i.e. never buying used baby cloth-ing) and denies her own needs in order to best care for her baby. Bytaking on this identity, young women “prove” that they can parenteffectively, often at a great cost to themselves in terms of maternal stress.Conclusions: Health care providers sometimes note behaviors inyoung mothers that can make interactions difficult. These behav-iors may be better understood in terms of hypervigilance/avoid-ance or as protective/adaptive responses to stigma. It is hoped thatbetter understanding will improve health care delivery.Support: NIMH Gender and Mental Health fellowship, Rackhamdissertation support, Univ. of Mich. Division of General Pediatricssmall grant program.

PII: S1054-139X(04)00292-7

PLATFORM RESEARCH PRESENTATIONS:SESSION IV

Parents, Providers and Patients

1.

PARENT AND ADOLESCENT VIEWS OF RISKBEHAVIOR RESEARCH AND CONSENTRyan H. Pasternak, M.D., M.P.H.,Tina L. Cheng, M.D., M.P.H., Gail Geller, Sc.D.,Catherine Parrish, M.D. Dept. of Ped., Johns Hopkins Sch. ofMed., Baltimore, Maryland.

Purpose: Data on adolescent risk behavior have frequently beenobtained from surveys without parental consent. Legal challengeshave led to increased scrutiny of adolescent research. There hasbeen little study, however, on parent and youth perceptions of theneed for this research, attitudes and expectations on confidentialityor disclosure, and views of the consent process. This study aims toassess parents’ views, compare their views with their adolescent,and identify predictors of these views.

104 Abstracts / 36 (2005) 95-110