BACK PAGE Jo-Anna L. Rorie, CNM, MSN, MPH

Are We Asking and Are We Listening?

As nurse-midwives, we are actively engaged in the care ofadolescent girls. Adolescents’ attitudes, behaviors, andtheir use of the health care system are linked directly totheir health and well being as adults.1 The results of the1998 Nurse-Midwifery Practice Survey indicated that 29%of all annual visits to midwives were by adolescents. Amidwife’s ability to meet the health care needs of anadolescent largely depends on the individual seeking care,as well as the ability of the midwife tolisten to what is alltoo often a “foreign” language—the language of adoles-cence. It is widely believed that when an adolescentactively seeks care from a midwife she has made anindependent decision about her health, which can beviewed as a positive developmental milestone.

Experimentation, although normal in adolescence, canresult in devastating consequences. Girls seem to “hit awall” at or around adolescence. Generally, adolescent girlsfeel good about themselves between and including the agesof 9 to 11. Self-confidence and self-esteem decline as girlsmatriculate through high school. At this time, adolescentboys experience the opposite. Recent data indicate thatmany adolescent girls do not have access to health carewhen they need it, and, when they do obtain care, theproviders they see often do not address their specificconcerns. Distinct opportunities for health prevention andamelioration of potentially significant health care problemsin adulthood are available for midwives who maintainadolescent girls as part of their clientele.

The 1997 Commonwealth Survey found a disturbinglyhigh rate of physical abuse and depressive symptomsamong teenage girls. Most abuse occurs at home, isrepetitive, and the abuser is usually a family member.2

Abused girls are more at risk for eating disorders. Routinehealth services are one pathway to receiving mental healthtreatment for depression in adolescent girls. One questionto ask is to what extent this phenomenon may be due to thebombardment of messages that adolescent girls receivefrom the media, including music videos and fashion mag-azines. In the media, a young girl’s physical appearance isprimarily the focus, while “human” qualities receive lowpriority. As a result, adolescent girls often find it hard todefine themselves in a healthy way.

“I know you’re out there. I can feel your presence.Every time I close my eyes. I can here your heartbeat. Your silhouette is outlined in the corner of mymind. The edges are so clear but the inside fadedgray. Your laughter rings in my ears. And I smile,thinking of you. Yet, I do not know you. I haven’tever met you but I am looking, looking. Looking intothe store and looking at the movies. Looking every-where I go knowing you are somewhere. But some-where is hard to find. So I close my eyes and hearyour heart. See your silhouette. And every time Ihear you laugh, I turn and look for you. I knowyou’re somewhere. But somewhere’s hard to find.”3

Some adolescent health risk behaviors appear to bedisproportionately high among youths of color, lower-income adolescents, and those living in poverty. Thesedemographic factors do not, however, accurately predictyouth health risk behaviors. As in all areas of health care,there are disparities across populations. Health risk behav-iors such as alcohol consumption, unprotected intercourse,and smoking can put an adolescents’ health at risk and havelifelong consequences. Traditional public health studieshave often given special attention to race, ethnicity, andfamily structure, thereby leading to statistical analyses thattend to negatively portray minority adolescents’ behavior asaberrant and provide little, if any understanding of thefactors that contribute to the behaviors under study. Howare we as providers to interpret research findings thatsuggest that White and Hispanic girls are more likely toengage in risky behaviors? When all is said and done, andeach of us remembers ourown adolescence. . . .who waslistening?

REFERENCES

1. Bright futures: guidelines for health supervision of infants, chil-dren and adolescents. 2nd ed, rev. Arlington VA: National Center forEducation in Maternal and Child Health, Georgetown University.

2. The Commonwealth Fund survey of the health of adolescentgirls. New York: Commonwealth Fund; 1997.

3. Woolf L. Somewhere’s hard to find. Love poems,Teen voicesonline http://www.teenvoices.com/issue_current/tvlovepoems.html.

242 Volume 48, No. 3, May/June 2003© 2003 by the American College of Nurse-Midwives 1526-9523/03/$30.00• doi:10.1016/S1526-9523(03)00085-0Issued by Elsevier Inc.