Being Healthy: Voices of Adolescent Women Who

1ORIGINAL
Blackwell
Oxford,
Journal
JSPN
©
1088-145X
January
11
Being UK
2006 ARTICLE
2005Healthy:
for
by Publishing,
Nursecom,
Specialists
VoicesLtd.
Inc.
in
ofPediatric
AdolescentNursing
Women Who are Parenting

Are Parenting

Christine A. Stevens

PURPOSE. The purpose of this ethnography was to Christine A. Stevens, PhD, MPH, RN, is an assistant
professor of nursing, University of Washington,
explore how adolescent women who are parenting Tacoma,WA.

describe what “being healthy” means to them and

how they define their health needs.
METHODS.
methods of interviewing and participant
observation, photovoice was utilized.
RESULTS. Women’s
were grouped into three categories: (1) “taking
care of my body,” (2) “not being stressed out,” and
(3) “having what you need.”
PRACTICE IMPLICATIONS.
research study suggest that healthcare
professionals should consider adolescent mothers
knowledgeable actors of their own lives and move
beyond current strategies to concentrate on issues,
such as socioeconomic contexts, that hinder the
health and nutrition of these young women.
Search terms: Adolescence, healthcare disparities
In addition to traditional ethnographic
definitions of “being healthy”
The findings of this
Public health policies have begun to focus on indi-
vidual behaviors and community issues that influence
the health of adolescents in the United States (U.S.
Department of Health and Human Services [USD-
HHS], 2000). Spurred by these policies, interventions
are designed to increase health promotion during ado-
lescence and decrease early mortality and morbidity.
The majority of these interventions focus on improving
nutrition and exercise habits of adolescents (American
Medical Association [AMA], 2003; Centers for Disease
Control and Prevention [CDC], 2000; National Adolescent
Health Information Center [NAHIC], 2004) to prevent
obesity and promote cardiovascular health (CDC, 2000,
2004; MacKay, Fingerhut & Duran, 2000), and reducing
risky behaviors such as violence, injury, sexually
transmitted diseases (VanDevanter et al., 2005), and
pregnancy (CDC, 2005).
Due to the perception that all adolescents and
young adults are basically healthy, the target of many
intervention programs is on risky behaviors for this
population. Research on health disparities, however,
has demonstrated that not all adolescents enter or
leave this developmental stage as healthy individuals
(MacArthur Research Network on Transitions to
Adulthood, 2005; National Adolescent Health Informa-
tion Center [NAHIC], 2004). Moreover, health risks
associated with the intersection of gender, class, and
race may make future health unpromising for some
groups of adolescent women, such as those who are
parenting (Williams, 2002).

Accepted for publication September 8, 2005.

Literature Review

Women in certain population groups have dispro-

portionately high rates of health problems in early to
Accepted for publication September 8, 2005. middle adulthood. Geronimus and other researchers

28 JSPN Vol. 11, No. 1, January, 2006

(Collins, David, Handler, Wall, & Andes, 2004;
Geronimus, 1993, 1994, 1996, 1997, 2000, 2001a, 2001b;
Hellenga, Aber, & Rhodes, 2002; Kirby, Coyle, &
Gould, 2001; SmithBattle, 2000; Williams, 2002) have
reported that many health disparities in infants born
to poor African American adolescents can be attrib-
uted to the adolescent mothers’ socioeconomic context
rather than to their age. Based on her review of epide-
miological data, Geronimus also found that poor Afri-
can American adolescent women have only a 60%
chance of surviving past 60 years of age (Geronimus,
1994, 2000; Krieger & Gruskin, 2001). In addition to
early mortality rates for this population, researchers
have indicated that chronic disease can be observed in
African American women as early as their twenties
(Astone, Ensminger, & Juon, 2002; Geronimus, Bound,
Waidmann, Hillemeier, & Burns, 1996; Geronimus,
2001a, 2001b; National Center for Health Statistics,
[NCHS], 2004).
Early health promotion may be a useful approach to
prevent the premature onset of illness in marginalized
populations of adolescent women. Health promotion
programs need to be based on the adolescent woman’s
own values about health. Thus, understanding what
health means to adolescent women and their perceived
barriers to achieving health is an important beginning.
Research with various population groups of women
has helped to increase our understanding of different
meanings of health for women at distinctive develop-
mental stages. Woods, Laffrey, Duffy, Lentz, Mitchell,
and Taylor (1988) surveyed 528 women (ages 18–45)
who were already in a study about their health. They
asked women to respond to the question “What does
being healthy mean to you?” One of the interesting
findings was that different age cohorts of women
defined health in different ways. For example, older
women in the study focused more on role perform-
ance in their definitions of health, whereas higher-
income women emphasized “exuberant well-being”
(Woods et al., 1988).
Perry and Woods (1995) replicated this study with
older women (ages 71–94), asking the same question.
JSPN Vol. 11, No. 1, January, 2006
They found that older women perceived themselves to
be healthier than healthcare professionals did. Their
responses were similar to the earlier study by Woods
et al. (1988) in that the older women put more empha-
sis on role performance in their definitions of health.
Woods et al. (1988) considered the women’s move-
ment in previous decades as influencing participants’
definition of health. Perry and Woods (1995) pointed
out that new views about aging have led to the older
women in this study having positive images of their
health. These two studies suggest that historical, polit-
ical, and social movements affect conceptualizations of
health, and that attitudes around health promotion
need to be considered within their historical context
(Mohammed, 2004).
There are few studies that explore how women
define being healthy, and there are even fewer that
explore this issue with adolescent women. Gillis (1994)
studied 184 adolescent females and their parents to
determine the relationship between health-promoting
lifestyles, perceived health status, and definitions of
health. She found a strong relationship between the
adolescents’ definitions of health (clinical, functional,
and eudaemonistic subscales) and health-promoting
lifestyles. The adolescents who defined health as “exu-
berant well-being” had higher scores on a measure of
health promotion behaviors than did those with other
definitions. This study provides evidence of an impor-
tant link between health definition and health promo-
tion; however, the findings are limited by the study
sample’s homogeneity in ethnicity and socioeconomic
status.
Slater, Guthrie, and Boyd (2001) explored health
concerns of adolescent women. Their findings demon-
strated that adolescent health issues are influenced by
gendered concerns of young women such as caring for
others, perceptions of relationships, and gender role
and ethnic socialization. These researchers asserted
that the gender role socialization of caring for others
before caring for one’s self influenced how these
women made choices about their health concerning
substance abuse, eating disorders, and depression.
29
Being Healthy: Voices of Adolescent Women Who are Parenting
Depression is becoming a mental health concern,
even among young adolescents, and feelings of sad-
ness and isolation are more pronounced in females
than in males (Calvete & Cardenoso, 2005; USDHHS,
2000). The role of ethnicity is a limitation of depression
research. Although studies have found lower inci-
dences of depression in African American adolescent
females, there may be two reasons for this finding.
Either we do not have culturally appropriate instru-
ments for this population, or their social networks pro-
vide some protective mechanism (Abrams, 2002; Stack,
1975; Wright, Aneshensel, Botticello, & Sepulveda,
2005). Issues regarding socialization for the adolescent
mother in her distinctive role as both an adolescent
and a mother would further complicate these decisions.
One marginalized group of adolescent women consists
of young women who are parenting children. These
young women face multiple challenges and must learn
to handle the responsibilities of parenthood, often
with few personal or family resources. Research on
adolescents who are mothers has predominantly focused
on their maternal role—strengthening their parenting
skills and limiting additional pregnancies. The under-
lying priority of this type of research has been to pro-
mote the health of the children of adolescent mothers
rather than promoting the health and well-being of the
adolescent women themselves (Corcoran, Franklin, &
Bennett, 2000; Geronimus, 2003; Hacker, Amare, Strunk,
& Horst, 2000; Koniak-Griffin, Mathenge, Anderson, &
Verzemnieks, 1999; Koniak-Griffin & Turner-Pluta,
2001; Santelli, Lindberg, Abma, Sucoff, & Resnick,
2000; Turley, 2003; Zavodny, 2001).
One gap in current research on adolescent women’s
health is the scarcity of data from the adolescent moth-
ers themselves, regarding perceptions on how they
view their own health issues. A result of exploring
health concerns and needs from the point of view of
the young women who are parenting would be health
promotion interventions that could be more innova-
tive and address the structural issues that affect the
health of all adolescent women. The purpose of this
ethnography was to explore how adolescent women
30
who are parenting describe what “being healthy” means
to them and how they define their own health needs.
One gap in current research on adolescent
women’s health is the scarcity of data from
the adolescent mothers themselves,
regarding perceptions on how they view
their own health issues.
Methods
Design
This exploratory study utilized ethnographic meth-
ods including in-depth interviews and participant
observation in the homes and neighborhoods of the
participants to provide the larger social and cultural
context for this study. Another method used in this
ethnography was photovoice, in which participants
took photographs and then interpreted the meaning of
the photographs as it related to their lives.
Sample
Young women who met the following inclusion
criteria were recruited for the study: (1) 15–21 years of
age, (2) parenting at least one child who was 3 months
of age or older, and (3) English speaking. Participants
who were single, married, had a partner, or living
with parents were eligible. Adolescent mothers who
were not living with their children or who were preg-
nant for the first time were excluded.
After receiving approval from the University of
Washington Human Subjects Committee, flyers
JSPN Vol. 11, No. 1, January, 2006
describing the study and how to contact the investiga- Table 1. Demographic Profile of Participants
tor were posted at various recruitment sites. These
sites, chosen for their diverse clientele and interest in Characteristics of participants (N = 18) N
serving adolescent women who are parenting, included Age range (years)
women, infant, and child (WIC) clinics, transitional 15–16 3
housing agencies for adolescent women, and teen 17–18 5
parenting classes. 19–20 7
If a potential participant was interested in the study 21 3
and met the inclusion criteria, an appointment was Age of children (N greater than 18; some women
had more than 1 child)
made to meet the investigator at a site chosen by the 0–3 months 2
participant. During the appointment, written consent 3–6 months 3
was obtained and the initial interview was conducted. 6–9 months 3
Parental consent was obtained if the participant was 9–12 months 1
under 18 years of age and living with the parent. 12–24 months 5
2–4 years 6
Parental consent was not required for adolescent
women under the age of 18 if they met the state crite- Ethnicity/race as identified by participant
Black 6
ria for being an emancipated minor. The state criteria White 7
required that the minor: (1) be a resident of the state of Black/White/Indian 3
Washington, (2) maintain a separate residence from Black/White/Mexican 1
the parent or guardian, and (3) manage her own Mexican/White 1
economic resources. Housing
Eighteen women, ages 15–21 years, were invited Transitional housing 6
Alone with child in apartment 5
into the study and completed the first interview (see Living with parent 2
Table 1). Fifteen out of the 18 women completed all Living with parent and boyfriend 1
parts of the study that included taking photographs Living with boyfriend 1
and a second interview. These diverse adolescent Moved during interviews 3
women were responsible for themselves and their chil-
dren, in addition to working, paying bills, accessing
health care, and attending school. Fifteen out of the 18 views that provided information about how each par-
participants lived on their own, whereas three lived ticipant lived, the neighborhood she lived in, and the
with their parents. Three out of the 18 participants services available to her. Interviews were unstructured
moved at least three times during the course of the and started with the question “What does being
study, seeking safer and more affordable housing. healthy mean to you?”
After the first interview, the young women were
Data Collection given cameras and asked to photograph aspects of
their everyday life that affected their health. Photo-
This study had a multi-method approach using graphs were used to contextualize the interviews and
interviews, participant observation, and photography. encourage adolescent women to speak about issues
The first interview was conducted in a location of that they wished to discuss. The film was retrieved
the young woman’s choice. Because of the difficulty from each participant and developed by the researcher.
of transportation with young children, most of the This provided another opportunity to spend time with
women invited me to their homes to conduct the inter- the young woman in her home or neighborhood. During

JSPN Vol. 11, No. 1, January, 2006 31

Being Healthy: Voices of Adolescent Women Who are Parenting
Table 2. Concepts of Health
Concept Taking care of my body
Subcategories Eating healthy
Don’t do things that harm your body
Exercise
the second interview, each participant reviewed the
photographs with the researcher. She described what
the pictures represented and discussed with the
researcher what they meant to her in terms of her
health. In this manner, the participant was able to
frame the representation of each photograph.
Participants were told verbally and in writing that
they could stop the interview and photography at any
time or decide not to answer any questions without
penalty. Compensation in the form of gift cards was
given to each woman after the first interview, when
the film was retrieved for developing, and after the
second interview. The young women were also given
reusable cameras that they could keep after the study
and an entire set of their photographs. Interviews
were audio taped, and the tapes transcribed.
Analysis
Data for analysis were taken from the transcripts of
the first in-depth interview, field notes from the meet-
ing with the participant to pick up the film, and the
narratives of the participant as she described what the
photographs meant to her health during the second
interview. The interview transcripts were entered into
the qualitative software program atlas-ti as a method
of data organization and analysis.
Analysis focused on participants’ views and mean-
ings of health as described in interviews and narra-
tives concerning the photographs. Interview phrases,
regarding representations of health, were used as the
unit of data analysis. This method produced over 283
phrases that were consigned into codes. These codes
were then grouped into categories that represented
32
Having what you need Not being stressed out
Socioeconomic resources Don’t get stressed out
Housing Avoiding negative people
Jobs Being sad
concepts of health that include “taking care of my
body,” “having what you need,” and “not being
stressed out” (see Table 2).
Results
Concepts of Health
Participants responded to the question, “What does
being healthy mean to you?” with numerous examples
and illustrations. In data analysis, three categories,
representing their concepts of health, were identified.
These were: “taking care of my body,” “not being
stressed,” and “having what you need” (Table 2).
Taking care of my body. The first category, “Taking
care of my body,” represented the responses of the
young women regarding efforts to take care of the cor-
poreal body. Three subcategories to “taking care of my
body” were found in data analysis. These included
“eating healthy,” “exercise,” and “don’t do things that
harm your body.”
Eating healthy. All of the young women responded
to the question about “What does being healthy mean
to you?” with the statement “eating healthy.” For
example, Taisha*, a 17-year-old mother of a 5-month-
old child who identified herself as Black, responded
“Healthy? As far as physical, like keeping your body
in shape. You know, eating healthy.”
Participants discussed junk food and eating vegetables
under the subcategory of “eating healthy.” Junk food
seemed to be the most common issue for these young
women as they tried to identify what they considered
*All names have been changed to protect the privacy of the participants
JSPN Vol. 11, No. 1, January, 2006
good nutrition. Many admitted that they felt that they
ate too much junk food, whereas some spoke about trying
to avoid buying and eating junk food. Taisha expressed
her thoughts regarding junk food as, “I need to start
shopping for more healthy stuff. Because I know I am
just a junk food fanatic and ever since I’ve been, not
even since I’ve been pregnant, but actually since I’ve
had him it’s been worse. It’s like all I want is just junk
food. It’s the only thing that will satisfy me or whatever.”
Taisha’s statement was echoed by many of the young
mothers who reported that they changed their eating
habits during their pregnancy, but since the birth of
their child, it became more difficult to eat healthy.
Taisha spoke about her plans for healthy eating in
the future, stating “I’m just going to get, my mom was
just telling me, just get a lot of lettuce and vegetables
and fruits. I’m going to get fruits. You know, because I
know it’s affecting him, too, because I’m nursing. So
he’s going to be intaking whatever I’m eating. So I’m
just going to go shopping and just go straight to the
health food aisle.”
Taisha is a single mother who is supporting her 5-
month-old son and living in an apartment. She was
looking for work while finishing high school, so
finances for food were limited. When I asked if she
thought that the health food aisle might be expensive,
she answered, “No, I doubt it. It probably will save me
some money. No, I think it will be—it’ll probably be, if
not the same, less. Because, you know, lettuce is like,
what, 79 cents a head. So I’m just going to get a lot of
healthy food. Already have it set out in my mind.”
My assumption was that the health food aisle meant
low-carbohydrate or low-calorie snacks, but Taisha
explained that she considered the produce aisle to be
the health food aisle.
A majority of the young women insisted that good
nutrition meant fruits and vegetables. Latisha, a 16-
year-old mother of a 17-month-old child who identi-
fied herself as Black stated, “to stay healthy. Like as far
as, well, I mean, like eating vegetables.” Many of the
young women wanted to emphasize that they wanted
to encourage their children to eat vegetables. Latisha
JSPN Vol. 11, No. 1, January, 2006
underscored this, stating, “I got my son into vegeta-
bles. A lot of kids don’t eat vegetables. This boy will
eat salad ‘til the end.”
Don’t do things that harm your body. The second
subcategory “don’t do things that harm your body”
consisted of phrases around substances and habits that
harmed the physical body. Many of the young women
reported that their eating habits and thoughts about
health changed when they found out that they were
pregnant. Latisha, an African American mother,
summarized what many of the young women stated
about harming their bodies. She said, “Harming your
body? Well, doing stuff that you know that’ll degrade
your body. Like for instance, like drinking, smoking
weed, stuff like that.”
Four of the 18 adolescent women spoke about their
struggle with smoking in their life. They were worried
about smoking and its relation to their health. Julie, a
21-year-old mother of a 2-year-old, who identified
herself as White, stated that being healthy is “Probably
to eat a little bit more healthy. Completely stop smok-
ing. I don’t really smoke that much, just every once in
a while, but just to completely stop, yeah.” There were
very few women who stated that they smoke, but the
four that reported smoking, stated that they were try-
ing to quit. Emily, a 21-year-old mother of a 20-month-
old child who identified herself as White, stated “Me
being healthy is, well, one thing that I’m trying to do
right now is not smoke . . . My health issue, I believe,
is smoking. Because that is ruining my health.” Emily
admitted that she has tried to quit smoking in the
past, and that it is very difficult. All the women who
smoked stated emphatically that they stopped smok-
ing during their pregnancies.
Although 14 of the 18 participants stated that they
did not smoke, they discussed smoking as a health
issue. Many of them tried to avoid smokers and smok-
ing because they saw it as influencing their health. Lat-
isha reflected many of their sentiments when she said,
“Not being around smokers. You know, trying to keep
your lungs clean. Because your lungs, well, you know,
later on. It might not be now, but it’ll take off some
33
Being Healthy: Voices of Adolescent Women Who are Parenting
years. So the more you protect your life now, is the
longer you’ll stay alive.”
Many of the young women made the connection
between their present health and their future health.
Several mentioned their mothers’ health issues with
diabetes, depression, and alcoholism and made the
connection between their own present-day health
practices and their future health. Taisha reinforced
how her future health was dependent on her present-
day actions, stating, “I also want to make sure I’m
physically fit to not have anything wrong in the
future, a heart attack, kidney failure.”
Many of the young women made the
connection between their present health and
their future health.
Exercise. The last subcategory of the concept “taking
care of my body” concerned exercise. Although partic-
ipants spoke about how eating healthy and not doing
drugs would affect their future health, exercising was
seen as having more immediate benefits for their bod-
ies. Taisha stated, “And just trying to exercise and,
you know, stay in shape.” Many of the young women
spoke about the issues that many new mothers have
about their bodies and its changed shape since preg-
nancy and birth of the baby. Some found that exercise
helped them with their new role. Emma, a 16-year-old
mother who identified herself as White, stated, “And
like I should not like just exercise, you know, every
day, but go for walks and get outside, not be a house
hermit.” Although some used walking with their child
as a means of exercise, most participants found that
the daily demands of school and work did not leave
much time for them. Joannie, a 20-year-old mother
who identified herself as White, summarized this
34
dilemma as a health need, stating, “More time to exer-
cise. I should definitely be doing that. I haven’t lost all
my pregnancy weight.”
Having what you need. The second concept the
young women expressed around “being healthy” was
“having what you need.” This is a complex issue for
all adolescent women but has more complexities for
young women who are parenting and balancing limited
resources. This category comprises issues of providing
essentials for children, housing, and employment.
All of the young women believed that their socioe-
conomic position affected their health. One woman,
Benita, an 18-year-old African American mother of a
5-month-old child, answered the question about what
“being healthy” means to her by stating, “So having
what you need to be, to get diapers and whatever,
that makes you healthy.” Benita disclosed that welfare
does not pay for diapers. She wanted to participate
in this research study to receive the gift card so that
she could purchase diapers. Although she stated that
she had family close by and was connected in the
welfare system, she spoke about the work of welfare
and looking for employment. Benita moved after the
first interview and could not be located for the next
interview.
Other participants also spoke about the difficulties
of financial constraints. Alyssa, a 19-year-old mother
of a 2-year-old child who identified herself as of mixed
race, stated, “I have to struggle and worry about how
I’m going to get food next month for me and my son.
Or how I’m going to get him some diapers or pay my
rent and my bills.” Alyssa spoke about how worrying
over these basic needs affected her ability to promote
her own health.
Some other areas of need that were identified by
participants included housing and transportation.
Thirteen of the 18 women spoke about the issues of
finding affordable housing. Kaya, an 18-year-old, African
American woman with a 3-month-old child spoke
about the difficulties of finding affordable housing
within her budget as affecting her health, stating,
“Apartments now are basically a whole welfare check.”
JSPN Vol. 11, No. 1, January, 2006
 Many of the young women could not live with their
families for various reasons and sought transitional
housing or housing assistance. Even the women who
lived with their parents, however, had difficulty find-
ing affordable housing. Emily, a 21-year-old White
mother of a 20-month-old child, who lived with her
boyfriend of 4 years at her parents’ home, described
how she felt her health was affected as a result of her
limited options on minimum wage, stating,
To make my life better, I think that they should
do something to make it easier for single—not
even single parents, I mean, people in general, to
live on their own. I had to live with my parents
‘til I was 21 to be able to rent an apartment and
make enough money to. I had my daughter for
almost 2 years before we could move out as a
family, to be able to make it. Two minimum
wages don’t cover even an apartment.
Finding a job was another common theme for most
of the young women who spoke about having what
you need to be healthy. Taisha spoke about this
dilemma, stating, “It seems like it’s stressful if I work,
and then if I don’t work, it seems like it’s stressful. So
either way it goes, it’s stressful.” Taisha also said, “It’s
just stress. I just need a job. I hate not being with a job
because it’s like, you know, just kind of struggling, I
guess.” Similar to Taisha, the majority of women
spoke about needing a job to pay bills, rent, food, and
child care, and how the stress of looking for work
affected their health.
Not being stressed out. The third concept of health
identified by the women was “not being stressed out.”
Their discussions were coded into three subcategories
that included “don’t get stressed out,” “avoiding neg-
ative people,” and “being sad.”
Don’t get stressed out. In the first subcategory,
“don’t get stressed out,” many of the women spoke
about how stress affected their present and future
health. Mahala, a 19-year-old mother of a 3-year-old
child who identified herself as Black, White, and
JSPN Vol. 11, No. 1, January, 2006
Cherokee, stated, “You know, just stress. Stress makes
you—somebody was telling me stress makes you gain
wrinkles. It makes you age quicker. And it, you only
live once. Why argue about something that’s going to
be forgotten in a week anyway?” Mahala proceeded to
say, “And the more you stress, the more you work
over, the more you let things bother you is the more
you let yourself work into a heart attack, or stress
panic, or just anything.” Similar to other women,
Mahala felt that “being healthy” meant managing
your own stress and reaction to your environment.
Similar to other women in this study, Taisha (17-year-
old mother) verbalized how she views stress and her
health, stating, “I think stress. Stress is a big health issue
because if you’re stressed out all the time, then you’re
not going, you know, it’s not good for your health.
And you’re just going to be, not going to be in very
good health.”
Latisha reflected that stress is something that you
do to yourself. “Um, I stress my own self out, I think,
you know. I mean, I’ve been through stuff when I was
younger. So I like carried it uphill with me. Up to my
age now. I still carry it. I should just let it go, you
know. But it’s like it’s hard to.” Similar to Latisha,
many other young women commented on how child-
hood issues affected their current health.
Avoiding negative people. In the second subcate-
gory, “avoiding negative people,” participants spoke
about how negative attitudes and situations affected
their health. Chandra, a 21-year-old mother of two children
who identified herself as Black, explained, “[friends]
they want to be positive, but their negative attitude is
still there. And that’s what makes me have a negative
attitude. And now I’m at the point now I have two
kids, I can’t be around negative people at all. Because
that makes me negative and I can’t let my kids see that
at all.” Chandra felt that avoiding negative people not
only affected her health, but also that of her children.
Although most of the women spoke about staying
away from friends who were negative in order to protect
their health, many of the women spoke about family
relationships that caused them stress. The stress from
35
Being Healthy: Voices of Adolescent Women Who are Parenting
past family relationships affected them in the present,
as Chandra related, “Because my real mom wasn’t there
for me and that’s what, it had a lot to do with making
me stressed out, that my real mom wasn’t there.”
Young women who had supportive mothers in
their lives even found some stress in these positive
relationships. Taisha expressed this complicated
relationship:
My mom. She can stress me out because she’s
always on me about something. But, on the other
hand, she always is helping me with something.
So she’s probably both. Sometimes she stresses
me out, and sometimes, you know, she helps me
with stress from other stuff.
While a majority of women spoke about staying away
from negative friends and family, they also felt judged
by the general public. Kaya (18-year-old mother)
explained:
And then people speak about people being on
welfare. Okay, just because you’re not on it
doesn’t mean that you have to knock people that
are on it. That it don’t make no sense for you to
knock somebody. Because if you wasn’t working
and you didn’t got the job that you got, you
would be on welfare, too.
Many of the women spoke about being judged
because of their age, having a child, and being poor. A
17-year-old White mother of a 15-month-old reflected
many of the young women’s sentiments by saying,
“Just because we’re 16, 17, even 18 years old doesn’t
make us any different or less healthier. It really
doesn’t. It makes it a little harder in life; we might be a
little more stressed out, but we’re still people.”
Being sad. In this third subcategory, 5 of the 18
young women linked stress to depression and discussed
how it influenced their ability to be healthy. Two of
the young women spoke about suicide attempts in
their past and how stress affected their health. Alyssa,
36
19-year-old mother of a 2-year-old child who identi-
fied herself as Black, White, and American Indian,
spoke about her history with “feeling sad” as a 14-
year-old, “Well, when I was 14, I tried killing myself
because I was depressed.” She stated that she received
medication and counseling treatment after her suicide
attempt, “Yeah. And they put me on an antidepressant,
and I was in counseling for a year. And the anti-
depressants, I think, I felt funny taking them. I didn’t
think I needed to take a pill. So, I mean, just speaking
about it with my counselor helped me out.”
Alyssa stated that speaking with people who are
positive helps her more than medication at this time in
her life, “Well, as long as I have somebody to, you know,
to vent with and at least share my problems with, it
helps me get a little something back, and I’m okay.”
Similar to other women, Alyssa spoke about how
stress started in her childhood and how she made
choices to handle stress and depression in a different
way than her mother did. She stated:
Well, my Mom is an alcoholic. And I don’t drink.
I don’t choose—because she deals with her prob-
lems by drinking. And I just—my Mom has a lot
of health problems and a lot of issues inside of
her head. I know I’m not going to be like that,
but she always gets really depressed just about
little things.
To Alyssa, there was a link between getting
stressed out and the return of her depression, so she
maintained that being healthy is managing stress,
“Well, you know, I get stressed out. And I try not to
get too depressed about it because I’ve had problems
with depression in the past. And I just, I try not to get
depressed about it.”
The adolescent women in this study defined being
healthy in three categories that reflected how their
personal health was influenced by social context. The
first concept of health was “taking care of my body”
and it incorporated statements about eating right,
exercise, and avoiding drugs or smoking. The second
JSPN Vol. 11, No. 1, January, 2006
concept of health, “having what you need,” explicated
the daily difficulties of providing the essentials (e.g.,
safe housing, employment, health care, and food) for
themselves and their children. The last category of
health, “not being stressed out,” included subcatego-
ries of managing stress, avoiding negative people, and
dealing with issues of sadness or depression.
Discussion
The young women in this study considered “being
healthy” in terms of eating healthy, exercise, and not
harming their bodies with smoking, drugs, and alcohol.
These young women both understood and accepted
responsibility for managing their lives around these
health behaviors and spoke of all the beneficial health
changes that they made during their pregnancies to
protect their babies. These findings refute the popular
belief that poor, young mothers lack education about
nutrition and other health-promoting behaviors. For
example, many of the young women stated that they
knew that junk food was not healthy and vegetables
were important for their health. One reason that healthy
eating was readily provided as an answer to “being
healthy” may be the availability of prenatal care that
emphasizes good nutrition during pregnancy.
These findings refute the popular belief that
poor, young mothers lack education about
nutrition and other health-promoting
behaviors.
Young mothers are frequently positioned as unedu-
cated and irresponsible about nutrition and risky
behaviors. However, findings from this study suggest
JSPN Vol. 11, No. 1, January, 2006
that it is not their knowledge base that is lacking, but
according to these participants, other issues such as
socioeconomic status make health-promoting activities
difficult to enact. Interventions for these busy, young,
working women and mothers must go beyond eating
healthy; they must address wider social problems that
these women face, such as limited budgets, transporta-
tion issues, and the complexities of managing work,
school, and caring for themselves and their children.
An interesting piece of information from some of
the young women was that their mothers continued to
be a significant source of health information in their
lives. Even the women who did not have ongoing rela-
tionships with their mothers turned to the older
women in their lives to inquire about nutrition and
child care. This information is significant in the design
of any future interventions and suggests the need to
seek information from cross-generational sources in
order to determine what health barriers they identify.
The fact that all women stressed the issue of “taking
care of your body” and “not being stressed out” is not
surprising because the media, education materials, and
public programs (WIC) focus on individual responsi-
bility in maintaining your own health. Women in this
study spoke about issues of family and personal his-
tory of depression. These findings reflect the research
that shows depression is prevalent among socioeco-
nomically disadvantaged adolescents (Hammack,
Robinson, Crawford, & Li, 2004; USDHHS, 2000).
Goodman and Whitaker (2002) found a link with obes-
ity and depression in their analysis of data from the
National Longitudinal Study of Adolescent Health
Survey. The women in this study confirmed that
depression and sadness did affect their ability to pro-
mote their health. Examining the relationship between
depression, nutrition, health promotion, racism, and
socioeconomic stress could have some exciting results.
The findings of this study confirm those of Woods
et al. (1988) and Perry and Woods (1995) that women
view health as an individual choice and discourse.
This discourse of individual responsibility is strong in
discussions about health and socioeconomic positions
37
Being Healthy: Voices of Adolescent Women Who are Parenting
that are prevalent in the United States. Until recently,
the public health literature continued to emphasize
individual behavior change models without fully con-
sidering the influence of structures and institutions
that regulate health choices. The young women in this
study accepted personal responsibility for their indi-
vidual health and also for obtaining resources for their
family. They were aware of the social and cultural
aspects that influence their ability to find housing and
employment and how this influences their ability to
promote their own health.
The category of “having what you need” illustrates
the influence of context on individual health. In this
study, participants clearly stated that there were basic
needs that they struggled to attain so they could be
healthy. The young women in this study defined
“having what you need” as having diapers for their
children, the ability to find employment, education
that prepares them for a livable wage, and child care.
All the young women stated that education was
important to achieving a good job. However, issues
regarding reliable child care, inflexibility of schedules
in minimum wage positions, and public policies that
emphasize employment over education after high
school are a few of the barriers that prevent them from
moving beyond low-wage jobs.
This group of parenting young women was knowl-
edgeable about healthy eating, exercise, and avoiding
risky behaviors such as smoking and drugs. They
attempted to promote their health and the health of
their children despite limited resources and numerous
constraints.
The implications of this study are that health pro-
motion programs and research need to move in
more innovative directions. Although health promo-
tion practices usually concentrate on nutrition and
education, the findings of the study suggest that
healthcare professionals need to consider adoles-
cents as knowledgeable actors of their own lives and
take into account wider social issues, such as socioeco-
nomic contexts, that hinder the health of these young
women.
38
How Do I Apply This Information to
Nursing Practice?
Adolescent mothers who are parenting are not a
homogeneous group of women; therefore, it is impor-
tant to take into account the individual context of each
woman before providing any health education. Con-
sidering each adolescent woman as a knowledgeable
actor in her own life and making choices about her
health, the nurse can partner with the young woman
to achieve her health goals as well as strengthening
her health-promoting activities.
This study revealed that all of the adolescent
women were aware of the public health messages
about health and health promotion, but barriers exist
as a result of larger structural issues of housing,
income, racism, and social support. The findings
indicate that nurses need to expand upon the tradi-
tional ways of educating about diet and exercise to
include the broader social context. For example, when
a young mother is enrolled in the WIC program,
the assumption should not be made that she has
enough food available to her. Exploration of the issues
of food sufficiency may reveal an unsafe living situa-
tion, lack of transportation to obtain food, or using
food to barter for other services from friends and
family. Information about food banks, transitional
housing, and low-income assistance programs (e.g.,
assistance with utility bills) should be available for all
mothers.
Asking the questions “What does being healthy
mean to you?” and “What do you think gets in the
way of being as healthy as you want to be?” demon-
strates that nurses consider the young mother to be a
competent person in her own life. These questions will
also facilitate assessment of individual strengths and
barriers to healthy behaviors.
Acknowledgment. Supported by Women’s Health
Research Nursing Training Grant T32-NRO7039
(NINR) and the University of Washington Hester
McLaws Nursing Scholarship Fund. Thank you to Dr.
JSPN Vol. 11, No. 1, January, 2006
Marcia Killien, Dr. June Lowenberg, Dr. Selina
Mohammed, and anonymous reviewers.
Author contact: cstevens@u.washington.edu, with a copy
to the Editor: roxie.foster@uchsc.edu
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