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Elias DE, Santos MR, Campaña H, Poletta FA, Heisecke SL, Gili JA, Ratowiecki J, Cosentino V, Uranga R, Saleme C, Rittler M, Krupitzki HB, Lopez Camelo JS, Gimenez LG. Indirect Effects of Neighbourhood Socioeconomic Status on Preterm Birth Risk in an Argentine Population. Matern Child Health J 2024:10.1007/s10995-024-03951-1. [PMID: 38831170 DOI: 10.1007/s10995-024-03951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to determine the indirect effects of neighbourhood socioeconomic status (NSES) on the risk of spontaneous PTB. METHODS We carried out a retrospective case-control study including sociodemographic and obstetric data of multigravid women who gave birth at a maternity hospital in Tucumán, Argentina, between 2005 and 2010: 949 women without previous PTB nor pregnancy loss who delivered at term and 552 who had spontaneous PTB. NSES was estimated from the Unsatisfied Basic Needs index of census data. Variables selected through penalised regressions were used to create a data-driven Bayesian network; then, pathways were identified and mediation analyses performed. RESULTS Maternal age less than 20 years mediated part of the protective effect of high NSES on spontaneous PTB [natural indirect effect (NIE) -0.0125, 95% confidence interval (CI) (-0.0208, -0.0041)] and on few prenatal visits (< 5) [NIE - 0.0095, 95% CI (-0.0166, -0.0025)]. These pathways showed greater sensitivity to unobserved confounders that affect the variables mediator-outcome in the same direction, and exposure-mediator in the opposite direction. They did not show sensitivity to observed potential confounders, nor to the parameterization used to define NSES. Meanwhile, urinary tract infections showed a trend in mediating the effect of low NSES on spontaneous PTB [NIE 0.0044, 95% CI (-0.0006, 0.0093), P 0.0834]. CONCLUSIONS High NSES has protective indirect effects on spontaneous PTB risk, mainly associated with a lower frequency of teenage pregnancy.
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Affiliation(s)
- Dario E Elias
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Maria R Santos
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Hebe Campaña
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando A Poletta
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina L Heisecke
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan A Gili
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Julia Ratowiecki
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Viviana Cosentino
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Rocio Uranga
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital San Juan de Dios, Buenos Aires, Argentina
| | - César Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Mónica Rittler
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo B Krupitzki
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S Lopez Camelo
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas G Gimenez
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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Macharia P, Pérez-Navarro A, Inwani I, Nduati R, Carrion C. Developing an Unstructured Supplementary Service Data-based mobile phone app to provide adolescents with sexual reproductive health information: a human-centered design approach. BMC Med Res Methodol 2022; 22:213. [PMID: 35927636 PMCID: PMC9351084 DOI: 10.1186/s12874-022-01689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent pregnancies and sexually-transmitted infections continue to impact 15 - 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information. OBJECTIVE The study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app's usability and user experience. METHODS A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app's quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions. RESULTS During the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as 'very interesting' to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either 'perfectly' or 'well targeted' on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated 'best app' by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011. CONCLUSIONS Adolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..
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Affiliation(s)
- Paul Macharia
- Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya, Barcelona, Spain. .,Consulting in Health Informatics, P.O Box 3966, Nairobi, 00100, Kenya. .,eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Antoni Pérez-Navarro
- Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Irene Inwani
- Kenyatta National Hospital, Hospital Rd, Nairobi, Kenya
| | - Ruth Nduati
- University of Nairobi, University Way, Nairobi, Kenya
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
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Pires R, Araújo-Pedrosa A, Pereira J, Canavarro MC. How Can Unintended Pregnancies Be Prevented among Adolescents Who Engaged in Sexual Intercourse at Earlier Ages? The Role of Female Education and Partner Age Difference. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10631. [PMID: 34682377 PMCID: PMC8535923 DOI: 10.3390/ijerph182010631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
Several studies have identified explicative factors for adolescents' sexual risk behaviors and related outcomes such as unintended pregnancy; however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1-6 years after first sexual intercourse by increasing the adolescents' likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.
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Affiliation(s)
- Raquel Pires
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
- Clinical Psychology Service Centro Hospitalar e Universitário de Coimbra, 3030-165 Coimbra, Portugal
| | - Joana Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
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Ineffective Pregnancy Prevention During Adolescence: Assisting Healthcare Providers in Portugal With Individualized Risk Assessment. J Prim Prev 2021; 42:385-407. [DOI: 10.1007/s10935-021-00637-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
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Buckingham P, Moulton JE, Subasinghe AK, Amos N, Mazza D. Acceptability of immediate postpartum and post-abortion long-acting reversible contraception provision to adolescents: A systematic review. Acta Obstet Gynecol Scand 2021; 100:629-640. [PMID: 33608901 DOI: 10.1111/aogs.14129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC. MATERIAL AND METHODS In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. RESULTS We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. CONCLUSIONS Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.
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Affiliation(s)
- Pip Buckingham
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica E Moulton
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Asvini K Subasinghe
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Natalie Amos
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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