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Xiao H, Chang M, Torres A, Flores G, Lau M. Preventing Teen Pregnancy: A Qualitative Study of the Perspectives of Parenting and Expecting Latino Adolescents. J Pediatr Adolesc Gynecol 2023; 36:532-540. [PMID: 37468034 DOI: 10.1016/j.jpag.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
STUDY OBJECTIVE Latino youths in the United States experience disproportionately high rates of teen pregnancy. The aim of this study was to obtain expecting and parenting Latino adolescents' perspectives regarding factors contributing to teen pregnancy and pregnancy prevention. METHODS Expecting/parenting Latino adolescents were recruited from high schools with high proportions of Latino youths and teen pregnancy. Participants completed a questionnaire on sociodemographic and background characteristics. Focus groups were stratified by age and gender and audio recorded. Grounded theory was used to identify themes from the transcribed audio recordings. RESULTS Thirty-two expecting/parenting Latino adolescents (20 females, 12 males) 14-19 years old participated in four focus groups. Quantitative results revealed that two-thirds of participants at birth had adolescent mothers. Over three-quarters of participants reported that their pregnancies had occurred too soon. Qualitative themes for factors contributing to teen pregnancy included lack of contraceptive knowledge/access, belief of invincibility, influence within relationships, male decisions on contraceptive use, desire to belong among peers, lack of parental support for contraceptive use, lack of parental attention, rebellion, normalization of adolescent parenthood in Latino culture, and media. Themes for pregnancy prevention included time alone with physicians, parenting teens as mentors, reproductive health education, and community pregnancy-prevention programs. CONCLUSION Multiple factors contribute to teen pregnancy in Latino youth, including influences from Latino culture, family, peers, partners, and social determinants of health. Pregnancy prevention should incorporate interventions to address these aspects, including disseminating culturally sensitive education materials, providing parenting teens as peer mentors, encouraging time alone with health care providers, and addressing various social determinants of health.
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Affiliation(s)
- H Xiao
- University of Texas Southwestern Medical School, Dallas, Texas
| | - M Chang
- Los Angeles County & University of Southern California Medical Center, Los Angeles, California
| | - A Torres
- Universidad Autonoma de Guadalajara School of Medicine, Guadalajara, Mexico
| | - G Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, Florida
| | - M Lau
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, Texas.
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Structural Racism and Its Influence On Sexual and Reproductive Health Inequities Among Immigrant Youth. J Immigr Minor Health 2023; 25:16-22. [PMID: 35930092 PMCID: PMC9362213 DOI: 10.1007/s10903-022-01385-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 01/07/2023]
Abstract
This community-based participatory research study explores the influence of structural racism on sexual and reproductive health (SRH) inequities among immigrant, including refugee, youth. We conducted interviews with emerging youth and youth service providers living in two communities in Massachusetts. Our results detail three major themes illustrating how structural racism influences SRH inequities among immigrant youth: (1) lack of culture-centered SRH supports for recently immigrated youth; (2) immigration enforcement and fear impacting access to adolescent SRH (ASRH) education and services; and (3) perceived ineligibility related to tenuous legal status as a barrier to accessing ASRH services. Conclusions: Findings illustrate the importance of rooting sexuality education curricula in a culture centered framework that recognizes local cultural understandings, acknowledges structural constraints faced by young people, and prioritizes youth agency and voice when engaging in this work. Raising awareness of SRH resources available to immigrant youth may expand access for this underserved population.
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3
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Boyce SC, Deardorff J, Minnis AM. Relationship Factors Associated With Early Adolescent Dating Violence Victimization and Perpetration Among Latinx Youth in an Agricultural Community. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9214-NP9248. [PMID: 33331222 PMCID: PMC8331330 DOI: 10.1177/0886260520980396] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Latinx early adolescents within the United States are particularly vulnerable to dating violence; yet, little research has examined early dating experiences and violence outside large urban settings. Latinxs, in particular, may experience a unique window of opportunity for dating violence (DV) prevention during early adolescence, based on their trends in risk behavior over the adolescent period. This study extends the current research on dating violence by examining a highly understudied population, Latinx early adolescent girls and boys residing in an agricultural community, by assessing victimization and perpetration, and examining interpersonal-level factors as potential risk and protective factors for violence. Using data from a prospective cohort study of Latinx adolescents with relationship experience (past six months) (N = 296; girls: n = 147; boys: n = 149; mean age: 13.8), we assessed the association between dating relationship characteristics and dating violence victimization and perpetration using modified-Poisson regression models with robust standard errors stratified by gender. In multivariable analyses, we found that girls with gang-affiliated partners, partner-related withdrawal from friends, and girls who had used drugs or alcohol with a partner experienced greater risk for dating violence. Additionally, holding beliefs supportive of female sexual naivete and engaging in and communicating about sexual activity were associated with victimization among girls. No significant associations were found among boys. Findings affirm the need for multilevel DV prevention programming that starts in middle school and addresses social isolation, gang exposure, and traditional Latinx gender-norm beliefs regarding marianismo. These findings underscore the imperative to coordinate dating and gang violence prevention efforts by addressing common co-occurring interpersonal and environmental risk factors, including social isolation and culturally-specific traditional beliefs. Such factors could also assist providers, families, and peers in early identification of Latinx early adolescents at risk for DV, especially in rural contexts where resources are often limited.
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Affiliation(s)
| | | | - Alexandra M. Minnis
- University of California, Berkeley, CA, USA
- RTI International, San Francisco, CA, USA
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Polk S, Leifheit KM, Brandt AJ, DeCamp LR. Comparing Healthcare Utilization and Diagnoses in Immigrant Versus Nonimmigrant Youth. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:98-106. [PMID: 34355584 DOI: 10.1177/15404153211036985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To inform efforts to provide healthcare to uninsurable, immigrant youth, we describe The Access Partnership (TAP) hospital-based charity care program and compare healthcare utilization and diagnoses among TAP and Medicaid patients. METHODS We use propensity scores to match each TAP patient to three Medicaid patients receiving care at a pediatric clinic from October 2010 to June 2015 on demographic characteristics. We use descriptive statistics to compare healthcare visits and diagnoses. RESULTS TAP (n = 78) and Medicaid patients (n = 234) had similar healthcare utilization, though Medicaid patients had more outpatient visits (10.8 vs. 7.7, p = .002), and TAP patients were more likely to have ever received subspecialty care (38.5% vs. 22.2%, p = .005). Diagnoses were similar between groups, with some exceptions: TAP patients more likely to present with genital and reproductive disease (33.3% vs. 19.7%, p = .013); Medicaid patients more likely to present with endocrine, metabolic, and nutritional disease (52.1% vs. 28.2%, p < .001), psychiatric, behavioral disease, and substance abuse (41.0, 26.9%, p = .026). CONCLUSIONS TAP patients had similar healthcare utilization and diagnoses to matched sample of Medicaid patients. Findings indicate policy proposals that extend public health insurance to all children would likely benefit immigrant children and not incur higher costs than those of low-income U.S. citizen children.
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Affiliation(s)
- Sarah Polk
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kathryn M Leifheit
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Department of Health Policy and Management, Fielding School of Public Health, 25808University of California, Los Angeles, CA, USA
| | - Amelia J Brandt
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Children's Hospital Colorado, 129263University of Colorado, Aurora, CO, USA
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5
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Gomez AM, Arteaga S, Freihart B. Structural Inequity and Pregnancy Desires in Emerging Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2447-2458. [PMID: 33511506 PMCID: PMC8316486 DOI: 10.1007/s10508-020-01854-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 06/12/2023]
Abstract
Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18-24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the "Things Will Be Different Later" theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the "I Don't Have Everything I Need" theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the "I'll Never Have Everything I Need" theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA
| | - Bridget Freihart
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA
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McDermott ER, Jahromi LB, Umaña-Taylor AJ, Martinez-Fuentes S, Jones SM, Updegraff KA. Mexican-Origin Adolescent Mothers' Economic Contexts, Educational Re-Engagement, and Their Children's School Readiness. Child Dev 2021; 92:e513-e530. [PMID: 33470434 PMCID: PMC8289935 DOI: 10.1111/cdev.13514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drawing on data from a longitudinal study of 204 Mexican-origin adolescent mothers, their mother figures, and their children, the current investigation examined (a) adolescent mothers' educational re-engagement and attainment beginning during their pregnancy and ending when their child was 5 years old; and (b) the influence of the family economic context on adolescent mothers' educational re-engagement and attainment and their children's academic and social-emotional outcomes. Findings detailed adolescent mothers' re-engagement in school after the birth of their child and revealed that family income during adolescents' pregnancies was directly associated with re-engagement and attainment, and also initiated cascade effects that shaped adolescents' economic contexts, their subsequent re-engagement and attainment, and ultimately their children's academic and social-emotional outcomes at age 5.
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Fuerst MF, George KE, Moore JE. Long-Acting Reversible Contraception in Medicaid: Where Do We Go From Here? Womens Health Issues 2020; 31:310-313. [PMID: 33376044 DOI: 10.1016/j.whi.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Megan F Fuerst
- Institute for Medicaid Innovation, Washington, District of Columbia.
| | - Karen E George
- Institute for Medicaid Innovation, Washington, District of Columbia
| | - Jennifer E Moore
- Institute for Medicaid Innovation, Washington, District of Columbia
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Garcia-Reid P, Lardier DT, Reid RJ, Opara I. Understanding the Influence of Sexual Risk Taking, Ethnic Identity, and Family and Peer Support on School Importance Among Hispanic Adolescents. EDUCATION AND URBAN SOCIETY 2020; 52:1011-1038. [PMID: 32742004 PMCID: PMC7394403 DOI: 10.1177/0013124518787827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite the broader academic gains experienced by Hispanic students, who represent the largest minority group in the United States, they remain the least educated of all major ethnic groups, and our understanding of their academic needs and strengths remains woefully inadequate. Therefore, this study examined the risk (e.g., sexual risk taking) and protective factors (e.g., family support, supportive peer networks, and ethnic identity) associated with school importance among Hispanic teens (N = 587) residing in a high-risk, resource poor urban community and the ways in which these relationships vary between adolescent males (46.5%) and adolescent females (53.5%). Schools that are able to harness the numerous assets embedded within the Hispanic community are well positioned to create learning environments that are encouraging, are culturally responsive, and can potentially reduce risk involvement that may interfere with valuing the role of school importance. Implications for school-based personnel are discussed.
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Hernandez ND, Chandler R, Nava N, Tamler I, Daley EM, Baldwin JA, Buhi ER, O’Rourke K, Romero-Daza N, Grilo S. Young adult US-born Latina women's thoughts, feelings and beliefs about unintended pregnancy. CULTURE, HEALTH & SEXUALITY 2020; 22:920-936. [PMID: 31382840 PMCID: PMC7002175 DOI: 10.1080/13691058.2019.1642517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Current measures of unintended pregnancy underestimate the co-occurring, complex set of social, cultural, economic and structural factors that influence how women interpret unintended pregnancy. The purpose of this study was to prospectively explore young adult US-born Latinas' thoughts, feelings and beliefs about pregnancy, specifically unintended pregnancies and the sociocultural factors identified as contributors to those beliefs. In-depth interviews (n = 20) were conducted with US-born, English-speaking Latinas aged 18-25 years in south Florida. Seventeen participants did not intend to get pregnant, while the remaining participants (n = 3) reported that their intentions kept changing. Participants' beliefs regarding their unintended pregnancy were influenced by social and economic hardship and cultural factors such as fatalism and familismo. Ideas and the meaning of pregnancy differed based on the woman's pregnancy resolution decision. Many women felt the term 'unintended pregnancy' placed blame on women and was stigmatising. When discussing pregnancy planning, most participants felt that women should not plan their pregnancies and doing so was going against fate. Findings suggest that salient influences such as culture and the social determinants related to unintended pregnancy should be incorporated into measurements examining unintended pregnancy.
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Affiliation(s)
- Natalie D. Hernandez
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Nancy Nava
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ilyssa Tamler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ellen M. Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Julie A. Baldwin
- Northern Arizona University, Department of Health Sciences, College of Health and Human Services, Flagstaff, AZ, USA
| | - Eric R. Buhi
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA
| | - Kathleen O’Rourke
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Stephanie Grilo
- Chronic Disease Epidemiology, Yale School of Public Heath, New Haven, CT, USA
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10
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Carvajal DN, Zambrana RE. Challenging Stereotypes: A Counter-Narrative of the Contraceptive Experiences of Low-Income Latinas. Health Equity 2020; 4:10-16. [PMID: 32154491 PMCID: PMC7058990 DOI: 10.1089/heq.2019.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: Reproductive autonomy is associated with educational attainment, advanced employment, and well-being. While U.S. Latinas use contraception to control their own childbearing and have reported a desire to do so, they often use it inconsistently and have the lowest rates of contraceptive use of any group. Reasons previously cited for why Latinas do not use contraception compared with non-Latino white women include lack of access, lack of knowledge, language barriers, emphasis on large families, machismo, and religiosity. These reasons are often overly simplistic and can lead to widespread generalizations about Latinas. Methods: Using focus groups and semistructured interviews from November 2014 through June 2015, this study describes the family planning perspectives and experiences of 16 Latinas living in Baltimore and recruited from two federally qualified health centers. A social determinant of health framework was used to guide identification of important concepts and explain findings. Results: Results demonstrated that respondents reported contraceptive agency and claimed autonomy over their bodies; described a sense of responsibility and often expressed caution about having families too large to care for; expressed educational and career aspirations; and perceived contraception as critical for the postponement of childbearing to achieve their goals. Conclusion: The patient/provider encounter should include communication that recognizes all patient preferences and lived experiences to support vulnerable and/or marginalized Latinas in their desires to control their own childbearing and life choices.
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Affiliation(s)
- Diana N. Carvajal
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ruth Enid Zambrana
- Department of Women's Studies, University of Maryland, College Park, Maryland
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Maslowsky J, Powers D, Hendrick CE, Al-Hamoodah L. County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017. J Adolesc Health 2019; 65:674-680. [PMID: 31474434 PMCID: PMC6814573 DOI: 10.1016/j.jadohealth.2019.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/01/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Approximately 16% of U.S. births to women aged 15-19 years are repeat (second or higher order) births. Repeat teen mothers are at elevated risk for poor perinatal outcomes. Geographic clustering and correlates of repeat teen birth are unknown. METHODS Data from birth certificates on N = 629,939 teen births in N = 3,108 U.S. counties in 2015-2017 were merged with data on county-level demographic, socioeconomic, and health provider characteristics. We identified contiguous clusters of counties with significantly elevated rates of first teen births only, repeat teen births, both, or neither between 2015 and 2017 and compared demographic, socioeconomic, and medical provider characteristics of counties between 2010 and 2016 in each cluster type. RESULTS A total of 193 counties (6.21%) had high rates of repeat births only; 504 (16.22%) had high rates of first teen birth only; 991 (31.89%) had high rates of both repeat and first teen births; and 1,420 (45.69%) had neither. Counties with high repeat (vs. first only) birth rates had higher rates of poverty and unemployment, higher levels of income inequality, lower high school graduation rates, a higher share of racial and ethnic minority residents, fewer publicly funded family planning clinics per capita, and more women receiving contraceptive services at publicly funded clinics. CONCLUSIONS First and repeat teen births cluster in differentially resourced geographic areas. Counties with high repeat teen birth rates have lower socioeconomic conditions than counties with high rates of first teen births only. These counties are more reliant on publicly funded family planning clinics but have fewer of them per capita.
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Affiliation(s)
- Julie Maslowsky
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, Austin, Texas.
| | - Daniel Powers
- Department of Sociology, College of Liberal Arts, University of Texas at Austin, Austin, Texas
| | - C Emily Hendrick
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Leila Al-Hamoodah
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, Texas
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Ralph LJ, Mauldon J, Biggs MA, Foster DG. A Prospective Cohort Study of the Effect of Receiving versus Being Denied an Abortion on Educational Attainment. Womens Health Issues 2019; 29:455-464. [DOI: 10.1016/j.whi.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
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Martinez I, Kershaw TS, Keene D, Perez-Escamilla R, Lewis JB, Tobin JN, Ickovics JR. Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City. Ann Behav Med 2019; 52:42-52. [PMID: 28707175 DOI: 10.1007/s12160-017-9924-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents. Purpose The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time. Methods In a cohort of 772 pregnant Latina adolescents (ages 14-21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time. Results We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = -0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = -0.1348, P ≤ 0.0001; β1stGen = -0.1932, P = 0.0005). Both immigrant generation (βImmigrant = -0.1125, P = 0.0035; β1stGen = -0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum. Conclusion Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.
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Affiliation(s)
- Isabel Martinez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Danya Keene
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Richards SD, Mendelson E, Flynn G, Messina L, Bushley D, Halpern M, Amesty S, Stonbraker S. Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2019-0017/ijamh-2019-0017.xml. [PMID: 31199763 PMCID: PMC6986322 DOI: 10.1515/ijamh-2019-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic's CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation. METHODS A mixed methods study was conducted among students aged 11-25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar's test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time. RESULT Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic. CONCLUSION Improvement in test scores supports MAMI CSEP's efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP.
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Affiliation(s)
- Sheyla D. Richards
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Columbia University Program for Global and Population Health, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Eva Mendelson
- Peace Corps Dominican Republic, Santo Domingo, Dominican Republic
| | - Gabriella Flynn
- Columbia University Program for Global and Population Health, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Luz Messina
- Clínica de Familia, La Romana, Dominican Republic
| | - Diane Bushley
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA, USA
| | - Mina Halpern
- Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- Columbia University Program for Global and Population Health, Vagelos College of Physicians and Surgeons, New York, NY, USA
- Columbia University Center for Family and Community Medicine, New York, NY, USA
- Heilbrunn Department of Population and Family Health, New York, NY, USA
| | - Samantha Stonbraker
- Clínica de Familia, La Romana, Dominican Republic
- Columbia University School of Nursing, New York, NY, USA
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Diamand M, Regev D, Snir S. Growing Up Together: Teenage Pregnancy and Motherhood in the Israeli New Orthodox Sector as Reflected in Drawings and Interviews. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2018.1548998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Moria Diamand
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Dafna Regev
- The School of Creative Arts Therapies and the Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Sharon Snir
- Department of Art Therapy, Tel Hai College, Qiryat Shemona, Israel
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16
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Richards SD, Stonbraker S, Halpern M, Amesty S. Cervical cancer screening among transactional female sex workers in the Dominican Republic. Int J STD AIDS 2018; 29:1204-1214. [PMID: 29966506 PMCID: PMC6089663 DOI: 10.1177/0956462418779662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18-54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8-14.5) or daily (AOR 4.9, 95% CI: 1.5-16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0-1.5) were significantly associated ( p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.
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Affiliation(s)
- Sheyla D Richards
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Samantha Stonbraker
- 2 Columbia University School of Nursing, New York, NY, USA
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Mina Halpern
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- 4 Heilbrunn Department of Population and Family Health, Columbia University, Mailman School of Public Health, New York, NY, USA
- 5 Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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17
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Peterson AJ, Bonell C. School experiences and young women's pregnancy and parenthood decisions: A systematic review and synthesis of qualitative research. Health Place 2018; 53:52-61. [PMID: 30055468 DOI: 10.1016/j.healthplace.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Abstract
Schools are considered high-potential environments for promoting adolescent sexual and reproductive health outcomes among young women. Qualitative studies provide context and meaning to how school experiences and systems contribute to pregnancy and parenthood decisions from the perspectives of youth. This systematic review screened 24,711 references from 8 databases, yielding 28 qualitative studies. Included studies were assessed for quality and synthesised using meta-ethnographic approaches. Reciprocal translation revealed that young women's education and life trajectories were at least partially shaped by a commitment to school values and expectations for academic achievement, influenced by structural and relational factors within the school. These findings resonate with Markham and Aveyard's theory of human functioning and school organisation. Future policy and practices might seek to improve teacher-student interactions, leverage young women's developing autonomy, and ensure physically and psychologically safe spaces for students.
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Affiliation(s)
- Amy J Peterson
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Chris Bonell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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18
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Hall M, Fullerton L, FitzGerald C, Green D. Suicide Risk and Resiliency Factors Among Hispanic Teens in New Mexico: Schools Can Make a Difference. THE JOURNAL OF SCHOOL HEALTH 2018; 88:227-236. [PMID: 29399842 DOI: 10.1111/josh.12599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 06/11/2017] [Accepted: 08/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Youth suicide is a serious public health problem in the United States. School environments, and the attention of school adults, are promising but minimally studied avenues for promoting mental health among students. METHODS The 2013 New Mexico Youth Risk and Resiliency Survey data were analyzed to identify ways in which the school environment influences suicide attempts in a sample of Hispanic students. Factors examined were: relationships with school adults, speaking a language other than English at home, being born outside the United States and not having enough to eat. Odds ratios were used to measure relationships. RESULTS Factors influencing suicide attempt were similar for boys and girls. The odds of suicide attempt declined by approximately one third as measures of positive relationships with school adults increased. Post-high school education plans also were protective. Being born outside the United States and not having enough to eat increased the odds of past-year suicide attempt. Speaking a language other than English at home was a weak risk factor for suicide attempt only among Hispanic girls. CONCLUSIONS Teachers and other school adults can decrease suicide risk for Hispanic teens by forming supportive relationships with students. Special consideration should be given to providing free breakfast in schools.
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Affiliation(s)
- Meryn Hall
- University of New Mexico School of Medicine, Department of Emergency Medicine, University of New Mexico, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131
| | - Lynne Fullerton
- Department of Emergency Medicine, University of New Mexico School of Medicine, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131
| | - Courtney FitzGerald
- University of New Mexico Prevention Research Center, MSC11 6145, 1 University of New Mexico, Albuquerque, NM 87131
| | - Dan Green
- Epidemiology and Response Division, New Mexico Department of Health, 1190 St. Francis Dr. N1320, Santa Fe, NM 87502-6110
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19
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Vieira EM, Bousquat A, Barros CRDS, Alves MCGP. Adolescent pregnancy and transition to adulthood in young users of the SUS. Rev Saude Publica 2017; 51:25. [PMID: 28380206 PMCID: PMC5575719 DOI: 10.1590/s1518-8787.2017051006528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 02/25/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood. METHODS This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables – planned pregnancy, living with a partner, and having left the parents’ house – have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance. RESULTS Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables. CONCLUSIONS The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons.
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Affiliation(s)
- Elisabeth Meloni Vieira
- Departamento de Medicina Social. Faculdade de Medicina. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Aylene Bousquat
- Departamento de Política, Gestão e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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20
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Coleman-Minahan K. The socio-political context of migration and reproductive health disparities: The case of early sexual initiation among Mexican-origin immigrant young women. Soc Sci Med 2017; 180:85-93. [PMID: 28324794 DOI: 10.1016/j.socscimed.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
Prior research often explains the lower risk of early sexual initiation among foreign-born Mexican-origin young women by a patriarchal and sexually conservative "traditional Latino culture." This definition overlooks structural factors such as exploitation of migrant workers, and conflates gender inequality and sexual expectations. I use an intersectional framework and the theory of gender and power to explore how gender inequality and sexual expectations are both influenced by structural factors and affect reproductive health outcomes. I integrate data from qualitative interviews with 21 first and second generation Mexican-origin women in 2013-2014 with data from discrete time hazard models with 798 Mexican-origin young women in the National Longitudinal Study of Adolescent to Adult Health. Qualitative results demonstrate that gender inequality and sexual expectations in Mexican-origin immigrant households are associated with structural factors. Gender inequality occurs more often in households with family instability, greater poverty, and among parents who migrated independently. Qualitative data also demonstrate that parental gendered expectations are sometimes at odds to what parents are actually doing in the household. Finally, contrary to assumptions that a patriarchal "traditional Latino culture" protects against early sexual initiation, qualitative and multivariate quantitative data suggest that household gender inequality increases risk of early sexual initiation. These findings challenge the utility of a culturalist approach that views culture as determining health behavior among immigrants and demonstrate the need to incorporate an intersectional framework that includes structural factors. This approach may reduce stereotypes and identify meaningful interventions to reduce reproductive health disparities.
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Affiliation(s)
- Kate Coleman-Minahan
- Department of Health and Behavioral Sciences, University of Colorado Denver, Campus Box 188, PO Box 173364, Denver, CO 80217, United States.
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21
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Lara D, Decker MJ, Brindis CD. Exploring how residential mobility and migration influences teenage pregnancy in five rural communities in California: youth and adult perceptions. CULTURE, HEALTH & SEXUALITY 2016; 18:980-995. [PMID: 27439657 DOI: 10.1080/13691058.2016.1150514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Teenage birth rates among young people aged 15-19 years in California, USA, have declined from 47 births per 1000 in 2000 to 24 per 1000 in 2013. Nevertheless, the US counties with the highest teenage birth rates are predominantly rural and have a high proportion of Latinos/as. We conducted 42 interviews with key stakeholders and 12 focus groups with 107 young people in five rural communities to better understand local migration patterns and their influence on intermediate and proximate variables of pregnancy, such as interaction with role models and barriers to access contraception. The migration patterns identified were: residential mobility due to seasonal jobs, residential mobility due to economic and housing changes and migration from other countries to California. These patterns affect young people and families' interactions with school and health systems and other community members, creating both opportunities and barriers to prevent risky sexual behaviours. In rural areas, residential mobility and migration to the USA interconnect. As a result, young people dually navigate the challenges of residential mobility, while also adapting to the dominant US culture. It is important to promote programmes that support the integration of immigrant youth to reduce their sense of isolation, as well as to assure access to sexual health education and reproductive health services.
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Affiliation(s)
- Diana Lara
- a Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , USA
| | - Martha J Decker
- a Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , USA
| | - Claire D Brindis
- a Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , USA
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22
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Social network recruitment for Yo Puedo: an innovative sexual health intervention in an underserved urban neighborhood—sample and design implications. J Prim Prev 2015; 36:51-64. [PMID: 25358834 DOI: 10.1007/s10935-014-0375-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Most existing evidence-based sexual health interventions focus on individual-level behavior, even though there is substantial evidence that highlights the influential role of social environments in shaping adolescents' behaviors and reproductive health outcomes. We developed Yo Puedo, a combined conditional cash transfer and life skills intervention for youth to promote educational attainment, job training, and reproductive health wellness that we then evaluated for feasibility among 162 youth aged 16-21 years in a predominantly Latino community in San Francisco, CA. The intervention targeted youth's social networks and involved recruitment and randomization of small social network clusters. In this paper we describe the design of the feasibility study and report participants' baseline characteristics. Furthermore, we examined the sample and design implications of recruiting social network clusters as the unit of randomization. Baseline data provide evidence that we successfully enrolled high risk youth using a social network recruitment approach in community and school-based settings. Nearly all participants (95%) were high risk for adverse educational and reproductive health outcomes based on multiple measures of low socioeconomic status (81%) and/or reported high risk behaviors (e.g., gang affiliation, past pregnancy, recent unprotected sex, frequent substance use; 62%). We achieved variability in the study sample through heterogeneity in recruitment of the index participants, whereas the individuals within the small social networks of close friends demonstrated substantial homogeneity across sociodemographic and risk profile characteristics. Social networks recruitment was feasible and yielded a sample of high risk youth willing to enroll in a randomized study to evaluate a novel sexual health intervention.
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23
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Mann ES, Cardona V, Gómez CA. Beyond the discourse of reproductive choice: narratives of pregnancy resolution among Latina/o teenage parents. CULTURE, HEALTH & SEXUALITY 2015; 17:1090-1104. [PMID: 25953108 DOI: 10.1080/13691058.2015.1038853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite the fact that the US teenage birth rate has declined dramatically in recent years, teen births among Latinas are higher than any other racial/ethnic group. Most studies focus on the causes and consequences of early motherhood among Latina teenagers, neglecting other important dimensions of the issue. This study examines how Latina/o teenage parents living in California narrate their experiences with unintended pregnancy resolution. Qualitative analysis reveals three central themes. First, participants expressed shock upon learning they or their partner was pregnant, followed by acceptance about their impending parenthood. Second, participants' views of abortion and adoption largely foreclosed these options as pathways by which to resolve their unintended pregnancies. Third, participants recounted numerous stories of the messages they received from parents, other family members and male partners that were frequently directive regarding how to resolve their pregnancies. These findings have implications for young people's reproductive health and rights, and for reproductive justice more broadly.
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Affiliation(s)
- Emily S Mann
- a Department of Health Promotion, Education and Behavior , Arnold School of Public Health, University of South Carolina , Columbia , USA
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24
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Nerlander LM, Callaghan WM, Smith RA, Barfield WD. Short interpregnancy interval associated with preterm birth in U S adolescents. Matern Child Health J 2015; 19:850-8. [PMID: 25062997 PMCID: PMC5547434 DOI: 10.1007/s10995-014-1583-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A short interpregnancy interval (IPI) is a risk factor for preterm delivery among women of reproductive age. As limited data exist concerning adolescents, we aimed to examine the association between short IPIs and preterm birth among adolescents using a majority of US births. Using 2007-2008 US natality data, we assessed the relationship between IPIs <3, 3-5, 6-11, and 12-17 months and moderately (32-36 weeks) and very (<32 weeks) preterm singleton live births among mothers <20 years, relative to IPIs 18-23 months. Adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs) adjusted for maternal race, age, previous preterm deliveries, marital status, smoking and prenatal care were determined from a multivariable multinomial logistic regression model. In 2007-2008, there were 85,077 singleton live births to women aged <20 who had one previous live birth, 69 % of which followed IPIs ≤18 months. Compared with IPIs 18-23 months, short IPIs were associated with moderately preterm birth for IPIs <3 months (aOR 1.89, 95 % CI 1.70-2.10), 3-5 months (aOR 1.33, 95 % CI 1.22-1.47), and 6-12 months (aOR 1.11, 95 % CI 1.02-1.21). IPIs <3 and <6 months were also associated with very preterm birth, with aORs of 2.52 (95 % CI 1.98-3.22) and 1.68 (95 % CI 1.35-2.10) respectively. Many adolescent mothers with repeat births have short IPIs, and shorter IPIs are associated with preterm birth in a dose-dependent fashion. Increasing adolescent mothers' use of effective contraception postpartum can address both unintended adolescent births and preterm birth.
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Affiliation(s)
- Lina M Nerlander
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,
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25
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Lau M, Lin H, Flores G. Pleased to be pregnant? Positive pregnancy attitudes among sexually active adolescent females in the United States. J Pediatr Adolesc Gynecol 2014; 27:210-5. [PMID: 24656702 DOI: 10.1016/j.jpag.2013.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To identify factors associated with a positive pregnancy attitude among sexually active US teen females. DESIGN Secondary database analysis of the National Survey of Family Growth. PARTICIPANTS Adolescent females 15-19 years old. SETTING Nationally representative sample. METHODS Bivariate and multivariable analyses were performed of the 2002 and 2006-08 cycles to examine whether sociodemographic factors, contraceptive history, sexual education and behavior history, medical services history, and family and sexual attitudes were associated with a positive pregnancy attitude among sexually active teen females. RESULTS Among the 975 sexually active US adolescent females surveyed, 15% reported a positive pregnancy attitude. Compared with adolescent females with a negative pregnancy attitude, those females with a positive pregnancy attitude were significantly (P < .05) more likely to have public insurance (43% vs 20%), to be poor (33% vs 10%), to have reached menarche at an earlier age (12 years old vs 13 years old), ever have HIV tested (35% vs 23%), but less likely to have ever been forced to have sex (1% vs 10%). In multivariable analyses, Latino race/ethnicity was associated with triple the odds, and African-American double the odds, of a positive pregnancy attitude. Older age of menarche and higher family income were associated with reduced odds of a positive pregnancy attitude. CONCLUSIONS One in 7 sexually active US adolescent females had a positive pregnancy attitude. Minority race/ethnicity was associated with greater odds of a positive pregnancy attitude, whereas older age of menarche and a higher family income were associated with lower odds of a positive pregnancy attitude. Assessing pregnancy attitudes for these groups of adolescent females might prove useful to decrease adolescent pregnancy rates.
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Affiliation(s)
- May Lau
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
| | - Hua Lin
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Glenn Flores
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX
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Minnis AM, vanDommelen-Gonzalez E, Luecke E, Dow W, Bautista-Arredondo S, Padian NS. Yo Puedo--a conditional cash transfer and life skills intervention to promote adolescent sexual health: results of a randomized feasibility study in san francisco. J Adolesc Health 2014; 55:85-92. [PMID: 24518532 PMCID: PMC4065819 DOI: 10.1016/j.jadohealth.2013.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE We designed and evaluated for feasibility an intervention-Yo Puedo-that addresses social network influences and socioeconomic opportunities in a neighborhood with substantial gang exposure and early childbearing. METHODS Yo Puedo combined conditional cash transfers for completion of educational and reproductive health wellness goals with life skills sessions, and targeted youth 16-21 years of age and same-aged members of their social network. We conducted a two-arm study with social networks randomized to the intervention or a standard services control arm. We evaluated intervention uptake, adherence, and safety; and assessed evidence of effects on behavioral outcomes associated with unintended pregnancy and sexually transmitted infection risk. RESULTS A total of 72 social networks composed of 162 youth enrolled, with 92% retention over 6 months. Seventy-two percent of youth randomized to the intervention participated in intervention activities: 53% received at least one conditional cash transfer payment and 66% came to at least one life skills session. We found no evidence that cash payments financed illicit or high-risk behavior. At 6 months, compared with controls, intervention participants had a lower odds of hanging out on the street frequently (odds ratio [OR], .54; p = .10) and a lower odds of reporting that their close friends had been incarcerated (OR, .6; p = .12). They reported less regular alcohol use (OR, .54; p = .04) and a lower odds of having sex (OR, .50; p = .04). CONCLUSIONS The feasibility evaluation of Yo Puedo demonstrated its promise; a larger evaluation of effects on pregnancy and sustained behavioral changes is warranted.
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Affiliation(s)
- Alexandra M. Minnis
- Women’s Global Health Imperative, RTI International, San Francisco, CA,School of Public Health, University of California, Berkeley
| | - Evan vanDommelen-Gonzalez
- Women’s Global Health Imperative, RTI International, San Francisco, CA,School of Public Health, University of California, Berkeley
| | - Ellen Luecke
- Women’s Global Health Imperative, RTI International, San Francisco, CA
| | - William Dow
- School of Public Health, University of California, Berkeley
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