Familial, cultural and psychosocial influences of use of effective methods of contraception among Mexican-American adolescents and young adults

Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approach

Health literacy is generally low in marginalized groups, leading to delays in accessing care, poor health outcomes, and health disparities. Yet, some individuals in these groups demonstrate higher health literacy and better health outcomes. These exceptional cases exemplify 'positive deviance' because they have found ways to be successful where others have not. Identifying the methods, practices, and resources that these individuals have used to gain health literacy and healthcare access may have generalized application to improve health literacy, access to care, and health outcomes. Using the Integrated Model of Health Literacy, the main objectives of this study are to (1) identify facilitators, barriers, and strategies to gain sexual and reproductive health literacy and healthcare access and (2) to explore each of the core domains of health literacy as they relate to successful access of sexual and reproductive healthcare services among individuals identified as positive deviants. For the purposes of this mixed methods community engaged study, positive deviants are defined as Mexican American young women aged 18-29 years old living in Rural Western New York who have accessed sexual and reproductive healthcare within the past year. A community advisory committee will be formed to provide community-engaged guidance and support for the recruitment of participants. Positive deviants will participate in a survey and semi-structured interview. Data collection and analysis will be simultaneous and iterative. Results will provide evidence of positive deviant methods, practices, and strategies to gain health literacy and access to sexual and reproductive healthcare. Findings may reveal characteristics and patterns in the relationship of health literacy and healthcare access that can inform interventions to improve health literacy and make healthcare more accessible for this demographic group and context.

Roe v. Wade Overturned: The Association of Acculturation with Interest in and Awareness of Hospital Services for Family Planning Among Hispanic Women

Introduction: The overturning of Roe v. Wade impacted family planning services in many areas of the United States (US). Our study investigates the association of acculturation with interest in and awareness of family planning hospital services of contraception and elective termination of pregnancy among Hispanic women. Methods: We surveyed 306 Hispanic women at a public hospital in a Long Island suburb of New York City. Predictor variables were acculturation (language, media, ethnic social relations) measured by the Short Acculturation Scale for Hispanics and years lived in the US. Outcome variables were interest in and awareness of hospital services of family planning for elective abortion and non-elective non-abortion family planning methods. Results: For interest in hospital services, both language and ethnic social relations acculturation were significantly positively associated with almost all family planning methods whether abortion or non-abortion. However, media acculturation and years lived in the US were significantly positively associated with abortion but not the non-abortion methods. For awareness of hospital services, only language acculturation was significantly positively associated with abortion and some nonelective non-abortion family planning methods. Conclusion: We recommend that healthcare providers and hospitals should be aware of acculturation levels when providing counseling and information about family planning methods to Hispanic women.

Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study

OBJECTIVES

To describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers.

STUDY DESIGN

We conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use.

RESULTS

At baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge.

CONCLUSION

Sexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it.

IMPLICATIONS

This study addressees gaps in knowledge about U.S. Latina adolescents' contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.

Hispanic Acculturation: Associations with Family Planning Behaviors and Attitudes

INTRODUCTION

The purpose of this study was to investigate the association of Hispanic acculturation in the U.S. with family planning behaviors and attitudes.

METHODS

Surveys of 225 Hispanic women were collected that used acculturation measures of number of years lived in the U.S. and the Short Acculturation Scale for Hispanics (SASH), along with questions about family planning behaviors, including birth control use, sterilization, and abortion.

RESULTS

SASH-Language statistically differed (p = 0.03) where those with 'yes birth control' had significantly lower English acculturation (M = 6.10, SD = 1.77) than those with 'no birth control' (M = 7.00, SD = 3.16). Greater U.S. acculturation on SASH-Ethnic Social Relations was associated positively with the attitude that finances are important when considering to have children (r = 0.18, p < 0.05). Number of years lived in the U.S. was associated positively with the attitude that it is a woman's personal choice to have an elective termination of pregnancy (r = 0.19, p < 0.01).

CONCLUSIONS

Healthcare providers should consider patient acculturation level when discussing family planning topics. It is possible that a more detailed explanation concerning the reasons for family planning is necessary when discussing family planning topics with Hispanic patients who exhibit higher levels of English language acculturation.

Perceptions of a Spanish language Reproductive Health Self-assessment Tool Among Spanish-Speaking Women at a Federally Qualified Health Center

Latinas face barriers to contraceptive and preconception care. Using a Reproductive Health Self-Assessment Tool (RH-SAT) before primary care visits may help overcome these barriers. Twenty Spanish-speaking women at a Federally Qualified Health Center in Chicago received the RH-SAT before their visit then completed a phone interview about their perceptions of the RH-SAT. Transcripts were thematically analyzed using a modified grounded theoretical approach. All participants self-reported Hispanic/Latina ethnicity, either of Mexican (N = 19) or Puerto Rican (N = 1) origin. Participants (1) believed the RH-SAT was easy to use and its content was useful for women with a variety of reproductive goals; (2) felt it provided new information about preparing for pregnancy and contraception; (3) were prompted by the RH-SAT to self-reflect and ask questions not previously considered; and (4) felt it could help overcome barriers some women experience in discussing reproductive health. Participants felt the RH-SAT provided new information and would prompt them to discuss contraception and/or preparing for pregnancy with their clinician. This tool has the potential to facilitate patient-clinician discussion of reproductive health in primary care and overcome barriers experienced by some Spanish-speaking women.

Young Men's Communication With Partners and Contraception Use: A Systematic Review

PURPOSE

The rate of adolescent unintended pregnancy in the U.S. is high compared with that in other developed countries. While past research and interventions have focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men's knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control such as condoms or withdrawal. However, less is known about how young men contribute to decision-making about contraceptive methods other than condoms with female partners. The purpose of this systematic review was to explore how young men communicate with their female partners and the effect of such communication on contraception use to prevent pregnancy.

METHODS

We conducted a systematic review of six databases to identify English language articles published from January 1, 2002, through March 24, 2019. The review specifically explored how young men aged 11-24 years communicate with and affect their female partner (noncondom) contraceptive use. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, communication strategies used by young men, and which dynamics of partner communication were measured in studies.

RESULTS

Of the 12 articles identified as exploring male partner communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, three of which produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Seven qualitative studies provided supporting narratives from young men describing communication with partners and how they influence contraception use by female partners. The articles also explored timing and strategies of communication, as well as topics, prompts, and communication cues used by young men. Measurements of both communication and contraception varied across studies.

CONCLUSIONS

With the small number of studies identified in this systematic review, we conclude that future research needs to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

Young adult US-born Latina women's thoughts, feelings and beliefs about unintended pregnancy

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.

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

Objective

To examine current levels, correlates of, and changes in contraceptive use among reproductive-age women in the United States between 2014 and 2016.

Design

We conducted simple and multivariable logistic regression analyses to identify associations between user characteristics and contraceptive use, with specific attention to methods requiring a visit to a health care provider.

Setting

Not applicable.

Patient(s)

All self-identified female respondents to the surveys. Secondary analysis of two rounds of the National Survey of Family Growth, an in-home, nationally representative survey of people ages 15–44 years (2013–2015) and 15–49 years (2015–2017).

Intervention(s)

None.

Main Outcome Measure(s)

Current use of a contraceptive method, including use of individual methods and grouped method use in 2016, and change in use from 2014.

Result(s)

Contraceptive use remained steady between 2014 and 2016 among sexually active females not seeking pregnancy (88%). Among users, use of long-acting reversible contraceptive (LARC) methods increased from 14% to 18%, as use of short-acting reversible contraceptive (SARC) methods fell from 32% to 28%. Implant use among 15- to 19-year-olds rose from 6% to 16% and represents one of the largest increases observed. Access to sexual and reproductive health care was strongly associated with use of all LARC and SARC methods except for the implant (adjusted odds ratios ranged from 3.21 to 13.53).

Conclusion(s)

Contraceptive users are shifting primarily among the most and moderately effective method groups, and not from contraceptive nonuse to use. Reductions in access to sexual and reproductive health care could have implications for individuals’ ability to use their preferred contraceptive methods.

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Contraceptive use in the United States remained steady between 2014 and 2016.

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Increases in use of long-acting reversible contraceptive methods paralleled a decrease in use of short-acting reversible contraceptive methods.

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Contraceptive users are shifting primarily among the most and moderately effective method groups and not from contraceptive nonuse to use.

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Access to sexual and reproductive health care is strongly associated with use of most long- and short-acting reversible contraception.

Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies

AIM OF THE STUDY

We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016.

METHODS

A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models.

RESULTS

The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94).

CONCLUSIONS

Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.

Knowledge, Beliefs, and Attitudes About Contraception Among Rural Latino Adolescents and Young Adults

PURPOSE

Latino youth experience significant disparities in rates of teen pregnancy, and reproductive health needs of rural Latino youth are not well understood. The purpose of this study was to describe knowledge, beliefs, and attitudes about contraception among rural Latino adolescents and young adults (Latino youth).

METHODS

Eighty-four Latino youth, aged 15-24 years from rural Kansas communities participated in 15 focus groups (FG) and completed an individual survey. The survey assessed demographics and acculturation. FG participants discussed attitudes, subjective norms, and perceived sexual behaviors regarding teen sexuality, pregnancy, and contraception.

RESULTS

FGs revealed multiple obstacles to accessing reproductive health services: geographical/rural location, cultural barriers, religious influences, lack of sexual education, and personal attitudes toward pregnancy and contraception use. Participants described close-knit communities with limited access to confidential reproductive health care. They identified cultural and religious factors (sexual taboo, virginity, Familismo, and family dishonor) that influence family planning behaviors among Latino youth and obstruct access to sexual health and contraception knowledge and services. Ambivalence regarding pregnancy intentions was common, along with the belief that contraception equates with abortion.

CONCLUSIONS

Latino youth in rural communities face multiple physical and sociocultural obstacles to accessing family planning information and services. Community-based pregnancy prevention interventions must target these obstacles to optimize reproductive health outcomes for Latino youth in rural settings.

The Association of Cultural and Structural Factors with Perceived Medical Mistrust Among Young Adult Latinos in Rural Oregon

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18-25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

Sociodemographic Factors Associated with the Knowledge and Use of Birth Control Methods in Adolescents before and after Pregnancy

Adolescent pregnancy rates are high worldwide. However, insufficient information exists regarding the frequency of birth control methods used before the first pregnancy and postpartum. In the current study, we analyzed the association of sociodemographic factors with the knowledge of birth control methods and their use before and after pregnancy in a sample of adolescents in Mexico City. A cohort study was conducted on 600 pregnant adolescents in Mexico City, from 2013 to 2017, at a health care institution providing prenatal care. Participants were assessed during the second trimester and four months postpartum. The questionnaire explored the knowledge of birth control methods, their use, and other associated factors. Two logistic regression models were implemented to identify potential variables associated with the lack of birth control method use before and after pregnancy. The mean age of participants was 15.4 + 1 years, of which, 48% and 65.2% used a birth control method before pregnancy and postpartum, respectively. We found that the main factors associated with increased risk of not using any birth control method before pregnancy included being under the age of 15 years, school dropout, having an educational lag, initiation of sexual life before the age of 15, and having a mother who did not inform their child about contraceptives. By contrast, variables associated with a higher risk of not using any contraceptive methods after pregnancy included educational lag, lower level of education, and the fact that the adolescent had not used any birth control prior to the pregnancy.

Racial and Ethnic Discrimination, Medical Mistrust, and Satisfaction with Birth Control Services among Young Adult Latinas

BACKGROUND

Racial/ethnic discrimination and medical mistrust contribute to disparities in use of and satisfaction with health care services. Previous work examining the influence of discrimination and medical mistrust on health care experiences has focused primarily on African Americans. Despite the finding that Latinas report lower rates of contraceptive use than White women, little is known about the influence of these factors on health care satisfaction, specifically satisfaction with contraceptive services, among Latina women.

METHODS

We conducted computer-assisted interviews with 254 Latina women aged 18 to 25 living in rural communities in Oregon. Only the 211 women who reported ever receiving birth control services answered the question regarding satisfaction with birth control services and were included in the analytic sample. Using multivariable logistic regression models, we explored the relationship between medical mistrust and everyday discrimination on satisfaction with birth control services, accounting for relevant factors.

RESULTS

More than 80% of the total sample reported ever seeing a health care provider for birth control services and of these women, 75% reported being very or extremely satisfied with their birth control services. Latinas who reported higher levels of medical mistrust and racial/ethnic discrimination reported being less satisfied with birth control services. After adjusting for perceived barriers to accessing contraceptive services and other relevant factors, only perceived barriers and racial/ethnic discrimination remained significantly associated with satisfaction.

CONCLUSIONS

This study contributes to the growing understanding of the pervasive effects that racial/ethnic discrimination and medical mistrust have on satisfaction with health services among Latinas in the United States.

Sexual risk during initial months in US among Latina young adults

Latina young adults are disproportionately at risk for sexually transmitted infections (e.g., HIV). However, little is known about social and cultural factors contributing to sexual health disparities among young adult Latina recent immigrants. The present study examined social and cultural factors contributing to sexual risk behaviors among 530 Latina women (ages 18-23) who immigrated to Miami-Dade County, Florida, approximately 12 months before assessment. At the cultural/macrosystemic level, participants who reported more sexual risk behaviors tended to (a) be less acculturated; (b) use less positive religious coping; (c) endorse to a greater extent the marianismo belief that Latinas should be the pillar of the family; and (d) endorse less of the marianismo belief that Latinas should be virtuous and chaste (i.e., abstain from premarital sex). As for individual-level factors, participants who reported more sexual risk behaviors also indicated (e) older age, (f) being married/partnered, (g) being employed, (h) living in the US longer, and (i) drinking more alcohol. Findings indicate areas for HIV/STI prevention for this underserved population.

Increasing Sexual and Reproductive Health Education Equity for Hispanics in Schools

In the United States, the overall teen birth rate has been decreasing. In 1991, the teen birth rate was 61.8 births for every 1,000 teen females, but in 2014, the same overall rate decreased to 24.2 births for every 1,000 teen females. Unfortunately, this decrease has not reflected equally across all the races/ethnic groups. In 2014, the teen birth rate for Hispanics was 38 births per 1,000 teen females. The NASN is aware about the disparities on teen birth among racial/ethnical groups and has released a specific statement about the role of school nurses on the improvement of pregnancy outcomes. This article explains the cultural, linguistic, and educational barriers faced by Hispanic teens with limited English proficiency when preventing pregnancy and describes the development and implementation of a sexual and reproductive health education curriculum. The implications for school nurses will be discussed.

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh

OBJECTIVE

This study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25years old.

METHODS

This study utilized a cross-sectional data (n=3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ² analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women.

RESULTS

This study observed that 71% fecund women aged below 25years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women.

CONCLUSIONS

Reproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use.

Actor-Partner Interdependence Model Analysis of Sexual Communication and Relationship/Family Planning Factors Among Immigrant Latino Couples in the United States

The Latino population in the United States is quickly growing, and its unintended pregnancy rate is increasing. To decrease unintended pregnancies, couples must mutually agree on family planning. Communication between partners is one key factor identified in successful family planning for couples. Therefore, the purpose of this study was to examine sexual communication and its associations with sexual relationship power, general communication, and views on family planning. The Actor-Partner Interdependence Model was used to analyze dyadic influences of the chosen variables. Forty immigrant Latino couples were recruited from prenatal care clinics. The study results were grouped according to the three types of power structures: exhibition of men's traditional machismo values, exhibition of women's increased power in their relationships, and exhibition of men's and women's own empowerment with sexual communication. There was a negative association between men's views on family planning and women's sexual communication (exhibition of machismo values); a negative association between women's sexual relationship power and their partners' sexual communication (exhibition of women's increased power); and positive associations between men's and women's general communication and sexual communication (exhibition of men's and women's own empowerment). Dyadic influences of sexual communication and associated variables need to be incorporated into interventions to facilitate family planning for couples.

Exploring how residential mobility and migration influences teenage pregnancy in five rural communities in California: youth and adult perceptions

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.

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

CONTEXT

Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations.

METHODS

A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy.

RESULTS

At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect).

CONCLUSIONS

Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Predictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy

STUDY OBJECTIVE

In the United States, teen pregnancy rates are declining. However, the United States still has the highest teen pregnancy rate among high-income countries. Understanding factors that predict discontinuation of effective contraception might help to further decrease teen pregnancy. We aimed to assess predictors of early discontinuation of effective contraception during typical use by high-risk teens. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We recruited 145 women aged 13-20 years (mean, 17.7 ± 1.8 years); 68% (99/145) Hispanic; 26% (38/145) black; 14% (20/145) ever pregnant; and 4% (6/145) high school dropouts who chose an effective contraceptive method during a health care visit and we prospectively assessed use of the method after 6 months. Contraceptive choices of the 130 participants who were reassessed at 6 months (90% retention) were: intrauterine device (IUD), 26% (34/130); depot medroxyprogesterone acetate (DMPA), 8% (10/130); combined oral contraceptives (COCs), 48% (62/130); transdermal patch (Patch), 13% (17/130); and intravaginal ring (Ring), 5% (7/130).

RESULTS

After 6 months, only 49 of 130 (38%) continued their chosen method; 28 of 130 (22%) never initiated the method; and 53 of 130 (40%) discontinued. Users and nonusers at 6 months did not differ according to cultural and/or social characteristics (age, ethnicity, acculturation, education, health literacy) but differed according to contraceptive method type. For the 102 of 130 who initiated a method, 88% continued use of the IUD, 20% DMPA, 43% COC, 17% Patch and Ring (P < .001). Using Cox proportional hazards multivariable analysis, compared with IUDs, all other methods predicted discontinuation: DMPA (hazard ratio [HR], 5.6; 95% confidence interval [CI], 1.2-26.7; P < .05); COCs (HR, 6.6; 95% CI, 1.8-25; P < .01); Patch and Ring (HR, 12; 95% CI, 3.0-48; P < .001). Discontinuation was also predicted by past use of hormonal contraceptives (HR, 1.9; 95% CI, 1.0-3.6; P < .05) and high school dropout (HR, 8.2; 95% CI, 1.6-41; P < .01).

CONCLUSION

Contraceptive method type is the strongest predictor of early discontinuation; compared with IUDs, all other methods are 6-12 times more likely to be discontinued. Cultural and/or social characteristics, with the exception of school dropout, are of little predictive value. Increasing the use of IUDs by high-risk teens could decrease discontinuation rates and possibly teen pregnancy rates.

Correlates and predictors of sexual health among adolescent Latinas in the United States: A systematic review of the literature, 2004-2015

Adolescent Latinas in the United States (US) are disproportionately affected by early pregnancy, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) in comparison to their non-Hispanic white counterparts. However, only a few studies have sought to understand the multi-level factors associated with sexual health in adolescent Latinas. Adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature review to better understand the correlates and predictors of sexual health among adolescent Latinas in the US, identify gaps in the research, and suggest future directions for empirical studies and intervention efforts. Eleven studies were identified: five examined onset of sexual intercourse, nine examined determinants of sexual health/risk behaviors (e.g., number of sexual partners and condom use), and three examined determinants of a biological sexual health outcome (i.e., STIs or pregnancy). Two types of variables/factors emerged as important influences on sexual health outcomes: proximal context-level variables (i.e., variables pertaining to the individual's family, sexual/romantic partner or peer group) and individual-level variables (i.e., characteristics of the individual). A majority of the studies reviewed (n=9) examined some aspect of acculturation or Latino/a cultural values in relation to sexual health. Results varied widely between studies suggesting that the relationship between individual and proximal contextual variables (including acculturation) and sexual health may be more complex than previously conceived. This review integrates the findings on correlates and predictors of sexual health among adolescent Latinas, and supports the need for strengths-based theoretically guided research on the mechanisms driving these associations.

Beyond the discourse of reproductive choice: narratives of pregnancy resolution among Latina/o teenage parents

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.

Sexual onset and contraceptive use among adolescents from poor neighbourhoods in Managua, Nicaragua

Background and objectives The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned.

Methods From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use.

Results Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption and not living with the parents. Catholic boys and boys never feeling peer pressure to have sexual intercourse were more likely to report consistent condom use. Having a partner and feeling comfortable talking about sexuality with the partner were associated with hormonal contraception.

Conclusions Our data identified associates of adolescents’ sexual behaviour related to personal characteristics (sex and alcohol use), to the interaction with significant others (parents, partners, peers) and to the environment (housing condition, religion). We interpreted those associates within the context of the rapidly changing society and the recently implemented health system reform in Nicaragua.

Chinese Abstract

摘要

背景与目的 尼加瓜拉是拉丁美洲青少年妊娠率最高的国家。本研究旨在深入了解其性行为相关因素。

方法 2011年7月至8月，研究者在马那瓜贫困地区随机抽样，通过入户访视对青少年进行调查。统计方法采用Logistic回归，分析与性发生及避孕相关的影响因素。

结果 研究分析了2 803名青少年的数据。在475名与299名有性活动的男孩与女孩中，分别有43%与54%采取了避孕措施。研究表明，性发生与年龄增长、男性性别、酒精摄入及脱离父母独居等因素呈正相关。天主教男孩与从未感受到性交方面同侪压力的男孩会坚持使用避孕套。有性伴侣且可以与性伴侣坦然讨论性话题与避孕药的使用相关。

结论 研究数据表明，青少年性行为与个人特征（性活动及酒精摄入）、其他个体影响（父母、性伴侣、同侪）以及环境因素（住房条件、宗教）相关。我们认为这些相关性发生的背景为尼加拉瓜瞬息万变的社会环境与近期实施的医疗系统体制的改革。

The social context of adolescent women's use of modern contraceptives in Zimbabwe: a multilevel analysis

BACKGROUND

Efforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics.

METHODS

Data from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM).

RESULTS

The odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces.

CONCLUSIONS

Both individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors.

Exploring young adults' contraceptive knowledge and attitudes: disparities by race/ethnicity and age

BACKGROUND

Half of pregnancies in the United States are unintended, with the highest proportions occurring among Blacks, Hispanics, and teenagers. Understanding differences in knowledge and attitudes about contraception by race/ethnicity and age can improve efforts to reduce disparities in unintended pregnancy.

METHODS

This analysis used data from the 897 female respondents in National Survey of Reproductive and Contraceptive Knowledge, a survey exploring young adults' knowledge and attitudes about contraception and pregnancy. Bivariate and multivariate logistic regression analyses were used to assess racial/ethnic and age group differences in knowledge and attitudes about contraceptives.

FINDINGS

Hispanics and teenagers (aged 18-19) had lower awareness of available contraceptive methods, and lower knowledge about individual methods compared with White women and young adults (age 20-29). For example, Hispanics (74%) and teenagers (77%) were less likely to have heard of the intrauterine device (IUD) than were White women (90%) and young adults (90%), and were less likely to know that a woman experiencing side effects could switch brands of oral contraceptive pills (72% of Hispanics vs. 86% of White women; 76% of teenagers vs. 90% of young adults). Hispanics born outside the United States had lower knowledge about contraceptives than U.S.-born Hispanics. For example, foreign-born Hispanics were less likely than U.S.-born Hispanics to have heard of the IUD (59% vs. 82%) or the vaginal ring (55% vs. 95%).

CONCLUSIONS

Lower contraceptive knowledge among teenagers and Hispanics, particularly immigrants, suggests the importance of disseminating family planning information to these women as one means to address disparities in unintended pregnancy.