The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans

Introduction

Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs.

Methods

We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach.

Results

Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists.

Conclusion

This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US.

The Continuum of Sexual and Reproductive Health Talk Types Daughters have with Mothers and Siblings

INTRODUCTION

Although sexual and reproductive health (SRH) is considered an important discussion topic for parents and their children, there is great variance in communication style and contradictory results on the effects of these contrasting styles. Research has explored SRH topics, yet still needs to investigate the types of parent-child SRH conversations to investigate how content gets relayed, and their effects, particularly among college-aged children.

METHODS

Data come from qualitative interviews in 2013 with 20 undergraduate Latina students about SRH conversations they had with their mothers and siblings.

RESULTS

Analysis revealed that mother-daughter SRH conversation types fell along a four-category continuum, irrespective of daughters' sexual practices, with open (n = 4) and no talk (n = 3) at the poles. The two middle categories, be careful (n = 6) and responsible sex (n = 7), were limited conversations that provided little guidance and tended to use risk language. Daughters in the no talk and be careful conversation categories tended to be more religious and have higher rates of sexual activity. Daughters' conversations with their siblings, particularly sisters, directly reflected the conversation types that they reported having with their moms.

CONCLUSIONS

Most daughters made assumptions about their mothers' statements and views due to the lack of straightforward communication and reported that most mothers did not alter their conversation styles to match their daughters' specific sexual histories. Moreover, these conversation styles could potentially affect the whole household due to siblings being other sources of sexual socialization and having talk types that reflected parental talk types, irrespective of siblings' sexual activity.

POLICY IMPLICATIONS

We recommend more attention and funding for SRH education programs that include extended family, especially siblings, given their importance in sexual socialization, and include college-aged children who still desire, and need, SRH information. Programs should equip parents and children with the tools to navigate multiple SRH conversations that evolve with and are sensitive to children's specific behaviors and circumstances.

Factors Contributing to Mother-Daughter Talk about Sexual Health Education in an Iranian Urban Adolescent Population

Background:

Parent–adolescent dialog on sexual issues reduces high-risk sexual behavior in adolescents. However, many adolescents are deprived of such training. Several factors may affect the sexual dialog between parents and adolescents. This study aimed to investigate the factors associated with mother–adolescent daughter dialog on sexual health matters in Iran.

Materials and Methods:

This cross-sectional study was carried out on 363 female adolescents aged 14-18 years in Ahvaz-Iran, between June 2015 and January 2016. Data collection was conducted utilizing multi-stage cluster sampling in high schools using the Parent–adolescent sexual dialog questionnaire and the parent–adolescent general dialogue questionnaire. The validity of the questionnaires was confirmed using content and face validity and their reliability was confirmed through internal consistency. The data were analyzed using descriptive statistics, Pearson's correlation coefficient, independent one-sample and two-sample t-tests, one-way ANOVA, and Post-HOC (Duncan) test.

Results:

The mean score of mother–daughter sexual dialog had a significant relationship with mother's education (F = 4.03, p > 0.003), adolescent's major (F = 4.48, p < 0.004), mother–daughter general communication (p < 0.001), and emotional relationship with parents (F = 6.47, p < 0.002). The more is the mother–daughter general communication, the more will be their sexual communication (p < 0.001). There was no relationship between the score of mother–daughter sexual communication and the age of mother or adolescent, parents' job, parents' marital status, and having sisters (p = 0.86).

Conclusions:

Some demographic characteristics of parents and adolescents, and the parent–adolescent emotional relationship can affect the communication between them about sexual issues. So efforts to enhance this communication should consider these factors as mediator variables.

"Power of Mom": A Mixed Methods Investigation of Mothers' Influence on Women's Contraceptive Attitudes and Behaviors

OBJECTIVES

Unintended pregnancy is an individual and public health problem with significant social and economic consequences. The literature has established that parents, especially mothers, play an important role in shaping the contraceptive attitudes and behaviors of young women and could therefore affect the likelihood of their daughter experiencing an unintended pregnancy. However, research has yet to fully explore the nuances of how mothers influence their daughters with respect to contraception.

METHODS

We conducted a mixed methods study to explore the impact of mothers on women's contraceptive attitudes and behaviors. In-depth interviews were conducted with 86 women of reproductive age to identify potential patterns and explore the nature of mothers' influences. We then analyzed medical and prescription claims for a cohort of 9813 pairs of women (mother-daughter proxies) enrolled in Medicaid, to determine if such patterns of contraceptive use held in a larger sample.

RESULTS

In-depth interviews reveal how and why mothers shape women's contraceptive attitudes and behaviors, particularly highlighting the nuances of communication, knowledge, and relationships. The statistical claims data supported such findings on a broader scale. For instance, across several types of contraceptives, including oral, injectable, and long-acting reversible contraceptives (LARCs), young women were significantly more likely to use a particular method if an older woman in the household (mother proxy) also used that method (AOR (95% CI) 1.99 (1.67-2.37), 2.06 (1.58-2.68) and 2.83 (1.64-4.88) respectively).

CONCLUSIONS FOR PRACTICE

This study fills a gap in the literature regarding the nuanced ways in which mothers influence women's contraceptive behavior. In turn, it supports the importance of familial context-especially the influence of mothers-in contraception decision-making and suggests that interventions aimed at improving access to and uptake of effective methods of contraception consider this context in their design and implementation.

Giving Our Daughters What We Never Received: African American Mothers Discussing Sexual Health With Their Preadolescent Daughters

African American girls experience disparate rates of pregnancy and acquisition of sexually transmitted infections, including human immunodeficiency virus, when compared to their non-Hispanic White counterparts. Among African American girls, current pregnancy rates are equal to the national crisis levels of teen pregnancy reported in 1990. This qualitative elicitation study was conducted to gain insight into the ways in which African American mothers and their daughters, between the ages of 9 and 14, communicate about sexual health. Early sexual health communication between mothers and daughters is known to enhance the sexual health outcomes of girls. A series of four focus groups and three in-depth interviews were conducted between July and September 2014. The theory of planned behavior was the organizing framework. Theoretical constructs that guided this study were attitudes, perceived behavioral control, and subjective norms. Results showed that what African American women share with their daughters about sexual health stems from their personal faith, values, and experiences. Findings from this study can inform interventions to provide support for this understudied population. Moreover, there are implications for health-care providers, particularly school nurses, who are in an ideal position to help increase mothers' self-efficacy to engage in sexual health conversations with their young daughters.

21st Century Parent-Child Sex Communication in the United States: A Process Review

Parent-child sex communication results in the transmission of family expectations, societal values, and role modeling of sexual health risk-reduction strategies. Parent-child sex communication's potential to curb negative sexual health outcomes has sustained a multidisciplinary effort to better understand the process and its impact on the development of healthy sexual attitudes and behaviors among adolescents. This review advances what is known about the process of sex communication in the United States by reviewing studies published from 2003 to 2015. We used the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SocINDEX, and PubMed, and the key terms "parent child" AND "sex education" for the initial query; we included 116 original articles for analysis. Our review underscores long-established factors that prevent parents from effectively broaching and sustaining talks about sex with their children and has also identified emerging concerns unique to today's parenting landscape. Parental factors salient to sex communication are established long before individuals become parents and are acted upon by influences beyond the home. Child-focused communication factors likewise describe a maturing audience that is far from captive. The identification of both enduring and emerging factors that affect how sex communication occurs will inform subsequent work that will result in more positive sexual health outcomes for adolescents.

The socio-political context of migration and reproductive health disparities: The case of early sexual initiation among Mexican-origin immigrant young women

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.

The Social Environment and Childbearing Expectations: Implications for Strength-Based Sexual Health Interventions for Latino Youth

In the United States, adolescent childbearing is disproportionately higher among Latino youth, a growing population facing substantial social exclusion. Exploring the relationship between the social environment and sexual health outcomes among Latino youth may offer insights into the development of novel interventions. In this study, Latino youth in partnerships were recruited from neighborhood venues in San Francisco and completed in-depth interviews. Youth reported a desire to complete higher education goals prior to starting a family to improve future opportunities and further personal development. Youth stated that social network members, family and partners, were supportive of their individual childbearing expectations. Social environment barriers tied to poverty, immigration status, and gang violence hindered educational attainment. Some differences were noted by gender and immigrant generation. Building on protective social ties and creating avenues in poor, urban neighborhoods for Latino youth to fully access educational opportunities may counter early childbearing and improve sexual health.

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.

Sociocultural factors of teenage pregnancy in Latino communities: preparing social workers for culturally responsive practice

Despite gains in reducing teenage pregnancy during the past 20 years, disparities in teenage pregnancy rates persist: The teenage pregnancy rate in Latino communities is now nearly double the average rate of teenage pregnancy in the United States. Considering the significant risks teenage pregnancy and parenting pose to both the teenager and the child, and that social workers are already often working in communities with populations at risk, this is not only a major public health issue, but one that the field of social work is well positioned to actively address. This article synthesizes pertinent literature on some of the social and cultural influences important for understanding this phenomenon. Implications for social work practice are discussed.

"Because you're on birth control, it automatically makes you promiscuous or something": Latina women's perceptions of parental approval to use reproductive health care

PURPOSE

To explore the perceptions of Latina women and healthcare providers about the role of parents in the young women's access to sexual and reproductive healthcare services.

METHODS

This qualitative study drew on 11 focus groups conducted with 95 young adult Latina women (ages 18-24 years) and 3 focus groups with 24 health providers recruited from clinics and programs with large Latino client-bases. The data were analyzed using an inductive approach.

RESULTS

Young adult Latinas and providers emphasized that parents play an important role in young adults' access to sexual and reproductive health services. Some young women perceived parental support to access these services while others did not. The primary reason young adult Latinas and providers felt parents did not provide support was due to parental transmission of cultural values and beliefs, specifically: (1) a high value placed on virginity; (2) a presumption that unmarried women are not sexually active and therefore do not require sexual and reproductive health services; and (3) a belief that conversations about sex and reproductive health services encourage sexual activity and promiscuity.

CONCLUSIONS

Findings suggest that young adult Latinas perceive parents as playing an important role in their sexual and reproductive health seeking behaviors into adulthood. Parents appear to influence their young adult daughters by transmitting the cultural values they have on virginity and familismo, which stresses the importance of family, familial solidarity, and adherence to traditional gender roles within the family structure.

The school readiness of children born to low-income, adolescent Latinas in Miami

Although studies show teenage parenting and low socioeconomic status predict poor child academic performance, limited research has examined relations between teen parenting and children's school readiness within low-income Latina mothers. In the context of the Miami School Readiness Project, low-income preschoolers (N = 3,023) attending subsidized child-care programs were assessed on cognitive, language, and fine motor skills, and parents and teachers reported on children's social skills and behavior concerns. Maternal teenage status at time of birth, maternal education, child attachment, child immigrant generational status, language, and other demographic variables were explored, as they uniquely and interactively predicted children's school readiness. Teenage parenting among low-income Latinas in this sample was less frequent (15%) than national estimates and more common among mothers born in the United States. Teen parenting was negatively associated with child cognitive and language competence at age 4, controlling for background variables. Maternal receipt of a high school diploma contributed additively, rather than interactively, to child outcomes. Parent-reported strong child attachment served as a buffer against the negative effects of teen parent status on child outcomes. Implications for intervention are discussed.

Contemporary Fertility Patterns and First-Birth Timing Among Mexican-Origin Women

This article examines first-birth timing among Mexican women in the United States over two birth cohorts. Currently, Mexican women are one of a small group that maintains above-replacement fertility in the United States, contributing to both Mexican population growth and overall national population growth. Yet, the fertility timing of Mexican women has undergone a significant transformation over the past 40 years. Using the 1988, 1995, and 2002 National Survey of Family Growth, this article employs first-birth probabilities and Cox proportional hazard models to show how Mexican fertility timing differs from that of other major racial and ethnic groups. The evidence suggests that the racial/ethnic, nativity, and educational diversity of the Mexican-origin population has led to the emergence of two distinct patterns of first-birth timing. The findings from this study point to the need to reconsider the role of Mexican fertility timing in important national discussions of women’s reproductive health and immigration/population polices.

Listening to Immigrant Latino Men in Rural Oregon

This study explored factors that affect access to and use of sexual and reproductive health services including family planning among immigrant Latino men residing in rural Oregon communities that have experienced a high growth in their Latino population. In-depth interviews were conducted with 49 sexually active men aged 18 to 30 years who recently immigrated to the United States. Findings from content analysis identified multiple overlapping individual-level barriers, including lack of knowledge, perception of personal risk for unintended pregnancy and STIs, and fear of disease. On a service delivery level, structural factors and the importance of confianza when interacting with providers and clinic staff were dominant themes. The majority of these themes were grounded in a cultural context and linked to men’s cultural background, beliefs, and experiences. Examining the needs of immigrant Latino men through this cultural lens may be critically important for improving access and use of sexual and reproductive health services.

Family Closeness and Domestic Abuse Among Caribbean and South American Women in South Florida

This paper focuses on the importance of family member closeness as a protective factor against domestic abuse. We explore the link between long-lasting relations within the family and intra-familial violence perpetrated against women in Latino households in South Florida. We use data from an Inter-generational Transmission of Drug Use between Latina Mothers and Daughters (ITDMD) study. The study includes data on family relations and domestic abuse. We estimate a series of multivariate regressions to obtain the probability of abuse against women, the types of abuse inflicted and the relationship with the abusers. Our results indicate that among abused women, the effects of long-lasting relations within the family differ depending on the type of relationship between the abuser and the victim and the degree of closeness the victim feels towards other family members. Given these findings, there is a need to further study family relations and abuse in Latino households.

Latina adolescents' perceptions of their male partners' influences on childbearing: findings from a qualitative study in California

Teenage births among Latina women living in the USA remain higher than any other racial/ethnic group. This study explored the role that male partners play in the occurrence of pregnancy and their influence on teenage mothers' future plans in a sample of women pregnant with their first child. Qualitative analysis revealed that partners played a significant role in the use of contraception, timing and desire for pregnancy and young women's post-pregnancy plans for education, work and childrearing. Men's older age, concerns about contraceptive use and fertility, reluctance to use condoms, and readiness for parenthood put their partners at increased risk for pregnancy. More acculturated men were supportive of young women's educational goals in many cases, whereas less acculturated males subscribed to more rigid gender roles which required that their partners remain at home after the birth of their child. These findings have important implications for programmes that seek to reduce teenage pregnancy in the US Latino population.

Predictive ability and stability of adolescents' pregnancy intentions in a predominantly Latino community

Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents' intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.

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

STUDY OBJECTIVE

To compare culturally relevant factors associated with ever having used an effective method of contraception among a cohort of predominantly Mexican American females.

DESIGN

Face to face interviews were conducted in either English or Spanish. The survey used was developed directly for this study based on qualitative research with this population as well as the existing literature. Women were grouped as either adolescents (ages 13-20) or young adults (ages 21-25) for study purposes.

SETTING

Two community-based outpatient clinics on Chicago's West Side.

PARTICIPANTS

Non-pregnant Latina females between 13-25 years of age.

MAIN OUTCOME MEASURES

Comparison of familial, cultural and psychosocial factors associated with use of effective contraception using bivariate and multivariable analyses.

RESULTS

Final analysis included 267 participants. Multivariable models yielded three factors found to be statistically significant predictors of effective contraception use, but only one was significant for both age groups. Number of children was a strong predictor of effective contraceptive use among both Latina adolescents and young adults (P < 0.001 for adolescents and P = 0.049 for young adults). Partner communication predicted effective contraceptive use among Latina adolescents (P = 0.001). Acculturation level strongly predicted effective contraceptive use among Latina young adults (P < 0.001).

CONCLUSIONS

Findings demonstrate the need to tailor messages to Latina adolescent and young adults to reduce unintended pregnancy. Interventions to improve effective contraceptive use among Latina adolescents should promote effective forms of contraception in conjunction with communication with their partners about birth control. In contrast, efforts to address unintended pregnancy among Latina young adults should be sensitive to degree of acculturation.

"El Sexo no es Malo": Maternal Values Accompanying Contraceptive Use Advice to Young Latina Adolescent Daughters

In this study, we utilized observational methods to identify maternal values and concerns accompanying contraceptive use advice in Latina mother-daughter sexuality conversations. The sample included non-sexually active early adolescents around 12 years of age and their mostly Spanish-speaking Latina mothers. Videotaped conversations were coded for the prevalence of messages related to four sexual values (abstinence, delay sex until older, sex is "normal", sex is "improper") and concerns about pregnancy and STD transmission. We examined whether the duration of time spent conversing about these messages was associated with participant characteristics, general communication openness, and the amount of time the dyads spent discussing contraceptive use. Results indicated that Latina mothers who had fewer years of education and lower family income talked longer to their daughters about the need to delay sex, avoid risky situations that would increase their chances of getting pregnant or acquiring an STD, and engage in self-protective practices. Less perceived openness in general communication as reported by both the mothers and the daughters was associated with increased time discussing that sex is improper. Although the duration of contraceptive use messages was brief, mothers and daughters who discussed the fact that sex is normal, and who communicated more about the importance of delaying sex, talked longer about contraceptive use practices compared to mothers and daughters who engaged in minimal discussion of these sexual values.

Contraceptive use among adolescent Latinas living in the United States: the impact of culture and acculturation

Although adolescent pregnancies have declined steadily during the past decade, Latina adolescents continue to have disproportionately high pregnancy rates. For nurse practitioners to effectively counsel this group of women concerning contraceptive use and sexual health, a basic understanding of the unique sociocultural factors influencing Latina adolescents' sexual activity is important. This article reviews recent literature concerning the effects of culture, acculturation, language, and significant relationships on Latina sexual behavior to provide recommendations for clinicians working with Latina adolescents in the primary care setting. Areas in need of further research are identified.

Family and racial factors associated with suicide and emotional distress among latino students

BACKGROUND

Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students.

METHODS

Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome.

RESULTS

Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year.

CONCLUSIONS

An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.

Interpersonal and personal factors influencing sexual debut among Mexican-American young women in the United States

PURPOSE

The purpose of this study is to better understand factors influencing the age of sexual initiation among Latina youth.

METHODS

Prior qualitative research with young women from the target population and the existing literature determined the theoretical framework for this study. A quantitative instrument was then developed and pre-tested. We enrolled a convenience sample of predominantly Mexican-American adolescent and young adult women from the west side of Chicago. A total of 271 participants were included in the analysis. Bi-variate and multivariable analyses were conducted to determine factors associated with age of first sexual intercourse.

RESULTS

We found that personal, family, and peer/partner related factors influence the sexual decision making of these young women. Strong family expectations regarding educational attainment, negative parental messages about premarital sex and pregnancy, resistance to the influence of peers and partners, greater sense of personal control over sexual behaviors, preference for speaking Spanish, and small age difference between the young woman and her first sexual partner were all positively associated with age of sexual initiation. Among these, greater sense of personal control over behaviors was the strongest factor influencing age of sexual initiation.

CONCLUSIONS

This study provides a model that can be used to better understand Latina sexual decision making. Our findings might also inform future programs for Latinas, as they suggest that increasing girls' feelings of personal control over decisions regarding sexual debut and helping Latino parents to communicate strong messages about educational achievement, pregnancy, and sexuality may lead to positive health behaviors.