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Cartwright AF, Wallace M, Su J, Curtis S, Angeles G, Speizer IS. Neighborhood-level racialized socioeconomic deprivation and contraceptive use in the United States, 2011-2019. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:182-196. [PMID: 38853371 PMCID: PMC11260244 DOI: 10.1111/psrh.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
INTRODUCTION The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the United States. METHODS We used restricted geographic data from four waves of the National Survey of Family Growth (2011-2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We also assessed for an interactive effect of ICE and health insurance type. RESULTS Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. CONCLUSIONS This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maeve Wallace
- Mary Amelia Center for Women’s Health Equity Research, Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jessica Su
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siân Curtis
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S. Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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3
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Neighborhoods matter. A systematic review of neighborhood characteristics and adolescent reproductive health outcomes. Health Place 2018; 54:178-190. [DOI: 10.1016/j.healthplace.2018.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022]
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Felkey AJ, Lybecker KM. Do Restrictions Beget Responsibility? The Case of U.S. Abortion Legislation. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0569434517692972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past decade, more than 25 U.S. states enacted legislation surrounding abortions. By analyzing state abortion legislation and proxying how the cost of obtaining an abortion varies across states, this study assesses the implications of legislative changes on women’s contraceptive choices. Examining women by race/ethnicity, income, age, and religious affiliation, the results show that women respond to increased restrictions on abortion availability and cost but that the effects are very small. This study demonstrates that legislation restricting women’s access to abortions fails to promote greater use of more effective contraceptive methods, increasing the likelihood of unwanted births and illegal abortion procedures. JEL Classifications: D1, D81, I18, J13
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Sommer M, Mmari K. Addressing Structural and Environmental Factors for Adolescent Sexual and Reproductive Health in Low- and Middle-Income Countries. Am J Public Health 2015; 105:1973-81. [PMID: 26270290 PMCID: PMC4566559 DOI: 10.2105/ajph.2015.302740] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/04/2022]
Abstract
A deeper understanding of how structure and environment shape the sexual and reproductive health vulnerabilities of youths across a range of outcomes has implications for the development of successful policies and programs. We have discussed some of the key structural and environmental factors that influence the sexual and reproductive health of adolescents, particularly in low- and middle-income countries, and the importance of engaging adolescents in identifying solutions. We have highlighted 2 case studies that describe structural or environmental approaches to improving adolescent sexual and reproductive health and made recommendations to more systematically incorporate attention to structure and environment to improve global adolescent health.
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Affiliation(s)
- Marni Sommer
- Marni Sommer is with the Mailman School of Public Health, Columbia University, New York, NY. Kristin Mmari is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristin Mmari
- Marni Sommer is with the Mailman School of Public Health, Columbia University, New York, NY. Kristin Mmari is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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6
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Jacobs J, Stanfors M. State abortion context and U.S. women's contraceptive choices, 1995-2010. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:71-82. [PMID: 26095730 DOI: 10.1363/47e3015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT The number of women in the United States exposed to restrictive abortion policies has increased substantially over the past decade. It is not well understood whether and how women adjust their contraceptive behavior when faced with restrictive abortion contexts. METHODS Data from 14,523 women aged 15-44 were drawn from the 1995 and 2010 cycles of the National Survey of Family Growth. A difference-in-differences approach was employed to examine the relationship between state-level changes in women's access to abortion and their contraceptive choices. Multinomial logistic regression analysis was used to determine the relative risk of using highly effective or less effective methods rather than no method for women exposed to varying levels of restrictive abortion contexts. RESULTS Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4). Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3). The transition to a more restrictive abortion context was not associated with women's contraceptive behavior, perhaps because states that introduced restrictive abortion legislation between 1995 and 2010 already had significant limitations in place. CONCLUSION To prevent unwanted pregnancies, it is important to ensure access to highly effective contraceptive methods when access to abortions is limited.
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Affiliation(s)
- Josephine Jacobs
- Ivey Business School, Western University, London, Ontario, Canada
| | - Maria Stanfors
- Centre for Economic Demography, Lund University, Lund, Sweden
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Wiehe SE, Kwan MP, Wilson J, Fortenberry JD. Adolescent health-risk behavior and community disorder. PLoS One 2013; 8:e77667. [PMID: 24278107 PMCID: PMC3835835 DOI: 10.1371/journal.pone.0077667] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Various forms of community disorder are associated with health outcomes but little is known about how dynamic context where an adolescent spends time relates to her health-related behaviors. OBJECTIVE Assess whether exposure to contexts associated with crime (as a marker of community disorder) correlates with self-reported health-related behaviors among adolescent girls. METHODS Girls (N = 52), aged 14-17, were recruited from a single geographic urban area and monitored for 1 week using a GPS-enabled cell phone. Adolescents completed an audio computer-assisted self-administered interview survey on substance use (cigarette, alcohol, or marijuana use) and sexual intercourse in the last 30 days. In addition to recorded home and school address, phones transmitted location data every 5 minutes (path points). Using ArcGIS, we defined community disorder as aggregated point-level Unified Crime Report data within a 200-meter Euclidian buffer from home, school and each path point. Using Stata, we analyzed how exposures to areas of higher crime prevalence differed among girls who reported each behavior or not. RESULTS Participants lived and spent time in areas with variable crime prevalence within 200 meters of their home, school and path points. Significant differences in exposure occurred based on home location among girls who reported any substance use or not (p 0.04) and sexual intercourse or not (p 0.01). Differences in exposure by school and path points were only significant among girls reporting any substance use or not (p 0.03 and 0.02, respectively). Exposure also varied by school/non-school day as well as time of day. CONCLUSIONS Adolescent travel patterns are not random. Furthermore, the crime context where an adolescent spends time relates to her health-related behavior. These data may guide policy relating to crime control and inform time- and space-specific interventions to improve adolescent health.
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Affiliation(s)
- Sarah E. Wiehe
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Mei-Po Kwan
- Department of Geography and Geographic Information Science, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Jeff Wilson
- Department of Geography, School of Liberal Arts, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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8
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Baba S, Goto A, Reich MR. Recent pregnancy trends among early adolescent girls in Japan. J Obstet Gynaecol Res 2013; 40:125-32. [DOI: 10.1111/jog.12138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 03/25/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Sachiko Baba
- Center for International Relations; Osaka University Graduate School of Medicine; Osaka Japan
| | - Aya Goto
- Department of Public Health; Fukushima Medical University School of Medicine; Fukushima Japan
- Takemi Program in International Health; Harvard School of Public Health; Boston Massachusetts USA
| | - Michael R. Reich
- Department of Global Health and Population; Harvard School of Public Health; Boston Massachusetts USA
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9
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Biello KB, Kershaw T, Nelson R, Hogben M, Ickovics J, Niccolai L. Racial residential segregation and rates of gonorrhea in the United States, 2003-2007. Am J Public Health 2012; 102:1370-7. [PMID: 22594733 PMCID: PMC3433945 DOI: 10.2105/ajph.2011.300516] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In the United States, Black persons are disproportionately affected by sexually transmitted infections (STIs), including gonorrhea. Individual behaviors do not fully explain these racial disparities. We explored the association of racial residential segregation with gonorrhea rates among Black persons and hypothesized that specific dimensions of segregation would be associated with gonorrhea rates. METHODS We used 2003 to 2007 national STI surveillance data and 2000 US Census Bureau data to examine associations of 5 dimensions of racial residential segregation and a composite measure of hypersegregation with gonorrhea rates among Black persons in 257 metropolitan statistical areas, overall and by sex and age. We calculated adjusted rate ratios with generalized estimating equations. RESULTS Isolation and unevenness were significantly associated with gonorrhea rates. Centralization was marginally associated with gonorrhea. Isolation was more strongly associated with gonorrhea among the younger age groups. Concentration, clustering, and hypersegregation were not associated with gonorrhea. CONCLUSIONS Certain dimensions of segregation are important in understanding STI risk among US Black persons. Interventions to reduce sexual risk may need to account for racial residential segregation to maximize effectiveness and reduce existent racial disparities.
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Affiliation(s)
- Katie B Biello
- Yale School of Public Health and Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
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10
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Medoff MH. Restrictive abortion laws, antiabortion attitudes and women's contraceptive use. SOCIAL SCIENCE RESEARCH 2012; 41:160-169. [PMID: 23017704 DOI: 10.1016/j.ssresearch.2011.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 09/15/2011] [Accepted: 09/26/2011] [Indexed: 06/01/2023]
Abstract
This study empirically examines the public and social policy question: Do state restrictive abortion laws affect the likelihood that women use more highly effective contraceptive methods? Using contraceptive use data from the Behavioral Risk Factor Surveillance System 2002 survey, the empirical results show that Medicaid Funding Restrictions, Informed Consent Laws, and Two-Visit Laws have no significant impact on adult women's (ages 18-44, 18-24, 25-34, 35-44) use of highly effective contraceptive methods. A state's antiabortion attitudes, which likely contribute to the enactment of restrictive abortion laws in a state, are a major factor in inducing greater use of highly effective contraceptive methods by adult women at-risk of an unintended pregnancy. The empirical findings remain robust for various population subgroups of adult women (i.e., married, single, employed, unemployed, with children, no children and college educated).
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Affiliation(s)
- Marshall H Medoff
- Department of Economics, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840, United States
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11
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Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls. J Pediatr Nurs 2011; 26:e45-54. [PMID: 22055383 DOI: 10.1016/j.pedn.2011.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 03/20/2011] [Accepted: 03/20/2011] [Indexed: 11/21/2022]
Abstract
This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.
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12
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Bersamin M, Todd M, Remer L. Does distance matter? Access to family planning clinics and adolescent sexual behaviors. Matern Child Health J 2011; 15:652-9. [PMID: 20499146 PMCID: PMC2943533 DOI: 10.1007/s10995-010-0618-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED The study examines the relationship between adolescent geographic access (distance, travel time, density) to Family Planning Clinics and adolescent sexual behaviors, including sexual initiation, number of partners and condom use. This cross-sectional study, conducted in 2005 in 10 California counties, utilized data from NICHD-funded study on adolescent sexual behavior (n = 921), geospatial coordinates of publicly-funded FPCs, and neighborhood characteristics. A series of regression models were used to assess the relationship between FPC distance, and density (number of FPCs within 1- and 3- mile radii of each adolescent's home), and adolescent sexual behaviors. Significant main effects between access measures of FPC and sexual behavior did not emerge. However, among older youth a significant inverse relationship emerged between number of FPCs within a 1-mile radius and initiating sexual intercourse. While not significant at α = .10, the results also indicate a negative relationship between density of FPCs and sexual partners (b = -.22, p < .15) among older youth. Access to FPCs was not associated with condom use. CONCLUSIONS Results suggest that increased options for family planning services may lead to less risky sexual behaviors among older youth. This finding has significant implications with regards to making family planning resources more readily available to older adolescents.
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Affiliation(s)
- Melina Bersamin
- Department of Child Development, California State University, Sacramento, 6000 J Street, Sacramento, CA 95819, USA.
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13
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Hedden SL, Whitaker DE, von Thomsen S, Severtson SG, Latimer WW. Latent Patterns of Risk Behavior in Urban African-American Middle School Students in Baltimore City. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2010. [DOI: 10.1080/1067828x.2011.534358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lang DL, Salazar LF, Crosby RA, DiClemente RJ, Brown LK, Donenberg GR. Neighborhood environment, sexual risk behaviors and acquisition of sexually transmitted infections among adolescents diagnosed with psychological disorders. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2010; 46:303-311. [PMID: 20857329 PMCID: PMC4435742 DOI: 10.1007/s10464-010-9352-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.
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Affiliation(s)
- Delia L Lang
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA.
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15
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Akers AY, Muhammad MR, Corbie-Smith G. "When you got nothing to do, you do somebody": A community's perceptions of neighborhood effects on adolescent sexual behaviors. Soc Sci Med 2010; 72:91-9. [PMID: 21129833 DOI: 10.1016/j.socscimed.2010.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 07/10/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
Abstract
This study explores community members' perspectives regarding the relationship between neighborhood characteristics and adolescent sexual behaviors in two rural, African American communities. The data were collected as part of a community needs assessment to inform the development of HIV prevention interventions in two contiguous counties in northeastern North Carolina, USA. We conducted eleven focus groups with three population groups: adolescents and young adults aged 16-24 (N = 38), adults over age 25 (N = 42), and formerly incarcerated individuals (N = 13). All focus groups were audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis and a constant comparison method. Six major themes emerged from the discussions linking neighborhood context and adolescents sexual behavior: the overwhelming absence of recreational options for community members; lack of diverse leisure-time activities for adolescents; lack of recreational options for adolescents who are dating; adolescent access to inappropriate leisure time activities that promote multiple risk behaviors; limited safe environments for socializing; and cost-barriers to recreational activities for adolescents. In addition, lack of adequate parental supervision of adolescents' time alone and with friends of the opposite sex, as well as ineffective community monitoring of adolescent social activities, were thought to create situations that promoted sexual and other risk behaviors. These findings allowed us to develop a conceptual model linking neighborhood structural and social organization factors to adolescent sexual behaviors and provided insights for developing interventions tailored to address local socioeconomic realities.
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Affiliation(s)
- Aletha Y Akers
- University of Pittsburgh, OB/GYN, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Cubbin C, Brindis CD, Jain S, Santelli J, Braveman P. Neighborhood poverty, aspirations and expectations, and initiation of sex. J Adolesc Health 2010; 47:399-406. [PMID: 20864010 DOI: 10.1016/j.jadohealth.2010.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cross-sectional research has demonstrated associations between neighborhood socioeconomic characteristics and adolescents' initiation of heterosexual intercourse. Prospective designs are needed to move toward causal inference, and to identify mediating and moderating influences to inform policies and programs. METHODS Among 5,838 nonsexually active participants in wave I (1994-1995) of the National Longitudinal Study of Adolescent Health, multilevel logistic regression analyses were used to predict initiation of sex by wave II (1996); models were stratified by gender and age group (11-14 and 15-17 yr). Predictors measured at wave I included census tract-level (neighborhood) poverty concentration, family-level income, parental education, race/ethnicity, and family structure. Adolescent college aspirations and life expectations were tested as possible mediators or moderators of the neighborhood poverty-sexual initiation association. RESULTS Neighborhood poverty concentration predicted older (15-17 yr) girls' and boys' sexual initiation, after considering individual-level covariates. However, adolescent college aspirations and life expectations were not found to mediate the prediction relationship. Moderating effects were identified for girls (college aspirations) and boys (positive life expectations) in high-poverty neighborhoods, paradoxically reflecting increased risk. CONCLUSIONS In this longitudinal study, moderating effects generally considered protective against sexual initiation were not protective or were harmful for adolescents living in high-poverty neighborhoods. Subsequent research to understand how to reduce the health risks of living in poor neighborhoods must examine an even wider range of variables and/or use different methodologies.
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Affiliation(s)
- Catherine Cubbin
- School of Social Work and Population Research Center, University of Texas at Austin, Austin, Texas 78712-0358, USA.
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17
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Sabia JJ, Rees DI. The effect of sexual abstinence on females' educational attainment. Demography 2010; 46:695-715. [PMID: 20084825 DOI: 10.1353/dem.0.0072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A number of studies have shown that teenagers who abstain from sex are more likely to graduate from high school and attend college than their sexually active peers. However it is unclear whether this association represents a causal relationship or can be explained by unmeasured heterogeneity. We employ a variety of statistical techniques to distinguish between these hypotheses, using data on females from the National Longitudinal Study of Adolescent Health. Our results provide evidence that delaying first intercourse leads to an increased likelihood of graduating from high school. This relationship appears to be strongest among respondents in the bottom third of the ability distribution. Controlling for fertility reduces, but does not eliminate, the estimated effect of delaying intercourse.
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Affiliation(s)
- Joseph J Sabia
- American University, Department of Public Administration & Policy, School of Public Affairs, 4400 Massachusetts Ave, NW, 336 Ward Circle Building, Washington, DC 20016, USA.
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18
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Kearney MS, Levine PB. Subsidized Contraception, Fertility, and Sexual Behavior. THE REVIEW OF ECONOMICS AND STATISTICS 2009; 91:137. [PMID: 20130787 PMCID: PMC2815331 DOI: 10.1162/rest.91.1.137] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We examine the impact of recent state-level Medicaid policy changes that expanded eligibility for family planning services to higher-income women and to Medicaid clients whose benefits would expire otherwise. We show that the income-based policy change reduced overall births to non-teens by about 2% and to teens by over 4%; estimates suggest a decline of 9% among newly eligible women. The reduction in fertility appears to have been accomplished via greater use of contraception. Our calculations indicate that allowing higher-income women to receive federally funded family planning cost on the order of $6,800 for each averted birth.
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Allgood KL, Silva A, Shah A, Whitman S. HIV testing practices and attitudes on prevention efforts in six diverse Chicago communities. J Community Health 2009; 34:514-22. [PMID: 19705263 DOI: 10.1007/s10900-009-9177-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data describing local level HIV testing practices and attitudes regarding HIV prevention are rarely available, yet would be useful for HIV policy and evaluation. A comprehensive health survey was conducted in six community areas of Chicago (n = 1,699) in 2002-2003. The HIV prevention module of this survey was used for this analysis. The proportion that ever tested for HIV ranged from 40 to 75% and 11 to 38% were tested in the past 12 months. Residents favored: needle exchange programs (59-77%), HIV information in high schools (95-100%) and elementary schools (85-94%), and condom distribution in high schools (74-93%). Attitudes were less favorable regarding pharmacies selling clean needles (37-58%) and condom distribution in elementary schools (22-66%). Adults in these areas are over three times more likely to have been tested recently than adults nationally. Residents strongly favor community based HIV prevention initiatives such as needle exchange programs, condom distribution in high schools, and HIV prevention taught in schools. These evidence-based observations may be valuable in planning HIV prevention programs and in shaping policy.
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Austin MJ, Lemon K. Promising Programs to Serve Low-Income Families in Poverty Neighborhoods. ACTA ACUST UNITED AC 2008; 21:65-94. [PMID: 16418128 DOI: 10.1300/j045v21n01_03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review of promising programs to address the challenges facing low-income families living in distressed neighborhoods reveals three key themes: (1) Earnings and asset development programs are used to increase the economic self-sufficiency of low-income families and include: place-based employment programs, a focus on good jobs, the use of work incentives, programs that promote banking, car and home ownership, and the use of the Earned Income Tax Credit; (2) Family strengthening programs are used to improve health and educational outcomes, as well as link families to needed support and benefit services and include: nurse home visitation, parenting education, early childhood educational programs, and facilitating the receipt of support services; and (3) Neighborhood strengthening programs are used to improve features of the neighborhood, collaboration among service providers, and resident involvement in neighborhood affairs and include: the use of community development corporations, comprehensive community initiatives and community organizing strategies.
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Affiliation(s)
- Michael J Austin
- Research Response Team, Bay Area Social Services Consortium, Center for Social Services Research, School of Social Welfare, University of California, Berkeley, USA
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Elliott MM, DeSilva NK, Middleman AB. Sexual activity and teenage females taking hormonal therapy for medical indications. J Adolesc Health 2007; 41:616-9. [PMID: 18023793 DOI: 10.1016/j.jadohealth.2007.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/26/2007] [Accepted: 07/26/2007] [Indexed: 11/30/2022]
Abstract
The objective of this study was to compare the rates of initiating sexual activity between a group of 13- through 18-year-old females placed on hormonal therapy for medical indications and a group of 13- through 18-year-old females not on hormonal therapy for medical indications. Although the number of participants was low, there was no statistically significant difference in the rates of sexual debut between the groups.
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Abstract
Abstract
In this article, I use a national sample of high school students to test for several types of social influences on the decision to have sexual intercourse. I find evidence of endogenous social interactions (social multipliers), where the propensity of an individual choosing to have sex varies with the average behavior in his or her school. Additionally, the magnitude of the social multipliers and several other interesting risk factors differ by gender and by race. These findings might help explain the large variation in sexual initiation across schools in the United States. These results also add to the debate over school vouchers and ability grouping because social multipliers imply changes in school-wide rates of sexual behavior with moderate changes in school-body composition. In this way, school vouchers and ability grouping might exacerbate the situation of high rates of teenage pregnancy and out-of-wedlock births in some communities. To show the potential benefits and costs of public policies that cause students to change schools, I present the results of several simulation exercises that predict the school-level changes in rates of sexual initiation following changes in school composition.
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Affiliation(s)
- Jason M Fletcher
- Yale University, School of Public Health, Division of Health Policy and Administration, 60 College Street, #303, New Haven, CT 06520, USA.
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Corneille MA, Belgrave FZ. Ethnic identity, neighborhood risk, and adolescent drug and sex attitudes and refusal efficacy: the urban African American girls' experience. JOURNAL OF DRUG EDUCATION 2007; 37:177-190. [PMID: 17977240 DOI: 10.2190/uj17-34j7-u306-2822] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study examined the impact of ethnic identity and neighborhood risk on drug and sex attitudes and refusal efficacy among early adolescent urban African American females (n = 175). The model also predicted a moderating relationship of ethnic identity on neighborhood risk for drug and sex attitudes and refusal efficacy. Data were collected as part of a larger drug education program and analyzed via hierarchical multiple regression. The analyses controlled for household structure and menarche. Results indicated a direct relationship of higher ethnic identity and higher sexual refusal efficacy, higher disapproval of drug use, and lowered intentions to use drugs. Neighborhood risk was directly related to lower disapproval of drug use. There was a small moderating effect of ethnic identity on neighborhood risk for intention to use drugs. Findings provide support for prevention programs for African American youth that seek to reduce risk behaviors by increasing ethnic identity, particularly in low resource communities.
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Affiliation(s)
- Maya A Corneille
- Department of Psychology, Virginia Commonwealth University, Richmond 23284-2018, USA.
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Daley MF, Liddon N, Crane LA, Beaty BL, Barrow J, Babbel C, Markowitz LE, Dunne EF, Stokley S, Dickinson LM, Berman S, Kempe A. A national survey of pediatrician knowledge and attitudes regarding human papillomavirus vaccination. Pediatrics 2006; 118:2280-9. [PMID: 17142510 DOI: 10.1542/peds.2006-1946] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A human papillomavirus vaccine was licensed in June 2006. The vaccine is quadrivalent, protecting against 2 human papillomavirus strains that cause cervical cancer and 2 that cause genital warts. The objective of this study was to determine physician characteristics, knowledge, and attitudes associated with an intention to recommend human papillomavirus vaccination. METHODS Between August and October 2005, a cross-sectional survey was administered to a national network of 431 pediatricians. The network was developed from a random sample of American Academy of Pediatrics members and was designed to be representative of the organization's membership with respect to urban/rural location, practice type, and region. The survey was conducted before human papillomavirus vaccine licensure and therefore focused on a candidate quadrivalent human papillomavirus vaccine and a range of potential vaccination recommendations. The main outcome measure was intention to recommend a quadrivalent human papillomavirus vaccine to young adolescent (10- to 12-year-old) females. RESULTS Survey response rate was 68%. If endorsed by national health organizations, 46% of respondents would recommend vaccination for 10- to 12-year-old females, 77% for 13- to 15-year-old females, and 89% for 16- to 18-year-old females. Corresponding rates for males were 37%, 67%, and 82%, respectively. Whereas 60% of respondents thought that parents would be concerned that human papillomavirus vaccination may encourage risky sexual behaviors, 11% reported that they themselves had this concern. Respondents who believed that other new adolescent immunization recommendations (eg, meningococcal, pertussis) would facilitate human papillomavirus vaccine implementation were more likely to intend to recommend vaccination. CONCLUSIONS Although a national sample of pediatricians expressed a high level of acceptance of human papillomavirus vaccination in older adolescent females, fewer than one half anticipated giving human papillomavirus vaccine to younger female patients. Provider concerns about parental vaccine acceptance will need to be addressed to optimize human papillomavirus vaccination implementation.
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Affiliation(s)
- Matthew F Daley
- Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA.
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Klerman LV, Johnson KA, Chang CH, Wright-Slaughter P, Goodman DC. Accessibility of Family Planning Services: Impact of Structural and Organizational Factors. Matern Child Health J 2006; 11:19-26. [PMID: 17131197 DOI: 10.1007/s10995-006-0149-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 09/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study sought to determine whether selected structural and organizational characteristics of publicly available family planning facilities are associated with greater availability. METHODS A survey was sent to 726 publicly available family planning facilities in four states. These included local health departments, federally qualified health centers (FQHC), Planned Parenthood sites, hospital outpatient departments, and freestanding women's health centers. Usable responses were obtained from 526 sites for a response rate of 72.5%. Availability variables included the provision of primary care services; the contraceptives offered; professional staffing; scheduling, waiting time, and transportation; and cultural congruence and competency. The structural and organizational variables were state, type of organization, and funding source. RESULTS Some states were more likely to offer emergency contraception while others were more likely to have weekend hours. FQHCs were most likely to provide primary care and Planned Parenthood sites most likely to offer emergency contraception. Title X funding was associated with increased likelihood of providing emergency contraception and staffing by midlevel practitioners and registered nurses. CONCLUSIONS This study found that availability varied by structural and organizational variables, many of which are determined by federal and state policies. Revising some of these policies might increase utilization of family planning facilities.
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Affiliation(s)
- Lorraine V Klerman
- Institute for Child, Youth and Family Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, 02454-9110, USA
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Goodman DC, Klerman LV, Johnson KA, Chang CH, Marth N. Geographic access to family planning facilities and the risk of unintended and teenage pregnancy. Matern Child Health J 2006; 11:145-52. [PMID: 17131196 DOI: 10.1007/s10995-006-0151-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 09/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study tested the hypotheses that greater geographic access to family planning facilities is associated with lower rates of unintended and teenage pregnancies. METHODS State Pregnancy Risk Assessment Monitoring System (PRAMS) and natality files in four states were used to locate unintended and teenage births, respectively. Geographic availability was measured by cohort travel time to the nearest family planning facility, the presence of a family planning facility in a ZIP area, and the supply of primary care physicians and obstetric-gynecologists. RESULTS 83% of the PRAMS cohort and 80% of teenagers lived within 15 min or less of a facility and virtually none lived more than 30 min. Adjusted odds ratios did not demonstrate a statistically significant trend to a higher risk of unintended pregnancies with longer travel time. Similarly there was no association with unintended pregnancy and the presence of a family planning facility within the ZIP area of maternal residence, or with the supply of physicians capable of providing family planning services. Both crude and adjusted relative rates of teenage pregnancies were significantly lower with further distance from family planning sites and with the absence of a facility in the ZIP area of residence. In adjusted models, the supply of obstetricians-gynecologists and primary care physicians was not significantly associated with decreased teen pregnancies. CONCLUSIONS This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.
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Affiliation(s)
- David C Goodman
- The Center for the Evaluative Clinical Sciences and the Department of Pediatrics, Dartmouth Medical School, 7251 Strasenburgh Hall, Hanover, NH 03755, USA.
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Charron-Prochownik D, Sereika SM, Falsetti D, Wang SL, Becker D, Jacober S, Mansfield J, White NH. Knowledge, attitudes and behaviors related to sexuality and family planning in adolescent women with and without diabetes. Pediatr Diabetes 2006; 7:267-73. [PMID: 17054448 DOI: 10.1111/j.1399-5448.2006.00197.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sexually active adolescents with diabetes are at high risk for unplanned pregnancies and reproductive complications. OBJECTIVE Knowledge, attitudes, intentions, and behaviors regarding diabetes and reproductive issues, sexuality, and contraception were examined in teens with diabetes in relation to a non-diabetic group. METHODS A multisite, case-control, theory-based structured telephone interview was conducted on adolescent women: 80 with diabetes mellitus (DM) and 37 matched controls without diabetes (non-DM). RESULTS Teens with diabetes appeared to lack an understanding of critical information that could prevent unplanned pregnancies and pregnancy-related complications. Although they scored significantly higher than the non-DM group on diabetes-related information, the DM group had their lowest mean average of 59% for the diabetes and pregnancy score. They did not appear to have greater protective attitudes regarding reproductive health issues than the non-DM group. The DM group felt that they were only moderately susceptible to becoming pregnant and that severe complications would not happen to them. The DM group perceived greater severity to sex-related outcomes (p = 0.001). The DM group did not report safer and more effective family planning behaviors (mean age coitus = 15.7 yr), which for them could be more detrimental. Similar trends were noted between groups regarding contraceptive methods; only a single method (e.g., pill only) rather than a dual method (e.g., pill and condom) was most frequently used. CONCLUSION Having diabetes did not appear to significantly decrease the risk-taking behavior of the teens. Early and some unsafe sexual practices may increase their risk for an unplanned pregnancy that could result in pregnancy-related complications. Enhancing awareness, knowledge, and attitudes through preconception counseling and reproductive health education may reduce these risks by empowering young women to plan healthy future pregnancies.
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Affiliation(s)
- Denise Charron-Prochownik
- Health Promotion & Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Brindis CD. A public health success: understanding policy changes related to teen sexual activity and pregnancy. Annu Rev Public Health 2006; 27:277-95. [PMID: 16533118 DOI: 10.1146/annurev.publhealth.27.021405.102244] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Teenage pregnancy prevention has long been on the American public health agenda. Over the past decade, a number of concurrent federal, state, and local policies have responded to the myriad and diverse needs of adolescents, from supporting adolescents who have not initiated sexual intercourse to strategies aimed at avoiding a repeat pregnancy among teenage parents. Key policies, including comprehensive family life education, access to contraceptive care, and youth development, have resulted in delays in sexual debut, improved contraceptive use, and have achieved reductions in pregnancies, abortions, and births. Although improvements are documented across all ethnic and racial subgroups, substantial health disparities continue to exist. Synergistic policy approaches represent a substantial change from the past when narrow, single-issue strategies were adopted and were limited in their effectiveness. Renewed efforts to implement narrow policy approaches (e.g., abstinence-until-marriage or restrictions to contraceptive access) need to be considered in light of existing research findings.
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Affiliation(s)
- Claire D Brindis
- Center for Reproductive Health Research and Policy, University of California, San Francisco, California 94143-0936, USA.
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Gold R, Connell FA, Heagerty P, Cummings P, Bezruchka S, Davis R, Cawthon ML. Predicting Time to Subsequent Pregnancy. Matern Child Health J 2005; 9:219-28. [PMID: 16231106 DOI: 10.1007/s10995-005-0005-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Women in poverty may benefit from avoiding closely spaced pregnancies. This study sought to identify predictive factors that could identify women at risk for closely spaced pregnancies. METHODS We studied 20,028 women receiving welfare (cash assistance) from Washington State. Using Cox proportional hazards methods, we estimated the effects of individual- and community-level variables on time from an index birth until a subsequent pregnancy (between June 1992 and December 1999). Prediction models developed in a random half of our data were validated in the other half. Receiver operator characteristic plots appropriate for proportional hazards models were calculated to compare the sensitivity and specificity of each model. RESULTS At 5 years of follow-up, the most predictive model contained just individual-level variables (age, education, race, marital status, number of prior pregnancies); the area under the receiver operator characteristic curve was 0.66 (.62-.69). The addition of community-level variables (percent in poverty, with a high school degree or higher, Black, Hispanic, in an urban area; female unemployment rate; income inequality) added little predictive ability. Differences were found between women with different individual- and community-level characteristics, but the results suggest that these factors are not strong predictors of pregnancy spacing. CONCLUSIONS Individual- and community-level characteristics are associated with interpregnancy intervals; however, we found little evidence that the selected variables predicted pregnancy interval in a useful manner.
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Affiliation(s)
- Rachel Gold
- Department of Epidemiology, Washington State Department of Social and Health Services, Division of Research and Data Analysis, University of Washington (UW) School of Public & Community Medicine, Portland, Oregon, 97239, USA.
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Kegler MC, Oman RF, Vesely SK, McLeroy KR, Aspy CB, Rodine S, Marshall L. Relationships among youth assets and neighborhood and community resources. HEALTH EDUCATION & BEHAVIOR 2005; 32:380-97. [PMID: 15851545 DOI: 10.1177/1090198104272334] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent research suggests that a youth development framework emphasizing youth assets may be a promising intervention strategy for preventing adolescent risk behaviors. Understanding how neighborhood and community resources relate to youth assets may aid in identifying environmental strategies to complement individually oriented asset-building interventions. In this study, 1,350 randomly selected inner-city youth and their parents (paired interviews) were interviewed in person. After controlling for demographic characteristics of youth and parents using multivariate logistic regression, parental perception of neighborhood safety was associated with the nonparental adult role model asset, peer role model asset, and for African American youth, the community involvement asset. City services and neighborhood services were associated with use of time (groups/sports) and use of time (religion), respectively. Psychological sense of community was associated with community involvement for Native American youth. Findings suggest that neighborhood and community-level influences should be considered when designing youth development interventions to reduce risk behaviors.
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Affiliation(s)
- Michelle Crozier Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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