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Gamino AM. The impact of juvenile curfews on teenage birth rates. HEALTH ECONOMICS 2024; 33:1528-1545. [PMID: 38483024 DOI: 10.1002/hec.4827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
I examine the effect of city-level juvenile curfews on teenage birth rates using the National Center for Health Statistics birth data from 1982 to 2002. I compare differences in birth rates between younger and older age groups in cities with and without curfew ordinances. Before curfew adoption, the age differential in birth rates trended similarly for cities that did and did not adopt a curfew. There were significant decreases in the age differential birth rates in cities that adopted a curfew relative to cities that did not. Curfews reduced birth rates by approximately 3 births per 1000 women ages 15-17. I find a decrease in birth rates among white women. The main results are corroborated using a variety of robustness checks and specifications.
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Affiliation(s)
- Aaron M Gamino
- Middle Tennessee State University, Murfreesboro, Tennessee, USA
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Ronen K, Gewali A, Dachelet K, White E, Jean-Baptiste M, Evans YN, Unger JA, Tandon SD, Bhat A. Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study. JMIR Form Res 2024; 8:e51066. [PMID: 38306159 PMCID: PMC10873795 DOI: 10.2196/51066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. OBJECTIVE We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. METHODS IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. RESULTS Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. CONCLUSIONS This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study's small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Erica White
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - S Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Laferriere E, Bennett N, Forrester E, Rice T, Ruiz J. Innovation to Impact: Introduction to the Special Issue on Evidence from the Teen Pregnancy Prevention Program Experiment with Innovation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:129-138. [PMID: 38047991 PMCID: PMC10764513 DOI: 10.1007/s11121-023-01620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
Congress has provided funding for the federal Teen Pregnancy Prevention (TPP) Program since 2009 for spending beginning in Fiscal Year 2010. Designated TPP programs develop, test, and evaluate innovations for reducing teen pregnancy, teen pregnancy disparities, and associated risk factors and for promoting positive youth development. Since its inception, the TPP Program has experimented with multiple uniquely structured cohorts of innovation and demonstration projects, producing critical insights into equitable and effective public health innovation while also serving as a highly productive contributor of evidence-based, TPP innovations for scale. This article briefly documents the innovation history of the TPP Program and its iterations in response to the shifting needs of the field. We then synthesize findings from the fifteen TPP innovators published in this special edition. We highlight emergent priorities of the TPP Program informed by this federal experiment in rigorous adolescent sexual health innovation development, testing, evaluation, and scaling and conclude by discussing how the TPP program adapted and refined its approach for fostering dynamic innovation-to-scale projects over time.
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Affiliation(s)
| | | | | | - Tara Rice
- Office of Population Affairs, Washington, DC, USA
| | - Jaclyn Ruiz
- Office of Population Affairs, Washington, DC, USA
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Melguizo-Ibáñez E, Zurita-Ortega F, Ubago-Jiménez JL, Badicu G, Yagin FH, González-Valero G, Ardigò LP, Puertas-Molero P. Are there differences between Mediterranean diet and the consumption of harmful substances on quality of life?-an explanatory model in secondary education regarding gender. Front Nutr 2023; 10:1283195. [PMID: 38024381 PMCID: PMC10651217 DOI: 10.3389/fnut.2023.1283195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Adolescence is a key life stage in human development. It is during this stage of development that healthy and physical behaviors are acquired that will last into adulthood. Gender differences in the acquisition of these behaviors have been observed. This research aims to (a) study the levels of Mediterranean diet adherence, quality of life and alcohol and tobacco consumption as regarding the gender of the participants and (b) study the effects of the variable adherence to the Mediterranean diet, alcohol consumption and tobacco consumption on quality of life as a function of the gender of the participants. Methods A non-experimental, cross-sectional, exploratory study was carried out in a sample of 1,057 Spanish adolescents (Average Age = 14.19; Standard Deviation = 2.87). Results The comparative analysis shows that the male teenagers shows a higher Mediterranean diet adherence compared to the male adolescents (p ≤ 0.05) and a higher consumption of alcoholic beverages (p ≤ 0.05). On the contrary, adolescent girls show a higher consumption of alcoholic beverages than male participants (p ≤ 0.05). The exploratory analysis indicates that for boys, alcohol consumption has a beneficial effect on the quality of life of adolescents (β = 0.904; p ≤ 0.001). Conclusion In this case, participants show differences in the levels of Mediterranean diet adherence, consumption of harmful substances and quality of life according to gender. Likewise, there are different effects between the variables according to gender. Therefore, gender is a key factor to consider during adolescence.
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Affiliation(s)
- Eduardo Melguizo-Ibáñez
- Department of Didactics of Musical, Plastic and Corporal Expression, University of Granada, Granada, Spain
| | - Félix Zurita-Ortega
- Department of Didactics of Musical, Plastic and Corporal Expression, University of Granada, Granada, Spain
| | - José Luis Ubago-Jiménez
- Department of Didactics of Musical, Plastic and Corporal Expression, University of Granada, Granada, Spain
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, Faculty of Physical Education and Mountain Sports, Transilvania University of Brasov, Brasov, Romania
| | - Fatma Hilal Yagin
- Department of Biostatistics, and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Türkiye
| | - Gabriel González-Valero
- Department of Didactics of Musical, Plastic and Corporal Expression, University of Granada, Granada, Spain
| | - Luca Paolo Ardigò
- Department of Teacher Education, NLA University College, Oslo, Norway
| | - Pilar Puertas-Molero
- Department of Didactics of Musical, Plastic and Corporal Expression, University of Granada, Granada, Spain
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Caira-Chuquineyra B, Fernandez-Guzman D, Meza-Gómez A, Luque-Mamani BM, Medina-Carpio SL, Mamani-García CS, Romani-Peña M, Díaz-Vélez C. Prevalence and factors associated with adolescent pregnancy among sexually active adolescent girls in Peru: Evidence from Demographic and Family Health Survey, 2015-2019. F1000Res 2023; 11:566. [PMID: 38524252 PMCID: PMC10958153 DOI: 10.12688/f1000research.108837.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 03/26/2024] Open
Abstract
Background The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem. Methods A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model. Results The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4-32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI:1.33-1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48-4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07-1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76-0.86), being currently studying (aPR: 0.43; 95%CI: 0.38-0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85-0.97), third (aPR: 0.81; 95%CI: 0.74-0.89), fourth (aPR: 0.79; 95%CI: 0.69-0.91) and fifth (aPR: 0.59; 95%CI: 0.47-0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69-0.83) or late adolescence (aPR: 0.40; 95%CI: 0.35-0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72-0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77-0.92). Conclusions Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnancy. To decrease the prevalence of teenage pregnancy in Peru, it is imperative to enhance national policies concerning family planning and provide comprehensive sex education targeted at adolescents.
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Affiliation(s)
- Brenda Caira-Chuquineyra
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Arequipa, 04001, Peru
| | - Daniel Fernandez-Guzman
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, 0800, Peru
| | - Adria Meza-Gómez
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Arequipa, 04001, Peru
| | | | - Shawny Luz Medina-Carpio
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Arequipa, 04001, Peru
| | - Carlos S. Mamani-García
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Arequipa, 04001, Peru
| | - Marilia Romani-Peña
- Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Arequipa, 04001, Peru
| | - Cristian Díaz-Vélez
- Universidad Privada Antenor Orrego, Trujillo, 13007, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Lima, 15001, Peru
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Ahinkorah BO, Kang M, Perry L, Brooks F. Knowledge and awareness of policies and programmes to reduce adolescent pregnancy in Ghana: a qualitative study among key stakeholders. Reprod Health 2023; 20:143. [PMID: 37740181 PMCID: PMC10517459 DOI: 10.1186/s12978-023-01672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/17/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. METHODS We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data. RESULTS Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies. CONCLUSION Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Melissa Kang
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Fiona Brooks
- Faculty of Health and Environmental Sciences/Te Ara Hauora Ā Pūtaiao, Auckland University of Technology, Auckland, New Zealand
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Bakhtiari A, Pasha H, Kashefi F, Nasiri-Amiri F, Bakouei F. Factors affecting students' attitudes towards reproductive health in the north of Iran: Designing an educational program. BMC Public Health 2023; 23:1557. [PMID: 37587441 PMCID: PMC10428581 DOI: 10.1186/s12889-023-16217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is essential to empower young people to promote reproductive health (RH) and develop effective educational programs to prevent risky behaviors. This study aimed to investigate the factors affecting students' attitudes towards RH based on the ecological model and then design an educational program. METHODS This cross-sectional study was conducted on 461 female students aged 18-29 in the north of Iran. This study was done in two stages. In the first stage, factors affecting the attitude towards RH including demographic questionnaire, interpersonal communication skills, family communication pattern, depression, stress and anxiety, body self-image, and self-confidence were determined. In the second stage, an educational program was designed based on the most effective factors. Independent t-test, ANOVA, and multiple linear regression were employed using SPSS version 20 software. Also, STATA version 15 software was utilized for statistical modeling to predict the best predictive model of attitude towards RH. RESULTS 47.7% of students had a good attitude toward RH. The majority of students had problems with interpersonal communication skills (60.7%). Also, 28.5% experienced depression, 35.8% anxiety, and 12.8% stress at different levels. More than a quarter of the students (26.5%) had poor body self-image and 18.7% had Undesirable self-esteem. Interpersonal skills (P = 0.002), family communication pattern (P = 0.004), stress (p = 0.019), anxiety (P = 0.001), and body self-image (P = 0.034) have a significant relationship with the attitude towards RH. The multiple regression showed that the most important effective factor on RH is the dialogue orientation of family communication pattern (P = 0.041), stress (P = 0.002), and anxiety (P = 0.001). CONCLUSION Stress and anxiety management training and the use of dialogue orientation in the family communication pattern for young female students are recommended based on the scientific model.
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Affiliation(s)
- Afsaneh Bakhtiari
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hajar Pasha
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
- Population, Family and Spiritual Research Core, Health Research Institute, Babol University of Sciences, Babol, Islamic Republic of Iran.
| | - Fatemeh Kashefi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Nasiri-Amiri
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Bakouei
- Department of Midwifery and Reproductive Health, Faculty of Nursing & Midwifery, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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Barral RL, Brindis CD, Hornberger L, Trent M, Sherman AK, Ramirez M, Finocchario-Kessler S, Ramaswamy M. The Perfect Storm: Perceptions of Influencing Adults Regarding Latino Teen Pregnancy in Rural Communities. Matern Child Health J 2023; 27:621-631. [PMID: 36840786 PMCID: PMC10317519 DOI: 10.1007/s10995-023-03627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Recognition of the importance of adolescents' environments in influencing their sexual and reproductive health (SRH) decision-making necessitates a deeper understanding of the role that community stakeholders play in shaping Adolescent and Young Adults (AYA) access to SRH education and care. We describe community stakeholders' knowledge, beliefs, and attitudes about AYA's SRH needs in three rural Latino communities in Kansas. METHODS Key stakeholders completed a written survey incorporating the theory of Planned Behavior to assess attitudes, norms, and intentions to support AYA's SRH education and access to care. RESULTS Across three rural immigrant community settings, respondents (N = 55) included 8 community health workers, 9 health care providers, 7 public health officials, 19 school health officials, and 12 community members. More than half self-identified as Latino (55%). Six (11%) participants, half of whom were in the health sector, thought SRH education would increase the likelihood that teens would engage in sexual activities. In contrast, other stakeholders thought that providing condoms (17, 30.9%), contraception other than condoms (14, 25.5%), and providing HPV immunization (5, 9.6%) would increase the likelihood of engaging in sexual activity. Ambivalence regarding support for SRH education and service provision prevailed across sectors, reflected even in the endorsement of the distribution of less effective contraceptive methods. Obstacles to care include immigration status, discrimination, lack of confidential services, and transportation. CONCLUSION Key stakeholders living in rural communities revealed misconceptions, negative attitudes, and ambivalent beliefs related to the delivery of SRH education and services, potentially creating barriers to AYA's successful access to care.
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Affiliation(s)
- Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 3101 Broadway Blvd, Kansas City, MO, 64111, USA.
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Claire D Brindis
- Department of Pediatrics, Adolescent and Young Adult Health National Resource Center, Philip R. Lee Institute for Health Policy Studies (IHPS), University of California San Francisco, San Francisco, CA, USA
| | - Laurie Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 3101 Broadway Blvd, Kansas City, MO, 64111, USA
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley K Sherman
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Mariana Ramirez
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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Minnis AM, Browne EN, Chavez M, McGlone L, Raymond-Flesch M, Auerswald C. Early Sexual Debut and Neighborhood Social Environment in Latinx Youth. Pediatrics 2022; 149:184753. [PMID: 35137189 PMCID: PMC9150543 DOI: 10.1542/peds.2021-050861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents. METHODS In a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA. RESULTS Most youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives. CONCLUSIONS Findings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.
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Affiliation(s)
- Alexandra M. Minnis
- Women’s Global Health Imperative, RTI International, Berkeley, California,School of Public Health, University of California, Berkeley, California,Address correspondence to Alexandra M. Minnis, PhD, MPH, Director and Senior Research Epidemiologist, Women’s Global Health Imperative, RTI International, 2150 Shattuck Ave, Ste 800; Berkeley, CA 94704. E-mail:
| | - Erica N. Browne
- Women’s Global Health Imperative, RTI International, Berkeley, California
| | - Marisol Chavez
- Women’s Global Health Imperative, RTI International, Berkeley, California,Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| | - Linda McGlone
- Monterey County Health Department, Salinas, California
| | | | - Colette Auerswald
- School of Public Health, University of California, Berkeley, California
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Gewali A, Lopez A, Dachelet K, Healy E, Jean-Baptiste M, Harridan H, Evans Y, Unger JA, Bhat A, Tandon D, Ronen K. A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design. JMIR Ment Health 2021; 8:e26188. [PMID: 34524086 PMCID: PMC8482173 DOI: 10.2196/26188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. OBJECTIVE We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths' mental health needs and document how they informed IMAGINE design. METHODS We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. RESULTS Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. CONCLUSIONS Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group.
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Affiliation(s)
- Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alana Lopez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elise Healy
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Holly Harridan
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Yolanda Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
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