1. COMMUNITY AND ENVIRONMENTAL INFLUENCES AND DECISION-MAKING

COMMUNITY AND ENVIRONMENTAL INFLUENCES AND DECISION-MAKING

Yarger, J., Berglas, N. F., Campa, M., Chabot, M., & Decker, M. J. (2019). Trends in adolescent birth rates: Examining the influence of community characteristics through geographic and temporal analysis.

his study documented the relationship between changes in community characteristics and the declining adolescent birth rate in California by examining the relationship between changes in demographic and economic characteristics and availability in sexual health services and changes in adolescent childbearing over three time periods: 2000-2002 (Time 1); 2006-2008 (Time 2) and 2012-2014 (Time 3). The community was defined as geographic areas smaller than the county level, known as Medical Service Study areas. The adolescent birth rate declined between Time 1 and Time 3 in 95% of the Medical Service Study areas. Between Time 1 and Time 2, the decline in the adolescent birth rate was smaller in those communities in which there was an increase in the percentage of the population that was black, Hispanic, unemployed, and foreign born, and an increase in the households receiving public assistance. There was a bigger decline in the adolescent birth rate in communities in which there was an increase in the percentage of households that were married and the percentage of young adults who completed high school. Between Time 2 and Time 3, there were smaller declines in the adolescent birth rate in communities in which there was an increase in the percentage of households receiving public assistance, and bigger declines in the adolescent birth rate in communities with an increase in the percentage of young adults who completed high school and attended college. The adolescent birth rate declined significantly more in Medical Service Study Areas that began offering publicly-funded long-acting contraception to adolescents. The adolescent birth rate declined more in urban than rural Medical Service Study Areas. However, the differences between rural and urban areas were no longer significant after controlling for access to long-acting contraception.

Maness, S., & Thompson, E. L. (2019). Associations between social determinants of health and adolescent contraceptive use: An analysis from the National Survey of Family Growth.

This study analyzed data from the 2015 National Survey of Family Growth and focused on sexually active males and females between ages 15 and 19. The main goal of this work was to increase understanding of sexual activity, teen births, and unintended pregnancy in adolescence by looking at social determinants of health that are linked to contraceptive use. Social determinants of health used in this study focused on domains such as economic stability (e.g., poverty, employment, food security), neighborhood and built environment, education (e.g., received high school diploma/GED), social and community context (e.g., family structure), and health and healthcare (e.g., access to healthcare). This study found high contraceptive use among participants at last sexual intercourse. The study found one link between contraceptive use and family structure, with significantly higher odds of using contraception at last sexual intercourse association for youth who had lived with the two biological or adoptive parents since birth. However, the study found low rates (4.5%) of participants using highly effective contraceptives to prevent pregnancy (i.e., IUD, implant). There were no significant relationships between social determinants and using highly effective contraception.

Ramos-Olazagasti, M. A., Elkington, K. S., Wainberg, M. L., Adams, C. M., Canino, G. J., Bird, H. R., Scorza, P., Wildsmith, E., Alegria, M., & Duarte, C. S. (2019). Does context and adversity shape sexual behavior in youth? Findings from two representative samples of Puerto Rican youth.

This study described patterns of sexual risk behaviors among Puerto Rican youth living in two contexts during a developmental period when sexual activity and risky behaviors are at their peak. Five behavior patterns were identified, ranging from current sexual inactivity to multiple, co-occurring sexual risk behaviors. The five behavior patterns were:

  • Currently sexually inactive, defined as no sex in the last 3 months (16.5% of the youth)
  • Single partner, low sexual activity (13.5% of the youth)
  • Single partner, inconsistent condom use (32% of the youth)
  • Single partner, no condom use (28% of the youth)
  • Multiple sexual risk behaviors such as multiple partners, inconsistent condom use, having sex while intoxicated (10% of the youth)

None of the groups were characterized by consistent condom use, putting the adolescents at risk for sexually transmitted diseases. Patterns that included behaviors usually associated with risk for adverse outcomes (e.g., multiple sex partners, sex while intoxicated) were more common among youth in the South Bronx, males, and youth who experienced greater Adverse Childhood Experiences (ACEs) related to child maltreatment and exposure to violence. Compared to youth in Puerto Rico, those in South Bronx were more likely to be in the single partner, sex without condoms class. Higher child maltreatment/violence ACEs scores also increased the odds of being in the single partner, low activity class, perhaps indicating an avoidance to sexual activity. Differences in youth’s patterns of sexual risk behaviors between youth living in the South Bronx and youth living in Puerto Rico were not explained by ACEs.