Swimming Upstream: Addressing Racial Disparities in Teen Births in North Carolina.

Despite the stark decline in North Carolina's teen birth rates over the past three decades, rates remain disproportionately highest amongst Black, Latinx, and Native American teens in comparison to white teens. Numerous upstream factors continue to drive racial inequities, creating greater disparities in birth rates among teens of color.

Using Participatory Methods to Assess PrEP Interest and Uptake Among Young People Living in the Southeastern US: A Mixed Methods Assessment.

Adolescents and young adults (AYA; 13-24 years-old) comprise 22% of new HIV infections in the United States (US), most of whom live in the South. We used the situated-Information, Motivation, Behavioral skills (sIMB) model to identify priorities for intervention on multi-level factors that influence HIV preventive care among Black AYA in Durham, North Carolina. We conducted two participatory workshops (ages 13-17, N = 6; ages 18-24, N = 7) to engage youth about how to discuss HIV. We also assessed sIMB constructs from a separate quantitative sample of youth to contextualize the workshop findings (N = 80). HIV knowledge was low overall, but lower among younger Black AYA, suggesting a need for comprehensive sexual education. Trusted adults provided sexual health information, motivation for health maintenance, and behavioral skills support. HIV prevention interventions should provide comprehensive sexual health education to Black AYA, be age-specific, and include social supporters like parents, teachers, and community members.

North Carolina Youth Connected: Lessons Learned in Engaging Community Leaders in Preventing Teen Pregnancy.

BACKGROUND: The North Carolina Youth Connected initiative aimed to reduce teen pregnancy rates in two large North Carolina counties by mobilizing local leaders to raise awareness of teen pregnancy and guide solutions. OBJECTIVES: We describe the strategies used to mobilize community leaders, the nature of engagement, and the challenges and lessons learned with engaging community leaders around teen pregnancy prevention. METHODS: A 22-member Community Advisory Council carried out community mobilization activities. Meeting minutes and internal logs tracked activities. Surveys and group discussions assessed members' challenges and lessons learned. Results were analyzed for salient themes. RESULTS: Lessons learned center on the importance of building meaningful relationships with local leaders, ensuring representation from all sectors, and key considerations for engaging leaders around a common goal when facing local pushback. CONCLUSIONS: Cross-sector collaborations, supported by a backbone organization, take time and commitment but can be effective in tackling teen pregnancy prevention.

Prevalence and Risk Factors of Women's Past-Year Physical IPV Perpetration and Victimization in Tanzania.

Recent studies of intimate partner violence (IPV) in high-resource countries suggest that men and women may perpetrate similar rates of violence against their partners, yet the prevalence and etiology of female-perpetrated IPV, especially in comparison with IPV victimization among females, remains largely understudied in low-resource, high-prevalence countries, particularly in sub-Saharan Africa. Using multivariate logistic regression models, the current study examines the prevalence of and risk factors associated with past 12-month experiences of isolated physical IPV perpetration (i.e., violence perpetrated against an intimate partner not in self-defense) and physical IPV victimization among a nationally representative sample of women of reproductive age (15-49 years) from Tanzania who completed the Tanzanian Demographic and Health Survey Domestic Violence Module (n = 5,372). Approximately 1.5% reported perpetrating violence in the past 12 months, whereas 35% reported victimization in the same time period. Risk factors of past 12-month IPV perpetration included past 12-month IPV victimization, making cash or in-kind earnings, having autonomy in decision making, and acceptance of justifications for wife beating. Women much younger than their partners had lower odds of IPV perpetration. Risk factors of past 12-month IPV victimization included past 12-month IPV perpetration, educational attainment, having children, partner's alcohol consumption, partner's decision making, acceptance of justifications for wife beating, and exposure to parental IPV. Making cash or in-kind earnings was the only protective factor against victimization. Findings suggest that female IPV perpetration and victimization may result from a combination of factors including power differentials between partners and attitudes about the acceptability of using violence. Future research directions and implications for policy and prevention efforts to reduce IPV in Tanzania are discussed.

Implications of Pubertal Timing for Romantic Relationship Quality Among Heterosexual and Sexual Minority Young Adults.

PURPOSE: Relative to on-time or late-maturing peers, girls who begin puberty early typically begin romantic and sexual experiences earlier; however, advanced pubertal status does not necessarily coincide with commensurate interpersonal skills necessary for healthy romantic relationships. Research is limited on the long-term implications of early puberty for relationship quality, and virtually nothing is known about the social implications of early timing for sexual minority females. METHODS: Using linear regression, we examine longitudinal associations between two measures of girls' pubertal timing (self-perceived timing and menarcheal age) and romantic relationship quality in young adulthood, stratified by sexual orientation, among 5,568 females in waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. We also examine whether identified associations are mediated by parent-adolescent relationship quality. RESULTS: Among sexual minorities, early self-perceived pubertal timing was associated with lower adult romantic relationship quality compared with on-time maturers (ß = -2.32; standard error = 1.44; p = .05); this association was mediated by parent-adolescent relationship quality. Among heterosexuals, girls experiencing menarche before age 12 (early maturers) reported lower adult relationship quality compared to on-time maturers (ß = -.43; standard error = .22; p = .03); parent-adolescent relationship quality did not mediate this association. CONCLUSIONS: Early maturation is associated with lower romantic relationship quality in young adulthood. However, evidence of the association varies by measure of pubertal timing, and the processes by which pubertal timing is linked to later relationship quality may be different for sexual minority and heterosexual females. Potential explanations and public health implications are discussed.

Attachment to Conventional Institutions and Adolescent Rapid Repeat Pregnancy: A Longitudinal National Study Among Adolescents in the United States.

Introduction There is limited research on rapid repeat pregnancies (RRP) among adolescents, especially using nationally representative samples. We examine distal factors-school, family, peers, and public/private religious ties-and their associations with RRP among adolescent mothers. Methods Guided by social development theory, we conducted multivariate logistic regression analyses, adjusted for sociodemographic characteristics, to examine associations between RRP and attachment to school, family, peers, and religion among 1158 female respondents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who reported at least one live birth before age 20. Results Attachments to conventional institutions were associated with lower likelihood of RRP. Adolescent mothers who had a stronger relationship with their parents had reduced odds of RRP (adjusted odds ratio [aOR] 0.83, 95 % CI 0.71-0.99). Increased odds of RRP were associated with anticipating fewer negative social consequences of sex (aOR 1.18, 95 % CI 1.02-1.35), never praying (versus praying daily; aOR 1.47, 95 % CI 1.10-1.96), and never participating in church-related youth activities (versus participating once a week; 1.04, 95 % CI 1.01-1.07). Discussion After an adolescent birth, social support from family, peers, and the community can benefit young mothers. Private aspects of religiosity may be especially important. Understanding the processes by which these distal factors are linked to the likelihood of RRP is needed to create multifaceted intervention programs that provide diverse methods of support customized to specific circumstances of adolescent mothers.

Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health.

PURPOSE: The purpose of this study was to explore the association between sexual orientation and teen pregnancy (before age 20 years) in a U.S. nationally representative cohort of young adult females aged 24-32 years. METHODS: A total of 5,972 participants in Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health were included. Self-reported sexual orientation identity was categorized as heterosexual, and three sexual minority (SM) groups: mostly heterosexual, bisexual, and lesbian (combining "mostly homosexual" and "100% homosexual"). Stepwise multivariate regression models were fit to compare odds of teen pregnancy and relative risk ratios of timing of teen pregnancy, between heterosexual and SM groups, adjusting for sociodemographic characteristics, sexual victimization history, and sexual risk behaviors. RESULTS: After adjusting for sociodemographics and sexual victimization, bisexual women had significantly higher odds than heterosexual peers of teen pregnancy (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.05-2.75); this association was marginally significant after adjusting for sexual risk behaviors. Bisexuals were also more likely to have an early (before age 18 years) teen pregnancy (OR = 2.04; 95% CI = 1.17-3.56). In contrast, lesbian women were significantly less likely to have a teen pregnancy than heterosexual (OR = .47; 95% CI = .23-.97), mostly heterosexual (OR = .46; 95% CI = .21-.99), and bisexual (OR = .29; 95% CI = .12-.71) women in final models. CONCLUSIONS: Expanding on extant literature, we found opposing risk patterns for teen pregnancy between bisexual and lesbian women, likely due to distinct patterns of sexual risk taking. Findings suggest that SM-inclusive teen pregnancy prevention efforts tailored to meet the unique needs of SM young women, particularly bisexuals, are needed.

Demographic and developmental differences in the content and sequence of adolescents' ideal romantic relationship behaviors.

This study utilizes data from 18,392 respondents (aged 12-19) in Wave 1 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) to provide a detailed descriptive analysis of U.S. adolescents' desired behaviors in their ideal romantic relationships. Age, gender, and ethnic group differences in the desire for--and preferred sequence of--a set of activities that could occur in a hypothetical romantic relationship were explored within subsets of heterosexual (n = 17,274) and sexual minority adolescents (n = 1118). Non-sexual behaviors were more commonly desired compared to sexual behaviors. The typical desired behavioral sequence was: holding hands, going out alone, telling others they were a couple, kissing, saying "I love you," sexual touching, and finally having sex. Overall, more similarities than differences emerged across groups, with some notable differences in the percentages who desired sexual behaviors. Results provide a nuanced picture of adolescent relationship scripts, with implications for education and prevention.

Correlates of adolescent and young adult sexual initiation patterns.

CONTEXT: Identifying adolescent characteristics associated with different patterns of sexual initiation is critical to promoting healthy sexual development. METHODS: Patterns of sexual initiation were examined among 12,378 respondents to Waves 1 (1994-1995) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Multinomial logistic regression explored associations between adolescent characteristics and membership in five latent classes capturing the timing, sequence, pace and variety of sexual initiation patterns. RESULTS: Age and indicators of greater psychosocial conventionality were associated with membership in the atypical "postponers" class (characterized by postponement of oral, vaginal and anal sexual activity until early adulthood), although patterns of associations varied by gender. For example, compared with males who attended religious services at least once a week, males who never attended religious services were more likely to appear in the vaginal initiators/multiple behaviors class (characterized by initiation of vaginal sex first and then initiation of another behavior after at least one year), rather than in the postponers class (relative risk ratio, 2.5). Compared with women who prayed at least once a day, those who never prayed were more likely to be in the vaginal initiators/single behavior class (whose members typically engaged in only one type of behavior), rather than in the postponers class (2.0). CONCLUSIONS: Individuals who are more adherent, and presumably more committed, to the attitudes, values and expectations of conventional society are more likely than others to delay multiple types of sexual activity until well beyond the norm for their peers.

The association between sequences of sexual initiation and the likelihood of teenage pregnancy.

PURPOSE: Few studies have examined the health and developmental consequences, including unintended pregnancy, of different sexual behavior initiation sequences. Some work suggests that engaging in oral-genital sex first may slow the transition to coital activity and lead to more consistent contraception among adolescents. METHODS: Using logistic regression analysis, we investigated the association between sequences of sexual initiation (i.e., initiating oral-genital or vaginal sex first based on reported age of first experience) and the likelihood of subsequent teenage pregnancy among 6,069 female respondents who reported vaginal sex before age 20 years and participated in waves I and IV of the National Longitudinal Study of Adolescent Health. RESULTS: Among female respondents initiating vaginal sex first, 31.4% reported a teen pregnancy. Among female respondents initiating two behaviors at the same age, 20.5% reported a teen pregnancy. Among female respondents initiating oral-genital sex first, 7.9% reported a teen pregnancy. In multivariate models, initiating oral-genital sex first, with a delay of at least 1 year to vaginal sex, and initiating two behaviors within the same year were each associated with a lower likelihood of adolescent pregnancy relative to teens who initiated vaginal sex first (odds ratio = .23, 95% confidence interval: .15-.37; and odds ratio = .78, 95% confidence interval: .60-.92, respectively). CONCLUSIONS: How adolescents begin their sexual lives may be differentially related to positive and negative health outcomes. To develop effective pregnancy prevention efforts for teens and ensure programs are relevant to youths' needs, it is important to consider multiple facets of sexual initiation and their implications for adolescent sexual health and fertility.