Social determinants of sexual health among Latinx adolescents and emerging adults in an agricultural community

项目概要/摘要 加州青少年出生率最高的主要是农村农业沿海地区的拉丁裔人口 和中央谷地区，在这些地区，不同的社会经济和社会因素在青少年健康方面发挥着作用， 存在。这些地区也构成了加州的核心人口增长区。在全国范围内， 传播感染（STI）大幅增加，加州的发病率达到流行病水平 超过了全国水平。这些感染中有一半发生在15至24岁的青年中。干预 性健康的基本社会决定因素是解决持续高发病率的核心， 拉丁裔青年的意外怀孕和性传播感染发病率上升。许多指导性健康的研究 美国青年的干预方法已在大城市地区进行，其中社会决定因素 例如集中不利条件和邻里社会凝聚力 青少年健康然而，了解有助于健康的独特的基本背景， 农村拉丁裔人口之间的差距是至关重要的，以实现实质性的改善健康， 青少年和年轻人。本研究的首要目标是确定社会环境的影响 拉丁裔青年居住在一个农业社区的性健康，因为他们从 青春期至成年初显期（18至21岁）。我们将通过扩展一个前景来实现这一目标。 队列研究招募了大约600名拉丁裔青年，并从8年级（13岁）开始随访， 保留率（2年时为92%）。我们建议每年再进行四次跟进，包括 定量数据收集、性传播感染和怀孕的生物检测以及深入访谈。具体 目标：目标1。研究青春期社会决定因素对意外怀孕的影响， 性传播感染、避孕药具的使用和生殖保健服务的使用 成人;目标2.使用混合方法确定社会决定因素影响的中介因素 性健康结果，以阐明成年初显期干预的可修改目标;以及目标3。 评估社会决定因素和中介因素对性健康结果的人口干预效应， 成年初显期我们建立的基础设施，强大的社区参与伙伴关系，以及现有的 队列定位我们的有效启动，严格执行，并在整个结果的合成， 八波后续行动这将使我们能够检查社会的时间和累积效应， 性健康的决定因素，确定中介，并确定最有效的干预目标， 在发病率最高的时期减少意外怀孕和性传播感染。重点 成年初显期是一个高度优先，往往被忽视的发展时期， 解决在理解支持向成年过渡的有效方法方面存在的巨大差距， 幸福和积极的性健康。

PROJECT SUMMARY/ABSTRACT The highest teen birth rates in California are primarily in Latinx populations in the rural agricultural coastal and central valley regions where distinct socioeconomic and social factors play a role in adolescent well- being. These areas also constitute the core population growth areas in California. Nationally, sexually transmitted infections (STIs) have increased substantially, with rates in California reaching epidemic levels that exceed national rates. Half of these infections occur among youth aged 15 to 24. Intervening on underlying social determinants of sexual health is central to addressing the persistently high rates of unintended pregnancy and rising STI incidence in Latinx youth. Much of the research guiding sexual health intervention approaches for US youth has been conducted in large urban areas, in which social determinants such as concentrated disadvantage and neighborhood social cohesion have been shown to affect adolescent health. However, understanding the unique underlying contexts that contribute to health disparities among rural Latinx populations is vital to achieving substantive improvements in the health of adolescents and young adults. The overarching goal of this study is to identify social environment influences on sexual health among Latinx youth residing in an agricultural community as they transition from adolescence to emerging adulthood (ages 18 to 21). We will accomplish this by extending a prospective cohort study of approximately 600 Latinx youth recruited and followed since 8th grade (age 13), with high retention (92% at 2 years). We propose to conduct four additional annual waves of follow-up, including quantitative data collection, biological testing for STIs and pregnancy, and in-depth interviews. The Specific Aims are: Aim 1. Examine the effects of social determinants in adolescence on unintended pregnancy, STIs, contraceptive use, and use of reproductive health care services during the period of emerging adulthood; Aim 2. Use a mixed methods approach to identify mediators of the effects of social determinants on sexual health outcomes to elucidate modifiable targets for intervention in emerging adulthood; and Aim 3. Estimate population intervention effects of social determinants and mediators on sexual health outcomes in emerging adulthood. Our established infrastructure, strong community-engaged partnerships, and existing cohort position us for efficient initiation, rigorous implementation, and synthesis of results across a total of eight waves of follow-up. This will allow us to examine the timing and cumulative effects of social determinants of sexual health, identify mediators, and determine the most impactful intervention targets to decrease unintended pregnancy and STIs during the time when the highest rates occur. The focus on emerging adulthood constitutes a high priority and often neglected developmental period, with opportunities to address substantial gaps in understanding effective ways to support transitions to adulthood that promote well-being and positive sexual health.