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

项目摘要/摘要 加州青少年出生率最高的主要是农村沿海农业地区的拉丁裔人口 和中央山谷地区，这些地区不同的社会经济和社会因素对青少年有很好的影响- 是存在的。这些地区也构成了加州人口增长的核心地区。全国性的，性的 传播感染(STI)大幅增加，加利福尼亚州的发病率达到流行水平 这超过了国家税率。这些感染中有一半发生在15岁至24岁的年轻人中。插手干预 性健康的潜在社会决定因素是解决持续高发的性健康问题的核心 拉丁裔青年意外怀孕和性传播感染发病率上升。大部分指导性健康的研究 对美国青年的干预方法已经在大城市地区进行，在这些地区，社会决定因素 如集中劣势和邻里社会凝聚力已被证明影响 青春期健康。然而，了解有助于健康的独特的潜在背景 农村拉丁裔人口之间的差距对于实现实质性改善农村拉丁裔人的健康至关重要 青少年和青壮年。这项研究的首要目标是确定社会环境的影响 关于居住在农业社区的拉丁裔青年从 青春期到初露头角的成年期(18至21岁)。我们将通过扩展预期实现这一目标 对大约600名拉丁裔青年进行了队列研究，这些青年从8年级(13岁)开始招募并跟踪调查， 保留(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测试，以及深入访谈。具体的 目标是：目标1.研究青春期社会决定因素对意外怀孕的影响， 新出现时期的性传播感染、避孕用具和生殖保健服务使用情况 成年期；目标2.使用混合方法确定社会决定因素影响的中介因素 关于性健康结果，以阐明对刚成年的干预的可修改目标；和目标3。 估计社会决定因素和中介因素对性健康结果的人群干预效果 即将进入成年期。我们已建立的基础设施、强大的社区参与伙伴关系以及现有的 队列定位使我们能够有效地启动、严格执行和综合总共 进行了八波后续行动。这将使我们能够检查社会变革的时机和累积影响 性健康的决定因素，确定媒介，并确定最有影响力的干预目标 在发病率最高的时期减少意外怀孕和性传播感染。重点放在 刚成年是一个高度优先的发展时期，往往被忽视，有机会。 解决在理解支持向成年期过渡的有效方式方面的重大差距，以促进 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.