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

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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.