Family Planning Clinics and Adolescent Sexual Behavior

描述(由申请人提供)：研究表明，提供和获得计划生育诊所和服务(FPC)可能会降低青少年早期性行为的风险，增加有效使用避孕措施的可能性。然而，这些研究大多依赖粗略的(即县一级)可获得性和可获得性的衡量标准，这不能充分反映青少年居住地和可获得性标准之间的空间关系(例如，居住在标准标准的街道对面的青少年可能与居住在15英里之外的青少年受到同等对待)。拟议的研究将有助于填补这一研究空白，方法是使用物理(至里程)和时间(至时间)距离和密度作为青少年居住地和FPC地点之间空间关系的更准确和敏感的衡量标准，来检查可获得性和可获得性之间的关系。此外，拟议的研究将考察直接和间接影响，具体地说，性期望、感知的同伴态度和行为、父母态度和父母沟通是否以及在多大程度上调节FPC和青少年性行为之间的关系。这项研究还将考虑年龄、性别、社会经济地位和性经验的可能调节作用，以及对重要背景变量的控制。这项研究将利用NICHD资助的一项关于青春期性行为的纵向研究的数据，其中包括一系列青春期性行为(口交、阴道性交和肛交)、避孕药使用、怀孕、性传播感染和心理社会预测因素的数据。拟议的研究将用加州公共资助的FPC的地理空间坐标来补充现有的数据集。纵向数据也将被用来确定FPC的可用性是否影响青少年性行为的变化和假设的中介。确定有效的战略，以减少危险的青少年性行为和相关的负面后果仍然是公共卫生研究的优先事项。这项研究的结果可能会对公共政策和公共卫生产生重大影响。例如，如果获得和获得计划生育诊所对青少年的性行为和随后的结果有明显的影响，社区领导人和城市规划者可以利用这些信息来更好地识别服务和服务不足的地区和人口，并相应地规划未来的诊所发展和服务。确定有效的战略，以减少危险的青少年性行为和相关的负面后果仍然是公共卫生研究的优先事项。这项研究的结果可能会对公共政策和公共卫生产生重大影响。例如，如果获得和获得计划生育诊所对青少年的性行为和随后的结果有明显的影响，社区领导人和城市规划者可以利用这些信息来更好地识别服务和服务不足的地区和人口，并相应地规划未来的诊所发展和服务。

DESCRIPTION (provided by applicant): Research suggests that availability of and access to family planning clinics and services (FPCs) may reduce adolescents' risk for early sexual intercourse and increase the likelihood of effective contraceptive use. However, most of these studies have relied on crude (i.e., county level) measures of FPC availability and access, which do not adequately capture spatial relationships between adolescents' place of residence and FPC locations (e.g., an adolescent who lives across the street from an FPC may be treated the same as one who lives 15 miles away). The proposed study will help fill this research gap by examining the relationship between availability and access to FPCs using physical (miles to) and temporal (time to) distance and density measures as more precise and sensitive measures of the spatial relationship between adolescents' place of residence and FPC locations. In addition, the proposed study will examine both direct and indirect effects, specifically, whether and to what degree sexual expectancies, perceived peer attitudes and behaviors, parental attitudes and parental communication, mediate the relationship between FPCs and adolescent sexual behavior. This study will also consider the possible moderating effects of age, gender, SES, and sexual experience, as well as control for important background variables. This study will utilize data from a longitudinal NICHD-funded study on adolescent sexual behavior with data on a range of adolescent sexual behaviors (oral sex, vaginal intercourse, and anal sex), contraceptive use, pregnancy, sexually transmitted infections, and psychosocial predictors. The proposed study will supplement the existing data set with geospatial coordinates of publicly-funded FPCs in California. Longitudinal data will also be used to determine whether FPC availability affects changes in adolescent sexual behavior and hypothesized mediators. Identifying effective strategies to reduce risky adolescent sexual behavior and related negative outcomes remains a public health research priority. Results of this study may have significant implications for both public policy and public health. For example, if access and availability to family planning clinics have an identifiable effect on adolescent sexual behaviors and subsequent outcomes, community leaders and city planners could use this information to better identify served and underserved areas and populations and plan future clinic development and services accordingly. Identifying effective strategies to reduce risky adolescent sexual behavior and related negative outcomes remains a public health research priority. Results of this study may have significant implications for both public policy and public health. For example, if access and availability to family planning clinics have an identifiable effect on adolescent sexual behaviors and subsequent outcomes, community leaders and city planners could use this information to better identify served and underserved areas and populations and plan future clinic development and services accordingly.