Competing Priorities: Pregnancy and Disease Prevention among Young Adults

描述（由申请人提供）：根据最近关于疾病传播和年轻人意外怀孕率的统计数据，预防意外怀孕和性传播感染（STI）的保护策略已成为研究兴趣的焦点。虽然同样的性行为会导致两种情况，但预防怀孕最有效的方法和预防性传播感染（包括艾滋病毒）最有效的方法是不一样的。此外，尽管事实上，青年人的特点是有多种连续和同时发生的关系，而且与使用避孕套有关的决定可能是针对特定的性伴侣作出的，但很少有研究探讨关系和伴侣因素是否以及如何影响使用某种预防疾病、预防怀孕或既预防疾病又预防怀孕的方法的决定。以往的研究主要集中在个体层面的解释因素上，只包括有限的与伴侣相关的因素 和关系动态，并依赖于横截面或回顾性调查的数据。此外，大多数研究都只对妇女进行。我们建议分析二级数据，从种族/民族多样化的样本中的妇女和男子年龄在18-30岁的合作伙伴动力学（POPD）项目。该应用程序的主要目标是通过增加有关生殖行为和艾滋病毒预防之间的交叉点的知识，进一步了解艾滋病毒的获得/传播。更具体地说，我们将研究在异性恋关系的背景下，艾滋病毒感染/传播风险增加的年轻成年女性和男性样本中怀孕和疾病预防方法的选择和使用。研究的具体目的是：1）调查哪些特定于伴侣的个体因素（例如，对怀孕和艾滋病毒/性传播感染的脆弱性的认识，安全套使用的自我效能）和关系因素（例如，承诺，关系类型，感知的排他性，以及与预防怀孕和疾病有关的决策）与预防方法的选择和使用的一致性相关，并检查哪些因素预测随着时间的推移和在伙伴关系中使用方法的变化; 2）确定哪些特定于伙伴的个人因素和关系因素预测使用避孕套的动机， 疾病预防、怀孕预防或双重保护，并研究哪些因素可以预测随着时间的推移和在关系中使用避孕套的动机的变化。POPD研究包括从洛杉矶地区招募的537名年轻人的数据，他们在1年的研究期间接受了4次访谈，每隔4个月。在每次访谈中，参与者都提供了自上次访谈以来所有异性伴侣关系的详细信息。将使用多水平多项式模型来研究个体和关系因素之间的关联以及用于疾病和妊娠预防的方法的类型和一致性。调查结果将为临床咨询和其他方案的设计提供信息，以增加双重保护，防止艾滋病毒/性传播感染的获得/传播和这一弱势群体的意外怀孕。

DESCRIPTION (provided by applicant): Protection strategies for the prevention of both unintended pregnancy and sexually transmitted infections (STIs) have become a focus of research interest in light of recent statistics on disease transmission and unintended pregnancy rates among young adults. Although the same sexual behavior leads to both, the methods most effective in preventing pregnancy and those most protective against STIs, including HIV, are not the same. Moreover, despite the fact that young adulthood is characterized by multiple sequential and concurrent relationships and decisions related to condom use are likely made with regard to a specific sexual partner, little research has addressed if and how relationship and partner factors influence the decision to use a method for disease prevention, pregnancy prevention or both disease and pregnancy prevention. Previous research has focused mainly on individual-level explanatory factors, included only a limited number of factors related to partners and relationship dynamics, and has relied on data from cross-sectional or retrospective surveys. Further, most studies have been conducted with women only. We propose to analyze secondary data from a racially/ethnically diverse sample of women and men aged 18-30 included in the Project on Partner Dynamics (POPD). The main objective of this application is to further our understanding of HIV acquisition/transmission by increasing knowledge regarding the intersection between reproductive behavior and HIV prevention. More specifically, we will examine choice and use of methods for pregnancy and disease prevention within the con- text of heterosexual relationships among a sample of young adult women and men at increased risk for HIV acquisition/ transmission. The specific aims of the study are to 1) investigate which partner-specific individual factors (e.g., perceived vulnerability to pregnancy and HIV/STIs, condom use self-efficacy) and relationship factors (e.g., commitment, relationship type, perceived exclusivity, and decision-making related to preventing pregnancy and disease) are associated with prevention method choice and consistency of use, and examine what factors predict change in method use over time and within partnerships; and 2) determine which partner- specific individual factors and relationship factors predict motivation to use condoms for disease prevention, pregnancy prevention or dual protection, and examine what factors predict change in motivation for condom use over time and within relationships. The POPD study includes data from 537 young adults recruited from the Los Angeles area who were interviewed 4 times, at 4-month intervals, over a 1-year study period. At each interview, participants provided detailed information about all heterosexual partnerships since the previous interview. Multilevel multinomial modeling will be used to investigate the associations between individual and relationship factors and the type and consistency of methods used for disease and pregnancy prevention. Findings will inform the design of clinical counseling and other programs to increase dual protection and prevent the acquisition/transmission of HIV/STIs and unintended pregnancy in this vulnerable population.