Reducing reproductive health disparities among Latinx youth living in rural communities

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Project Summary/Abstract Teenage pregnancy (TP) is largely unintended and can lead to adverse health, educational, and economic outcomes for both the mother and the child. Although TP rates have declined in the U.S. over several decades, disparities persist. Birth rates among Latinx teens in the U.S. are 1.5 times higher than the national average and more than 2 times higher in rural areas compared to rural White teens. Latinx immigrants settling in rural areas represent the largest and fastest growing minority group in rural America. Best practices for implementing evidence-based TP prevention programs in these unique communities remain largely unknown. Thus, a critical need exists to develop and evaluate a set of responsive interventions tailored specifically to these vulnerable teens. The transcreation implementation science framework has been used to address other health disparities among Latinx rural communities. Based on our previous work demonstrating the need for TP prevention interventions tailored to meet needs in this unique population, we will use this framework to build upon Cuídate (Take Care), an evidence-based, culturally responsive intervention that has been shown to decrease sexual risk behaviors among urban Latinx youth. Dr. Barral, an adolescent medicine physician and candidate for this career development award, is committed to a patient-oriented clinical research career targeting interventions to reduce reproductive health disparities. Her five-year career development plan includes structured mentoring and formal didactics to address critical gaps in her training through acquisition of expertise in theories of behavior change, clinical trials for adolescent behavioral research, and community engaged research. The proposed study complements other training activities by enabling hands-on experience in intervention co-development and feasibility trial. Following identification of key factors needed for the development of an acceptable TP prevention intervention for rural Latinx teens, Dr Barral will use the transcreation framework to co-develop an intervention that best fits the community’s unique needs and context. Dr. Barral will conduct a one arm feasibility trail to evaluate acceptability and practicality of the co-created intervention. The proposed investigation will improve scientific knowledge in disparities in TP prevention by addressing the intersectionality and context of TP occurring among emerging immigrant Latinx populations embedded in rural communities. She will comprehensively incorporate community and stakeholder guidance into a co-created and novel intervention that optimally fits local needs of these unique new immigrant populations. Study findings will inform the development of a larger hybrid efficacy implementation study, supported by an R01 submission during the K23 award period. This training and research plan are consistent with the mission of the National Institutes of Health and the National Institute on Minority Health and Health Disparities.