Understanding developmental trajectories among early adolescents to improve reproductive health

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Project Summary The goal of this research is to inform the development of adolescent health programs through understanding the development and trajectories of empowerment over the course of adolescence, among girls and boys, and quantifying how this process influences sexual and reproductive health behaviors and outcomes. The proposed project will use four waves of longitudinal data, collected annually from a sample of 2,842 adolescents, aged 10-14 years at enrollment, in Kinshasa, Democratic Republic of Congo. Learnings from this research will inform interventions designed to improve empowerment and affect long-term health trajectories of adolescents as they transition into adulthood. The specific aims are: 1. Establish how agency evolves over time for boys and girls. Using each sub-scale of agency (Freedom of Movement, Voice, Decision-Making) and a combined agency score across all domains, we will conduct latent growth curve modeling to assess how individual scores change over time and explore how these trajectories differ by gender. 2. Identify significant socio-ecological factors (opportunity structures) that influence trajectories, by gender. We will use latent growth curve modeling to explore the effect of time varying socio- ecological factors (including individual, family, peer, and neighborhood factors) that predict changes in total agency and within each agency sub-scale to assess how opportunity structures influence the development of agency over time. 3. Assess the association of agency in very young adolescence with sexual and reproductive health behaviors in later adolescence. We will use Cox Proportional Hazard models to assess the relationship of each domain of agency with age at sexual debut and logistic regression to evaluate contraceptive behavior, and volitional sex, assessing the effect of both baseline levels of agency and change over time in its impact on sexual and reproductive health behaviors. The study is a secondary data analysis of longitudinal data from the Global Early Adolescent Study. Aims 1 and 2 will employ stratified latent growth curve models to explore how three previously validated measures of agency change over time and by gender. Aim 3 will employ Cox Proportional Hazards models and multivariable logistic regression models to estimate the relationship between empowerment and key sexual and reproductive health behaviors and outcomes.