Competing Priorities: Pregnancy and Disease Prevention among Young Adults

说明(由申请人提供)：根据最近关于年轻人疾病传播和意外怀孕率的统计数据，预防意外怀孕和性传播感染的保护战略已成为研究兴趣的重点。尽管同样的性行为导致了这两种情况，但在预防怀孕方面最有效的方法和那些最能防止性传播感染的方法，包括艾滋病毒，是不同的。此外，尽管青壮年的特点是多个顺序和同时发生的关系，与使用避孕套有关的决定很可能是针对特定的性伴侣做出的，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一种方法预防疾病、预防怀孕或同时使用疾病和怀孕预防的决定。以前的研究主要集中在个人层面的解释因素上，只包括有限数量的与伴侣有关的因素 和关系动态，并依赖于横断面或回溯性调查的数据。此外，大多数研究只在女性身上进行。我们建议分析包括在伙伴动态项目(POPD)中的18-30岁女性和男性的种族/民族多样性样本的次要数据。这项应用的主要目的是通过增加关于生殖行为和艾滋病毒预防之间的交集的知识来加深我们对艾滋病毒获得/传播的理解。更具体地说，我们将在异性关系的背景下，研究艾滋病毒感染/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。这项研究的具体目的是1)调查哪些伴侣特有的个人因素(例如，对怀孕和艾滋病毒/性传播感染的易感性，使用避孕套的自我效能)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有关，并检查哪些因素预测随着时间的推移和伙伴关系中方法使用的变化；以及2)确定哪些伴侣特有的个体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，并检查哪些因素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的这项研究包括从洛杉矶地区招募的537名年轻人的数据，他们在一年的研究期间每隔4个月接受4次采访。在每一次采访中，参与者都提供了自上次采访以来所有异性伴侣关系的详细信息。多水平多项式模型将用于调查个人和关系因素之间的联系，以及用于疾病和怀孕预防的方法的类型和一致性。研究结果将指导临床咨询和其他计划的设计，以加强双重保护，防止在这一脆弱人群中感染/传播艾滋病毒/性传播疾病和意外怀孕。

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.