Competing Priorities: Pregnancy and Disease Prevention among Young Adults

描述（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（sti）的保护战略已成为研究兴趣的焦点。虽然同样的性行为会导致这两种情况，但最有效的避孕方法和最有效的预防性传播感染（包括艾滋病毒）的方法是不一样的。此外，尽管青年成年的特点是有多重连续和同时发生的关系，而且很可能是针对某一特定的性伴侣作出有关使用避孕套的决定，但很少有研究涉及关系和伴侣因素是否以及如何影响使用某种方法预防疾病、预防怀孕或既预防疾病又预防怀孕的决定。以往的研究主要集中在个人层面的解释因素，只包括有限数量的与伴侣有关的因素

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.