Distal Determinants of Disparities in Unintended Fertility

描述(由申请人提供)：美国的意外生育率很高：一半的怀孕和三分之一的新生儿是意外生育，年轻人和出生在种族中的少数族裔的意外生育率更高。由于意外生育与消极的健康后果相关，少数群体中意外生育率较高可能会加剧健康差距，自1980年代以来，降低意外生育率一直是公共卫生目标。虽然意外生育的直接决定因素很清楚(没有有效避孕措施的性行为和意外怀孕足月怀孕)，但这些行为以及种族-民族-出生差异的根本原因并不是很清楚。该项目借鉴了现有的理解生育率差异的框架，提出了两个关键的远端决定因素--生殖知识和生育动机--这可能解释不同种族-民族-原籍群体之间意外生育率的差异。该项目将测试以下假设：出生于少数民族的种族拥有较低的生殖知识和避孕动机；这些差异在成年后扩大；以及这些远端决定因素导致近端决定因素(主要是性别和避孕)和生育本身的差异。这个项目超越了以前的描述性工作，以确定青年时期危险的性行为和意外生育的前兆，这是一个高度可变的生命过程阶段，但在生育文献中研究不足。我们还通过吸收男性和女性以及不同的种族、民族和出生群体来扩展先前的工作。我们的项目将从三个相辅相成的数据集中得出可靠和一致的措施：关系动态和社会生活研究(“RDSL”；2008/09年度居住在密歇根县的18-19岁妇女的基于人口的样本，为期2.5年的每周跟踪调查)，全国青少年健康纵向研究(“Add Health”；青年在1995年入学，7-12年级，并于1996、2001/02和2007/08年度重新采访)和2009年全国生殖和避孕知识调查(“雾区”；18-29岁未婚男女的全国样本)。首先，该项目将在综合数据分析技术的指导下，使用因素和潜在类别分析，在调查和种族-族裔-原籍之间创建远端决定因素的等效衡量标准。其次，随着年轻人学习和获得可能影响其生殖知识和生育动机的新经验，将使用交叉滞后回归模型来检验这些结构的稳定性。第三，这项工作将使用事件历史模型来确定生育动机和生殖健康知识的要素，这些要素最能预测危险的性行为和意外生育。研究结果将指导未来针对意外生育风险人群的研究和干预，并强调干预的最关键领域。为了向政策制定者和从业者传播我们的发现，我们将与全国预防青少年和意外怀孕运动的顾问合作，这是一个受到全国尊重的、政治中立的私人倡导组织。

DESCRIPTION (provided by applicant): Levels of unintended fertility in the United States are high: half of all pregnancies and a third of all births are unintended, with higher levels among young adults and among race-ethnic-nativity minorities. Because unintended births are associated with negative health outcomes, higher rates of unintended fertility among minorities may exacerbate health disparities, and reducing unintended fertility has been a public health goal since the 1980s. Although the proximate determinants of unintended fertility are clear (sex without effective contraceptive use and carrying unintended pregnancies to term), the underlying causes of these behaviors, and of race-ethnic-nativity differences, are not well understood. Drawing on existing frameworks for understanding fertility differentials, this project proposes two key distal determinants - reproductive knowledge and fertility motivation - that may explain differences in unintended fertility across race-ethnic-nativity groups. The project wil test the hypotheses that race-ethnic-nativity minorities have lower reproductive knowledge and motivation to prevent pregnancy; that these differences widen during young adulthood; and that these distal determinants drive differences in the proximate determinants (primarily sex and contraception) and in fertility itself. This project moves beyond prior descriptive work to identif precursors of risky sexual behavior and unintended fertility during young adulthood, a life course stage that is highly variable yet understudied in the fertility literature. We also extend prior wok by incorporating both men and women as well as diverse race- ethnic-nativity groups. Our project will derive robust and consistent measures from three complementary datasets: the Relationship Dynamics and Social Life study ("RDSL"; a population-based sample of women aged 18-19 residing in a Michigan county in 2008/09, followed weekly for 2.5 years), the National Longitudinal Study of Adolescent Health ("Add Health"; youths enrolled in grades 7-12 in 1995 and reinterviewed in 1996, 2001/02, and 2007/08), and the 2009 National Survey of Reproductive and Contraceptive Knowledge ("Fog Zone"; a national sample of unmarried men and women aged 18-29). First, the project will create equivalent measures of the distal determinants across surveys and race-ethnicity-nativity, using factor and latent class analyses guided by integrative data analysis techniques. Second, cross-lag regression models will be used to examine the stability of these constructs as young adults learn and gain new experiences that may affect their reproductive knowledge and fertility motivation. Third, this work will use event history models to identify the elements of fertility motivation and reproductiv health knowledge that are most predictive of risky sexual behavior and unintended births. Findings will guide future research and interventions in targeting those at risk for unintended fertility and highlighting the most crucial domains for intervention. To disseminate our findings t policymakers and practitioners, we will work with a consultant from the National Campaign to Prevent Teen and Unplanned Pregnancy, a nationally respected, politically neutral, private advocacy organization.