Gender, Autonomy, and Contraceptive Use Among Young People

描述（由申请人提供）：职业目标：这是Ushma Upadhyay，博士，公共卫生社会科学家，旧金山加利福尼亚大学的K01人口研究职业发展奖的申请。她的初步研究重点是避孕药具的使用和意外怀孕，包括发展生殖自主的第一个措施，评估妇女决定和控制与避孕药具使用、怀孕和生育有关的事项的权力。在短期内，她的目标是在这项工作的基础上，调查基于性别的权力对年轻人使用避孕药具的影响。从长远来看，她渴望开展研究，以证据为基础的干预措施，帮助年轻人控制自己的生育能力。她将从K01奖项中获得的知识和经验将为她争取NICHD R01资助做准备，以设计一项随机干预试验，以测试基于性别的权力干预对青少年和年轻人使用避孕药具和意外怀孕的影响。环境：加州大学旧金山分校（UCSF）为初级教师提供慷慨的支持。加州大学旧金山分校的研究人员在生殖健康方面有着追求创新理念的悠久历史。作为一个机构，它一直毫不含糊地支持关于避孕药具使用和意外怀孕的研究。研究职业发展计划的关键要素：Upadhyay博士在流行病学和人口统计学方法方面拥有丰富的背景，具有分析大型数据集的丰富经验。这一职业发展奖将使她能够解决与她的职业目标有关的培训中仍存在的一些差距，并获得规划和执行关于基于性别的权力和避孕药具使用的主要数据收集研究的应用经验。她的培训目标是在青少年性别的社会学理论、定性研究、先进的定量方法和将证据转化为干预方面获得经验和专业知识。为了实现这些目标，Upadhyay博士组建了一个独特的跨学科培训和指导团队。它包括一位主要导师，蒂娜·雷尼-贝内特，医学博士，公共卫生硕士，前加州大学旧金山分校的临床科学家，现在是Kaiser Permanente妇女健康研究所的研究主任，专门研究青少年意外怀孕和种族差异，以及共同导师莎莉·德沃金，博士，硕士，加州大学旧金山分校社会和行为科学系的医学社会学家和性别权力专家。她的团队还包括另外三位互补性顾问：加州大学旧金山分校妇产科和生殖科学系的人口统计学家戴安娜·福斯特博士，她研究意外怀孕的后果；Torsten B. Neilands博士，加州大学旧金山分校艾滋病预防研究中心的定量方法学家，擅长潜在变量（结构方程）建模；和克莱尔·布林迪斯博士

DESCRIPTION (provided by applicant): Career Goals: This is an application for a K01 Career Development Award in Population Research for Ushma Upadhyay, PhD, MPH, a Public Health Social Scientist at the University of California, San Francisco. Her preliminary research focuses on contraceptive use and unintended pregnancy, and includes the development of the first measure of reproductive autonomy, assessing a woman's power to decide about and control matters related to contraceptive use, pregnancy and childbearing. In the short term, she aims to build on this work, investigating the effect of gender-based power on contraceptive use among young people. In the long term, she aspires to conduct research that results in evidence-based interventions that help young people to control their fertility. The knowledge and experience she will gain from the K01 award will prepare her to compete for NICHD R01 funding to design a randomized intervention trial to test the effects of a gender-based power intervention on contraceptive use and unintended pregnancy among adolescents and young people. Environment: The University of California, San Francisco (UCSF) provides generous support for junior faculty. UCSF researchers have a long history of pursuing innovative ideas in reproductive health. As an institution, it has been unequivocally supportive of research on contraceptive use and unintended pregnancy. Key Elements of Research Career Development Plan: Dr. Upadhyay has a rich background in epidemiologic and demographic methods, with substantial experience analyzing large datasets. This career development award will enable her to address several remaining gaps in her training specific to her career goals, and to gain applied experience planning and executing a primary data collection study on gender-based power and contraceptive use. Her training goals are to gain experience and expertise in sociological theories of gender among adolescents, qualitative research, advanced quantitative methods, and translating evidence into intervention. To achieve these goals, Dr. Upadhyay has assembled a unique interdisciplinary training and mentoring team. It includes a Primary Mentor, Tina Raine-Bennett, MD, MPH, a clinician scientist formerly at UCSF who is now Research Director of the Women's Health Research Institute at Kaiser Permanente specializing in adolescent unintended pregnancy and racial disparities, and co-mentor Shari Dworkin, PhD, MS, a medical sociologist in UCSF's Department of Social and Behavioral Sciences and an expert on gender- based power. Her team includes three additional, complementary advisors: Diana Foster, PhD, a demographer in UCSF's Department of Obstetrics, Gynecology, and Reproductive Sciences, who studies the consequences of unintended pregnancy; Torsten B. Neilands, PhD, a quantitative methodologist at UCSF's Center for AIDS Prevention Studies with expertise in latent variable (structural equation) modeling; and Claire Brindis, DrPH, Professor of Pediatrics and Health Policy whose research focuses on adolescent and child health policy, adolescent pregnancy and pregnancy prevention, and adolescent health and risk-taking behaviors. Dr. Upadhyay's training will include a combination of structured reading lists and tutorials with mentors, coursework, self-directed learning, conference presentations and attendance, and seminars. Description of the Research Project: Unintended pregnancy is an important public health problem; half of all pregnancies in the United States are unintended. The transition to adulthood is a particularly vulnerable period for unintended pregnancy; women ages 15 to 24 are at highest risk. One of the main reasons for unintended pregnancy is lack of consistent contraceptive use. The overall objective of this study is to conduct mentored research that examines the pathways between power, gender norms, and masculinities and contraceptive use among young people ages 15 to 24. My main hypothesis is that adherence to gender norms and traditional norms of masculinity lead to inconsistent and non-use of contraceptives. This research will assess this hypothesis through three specific aims. Aim 1 is to explore the role that relationship power, gender norms, and masculinities have in influencing adolescent and young people's contraceptive use. This aim involves qualitative in-depth interviews with adolescent and young women, men, and couples. Aim 2 is to adapt and validate existing instruments that measure relationship power, gender norms, and masculinities so that they are appropriate for adolescents and young people. This aim involves adapting my own Reproductive Autonomy Scale, the Gender Relations Scale, and the Masculinity Ideology in Relationships Scale for use among adolescents and young men and women. Aim 3 is to determine how relationship power, gender norms, and masculinities impact adolescent and young people's contraceptive use through a 3-month pilot prospective study at an adolescent family planning clinic. Examining gender-based power from the perspectives of multiple disciplines using mixed-methods, I expect to make important contributions in three areas: 1) theory on gender and power and contraceptive use, 2) measurement of gender-based power among adolescents, and 3) potential interventions that reduce unintended pregnancy. Ultimately, this mentored research will prepare me for the successful submission of an R01 application to test an adolescent contraceptive use intervention and a research career in gender and power-related determinants of adolescent reproductive health.