Distal Determinants of Disparities in Unintended Fertility

描述（由申请人提供）：美国的意外生育水平很高：一半的怀孕和三分之一的分娩是意外的，在年轻人和少数民族中比例更高。由于意外生育与负面健康结果有关，少数民族意外生育率较高可能会加剧健康差距，自1980年代以来，减少意外生育率一直是一项公共卫生目标。虽然意外生育的直接决定因素是明确的（没有有效使用避孕措施的性行为和意外怀孕足月），但这些行为的潜在原因，以及种族-民族-出生地差异的潜在原因，还没有得到很好的理解。利用现有的理解生育差异的框架，本项目提出了两个关键的远端决定因素——生殖知识和生育动机——这可能解释种族-民族-本土群体之间意外生育的差异。该项目将检验以下假设：种族-民族-本土少数民族的生殖知识和预防怀孕的动机较低；这些差异在青年时期会扩大；这些远端决定因素驱动了近端决定因素（主要是性和避孕）和生育本身的差异。该项目超越了先前的描述性工作，以确定青年期危险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。我们还扩展了之前的工作，将男性和女性以及不同的种族-民族-土著群体纳入其中。我们的项目将从三个互补的数据集中得出强有力和一致的措施：关系动态和社会生活研究（“RDSL”；2008/09年居住在密歇根州一个县的18-19岁妇女的基于人口的样本，每周随访2.5年），全国青少年健康纵向研究(“增加健康”；1995年7-12年级入学的青少年，并于1996年、2001/02年和2007/08年再次接受采访)，以及2009年全国生殖和避孕知识调查（“雾区”；全国18-29岁未婚男女样本）。首先，该项目将利用综合数据分析技术指导下的因素分析和潜在阶层分析，创建跨调查和种族-民族-出生的远端决定因素的等效度量。其次，交叉滞后回归模型将用于检验这些结构的稳定性，因为年轻人学习和获得可能影响他们的生殖知识和生育动机的新经验。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因素，这些因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的研究和干预措施，针对那些有意外生育风险的人，并突出最关键的干预领域。为了向决策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，这是一个在全国受人尊敬的、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.