Explaining Trends in Teenage Childbearing in Sweden

The teenage fertility rate fell precipitately in Sweden after 1966 and is now one of the lowest in Europe. This decline can be seen in the context of major reforms enacted in 1975 whereby the school sex-education curriculum was revised, contraceptive services were improved, and abortion was provided free and on demand. By means of microsimulation, the possible roles of contraception and induced abortion in causing teenage fertility to fall are examined. Before 1975, the decline appears to have been caused primarily by an increase in the number of induced abortions. After that date, however, an increase in the use of highly efficient methods of contraception led to a decline in the pregnancy rate in such a way that, even though the proportion of teenagers who sought abortion increased, the abortion rate declined. Parallels are drawn with the experience of other European countries, and contrasts with that of the United States, where no such developments have occurred, are noted.     

Teenage Childbearing and Educational Attainment in South Africa

The relationship between teenage childbearing and school attainment is investigated using nationally representative longitudinal data drawn from South Africa's National Income Dynamics Study. The analysis focuses on the outcomes by 2010 of a panel of 673 young women who were aged 15–18 and childless in 2008. Controlling for other factors, girls who went on to give birth had twice the odds of dropping out of school by 2010 and nearly five times the odds of failing to matriculate. Few girls from households in the highest‐income quintile gave birth. Girls who attended schools in higher‐income areas and were behind at school were much more likely to give birth than those who were in the appropriate grade for their age or were in no‐fee schools. New mothers were much more likely to have re‐enrolled in school by 2010 if they were rural residents, they belonged to relatively well‐off households, or their own mother had attended secondary school. These findings suggest that, in South Africa, interventions that address poor school attainment would also reduce teenage childbearing.     

Decomposing Trends in Nonmarital Fertility Among Latinas

CONTEXT: For Latinos, high rates of nonmarital fertility reinforce economic inequality and slow the pace of social and economic incorporation into American society.
METHODS: Changes in the nonmarital fertility ratio—nonmarital births as a percentage of all births (NMFR)—among women aged 15–44 over the period 1994–2005 were partitioned into three components: changes in marital and in nonmarital fertility, and in the proportion of women who were married. Annual birth data were drawn from the national Natality Detail File, and population estimates were drawn from the Current Population Surveys. Analyses were conducted for blacks, whites and Latinas, as well as for selected subgroups of Latinas; differences in NMFRs between racial and ethnic groups were also calculated.
RESULTS: NMFRs were largely unchanged between 1994 and 2002, and then began to rise; they averaged 43% for Latinas, 69% for blacks and 23% for whites over the study period. In 2005, 48% of births to Latinas were nonmarital. Most of the rise in Latinas' NMFR was linked to a decline in marriage. Among foreign-born Latinas, a six-percentage-point increase in the NMFR was due mostly to a rise in nonmarital fertility and a decline in marital fertility, which offset the beneficial effects of a rising marriage rate. The difference between Latinas' and whites' NMFRs was largely attributed to Latinas' higher nonmarital fertility, whereas the difference between blacks' and whites' NMFRs was driven mostly by lower marriage rates among blacks.
CONCLUSIONS: Efforts to reduce out-of-wedlock childbearing among Latinas are needed, and programs should promote healthy marriages, especially among foreign-born Latinas.     

HIV Knowledge Among Pregnant Latinas in Rural South Carolina

To inform and strengthen culturally-tailored HIV perinatal prevention, we assessed HIV knowledge among pregnant Latinas receiving prenatal care in rural South Carolina. We administered an 11 item HIV knowledge scale (n = 171). Women who answered 8 of 11 (73 %) items correctly were categorized as having “high” knowledge; <8 items correct was categorized as “low” knowledge. Seventy-six percent of participants had low HIV knowledge; only 37 % knew that there is medicine to prevent mother-to-child HIV transmission. In multivariate analyses, high HIV knowledge was more likely among women who had ≥high school education compared with women with elementary school education only (Adjusted Odds Ratio 10.5, 95 % Confidence Interval 3.3–33.6). These findings highlight the need for targeted educational interventions to better inform Latinas regarding perinatal HIV prevention and transmission risks. Enhancing efforts with patients and providers is aligned with national goals for HIV prevention and elimination of perinatal transmission.     

Vaginal Douching Among Latinas: Practices and Meaning

OBJECTIVES: Vaginal douching is widely practiced by American women, particularly among minority groups, and is associated with increased risk of pelvic and vaginal infections. This research sought to investigate vaginal hygiene practices and meaning associated with them among Latina women and adolescents. Study results would guide development of an intervention to decrease douching among Latinas. METHODS: In depth qualitative interviews conducted with English- and Spanish-speaking women aged 16-40, seeking care for any reason who reported douching within the last year (n = 34). Interviews were audiotaped, transcribed and analyzed using qualitative methods. One-third of interviews were conducted in Spanish. RESULTS: Two explanatory models for douching motives emerged: one stressed cosmetic benefits; the other, infection prevention and control. Most women reported douching to eliminate menstrual residue; a small number reported douching in context of sexual intercourse or vaginal symptoms. Many were unaware of associated health risks. Respondents typically learned about douching from female family members and friends. Male partners were described as having little to no involvement in the decision to douche. Women varied in their willingness to stop douching. Two-thirds reported receiving harm reduction messages about "overdouching". About half indicated previous discussion about douching with health care providers; some had reduced frequency in response to counseling. A number of previously unreported vaginal hygiene practices and products were described, including use of a range of traditional hygiene practices, and products imported from outside the US. CONCLUSIONS: Respondents expressed a range of commitment to douching. Counseling messages acknowledging benefits women perceive as well as health risks should be developed and delivered tailored to individual beliefs. Further research is needed to assess prevalence and safety of previously unreported practices.     

Regression analysis of pesticide use and breast cancer incidence in California Latinas

An evaluation of pesticide use data and breast cancer incidence rates in California Hispanic females was conducted via a regression analysis. The analysis used 1988-2000 data from the California Cancer Registry, the population-based cancer registry that monitors cancer incidence and mortality in California. It also used pesticide use data from 1970-1988 from the California Department of Pesticide Regulation. California is the leading agricultural state in the United States, and more than a quarter of all pesticides in the United States are applied there. Hispanic (Latina) females are commonly employed in agricultural operations. The authors performed regression analysis of county-level specific pesticide use data (pounds of active ingredients applied) for two classes of pesticides, organochlorines and triazine herbicides, against the breast cancer incidence rates among Latinas, controlling for age, socioeconomic status, and fertility rates, using negative binomial regression models. A total of 23,513 Latinas were diagnosed with breast cancer in California during the years 1988-1999. Risk of breast cancer was positively and significantly associated with age and socioeconomic status, and inversely and significantly associated with fertility levels. With respect to pesticides, breast cancer was positively associated with pounds of the organochlorines methoxychlor (adjusted incidence rate ratio [IRR] for highest quartile = 1.18; confidence interval [CI] = 1.03-1.35) and toxaphene (IRR = 1.16; CI = 1.01-1.34). No significant associations were found for the triazine herbicides atrazine and simazine.     

A Lifetime of Low-Risk Behaviors Among HIV-Positive Latinas in Los Angeles

The objective is to assess the differences in lifetime and current transmission risk behaviors of HIV-positive and HIV-negative Latinas. In 2005–2006, 214 HIV-positive Latinas were recruited from systems of care and 111 HIV-negative Latina-matched controls were interviewed in Los Angeles, CA regarding lifetime and recent sexual and drug-taking risk behaviors. Multivariate OLS regression and logistic regression models were used to assess differences in lifetime and current transmission risk. There was no significant difference between the two groups with respect to lifetime exposure through injection drug use. HIV-positive Latinas reported significantly more lifetime sexual partners than HIV-negative Latinas. Rates of current sexual activity were not significantly different across the two groups. HIV-positive Latinas were less likely to report recent unprotected sex relative to HIV-negative Latinas. In Los Angeles, HIV-positive and HIV-negative Latinas were very similar with respect to transmission risk. The challenges these findings pose to prevention efforts that target Latinas and suggestions for new interventions are discussed.     

Acculturation and Depressive Symptoms Among Pregnant and Postpartum Latinas

Objectives Among childbearing Latinas, higher acculturation has been found to be significantly associated with increased risk for mental health problems (Acevado (Child Abuse Neglect, 24:11–127, 2000)), although these findings have been inconsistent (Beck (Maternal Child Nurs, 31(2), 114–120, 2006)). The aims of this study are to assess and compare the prevalence of elevated depressive symptoms among pregnant and postpartum U.S.- and Mexican-born Latinas, and to describe the relation of elevated depressive symptoms and acculturation indicators. Methods A convenience sample of 439 pregnant and postpartum Latinas attending Public Health Clinics in San Antonio, Texas was screened for depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) Scale. Women with a score of 21 or greater were classified as having elevated depressive symptoms. Sociodemographic data, including birth country and language of interview, were collected as indicators of acculturation. Results 21% of the sample had moderate depressive symptoms; 15% met the threshold for high depressive symptoms. Bivariate analysis showed Latinas who were U.S.-born, single, preferred English or were pregnant were more likely to express elevated levels of depressive symptoms. Being U.S.-born, pregnant and single was significantly associated with moderate levels of depressive symptoms in logistic regression analyses controlling for other variables in the model. Controlling for other variables, being pregnant and single was significantly associated with high levels of depressive symptoms. Conclusions Higher acculturation, pregnancy and single status were positively associated with elevated depressive symptoms. Screening for depression during pregnancy is important for this population group, given Latinas’ high rates of fertility and births to single women, particularly among more acculturated, U.S.-born Latinas.     

The Sociocultural Contexts of Attempting Suicide Among Women in Iran

In this study, we investigated the sociocultural contexts of suicide attempts among women in Iran. Fifty women who attempted suicide and were admitted to the two main hospitals in Isfahan in 2006 were interviewed. The main themes identified were family problems, marriage and love, social stigma, pressure of high expectations, and poverty. We observed significant sociocultural influence on attempting suicide among the Iranian women in this study. Based on our findings we conclude that the women in the study were affected by social changes and the interplay between traditional and modern values and attitudes. Understanding sociocultural aspects of suicide in Iran is critical in providing effective and culturally sensitive suicide prevention and care programs.     

Trends in Sexual Experience,Contraceptive Use,and Teenage Childbearing: 1992–2002

PurposeTo examine how cohort trends in family, individual, and relationship characteristics are linked to trends in adolescent reproductive health outcomes to provide a better understanding of factors behind recent declines in teenage birth rates.MethodsWe examine a sample of three cohorts of females and males aged 15–19 in 1992, 1997, and 2002, based on retrospective information from the 2002 National Survey of Family Growth. We identify how family, individual, and relationship characteristics are associated with the transition to sexual intercourse, contraceptive use at first sex, and the transition to a teen birth.ResultsCohort trends and multivariate analyses indicate changes in family and relationship characteristics among American teens have been associated with positive trends in reproductive health since the early 1990s. Factors associated with improvement in adolescent reproductive health include positive changes in family environments (including increases in parental education and a reduced likelihood of being born to a teen mother) and positive trends in sexual relationships (including an increasing age at first sex and reductions in older partners). These positive trends may be offset, in part, by negative changes in family environments (including an increased likelihood of being born to unmarried parents) and the changing racial/ethnic composition of the teen population.ConclusionsRecent increases in the U.S. teen birth rate highlight the continued importance of improving reproductive health outcomes. Our research suggests that it is important for programs to take into consideration how family, individual, and relationship environments influence decision-making about sex, contraception, and childbearing.     

Health Literacy Predicts Change in Physical Activity Self-efficacy Among Sedentary Latinas

Health literacy (HL) is associated with preventive health behaviors. Self-efficacy is a predictor of health behavior, including physical activity (PA); however, causal pathways between HL and self-efficacy for PA are unknown, especially among Latinas who are at risk for chronic disease. To explore this potential relationship, secondary analyses were conducted on data [Shortened Test of Functional Health Literacy in Adults (STOFHLA), PA self-efficacy, and socio-demographics] from a 6-month, randomized controlled trial of a print-based PA intervention (n = 89 Spanish-speaking Latinas). Linear regression models revealed associations between HL and baseline self-efficacy in addition to changes in self-efficacy at 6-months. After controlling for significant covariates, higher HL scores were associated with lower baseline PA self-efficacy. Regardless of treatment assignment, higher HL scores at baseline predicted greater changes in PA self-efficacy at 6-months. HL may contribute to Latinas’ improved PA self-efficacy, though further research is warranted.     

Identifying Sociocultural Barriers to Mammography Adherence Among Appalachian Kentucky Women

Despite lower breast cancer incidence rates, Appalachian women evidence lower frequency of screening mammography and higher mortality risk for breast cancer compared to non-Appalachian women in Kentucky, and in the United States, overall. Utilizing data from 27 in-depth interviews from women in seven Appalachian Kentucky counties, this study examines how Appalachian women explain sociocultural barriers and facilitators to timely screening mammography, and explores their common narratives about their mammography experiences. The women describe how pain and embarrassment, less personal and less professional mammography experiences, cancer fears, and poor provider communication pose barriers to timely and appropriate mammography schedule adherence and follow-up care. The study also identifies how improving communication strategies in the mammography encounter may improve mammography experiences and adherence to screening guidelines.