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1.  Adolescent Pregnancy Intentions and Pregnancy Outcomes: A Longitudinal Examination 
(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.
Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between females who reported “any” and “no” pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.
Adolescents’ reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (χ2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: χ2 = 19.08, df = 2, p < .01; Positive Results: χ2 = 8.84, df = 2, p = .015).
To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.
PMCID: PMC1602042  PMID: 15581524
Pregnancy intentions; Adolescent females; Attitudes; Intentions; Contraceptive use
2.  Pregnancy Intentions Among Women Who Do Not Try: Focusing On Women Who Are Okay Either Way 
Maternal and child health journal  2011;15(2):178-187.
Are women who are intentional about pregnancy (trying to or trying not to get pregnant) systematically different from women who are “okay either way” about getting pregnant? We use a currently sexually active subsample (n = 3,771) of the National Survey of Fertility Barriers, a random digit dialing telephone survey of reproductive-aged women (ages 25–45) in the United States. We compare women who are trying to, trying not to, or okay either way about getting pregnant on attitudes, social pressures, life course and status characteristics using bivariate analyses (chi-square tests for categorical and ANOVA tests for continuous variables). Multivariate multinomial logistic regression provides adjusted associations. Most women say that they are trying not to get pregnant (71%) or are okay either way (23%); few are trying to get pregnant. Among women with no prior pregnancies (n = 831), more say that they are trying to get pregnant (14%) but a similar percentage are okay either way (26%). Several characteristics distinguish those trying to from those okay: fertility intentions, importance of motherhood, age, parity, race/ethnicity and self identifying a fertility problem. Additional characteristics are associated with trying not to get pregnant compared to being okay: ideal number of children, wanting a baby, trusting conception, relationship satisfaction, race ethnicity, economic hardship, and attitudes about career success. Women who are “okay either way” about pregnancy should be assessed separately from women who are intentional (trying to, trying not to) about pregnancy.
PMCID: PMC3010258  PMID: 20449643
Pregnancy intentions; Pregnancy planning; Life course; Fertility intentions
3.  Correlates of delayed sexual intercourse and condom use among adolescents in Uganda: a cross-sectional study 
BMC Public Health  2012;12:817.
Comprehensive sex education, including the promotion of consistent condom use, is still an important intervention strategy in tackling unplanned pregnancies, HIV/AIDS and sexually transmitted infections (STIs) among Ugandan adolescents. This study examines predictors of the intention to use a condom and the intention to delay sexual intercourse among secondary school students (aged 12–20) in Uganda.
A school-based sample was drawn from 48 secondary schools throughout Uganda. Participants (N = 1978) completed a survey in English measuring beliefs regarding pregnancy, STIs and HIV and AIDS, attitudes, social norms and self-efficacy towards condom use and abstinence/delay, intention to use a condom and intention to delay sexual intercourse. As secondary sexual abstinence is one of the recommended ways for preventing HIV, STIs and unplanned pregnancies among the sexually experienced, participants with and without previous sexual experience were compared.
For adolescents without sexual experience (virgins), self-efficacy, perceived social norms and attitude towards condom use predicted the intention to use condoms. Among those with sexual experience (non-virgins), only perceived social norm was a significant predictor. The intention to delay sexual intercourse was, however, predicted similarly for both groups, with attitudes, perceived social norm and self-efficacy being significant predictors.
This study has established relevant predictors of intentions of safe sex among young Ugandans and has shown that the intention to use condoms is motivated by different factors depending on previous sexual experience. A segmented approach to intervention development and implementation is thus recommended.
PMCID: PMC3503743  PMID: 22998762
Ugandan adolescents; Delayed sexual intercourse; Condom use; Attitudes; Social norms; Self-efficacy; Segmented approach; sub-Saharan Africa
4.  Let’s stay together: relationship dissolution and sexually transmitted diseases among parenting and non-parenting adolescents 
Journal of behavioral medicine  2010;33(6):454-465.
Relationships influence sexual risk and maternal-child health. Few studies have assessed relationship dissolution and its association with sexually transmitted diseases (STD) among adolescent parents. Our study aimed to describe relationship dissolution among 295 parenting and non-parenting adolescents over an 18-month period and how it related to STD incidence. Results showed that nonparenting adolescents in a relationship with someone other than their baby’s father were more likely to have a relationship dissolution over an 18-month period compared to those in a relationship with the baby’s father (OR = 1.69, P < .05). Parenting adolescents who ended their relationship with their baby’s father were 3 times more likely to get an STD over the course of the study compared to parenting adolescents who remained with their baby’s father (39% vs. 13%). Comparatively, non-parenting adolescents who ended their relationship were only 1.4 times more likely to get an STD compared to non-parenting adolescents who remained with their partner (44% vs. 32%). Our results suggest that prevention programs that incorporate male partners and components that strengthen relationship skills may reduce HIV/STD risk and help adolescents adapt during times of transition such as parenthood.
PMCID: PMC3085168  PMID: 20607596
Relationship dissolution; STDs; Pregnancy; Adolescent relationships
5.  Pregnancy Intentions and Teenage Pregnancy Among Latinas: A Mediation Analysis 
The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high.
Prospective, time-varying data from 2001–2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression.
Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low sexual relationship power with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%.
Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.
PMCID: PMC2951312  PMID: 20887287
6.  Predictive Ability and Stability of Adolescents’ Pregnancy Intentions in a Predominantly Latino Community 
Studies in Family Planning  2010;41(3):179-192.
Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents’ intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.
PMCID: PMC3265987  PMID: 21469271
7.  Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners 
Sexually Transmitted Infections  2004;80(2):130-137.
Objectives: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual).
Methods: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study.
Results: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values.
Conclusions: Implications for designing interventions for adolescent males and females are discussed.
PMCID: PMC1351212  PMID: 15054176
8.  Perceived STD Risk, Relationship and Health Values in Adolescents’ Delaying Sexual Intercourse with New Partners 
Sexually transmitted infections  2004;80(2):130-137.
To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual).
Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study.
Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ2 = 31.97, p<.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month vs. 2 months (main) [t=3.47, p<.001]; medians of 2 weeks vs. 1 month (casual), [t=6.14, p<.0001]). Factors influencing intentions to delay intercourse with future main partners differed by gender; males’ were negatively influenced by importance of sex in relationships, while females’ were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values.
Implications for designing interventions for adolescent males and females are discussed.
PMCID: PMC1351212  PMID: 15054176
Adolescents; sexual intercourse delay; partner types
9.  Pregnancy coercion, intimate partner violence, and unintended pregnancy 
Contraception  2010;81(4):316-322.
Reproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services.
Study Design
A cross-sectional survey was administered to females ages 16–29 years seeking care in five family planning clinics in Northern California (N=1278).
Fifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion, and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36, 2.46, and AOR 1.58, 95% CI 1.14, 2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence.
Pregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.
PMCID: PMC2896047  PMID: 20227548
Pregnancy; unwanted; Domestic Violence; Contraception; barrier; Family Planning Services
10.  Which outcome expectancies are important in determining young adults’ intentions to use condoms with casual sexual partners?: a cross-sectional study 
BMC Public Health  2013;13:133.
The prevalence of unwanted pregnancy and sexually transmitted infection amongst young adults represents an important public health problem in the UK. Individuals’ attitude towards the use of condoms has been identified as an important determinant of behavioural intentions and action. The Theory of Planned Behaviour has been widely used to explain and predict health behaviour. This posits that the degree to which an individual positively or negatively values a behaviour (termed ‘direct attitude’) is based upon consideration of the likelihood of a number of outcomes occurring (outcome expectancy) weighted by the perceived desirability of those outcomes (outcome evaluation). Outcome expectancy and outcome evaluation when multiplied form ‘indirect attitude’. The study aimed to assess whether positive outcome expectancies of unprotected sex were more important for young adults with lower safe sex intentions, than those with safer sex intentions, and to isolate optimal outcomes for targeting through health promotion campaigns.
A cross-sectional survey design was used. Data was collected from 1051 school and university students aged 16–24 years. Measures of intention, direct attitude and indirect attitude were taken. Participants were asked to select outcome expectancies which were most important in determining whether they would use condoms with casual sexual partners.
People with lower safe sex intentions were more likely than those with safer sex intentions to select all positive outcome expectancies for unprotected sex as salient, and less likely to select all negative outcome expectancies as salient. Outcome expectancies for which the greatest proportion of participants in the less safe sex group held an unfavourable position were: showing that I am a caring person, making sexual experiences less enjoyable, and protecting against pregnancy.
The findings point to ways in which the attitudes of those with less safe sex intentions could be altered in order to motivate positive behavioural change. They suggest that it would be advantageous to highlight the potential for condom use to demonstrate a caring attitude, to challenge the potential for protected sex to reduce sexual pleasure, and to target young adults’ risk appraisals for pregnancy as a consequence of unprotected sex with casual sexual partners.
PMCID: PMC3599836  PMID: 23406327
Outcome expectancies; Condom use; Theory of planned behaviour; Attitude; Expectancy-value muddle; Dimensional salience
11.  Measuring Youth Sexual Risk-Taking in Port-au-Prince, Haiti: Programmatic Recommendations from Different Methodological Approaches 
Studies in family planning  2009;40(4):277-288.
No studies have examined the applicability of varying methods for identifying youth at high risk of unintended pregnancies and contracting HIV. This study compares sociodemographic characteristics and sexual behaviors of youth (ages 15-24) in Port-au-Prince, Haiti surveyed using three different study methodologies. The three study methodologies are compared in terms of their utility for identifying high risk youth and utility for program planning. The three study methodologies are: a representative sample of youth from the 2005/6 Demographic and Health Survey (HDHS); a 2004 facility-based study; and a 2006/7 venue-based study that used the Priorities for Local AIDS Control Efforts (PLACE) method. The facility-based and PLACE studies included larger proportions of single, sexually experienced youth and youth who knew someone with HIV/AIDS than the HDHS. More youth in the PLACE study had multiple sexual partners in the last year and received money or gifts for sex compared to youth in facilities. At first and last sex, more PLACE youth used contraception including condoms. Pregnancy experience was most common in the facility-based data; however, more ever-pregnant PLACE youth reported ever terminating a pregnancy. Program managers seeking to target prevention activities should consider using facility- or venue-based methods to identify and understand the behaviors of high-risk youth.
PMCID: PMC3833725  PMID: 23012724
12.  Perceptions of Level of Intoxication and Risk Related to Drinking and Driving 
Addictive behaviors  2007;33(4):605-615.
This study investigated variables of perceived risk associated with one’s decision to drink and drive, as well as with the occurrence and successfulness of intervention efforts by others in preventing individuals from drinking and driving. Undergraduate students were presented with scenarios manipulating number of drinks, consumption time, and distance needed to drive. Participants then provided estimates of intoxication, degree of impairment, and likelihood of getting in an accident and getting arrested for drinking and driving. In addition, participants rated three criterion variables: intention to drive, likelihood someone would try to intervene, and receptiveness to someone attempting to intervene. Data was analyzed using three random effects regression models, one for each of the criterion variables. Results indicated that perceptions of risk were associated with decisions to drive after drinking and expected likelihood of, and receptiveness to, intervention efforts, over and above one’s estimate of intoxication.
PMCID: PMC2350193  PMID: 18068307
drinking and driving; perceived risk; intervention
13.  Young Women’s Perceptions of the Benefits of Childbearing: Associations with Contraceptive Use and Pregnancy 
High unintended pregnancy rates, and inconsistencies between reported pregnancy intentions and contraceptive behaviors, have been well documented among young U.S. women. Women’s beliefs about the benefits of childbearing and motherhood may be related to the apparent disconnect between pregnancy intentions and reproductive outcomes.
Perceived benefits of childbearing and feelings about a potential pregnancy were assessed among 1,377 women aged 15–24 (most of them black or Latina) participating in a longitudinal study in 2005–2008. The women, who were initiating hormonal contraception at public family planning clinics and did not want to become pregnant for one year, were followed for 12 months. Differences in perceived benefits of childbearing by participant characteristics were examined with linear regression, using a new multi-item measure. Cox proportional hazard regression was used to investigate the association of perceived benefits of childbearing with subsequent contraceptive discontinuation and pregnancy.
Perceptions of the benefits of childbearing decreased with increasing age (coefficient, −0.04), and white women perceived fewer benefits to childbearing than blacks (−0.2) and Latinas (p ≤ .01). As women’s perception of the benefits of childbearing increased, their one-year pregnancy rates increased, after demographic characteristics and feelings about a potential pregnancy were controlled for (hazard ratio, 1.2). Benefits of childbearing were not associated with contraceptive discontinuation.
To better assess pregnancy risk among young women wanting to avoid pregnancy, it may be useful to acknowledge that they hold not only explicit pregnancy desires, but also beliefs about the benefits of childbearing, which may influence sexual behavior and pregnancy.
PMCID: PMC3620026  PMID: 23489854
14.  Better learning in schools to improve attitudes toward abstinence and intentions for safer sex among adolescents in urban Nepal 
BMC Public Health  2013;13:244.
School-based sex education is an effective medium to convey health information and skills about preventing sexually transmitted infections (STIs) and unwanted pregnancies among adolescents. However, research on school-based sex education is limited in many developing countries, including Nepal. This study thus had two main objectives: (1) to assess students’ evaluation of school-based sex education, and (2) to examine the associations between students’ evaluations of school-based sex education and their (a) attitudes toward abstinence and (b) intentions for safer sex.
This cross-sectional study was conducted among 634 students from six schools in the Kathmandu Valley during May–June 2010. We used a self-administered questionnaire to assess students’ evaluations of school-based sex education, attitudes toward abstinence, and intentions for safer sex. The data were then analyzed using multiple linear regression models.
Regarding “information on HIV and sexual health”, many students perceived that they received the least amount of information on HIV counseling and testing centers (mean 2.29, SD 1.00) through their schools. In terms of “support and involvement of teachers and parents” in sex education, parents’ participation ranked as the lowest (mean 1.81, SD 1.01). Audiotapes were reported as the least used among the listed “teaching aids for sexual health education” (mean 1.54, SD 0.82). In multivariate analysis, receiving more “information on HIV and sexual health” was positively associated with more positive “attitudes toward abstinence” (β = 0.11, p = <0.018) and greater “intentions for safer sex” (β = 0.17, p = <0.001) among students. Similarly, increased “support and involvement from teachers and parents” was also positively associated with more positive “attitudes toward abstinence” (β = 0.16, p = <0.001) and greater “intentions for safer sex” (β = 0.15, p = <0.002).
Our results suggest that students’ needs and expectations regarding HIV and sexual health education are not being met through their schools. Moreover, comprehensive information on HIV and sexual health along with increased support and involvement of teachers and parents in sex education might help to improve adolescents’ attitudes toward abstinence and intentions for safer sex. Adapting future school-based interventions to incorporate such elements may thus be an effective strategy to promote adolescent sexual health.
PMCID: PMC3608152  PMID: 23509909
Students; School health services; Sex education; Attitudes; Intentions; Abstinence; Safer sex; Nepal
15.  Temperament, Context and Sexual Risk among College Students 
Nursing Research and Practice  2011;2011:504571.
Much is known about predictors of risky sexual behaviors in young adults. Little is known; however, about the contribution of temperament and how temperament interacts with context to influence sexual risk intentions and actual behaviors. Since intentions are closely linked to behavior, knowing how temperament influences these decisions is important in planning interventions. The purpose of this quasiexperimental study was to examine the effect of gender, temperament, and context on sexual risk intentions and behaviors among college students (N = 145). Although individual components of temperament were associated with sexual risk intentions, temperament did not predict sexual risk intentions in a safer or risky context or actual behaviors. There were also no differences by gender. In this study, temperament did not interact with context to influence sexual risk intentions or behaviors. According to these results, interventions promoting safer sexual behaviors may not have to be tailored to individuals with different temperament styles.
PMCID: PMC3169902  PMID: 21994829
16.  Race/Ethnicity and Pregnancy Decision Making: The Role of Fatalism and Subjective Social Standing 
Journal of Women's Health  2010;19(6):1195-1200.
Rates of unintended pregnancy in the United States differ by race and ethnicity. We examined whether these differences might be explained by maternal fatalism and subjective social standing.
We used data from 1070 pregnant women of sociodemographically diverse backgrounds enrolled in prenatal care in the San Francisco Bay area. Logistic regression was used to explore the relationship between attitude variables and a measure of pregnancy decision making (“not trying to get pregnant”).
African American women were more likely than others to report not trying to get pregnant with the current pregnancy (adjusted odds ratio [AOR] 2.04, 95% confidence interval [95% CI] 1.22-3.43, p = 0.007). Higher subjective social standing was associated with a lower likelihood of not trying among white and U.S.-born women only (AOR 0.67, p = 0.001 and AOR 0.75, p < 0.001, respectively. Fatalism was associated with not trying in bivariate but not multivariable analyses.
In this population, the likelihood of reporting not trying to get pregnant was higher among racial/ethnic minorities regardless of subjective social standing. Programs aimed at reduction in unintended pregnancy rates need to be targeted to a broader population of women.
PMCID: PMC2924781  PMID: 20469962
17.  HIV Testing, Perceived Vulnerability and Correlates of HIV Sexual Risk Behaviors of Latino and African American Young Male Gang Members 
This study examined HIV testing behaviors, perceived vulnerability to HIV, and correlates of sexual risk behaviors of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members ages 18–26 years old. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviors: had sex with someone they just met (Adjusted Odds Ratio [AOR] = 4.51), had sex with someone they think or know had an STD (AOR = 4.67), or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR= 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members.
PMCID: PMC3244469  PMID: 21364062
Sexual risk behavior; HIV testing; perceived vulnerability to HIV; male gang members; HIV prevention
We examined condom attitudes, perceived vulnerability to HIV, HIV testing experiences, and sexual and substance use risk behaviors of 161 active Latino male gang members, aged 18–26 years old, living in Los Angeles, California. Gang members reported negative condom attitudes and a perceived vulnerability to HIV. The majority (53%) of gang members reported unprotected vaginal intercourse (UVI) in the previous 12 months. Multivariate analyses indicated that participants who engaged in the following behaviors were more likely to report UVI: had sex with someone they just met (adjusted odds ratio [AOR] = 3.66), received money or drugs for sex (AOR = 5.05), or had sex with someone who had a sexually transmitted disease (AOR = 4.99). Participants with a higher perceived vulnerability to HIV were less likely to report UVI (AOR = 0.82). Our findings offer implications for development of an HIV prevention intervention for Latino male gang members.
PMCID: PMC2819198  PMID: 19824836
19.  The Hidden Infertile: Infertile Women without Pregnancy Intent in the United States* 
Fertility and sterility  2009;93(6):2080-2083.
A national probability sample reveals two relatively distinct groups of infertile women: those with intent, who have experienced a period of 12 or more months during which they tried to conceive but did not, and those without intent, who had a period of at least 12 months during which they could have conceived and did not but who do not describe themselves as having tried to become pregnant at that time. Those with intent are more likely to identify as having a fertility problem, to be distressed, and to pursue infertility treatment than those without intent, suggesting that many women do not realize that they meet the medical criteria for infertility and may therefore wait longer to get help, therefore lowering their chances of conception.
PMCID: PMC2847620  PMID: 19782354
20.  HIV/STD Risk Behaviors Among In-School Adolescents in Post-Conflict Liberia 
We conducted a randomized trial to address the health needs of in-school adolescents in Liberia, where we analyzed data from a behavioral survey administered to 820 students from 8 urban schools. Our findings suggest that adolescents are at significant risk for HIV and other sexually transmitted diseases (STDs): 36% of respondents were sexually experienced, 34% of those had first sex at ages 14 or younger, and 66% of first sexual encounters were unprotected while 16% were described as “forced.” Also, females were more likely to have older boyfriends (Pearson chi square = 19.2, p = 0.0001) and sex resulting into pregnancies (Pearson chi square = 11.5, p = 0.01), while males were more likely to have a greater number of sexual partners (Pearson chi square = 5.6, p = 0.05) in the previous 3 months. We recommend further research to explore challenges associated with implementing behavioral-driven studies in post-conflict environments.
PMCID: PMC3244556  PMID: 21924644
adolescents; HIV/STDs; Liberia; post-conflict setting; school; sub-Saharan Africa
21.  Variation in distress among women with infertility: evidence from a population-based sample† 
Human Reproduction (Oxford, England)  2011;26(8):2101-2112.
We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years.
General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was conducted on self-report data (based on a telephone interview) from a probability-based sample of US women aged 25–45 years. We compare women with infertility who have had a prior pregnancy (secondary infertility, n = 628) to women with infertility with no prior pregnancies (primary infertility, n = 399). We further distinguish between women with infertility who were actually ‘trying’ to become pregnant (the infertile with intent) with those who met the medical definition of infertile but did not describe themselves as trying to become pregnant (infertile without intent).
Both types of infertility (primary versus secondary) (β = 0.31*) and intentionality (infertile with and without intent) (β = 0.08*) are associated with FSD. These associations persist when we control for resource and demographic variables, life course variables, social support and social pressure variables. General distress does not vary by infertility type or intentionality.
Results reveal variation in women's recalled experiences of infertility and that FSD is more sensitive to effects of different experiences than general distress. Women with primary infertility who were explicitly trying to become pregnant at the time of the infertility episode stand out as a particularly distressed group. Caregivers should be aware that the emotional needs of women with primary infertility may differ from those with secondary infertility.
PMCID: PMC3137388  PMID: 21659313
fertility-specific distress; infertility; pregnancy intentionality; population-based study; women
22.  Intention to start cigarette smoking among Iranian male adolescents: usefulness of an extended version of the theory of planned behaviour 
Heart Asia  2012;4(1):120-124.
Smoking is one of the risk behaviours that begin in adolescence, and therefore identifying predictors of smoking is necessary for planning prevention programmes.
To examine the ability of the extended theory of planned behaviour (TPB) to predict the intention to smoke.
This was a cross-sectional study carried out in Iran, 2011. The data were collected by a self-administered questionnaire which included items on demographics, smoking behaviour, components of the TPB model (attitude, subjective norms, perceived behaviour control and intention) and an added construct on smoking self-identity. Data were analysed using descriptive, correlation and linear regression statistics.
365 male high school students with a mean age of 16.5 (SD=1.2) years were studied. Fifty-five (15.1%) of the students surveyed were current smokers. All components of the TPB model and smoking self identity were statistically significantly related to intention to smoke (p<0.001). The TPB constructs with and without smoking self-identity accounted for 58.5% (adjusted R2) and 54.8% of the variance observed for intention to smoke, respectively. Result also revealed the highest weights for perceived behaviour control (β=−0.35).
The extended model of the TPB predicted ‘intention to smoke’ better than the original TPB. The findings of this study might be used as a framework in designing heart disease prevention programmes. Thus the findings have implications for both health promotion specialists and cardiologists. They could place an emphasis on perceived behaviour control, specifying that individuals who do not smoke should not start and if they are smokers it is possible to stop smoking.
PMCID: PMC3622501  PMID: 23585785
23.  Adolescents’ Pregnancy Intentions 
This study explores if and how adolescents’ pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum.
Adolescent girls who reported that they had “wanted a baby” (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy “just happened” (n = 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy.
Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child.
Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby.
PMCID: PMC3864670  PMID: 10331837
Adolescent pregnancy; Unintended pregnancies; Childbearing intentions; Child abuse/neglect
24.  Correlates of STI testing among vocational school students in the Netherlands 
BMC Public Health  2010;10:725.
Adolescents are at risk for acquiring sexually transmitted infections (STIs). However, test rates among adolescents in the Netherlands are low and effective interventions that encourage STI testing are scarce. Adolescents who attend vocational schools are particularly at risk for STI. The purpose of this study is to inform the development of motivational health promotion messages by identifying the psychosocial correlates of STI testing intention among adolescents with sexual experience attending vocational schools.
This study was conducted among 501 students attending vocational schools aged 16 to 25 years (mean 18.3 years ± 2.1). Data were collected via a web-based survey exploring relationships, sexual behavior and STI testing behavior. Items measuring the psychosocial correlates of testing were derived from Fishbein's Integrative Model. Data were subjected to multiple regression analyses.
Students reported substantial sexual risk behavior and low intention to participate in STI testing. The model explained 39% of intention to engage in STI testing. The most important predictor was attitude. Perceived norms, perceived susceptibility and test site characteristics were also significant predictors.
The present study provides important and relevant empirical input for the development of health promotion interventions aimed at motivating adolescents at vocational schools in the Netherlands to participate in STI testing. Health promotion interventions developed for this group should aim to change attitudes, address social norms and increase personal risk perception for STI while also promoting the accessibility of testing facilities.
PMCID: PMC3009645  PMID: 21106064
25.  Predicting HPV Vaccine Intentions of College-Age Males: An Examination of Parents and Son’s Perceptions 
To examine male students and their parents’ human papillomavirus (HPV) vaccine communication in relation to males’ willingness to discuss the vaccine with their healthcare provider and likelihood being vaccinated.
Dyads (n=111) of students and parents.
Participants completed a HPV vaccine survey based on the risk perception attitude framework in 2009.
Male’s perceived susceptibility for HPV and self-efficacy to talk to their provider were directly related to their intention to discuss the HPV vaccine, and their intention was directly related to their likelihood of being vaccinated. Parents’ perceived self-efficacy to talk to their son and response-efficacy of the vaccine were directly related to their intention to talk to their son; however, parents’ intention was not related to the likelihood of their son being vaccinated.
College males may benefit from HPV vaccine educational programs that include communication skills training to discuss the HPV vaccine with their parents.
PMCID: PMC3412301  PMID: 22857137

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