Hall Kelli Stidham, Beauregard Jennifer L, Rentmeester Shelby T, Livingston Melvin, Harris Kathleen Mullan
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, GCR 560, Atlanta, GA 30322, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, USA.
SSM Popul Health. 2018 Dec 21;7:100344. doi: 10.1016/j.ssmph.2018.100344. eCollection 2019 Apr.
We examined the effects of adverse life experiences (ALEs) on rates of unintended first pregnancy, including differential effects by race/ethnicity and socioeconomic status, among women in a national longitudinal cohort study.
We drew upon 15-years of data from 8810 adolescent and young adult females in the National Longitudinal Study of Adolescent to Adult Health. Using 40 different ALEs reported across childhood and adolescence, we created an additive ALE index, whereby higher scores indicated greater ALE exposure. We employed Cox proportional hazard models, including models stratified by racial/ethnic and socioeconomic groups, to estimate the effects of ALEs on time to first unintended pregnancy, controlling for time-varying sociodemographic, health and reproductive covariates.
Among all women, a 1-standard deviation increase in ALE scores was associated with an increased rate of unintended first pregnancy (adjusted Hazard Ratio 1.11, 95% Confidence Interval=1.04-1.17). In stratified models, associations between ALE scores and risk of unintended pregnancy varied across racial/ethnic, socioeconomic, and age groups and according to various elevated ALE thresholds. For example, the 1-standard deviation increase in ALE score indicator increased the unintended pregnancy risk for African-American (aHR=1.12, CI=1.01-1.25), Asian (aHR 1.69, CI=1.26-2.26), and White women (aHR=1.12, CI=1.03-1.22), women in the lowest ($0-$19,999; aHR=1.21, CI = 1.03-1.23) and highest (>$75,000; aHR=1.36, CI=1.12-1.66) income categories, and women aged 20-24 (aHR=1.13, CI=1.04-1.24) and >24 years (aHR 1.25, CI=1.06-1.47), but not among the other sociodemographic groups.
ALEs increased the risk of unintended first pregnancy overall, and different levels of exposure impacting the risk of pregnancy differently for different sub-groups of women. Our ongoing research is further investigating the role of stress-associated adversity in shaping reproductive health outcomes and disparities in the United States.
在一项全国性纵向队列研究中，我们考察了不良生活经历（ALE）对意外首次怀孕发生率的影响，包括种族/族裔和社会经济地位的差异影响。
我们利用了青少年到成人健康全国纵向研究中8810名青少年和年轻成年女性的15年数据。通过使用在童年和青少年时期报告的40种不同的ALE，我们创建了一个累加ALE指数，得分越高表明ALE暴露程度越高。我们采用Cox比例风险模型，包括按种族/族裔和社会经济群体分层的模型，来估计ALE对首次意外怀孕时间的影响，并控制随时间变化的社会人口统计学、健康和生殖协变量。
在所有女性中，ALE得分每增加1个标准差，意外首次怀孕率就会增加（调整后风险比1.11，95%置信区间=1.04 - 1.17）。在分层模型中，ALE得分与意外怀孕风险之间的关联在种族/族裔、社会经济和年龄组中各不相同，并根据不同的ALE升高阈值而有所不同。例如，ALE得分指标每增加1个标准差，非裔美国女性（调整后风险比=1.12，置信区间=1.01 - 1.25）、亚裔女性（调整后风险比1.69，置信区间=1.26 - 2.26）和白人女性（调整后风险比=1.12，置信区间=1.03 - 1.22）、收入最低（0 - 19,999美元；调整后风险比=1.21，置信区间 = 1.03 - 1.23）和最高（>75,000美元；调整后风险比=1.36，置信区间=1.12 - 1.66）类别中的女性，以及20 - 24岁（调整后风险比=1.13，置信区间=1.04 - 1.24）和>24岁（调整后风险比1.25，置信区间=1.06 - 1.47）的女性意外怀孕风险增加，但在其他社会人口统计学群体中并非如此。
ALE总体上增加了意外首次怀孕的风险，不同程度的暴露对不同女性亚组的怀孕风险影响不同。我们正在进行的研究进一步调查与压力相关的逆境在美国生殖健康结果和差异形成中的作用。
