Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Sociology, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana.
J Adolesc Health. 2024 Dec;75(6):947-951. doi: 10.1016/j.jadohealth.2024.06.018. Epub 2024 Aug 14.
Rural adolescent pregnancy is a serious public health issue, largely due to low contraceptive use. Existing data focuses on urban populations. Using a positive youth development framework, we examine associations between modifiable protective factors and birth control use in a rural population.
Prior to an evidence-based health education program, students in 10th grade health class in two low-to-middle income rural schools completed surveys. For contraceptive use at last sex, students could check all methods that applied which were collapsed into three rank-ordered categories: none, condoms only, and hormonal contraception. Predictor variables included sexual self-efficacy (six items, α = 0.66, "able to say no"), parent connectedness (five items, α = 0.94, "satisfaction with your parent/guardian?"), language acculturation (one item, "in your home do you speak…"), school connectedness (five items, α = 0.85, "I feel close to people at my school") and adverse childhood experiences (eight item score). These variables were entered into a multivariable logistic ordinal regression.
The sample (N = 287) was 52% female, 48% LatinX and 49% white. Higher sexual self-efficacy and parent connectedness scores significantly increased the odds of using more effective birth control. Higher language acculturation (more likely to speak another language at home) suggested less likely to use more effective birth control. School connection and adverse childhood experiences were not significant in the final model.
Contraception focused interventions in rural communities should address modifiable protective factors, such as self-efficacy and parent connection. Interventions need to be trauma-informed and language accessible.
农村青少年怀孕是一个严重的公共卫生问题，主要原因是避孕措施使用率低。现有数据主要集中在城市人口。本研究采用积极的青年发展框架，研究了可改变的保护因素与农村人群中节育措施使用之间的关系。
在一项基于证据的健康教育计划之前，两所低收入和中等收入农村学校的 10 年级健康课的学生完成了调查。对于上次性行为时使用的避孕方法，学生可以勾选所有适用的方法，这些方法被分为三个有序类别：无、仅使用避孕套和激素避孕。预测变量包括性自我效能感（六个项目，α=0.66，“能够说不”）、父母联系（五个项目，α=0.94，“对您的父母/监护人满意吗？”）、语言文化适应（一个项目，“在您的家中，您会说……”）、学校联系（五个项目，α=0.85，“我与学校的人很亲近”）和不良童年经历（八项评分）。这些变量被纳入多变量逻辑有序回归。
样本（N=287）中 52%为女性，48%为拉丁裔，49%为白人。较高的性自我效能感和父母联系得分显著增加了使用更有效的避孕方法的几率。较高的语言文化适应（在家中更有可能说另一种语言）表明不太可能使用更有效的避孕方法。学校联系和不良童年经历在最终模型中并不显著。
农村社区的避孕重点干预措施应针对可改变的保护因素，如自我效能感和父母联系。干预措施需要具有创伤意识并能使用多种语言。
