title: Social discrimination, stress, and risk of unintended pregnancy among young women.
abstract: OBJECTIVE
  Prior research linking young women's mental health to family planning outcomes has often failed to consider their social circumstances and the intersecting biosocial mechanisms that shape stress and depression as well as reproductive outcomes during adolescence and young adulthood. We extend our previous work to investigate relationships between social discrimination, stress and depression symptoms, and unintended pregnancy among adolescent and young adult women.
  
  
  METHODS
  Data were drawn from 794 women aged 18-20 years in a longitudinal cohort study. Baseline and weekly surveys assessed psychosocial information including discrimination (Everyday Discrimination Scale), stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies-Depression Scale), and reproductive outcomes. Multilevel, mixed-effects logistic regression and discrete-time hazard models estimated associations between discrimination, mental health, and pregnancy. Baron and Kenny's method was used to test mediation effects of stress and depression on discrimination and pregnancy.
  
  
  RESULTS
  The mean discrimination score was 19/45 points; 20% reported moderate/high discrimination. Discrimination scores were higher among women with stress and depression symptoms versus those without symptoms (21 vs. 18 points for both, p < .001). Pregnancy rates (14% overall) were higher among women with moderate/high (23%) versus low (11%) discrimination (p < .001). Discrimination was associated with stress (adjusted relative risk ratio, [aRR], 2.2; 95% confidence interval [CI], 1.4-3.4), depression (aRR, 2.4; CI, 1.5-3.7), and subsequent pregnancy (aRR, 1.8; CI, 1.1-3.0). Stress and depression symptoms did not mediate discrimination's effect on pregnancy.
  
  
  CONCLUSIONS
  Discrimination was associated with an increased risk of mental health symptoms and unintended pregnancy among these young women. The interactive social and biological influences on reproductive outcomes during adolescence and young adulthood warrant further study.
authors.affiliation: Department of Obstetrics and Gynecology, Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, Michigan. Electronic address: hkelli@umich.edu.
authors.forename: Kelli Stidham
authors.initials: KS
authors.lastname: Hall
authors.affiliation: Institute for Social Research, Population Studies and Survey Research Centers, University of Michigan, Ann Arbor, Michigan.
authors.forename: Yasamin
authors.initials: Y
authors.lastname: Kusunoki
authors.affiliation: Institute for Social Research, Population Studies and Survey Research Centers, University of Michigan, Ann Arbor, Michigan.
authors.forename: Heather
authors.initials: H
authors.lastname: Gatny
authors.affiliation: Department of Sociology, Institute for Social Research, Population Studies and Survey Research Centers, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barber
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D017677:Age Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008603:Mental Health; D015999:Multivariate Analysis; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D018570:Risk Assessment; D063508:Social Discrimination / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D014481:United States; D055815:Young Adult
keywords: Adolescents; Mental health; Social discrimination; Social epidemiology; Stress; Unintended pregnancy