title: Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power.
abstract: Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15-21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.
authors.affiliation: Department of Epidemiology, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA. janet@post.harvard.edu.
authors.forename: Janet E
authors.identifier: 0000-0001-9796-513X
authors.initials: JE
authors.lastname: Rosenbaum
authors.affiliation: Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zenilman
authors.affiliation: Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Eve
authors.initials: E
authors.lastname: Rose
authors.affiliation: Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Wingood
authors.affiliation: Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: DiClemente
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001741:Black or African American / Q000523:psychology*; D005260:Female; D005544:Forecasting; D006801:Humans; D007407:Interviews as Topic; D000066511:Intimate Partner Violence; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011582:Psychological Theory; D036301:Qualitative Research; D014481:United States; D047568:Unsafe Sex; D014505:Urban Population
keywords: Adolescents; Condoms; Intimate partner violence; Safe sex; Unplanned pregnancy