American Journal of Epidemiology Advance Access originally published online on February 27, 2008
American Journal of Epidemiology 2008 167(9):1102-1109; doi:10.1093/aje/kwn011
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ORIGINAL CONTRIBUTIONS |
Gang Exposure and Pregnancy Incidence among Female Adolescents in San Francisco: Evidence for the Need to Integrate Reproductive Health with Violence Prevention Efforts
1 Women's Global Health Imperative, RTI International, San Francisco, CA
2 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
3 Department of Medicine, University of North Carolina, Chapel Hill, NC
4 Department of Pediatrics, University of California, San Francisco, CA
5 Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
Correspondence to Dr. Alexandra Minnis, Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104 (e-mail: aminnis{at}rti.org).
Received for publication September 1, 2007. Accepted for publication January 11, 2008.
Among a cohort of 237 sexually active females aged 14–19 years recruited from community venues in a predominantly Latino neighborhood in San Francisco, California, the authors examined the relation between gang exposure and pregnancy incidence over 2 years of follow-up between 2001 and 2004. Using discrete-time survival analysis, they investigated whether gang membership by individuals and partners was associated with pregnancy incidence and determined whether partnership characteristics, contraceptive behaviors, and pregnancy intentions mediated the relation between gang membership and pregnancy. Pregnancy incidence was determined by urine-based testing and self-report. Latinas represented 77% of participants, with one in five born outside the United States. One quarter (27.4%) became pregnant over follow-up. Participants' gang membership had no significant effect on pregnancy incidence (hazard ratio = 1.25, 95% confidence interval: 0.54, 3.45); however, having partners who were in gangs was associated with pregnancy (hazard ratio = 1.90, 95% confidence interval: 1.09, 3.32). The male partner's perceived pregnancy intentions and having a partner in detention each mediated the effect of partner's gang membership on pregnancy risk. Increased pregnancy incidence among young women with gang-involved partners highlights the importance of integrating reproductive health prevention into programs for gang-involved youth. In addition, high pregnancy rates indicate a heightened risk for sexually transmitted infections.
adolescent; Hispanic Americans; pregnancy; sexually transmitted diseases; sexual partners; violence
Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; HR, hazard ratio; HSV-2, herpes simplex virus type 2; STI, sexually transmitted infection