Adolescent and young adult women in the U.S., especially racial/ethnic minority and poor young women, have high rates of early and unintended pregnancy, which are associated with a host of adverse outcomes. While proximal and distal determinants of fertility have been widely studied, little research has focused on the role of stress in unintended pregnancy. Stress is a leading contributor to morbidity and mortality and a key mechanism that links social context and health disparities. The biological and psychological processes of stress may affect the pathways to unintended pregnancy, but this has not been addressed in reproductive health research. Moreover, how social determinants of stress shape young women's risk of unintended pregnancy is unknown. To improve our knowledge of the complex, interrelated determinants of unintended pregnancy and to advance reproductive health scholarship at the intersection of biological and social processes (i.e. biosocial), this K01 Mentored Research Scientist Development Award focuses on the important but understudied role of stress in unintended pregnancy during adolescence and young adulthood. So that I may conduct cutting-edge research in this area, I propose career development training to: 1) learn sociological theories, concepts, and methods for studying unintended pregnancy and stress; 2) build competency in bio demographic research methods and their application to fertility research; 3) attain a more nuanced understanding of the theory and research on the biology of stress and fecund ability; and 4) become proficient in advanced multilevel, longitudinal, and mediational statistical methods required for modeling the life course of and pathways between stress and unintended pregnancy. The corresponding K01 research project will: 1) estimate how trajectories of stress relate to unintended pregnancy; 2) investigate relationships between social determinants of stress (social stressors), stress trajectories, and unintended pregnancy; and 3) explore the biological processes (e.g., neuroendocrine, inflammatory, and immune) through which stress influences unintended pregnancy, during adolescence and young adulthood. To assist with the K01 training and research plans, I have assembled a strong multidisciplinary advisory board comprised of esteemed scholars, including mentor Jennifer Barber PhD, co-mentor Kathleen Mullan Harris PhD, scientific advisors Ana Diez Roux MD PhD, Timothy Johnson MD, and Julia Seng PhD MSN, and statistical consultant Yu Xie PhD. The University of Michigan Department of Obstetrics and Gynecology and Institute for Social Research and The University of North Carolina at Chapel Hill School of Public Health and Carolina Population Center will provide the infrastructures to support these activities. This K01 will establish me as an independent investigator poised to conduct new biosocial studies of fertility and ultimately lead innovative, interdisciplinary research efforts to improve outcomes an reduce disparities in young women's reproductive health.

Public Health Relevance

Unintended pregnancy during adolescence and young adulthood is a persistent public health problem with negative implications for young women, their offspring, and society. Stress, which is prevalent across the reproductive life course and is a contributor to morbidity, mortality, and health disparities, has been understudied in reproductive health research. Using an innovative, comprehensive, and interdisciplinary approach, this study will provide new insights into the biosocial processes of stress that shape the risk of unintended pregnancy during adolescence and young adulthood, and findings will help identify reproductive health services, programs, and policies to improve reproductive outcomes and reduce disparities among young women.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01HD080722-04
Application #
9491596
Study Section
National Institute of Child Health and Human Development Initial Review Group (CHHD)
Program Officer
King, Rosalind B
Project Start
2015-08-26
Project End
2019-05-31
Budget Start
2018-06-01
Budget End
2019-05-31
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Emory University
Department
Psychology
Type
Schools of Public Health
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Hall, Kelli Stidham; Morhe, Emmanuel; Manu, Abubakar et al. (2018) Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana. PLoS One 13:e0195163
Hall, Kelli Stidham; Manu, Abubakar; Morhe, Emmanuel et al. (2018) Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana. J Sex Res 55:60-72
Hall, Kelli Stidham; Manu, Abubakar; Morhe, Emmanuel et al. (2018) Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma. Qual Res Med Healthc 2:55-64
Challa, Sneha; Manu, Abubakar; Morhe, Emmanuel et al. (2018) Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana. Women Health 58:434-450
Hall, Kelli Stidham; Richards, Jennifer L; Harris, Kathleen Mullan (2017) Social Disparities in the Relationship Between Depression and Unintended Pregnancy During Adolescence and Young Adulthood. J Adolesc Health 60:688-697
Hall, Kelli Stidham; Dalton, Vanessa K; Zochowski, Melissa et al. (2017) Stressful Life Events Around the Time of Unplanned Pregnancy and Women's Health: Exploratory Findings from a National Sample. Matern Child Health J 21:1336-1348
Hogue, Carol J; Hall, Kelli Stidham; Kottke, Melissa (2017) Hormonal Contraceptives Improve Women's Health and Should Continue to Be Covered by Health Insurance Plans. Ann Intern Med 167:666-667
Hall, Kelli Stidham; Kottke, Melissa; Dalton, Vanessa K et al. (2017) Ongoing Implementation Challenges to the Patient Protection and Affordable Care Act's Contraceptive Mandate. Am J Prev Med 52:667-670
Hall, Kelli Stidham; Harris, Lisa H; Dalton, Vanessa K (2017) Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers. Womens Health Issues 27:196-205
Crissman, Halley P; Hall, Kelli Stidham; Patton, Elizabeth W et al. (2016) U.S. Women's Intended Sources for Reproductive Health Care. J Womens Health (Larchmt) 25:91-8

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