(provided by the investigator): Unintended pregnancy occurs frequently in the U.S. and has many social and economic costs. The 2001 National Survey of Family Growth (NSFG) estimated that 49% (3.1 million) of all U.S. pregnancies were unintended (Finer &Henshaw, 2006). A Healthy People 2010 objective is to reduce this figure to 30% (objective 9-1). Hispanic women have higher than average fertility rates and unintended pregnancy rates and also terminate a smaller percentage of unintended pregnancies than the national average. These factors combined give Hispanic women an unintended birth rate of almost twice the national average (Finer &Henshaw, 2006). To design effective and culturally competent programs to help Hispanic women prevent these unintended births, it is important to understand the correlates, cultural context, and women's perceptions of unintended pregnancy in Hispanic communities. As such, specific aims of this mixed-method dissertation are: to determine the sociodemographic correlates of pregnancy intention in a sample of predominantly low-income Latina women using previously-collected quantitative data, to explore the cultural relevance of the construct of pregnancy intendedness among Latina women though qualitative interviews, and to use cognitive interviewing techniques to explore women's perceptions of commonly-used measures of pregnancy intendedness and provide data on women's cognitive processing of the given measures. A second component of this dissertation is to test the adverse effects of unintended births on perinatal depression in this population. Postpartum depression is common (prevalence 13%;O'Hara &Swain, 1996) and Hispanic women exhibit a risk of depressive symptoms twice as high as White, non-Hispanic women (Howell, Mora, Horowitz, &Leventhal, 2005;Huang, Wong, Ronzio, &Yu, 2007;Rich-Edwards et al., 2006). There is limited research on pregnancy intention and maternal mental health outcomes (Gipson, Koenig, &Hindin, 2008). The few studies that have been conducted suggest an association between unintended pregnancy and poor maternal mental health (Barber, Axinn, &Thornton, 1999;Lau &Keung, 2007;Najman, Morrison, Williams, Andersen, &Keeping, 1991;Nakku, Nakasi, &Mirembe, 2006;Orr &Miller, 1997;Sayil, Gure, &Ucanok, 2006). However, many of these studies have methodological limitations, including cross-sectional study design, bivariate statistical analyses that do not control for confounding variables, and uncommon or unvalidated measures of depression and/or pregnancy intention. To fill this gap in research on the outcomes of unintended pregnancy, the final specific aim of this dissertation is to use longitudinal linear regression models to determine if there is an adjusted association between unintended pregnancy and perinatal depressive symptoms using previously-collected longitudinal data on mental health among Latinas.

Public Health Relevance

Hispanic women in the U.S. have higher than average unintended pregnancy rates. There may be cultural differences in Hispanic women's family planning decision-making, their reproductive self-efficacy (feelings of control over family planning), as well as their perceptions and consequences of unintended pregnancy. In order to develop targeted, culturally-appropriate, and effective programs to prevent unintended pregnancy in this population and achieve the Healthy People 2010 objective of reducing unintended pregnancy in the U.S., public health research must explore the correlates, cultural context, and consequences of unintended pregnancy in this growing high-risk population.

National Institute of Health (NIH)
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Dissertation Award (R36)
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Special Emphasis Panel (ZCD1-CJM (07))
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Johns Hopkins University
Schools of Public Health
United States
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Christensen, Anna L; Stuart, Elizabeth A; Perry, Deborah F et al. (2011) Unintended pregnancy and perinatal depression trajectories in low-income, high-risk Hispanic immigrants. Prev Sci 12:289-99