The proposed Mentored Patient-Oriented Research Career Development Award (K23) is to provide the candidate with training and research experiences that will promote her development as an independent clinician-researcher, with particular emphasis in the field of healthcare-based intervention research addressing gender-based violence, specifically reproductive coercion (RC), among medically underserved female adolescents in Mexico. This training will provide her with the opportunity to develop knowledge and skills in: 1) reproductive coercion (RC) epidemiology, assessment and prevention; 2) acquire knowledge in the theory, development, implementation, and adaptation of theoretically driven clinic-based behavioral interventions to reduce RC; 3) Acquire skills in multilevel modeling of longitudinal data to assess the efficacy of clinic-based behavioral interventions. Training activities will include didactic coursework and specific workshops, directed readings and one-on-one tutorials with mentors, and instruction in the responsible conduct of research. The candidate will receive mentorship from a Training Committee comprised of globally renowned experts in the fields of gender-based violence, reproductive coercion, adolescent health, healthcare-based screening and brief interventions for RC and epidemiology research. The present K23 research project emerges from the existing research infrastructure of Drs. Silverman and Miller's ARCHES (Addressing Reproductive Coercion in Healthcare Settings) intervention, specific aims are to conduct secondary data analysis of the sub-sample of adolescents (16-20 years old) from ARCHES and 1) Conduct epidemiologic research to estimate the prevalence and correlates of RC among US female adolescents ages 16-20 (n=1311) from the ARCHES intervention; 2) Conduct multilevel longitudinal data analyses of the ARCHES adolescent sample to evaluate the effect of the intervention on RC among this group; 3) Conduct qualitative research to identify barriers to and adapt the ARCHES intervention to improve the reproductive autonomy of female adolescents in urban health clinics in Tijuana (Mexico); 4) Implement the adapted ARCHES intervention for female adolescents in urban health clinics in Tijuana, pilot test its feasibility and estimate effect sizes needed for future lrge-scale randomized controlled trial (RCT). While the specified initial goal of this work is a clinic-based intervention model adapted for adolescent health care in Mexico, the candidates' longer-term goal is to expand implementation of such programs throughout Latin America and in other low and middle-income countries.

Public Health Relevance

Reproductive Coercion (RC) has been associated with numerous negative effects on the physical, sexual, and mental health of young women and girls, with RC prevalence the highest among adolescents; 20% of adolescent family planning (FP) clients reporting such abuse. Findings from the proposed research will be critical to the adaptation, implementation, and evaluation of theoretically driven, empirically informed behavioral interventions that address RC among adolescents in a Latin-American country (Mexico) that can be further applied to other settings. In addition, the proposed project will allo the candidate to master a complex set of research skills in development and evaluation of theoretically driven clinic-based interventions, and develop topical expertise required to fully characterize and reduce the impact of RC, and potentially unintended pregnancies among underserved female adolescents in Mexico and other low and middle-income countries.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Biobehavioral and Behavioral Sciences Subcommittee (CHHD)
Program Officer
Newcomer, Susan
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University of California San Diego
Internal Medicine/Medicine
Schools of Medicine
La Jolla
United States
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Servin, Argentina E; Reed, Elizabeth; Brouwer, Kimberly C et al. (2017) Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region. Sex Transm Dis 44:477-482