This is an application for a K23 award for Marissa Raymond-Flesch, MD, MPH, whose research focuses on the reproductive health and health disparities of Latino adolescents. She has completed three primary data collection projects utilizing community-engaged qualitative methods and has been contributing to the Salinas Teen Health Study, on which this application builds, for the past two years. Her research training includes a masters of public health and fellowships in Adolescent Medicine and Health Policy. Through the activities proposed in this application Dr. Raymond-Flesch will build skills in cross-sectional and longitudinal quantitative data analysis. She will benefit from UCSF's nationally recognized Division of Adolescent and Young Adult Medicine and Institute for Health Policy Studies as well as the university's course work in biostatistics and research methodology. In addition, UCSF will continue to support her productive collaboration with the Salinas Teen Health Study team at RTI. Across these intuitions Dr. Raymond-Flesch has established an experienced mentoring team with expertise in epidemiology, mixed methods research, and adolescent reproductive and mental health. By the completion of this award she will be well positioned to launch a career as an independent investigator, including applying for an R01 award. Informed by the social ecological model, this proposal builds on the Salinas Teen Health Study (R01- HD075787), a prospective cohort study of 600 Latino adolescents over two years as they transition from early to middle adolescence in a Californian agricultural community. Latino youth experience a variety of health disparities, including higher rates of depression and adverse reproductive health outcomes (unintended pregnancy and sexually transmitted infections). Current evidence links depression with negative sexual and reproductive health outcomes in adults, but there is a paucity of research on these associations in Latino adolescents. Additionally, data on how immigrant generation affects these outcomes for Latino adolescents are limited. Dr. Raymond-Flesch's specific aims include a quantitative analysis of the associations between depressive symptoms and sexual and reproductive health outcomes at baseline across first, second, and third generation Latino early adolescents (Aim 1); longitudinal analysis of two years of quantitative data to determine the effect of depressive symptoms during early adolescence on subsequent sexual and reproductive health (Aim 2); qualitative analysis of youth interviews to describe how emotional wellbeing influences sexual and reproductive health (Aim 3); and qualitative interviews with mothers to characterize early environmental and structural factors affecting emotional wellbeing, psychosocial development, and sexual and reproductive health for Latino youth (Aim 4). The roles of immigrant generation and protective family influences will be examined across all aims. At the conclusion of this award Dr. Raymond-Flesch will apply findings to the development of a R01 application for a culturally informed intervention to reduce mental and reproductive health disparities.
Public Health Relevance Latinas have disparately high rates of pregnancy compared to all other racial and ethnic groups of adolescents, with rates highest in California among rural populations, despite falling rates of teen pregnancy nationally. Factors such as emotional health and immigrant generation likely impact engagement in the high risk sexual and reproductive health behaviors that give rise to high rates of teen pregnancy, sexually transmitted infections, and other poor health outcomes for these youth, but additional research is needed to understand the individual, family, and structural factors that give rise to these disparities, particularly for youth in agricultural communities. This study uses quantitative and qualitative methods, including questionnaires and interviews with youth and mothers, to prospectively investigate the individual, family, and structural factors that either promote positive youth development or place youth at risk for high risk sexual and reproductive health outcomes such as pregnancy and sexually transmitted infections.