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Volume 48, Issue 2
Pages 57 - 64

Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator?

CONTEXT

Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations.

METHODS

A sample of 841 female adolescents (aged 16–19) and 1,387 young adult women (aged 20–24) recruited from 24 family planning clinics in western Pennsylvania in 2011–2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy.

RESULTS

At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, −0.27 to −0.13) and increased odds of STD diagnosis (odds ratios, 1.03–1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect).

CONCLUSIONS

Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.

Authors' Affiliations

Kelley A. Jones is postdoctoral associate, Division of Adolescent and Young Adult Medicine, School of Medicine at the University of Pittsburgh.

Marie D. Cornelius is associate professor, Department of Psychiatry, School of Medicine at the University of Pittsburgh.

Jay G. Silverman is professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA.

Daniel J. Tancredi is associate professor in residence, Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA.

Michele R. Decker is associate professor, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Catherine L. Haggerty is associate professor, Department of Epidemiology, Graduate School of Public Health at the University of Pittsburgh.

Natacha M. De Genna is assistant professor, Department of Psychiatry, School of Medicine at the University of Pittsburgh.

Elizabeth Miller is associate professor, Department of Pediatrics, School of Medicine at the University of Pittsburgh.

Disclaimer
The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.

Perspectives on Sexual and Reproductive Health