Objectives We compared fertility desires and intentions among women with disabilities and women without disabilities in the United States, using a new evidence-based measure of disability. Methods We analyzed data from a sample of 5601 US women 15–44 years of age in the 2011–2013 National Survey of Family Growth. The data were analyzed via cross-tabulation and logistic regression. We classified women into those with a disability and those without a disability. Results Women with disabilities were about as likely to want a baby (61%) as women without disabilities (60%). But only 43% of women with disabilities intended to have a baby in the future, compared with 50% of women without disabilities. Thus, the difference between the percent who want a baby and the percent who intend to have one was larger for disabled women. Women with disabilities were also less certain of their fertility intentions. Multivariate analysis shows that having a disability lowers the odds of intending another birth, after controlling for several other determinants of fertility intentions. Conclusions for Practice All women, regardless of disability status, desired more children than they actually planned to have, but the gap was larger for most groups of women with disabilities than for non-disabled women. Given the sample sizes available in this analysis, future research should use more detailed classifications of disability, however, we have shown that women living with disabilities constitute large populations with unexplored family planning needs.

BackgroundThe Well-Being of Adolescents in Vulnerable Environments (WAVE) study was conducted among adolescents aged 15-19 years in Baltimore, Ibadan, Johannesburg, New Delhi, and Shanghai to examine perceived factors related to their health. A preliminary analysis of the data, unexpectedly, revealed that the influence of the physical environment on adolescent health was a dominant theme across every site examined. To explore this further, this paper analyzed the specific components of the physical environment that were perceived to influence health, and how they contributed to various health outcomes across sites.MethodsResearchers in each site conducted in-depth interviews among adolescents; community mapping and focus groups among adolescents; a Photovoice methodology, in which adolescents were trained in photography and took photos of the meaning of ‘health’ in their communities; and key informant interviews among adults who work with young people. A total 529 participants from across the sites were included in the analysis.ResultsFindings showed that while there was surprising uniformity in how adolescents characterized their physical environment, perceived health outcomes related to the physical environment varied by site and gender. In Baltimore and Johannesburg, vacant homes and the lack of recreation facilities were perceived to impact on sexual and reproductive health problems for girls, while among boys they contributed to drugs and violence. In Shanghai, New Delhi, and Ibadan, garbage and trash observed in their communities were perceived to have a higher impact on infectious and chronic diseases.ConclusionsAs the world continues to urbanize, our study points to a strong need to examine how the physical aspects of a living environment contribute to the health of adolescents. Specific aspects, such as housing, safety, garbage, and recreational spaces must all be examined as possible pathways for making improvements to health of adolescents, particularly among those living in poor urban environments.

Parent-teen discussions about sexual and reproductive health (SRH) are associated with delayed sex and higher contraceptive use among teens. Using the National Survey of Family Growth, we conducted bivariate and multivariate analyses of different types of parent-teen SRH discussions among two cohorts of teens. We describe differences in patterns for males and females by race/ethnicity and nativity, and test for racial/ethnic interactions within each cohort. Analyses found that the prevalence of parent-teen discussions about SRH increased across cohorts. For males and females, there were increases in parent-teen discussions about condoms, and for males only, there were increases in any SRH discussions and discussions about contraception and STIs. Based on interactions, parent-teen discussions and STI discussions increased most for Hispanic females, and among Hispanics, increased most for the foreign-born. These data indicate increases in different types of parent-teen SRH discussions, particularly for males and foreign-born teens overall, and for Hispanic teen females regarding condom use. Future research should examine what factors are driving these changes, including changes in the structure of U.S. Hispanic communities and expansion of evidence-based teen pregnancy prevention programs.

Purpose This study uses data collected as part of the Well-Being of Adolescents in Vulnerable Environments (WAVE) study to: 1) compare the perceptions of neighborhood-level factors among adolescents across five different urban sites; 2) examine the associations between factors within the physical and social environments; and 3) examine the influence of neighborhood-level factors on two different health outcomes -- violence victimization in the past 12 months and ever smoked. Methods Across five urban sites (Baltimore, New Delhi, Johannesburg, Ibadan, and Shanghai), 2320 adolescents aged 15-19 years completed a survey using ACASI technology. To recruit adolescents, each site used a respondent-driven sampling method, which consisted of selecting adolescents as ‘seeds’ to serve as the initial contacts for recruiting the entire adolescent sample. All analyses were conducted with Stata 13.1 statistical software, using complex survey design procedures. To examine associations between neighborhood-level factors, as well as among our two outcomes, violence victimization and ever smoked, bivariate and multivariate analyses were conducted. Results Across sites, there was great variability in how adolescents perceived their neighborhoods. Overall, adolescents from Ibadan and Shanghai held the most positive perceptions about their neighborhoods, while adolescents from Baltimore and Johannesburg held the poorest. In New Delhi, despite females having positive perceptions about their safety and sense of social cohesion, they had the highest sense of fear, as well as the poorest perceptions about their physical environment. The study also found that one of the most consistent neighborhood-level factors across sites and outcomes was witnessing community violence, which was significantly associated with smoking among adolescents in New Delhi and Johannesburg, and with violence victimization across nearly every site except Baltimore. No other neighborhood-level factor exerted greater influence. Conclusions This study confirms the important associations between perceptions of a neighborhood and adolescent health. At the same time, it demonstrates that not all neighborhood-level factors are associated with adolescent health outcomes in the same way across different urban contexts. Further longitudinal research is needed to examine the direction of causation between adolescent health neighborhood contexts and health outcomes, and the reasons for why different urban contexts may exert varying levels of influence on the health of adolescents.