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  1. Predictors of Sexual Relationship Power, Communication and Sexual Decision Making among Latino Couples Yui Matsuda, PhD, RN, MPH School of Nursing University of North Carolina at Chapel Hill Jacqueline M. McGrath, PhD, RN, FNAP, FAAN School of Nursing, University of Connecticut Nancy Jallo, PhD, RNC, FNP-BC, WHNP-BC, CNS School of Nursing, Virginia Commonwealth University Everett Worthington, Jr. PhD Department of Psychology, Virginia Commonwealth University Rosalie Corona, PhD Department of Psychology, Virginia Commonwealth University

  2. Acknowledgement This study was supported by -2011 Council for Advancement of Nursing Science (CANS)/Southern Nursing Research Society (SNRS) Dissertati​on Award, &-Sigma Theta Tau International Gamma Omega Chapter; Nursing Research Grant • Drs. Marie Harvey, Linda Castillo and Joseph Catania for their permission to use their questionnaires

  3. Latinos in the United States &Unintended Pregnancies • One in six Americans are Latinos(U.S. Census, 2011) • Account for over 50% of U.S. growth rate (Pew Hispanic Center, 2011) • Increasing unintended pregnancy rate (Finer and Henshaw, 2006) • Short birth interval-negative effect on family’s lives at birth and beyond(Fuente-Afflick & Hessol, 2000; Bhutta et al., 2002; Conde-Agudelo, Rosas-Bermudez, & Kafury-Goeta, 2007; El-Kamary, Higman, Fuddy, McFarlane, Sia, & Duggan, 2004)

  4. Critical elements for unintended pregnancy prevention -Family planning (WHO, 2008) -Discussion and decision making among couples (Becker, 1995; Harvey, Henderson, & Casillas. 2006; Harvey & Henderson, 2006; Beckman et al., 2006) -Both member of couple’s involvement  (Kraft et al., 2007; Harvey et al., 2004) • Prenatal period is perfect time to reach the immigrant Latino population (Geltman & Meyers, 1999) • Hard to reach population at other times (Pearson, Ahluwalia, Ford, & Mokdad, 2008)

  5. Specific Aims Determine predictors of -Sexual relationship power -Communication -Sexual decision making

  6. Framework Individual Characters Influence of Cultural Values Relationship Adjustment Communication Perception, Attitude, Norms towards Contraception Relationship Commitment Number of Children Sexual Relationship Power Sexual Decision Making Religiosity/ Spirituality

  7. Study Design • Cross-sectional descriptive study • Pregnant Immigrant Latinas and their male Latino partners • Sample size: 40 couples

  8. Study Participants-Inclusion Criteria • Both partners: 18 or older • Female partner in second or third trimester • Both partners being born in any Latin American countries and immigrated to the U.S. • Latinos who understand and speak Spanish • Couples who are in some form of relationship (married or living together) • Couples who intend to sexually active after delivery • Partner without sterilization procedure • Both members of the couple want to participate in the study.

  9. Recruitment • 2 Prenatal CareClinics in Richmond, Virginia • Total number of womenapproached : 130 • Numberrecruited and enrolled: 40 couples

  10. Variables(total:177[men],180 [women]items)

  11. Data Analysis • Descriptive Statistics (women and men separately) • Hierarchical Multiple Regression Analyses (women and men separately)

  12. DescriptiveStatistics

  13. Participants’ Characteristics

  14. HierarchicalMultipleRegressionAnalyses

  15. Sexual RelationshipPower (Women) F(8,26) = 6.776, p < 0.001. PerceivedRelationshipCommitment β=0.59 p=0.004 RelationshipSatisfaction β=0.422 p=0.007 ∆ R2 0.393 PerceivedDecisionMaking β=-0.398 p=0.041 RelationshipCommitment DecisionMaking Model 3 (R2=0.822) Model 2 : (R2=0.532) Communication & Sexual Comunication ∆ R2 0.171 Model 1: (R2 =0.334) Machismo β=-0.562 P=0.001

  16. Sexual RelationshipPower (Men) F(8,27) = 1.718, p = 0.14 -Relationship Commitment -Perceived Relationship Commitment -Relationship Satisfaction -Decision Making -Perceived Decision Making Model 3 (R2=0.337) ∆ R2 0.206 ∆ R2 0.094 Sexual Comunication β=0.549 p=0.013 Model 2 : (R2=0.243) Communication Model 1: Machismo (R2 =0.037)

  17. Sexual RelationshipPower (Men-uniquemodel) F(9,26)=3.293, p =0.008 Model 5 (R2=0.553) Relationship Satisfaction Decision Making Perceived Decision Making ∆ R2 0.004 Model 4: (R2=0.451) ∆ R2 0.082 Sexual Communication ∆ R2 0.008 Model 3 : (R2=0.443) Contraception Barrier β=-0.672 p=0.01 ∆ R2 0.262 Model 2 : (R2=0.181) Machismo β=0.574 p=0.028 Model 1: (R2=0.177) Age, Years of Education, & Time in US

  18. Model 5: Sexual RelationshipPower (R2 =0.502) RelationshipSatisfaction β=0.484 p=0.021 Model 4 (R2=0.481) ∆ R2 0.02 ∆ R2 0.334 RelationshipCommitment& DecisionMaking Model 3 : (R2=0.147) Machismo β=0.69 p=0.001 Marianismo β=-0.855 p=0.003 Model 2 : (R2=0.051) Length of Relationship ∆ R2 0.097 Time in US β=-0.465 P=0.008 ∆ R2 0.09 Communication (Women) F(8,28) =3.524, p =0.006 Model 1 (R2=0.042)

  19. Model 5: Sexual RelationshipPower (R2 =0.545) RelationshipCommitment β=0.432 p=0.012 ∆ R2 0.000 Model 4 (R2=0.545) RelationshipSatisfaction& DecisionMaking ∆ R2 0.274 Machismo &Marianismo Model 3 : (R2=0.271) Model 2 : (R2=0.231) Length of Relationship ∆ R2 0.04 Time in US β=-0.473 P=0.003 ∆ R2 0.072 Communication (Men) F(8,27) =4.044, p =0.003 Model 1 (R2=0.159)

  20. Model 3 (R2=0.541) Model 4: Sexual RelationshipPower (R2 =0.547) PerceivedRelationshipCommitment, RelationshipSatisfaction& DecisionMaking ∆ R2 0.006 RelationshipCommitment β=0.379 p=0.029 Model 1 (R2=0.152) ∆ R2 0.388 Time in US β=-0.384 P=0.015 Model 2 : (R2=0.153) Number of Children ∆ R2 0.000 Years of Education Communication (Men-UniqueModel) F(8,28) =4.229, p =0.002

  21. Model 5: Sexual RelationshipPower (R2 =0.464) RelationshipCommitment β=0.484 p=0.021 Model 4 (R2=0.444) ∆ R2 0.019 ∆ R2 0.323 RelationshipSatisfaction Length of Relationship β=-0.438 P=0.006 Model 3 : (R2=0.122) Contraception Barrier Model 2 : (R2=0.099) ∆ R2 0.023 Model 1: (R2=0.006) Age & Years of Education ∆ R2 0.093 # of children in Life Sexual Communication (Women) F(8,29) =3.136, p =0.011

  22. RelationshipCommitment β=0.54 p=0.001 Model 5: Sexual RelationshipPower (R2 =0.528) Model 4 (R2=0.485) ∆ R2 0.043 ∆ R2 0.276 RelationshipSatisfaction Model 3 : (R2=0.209) Contraception Barrier Model 2 : (R2=0.045) Length of Relationship # of children in Life ∆ R2 0.164 Model 1: (R2=0.022) Age & Years of Education ∆ R2 0.023 Sexual Communication (Men) F(8,29) =4.058, p =0.002

  23. RelationshipCommitment β=0.595 p=0.002 Model 4: Sexual RelationshipPower (R2 =0.555) ∆ R2 0.027 Model 3 (R2=0.529) RelationshipSatisfaction & DecisionMaking ∆ R2 0.309 Contraception Barrier β=-0.345 p=0.037 Model 2 : (R2=0.219) ∆ R2 0.188 Model 1: (R2=0.031) Age,Years of Education, & Time in US Sexual Communication (Men-uniquemodel) F(8,28) =4.37, p =0.002

  24. Model 3 (R2=0.73) RelationshipSatisfaction β=0.508 p=0.000 RelationshipCommitment β=0.719 p=0.000 Model 4: Sexual RelationshipPower (R2 =0.751) ∆ R2 0.021 Communication ∆ R2 0.577 Model 1: (R2=0.01) Model 2 : (R2=0.153) Marianismo β=-0.944 p=0.000 Religious Commitment β=0.315 p=0.011 ∆ R2 0.143 Time is US β=-0.432 p=0.001 Age Sexual DecisionMaking (Women) F(8,27) =10.167, p =0.000

  25. Sexual DecisionMaking (Men) F(8,28)=2.000, p=0.084 Model 4: Sexual RelationshipPower (R2 =0.364) Model 3 (R2=0.361) Communication, RelationshipCommitment, & RelationshipSatisfaction ∆ R2 0.003 ∆ R2 0.075 Model 2 : (R2=0.286) Marianismo ∆ R2 0.153 Model 1: (R2=0.133) Age, Religious Commitment, Time is US

  26. Model 4: Sexual RelationshipPower (R2 =0.547) Model 4 : (R2=0.45) Communication & RelationshipSatisfaction ∆ R2 0.006 ∆ R2 0.075 Marianismo β=0.394 p=0.018 ∆ R2 0.169 # of Children in Life β=0.438 P=0.034 Model 1 (R2=0.135) Age, Years of Education & Religious Commitment Model 3 (R2=0.541) ∆ R2 0.071 Sexual DecisionMaking (Men-UniqueModel) F(8,28)=2.932, p=0.016 Model 2 (R2=0.206)

  27. Discussion • Power (sharedpower vs. dominatingpower) • Difference in results -Women: Relationshipfactors -Men: Contraceptionbarriers, demographics • RelationshipCommitment • Cultural factors • Acculturation

  28. NursingImplication POSTPARTUM CONTRACEPTION DURING PRENATAL CARE VISITS • Contraceptioneducationforcouples (particularly MEN) • Encouragemen’sinvolvement at prenatal carevisits • Clinicianbecomingaware of partner status/dynamics • Askingaboutthepregnancyintention • Askingabout plan, reason, experience & partner’sthoughts • Incorporatecouples’ piece in theCenteringPregnancyprogram • Maynotseethewomenuntilnext time they are pregnant

  29. Limitation • Design: cross-sectionalstudy (vs. Intervention, longitudinal study) • Sampling: Convenientsampling • Samplesize: limitfactorsincluded in theregressionanalyses • Characteristicsamong Latinos fromdifferentcountries • Selfreportabout sexual decisionmaking

  30. FutureResearch • Comparison of Couples’ score pairs • Dyadicanalysis • Psychometric properties for the Sexual Relationship Power Scale on men • Examine further about Pregnant Single Women (almost 20% of the recruitment population) • Look at associations of the variables studied and unintended pregnancy, depressive symptoms and past violence/abuse/trauma experience • Designcouples’ interventiontoaddress sexual relationshippower, increasecouples’ communication and sexual decisionmakingforthebetterqualitylifefor Latino family

  31. Questions? Yui Matsuda Postdoctoral fellow, T32 Grant Health Care Quality & Patient Outcomes School of Nursing The University of North Carolina at Chapel Hill 4110 Carrington Hall, Campus Box 7460 Chapel Hill, NC 27599-7460 TEL: (804)840-9707, FAX: (919) 966-0984 ymatsuda@email.unc.edu

  32. References • Becker S. Couples and reproductive health: a review of couple studies. Stud FamPlann 1996 November;27(6):291-306. • Beckman LJ, Harvey SM, Thorburn S, Maher JE, Burns KL. Women's acceptance of the diaphragm: the role of relationship factors. J Sex Res 2006 November;43(4):297-306. • Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002 August 14;288(6):728-37. • Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. Am J ObstetGynecol 2007 April;196(4):297-30. • El-Kamary SS, Higman SM, Fuddy L, McFarlane E, Sia C, Duggan AK. Hawaii's Healthy Start Home Visiting Program: Determinants and Impact of Rapid Repeat Birth. Pediatrics 2004; 114(3):e317-326. • Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006 June;38(2):90-6. • Fuentes-Afflick E, Hessol NA. Interpregnancy interval and the risk of premature infants. Obstet Gynecol 2000 March;95(3):383-90. • Geltman PL, Meyers AF. Immigration legal status and use of public programs and prenatal care. Journal of immigrant health, 1999;1(2):91-7.

  33. Geltman PL, Meyers AF. Immigration legal status and use of public programs and prenatal care. Journal of immigrant health, 1999;1(2):91-7. • Harvey SM, Henderson JT. Correlates of condom use intentions and behaviors among a community-based sample of Latino men in Los Angeles. J Urban Health 2006 July;83(4):558-74. Harvey SM, Henderson JT, Casillas A. Factors associated with effective contraceptive use among a sample of Latina women. Women Health 2006;43(2):1-16. • Harvey SM, Henderson JT, Thorburn S et al. A randomized study of a pregnancy and disease prevention intervention for Hispanic couples. Perspect Sex Reprod Health 2004 July;36(4):162-9. • Kraft JM, Harvey SM, Thorburn S, Henderson JT, Posner SF, Galavotti C. Intervening with couples: assessing contraceptive outcomes in a randomized pregnancy and HIV/STD risk reduction intervention trial. Womens Health Issues 2007 January;17(1):52-60. • Pearson WS, Ahluwalia IB, Ford ES, Mokdad AH. Language preference as a predictor of access to and use of healthcare services among Hispanics in the United States. Ethnicity & Disease, 2008; 18(1):93-7. • Pew Hispanic Center. Hispanics Account for More than Half of Nation's Growth in Past Decade. Internet 2011. Available at: URL: http://pewhispanic.org/reports/report.php?ReportID=140 • U.S. Census. The Hispanic population:2010. Internet 2011; Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf • World Health Organization. Family Planning. Internet 2008;Available at: URL: http://www.who.int/topics/family_planning/en/.