OBJECTIVES/SPECIFIC AIMS: Alabama (AL) experienced a 145%
increase in its Latino population between 2000 and 2010; making it
the state with the second fastest growing Latino population in the United States
(US) during that time. Adolescent Latinas in the United States and in AL are
disproportionately affected by sexual health disparities as evidenced by the
disproportionate burden of HIV, STIs and early pregnancy compared with their
non-Hispanic, White counterparts. In 2011, Alabama passed 1 of the harshest
anti-immigration laws in the nation. Following the passing of this law, county
health department visits among Latino adults decreased by 25% for
STIs and 13% for family planning. Empirical data with adult Latinas
in the Southeast suggest significant barriers to sexual healthcare access.
However, to our knowledge, no other researchers have examined barriers and
facilitators to sexual healthcare access for this subpopulation. Therefore, the
goal of this 3-phase study is to: (a) better understand the factors underlying
sexual health disparities and gaps in healthcare access among adolescent
Latinas; (b) develop a conceptual model based on these data and the extant
literature summarizing the theorized pathways through which factors at differing
levels of the socioecological model of health (SEMH) impact sexual healthcare
access for this group; and (c) develop community-driven, theory-based,
culturally-relevant, multilevel intervention strategies to reduce sexual health
disparities and increase sexual healthcare access for adolescent Latinas through
a community-engaged, intervention mapping process. Community based participatory
research (CBPR), which ensures equitable participation of stakeholder groups
through partnerships, and the SEMH, which conceptualizes the individual as
nested within a set of social structures, provide the philosophical and
theoretical frameworks for the work. METHODS/STUDY POPULATION: From January of
2017 to December of 2017 we completed phase 1 of the study: conducting and
analyzing 20 semi-structured qualitative interviews with adolescents who:
self-identified as Latina, were between 15 and 20 years of age, had been in the
United States for over 5 years, and lived in one of the counties of West AL and
15 semi-structured qualitative interviews with key stakeholders (healthcare
providers, parents, policy makers, etc.) who regularly work with Latina
adolescents. Interview participants were recruited through
purposeful-convenience sampling. Two bilingual (in English and Spanish) coders
used an iterative process (between independent coding and consensus building) to
analyze the data using NVivo 11. Phase 2 of the study is currently underway:
constructing a conceptual model on sexual healthcare access for young Latinas in
Alabama. We have utilized an iterative process between qualitative interview
data collected in phase 1 and review of the extant literature to draft a
conceptual model of healthcare access among adolescent Latinas in the US South.
This model will serve as the foundation of future studies including the
development of intervention strategies through a CBPR process (phase 3), to
commence in January 2018. RESULTS/ANTICIPATED RESULTS: PHASE 1: Several barriers
and facilitators to sexual healthcare access emerged from the semi-structured
qualitative research interviews with young women. These included: (1) parental
approval/disapproval and embarrassment
(“pena”); (2) structural barriers/facilitators
to care (e.g., lack of transportation, flexible clinic hours); and (3)
negative/positive experiences with providers (e.g., perceived
discrimination based on immigrant status). Key stakeholders identified the
following barriers and facilitators to sexual healthcare access for adolescent
Latinas in their interviews: (1) language barriers/need for
interpreters and outreach workers to work with young Latina women; (2) need for
better sexual health education across the state; (3) lack of knowledge among
young women and their parents about institutions in general and sexual
healthcare, in specific; and (4) perceived lack of
“deservingness” and discrimination from
providers/“not my patients” phenomenon. PHASE
2: This presentation will summarize the development of our conceptual model (see
drafts attached). For ease of interpretation, we have created 2 sub-models
(centering gender and immigration, respectively) which summarize theorized
pathways through which policy, community, organizational, and family-level
factors influence young Latina women’s access to sexual healthcare
services. DISCUSSION/SIGNIFICANCE OF IMPACT: The proposed research is
significant because: (1) the state of AL experienced a dramatic increase in its
Latino/a population over the last 15 years and adolescent Latinas in AL are
disproportionately affected by sexual health disparities; (2) to our knowledge,
this is the only study to examine the multilevel factors associated with sexual
healthcare access for adolescent Latinas in the South and inform intervention
strategies to promote sexual healthcare access in this population; (3) the work
is being conducted under the philosophical lens of CBPR such that community
members are involved in every step of the research process, resulting in
culturally relevant and youth-specific intervention strategies.
Detailed Transmission Network Analysis of a Large Opiate-Driven Outbreak of HIV Infection in the United States
