Male partners' support and influence on pregnant women's oral PrEP use and adherence in Malawi.

Introduction: Daily oral pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for pregnant and postpartum women, but adherence barriers exist. Understanding the role of male partners in supporting PrEP use may inform strategies to support PrEP adherence among pregnant and breastfeeding women. Methods: To understand male partners' involvement in women's use of PrEP, we conducted in-depth interviews with pregnant women in Lilongwe, Malawi who had recently decided to use PrEP (n = 30) and their male partners (n = 20) in the context of a PrEP adherence trial. Women were purposively recruited to ensure variation in their partners' HIV status. Interviews were conducted in Chichewa using a semistructured guide. We followed a thematic approach to analyze the interview data. Results: Most male partners were receptive to women using PrEP during pregnancy because it eased their fears of the woman and baby acquiring HIV. Men often played a key role in women's PrEP adherence by providing daily reminders and encouragement to adhere to their medication. The majority of women appreciated this support from the men as it lessened the burden of remembering to take their medications daily on their own and aided their adherence. However, several women who lacked male partner support spoke of wanting their partners to be more involved. Many men living with HIV found the mutual support beneficial for their antiretroviral therapy adherence, while men without HIV or with status unknown appreciated knowing that the family was protected. While most men were open to women continuing PrEP beyond the current study, some would only support it if women were still at risk for acquiring HIV. Conclusion: In this study, male partners were strongly motivated to support the PrEP adherence of their female partners as a way of ensuring that the pregnant women and unborn babies were protected against HIV. Promoting disclosure and tangible support that arises organically among men may be helpful, but programs to enhance this support and identify ways to support women who do not receive support from their partners or do not wish to disclose their PrEP use to partners may be needed.

Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed-methods study.

INTRODUCTION: Pre-exposure prophylaxis (PrEP) is a promising tool for HIV prevention during pregnancy. With increasing rollout in antenatal settings, counselling strategies to help pregnant women make appropriate decisions about PrEP use are needed. Understanding women's motivations and concerns for PrEP use-and how these inform their decision making and feelings about the decision to start PrEP-are critical to inform these strategies. METHODS: We conducted a convergent mixed-methods study from June 2020 to June 2021 in the context of a PrEP adherence support trial among HIV-negative pregnant women in Lilongwe, Malawi. Two hundred women completed a survey reporting their motivations and concerns about PrEP use, and their feelings about the decision to start PrEP (Decisional Regret Scale). Thirty women completed in-depth interviews to better understand the decision-making process, including motivations and concerns weighed in women's decision to use PrEP. Analyses comprised descriptive and bivariate statistics, thematic qualitative analysis, and integration of quantitative and qualitative results. RESULTS: Women initiating PrEP during pregnancy were highly motivated to obtain HIV protection for themselves and their unborn child, often due to perceived HIV risk connoted by a recent sexually transmitted infection and/or concerns about partner non-monogamy. These motivations prevailed despite some concerns about safety and side effects, anticipated stigmatization, and concerns about adherence burden and pill attributes. Many women had informed their partner of their decision to use PrEP yet few felt their decision was contingent upon partner approval. Most women felt positively about the decision to start PrEP (mean decisional regret = 1.2 out of 5), but those with a greater number of concerns reported greater decisional regret (B = 0.036; p = 0.005). Furthermore, women who were specifically concerned about partner disclosure, who disliked pills or who had no perceived HIV risk reported greater decisional regret. CONCLUSIONS: Pregnant women were strongly motivated by the promise of HIV protection offered by PrEP and accepted it despite diverse concerns. A shared decision-making approach that centres pregnant women and offers partner involvement may help identify and address initial concerns about PrEP use and support prevention-effective use of PrEP during this important period.

How Religion, Social Class, and Race Intersect in the Shaping of Young Women's Understandings of Sex, Reproduction, and Contraception.

Using a complex religion framework, this study examines how and why three dimensions of religiosity-biblical literalism, personal religiosity, and religious service attendance-are related to young women's reproductive and contraceptive knowledge differently by social class and race. We triangulate the analysis of survey data from the Relationship Dynamics and Social Life study (RDSL) and semi-structured interview data from the National Study of Youth and Religion (NSYR) to identify and explain patterns. From the quantitative data, we find that all three dimensions of religiosity link to young women's understandings of sex, reproduction, and contraception in unique ways according to parental education and racial identity. There is a lack of knowledge about female reproductive biology for young women of higher SES with conservative Christian beliefs (regardless of race), but personal religiosity and religious service attendance are related to increased contraceptive knowledge for young black women and decreased knowledge for young white women. From the qualitative data, we find that class and race differences in the meaning of religion and how it informs sexual behavior help explain results from the quantitative data. Our results demonstrate the importance of taking a complex religion approach to studying religion and sex-related outcomes.

Understanding Why Religious Involvement's Relationship With Education Varies by Social Class.

Religiosity's impact on adolescent educational outcomes has been widely documented in the sociology of religion literature. Building upon King's conceptual framework of ideological, social, and transcendent resources that are made available to youth through religious participation, we use qualitative and quantitative data from the National Study of Youth and Religion (NSYR) to explore how the associations between religious involvement and educational outcomes may vary among lower and higher socioeconomic status youth. Our findings indicate significant positive effects of transcendent and ideological resources on educational outcomes, especially among youth from disadvantaged backgrounds, but limited influence of social resources through youth's religious participation.

The Increasing Diversity and Complexity of Family Structures for Adolescents.

The structure of adolescents' families, and thus parental forms, in the United States, have become more heterogeneous and fluid over the past several decades. These changes are due to increases in never-married, single parents, divorce, cohabitation, same-sex parenting, multi-partnered fertility, and co-residence with grandparents. We document current diversity and complexity in adolescents' families as important context for rethinking future parenting theory and research. We also discuss how understandings of adolescents' families are somewhat limited by current methods used to measure characteristics of families. We recommend social network and profile-based methods as alternatives to capturing key dimensions of family structure and processes. Understanding the diversity of households and families in which adolescents are raised can improve theory and research on parenting.

Measuring Five Dimensions of Religiosity across Adolescence.

This paper theorizes and tests a latent variable model of adolescent religiosity in which five dimensions of religiosity are interrelated: religious beliefs, religious exclusivity, external religiosity, private practice, and religious salience. Research often theorizes overlapping and independent influences of single items or dimensions of religiosity on outcomes such as adolescent sexual behavior, but rarely operationalizes the dimensions in a measurement model accounting for their associations with each other and across time. We use longitudinal structural equation modeling (SEM) with latent variables to analyze data from two waves of the National Study of Youth and Religion. We test our hypothesized measurement model as compared to four alternate measurement models and find that our proposed model maintains superior fit. We then discuss the associations between the five dimensions of religiosity we measure and how these change over time. Our findings suggest how future research might better operationalize multiple dimensions of religiosity in studies of the influence of religion in adolescence.

Postmarital Living Arrangements in Historically Patrilocal Settings: Integrating Household Fission and Migration Perspectives.

This study integrates theory and research on household fission (or partition) and migration to better understand living arrangements following marriage, especially in historically patrilocal and primarily agricultural settings. Using panel data from the Chitwan Valley Family Study to analyze the sequential decision-making process that influences men's living arrangements subsequent to first marriage, we demonstrate the importance of distinguishing among extended family living, temporary migration, and the establishment of an independent household. We find that community economic characteristics, such as access to markets or employment, as well as household wealth affect the initial decision to leave the natal home. Household resources and use of farmland, along with the young men's own education, media exposure, travel, and marital behavior, influence the decision to make the departure from the natal home permanent. Our findings explain why previous results regarding household fission and those focused on migration have provided such mixed results, and we establish a new framework for thinking about how families and individuals manage living situations.

A School Support Intervention and Educational Outcomes Among Orphaned Adolescents: Results of a Cluster Randomized Controlled Trial in Kenya.

Globally, significant progress has been made in primary school enrollment. However, there are millions of adolescents-including orphans in sub-Saharan Africa-who still experience barriers to remaining in school. We conducted a 4-year cluster randomized controlled trial (cRCT) (N = 835) in a high HIV prevalence area in western Kenya to test whether providing orphaned adolescents with a school support intervention improves their educational outcomes. The school support intervention consisted of directly paying tuition, exam fees, and uniform costs to primary and secondary schools for those students who remained enrolled. In addition, research staff monitored intervention participants' school attendance and helped to address barriers to staying in school. This school support intervention had significant positive impacts on educational outcomes for orphaned adolescents. Over the course of the study, school absence remained stable for intervention group participants but increased in frequency for control group participants. Intervention group participants were less likely to drop out of school compared to the control group. Furthermore, the intervention participants were more likely to make age-appropriate progression in grade, matriculate into secondary school, and achieve higher levels of education by the end of the study. The intervention also increased students' expectations of graduating from college in the future. However, we found no significant intervention impact on primary and secondary school test scores. Results from this cRCT suggest that directly covering school-related expenses for male and female orphaned adolescents in western Kenya can improve their educational outcomes.

Religious Pathways from Adolescence to Adulthood.

Prior research suggests the significance of religion for development and wellbeing in adolescence and beyond. Further, new developments and applications of statistical methods have led to ways of better accounting for the multidimensional nature of religiosity (e.g. latent class analysis), as well as the dynamic aspects of religiosity (e.g. latent growth curve models). Yet, rarely if ever are both features of religiosity incorporated and examined together. Therefore, we propose and conduct a latent class analysis using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to identify seven distinct pathways of religiosity that involve independently changing levels of religious affiliation, religious service attendance, personal importance of religion, and prayer from adolescence to adulthood. We also show how individuals' religious pathways are related to gender, race, parents' education, their own education, and family formation experiences in the transition to adulthood. Our findings inform the study of how multiple dimensions of religiosity take shape across adolescence and the transition to adulthood, and suggest a new way for measuring the dynamics of religiosity in studies of the impact of religion across the life course.

"I Feel Like More of a Man": A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention.

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25-2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26-4.03), and reporting increased ability to satisfy their partners post-circumcision (OR = 2.30, 95% CI: 1.11-4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner, and men's experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.

CONSERVATIVE PROTESTANTISM AND HORIZONTAL STRATIFICATION IN EDUCATION: THE CASE OF COLLEGE SELECTIVITY.

College selectivity is associated with numerous positive life outcomes, but research on the antecedents of college selectivity, including religion, is limited-despite a long tradition of religion and stratification research. Using survey data from the National Longitudinal Study of Adolescent to Adult Health (N=2,093) and semi-structured interviews from the National Study of Youth and Religion (N=46), we test for and seek to explain differences in the college selectivity of students from conservative Protestant (CP) religious backgrounds compared to others. Based on prior literature and theory, we hypothesize that CPs attend less selective colleges than other young adults, and that this may especially be the case among women. Our quantitative findings suggest CPs do attend less selective colleges, and the difference is greater among those with better high school GPAs. These differences vary by gender: They are nonexistent for men once background factors are controlled, but CP women attend less selective colleges-a difference that is even larger among women with higher academic ability. Our qualitative findings suggest that these differences stem from young women's different understandings of the purposes of college (general self-betterment versus human capital investment) which relate to unique strategies for balancing work and family, enacting altruism, and achieving self-satisfaction. These findings show the continued link between religion and stratification and, more broadly, culture and stratification.

The Dynamics and Correlates of Religious Service Attendance in Adolescence.

This study examines changes in religious service attendance over time for a contemporary cohort of adolescents moving from middle to late adolescence. We use two waves of a nationally representative panel survey of youth from the National Study of Youth and Religion (NSYR) to examine the dynamics of religious involvement during adolescence. We then follow with an analysis of how demographic characteristics, family background, and life course transitions relate to changes in religious service attendance during adolescence. Our findings suggest that, on average, adolescent religious service attendance declines over time, related to major life course transitions such as becoming employed, leaving home, and initiating sexual activity. Parents' affiliation and attendance, on the other hand, are protective factors against decreasing attendance.

How Early Life Religious Exposure Relates to the Timing of First Birth.

This paper examines intermediary processes explaining how religious socialization and involvement early in life are related to the timing of first births for women in the United States. The theory of conjunctural action forms the basis for hypotheses for how religious schema and materials operate to influence birth timing. Using the NLSY79 data and event history methods, the study finds evidence for expected family size, work-family gender ideology, educational attainment and enrollment, cohabitation, and age at marriage as mediators of associations between early life religious exposure (affiliation and attendance) and the timing of nonmaritally and maritally conceived first births. These findings corroborate other research identifying the long reach of religious socialization and involvement in youth, elucidate some of the pathways for these connections, and motivate further work to understand linkages between religion and family behaviors in the United States.

Explaining religious differentials in family-size preference: Evidence from Nepal in 1996.

We examine how religio-ethnic identity, individual religiosity, and family members' religiosity were related to preferred family size in Nepal in 1996. Analyses of survey data from the Chitwan Valley Family Study show that socio-economic characteristics and individual experiences can suppress, as well as largely account for, religio-ethnic differences in fertility preference. These religio-ethnic differentials are associated with variance in particularized theologies or general value orientations (like son preference) across groups. In addition, individual and family religiosity are both positively associated with preferred family size, seemingly because of their association with religious beliefs­beliefs that are likely to shape fertility strategies. These findings suggest the need for improvements in how we conceptualize and measure supra-individual religious influence in a variety of settings and for a range of demographically interesting outcomes.

The Four U's: Latent Classes of Hookup Motivations Among College Students.

College students' "hookups" have been the subject of a great deal of research in recent years. Motivations for hooking up have been linked to differences in well-being after the hookup, but studies detailing college students' motivations for engaging in hookups focus on single motivations. Using data from the 2010 Duke Hookup Survey, we consider how motivations for hooking up cluster to produce different classes, or profiles, of students who hook up, and how these classes are related to hookup regret. Four distinct classes of motivations emerged from our latent class analysis: Utilitarians (50%), Uninhibiteds (27%), Uninspireds (19%), and Unreflectives (4%). We find a number of differences in hookup motivation classes across social characteristics, including gender, year in school, race-ethnicity, self-esteem, and attitudes about sexual behavior outside committed relationships. Additionally, Uninspireds regret hookups more frequently than members of the other classes, and Uninhibiteds report regret less frequently than Utilitarians and Uninspireds. These findings reveal the complexity of motivations for hooking up and the link between motivations and regret.

A Person-Centered Examination of Adolescent Religiosity Using Latent Class Analysis.

Empirical studies of religion's role in society, especially those focused on individuals and analyzing survey data, conceptualize and measure religiosity on a single measure or a summary index of multiple measures. Other concepts, such as "lived religion," "believing without belonging," or "fuzzy fidelity," emphasize what scholars have noted for decades: humans are rarely consistently low, medium, or high across dimensions of religiosity including institutional involvement, private practice, salience, or belief. A method with great promise for identifying population patterns in how individuals combine types and levels of belief, practice, and personal religious salience is latent class analysis. In this paper, we use data from the first wave of the National Study of Youth and Religion's telephone survey to discuss how to select indicators of religiosity in an informed manner, as well as the implications of the number and types of indicators used for model fit. We identify five latent classes of religiosity among adolescents in the United States and their socio-demographic correlates. Our findings highlight the value of a person-centered approach to understanding how religion is lived by American adolescents.