Social Network Influences on Adolescent Sexual and Reproductive Health Outcomes

Abstract

Multiple contexts influence adolescent sexual and reproductive health (ASRH) outcomes, including peer groups, schools, and neighborhoods. Most empirical applications study these three contexts in isolation and the domains of social groups and physical environments are rarely combined in analyses. Thus, little is known about their relative influence. In response to this gap, this dissertation uses innovative quantitative and qualitative methodologies to examine socio-contextual and normative influences on ASRH.

Chapter 1 combines social network community detection and cross-classified multilevel modeling to compare the contributions of peer groups, schools, and neighborhoods to the total variation in age of sexual debut. After adjusting for relevant covariates, we find that peer group contributes more to variation in age of sexual debut than either school or neighborhood contexts. This relationship is stronger in gender-stratified analyses, indicating that peer group influences differ by gender. Results are robust to multiple sensitivity tests.

Chapter 2 uses this same methodology to examine variation in rates of teen pregnancy, and additionally examines whether outcome variation can be explained by normative influences at individual and group-levels. We find substantial clustering in individual normative beliefs at higher socio-contextual levels, especially at the peer group level. Longitudinal analyses indicate that social norms about teen pregnancy at the individual and peer group levels are positively and significantly predictive of increased odds of teen pregnancy in a subsequent wave of data collection.

Finally, Chapter 3 uses qualitative data from a popular online social network platform to provide in-depth understanding of the normative forces quantitatively assessed in Chapter 2. In the peer-to-peer online exchanges, a majority of user comments reflected the American societal norm pathologizing teen pregnancy. Age-disaggregated results show stricter enforcement of norms for younger teens (i.e., those 15 years old or younger). Female adolescents on this platform who reported experience with a pregnancy also shared stories of bullying, social exclusion and fear, reflecting the stigma faced by young women who transgress this social norm against teen pregnancy. Findings highlight the need to incorporate considerations of gender, adolescent social networks, and social norms in health promotion policies and programs.