Economic Vulnerability and Associated Sexual Risk Factors for Adolescent Pregnancy Among Adolescent Females in Southern California

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper is mostly descriptive and tabulates results on logistic regression on risk factors and food security for 19-22-year-old females in Southern California. The paper offers new insights and can be significantly strengthened by:

1. Creating a review of literature section that focuses on factors that at least cover the following: a) the role of SNAP on the subject in question; California is widely served by this nutrition program. Additionally, it would be useful to know if the subjects in questions are also SNAP dependent; 2) What kind of family structure do the subjects come from and how this may contribute to teen pregnancy; and 3) shed light on the role of income and education on the topic in question.
   
   
2. The abstract mentions a multivariate regression model! Is it? Or is the model a multiple adjusted logistic regression model? Please provide the specific model specification used in the analysis.
   
   
3. Please provide goodness of fit statistics and assess the reliability of model results.
   
   
4. Please rewrite the paragraph starting on line 229. You wrote: “….Most (62%) participants ages 18-22 reported food insecurity, suggesting older participants were more likely to report food insecurity….” Could it be that food insecurity is higher for this age group? Or could it be that the 15-17 age cohort still live with parents and are less food insecure?
   
   
5. Order matters in Table 2. The “OR 95% Confidence Interval, p value column reports the values in “p value, CI” order. Solution: move the p value to the right-hand side or change the order on the column title.
   
   
6. Add appropriate elements in comment 1 above to the “Discussion” section, particularly emphasizing the role of the SNAP program, education, and income relative to limitations of the work.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Your paper is interesting but leaves one with several questions. The most important is the educational status of the adolescents. It is surprising that a significant proportion of the youth are still in high school despite being between 18 and over. Are most of these women closer to 18 than to 22?

Second, it seems that a significant proportion are living apart from patents. What kind of living arrangement do those youth have? Could they be living with their partner?

Third, you describe those who are not in a relationship as single, but the common meaning for this is not married. Are any of the women in a stable relationship that might explain their dependence on a male partner?

Fourth, the results in Table 2 are confusing. How did you decide to control for different variables in the analyses? It seems arbitrary and controlling for relationship status may not be appropriate as in the item about dependence on a partner for transportation. Why should one control for that variable in that analysis?

Fifth, I think the Discussion should consider the relationship status of the women. Are the ones who are food insecure in some kind of stable relationship, especially those older than 17? It could be that this is seen as a pathway to either marriage or a potential longer term relationship. This would make the risk nature of the sex a bit different from having a more transitional relationship. This bears on your concern that being in a food insecure situation makes the women less powerful in sexual decision making (lines 335-336).  This is possible, but we really don’t understand what is going on in these relationships based on the data presented.

Finally, there is some confusion in the paper regarding age of sexual initiation in Table 2. Is that a typo? You also say that a majority lived with both parents but this not true (line 227).  Also, what happened to those who are not classified as either secure or not?  The numbers don’t add up to 204.  Finally, your food insecurity items are not answered on a Likert scale. It adds nothing to describe a scale of magnitude as a Likert scale which is measured as agree-disagree.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks for the opportunity to review this manuscript. The manuscript presents a timely investigation of food insecurity and sexual risk behaviours among Latina adolescents. Although the study design is robust and addresses a critical gap, several revisions are required to enhance clarity, methodological transparency, and scholarly rigour. I have provided ten suggestions for authors to consider to improve their manuscript below.

1. The title conflates "economic vulnerability" with the specific measure "food insecurity". Therefore, revising it to specify the latter (e.g., "Food Insecurity and Sexual Risk Factors...") would improve clarity.

2. The abstract omits key methodological details, such as study design and recruitment timeframe. Thus, including these details would enhance transparency.

3. With respect to regional context, it seems that the justification for focusing on the U.S.–Mexico border region is underdeveloped, so adding local epidemiological data would strengthen relevance.

4. Because the abbreviated food insecurity scale lacks validation for adolescents, it is necessary to acknowledge this limitation and cite prior adaptations.

5. The "early sexual initiation" threshold (≤14 years) lacks regional justification. It could be better to reference local literature to support this cut-off.

6. Small subsamples (e.g., n=65 sexually active participants) limit reliability in terms of adequate statistical power. Therefore, please explicitly caution against overinterpreting non-significant findings.

7. Covariates (e.g., employment status) lack justification. The authors are suggested to briefly explain their inclusion based on bivariate associations.

8. The Reference 6 cites a CDC report without a DOI. The authors can replace it with peer-reviewed sources or provide a persistent identifier.

9. The parental consent procedures lack specificity. The authors are suggested to clarifying how assent was obtained alongside parental consent.

10. About the policy implications, I think that the Conclusion section omits actionable recommendations. I suggest integrating food assistance into sexual health programmes.

In summary, the manuscript addresses a critical gap but requires revisions to resolve methodological ambiguities and improve clarity. With these adjustments, it holds strong potential for publication.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Not properly integrating SNAP limits the scope of the analysis.

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks for the thorough and substantive revisions. I have no further comments.