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Bardin S, Fotheringham AS. When everyone's doing it: The relative effects of geographical context and social determinants of health on teen birth rates. Health Place 2024; 87:103249. [PMID: 38685183 DOI: 10.1016/j.healthplace.2024.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
Geographic disparities in teen birth rates in the U.S. persist, despite overall reductions over the last two decades. Research suggests these disparities might be driven by spatial variations in social determinants of health (SDOH). An alternative view is that "place" or "geographical context" affects teen birth rates so that they would remain uneven across the U.S. even if all SDOH were constant. We use multiscale geographically weighted regression (MGWR) to quantify the relative effects of geographical context, independent of SDOH, on county-level teen birth rates across the U.S. Findings indicate that even if all counties had identical compositions with respect to SDOH, strong geographic disparities in teen birth rates would still persist. Additionally, local parameter estimates show the relationships between several components of SDOH and teen birth rates vary over space in both direction and magnitude, confirming that global regression techniques commonly employed to examine these relationships likely obscure meaningful contextual differences in these relationships. Findings from this analysis suggest that reducing geographic disparities in teen birth rates will require not only ameliorating differences in SDOH across counties but also combating community norms that contribute to high rates of teen birth, particularly in the southern U.S. Further, the results suggest that if geographical context is not incorporated into models of SDOH, the effects of such determinants may be interpreted incorrectly.
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Affiliation(s)
- Sarah Bardin
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, AZ, 85281, USA.
| | - A Stewart Fotheringham
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, AZ, 85281, USA
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Stevens J, Rausch J, Osuagwu N, Lutz R. Efficacy of Behavioral Economic Nudges to Assist Teen Mothers: the Healthy Adolescent Transitions Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:509-520. [PMID: 38429618 PMCID: PMC11093778 DOI: 10.1007/s11121-024-01660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Communities may often lack the resources to deliver intensive programs to assist teen mothers, and many eligible adolescents may decline participation in lengthy interventions. Therefore, alternative approaches involving less resource and time may be needed. Behavioral economics (BE) can inform the development of such novel interventions. BE often feature low-intensity approaches designed to "nudge" people to help them reach their long-term goals. Nudges can include giving reminders, making the desired behavior more convenient, and optimizing the verbal presentation of recommended options. Three hundred thirty-one American adolescents (ages 14 to 19) who were 22 to 35 weeks pregnant were enrolled in the present trial. One hundred sixty-six participants were randomly assigned to the intervention condition featuring a three-month BE intervention delivered by a registered nurse and social worker. The remaining 165 youths were assigned usual care. Surveys were completed at baseline, 3 months, 12 months, and 18 months. Data collection occurred from 2017 to 2021. Qualitative feedback indicated that the BE intervention was well-received by adolescents. However, there were no significant differences between the intervention and control groups at any time point regarding repeat pregnancy, contraceptive usage, financial literacy, school completion, job attainment, HPV vaccinations, nicotine usage, perception of having a medical home, urgent care/ED usage, and nutritional intake (all p > .05). Our findings suggest that a BE-based intervention may not be sufficient to facilitate change for teen mothers. Future programs should consider lasting longer, featuring a higher dose, and/or incorporating systems-level changes. This trial was prospectively registered (NCT03194672 clinicaltrials.gov).
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Affiliation(s)
- Jack Stevens
- Nationwide Children's Hospital, NEOB 3rd Floor, Columbus, OH, 43205, USA.
- Department of Pediatrics, Ohio State University, Columbus, OH, USA.
| | - Joseph Rausch
- Nationwide Children's Hospital, NEOB 3rd Floor, Columbus, OH, 43205, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Ngozi Osuagwu
- OhioHealth Research and Innovation Institute, Columbus, OH, USA
- Ohio University Heritage College of Osteopathic Medicine, Columbus, OH, USA
| | - Robyn Lutz
- OhioHealth Research and Innovation Institute, Columbus, OH, USA
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Pabayo R, Liu S, Grinshteyn E, Steele B, Cook D, Muennig P. Voting restrictions associated with health inequities in teenage birth rates. Public Health 2023; 218:121-127. [PMID: 37019027 DOI: 10.1016/j.puhe.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Since the Landmark Shelby V. Holder Supreme Court Ruling, the number of laws in the United States that make it difficult to vote has increased dramatically. This may lead to legislation that limits access to health care, including options for family planning services. We determine whether voting restrictions are associated with county-level teenage birth rates. STUDY DESIGN This is an ecological study. METHODS The Cost of Voting Index, a state-level measure of barriers to voting during US elections from 1996 to 2016, was used as a proxy for access to voting. County-level teenage birth rates were obtained from the County Health Rankings data. We used multilevel modeling to determine whether restrictive voting laws were associated with county-level teenage birth rates. We tested whether associations varied across racial and socio-economic groups. RESULTS When confounders were included, a significant association was observed between increasing voting restrictions and teenage birth rates (β = 1.72, 95% confidence interval: 0.54, 2.89). A Cost of Voting Index-median income interaction term was tested and was statistically significant (β = -1.00, 95% confidence interval: -1.36, -0.64), indicating that the observed relationship was particularly strong among lower-income counties. The number of reproductive health clinics per capita within each state is a potential mediator. CONCLUSION Restrictive voting laws were associated with higher teenage birth rates, particularly for low-income counties. Future work should use methods in which a causal relation can be identified.
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Maslowsky J, Stritzel H, Gershoff ET. Post-Pregnancy Factors Predicting Teen Mothers' Educational Attainment by Age 30 in Two National Cohorts. YOUTH & SOCIETY 2022; 54:1377-1401. [PMID: 38107471 PMCID: PMC10723653 DOI: 10.1177/0044118x211026941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Women who begin childbearing as teenagers attain lower levels of education than women who delay childbearing until age 20 and later. Little is known about post-pregnancy factors that predict educational attainment among teen mothers. The current study examined whether teen mothers' environment and experiences 2 years after their first birth contribute to their educational outcomes by age 30, net of selection factors associated with teenage childbearing. Data were from two cohorts, the National Longitudinal Surveys of Youth 1979 (N = 241) and 1997 (N = 378). Multinomial logistic regression modeling was used to assess associations of post-pregnancy factors with teen mothers' educational attainment. Having child care was associated with increased odds of attaining a high school diploma and of attending college in both cohorts. Providing regular and subsidized child care for teen mothers is an opportunity to support teen mothers in achieving higher levels of educational attainment.
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Braverman-Bronstein A, Vidaña-Pérez D, Ortigoza AF, Baldovino-Chiquillo L, Diez-Canseco F, Maslowsky J, Sánchez BN, Barrientos-Gutiérrez T, Diez Roux AV. Adolescent birth rates and the urban social environment in 363 Latin American cities. BMJ Glob Health 2022; 7:bmjgh-2022-009737. [PMID: 36253017 PMCID: PMC9577896 DOI: 10.1136/bmjgh-2022-009737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. Methods We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15–19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). Results The median subcity ABR was 58.5 per 1000 women 15–19 (IQR 43.0–75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). Conclusions The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brisa N. Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Dyer L, Vilda D, Harville E, Theall K, Wallace M. Income Inequality and Pregnancy-Associated Homicide in the US: A Longitudinal, State-Level Analysis. Violence Against Women 2022:10778012221120446. [PMID: 36017550 DOI: 10.1177/10778012221120446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The exposure, the state Gini index, was categorized into tertiles to compare states by levels of income inequality. In the final adjusted longitudinal linear model, those who experienced the greatest amount of income inequality had a significant 1.28 per 100,000 homicide rate when compared to the lowest income inequality tertile.
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Affiliation(s)
- Lauren Dyer
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dovile Vilda
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emily Harville
- Department of Epidemiology, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Katherine Theall
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Maeve Wallace
- Mary Amelia Women's Center, Department of Social, Behavioral and Population Sciences, 25812Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Hale N, Tatro K, Orimaye SO, Smith M, Meit M, Beatty KE, Khoury A. Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012-2018. JOURNAL OF APPALACHIAN HEALTH 2022; 4:31-50. [PMID: 35769510 PMCID: PMC9200451 DOI: 10.13023/jah.0401.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist, and little is known about the extent to which broader declines are seen within Appalachia. Purpose The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia. Methods We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance. Results About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= -5.78, CI: -9.58, -1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable. Implications This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably.
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Cone JN, Hendrick CE, Owotomo O, Al-Hamoodah L, Maslowsky J. Socioeconomic well-being in early adulthood among repeat versus one-time teenage mothers. YOUTH & SOCIETY 2021; 53:1090-1110. [PMID: 34565925 PMCID: PMC8457247 DOI: 10.1177/0044118x19892455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Teenage mothers are known to be at elevated risk for poor socioeconomic outcomes in adulthood. However, little is known about the socioeconomic outcomes of mothers who bear multiple children during the teenage years (repeat teenage mothers) compared to one-time teenage mothers. This study examines socioeconomic outcomes in the mid- to late 20s of repeat teenage mothers compared to one-time teenage mothers in a national U.S. sample. Repeat teenage mothers were less likely to graduate high school and more likely to receive public assistance and experience material hardship than one-time teenage mothers in their mid- to late- 20s. Lower educational attainment plus the responsibility of caring for multiple children as a young mother may make it difficult for repeat teenage mothers to secure economic stability. Additional supports may be necessary to improve long-term socioeconomic outcomes of repeat teenage mothers.
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Affiliation(s)
- Joshua N. Cone
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, D3700 Austin, TX 78712
| | - C. Emily Hendrick
- Division of Reproduction and Population Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53726
| | - Olusegun Owotomo
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, D3700 Austin, TX 78712
| | - Leila Al-Hamoodah
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, 2300 Red River St., E2700, Austin, TX 78712
| | - Julie Maslowsky
- Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd, D3700 Austin, TX 78712
- Population Research Center, University of Texas at Austin, 305 E. 23 Street, G1800 Austin, TX 78712
- Department of Population Health, Dell Medical School, University of Texas at Austin, 1601 Trinity Street, Z0500, Austin, TX 78712
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Jalanko E, Gyllenberg F, Krstic N, Gissler M, Heikinheimo O. Municipal contraceptive services, socioeconomic status and teenage pregnancy in Finland: a longitudinal study. BMJ Open 2021; 11:e043092. [PMID: 33597141 PMCID: PMC7893665 DOI: 10.1136/bmjopen-2020-043092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Declining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking. DESIGN AND SETTING This retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000-2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model. PRIMARY OUTCOME MEASURES Annual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15-19 years old in the 100 largest municipalities in Finland from 2000 to 2018. RESULTS The following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively). CONCLUSION Providing free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.
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Affiliation(s)
- Eerika Jalanko
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Frida Gyllenberg
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- City of Vantaa, Division of Health Care and Social Services, Vantaa, Finland
| | - Nikolas Krstic
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mika Gissler
- Information, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Oskari Heikinheimo
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Maslowsky J, Stritzel H, Al-Hamoodah L, Hendrick CE, Powers D, Barrientos-Gutierrez T, Santelli J. Health Behaviors and Prenatal Health Conditions in Repeat Vs First-time Teenage Mothers in the United States: 2015-2018. J Pediatr Adolesc Gynecol 2021; 34:47-53. [PMID: 32781232 PMCID: PMC7855354 DOI: 10.1016/j.jpag.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE Repeat teenage mothers, those who give birth to a second or higher-order infant before age 20 years, are at elevated risk for adverse perinatal outcomes compared with first-time teenage mothers. The objective of the current study was to compare the prevalence of negative pregnancy-related behaviors and gestational health conditions in the national United States population of first-time and repeat teenage mothers. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, population-based cohort study using annual US birth data files from 2015 to 2018, N = 799,756 (673,394 [84.2%] first, 126,362 [15.8%] repeat) births to women ages 15-19 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Pregnancy-related behaviors (including adequacy of prenatal care and weight gain, sexually transmitted infection, smoking, and breastfeeding) and gestational health conditions (gestational hypertension and gestational diabetes). RESULTS Repeat (vs first-time) mothers had higher prevalence of negative pregnancy-related behaviors: inadequate prenatal care, smoking, inadequate weight gain, and sexually transmitted infection during pregnancy; they were also less likely to breastfeed. Conversely, repeat teenage mothers experienced lower prevalence of gestational hypertension and gestational diabetes. CONCLUSION Repeat teenage mothers experienced lower prevalence of physical health complications during pregnancy but engaged in more negative pregnancy-related health behaviors. Negative health behavior in pregnancy can lead directly to poor perinatal outcomes for infants. To prevent adverse outcomes from repeat teenage childbearing, we must ensure access to quality, timely, prenatal and postpartum care so teenage mothers can receive support for healthy pregnancy-related behaviors as well as linkage to highly effective contraception to prevent unintended repeat births.
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