Re-referrals to Child Protective Services for children born to young parents

BACKGROUND

Children of teenage parents are at increased risk for child maltreatment but there is limited information about the risks teenage parenthood poses for maltreatment recurrence after prior Child Protective Service (CPS) involvement.

OBJECTIVE

Determine whether children born to teenage parents are at increased risk of maltreatment re-referral to CPS compared to children born to older parents.

PARTICIPANTS AND SETTING

Children under 6 years with substantiated reports of parental maltreatment between 2002 and 2018 were identified from National Child Abuse and Neglect Data System (NCANDS) data.

METHODS

Youngest known parental age at child's birth, in years, was categorized as <20, 20-24, 25-29, or ≥30 (referent group). The number of re-referrals within 5 years was the outcome of interest. Negative binomial regression analyses assessed whether being born to a teen parent was associated with a greater risk of re-referral.

RESULTS

In a study population of 2,680,961 children, having a teen parent, one aged 20-24 years, or 25-29 years at birth was associated with 19% (95% CI 1.18-1.19), 16% (95% CI 1.16-1.17), and 11% (95% CI 1.11-1.12) greater risk of re-referral compared to having a parent aged 30 years or older adjusting for child age, gender, race-ethnicity, state, and initial maltreatment type.

CONCLUSION

The small, but significant increased risk for re-referral to CPS for child maltreatment in young children with at least one teenage or young parent at the time of birth compared to children with older parents suggests that specifically targeting young parents with appropriate services when initially referred to CPS may help reduce the risk of maltreatment recurrence.

Analysis of Pregnancy and Birth Rates Among Black and White Medicaid-Enrolled Teens

PURPOSE

In the United States, black teens overall have higher pregnancy and birth rates than whites, and it is commonly believed that minority race and low income account for this disparity. We examined racial differences in pregnancy and birth rates among teens from low-income households using Medicaid-enrollment as a proxy for low income.

METHODS

This was a retrospective study of Louisiana Medicaid claims data for female teens aged 15-17 years in 2014 (n = 66,069). Pregnancy and pregnancy outcome codes were identified (n = 2,276) and analyzed for differences by black and white race. We conducted validity analyses with different rate definitions and teens' claims status.

RESULTS

The cohort was 36% white and 54% black. More black teens than whites lacked any claims data (15.6% vs. 12.6%; p < .001). Rates calculated as events per 1,000 person-years of Medicaid coverage showed no difference in live birth rates between white and black teens (24.6 vs. 25.8; relative incidence ratio, 1.05; 95% confidence interval, .93-1.18; p = .43); however, pregnancy rates for whites were higher than those for blacks (42.7 vs. 36.1; relative incidence ratio, .85; 95% confidence interval, .77-.93; p < .001).

CONCLUSION

In contrast to national trends, which include teens from diverse racial and socioeconomic backgrounds, Louisiana Medicaid-enrolled teens aged 15-17 years had equal birth rates regardless of black or white race, and whites had higher pregnancy rates. Decreased racial disparities in pregnancy and birth rates among these adolescents highlights socioeconomic influences in sexual health behavior and a need to examine the interplay of risk factors contributing to racial disparities seen among adolescents nationally.

Did parental involvement laws grow teeth? The effects of state restrictions on minors' access to abortion

We compile data on the locations of abortion providers and enforcement of parental involvement laws to document dramatic increases in the distances minors must travel if they wish to obtain an abortion without involving a parent or judge: from 58 miles in 1992 to 454 in 2016. Using both double and triple-difference estimation strategies, we estimate the effects of parental involvement laws, allowing them to vary with the distances minors might travel to avoid them. Our results confirm previous findings that parental involvement laws did not increase teen births in the 1980s, and provide new evidence that in more recent decades they have increased teen birth by an average of 3 percent. The estimated effects are increasing in avoidance distance to the point that a confidential abortion is more than a day's drive away, and also are substantially larger in the poorest quartile of counties.

A housing mobility program's impacts on teen and young adult parenting

OBJECTIVE

To assess the impact of Moving to Opportunity for Fair Housing Demonstration Program (MTO) implemented in 1994 in five U.S. cities (Baltimore, Boston, Chicago, Los Angeles, and New York City) on teen births.

METHODS

We analyzed baseline and long-term evaluation data for youth (ages 13-20) and young adults (ages 21-30) (N = 7861) who were children or teens at baseline. We used regression analyses to estimate the impact of housing vouchers on having a teen birth.

RESULTS

Overall, MTO had no significant effect on teen births. However, among young adults whose parent had a child before age 20, the proportion with a teen birth themselves was 21% lower among those offered housing vouchers to low-poverty neighborhoods with no restrictions compared to those not offered housing vouchers (p < 0.05).

CONCLUSION

MTO appeared to decrease intergenerational teen births among young adults. Further exploration of housing relocation may help untangle risks and protective factors for reducing intergenerational teen births.

PUBLIC HEALTH IMPLICATIONS

Reducing intergenerational teen births is important, especially among those facing economic, environmental, and health risks. Comprehensive programs addressing multiple social determinants of health are vital to reducing teen births.

Changing disparities in teen birth rates and repeat birth rates in Georgia: implications for teen pregnancy prevention

OBJECTIVE

To understand teen birth trends in Georgia by racial and geographic factors.

STUDY DESIGN

We analyzed overall birth and repeat teen birth rates by race, urban/rural status and adequacy of obstetric care from 2008 to 2016 using vital records from all Georgia counties.

RESULTS

Overall birth rates among teens analyzed decreased dramatically in Georgia, from 45.63 births per 1000 teens in 2008-2010 to 26.28 per 1000 teens in 2014-2016. Repeat birth rates followed a similar decline, from 9.40 to 4.53 repeat births per 1000 teens over the same time period. These rates decreased in all subgroups of teens but to varying degrees. The difference in birth and repeat birth rates between black and white teens decreased fourfold during this time period, whereas the declines in these rates for teens living in rural versus urban counties and with inadequate versus adequate obstetric care were less pronounced.

CONCLUSION

While remarkable reductions in teen birth and repeat birth rates have occurred since 2008, these declines have not been equally experienced by all groups of teens.

IMPLICATIONS

Our analysis suggests that persistent disparities in teen birth and repeat birth rates exist, particularly in areas with limited or threatened access to reproductive health care. Applying targeted teen pregnancy prevention initiatives to these areas could help ensure equitable health and social outcomes for teens.

Extended Foster Care for Transition-Age Youth: An Opportunity for Pregnancy Prevention and Parenting Support

PURPOSE

This analysis examined California county birth rate variations among girls in foster care. The objective was to generate data to assess potential intervention points tied to federal legislation extending foster care beyond age 18 years.

METHODS

Child protection records for all adolescent girls in foster care at age 17 years between 2003 and 2007 (N = 20,222) were linked to vital birth records through 2011. The cumulative percentage of girls who had given birth by age 21 years was calculated by county and race/ethnicity.

RESULTS

One in three (35.2%) adolescent girls in foster care had given birth at least once before age 21 years. Although significant birth rate variations emerged, even at the low end of the county range, more than one in four girls had given birth by age 21 years.

CONCLUSIONS

Child welfare systems are now charged with coordinating transitional services for foster youth beyond age 18 years. Extended foster care provides new opportunities for pregnancy prevention work and targeted parenting support.

Cumulative teen birth rates among girls in foster care at age 17: an analysis of linked birth and child protection records from California

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports.