Examining changing disparities in teen birth and repeat birth rates in Georgia: implications for teen pregnancy prevention Open Access

Nandi, Preetha (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/s1784m94c?locale=en
Published

Abstract

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 2008-2016 using vital records from all Georgia counties. We additionally used Poisson regression using backwards elimination to better characterize independent and interaction effects.

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 sub-groups of teens, however to varying degrees. The difference in birth and repeat birth rates between black and white teens decreased four-fold 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. The Poisson regressions demonstrated key interaction effects with some exposure variables and a time variable; other effects were not clinically relevant or otherwise relevant for public health interventions.

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.

Table of Contents

Chapter I: Background and literature review..............................................................1

Overview .................................................................................................................1

National trends in teen pregnancy ..........................................................................2

Facilitators of progress in declining teen births ......................................................3

Health, social and economic impact of teen pregnancy...........................................5

Overview and implications of repeat teen pregnancy .............................................6

Regional characteristics of teen birth in Georgia ....................................................7

Chapter II: Methods and results.................................................................................9

Published manuscript: Nandi, P., Kramer, M., & Kottke, M. (2018). Changing

disparities in teen birth rates and repeat birth rates in Georgia: implications for

teen pregnancy prevention. Contraception.............................................................9

Table 1: Teen birth rates (BR) and repeat birth rates (RBR) among Georgia

counties (N=159) by race, stratified by urban/rural status and adequacy of

obstetric care ......................................................................................................17

Figure 1: Comparison of teen birth rates and repeat birth rates among Georgia

counties by race, urban/rural status, and adequacy of obstetric care,

2008-2016 ...........................................................................................................18

Additional methods: Poisson regression models...................................................19

Additional results: Poisson regression models.......................................................21

Table 2a: Poisson regression analysis for birth rates per 1000 teens (regression

coefficient estimates) ..........................................................................................22

Table 2b: Poisson regression analysis for repeat birth rates per 1000 teens

(regression coefficient estimates) ........................................................................23

Chapter III: Public health implications and future research ....................................25

Targeted strategies for teen pregnancy prevention................................................25

Contraception access...........................................................................................25

Sexual health education ......................................................................................28

Social support for teens........................................................................................29

Threats to progress in teen pregnancy prevention in Georgia...............................30

Future research directions.......................................................................................31

References..................................................................................................................32

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