Trends in Adolescent Birth Rates in California: Examining the Influence of Community Characteristics Through Geographic and Temporal Analysis.

Abstract

The aim of the article was to understand community-level factors associated with the decline in the adolescent birth rate (ABR) in California from 2000 to2014. We consolidated multiple data sources at the level of the Medical Service Study Area (MSSA), a federally recognized subcounty geographic unit (N= 497). We used ordinary least squares regression to examine predictors of change in the ABR at the MSSA level over three periods of notable change in California's ABR: 2000-2002, 2006-2008, and 2012-2014. Variables assessed include geographic density, change in sociodemographic and economic characteristics, and change in the availability of publicly funded sexual health services. The ABR declined more in urban than rural MSSAs. In the earlier period, growth in the black, Hispanic, and foreign-born populations, unemployment, and receipt of public assistance were associated with smaller declines in the ABR. Growth in the share of married households and high school completion were associated with larger declines in the ABR. In the later period, growth in public assistance receipt was associated with smaller declines in the ABR, whereas growth in high school completion and college attendance were associated with larger declines. Decline in the ABR was steeper in areas that began offering publicly funded long-acting contraception to adolescents. Rural-urban differences were no longer significant after controlling for change in the provision of long-acting contraception. Identifying the independent contributions of changes in sociodemographic, economic, and service characteristics to changes in the ABR supports the development of programs and policies that are more responsive to the communities they serve.