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Adverse Birth Outcomes among Adolescents in the San Joaquin Valley: Impact of Prenatal Care, Education, and Race-Ethnicity Adolescent pregnancy has been an issue of concern in the U.S., specifically in the San Joaquin Valley, due to adverse birth outcomes experienced by both mother and child (California Department of Public Health [CDPH], 2011; McKenzie, Pinger, & Kotecki, 2011) . Counties within the San Joaquin Valley have teen birth rates significantly higher than the U.S. and California as a whole (CDPH, 2011). The three –year average (2008-2010) of adolescent birth rates for counties within the San Joaquin Valley ranged from 37.4- 60.4 1,000 females aged 15-19 years old (CDPH, 2011). Studies have shown that adolescents are more likely to have adverse birth outcomes in comparison to women over the age of 20 (American College of Obstetricians and Gynecologists.,2001; Debiec, Paul, Mitchel, & Hitti, 2010) .This study investigated the roles of prenatal care (PNC), education, racial/ethnicity/nativity, and insurance differences in adolescents experiencing low-birth weight and preterm birth in the San Joaquin Valley. INTRODUCTION OBJECTIVE There was a total of 16,561 adolescent females age 11-18 years old in the sample. Table 1, shows the percentage of adolescents that birthed either a premature and/or low birth weight infant in the San Joaquin Valley during 2002-2004. Approximately, 14 % of adolescents had a preterm birth and 8% had a low birth weight infant. RESULTS Table 2 shows logistic regressions for low birth weight and preterm birth. Adolescents who used MediCal or Private/HMO for PNC were consecutively, 7 times and 8 times more likely to have a preterm birth. Adolescent who were not of Hispanic background were 10 times more likely to have a low birth weight and/or preterm birth. Adolescents who received no PNC during pregnancy were 11 times more likely to have a low-birth weight infant and 8 times more likely to have a preterm birth. Adolescents who identified as an immigrant were 9 times more likely to have a low birth weight infant. Additionally, adolescents who sought no PNC were 11 times more likely to have a low birth weight infant and 8 times more likely to have a preterm birth. Lastly, adolescents who sought PNC during the sixth month of pregnancy were 6 times more likely to have a preterm birth CONCLUSIONS These findings suggest that low birth weight and preterm birth are impacted similarly and distinctively by social factors. Both low birth weight and preterm birth are strongly associated with ethnicity (Non- Hispanic) and receiving no PNC during pregnancy. There is a strong relationship between low birth weight and place of birth, particularly, immigrants excluding those from Mexico. Additionally, there was a strong relationship between preterm birth and payment for PNC (MediCal and Private/HMO) and beginning PNC in the 6 month of pregnancy. However, the data shows that there might be additional factors beyond variables investigated in this study that contribute to adolescents experiencing preterm births. REFERENCES 1. American College of Obstetricians and Gynecologists. (2001). Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin ,31.Gynecol 2001;98:709-16. 2. California Department of Public Health (2011). Teen Pregnancy. 3. Debiec K.E., Paul K.J., Mitchell C.M., & Hitti J.E. (2010) Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol;203:122.e1-6. 4. McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2011). An introduction to community health: Jones & Bartlett Publishers. CONTACT Brittany Chambers Central Valley Health Policy Institute College of Health and Human Services California State University, Fresno Office: 559.228.2158 Cell: 510-847-2504 [email protected] Demonstrate the impact of PNC, mother’s education, racial/ethnicity/nativity, and insurance on adolescents experiencing low birth weight and preterm births in the San Joaquin Valley. Brittany Chambers, BA & Marlene Bengiamin, PhD Adverse Birth Outcome Percent Preterm Birth No 86.2 Yes 13.8 Low Birth Weight No 91.9 Yes 8.1 Low Birth Weight Preterm Birth Variables Wald df Sig. Wald df Sig. Mother's Education 3.907 3 0.272 5.252 3 0.154 Unknown or not available 0.995 1 0.319 2.712 1 0.1 Below HS 0.14 1 0.708 0.226 1 0.635 High School 0.102 1 0.749 0.059 1 0.807 Payment for Prenatal Care 3.413 4 0.491 8.567 4 0.073 MediCal 0.269 1 0.604 7.139 1 0.008* Public/Other 2.612 1 0.106 0.373 1 0.542 Private/HMO 0.793 1 0.373 8.382 1 0.004* All others 1.718 1 0.19 0.292 1 0.589 Not Hispanic 10.288 1 0.001* 9.705 1 0.002* Early Prenatal Care 1.659 1 0.198 0.135 1 0.713 Rural Cluster 0.267 2 0.875 2.258 2 0.323 Rural 0.266 1 0.606 0.001 1 0.971 Urban 0.016 1 0.901 2.019 1 0.155 Mother's Place of Birth 12.963 2 0.002 0.3 2 0.861 Mexico 3.641 1 0.056 0.274 1 0.601 Immigrant 8.715 1 0.003* 0.018 1 0.892 Month Prenatal Care Began 21.11 9 0.012 32.995 9 0 No prenatal care 10.637 1 0.001* 8.028 1 0.005* First month 0.539 1 0.463 1.724 1 0.189 Second month 0.216 1 0.642 0.737 1 0.391 Third month 0.152 1 0.697 1.592 1 0.207 Fourth month 0.067 1 0.796 1.988 1 0.159 Fifth month 0.493 1 0.482 2.899 1 0.089 Sixth month 1.161 1 0.281 5.576 1 0.018* Seventh month 0.316 1 0.574 3.076 1 0.079 Eighth month 0.138 1 0.71 0.548 1 0.459 Mother's aged 11-14 0.491 1 0.484 0.907 1 0.341 METHODS The California Master Birth Files 2002-2004 were used in this study . We extracted the eight counties that represent the San Joaquin Valley. The San Joaquin Valley consist of eight counties in Central California; Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare Counties. In this study, adolescent was defined as women under the age of 19. Independent variables: payment for PNC, race/ethnicity (Hispanic vs. Non- Hispanic), education, age, place of birth, rural/urban, and month PNC began. Dependent variables: low-birth weight and preterm birth. We used Binary Logistic Regression for analysis. Table 1. Percentage of adverse birth outcomes among adolescents aged 11-18 in the San Joaquin Valley a. N= 16, 561 Table 2. Binary Logistic Regressions for Low Birth Weight and Preterm Births among adolescents aged 11-18 in the San Joaquin Valley a. N= 16, 561 b. * = p-value less than .05

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Adverse Birth Outcomes among Adolescents in the San Joaquin Valley: Impact of Prenatal Care, Education, and Race-Ethnicity. CONCLUSIONS. - PowerPoint PPT Presentation

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Page 1: INTRODUCTION

Adverse Birth Outcomes among Adolescents in the San Joaquin Valley: Impact of Prenatal Care, Education, and Race-Ethnicity

Adolescent pregnancy has been an issue of concern in the U.S., specifically in the San Joaquin Valley, due to adverse birth outcomes experienced by both mother and child (California Department of Public Health [CDPH], 2011; McKenzie, Pinger, & Kotecki, 2011) . Counties within the San Joaquin Valley have teen birth rates significantly higher than the U.S. and California as a whole (CDPH, 2011). The three –year average (2008-2010) of adolescent birth rates for counties within the San Joaquin Valley ranged from 37.4- 60.4 1,000 females aged 15-19 years old (CDPH, 2011).

Studies have shown that adolescents are more likely to have adverse birth outcomes in comparison to women over the age of 20 (American College of Obstetricians and Gynecologists.,2001; Debiec, Paul, Mitchel, & Hitti, 2010) .This study investigated the roles of prenatal care (PNC), education, racial/ethnicity/nativity, and insurance differences in adolescents experiencing low-birth weight and preterm birth in the San Joaquin Valley.

INTRODUCTION

OBJECTIVE

There was a total of 16,561 adolescent females age 11-18 years old in the sample. Table 1, shows the percentage of adolescents that birthed either a premature and/or low birth weight infant in the San Joaquin Valley during 2002-2004. Approximately, 14 % of adolescents had a preterm birth and 8% had a low birth weight infant.

RESULTS

Table 2 shows logistic regressions for low birth weight and preterm birth. Adolescents who used MediCal or Private/HMO for PNC were consecutively, 7 times and 8 times more likely to have a preterm birth. Adolescent who were not of Hispanic background were 10 times more likely to have a low birth weight and/or preterm birth. Adolescents who received no PNC during pregnancy were 11 times more likely to have a low-birth weight infant and 8 times more likely to have a preterm birth. Adolescents who identified as an immigrant were 9 times more likely to have a low birth weight infant. Additionally, adolescents who sought no PNC were 11 times more likely to have a low birth weight infant and 8 times more likely to have a preterm birth. Lastly, adolescents who sought PNC during the sixth month of pregnancy were 6 times more likely to have a preterm birth

CONCLUSIONS

These findings suggest that low birth weight and preterm birth are impacted similarly and distinctively by social factors. Both low birth weight and preterm birth are strongly associated with ethnicity (Non- Hispanic) and receiving no PNC during pregnancy. There is a strong relationship between low birth weight and place of birth, particularly, immigrants excluding those from Mexico. Additionally, there was a strong relationship between preterm birth and payment for PNC (MediCal and Private/HMO) and beginning PNC in the 6 month of pregnancy. However, the data shows that there might be additional factors beyond variables investigated in this study that contribute to adolescents experiencing preterm births.

REFERENCES

1. American College of Obstetricians and Gynecologists. (2001). Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin ,31.Gynecol 2001;98:709-16.

2. California Department of Public Health (2011). Teen Pregnancy.

3. Debiec K.E., Paul K.J., Mitchell C.M., & Hitti J.E. (2010) Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol;203:122.e1-6.

4. McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2011). An introduction to community health: Jones & Bartlett Publishers.

CONTACT

Brittany ChambersCentral Valley Health Policy InstituteCollege of Health and Human ServicesCalifornia State University, FresnoOffice: 559.228.2158Cell: [email protected]

Demonstrate the impact of PNC, mother’s education, racial/ethnicity/nativity, and insurance on adolescents experiencing low birth weight and preterm births in the San Joaquin Valley.

Brittany Chambers, BA & Marlene Bengiamin, PhD

Adverse Birth Outcome PercentPreterm Birth

No 86.2Yes 13.8

Low Birth WeightNo 91.9Yes 8.1

Low Birth Weight Preterm BirthVariables Wald df Sig. Wald df Sig.

Mother's Education 3.907 3 0.272 5.252 3 0.154Unknown or not available 0.995 1 0.319 2.712 1 0.1Below HS 0.14 1 0.708 0.226 1 0.635High School 0.102 1 0.749 0.059 1 0.807

Payment for Prenatal Care 3.413 4 0.491 8.567 4 0.073MediCal 0.269 1 0.604 7.139 1 0.008*Public/Other 2.612 1 0.106 0.373 1 0.542Private/HMO 0.793 1 0.373 8.382 1 0.004*All others 1.718 1 0.19 0.292 1 0.589

Not Hispanic 10.288 1 0.001* 9.705 1 0.002*Early Prenatal Care 1.659 1 0.198 0.135 1 0.713Rural Cluster 0.267 2 0.875 2.258 2 0.323

Rural 0.266 1 0.606 0.001 1 0.971Urban 0.016 1 0.901 2.019 1 0.155

Mother's Place of Birth 12.963 2 0.002 0.3 2 0.861Mexico 3.641 1 0.056 0.274 1 0.601Immigrant 8.715 1 0.003* 0.018 1 0.892

Month Prenatal Care Began 21.11 9 0.012 32.995 9 0No prenatal care 10.637 1 0.001* 8.028 1 0.005*First month 0.539 1 0.463 1.724 1 0.189Second month 0.216 1 0.642 0.737 1 0.391Third month 0.152 1 0.697 1.592 1 0.207Fourth month 0.067 1 0.796 1.988 1 0.159Fifth month 0.493 1 0.482 2.899 1 0.089Sixth month 1.161 1 0.281 5.576 1 0.018*Seventh month 0.316 1 0.574 3.076 1 0.079Eighth month 0.138 1 0.71 0.548 1 0.459

Mother's aged 11-14 0.491 1 0.484 0.907 1 0.341

METHODS

The California Master Birth Files 2002-2004 were used in this study . We extracted the eight counties that represent the San Joaquin Valley. The San Joaquin Valley consist of eight counties in Central California; Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare Counties. In this study, adolescent was defined as women under the age of 19.

Independent variables: payment for PNC, race/ethnicity (Hispanic vs. Non- Hispanic), education, age, place of birth, rural/urban, and month PNC began.

Dependent variables: low-birth weight and preterm birth.

We used Binary Logistic Regression for analysis.

Table 1. Percentage of adverse birth outcomes among adolescents aged 11-18 in the San Joaquin Valley

a. N= 16, 561

Table 2. Binary Logistic Regressions for Low Birth Weight and Preterm Births among adolescents aged 11-18 in the San Joaquin Valley

a. N= 16, 561b. * = p-value less than .05

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