Examining the Social Ecological Context of Teenage Pregnancy among Native Hawaiian Youth Elizabeth M. Aparicio,* Andrew Wey,* Naomi Manuel,** Patricia McKenzie,*** & Hokulani Porter*** *University of Hawai‘i at Manoa, **ALU LIKE, Inc., ***Waianae Coast Comprehensive Health Center

Teen Pregnancy in Hawaii As a state, rates slightly higher than U.S. average Major racial and ethnic disparities Native Hawaiian youth at high risk Compared to national rates, pregnancy rate is 5 times higher Compared to African American and Latino youth nationwide, 3 times higher Why?

Research Question What are the predictors of birth timing (teenage versus older birth) among Native Hawaiian women in Hawaii? Part of larger mixed method study on teenage pregnancy and parenting among Native Hawaiian youth

Method Secondary data analysis Pregnancy Risk And Monitoring Survey (PRAMS) 2009-2011 version Prenatal and postpartum care, substance use, mental health, adjunct service use, demographics Sent out monthly to approximately 200 new mothers each month who give birth in Hawai‘i Current study sample of Native Hawaiian women living in Hawai‘i: N=1493

Sample Of the 1493 Native Hawaiian women (unweighted percentages): 516 (35%) live on Oahu 981 (69%) have a family income over $10,000 171 (12%) were teenage mothers

Method, cont. Variables examined: Pre-pregnancy traumatic stress (composite variable: homeless, involved in a physical fight, partner or self went to jail, or someone very close had a problem with drinking or drugs) Household income Use of WIC during pregnancy Intimate partner violence (IPV) prior to pregnancy Pre-pregnancy marijuana use Pre-pregnancy binge drinking IPV during pregnancy Desire to become pregnant Pre-pregnancy emotional stress (composite variable: if anyone in their household was ill and hospitalized or if someone close died) Actively trying to get pregnant Contraception use Previous birth

Method, cont. Descriptive analysis to examine frequencies and correlates Logistic regression to examine predictors of birth timing after adjusting for income greater $10,000 PRAMS is stratified by island and gestational age Survey weights account for the complex survey design

Bivariate Results Native Hawaiian women who gave birth as teens (19 years or younger), as compared to older mothers (20 years or older) had significantly Lower household incomes (65% vs. 27% under $10,000/yr) Higher use of WIC during pregnancy (78% vs. 59%) Higher levels of intimate partner violence Prior to pregnancy (14% vs. 6%) During pregnancy (9% vs. 4%) Higher levels of pre-pregnancy marijuana use (15% vs. 7%) Lower rates of pre-pregnancy binge drinking (32% vs. 54%)

Bivariate Results, cont. Native Hawaiian women who gave birth as teens (19 years or younger), as compared to older mothers (20 years or older) had significantly (p < .05) Higher levels of stress Emotional stressors (41% vs. 31%) Traumatic stressors (32% vs. 20%)

Results, cont. Among teenage mothers: 15% desired to get pregnant then 10% were trying to get pregnant Among those teenage mothers who did not desire to get pregnant then, 49% were using contraception 15% had a previous birth

Multivariate Results Variables Odds Ratio 95% CI P-value Wanted Pregnancy 0.25 (0.13, 0.46) 0.000 Trying to get Pregnant 0.21 (0.10, 0.45) IPV Prior to Pregnancy 1.52 (0.71, 3.25) 0.285 IPV During Pregnancy 1.69 (0.72, 3.99) 0.229 Previous Birth 0.08 (0.04, 0.16) Emotional Stressors 1.78 (1.08, 2.93) 0.025 Traumatic Stressors 1.39 (0.82, 2.33) 0.218 Marijuana Use 1.59 (0.83, 3.06) 0.162 Binge Drinking 0.41 (0.25, 0.68) 0.001 These are the results of a logistic regression examining how these predictors affect the odds of women becoming pregnant as a teen (meaning 19 and under) or as an older mother. After adjusting for family income, some of the bivariate differences we saw earlier were accounted for. I’ll highlight a few things from this table. After adjusting for family income, we can see that women who wanted to or were trying to get pregnant had lower odds of being a teen mother. IPV prior to pregnancy and during pregnancy did not significantly predict a difference in birth timing Experiencing emotional stressors was a significant predictor of birth timing. Women who experienced 1 or more emotional stressors had 78% greater odds of experiencing a teenage birth Women who engaged in pre-pregnancy binge drinking had lower odds of having given birth as a teen

Discussion Poor pregnancy prevention available through local public schools Recently established a mandatory “opt-in” policy; may exclude those at greatest risk Concerning rates of IPV prior to and during pregnancy, especially related to being part of a low income family Need for exploring circumstances of pregnancy IPV is the leading cause of injury and death among women of childbearing age Locally: Hawaii Says No More campaign; One Billion Rising

Discussion, cont. Teen mothers clearly have need for support with emotional stressors Lack of mental health resources in areas of highest teen pregnancy rates in Hawai‘i Implications for young parents and for their children Native Hawaiian children under 5 are the most heavily overrepresented group involved with Child Welfare Services In other samples, children of teenage parents are typically 2-3 times as likely to enter foster care

Discussion, cont. Larger mixed method study in progress Semi-structured interviews of 18-19 year old youth Some avoided teen pregnancy and some are parenting Emerging Themes Impact of Intergenerational Homelessness Parenting Youth Histories of Child Maltreatment & Desire to Do Things Differently Mixed Levels of Concern About Teen Pregnancy for Hawaiian Communities Value of ’Ohana as Protective – Mostly Value of Higher Education as Protective

Concluding Thoughts Teenage pregnancy disproportionately affects Native Hawaiian youth IPV among lower income teen mothers and coping with emotional stressors among teen mothers are of particular concern Compounded risk to young mother and to her infant Need for targeted violence prevention, mental health support Need for culturally attuned teen pregnancy prevention, when desired

Mahalo Nui Loa Thank You Very Much Study Participants Community Partners: Hawai‘i Department of Health Waikiki Health Center Waianae Coast Comprehensive Health Center Contact: Study PI Elizabeth Aparicio, PhD eaparici@Hawaii.edu The project was partially supported by the National Institute on Minority Health and Health Disparities (U54MD007584), National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or NIH.