Office of Public Health Studies Racial and Ethnic Disparities of Teen Pregnancy in Hawai`i: 2005-2009 Office of Public Health Studies Nandar Aunga,b, MPH, MBA, Eric L. Hurwitza, DC, PhD, Nancy S. Partikaa, RN, MPH aDepartment of Public Health Sciences, University of Hawai`i at Mānoa bStudent Affiliate, East West Center Background Results Results 50% of the teen mothers were of Hawaiian or Filipino ancestry. (Figure 1) Although the largest proportion of teen births occurred on Oahu (Table 1), the risks of being a teen mom were highest on Hawai`i Island (0.124), Kauai (0.112), and Maui (0.094), and lowest on Oahu (0.076). The majority of the teen mothers lived in rural areas of the State. (Table 1) 60% of teen births were Medicaid at discharge. (Figure 2) Teen moms were more likely than older moms to deliver preterm and low birth weight infants. (Table 2) Hawai`i has the 17th highest teen pregnancy rate in the U.S.1 Approximately 3,600 teen pregnancies occur in Hawai`i annually. Teen pregnancy has negative consequences on teen mothers, children born by teen mothers, and overall wellbeing of society. Table 2. Comparisons of teen moms to others on selected health problems Health Effects Odds Ratios [OR] 19 and younger vs. 20-29 years 19 and younger vs. 30+ years Have preterm delivery 1.28 1.26 Test positive for substance abuse 1.02 1.36 Deliver a low birth weight Infant 1.40 1.14 Objectives To analyze the characteristics of teen mothers and infant birth outcomes. To define the existing disparities of teen pregnancy in Hawai`i among its populations. Table 1. Distributions of teen births by Community of Maternal Residence Maternal Residence Age (19 and younger) Island Community SES n % Oahu (63%) Ewa 997 13.75 West Honolulu 786 10.84 Waianae 719 9.92 Kaneohe - Kailua 604 8.33 North Shore 548 7.56 Aiea - Pearl City 484 6.68 Central Honolulu 292 4.03 East Honolulu 140 1.93 Hawai`i (18%) Hilo - North Hawai`i 540 7.45 Kona 416 5.74 South Hawai`i 377 5.20 Maui (9%) West & Central Maui 637 8.79 Kauai (6%) East Kauai 229 3.16 North & West Kauai 199 2.74 Molokai-Lanai - East Maui (4%) Molokai - Lanai – East Maui 254 3.50 Other Other US 28 0.39 Total 7250 8.54 Discussion Methodology Findings confirm that the risk of being a teen mom depends on maternal ethnicity and area of residency. These disparities may be due to the lack of health care services, reproductive as well as general health care, necessary contraceptives, and knowledge on contraception and healthy behaviors. Lifestyle and cultural differences, and family values toward pregnancy may also account for the disproportionate occurrence of teen pregnancies among Hawaiian and Filipino teens in Hawai`i. Culturally-sensitive Hawai`i teen pregnancy prevention programs should target Hawaiians and Filipinos, particularly in rural communities. The relationship between teen births, substance abuse, and poor pregnancy outcomes need to be addressed in educational programs. The findings of this study can be used to better inform policymakers and assist the State in developing more effective and targeted teen pregnancy prevention programs for Hawai`i teens. Hospital discharge data representing all 84,920 births in Hawai`i hospitals from January 1, 2005 through June 30, 2009 were linked (mother to baby), extracted, and analyzed. Over the 4.5-year study period, a total of 7,250 hospital births were by teen mothers (<19years) in Hawai`i. Descriptive and inferential statistics were computed on mother and newborn variables to identify factors and estimate associations. Figure 1. Distributions of births by maternal ethnicity and age (Hawai`i Hospitals from Jan 2005- Jun 2009) Figure 2. Distributions of teen moms by insurance status at labor and delivery discharge Acknowledgements Data provided by the Hawai`i Health Information Corporation. Conference scholarship provided by the Elmer J. Anderson Professional Travel Award, Office of Public Health Studies. References: 1Guttmacher Institute. (2010). U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity.. For more information, please contact nandar@hawaii.edu

Background Hawai`i 17th highest teen pregnancy rate in the U.S.1 3,600 teen pregnancies occur in Hawai`i annually. Teen pregnancy: negative consequences on teen mothers, children born by teen mothers, and overall wellbeing of society. References: 1Guttmacher Institute. (2010). U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity.

Objectives Methodology To analyze the characteristics of teen mothers and infant birth outcomes. To define the existing disparities of teen pregnancy in Hawai`i among its populations. Methodology Hospital discharge data representing all 84,920 births in Hawai`i hospitals from January 1, 2005 through June 30, 2009 were linked (mother to baby), extracted, and analyzed. Over the 4.5-year study period, a total of 7,250 hospital births were by teen mothers (<19years) in Hawai`i. Descriptive and inferential statistics were computed on mother and newborn variables to identify factors and estimate associations.

Distributions of births by maternal ethnicity and age (Hawai`i Hospitals from Jan 2005- Jun 2009)

Molokai-Lanai-East Maui (4%) Distributions of teen births by community of Maternal Residence Maternal Residence Age (19 and younger) Island Community SES n % Oahu (63%) Ewa 997 13.75 West Honolulu 786 10.84 Waianae 719 9.92 Kaneohe - Kailua 604 8.33 North Shore 548 7.56 Aiea - Pearl City 484 6.68 Central Honolulu 292 4.03 East Honolulu 140 1.93 Hawai`i (18%) Hilo - North Hawai`i 540 7.45 Kona 416 5.74 South Hawai`i 377 5.20 Maui (9%) West & Central Maui 637 8.79 Kauai (6%) East Kauai 229 3.16 North & West Kauai 199 2.74 Molokai-Lanai-East Maui (4%) Molokai - Lanai – East Maui 254 3.50 Other Other US 28 0.39 Total 7250 8.54

Distributions of teen moms by insurance status at discharge Medicaid/Quest (n=4359) Medicaid Quest AlohaCare HMSA Quest Kaiser Quest (any other QUEST)

Comparisons of teen moms to others on selected health problems Health Effects Odds Ratios [OR] 19 and younger vs. 20-29 years 19 and younger vs. 30+ years Have preterm delivery 1.28 1.26 Test positive for substance abuse 1.02 1.36 Deliver a low birth weight Infant 1.40 1.14

Results 50% of the teen mothers were of Hawaiian or Filipino ancestry. Although the largest proportion of teen births occurred on Oahu, the risks of being a teen mom were highest on Hawai`i Island (0.124), Kauai (0.112), and Maui (0.094), and lowest on Oahu (0.076). The majority of the teen mothers lived in rural areas of the State. 60% of teen births were Medicaid at discharge. Teen moms were more likely than older moms to deliver preterm and low birth weight infants.

Discussion Risk of being a teen mom depends on maternal ethnicity and area of residency. Disparities may be due to the lack of health care services, reproductive as well as general health care, necessary contraceptives, and knowledge on contraception and healthy behaviors. Lifestyle and cultural differences, and family values toward pregnancy may also account for the disproportionate occurrence of teen pregnancies among Hawaiian and Filipino teens in Hawai`i.

Discussion – cont’d Culturally-sensitive Hawai`i teen pregnancy prevention programs should target Hawaiians and Filipinos, particularly in rural communities. The relationship between teen births, substance abuse, and poor pregnancy outcomes need to be addressed in educational programs. The findings of this study can be used to better inform policymakers and assist the State in developing more effective and targeted teen pregnancy prevention programs for Hawai`i teens.

Acknowledgements APHA Data provided by the Hawai`i Health Information Corporation. APHA Session 3363.0, "Asian & Pacific Islander Health Across the Life Course (e.g. prenatal, infant, child, adolescent, and/or aging)" Board #5 : Racial and Ethnic Disparities of Teen Pregnancy in Hawai`i: 2005-2009, Monday, November 8, 2010, 4:30pm

Questions nandar@hawaii.edu