Exploring the Predictors that may Influence the Variations in Teen Birth Rates by State Deepthi Moparthi, MBBS, MPH, M. Elizabeth Fore, Ph.D., Monica Mispireta, MD, MHS, Ph.D. (C)., Neill F. Piland, Dr.P.H Idaho State University, Master of Public Health Program This study found that, when keeping all other factors constant Teen birth rate was directly associated with number of uninsured adults (p < 0.001) Teen birth rate was directly associated with level of religiosity (p < 0.001) Teen birth rate was inversely associated with average freshman graduation rate (p = 0.054) Teen birth rate was inversely associated with the supply of abortion providers in the state (p = 0.011). No statically significant relationship between policies on sex education and parental consent for abortion with the teen birth rates by state. Source: CDC/NCHA. National Vital Statistics System, 2010 Methods  Cross-sectional quantitative analysis of secondary data from the following sources: Natality (US DHHS, 2012). State policies in brief in 2009 dataset (Guttmacher Institute, 2009), policies on parental consent for abortion by state (Guttmacher Institute, 2012a), percentage of counties without abortion provider for the year 2008 by state (Guttmacher Institute, 2012c) and number of abortion providers in 2008 by state (Guttmacher Institute, 2012d) Data for Average Freshmen Graduation rate, gini coefficient on income inequality, and percentage of uninsured is obtained from State data about on health rankings from County Health Ranking & Road Maps (County Health Ranking, 2012) Percentage of religiosity of the states from article entitled “State of States: Importance of Religion for the year 2009 from Gallup” (Newport, 2009) Political preferences of state based on outcome of the 2008 presidential election (CNN, 2008).  The sample represented teen births in all 50 states in United States and the District of Columbia (D.C.) and population of female teens for each state and DC. in the year The unit of measurement was the state for a sample size of n= 51.  Bivariate analysis was used for each of the factors.  Multiple regression analysis with all variables using forward selection. Bivariate Analysis of Variables Bivariate Analysis Factors β- coefficient * 95%Confidenc e Interval p- value** State Policy Abstinence only sex education Comprehensive sex education Required Parent Consent for Abortion Economy Gini Coefficient Education Average Freshman Graduation Rate Social Factors Religiosity Political Preferences - Democratic state Political Preference – Republican State Health Services Percentage of uninsured Percentage of counties without a known abortion provider Number of abortion providers per state Multivariate Analysis of Variables with Significant Outcome Multivariate Analysis Factors Predicting Teen Birth Rates β- coefficient* 95%Confidenc e Interval p- value** Education Average Freshman Graduation Rate Social Factors Religiosity Health Services Percentage of uninsured Number of abortion providers Birth rate for women aged 15 – 19. By state for 2010 *β-coefficient shows the strength of association **P<0.05 is said to be significant Introduction The U.S. teen birth rate declined in 2010, reaching a historic low at 34.3 births per 1000 women aged Despite the steady decline in birth rates, the United Nations reports that the teenage pregnancy rate in the United States continues to be nearly nine times higher than the majority of other developed nations (Hamilton, Martin, Ventura, 2011). Numerous factors were said to contribute to high rate of teenage births in the U.S. Various individual-level factors that are attributed to the disparities in teen birth rate include, race and ethnicity, family structure, single parent household, and behavioral factors such as early sexual activity Despite a significant decline of 44% in the U. S. teen birth rate from , the continuing wide range of state specific rates from 15.7 per 1000 teens in New Hampshire to 55.0 births per 1000 teens in Mississippi in 2010 has raised concern about identifying factors influencing state level variation. Teen birth rates were higher in South and Southwest and lower in the Northeast and Upper Midwest. No data is available on possible disparities in teen birth rates of states with various economies, education, social, health care services, and policies of states with regards to sex education programs and abortion policies requiring parental consent. The aim of this study was to examine the relationship between sex education, abortion policies, socio-demographic factors including education, poverty, conservatism and religiosity, and access to health services and state-level teen birth rates. The findings will impact future policy and funding decisions. Results Discussion  Teen birth rates of states with high teen birth rates have lower high school graduation rates, are more religious, and have more uninsured patients and fewer abortion providers. These factors might have played a significant role in the differences in teen birth rates of states.  Sex education policies and policies on parental consent for abortion did not have a significant relationship with the teen birth rates by state. The wide variation in teen birth rates across states and in state specific factors makes implementation of health policies difficult thereby reducing the applicability and effectiveness of adopted policies. Strengths and Limitations  This study explored the impact that these significant factors could cause in the implementation of various preventive measures and policies to reduce teen birth rates indicating the need for states to address the concerns and perceptions of their conservative populations when planning and implementing prevention programs.  As the data obtained for this study included all the population of the U.S., the results of this study can be generalized to all of the U.S. population.  The study was limited to the data and information provided by the primary sources.  Furthermore this was an ecological study. Individual factors which are beyond the scope of this ecological study could not be assessed.