1. Who is having intended births: Analysis of two adolescent birth cohorts (2000-2001 and 2010-2011) Isia Rech Nzikou Pembe and Ann Dozier, RN PhD University of Rochester Department of Public Health Sciences I. Background III. Methods IV. Results V. Conclusions VI. Implications VII. Limitations Wanted to be pregnant sooner Wanted to be pregnant then Intended Wanted to be pregnant later Did not want to be pregnant then or in future Unintended Data Source: Birth registry of all live hospital births in a 9 county region of Upstate New York [one urban; 8 rural]. Data collected post-birth: maternal interviews, prenatal/hospital records Cohorts: births in 2000-2001 (00/01) and 2010-2011 (10/11) Inclusion Criteria: mothers 12-19 years of age; no prior live birth Exclusion Criteria: No response to pregnancy intention question After applying exclusion criteria: 2000/01 cohort: 3069 births  2252 births (73.4%) 2010/11 cohort: 2369 births  1614 births (68.1%) Dependent Variable: Intention classified as : Compare 2 cohorts of adolescent mothers with live births by pregnancy intention to determine: changes in incidence of intended births characteristics of those with intended births differences by intention status within the two cohorts US adolescent pregnancy and birth rates declined since 1990s but remain among the highest in the developed world ~18% of all US pregnancies to adolescents are intended or ambivalent. Some adolescents actively plan their pregnancies and intend to give birth Perception about benefits of childbearing Uncertain effectiveness of pregnancy prevention interventions for these adolescents Notable Results from Table 1: 28.3% fewer births to adolescents over the 10 year period Compared to 00/01 the 10/11 cohort had fewer mothers who were: Age (12-17); High School graduates; Early prenatal care (1 st Trimester) 10% more adolescents with intended births had a paternity acknowledgement Notable Results from Table 2: About 5% fewer intended births over the 10 year period; Significant relationship with birth intention(p< 0.10) included in regression model: 2000/01 Cohort2010/11 Cohort Age Race – Black Foreign Born Prior Pregnancies (no live birth) Medicaid Funded Birth County of Birth – Urban Smoker Pre-Pregnancy Paternity Acknowledgement Father Hispanic 2000/01 Cohort2010/11 Cohort GREATER LIKELIHOOD OF INTENDED BIRTH Age (18-19) Prior Pregnancies (no live birth) Race – Black Hispanic Medicaid Funded Paternity Acknowledgement LESS LIKELIHOOD OF INTENDED BIRTH Mother US Born Notable Results from Table 3: Variables with statistically significant relationship to birth intention (p<.05): Pregnancy intent was asked in the immediate postpartum period - could bias responses Secondary data analysis limited to available data (e.g. missing some personal factors, contraceptive use) and missing/incomplete data (e.g. paternal age/education) Results could be unique to the region in which the study was conducted. Acknowledgments: Joseph Duckett, Information Analyst University of Rochester, Department of Public Health Sciences As with US trends, adolescent births declined; Intended births also declined Those ages 18-19 and those with Paternity Acknowledgement most likely to have intended births Maternal education level and birth intention not related II. Purpose Partner influence and perceived partner desire for pregnancy may contribute to intended pregnancies Adolescents intending pregnancies might not grasp the full extent of what it means to become parents and often times are under the impression that having a baby will create a stable family unit Black race and Hispanic ethnicity were significant factors in the earlier but not the later cohort Prior pregnancy (or pregnancies) increased the risk for subsequent pregnancy (especially if the first pregnancy did not turn out as planned) a Only hospital births. b Variable is missing <10% of its data in the 2000 to 2001 cohort; c Variable is missing <10% of its data in the 2010 to 2011 cohort. d Birth certificate data from a 9 county region with one primarily urban county. e Variable not collected in the 2000-2001 cohort. f Results in BOLD indicate significant differences ( ≥10% ) amongst both cohorts. Table 3. Binary Logistic Regression Models Intended Births to Adolescent Mothers ≤ 19 Years Old (only variables with significant bivariate relationships) 2000/01 Cohort2010/11 Cohort OR [95% CI] Maternal Characteristics [ref] Age 18-19 [12-17]1.56 [1.25-1.94]2.30 [1.66-3.20] Black Race [No]1.40 [1.09-1.80]0.87 [0.64-1.19] Hispanic [No]1.47 [1.03-2.10]1.24 [0.87-1.75] ≥ High School Education [<High School] 0.81 [0.64-1.01]0.80 [0.62-1.04] Country of Birth - USA [Foreign Born] 0.59 [0.39-0.89]0.51 [0.28-0.93] Prenatal History & Birth Variables [ref] Pre-pregnancy Smoker [Non – Smoker] b 1.00 [0.81-1.24]1.15 [0.89-1.49] Prior Pregnancies - ≥ 1 [0] 1.36 [1.08-1.71]1.57 [1.18-2.11] Medicaid Funded Birth [Other] 1.38 [1.12-1.68]1.03 [0.80-1.32] County of Birth – Urban [No] c 1.08 [0.86-1.36]0.92 [0.69-1.21] Paternity Acknowledgement. [No]0.98 [0.82-1.19]1.82 [1.39-2.37] Table 1. Characteristics of births from two Upstate New York birth cohorts to adolescent mothers ≤ 19 Table 2. Bivariate Analyses of Birth Intention and Parental Characteristics for two birth cohorts of mothers ≤ 19 (%) 2000/012010/112000/01 Births (%)2010/11 Births (%) Births = 2252 n (%) Births = 1614 n (%) Unintended Births n = 1578 Intended Births n = 674 Unintended Births n = 1214 Intended Births n = 400 Maternal Characteristics Age 12-17 39.927.042.135.030.715.7 18-19 60.173.057.965.069.384.3 Black Race 29.733.827.933.835.728.0 Hispanic 11.114.69.415.313.817.3 Education – No HS grad 65.551.964.667.853.048.5 Foreign Born − Yes 6.33.04.99.82.45.0 Mother’s Prenatal History & Birth Variables Smoker Pre-pregnancy b 30.531.030.829.929.635.3 Pre-Preg. BMI − Nml c 62.563.062.5 62.664.3 Prior Pregnancies − Yes 18.817.217.023.015.023.7 Began care 1 st Trimester 65.255.665.863.854.959.0 Income Proxies Prenatal WIC72.477.671.973.677.777.3 Medicaid Funded Birth 60.266.757.167.566.666.8 County of Birth − Urban d 60.563.058.665.164.060.0 Father’s Characteristics Paternity Acknow. −Yes 54.364.455.052.760.775.5 Hispanic e --46.3-- 51.530.7 b Variable is missing <10% of its data in the 2000 to 2001 cohort; c Variable is missing <10% of its data in the 2010 to 2011 cohort. d Birth certificate data from a 9 county region with one primarily urban county. e Variable not collected in the 2000-2001 cohort. f Results in BOLD indicate significant differences ( ≥10% ) amongst both cohorts or if BOLD only significant in one cohort