CARE Women’s Health publishes on adolescent birth rates in Appalachia

Dr. Nathan Hale, Associate Professor in the East Tennessee College of Public Health’s Department of Health Services Management and Policy and faculty member of the Center for Applied Research and Evaluation (CARE) Women’s Health, is lead author of an article in the Journal of Appalachian Health.  The article, Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012–2018, discusses disparities in adolescent birth rates and the extent to which declines are seen in Appalachia.  

Kathleen Tatro, student in the College’s Doctor of Public Health program, is a co-author.  Additional co-authors include CARE Women’s Health researches Drs. Sylvester Orimaye, Michael Smith, Kate Beatty, and Amal Khoury, as well as Center for Rural Health Research Director Michael Meit.

Adolescent birth rates have steadily declined in the U.S. over the past three decades, reaching a record low of fewer than 18 births per 1,000 females between 15 and 19 years of age in 2018. Few studies have examined the extent to which observed declines in adolescent birth rates nationally are mirrored in more vulnerable geographic regions of the United States, specifically Appalachia.

This study was unique in that it focused on examining changes in adolescent birth rates longitudinally within the subregions of Appalachia, not just Appalachia as a whole, relative to counties outside of Appalachia.

The study found that adolescent birth rates were higher among most Appalachian subregions relative to non-Appalachian counties at baseline, but the rate of decline during the study period was similar. A notable exception was Central Appalachia which experienced greater declines during the study period than what was observed among non-Appalachian counties. The study also found that economic vulnerability, limited access to healthcare providers and services were also associated with increasing rates of adolescent births. These factors were more common among the counties of Appalachia and may explain why adolescent birth rates remain higher most sub regions of Appalachia.  

The finding that the overall rate of change was similar and that the gap has narrowed in Central Appalachia is encouraging. While a broad array of factors contributes to observed declines nationally, delayed sexual initiation and the increased use of effective contraception are two important factors driving observed decreases and are likely important factors in Appalachia as well.

These findings affirm the impact of front-line health care providers and reproductive health services provided to adolescents and public health practitioners involved in health education and promotion activities in communities in Central Appalachia. These findings can be also used to further target public health interventions and provide a more nuanced perspective on health outcomes within the Appalachian subregions.