Teen Pregnancy in Arizona and the Arizona Youth Partnership, Starting Out Right Program, 2010-2019

Abstract

Background.Teenage pregnancy is recognized as a significant public health concern associated with a range of risks for both the mother and baby. Supporting teens who are pregnant through community-based programs may help to avoid compounding adverse health effects that have been associated with teenage pregnancy. Understanding health needs of pregnant teens and characteristics of participants of teen pregnancy programs is important in developing and improving programs. In Arizona, the Starting Out Right (SOR) program of Arizona Youth Partnership (AzYP) provides prenatal education services and support for pregnant teens. This study has three specific aims: 1) describes participation patterns in the SOR program in 2018 and 2019, 2) describe the prevalence of smoking, hypertension, preeclampsia, eclampsia, overweight and obesity, gestational diabetes, and sexually transmitted infections (STIs) in teens who gave birth in Arizona from 2010-2019, and 3) compare the health characteristics, prenatal services, and birth outcomes of SOR participants and nonparticipants from 2010-2019 using state vital statistics records. Methods. For aim one, the SOR program provided a de-identified report of teens who enrolled or inquired to enroll into the program in 2018 and 2019 with their demographic information and class participation. These data were utilized to examine factors related to non-attendance and factors related to low, moderate, and high attendance. Logistic regression tested the association of non-attendance and county of residence, race, ethnicity, referral type, age, and weeks of gestation at enrollment. Multinomial logistic regression tested the association between levels of attendance (low, moderate, and high) and county of residence, race, ethnicity, referral type, age, and weeks of gestation at enrollment. For aims two and three, in collaboration with the Arizona Department of Health Services, the University of Arizona obtained vital statistics birth data for teen births (mothers  19 years of age) from 2010-2019 from three counties in Arizona: Pima, Maricopa, and Gila. The SOR program provided a list of program participants from 2010-2019 to the University of Arizona Data Information Services who provided a de-identified data set with a variable that identified those who were in the SOR program and those who were not in the SOR program. For aim two, this data was used to compute parametric tests for trend over time for health characteristics that are associated with pregnancy risk factors, mean differences in these factors by county, and percent differences by county. For aim three, chi-square analysis and multiple logistic regression tested differences for health characteristics and birth outcomes between SOR participants and nonparticipants. Results. The results for aim one showed that participants in Maricopa had a greater odds of higher attendance versus lower attendance than Pima County (OR 2.8, 95% CI 1.1, 7.5), and participants in Gila County had a greater odds of higher attendance versus lower attendance than Pima County (OR 6.5, 95% CI 1.5, 27.6). A significantly greater percentage (p < 0.001) of teens who were referred to SOR by a physician or community agency initiated participation (36%) compared with teens who never attended (17%). The number of classes attended for participants who enrolled late in pregnancy (> 28 weeks) was nearly equivalent to participants who enrolled early in pregnancy (<20 weeks). Results for aim two found that the mean age of teen moms was 17.7  1.1 years, consistent over the 10-year time span. Cigarette smoking was much higher in rural Gila County (11.2%), compared to suburban and urban Pima (4.2%) and Maricopa (4%) counties. Preeclampsia had an upward trend, starting from 4.4% in 2010 increasing to 9.6% in 2019 (p<0.001). The prevalence of overweight and obese was 35.4% for the total sample and ranged from a low of 32.1% in 2014 to a high of 37.5% in 2017 (p<0.001). Positive STIs ranged from 6.8% of the sample in 2014 to 11.7% in 2017, a significant increase over time (p<0.001). Results for aim three found that the adjusted odds ratios for the noted health characteristics (smoking, hypertension, preeclampsia, eclampsia, overweight and obesity, gestational diabetes, and sexually transmitted infections) were not significantly different for SOR participants and nonparticipants. SOR participants had reduced odds of having a preterm birth, aOR 0.8 (95% CI 0.7,0.9), and reduced odds of having a low birthweight baby, aOR 0.8(95% CI 0.6,0.9), compared to nonparticipants. SOR participants had increased odds of breastfeeding at discharge, aOR 1.3(95% CI 1.0,1.7), compared to nonparticipants. Conclusions. Aim 1. Strengthening referral systems may be one way to increase overall enrollment. Teens who enrolled later in pregnancy were just as likely as those who enrolled earlier in pregnancy to participate with high attendance and complete the program curriculum. Pregnant teens should continue to be referred to teen pregnancy programs from a variety of sources at any stage during their pregnancy. Aim 2. Births from teen pregnancies decreased in Pima, Maricopa, and Gila counties from 2010-2019 but there are still many births to teen mothers every year. The prevalence of preeclampsia and STIs in teen pregnancies in Arizona has increased over time and are both significantly higher in rural areas than urban or suburban areas. Smoking during pregnancy and STI infections were higher in rural areas and are health behaviors that can be addressed during teen pregnancy. Teens need access to appropriate health information and support during pregnancy to effectively prevent STIs, reduce or quit smoking during pregnancy, and make other positive behavior changes, including improving diet quality. Aim 3. Engagement with the SOR program was associated with significant positive effects on birth outcomes including reduced preterm birth and low birthweight, and increased initiation of breastfeeding. The SOR program should continue to provide these valuable services during teen pregnancy and look for ways to draw in more teens that may be less likely to participate in programs, or who may be delaying prenatal care.