Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012–2018

Authors

Nathan Hale, East Tennessee State UniversityFollow
Kathleen Tatro, East Tennessee State UniversityFollow
Sylvester Olubolu Orimaye, East Tennessee State UniversityFollow
Michael Smith, East Tennessee State UniversityFollow
Michael Meit, East Tennessee State UniversityFollow
Kate E. Beatty, East Tennessee State UniversityFollow
Amal Khoury, East Tennessee State UniversityFollow

Corresponding Author

Nathan Hale, PhD

halenl@etsu.edu

Author Affiliations

Nathan Hale, PhD. Associate Professor. Department of Health Services Management & Policy East Tennessee State University, College of Public Health. Center for Applied Research and Evaluation in Women’s Health.

Kathleen Tatro, MPH. Graduate Assistant. Department of Health Services Management & Policy East Tennessee State University, College of Public Health

Sylvester Olubolu Orimaye, PhD. Research Associate. Department of Health Services Management & Policy East Tennessee State University, College of Public Health. Center for Applied Research and Evaluation in Women’s Health.

Michael Smith, DrPH. Assistant Professor. Department of Health Services Management & Policy East Tennessee State University, College of Public Health. Center for Applied Research and Evaluation in Women’s Health.

Michael Meit. Research Associate Professor. Department of Health Services Management & Policy. Center for Rural Health Research.

Kate Beatty, PhD. Associate Professor. Department of Health Services Management & Policy East Tennessee State University, College of Public Health. Center for Rural Health Research. Center for Applied Research and Evaluation in Women’s Health.

Amal Khoury, PhD. Professor & Department Chair. Department of Health Services Management & Policy East Tennessee State University, College of Public Health. Center for Applied Research and Evaluation in Women’s Health.

Author Area of Expertise

Nathan Hale. Rural Health, Appalachian Health, Maternal and Child Health. Public Health Systems.

Abstract

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist and little is known about the extent to which broader declines are seen within Appalachia.

Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia.

Methods: We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance.

Results: About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= –5.78, CI: –9.58, –1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable.

Implications: This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably.

DOI

https://doi.org/10.13023/jah.0401.05

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Hale N, Tatro K, Orimaye SO, et al. Changes in adolescent birth rates within Appalachian subregions and non-Appalachian counties in the United States, 2012–2018. J Appalach Health 2022;4(1):31–50. DOI: https://doi.org/10.13023/jah.0401.05.