title: Reasons for and challenges of recent increases in teen birth rates: a study of family planning service policies and demographic changes at the state level.
abstract: OBJECTIVE
  After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level.
  
  
  METHODS
  With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis.
  
  
  RESULTS
  Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates.
  
  
  CONCLUSIONS
  Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. zyang26@sph.emory.edu
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yang
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gaydos
mesh_terms: D000293:Adolescent; D001723:Birth Rate / Q000639:trends*; D003267:Contraception / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008484:Medicaid; D016134:Organizational Policy; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data; D011640:Public Policy; D012736:Sex Education; D012746:Sexual Abstinence; D013219:State Government; D014481:United States; D055815:Young Adult