title: Trends and Progress in Reducing Teen Birth Rates and the Persisting Challenge of Eliminating Racial/Ethnic Disparities.
abstract: We examined progress made by the Milwaukee community toward achieving the Milwaukee Teen Pregnancy Prevention Initiative's aggressive 2008 goal of reducing the teen birth rate to 30 live births/1000 females aged 15-17 years by 2015. We further examined differential teen birth rates in disparate racial and ethnic groups.
  
  
  
  We analyzed teen birth count data from the Wisconsin Interactive Statistics on Health system and demographic data from the US Census Bureau. We computed annual 2003-2014 teen birth rates for the city and four racial/ethnic groups within the city (white non-Hispanic, black non-Hispanic, Hispanic/Latina, Asian non-Hispanic). To compare birth rates from before (2003-2008) and after (2009-2014) goal setting, we used a single-system design to employ two time series analysis approaches, celeration line, and three standard deviation (3SD) bands.
  
  
  
  Milwaukee's teen birth rate dropped 54 % from 54.3 in 2003 to 23.7 births/1000 females in 2014, surpassing the goal of 30 births/1000 females 3 years ahead of schedule. Rate reduction following goal setting was statistically significant, as five of the six post-goal data points were located below the celeration line and points for six consecutive years (2010-2014) fell below the 3SD band. All racial/ethnic groups demonstrated significant reductions through at least one of the two time series approaches. The gap between white and both black and Hispanic/Latina teens widened.
  
  
  
  Significant reduction has occurred in the overall teen birth rate of Milwaukee. Achieving an aggressive reduction in teen births highlights the importance of collaborative community partnerships in setting and tracking public health goals.
authors.affiliation: Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA. ngui@uwm.edu.|Center for Urban Population Health, Milwaukee, WI, USA. ngui@uwm.edu.
authors.forename: Emmanuel M
authors.initials: EM
authors.lastname: Ngui
authors.affiliation: Center for Urban Population Health, Milwaukee, WI, USA.|Aurora Health Care, Inc., Milwaukee, WI, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Greer
authors.affiliation: Center for Urban Population Health, Milwaukee, WI, USA.|College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA.
authors.forename: Farrin D
authors.initials: FD
authors.lastname: Bridgewater
authors.affiliation: Center for Urban Population Health, Milwaukee, WI, USA.|Health Promotion & Behavior, College of Public Health, The University of Georgia, Athens, GA, USA.
authors.forename: Trina C
authors.initials: TC
authors.lastname: Salm Ward
authors.affiliation: Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA.|Center for Urban Population Health, Milwaukee, WI, USA.|Aurora Health Care, Inc., Milwaukee, WI, USA.|College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA.|School of Medicine and Public Health, University of Wisconsin, Madison, USA.
authors.forename: Ron A
authors.initials: RA
authors.lastname: Cisler
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D001723:Birth Rate / Q000208:ethnology* / Q000639:trends*; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology*; D044465:White People / Q000706:statistics & numerical data; D014922:Wisconsin
keywords: Adolescent; Goals; Health disparities; Race/ethnicity; Racial disparities; Teen birth; Teen pregnancy; Trend analysis