County Health Rankings Model

Teen Births

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Use County Health Rankings’ model of health to explore the measures that influence how long and how well we live.

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About

Number of births per 1,000 female population ages 15-19. The 2022 County Health Rankings used data from 2014-2020 for this measure.

Early childbearing during teenage years has been associated with adverse health outcomes for the mother-child dyad, the impacts of which can extend to partners, other family members, and the community. Negative outcomes for children and mothers with early childbearing are best explained by social disadvantage and social adversity.[1] Mothers who give birth during teen years face barriers to attaining an education at or above high school completion and face additional mental and physical stress as well as chronic lack of community support.[2-4] Young parents may struggle to find affordable, quality childcare, and suitable transportation, further hampering options for education or employment.

Inequities exist in support for pregnant and parenting youth. Parenting youth who are without documentation status in the U.S. may face additional barriers to accessing healthcare and education, making their families particularly vulnerable.[5]

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Data and methods

Data Source

National Center for Health Statistics - Natality files

Data on deaths and births were provided by NCHS and drawn from the National Vital Statistics System (NVSS). These data are submitted to the NVSS by the vital registration systems operated in the jurisdictions legally responsible for registering vital events (i.e., births, deaths, marriages, divorces, and fetal deaths). We requested this data for the first time for the 2018 Rankings. This was done because of the discontinuation of Health Indicators Warehouse. This change also allows to to perform additional analyses for state and national reports which if obtained from CDC WONDER would have numerous missing counties. 

Counties can find the same data from CDC WONDER. However, we use the raw data files. CDC WONDER does not report data for all counties per their missing data criteria.

The methods for calculating the error associated with death rates can be found here:

https://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf

For counties with fewer than 20 births a missing value for all values is reported. 

For counties with between 20 and 99 births a gamma adjustment from the poisson distribution is used to calculate the CIs. 

For counties with 100 births or more CIs are calulated according to the normal distribution. Standard errors (SE) and birth rates for each age group are calculated. These SEs are squared and multiplied by the square of the weights and then divided by the total number of births over all age groups. The sum of these provides the variance of the estimate for each county. The square root of the variance gives the standard deviation which is then used as estimate +/- 1.96*STDEV. 

Website to download data

Key Measure Methods

Teen Births is a rate

Teen Births is the number of births to females ages 15-19 per 1,000 females in a county. Rates measure the number of events (e.g., deaths, births, etc.) in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare health data across counties with different population sizes.

Births are counted in the mother's county of residence

Births are counted in the county corresponding to the mother’s address on the child’s birth certificate, not the county the child was born in.

Some data are suppressed

A missing value is reported for counties with fewer than 10 teen births in the time frame.

Measure limitations

The primary limitation of this measure is that it does not capture births among teens younger than 15. Also, teen births and teen pregnancy are distinct but related measures. Although all births are the culmination of a pregnancy, not all pregnancies culminate in a birth.

Numerator

The numerator is the total number of births to mothers ages 15-19 in the 7-year time frame.

Denominator

The denominator is the aggregate female population, ages 15-19, over the 7-year time frame.

Can This Measure Be Used to Track Progress

This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 7-year average. However, in most counties, it is relatively simple to obtain single-year estimates from the resource included below. 

Digging Deeper

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We recommend starting with the CDC Wonder database, which contains information on birth rates by race, ethnicity, age, gender, and geography of mother and child for counties with populations greater than 100,000. For counties with smaller populations, most states maintain databases of birth and death data. You can find links to these in State-Specific Data Sources.

Another way to access this data is through the Community Commons. Data by race can be found for some communities. Note that you will need to login to access this report, but registration is free for all.

References

[1] Smithbattle L. Reframing the risks and losses of teen mothering. The American Journal of Maternal/ Child Nursing. 2009;34(2). 122-8.
[2] Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: economic costs and social consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press.
[3] Chang, T., Choi, H., Richardson, C. R., Davis, M. M. "Implications of teen birth for overweight and obesity in adulthood." American journal of obstetrics and gynecology 209.2. 2013: 110-e1.
[4] SmithBattle, L., Freed, P. "Teen mothers' mental health." MCN: The American Journal of Maternal/Child Nursing 41.1. 2016: 31-36.
[5] Toomey RB. Umaña-Taylor AJ. Williams DR. Harvey-Mendoza E. Jahromi LB. Updegraff KA. Impact of Arizona's SB 1070 immigration law on utilization of health care and public assistance among Mexican-Origin adolescent mothers and their mother figures. American Journal of Public Health. 2014:104. S28-S34.

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