Adolescent pregnancy: Black and white

According to recent data from the Alan Guttmacher Institute, the United States leads nearly all other developed nations of the world in rates of teenage pregnancy, abortion and child-bearing even though it has comparable rates of sexual activity. Data show that this top-ranked status is not due to the high rates of pregnancy and parenthood among minority teens alone. Pregnancy rates for white teenagers are twice as high as those of Canada, France, and England. Moreover, the maximum difference in birth rates by race occurs among girls under 15, the most vulnerable teenagers. International data make it clear that the enormous costs of adolescent parenthood for teen parents, their children and society are not the inevitable outcomes of increased adolescent sexual activity. These costs represent inability as a society to deal in a preventive way with the implications of that increase, to provide adequate and comprehensive sex education, and to give sexually active teens easy access to family planning services and counseling. Many object to giving teenagers thecapacity to delay parenthood while unsuccessfully imploring them to delay sexual activity. Withholding sex education and family planning services hasnot led to less teenage sexual activity in the U.S. Conversely, the provision of needed information and services in Europe and Canada has not resulted in increased sexual activity, but in heightened sexual responsibility. The costs of adolescent parenthood fall disproportionately on those least able to support them, teens from low-income/minority families and teens with poor basic skills and poor employment potential. They initiate sexual activity earlier than more advantaged teens and have poorer access to information and services. Of critical importance, these teens also lack compelling reasons to delay parenthood. Those in and outside of government have two enormous tasks ahead: to bring the rates of pregnancy, abortion, and births in the U.S. down to levels comparable to those found in other affluent countries, and to bring these rates among low-income and minority teens down to the levels found among advantaged, non-minority youth. A shift of focus is required—from preventing sexual activity to preventing pregnancies. The second task requires a fundamental shift from preparingsome youth for adulthood, to preparingall youth.Marian Wright Edelman, J.D. is President of Children's Defense Fund. Karen Johnson Pittman is Director of the Adolescent Pregnancy Program, Children's Defense Fund.     

Adolescent pregnancy in the United States: an interstate analysis

Rates of teenage pregnancy, birth and abortion vary greatly among states. Because states that have high birthrates tend to have low abortion rates, pregnancy levels vary much less than do the birth and abortion measures. The role of unintended pregnancy is highlighted by the fact that in states that have very high pregnancy rates, the adolescent abortion rate is higher than the birthrate and the abortion rate combined in states that have the lowest pregnancy rates. A series of multivariate analyses that controlled for the percentage of the state population that was black, poor and metropolitan showed that social factors tend to be more important determinants of state differences in teenage pregnancy, birth and abortion levels than are policy-related variables, particularly for whites. Nevertheless, some policy measures have important associations for both races, especially for blacks. Social factors. High rates of population growth and residential mobility over the previous decade, a high crime rate, a high teenage suicide rate, extensive circulation of sexually explicit magazines, a large percentage not voting in elections and a high level of stress are all associated with high pregnancy-related rates for teenagers. The percentage of children living in female-headed households correlates positively with abortion and pregnancy levels among white teenagers, but has no significant association with the birthrate. The percentage of a state's population that belongs to fundamentalist religious groups is positively associated with adolescent birthrates. Political liberalism correlates with relatively low pregnancy rates and birthrates but with a somewhat higher likelihood of pregnancies being terminated by abortion. In states where women's status is higher, birthrates are lower, but abortion levels are higher. Policy measures. States that have high proportions of teenagers dropping out of school and of young women not graduating from high school tend to have high pregnancy rates and birthrates and a somewhat lower proportion of pregnancies ending in abortion. Increased spending on education is associated with relatively high abortion rates (and, therefore, pregnancy rates). The higher the teacher-student ratio, the lower the adolescent birthrate and the more likely the pregnant teenager is to have an abortion. Welfare payments to teenage mothers are negatively associated with both black and white teenage birthrates, and higher maximum payments are associated with relatively high abortion levels.(ABSTRACT TRUNCATED AT 400 WORDS)     

Dental caries in Brazil: decline, polarization, inequality and social exclusion]

OBJECTIVE: To examine the caries situation in Brazilian schoolchildren between 1980 and 2003 and to determine the distribution of caries and access to treatment in this population group. METHODS: We employed secondary data concerning the number of decayed, missing or filled teeth (DMFT). The studies whose data were used differed in terms of study type, study design, sampling methods, and diagnostic criteria, but yielded national estimates that are considered valid for the DMFT index. Therefore, a trend analysis based on these studies was thought to be feasible. RESULTS: Analysis of DMFT values revealed a high frequency of dental caries in 1980 and a moderate frequency in the 1990s. In 2003, the DMFT index was still within the moderate range. Between 1980 and 2003, a 61.7% decrease in DMFT frequency was observed. The percentage of children with no DMFT increased from 3.7% in 1986 to 31.1% in 2003. On the other hand, in the segment of the study population least affected, the percentage of children who received care increased from 26.3 in 1986 to 34.7 in 2003, yet in the group with DMFT this percentage fell from 50.2 in 1986 to 39.3 in 2003. In the segment with DMFT >/=6, the percentage of those who received care remained stable (28%). During the study period, 60% of the dental caries were found in 20% of the study population. CONCLUSION: An important decline in DMFT was observed between 1980 and 2003, perhaps as a result of increased access to fluoridated water and toothpaste and of changes in the goals of public oral health programs. Despite the improvement, caries is unevenly distributed in the pediatric population; a small proportion of individuals carries most of the disease burden. In addition, the proportion of teeth with caries that went untreated did not change between 1980 and 2003. Reducing socioeconomic disparities and adopting public health measures that target and reach the most vulnerable groups remain a challenge for policy makers in Brazil.     

Lack of food and nutritional security in Central America: contributing factors and social exclusion]

In August 2001, the XVII Meeting of the Health Sector in Central America and the Dominican Republic (RESSCAD) was held in Managua, Nicaragua. At the meeting, a resolution was adopted in support of strengthening and furthering the Central American initiative for the Promotion of Food and Nutritional Security. This paper examines the conceptual framework behind the initiative, which was approved by the XIV Central American Presidents Summit Meeting (Guatemala City, Guatemala) and launched in 1994 at the regional, national, and municipal levels (Guacimo, Costa Rica, 1994). It focuses on the accomplishments attributable to this initiative, the challenges it has faced over 2001 and those it will be facing over the next biennium, and the measures taken or recommended so far in order to ensure its long-term success.     

Addressing racial disparities in social welfare programs: using social equity analysis to examine the problem

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) allows states considerable discretion in developing and implementing their Temporary Assistance for Needy Families (TANF) programs. Little research so far has compared the implementation of TANF programs across racial groups. Without such analysis, it is difficult to interpret program outcomes. Using client survey data from a large Manpower Demonstration Research Corporation (MDRC) study, the Project on Devolution and Urban Change, this article compares African-American, Hispanic and White Clients' experiences with diversion, case management, sanctioning, exiting welfare, and dispute resolution. Using residual differences analysis, this article identifies significant differences in treatment among racial and ethnic groups.     

Monitoring poverty and social exclusion 2003

The New Policy Institute has produced its sixth annual report of indicators of poverty and social exclusion. This year's report focuses on regional variations across England, Scotland and Wales. With 5 years of data now available to measure progress since Labour came to office in 1997, it is becoming much clearer where the Government's strategy for combating poverty and social exclusion is being successful – and where it is not. With the number of people living in low‐income households now on a steady downward trend, the latest figures (for 2001/2002) passed the notable milestone of taking income poverty lower than at any time in the 1990s. The main reason why the number of people in low‐income households fell in the 5 years to 2001/2002 is that there were fewer people in workless households. But, over the same period, the number of people in low‐income, working households did not fall. Out‐of‐work benefits to both working‐age families with dependent children and to pensioners have risen by around 30% in real terms since 1998, faster than earnings. This, plus the rise in tax credits, will have had a significant impact on the severity of poverty suffered by some low‐income households even when it has not taken them above the low‐income threshold. In education, earlier progress in increasing the numbers of those with an adequate minimum level of qualification has stalled, with no further advance since 2000, compared with rapid progress during the second half of the 1990s. Around a quarter of young people at each of the ages of 11, 16 and 19 are still failing to reach a basic level of attainment. There is no sign of any reduction since 1997 in the health inequalities which leave people with low incomes more likely to suffer serious health‐related problems. Across the range of indicators, problems of poverty and social exclusion are generally more prevalent in the North‐east than in other areas of the country. London has particular problems centred on low income and work and Scotland has particular problems centred on health.     

Adolescent pregnancy: Networking and the interdisciplinary approach

The networking approach to providing needed services to pregnant and parenting teenagers has numerous merits. An historical overview of the formation of the Brooklyn Teen Pregnancy Network highlights service agency need for information and resource sharing, and improved client referral systems as key factors in the genesis of the Network. The boroughwide approach and its spread as an agency model throughout New York City's other boroughs and several other northeastern cities is also attributed to its positive client impact, including: improved family communication and cooperation; early prenatal care with its concomitant improved pregnancy outcomes; financial support for teens; continued teen education; and parenting skills development.Resource information is provided regarding networks operating in the Greater New York metropolitan area. A planned Eastern Regional network initiative is under development.Mary J. Canada is Executive Director of the Brookly Teen Pregnancy Network.     

Adolescent pregnancy trends and demographics

In the United States today, 9% of women aged 15 to 19 years become pregnant each year: 5% give birth, 3% have induced abortions, and 1% have miscarriages or stillbirths--rates much higher than those in other developed countries. Rates are highest among those who are older, from disadvantaged backgrounds, black or Hispanic, married, have much older male partners, and live in southern states. Teen pregnancies are overwhelmingly unintended, reflecting substantial gaps in contraceptive use, and difficulties using reversible methods effectively. Teen pregnancy, birth, and abortion levels have decreased in recent years, primarily because of more effective contraceptive use (responsible for about 75% of the decline), and because of fewer adolescents having sexual intercourse (about 25%). Much work remains to improve the conditions in which young people grow up, provide them with information and education regarding sexuality and relationships, and improve access to sexual and reproductive health services.     

Adolescent smoking behavior: measures of social norms

BACKGROUND: Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior. METHODS: Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking. RESULTS: The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking (p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models. CONCLUSIONS: Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.     

Risk of child poverty and social exclusion in two Spanish regions: social and family determinants

ObjectiveDescribe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk Of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment).MethodFamilies in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn's diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis.ResultsFor LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother's foreign origin, and paternal education and smoking.ConclusionThere is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood.