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Adverse Birth Outcomes among Adolescents in the San Joaquin Valley: Impact of Prenatal Care, Education, and Race-Ethnicity Adolescent pregnancy has been an issue of concern in the U.S., specifically in the San Joaquin Valley, due to adverse birth outcomes experienced by both mother and child (California Department of Public Health [CDPH], 2011; McKenzie, Pinger, & Kotecki, 2011). Counties within the San Joaquin Valley have teen birth rates significantly higher than the U.S. and California as a whole (CDPH, 2011). The three –year average (2008-2010) of adolescent birth rates for counties within the San Joaquin Valley ranged from 37.4- 60.4 1,000 females aged 15-19 years old (CDPH, 2011). Studies have shown that adolescents are more likely to have adverse birth outcomes in comparison to women over the age of 20 (American College of Obstetricians and Gynecologists.,2001; Debiec, Paul, Mitchel, & Hitti, 2010).This study investigated the roles of prenatal care (PNC), education, racial/ethnicity/nativity, and insurance differences in adolescents experiencing low-birth weight and preterm birth in the San Joaquin Valley. There was a total of 16,561 adolescent females age 11-18 years old in the sample. Table 1, shows the percentage of adolescents that birthed either a premature and/or low birth weight infant in the San Joaquin Valley during 2002-2004. Approximately, 14 % of adolescents had a preterm birth and 8% had a low birth weight infant. Table 2 shows logistic regressions for low birth weight and preterm birth. Adolescents who used MediCal or Private/HMO for PNC were consecutively, 7 times and 8 times more likely to have a preterm birth. Adolescent who were not of Hispanic background were 10 times more likely to have a low birth weight and/or preterm birth. Adolescents who received no PNC during pregnancy were 11 times more likely to have a low-birth weight infant and 8 times more likely to have a preterm birth. Adolescents who identified as an immigrant were 9 times more likely to have a low birth weight infant. Additionally, adolescents who sought no PNC were 11 times more likely to have a low birth weight infant and 8 times more likely to have a preterm birth. Lastly, adolescents who sought PNC during the sixth month of pregnancy were 6 times more likely to have a preterm birth These findings suggest that low birth weight and preterm birth are impacted similarly and distinctively by social factors. Both low birth weight and preterm birth are strongly associated with ethnicity (Non- Hispanic) and receiving no PNC during pregnancy. There is a strong relationship between low birth weight and place of birth, particularly, immigrants excluding those from Mexico. Additionally, there was a strong relationship between preterm birth and payment for PNC (MediCal and Private/HMO) and beginning PNC in the 6 month of pregnancy. However, the data shows that there might be additional factors beyond variables investigated in this study that contribute to adolescents experiencing preterm births. 1.American College of Obstetricians and Gynecologists. (2001). Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin,31.Gynecol 2001;98:709-16. 2.California Department of Public Health (2011). Teen Pregnancy. 3.Debiec K.E., Paul K.J., Mitchell C.M., & Hitti J.E. (2010) Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol;203:122.e1- 6. 4.McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2011). An introduction to community health: Jones & Bartlett Publishers. Brittany Chambers Central Valley Health Policy Institute College of Health and Human Services California State University, Fresno Office: 559.228.2158 Cell: 510-847-2504 bchambers@mail.fresnostate.edu Demonstrate the impact of PNC, mother’s education, racial/ethnicity/nativity, and insurance on adolescents experiencing low birth weight and preterm births in the San Joaquin Valley. Adverse Birth OutcomePercent Preterm Birth No86.2 Yes13.8 Low Birth Weight No91.9 Yes8.1 Low Birth WeightPreterm Birth VariablesWalddfSig.WalddfSig. Mother's Education3.90730.2725.25230.154 Unknown or not available0.99510.3192.71210.1 Below HS0.1410.7080.22610.635 High School0.10210.7490.05910.807 Payment for Prenatal Care3.41340.4918.56740.073 MediCal0.26910.6047.13910.008* Public/Other2.61210.1060.37310.542 Private/HMO0.79310.3738.38210.004* All others1.71810.190.29210.589 Not Hispanic10.28810.001*9.70510.002* Early Prenatal Care1.65910.1980.13510.713 Rural Cluster0.26720.8752.25820.323 Rural0.26610.6060.00110.971 Urban0.01610.9012.01910.155 Mother's Place of Birth12.96320.0020.320.861 Mexico3.64110.0560.27410.601 Immigrant8.71510.003*0.01810.892 Month Prenatal Care Began21.1190.01232.99590 No prenatal care10.63710.001*8.02810.005* First month0.53910.4631.72410.189 Second month0.21610.6420.73710.391 Third month0.15210.6971.59210.207 Fourth month0.06710.7961.98810.159 Fifth month0.49310.4822.89910.089 Sixth month1.16110.2815.57610.018* Seventh month0.31610.5743.07610.079 Eighth month0.13810.710.54810.459 Mother's aged 11-140.49110.4840.90710.341 The California Master Birth Files 2002-2004 were used in this study. We extracted the eight counties that represent the San Joaquin Valley. The San Joaquin Valley consist of eight counties in Central California; Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare Counties. In this study, adolescent was defined as women under the age of 19. Independent variables: payment for PNC, race/ethnicity (Hispanic vs. Non- Hispanic), education, age, place of birth, rural/urban, and month PNC began. Dependent variables: low-birth weight and preterm birth. We used Binary Logistic Regression for analysis. Table 1. Percentage of adverse birth outcomes among adolescents aged 11-18 in the San Joaquin Valley a. N= 16, 561 Table 2. Binary Logistic Regressions for Low Birth Weight and Preterm Births among adolescents aged 11-18 in the San Joaquin Valley a.N= 16, 561 b.* = p-value less than.05