1. Examining the Social Ecological Context of Teenage Pregnancy among Native Hawaiian Youth
Elizabeth M. Aparicio,* Andrew Wey,* Naomi Manuel,** Patricia McKenzie,*** & Hokulani Porter***
*University of Hawai‘i at Manoa, **ALU LIKE, Inc., ***Waianae Coast Comprehensive Health Center

2. Teen Pregnancy in Hawaii
As a state, rates slightly higher than U.S. average
Major racial and ethnic disparities
Native Hawaiian youth at high risk
Compared to national rates, pregnancy rate is 5 times higher
Compared to African American and Latino youth nationwide, 3 times higher
Why?

3. Research Question
What are the predictors of birth timing (teenage versus older birth) among Native Hawaiian women in Hawaii?
Part of larger mixed method study on teenage pregnancy and parenting among Native Hawaiian youth

4. Method Secondary data analysis
Pregnancy Risk And Monitoring Survey (PRAMS) version
Prenatal and postpartum care, substance use, mental health, adjunct service use, demographics
Sent out monthly to approximately 200 new mothers each month who give birth in Hawai‘i
Current study sample of Native Hawaiian women living in Hawai‘i: N=1493

5. Sample Of the 1493 Native Hawaiian women (unweighted percentages):
516 (35%) live on Oahu
981 (69%) have a family income over $10,000
171 (12%) were teenage mothers

6. Method, cont. Variables examined:
Pre-pregnancy traumatic stress (composite variable: homeless, involved in a physical fight, partner or self went to jail, or someone very close had a problem with drinking or drugs)
Household income
Use of WIC during pregnancy
Intimate partner violence (IPV) prior to pregnancy
Pre-pregnancy marijuana use
Pre-pregnancy binge drinking
IPV during pregnancy
Desire to become pregnant
Pre-pregnancy emotional stress (composite variable: if anyone in their household was ill and hospitalized or if someone close died)
Actively trying to get pregnant
Contraception use
Previous birth

7. Method, cont.
Descriptive analysis to examine frequencies and correlates
Logistic regression to examine predictors of birth timing after adjusting for income greater $10,000
PRAMS is stratified by island and gestational age
Survey weights account for the complex survey design

8. Bivariate Results
Native Hawaiian women who gave birth as teens (19 years or younger), as compared to older mothers (20 years or older) had significantly
Lower household incomes (65% vs. 27% under $10,000/yr)
Higher use of WIC during pregnancy (78% vs. 59%)
Higher levels of intimate partner violence
Prior to pregnancy (14% vs. 6%)
During pregnancy (9% vs. 4%)
Higher levels of pre-pregnancy marijuana use (15% vs. 7%)
Lower rates of pre-pregnancy binge drinking (32% vs. 54%)

9. Bivariate Results, cont.
Native Hawaiian women who gave birth as teens (19 years or younger), as compared to older mothers (20 years or older) had significantly (p < .05)
Higher levels of stress
Emotional stressors (41% vs. 31%)
Traumatic stressors (32% vs. 20%)

10. Results, cont. Among teenage mothers: 15% desired to get pregnant then
10% were trying to get pregnant
Among those teenage mothers who did not desire to get pregnant then,
49% were using contraception
15% had a previous birth

11. Multivariate Results Variables Odds Ratio 95% CI P-value
Wanted Pregnancy
0.25
(0.13, 0.46)
0.000
Trying to get Pregnant
0.21
(0.10, 0.45)
IPV Prior to Pregnancy
1.52
(0.71, 3.25)
0.285
IPV During Pregnancy
1.69
(0.72, 3.99)
0.229
Previous Birth
0.08
(0.04, 0.16)
Emotional Stressors
1.78
(1.08, 2.93)
0.025
Traumatic Stressors
1.39
(0.82, 2.33)
0.218
Marijuana Use
1.59
(0.83, 3.06)
0.162
Binge Drinking
0.41
(0.25, 0.68)
0.001
These are the results of a logistic regression examining how these predictors affect the odds of women becoming pregnant as a teen (meaning 19 and under) or as an older mother.
After adjusting for family income, some of the bivariate differences we saw earlier were accounted for. I’ll highlight a few things from this table.
After adjusting for family income, we can see that
women who wanted to or were trying to get pregnant had lower odds of being a teen mother.
IPV prior to pregnancy and during pregnancy did not significantly predict a difference in birth timing
Experiencing emotional stressors was a significant predictor of birth timing. Women who experienced 1 or more emotional stressors had 78% greater odds of experiencing a teenage birth
Women who engaged in pre-pregnancy binge drinking had lower odds of having given birth as a teen

12. Discussion
Poor pregnancy prevention available through local public schools
Recently established a mandatory “opt-in” policy; may exclude those at greatest risk
Concerning rates of IPV prior to and during pregnancy, especially related to being part of a low income family
Need for exploring circumstances of pregnancy
IPV is the leading cause of injury and death among women of childbearing age
Locally: Hawaii Says No More campaign; One Billion Rising

13. Discussion, cont.
Teen mothers clearly have need for support with emotional stressors
Lack of mental health resources in areas of highest teen pregnancy rates in Hawai‘i
Implications for young parents and for their children
Native Hawaiian children under 5 are the most heavily overrepresented group involved with Child Welfare Services
In other samples, children of teenage parents are typically 2-3 times as likely to enter foster care

14. Discussion, cont. Larger mixed method study in progress
Semi-structured interviews of year old youth
Some avoided teen pregnancy and some are parenting
Emerging Themes
Impact of Intergenerational Homelessness
Parenting Youth Histories of Child Maltreatment & Desire to Do Things Differently
Mixed Levels of Concern About Teen Pregnancy for Hawaiian Communities
Value of ’Ohana as Protective – Mostly
Value of Higher Education as Protective

15. Concluding Thoughts
Teenage pregnancy disproportionately affects Native Hawaiian youth
IPV among lower income teen mothers and coping with emotional stressors among teen mothers are of particular concern
Compounded risk to young mother and to her infant
Need for targeted violence prevention, mental health support
Need for culturally attuned teen pregnancy prevention, when desired

16. Mahalo Nui Loa Thank You Very Much
Study Participants
Community Partners:
Hawai‘i Department of Health
Waikiki Health Center
Waianae Coast Comprehensive Health Center
Contact: Study PI Elizabeth Aparicio, PhD
The project was partially supported by the National Institute on Minority Health and Health Disparities (U54MD007584), National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or NIH.