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Behavioral and Community Correlates of Adolescent Pregnancy and Chlamydia Rates in Rural Counties in Minnesota

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Abstract

Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15–19 year-old females were compared across Minnesota’s 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study.

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Acknowledgments

The authors gratefully acknowledge the following individuals who assisted in data source identification and interpretation: Judy Palermo, Information Technology Specialist, Minnesota Center for Health Statistics, Minnesota Department of Health; Dawn Ginzl, MPH, STD Surveillance Coordinator, Minnesota Department of Health; and Ann Kinney, PhD, Senior Research Scientist, Minnesota Center for Health Statistics, Minnesota Department of Health. This research was made possible by the funding from a Community Health Collaborative Grant from the University of Minnesota Clinical and Translational Sciences Institute. This work was also supported by the Building Interdisciplinary Research Careers in Women’s Health Grant (No. K12HD055887) from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), the Office of Research on Women’s Health, and the National Institute on Aging, at the National Institutes of Health, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health.

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Authors and Affiliations

  1. Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455, USA

    Katy B. Kozhimannil, Eva Enns & Cori Blauer-Peterson

  2. Teenwise Minnesota, 1619 Dayton Avenue, Suite 111, Saint Paul, MN, 55104, USA

    Jill Farris & Judith Kahn

  3. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, West Bank Office Building, 1300 S Second St., STE 300, Minneapolis, MN, 55454-1015, USA

    Shalini Kulasingam

Authors
  1. Katy B. Kozhimannil
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  2. Eva Enns
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  3. Cori Blauer-Peterson
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  4. Jill Farris
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  5. Judith Kahn
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  6. Shalini Kulasingam
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Correspondence to Katy B. Kozhimannil.

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Kozhimannil, K.B., Enns, E., Blauer-Peterson, C. et al. Behavioral and Community Correlates of Adolescent Pregnancy and Chlamydia Rates in Rural Counties in Minnesota. J Community Health 40, 493–500 (2015). https://doi.org/10.1007/s10900-014-9962-3

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  • DOI: https://doi.org/10.1007/s10900-014-9962-3

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