222670 Adolescent Pregnancy Trends and the Deficiencies of Dichotomous Measures of Rurality

Monday, November 8, 2010

Regina Rutledge, MPH , Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Decatur, GA
OBJECTIVES: Adolescent pregnancy trends remain understudied in rural America. Recent publications cite rate decreases but may not be representative of teenagers living outside urban areas. This study examines the relationship between classifications of rurality and adolescent pregnancy trends. It hypothesizes that traditional classifications of rurality will misrepresent outcomes and mask rural inequities. METHODS: Analysis was conducted to estimate association between rurality and adolescent pregnancy rates in North Carolina counties (n=100). Counties were stratified by Urban Influence Codes and annual pregnancy rates were analyzed over a thirteen-year period. Pregnancy rates were compared using dichotomous geography (‘urban' and ‘rural') and categorical geography (‘urban', ‘micropolitan rural', ‘small adjacent rural', ‘remote rural'). Social measures were incorporated including poverty, insurance coverage and high school graduation. Bivariate correlation and linear regression models were constructed and analyzed. RESULTS: Adolescent pregnancy rates have declined throughout North Carolina as studies suggested. However, declines have been concentrated in urban counties. Within rural counties, more urbanized (micropolitan) have experienced comparable declines while remote counties have seen minimal pregnancy rate decreases and actual increases recently. Strong racial inequities remain consistent across all geographic strata. CONCLUSIONS: Dichotomous measures of rurality do not accurately represent adolescent pregnancy trends across North Carolina. Rural averages disproportionately capture declines of micropolitan counties while masking minimal improvements among small adjacent and remote rural counties. Dichotomous geographic classification is commonly utilized and may yield similar misconceptions across fields. Researchers studying geographic influences should reconsider traditional classification schemes for more comprehensive categorical methods to better capture differences and health inequities.

Learning Areas:
Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Identify various methods of geographically classifying counties, per federal guidance. Demonstrate the inherent shortcomings of using only dichotomous measures of rurality (‘urban’ and ‘rural’). Analyze how adolescent pregnancy trends vary significantly across geographic strata. Describe how ineffective classifications of rurality further propagate geographically based health inequities by masking marked disparities.

Keywords: Pregnancy, Rural Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an an abstract author and poster presenter because I have conducted thorough research in reproductive statistics during my graduate studies and now professionally. I currently work as a Public Health Prevention Specialists for the Centers for Disease Control in the Geospatial Research, Analysis and Services Program where I work specifically with rural health inequities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.