Examining social determinants of teen pregnancy

Background: Teen pregnancy occurs disproportionately among disadvantaged urban youth of color. To develop effective pregnancy prevention programs, it is essential to specify pathways through which social-structural disadvantage (SD) affects pregnancy risk. Methods: A computer-assisted self-administered survey was completed by 795 sexually active 14-17 yr olds recruited from hospital-affiliated practices in the Bronx, NY. We examined the relationships between pregnancy risk behavior ((PRB), # vaginal sex episodes without a condom last 6 months ) and SD factors: a) family type (not living with a parent vs. other types); b) parent education (< high school graduate); and c) economic insecurity (receives public benefits). We tested whether these relationships were mediated by pregnancy receptivity ((PR), “definitely didn't want pregnancy” vs. all others ) and relationship type ((RT), serious relationship or not ). We used Poisson regression, controlling for race and age. First, we tested bivariate relationships of PRB to independent variables (SD) and to mediators (PR&RT), and then of independent variables to mediators; models were tested in the overall sample, and boys (N=334) and girls (N=461) separately. Results: Parent education and economic insecurity were associated with PRB for the total sample and girls. Adding PR to the models substantially reduced these SD coefficients, suggesting mediation by PR. For boys, family type was associated with increased PRB, and RT emerged as a mediator. Conclusions: Structural disadvantage increased pregnancy risk behavior via pregnancy receptivity and having a serious relationship (boys). Pregnancy prevention programs should address pregnancy receptivity and relationship type as mediators of socio-structural determinants.