California hot spots study: An innovative mixed-methods approach to neighborhood level factors affecting teenage pregnancy

During the past twenty years, teen birth rates have declined at the national and state levels. However, significant disparities in teen birth rates remain at the county and sub-county levels among communities with similar demographic characteristics. We used an innovative mixed-methods approach to explore the role that neighborhood traits may play in teen pregnancy. We selected medical service study areas (MSSAs), which are contiguous census tracts, as the geographic unit of analysis. Using GIS mapping, we geo-located teen births that occurred during 2009 and 2010 by MSSA. We used population-level data to calculate teen birth rates for each of the 541 MSSAs in California, and calculated rate changes for each MSSA between 2004–05 and 2009–10. We selected ten MSSAs with significantly elevated or declining teen birth rates for further qualitative study. We conducted semi-structured interviews with adult stakeholders (n=94), and single-sex focus groups with male and female youth ages 13–18 (n=186, 60% female), including a brief quantitative survey. Adult stakeholders interviewed included religious leaders, health educators, clinicians, teachers, politicians, and law enforcement personnel, among others. Focus group and interview topics included neighborhood physical and social attributes, resources and socioeconomic opportunities for youth, attitudes about teenage pregnancy, and access to reproductive health services. Data were analyzed in Atlas.ti using a grounded theory approach. A mixed-methods approach for sample selection and data analysis — incorporating GIS mapping, purposive sampling and in-depth qualitative data collection with youth and adults — can help to identify neighborhood factors for future interventions and resource allocation.