A Framework for Community-Engaged Research to Inform Decisions to Improve Adolescent Sexual Health

Background: Rates of adolescent pregnancy and chlamydia infection vary considerably across communities. Our goal was to collaboratively create a broad framework for addressing teen sexual health, and to apply it by analyzing county-level predictors of pregnancy and chlamydia among adolescents.

Methods: Framework development relied on data from structured focus group discussions in three high-risk communities. Using state-reported information on county teen pregnancy rates (among females 15-19, 2009-2011) and chlamydia rates (among females 15-19, 2012) together with a merged dataset of publicly-available, county-level information on behavioral and community measures, we conducted multivariate regression analyses for the 87 counties in Minnesota.

Results: County rates of teen pregnancy and chlamydia varied widely, ranging from 7-101/1000 and from 558-4673/100,000, respectively. Factors independently associated with increased rates of teen pregnancy included lower contraceptive use among 12th grade males, a lower percentage of 12th graders who feel safe in their neighborhoods, a higher percentage of 9th graders who report feeling overweight, and county rates of single parenthood and age-adjusted mortality. Factors associated with elevated chlamydia rates were higher percentage of 12th graders who reported feeling overweight and who skipped school in the past month because they felt unsafe (p<0.05 for all comparisons reported).

Conclusions: Much prior research and programming has focused on modifying individual behaviors to address teen sexual health, but communities cited broader issues of concern. This analysis identified community-level correlates, including adolescent self-image, community safety, family structure, and overall health. Addressing social determinants collaboratively with community members may hold promise for improving adolescent health.