RT Journal Article
SR Electronic
T1 Impact of social service and public health spending on teenage birth rates across the USA: an ecological study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e013601
DO 10.1136/bmjopen-2016-013601
VO 7
IS 5
A1 Heather L Sipsma
A1 Maureen Canavan
A1 Melissa Gilliam
A1 Elizabeth Bradley
YR 2017
UL http://bmjopen.bmj.com/content/7/5/e013601.abstract
AB Objective To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA.Design Ecological study.Setting USA.Participants 50 states.Primary outcome measure Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders.Results The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001).Conclusion Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical.