Teen Health Centers Are Associated with Lower Birth Rates in Adolescent Females in King County, Washington, USA

Background: The rates of sexually transmitted infections (STIs) and unintended pregnancy in adolescents remain high in the United States.  Over the past two decades medical clinics have been established in schools to improve adolescents’ access to reproductive healthcare.  In Washington (WA) State, only one school district has Teen Health Centers (THC).

Objectives: The purpose of this study is to evaluate the impact of these clinics on unintended pregnancy and STIs in adolescents within the Seattle School District.

Methods: This is an ecological study of 1990-2006 WA State Department of Health surveillance data.  We compared General Fertility Rates (GFR) of non-Hispanic white, non-Hispanic black and Hispanic 15-19 year-old females in Seattle to 17 other school districts in King County, WA.  The fertility rates were weighted for population estimates and standardized for race/ethnicity distributions.  Differences were assessed using linear regression.

Results: Over fifteen years, GFR dropped form 42.5 to 14.8 per 1000 in Seattle and from 30 to 22.4 per 1000 for other school districts.  There was a consistent downward trend in GFR for all districts, however the average change in rate of decrease was almost twice as high in Seattle [-2.03 ( 95% CI  -2.30, -1.76)] as in the others [-1.08 (95% CI -1.35, -0.81)].  We are in the process of assessing chlamydia rates of Seattle and the other districts.

Conclusions: These results must be interpreted with the inherent limitations of ecological studies.  However, our results are consistent with the association of Teen Health Centers reducing unintended pregnancy in adolescents.

Implications for Programs, Policy, and/or Research: This study initiates effectiveness assessments of school-based clinics in reducing adolescent health morbidity and a more definitive study is needed.  Proving the degree of THC effectiveness has potential implications for the programmatic approach to adolescent healthcare delivery.