Background: Rates of teenage pregnancy and chlamydia infection vary considerably across rural and urban communities. While individual-level behavior is the most commonly-assessed determinant of pregnancy and STI risk, identifying community-level features associated with high rates may provide insight into the social, economic, and systemic factors that may be important for addressing rural/urban sexual health disparities.
Methods: Our objective was to describe county-level predictors of pregnancy and chlamydia among Minnesota adolescents based on rural-urban designations. We created a merged dataset of behavioral (proximal) measures reported by adolescents in the 2010 Minnesota Student Survey and other publicly-available, county-level information on community (distal) measures. The associations between these measures and state-reported county teen pregnancy rates (among females 15-19, 2009-2011) and chlamydia rates (among adolescents 15-19, 2012) were analyzed through bivariate and multivariate regression over Minnesota’s 87 counties.
Results: County rates of teen pregnancy and chlamydia varied widely, ranging from 7 to 101 pregnancies per 1,000 females ages 15-19 and from 343 to 2,446 chlamydia infections per 100,000 adolescents ages 15-19. Rates averaged over urban and rural counties were similar, though counties with the lowest and highest rates were all rural. Factors independently associated with increased rates of teen pregnancy include reported contraceptive use among 9th and 12th grade males, percent of uninsured residents, and the number of single-parent families; in rural counties, the only independent predictor was contraceptive use among 12th grade males. There were no consistent associations between county-level predictors and chlamydia infection rates across all counties; however, in rural counties, condom use by 12th grade males, the rate of excessive drinking among adults, and the number of single-parent families were factors associated with higher rates of adolescent chlamydia infections.
Conclusions: Programmatic approaches focusing on behavior change among male adolescents may be appropriate interventions to support teen sexual health in rural counties