Running head: TEEN BIRTH DISPARITIES IN SARASOTA 1

Teen Birth Disparities in Sarasota, Florida

Makeda de Comas

University of South Florida

TEEN BIRTH DISPARITIES IN SARASOTA 2

Teen Birth Disparities in Sarasota, Florida

Teen birth is a multifaceted issue which affects not only mother and child, but the

community they live in as well. Teenage mothers are 40% less likely to receive a high school

diploma than teenagers who did not give birth and have a higher chance of unemployment than

their peers (Mueller et al., 2017). The children of teenage mothers are more likely to have health

complications at birth such as low birth weight with younger mothers being at increased risk for

very low birth weight (Leftwich & Alves, 2017). Thankfully, the rate of teen birth has decreased

by a dramatic 64% over the last two decades, but this decrease has not affected all teenagers in

the united states equally (Hamilton, Ventura & Osterman, 2016). As of 2014, Black teenagers in

the United States have a birth rate 2.2 times higher than non-Hispanic white teenagers (Romero

et al., 2016). In Sarasota county, the ratio is 2.6 (County Health Rankings & Roadmaps

[CHR&R], 2018). Significant efforts should be put into reducing this disparity.

Overview of Sarasota County.

Sarasota county is located on the central West coast of Florida comprising of 725 square

miles of land and 390,000 permanent residents (Sarasota County Government [SCG], 2018).

This population increases to 476.000 during the winter, and Sarasota’s Siesta Beach has been

named “America’s Best Beach” (SCG, 2018). The county is predominantly urban and suburban

with only 4.3% of the residents living in rural areas (CHR&R, 2018). The largest employers in

Sarasota are Sarasota Memorial Hospital, PGT Innovations (a window and door manufacturing

plant), and Publix which has its Florida distribution center stationed in the county (Economic

Development Corporation [ECD], 2018). Sarasota Memorial Hospital is the county’s public

hospital, with the next largest medical centers being Venice Regional Medical Center and

Doctors Hospital (EDC, 2018). Compared to the rest of Florida, Sarasota has several differences.
TEEN BIRTH DISPARITIES IN SARASOTA 3

Comparison of Local vs. State Populations

Sarasota differs from the larger Florida community in many ways. Notably, the county

has a significantly different age distribution than the state with 35% of residents being over the

age of 65, and only 14.5% of residents below the age of 18. 10.5% of the Sarasota natives live

below the federal poverty line compared to 15.5% of Floridians (Florida Department of Health

[FDH], 2017). 29.6% of Sarasota natives over the age of 25 have a high school diploma

compared to 29.0% for Floridians (FDH, 2017). 5.3% of Floridians older than five speak English

less than very well compared to 11.8% of Floridians (FDH, 2017). The ratio of Primary Care

Physicians to residents is 1260:1 compared to 1380:1 for Floridians (CHR&R, 2018). 16% of

Sarasota residents are uninsured which is equal to the percentage of uninsured Floridians

(CHR&R, 2018).

Analysis and Interpretation of Data

Sarasota has many differences from the general Florida population. The County Health

Rankings puts Sarasota at sixth place of the 67 Florida counties, and it has many health care

strengths (CHR&R, 2018). Unfortunately, Sarasota has several weaknesses as well, especially

with disparities in the health of Black, Hispanic and White residents (CHR&R, 2018).

Identified Strengths

Sarasota has 32 days of preventable hospital stays per 1000 Medicare enrollees in

ambulatory-care sensitive conditions compared to 54 days for Florida (CHR&R, 2018). This

condition can be used to measure access and effectiveness of primary care for Medicare enrollees

in a county (CHR&R, 2018). This is important because providing adequate primary care allows

residents to live more healthy lives and spend less days hospitalized. The rate has stayed similar

since 2006 at between 32-36 days (CHR&R, 2018).

TEEN BIRTH DISPARITIES IN SARASOTA 4

Rates of physical inactivity is another area Sarasota excels in. 20% of Sarasota residents

are physically inactive which is equal to the top U.S. performers, and above the Florida rate of

24% (CHR&R, 2018). This is an important measure because physical inactivity is heavily related

to metabolic conditions and is the direct cause of 11% of premature death (CHR&R, 2018). This

rate has stayed similar since 2006 at 19-21% (CHR&R, 2018).

Mammography screening is another measure that Sarasota does well in. 74% of female

residents 67-69 receive mammograms in Florida compared to 68% of Floridians (CHR&R,

2018). This is an important measure because mammograms can increase treatment options and

reduce lethality of breast cancer (CHR&R, 2018). This is also an area with low disparity between

residents with 71% of Black residents and 71% of White residents receiving mammograms

(CHR&R, 2018).

Identified Weaknesses

Sarasota has an unacceptably large disparity with children in poverty. Although the

overall rate of children in poverty is 18%, 55% of Black children and 30% of Hispanic children

are living in poverty compared to 11% of White children (CHR&R, 2018). Poverty plays a large

role in childhood physical and mental development, and a disparity this large is unacceptable

(CHR&R, 2018). Furthermore, the overall rate for children in poverty has increased to 18% from

12% from 2006 to 2018 (CHR&R, 2018).

Sarasota also has an unacceptably high infant mortality rate among Black residents.

While the overall infant mortality rate is 5:1000 compared to 6:1000 for Floridians, the rate

amongst White residents is 4:1000 and 11:1000 amongst Black residents (CHR&R, 2018). This

is a large and unacceptable disparity as it affects infants which are the most vulnerable age

group.
TEEN BIRTH DISPARITIES IN SARASOTA 5

Although the percentage of low birthweight (LBL) infants in Sarasota is lower than the

state average for low birthrate, there is a disparity amongst who is affected by LBL. Although the

overall rate is 7% for LBL compared to 9% for the state, the rate for Black infants is 13%

(CHR&R, 2018). LBL is a risk factor for future health risks and can be a cause of infant or

childhood mortality (CHR&R, 2018).

Identification of a Priority Health Issue

One of the most important health disparities to be worked on in Sarasota is the rate of

adolescent births. 22 per 1000 teenagers gives birth in Sarasota, but demographically this breaks

down to 47:1000 Black teenagers and 18:1000 White teenagers (CHR&R, 2018). Black

teenagers in Sarasota have a birth rate 2.6 times higher than non-Hispanic white teenagers. This

is important because teen birth has long-lasting economic and psychological impacts on the life

of both mother and child (Leftwich & Alves, 2017).

Discussion and Application of Community Health Models

Social determinates of health are conditions in the environments in which people are

born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and

quality-of-life outcomes and risks (United States Department of Health and Human Services

[HHS], Healthy People 2020, 2019). Healthy People 2020 separates these into five major

categories under which all social determinates fall into. These categories are economic stability,

education, social and community context, health and health care, and neighborhood and built

environment (HHS, Healthy People 2020, 2019). This method of organization is useful as it

groups related social problems and can be used to gather evidence based research related to the

social issue being examined (HHS, Healthy People 2020, 2019).

TEEN BIRTH DISPARITIES IN SARASOTA 6

Ethnic disparities in teenage pregnancy rates is an issue that can be traced back to

multiple categories of social determinates of health. Increased teenage pregnancy rates are seen

when there is economic instability, especially in those who live in poverty (Romero et al., 2016).

In Sarasota County, poverty rates for adolescents are significantly higher for Black residents than

White residents (55% versus 11%) leading to a higher rate of teenage pregnancy among black

residents of Sarasota (CHR&R, 2018). Teenage pregnancy rates are also increased when there is

insufficient health literacy. When teenagers are presented with comprehensive education on safe

sexual practices, pregnancy rates are lowered and ethnic disparities in the rate are reduced

(Lewin et al., 2016).

Population Diagnosis

Teenagers in Sarasota County are at an increased risk for teenage pregnancy due to

insufficient health education about pregnancy prevention and high rates of poverty.

Community/Population-based Interventions

Teenage pregnancy is a multifaceted issue which requires extensive efforts to effectively

combat. The are three basic levels of intervention which can be used to target this issue. The first

is primary, which will focus on identifying those teenagers at highest risk for pregnancy and

providing them methods of pregnancy prevention (Savage, Kub & Groves, 2016). Next is

secondary, which will focus on the early identification of pregnancy by screening those at risk

for pregnancy and administering swift prenatal care to prevent complications of teenage

pregnancy. Finally, tertiary prevention focuses on prevention of future complications and

reoccurrence of pregnancy during adolescence.

TEEN BIRTH DISPARITIES IN SARASOTA 7

Primary Level of Prevention

Primary care visits provide an excellent opportunity to measure teenagers’ health literacy

regarding preventing pregnancy and to provide education on preventing pregnancy on the

individual level. One study showed that teenagers who became pregnant had an average of 2.7

primary care visits in the year prior to the pregnancy, and that less than half of these teenagers

had received reproductive health counseling (Kharbanda, Stuck, Molitor & Nordin, 2014).

Primary care practitioners and nurses should be prepared to deliver adequate reproductive health

counseling to their teenage patients as increased health knowledge is proven to decrease teenage

pregnancy rates (Lewin et al., 2016). As this would be part of regular primary care visits, cost

would not be an issue, though time taken to deliver this education would need to be considered.

Community health nurses could be instrumental in creating awareness for primary care

practitioners of the importance of reproductive health counseling, especially for high risk

teenagers.

Secondary Level of Prevention

Teenagers have an increased risk of negative maternal and fetal outcomes in comparison

to older mothers (Leftwich & Alves, 2017). For this reason, it is incredibly important to screen

teenagers for pregnancy so that they can receive adequate pre-natal care. Teenagers who receive

comprehensive prenatal counseling using the Centering Pregnancy model during their pregnancy

were more likely to have normal vaginal deliveries and their infants were less likely to have a

low birth weight than those who did not receive prenatal counseling (Mersal, Esmat & Khalil,

2013). Another study showed that teenager mothers were also more likely to breast feed and use

long-acting reversible contraception after birth when they received Centering Pregnancy prenatal

care (Trotman et al., 2015). Although providing increased levels of prenatal care may cost more
TEEN BIRTH DISPARITIES IN SARASOTA 8

during pregnancy, enhanced patient outcomes for mother and infant reduces costs after birth.

Community health nurses can be instrumental in initiating programs to support teenagers who

are pregnant and connecting pregnant teenagers to sources for primary care. Community health

nurses can use demographic data to target communities most in need of prenatal resources for

teenagers who are currently pregnant.

Tertiary Level of Prevention

Teenagers who have already been pregnant have a high risk of reoccurrence of

pregnancy. 18% of teenage mothers become pregnant again while they are still teenagers

(Conroy et al., 2016). This statistic shows that teenage mothers require intervention to prevent

rapid repeat pregnancies in adolescence (Conroy et al., 2016). Motivational interviewing with the

focus on long-acting reversible birth control is one method on the individual level which has

been shown to be effective in reducing rapid repeat pregnancies in teenagers (Tomlin et al.,

2017). This would prevent a further negative impact on the health of the mother and her child or

children, as rapid repeat pregnancies can have numerous health complication for mother and

child as well as further economic impacts (Conroy et al., 2016). This education could be done

during primary post-natal care, though the cost of birth control for the mother may be a concern.

Community health nurses could help carry out this education by seeking out teenage mothers to

deliver motivational interviewing on the benefits of long-term birth control and the negative

effects of rapid repeat pregnancies.

Development of Health Policy

Rapid repeat pregnancy in adolescence is a complicated issue which requires attention

and resources to prevent. Pregnancies less than two years apart are detrimental to the health of

the baby and is detrimental to the teenage parent’s ability to work or achieve educational goals
TEEN BIRTH DISPARITIES IN SARASOTA 9

(Centers for Disease Control [CDC], 2013). 1 in 5 teenage births are a repeat birth by a teenager

who already has given birth (CDC, 2013). Furthermore, Hispanic and Black teenagers are 1.5

times more likely to have a repeat birth after pregnancy (CDC, 2013). Preventing rapid repeat

pregnancies in teenagers, therefore, has the potential to significantly reduce the number of

teenage births in Sarasota County. This would be beneficial to the population health of Sarasota

County, as teenage parents and their children are more likely to live in poverty and have worse

health than their peers (Leftwich & Alves, 2017).

One method of combating pregnancies in teenagers on a tertiary level is through the

implementation of a home-based mentoring programs for teenage mothers. In this program,

pregnant teenagers would be referred to a trained community health nurse after they give birth

for recurring motivational interviewing on methods of birth control and the risks of repeat

pregnancy during adolescence. A 2016 review of the effectiveness of home-based motivational

interviewing campaigns aimed at educating teenagers mothers found an average decrease of 30%

in repeat adolescent births (Maravilla et al., 2016). A 2017 follow-up review showed that an

average of 4.5 hours of motivational interviewing spread over at least 6 meetings is most

effective to significantly increase teenagers use of long-active contraceptives and significantly

decrease repeat pregnancy (Stevens et al., 2017). This type of intervention can be aimed towards

all pregnant teenagers or specifically geared towards demographics at higher risk for repeat

teenage pregnancy, such as black and Hispanic teenage mothers depending on the resources

available.

This plan would be presented as a public health initiative to reduce teenage pregnancy

and improve the quality of life for teenage mothers and their children. The goal would be to

prevent pregnancy by providing teenage mothers with home-visits from public health nurses
TEEN BIRTH DISPARITIES IN SARASOTA 10

trained in motivational interviewing and birth control recommendations for adolescents. The

costs of this initiative would entail training in motivational interviewing for the public health

nurses involved in the initiative and the costs of employing these nurses for the course of the at-

home visits. The Pregnancy Assistance Fund is a federal program which could give funding to

cover this initiative. Also, the Healthy Start Coalition of Sarasota, which works to ensure the

health and well-being of pregnant women and infants, could be appealed to assist in the

implementation of this program, as preventing repeat teenage pregnancy is in the best interest of

the health and wellbeing of both mother and child (Healthy Start Coalition of Sarasota County,

2017).

The first step in presenting this health policy proposal would be to gather the research

collected in this paper to prove that teenage pregnancy is a problem in Sarasota and that

motivational interviewing is a viable method of reducing repeat teenage pregnancies. Then, this

research would be complied into an application for a grant from the Pregnancy Assistance Fund.

With this grant money, a partnership with the Healthy Start Coalition of Sarasota could be

formed to have community health nurses meet continuously with teenage mothers. This

partnership would be beneficial as the Healthy Start Coalition of Sarasota has an established

relationship with low-income mothers in Sarasota and their involvement would add legitimacy to

the campaign.

The Healthy Start Coalition of Sarasota is one stakeholder expected proponent of this

initiative, as the goals of the program align with the goals of the Coalition. One of the major

opposing forces to the implementation of this program would be proponents of abstinence-only

sexual education for adolescents. This has the potential to be a strong opposition, as many find

providing birth control advice to minors to be immoral. To combat the opposition, we would
TEEN BIRTH DISPARITIES IN SARASOTA 11

ensure that it is made clear that the program is optional and that abstinence is always included in

education as one way to prevent pregnancy.

Conclusion

Teenage pregnancy is a multifaceted issue which requires both individual and community

interventions at the primary, secondary and tertiary level. Education is key on every level of

prevention starting with ensuring everyone has equal and comprehensive access to effective

sexual education. Enhanced surveillance for teenage pregnancy is necessary to give teenagers

who do become pregnant more access to effective prenatal care as soon as pregnancy occurs.

After birth, teenage mothers require more education and motivation to ensure repeat teenage

pregnancy is avoided. The community health nurse is instrumental in ensuring that this education

is provided continuously using motivational interviewing to ensure teenage parents understand

the importance of preventing pregnancy and using reliable methods of birth control. The

pregnant teenager must be continually met with to ensure that they understand the importance of

preventing pregnancy for their own health, vocational and educational prospects as well as the

prospects of their child. Repeat teenage births increase the psychological and economic impacts

on both mother and child significantly, so it is very important that we intervene to prevent repeat

teenage births from occurring (CDC, 2013).

This paper is very relevant to my future career in nursing. As a prospective pediatric

nurse, I will be in contact with adolescents who are pregnant and the children of adolescent

parents during my career. Furthermore, I want to go into public health during my career as a

nurse and would love to do motivational interviewing to prevent repeat pregnancies immediately.

This has a potential to have a life-changing impact on both mother and child, and is definitely a

program I find worthwhile. Programs like this have been trialed in other states, and the Healthy
TEEN BIRTH DISPARITIES IN SARASOTA 12

Start Coalition of Sarasota provides mothers with home-visits under some situations. If this

program was implemented, it would potentially improve the outcome of Sarasota’s adolescent

population significantly.
TEEN BIRTH DISPARITIES IN SARASOTA 13

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TEEN BIRTH DISPARITIES IN SARASOTA 14

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