Objective: This investigation explored the relationship between adolescent social, cultural and behavioral indicators and geographically disparate rates of adolescent (15 to 19 years of age) births in Palm Beach County, Florida for the year ending 1999 (Cornerstone, 2001). Through more in-depth analysis of primary data (Florida Department of Health, 1999a) the intent of this investigation was to predict what distinguished (1) infant birth weight and (2) childbearing adolescents in high birth rate zip code areas and low birth rate zip code areas in Palm Beach County.
Population: The sample was derived from the 1999 Palm Beach County Live Birth Specifications Subsection of the Florida Vital Statistics Annual Report (Florida Department of Health, 1999a; 1999b). A total of 443 childbearing adolescents between 15 and 19 years of age were selected for their residency in extremely high or extremely low adolescent birth rate postal zip codes in Palm Beach County, Florida (Cornerstone, 2001; Florida Department of Health, 1999b).
Four zip code areas with 346 adolescents had teen birth rates of 100 to 153 per 1000 women which is two to three times greater than the county birth rate average of 49 births per 1000 women 15 to 19 years of age (Florida Department of Health, 1999a). These four postal zip code zones were designated as the top hot spot areas in the initial investigation (Cornerstone, 2001). Fifteen postal zip code areas with 97 adolescents had teen birth rates of 1.4 to 24.4 per 1000 women which is two to three times less than the county birth rate average and were selected for comparative analysis (Florida Department of Health, 1999a; 1999b).
Method: Predictive discriminant analysis was utilized to test the ability and strength of the predictor variables maternal age, education, race/ethnicity, prenatal care use, alcohol use and tobacco use in their contribution to classification in the criterion variables (1) high and low infant birth weight and (2) childbearing adolescents in high birth rate zip code areas and low birth rate zip code areas in Palm Beach County in 1999. The overall objectives of predictive discriminant analysis are essentially the same as regression analysis (Kachigan, 1991).
Findings: The results demonstrated that childbearing youth within Palm Beach County's high birth rate zip code areas were more likely to live in disadvantaged environments, be Black, Mexican, Central or South American Hispanic, have fewer prenatal visits, less years of education, smoke and have their infant be of less than average birth weight.
Conclusions: The individual factors of disadvantage identified in this investigation of less education, less prenatal health care, smoking, and race/ethnicity are inextricably linked in one unfortunate outcome; marginalized adolescent women in Palm Beach County bear infants of less than average birth weight at rates significantly higher than average.
Implications: Despite declining national birth rates, the US continues to have the highest adolescent pregnancy and childbearing rates of all industrialized nations (Alan Guttmacher Institute, 1999; National Campaign to Prevent Teenage Pregnancy, 2000). Of particular concern are the alarmingly high rates of pregnancy and births among certain segments of our population, specifically minority teens. In Palm Beach County, as in the rest of the nation, the poorest and most disadvantaged youth experience the highest rates of pregnancy and childbearing (Cornerstone, 2001; Ventura, Martin, Curtin, & Menacker, 2001).
Eliminating the health and racial inequalities that pervade the experiences of Palm Beach County's childbearing adolescents, mandates expertise in the cultures of minority populations. Nurses are uniquely qualified and situated as front-line providers of health care with a person-environment perspective to implement culturally competent individual, family and community based programs that address the Healthy People 2010 national health initiative (US DHHS, 2000). Nursing interventions that integrate the larger social context with specific at-risk behaviors could substantially reduce childbearing among young adolescents.
Promoting health-enriching life style options, with knowledge of and respect for at-risk minority cultures, is nursing care that is culturally competent. Culturally competent nursing care can result in positive health experiences throughout the life span for at-risk adolescents (Pender, Murdaugh, & Parsons, 2002) and interrupt the intergenerational cycle of social disorganization that has been historically endemic to adolescent childbearing. A discussion of culturally competent nursing health care delivery options for at-risk populations and recommendations for nursing policy, practice and research are provided.
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