Teen Mothers: Selected Socio-Demographic Characteristics and Risk Factors
(Letter Report, 06/30/98, GAO/HEHS-98-141).

Pursuant to a congressional request, GAO provided social and demographic
information about teen mothers, focusing on: (1) trends in birth rates
for teens; (2) a profile of teen mothers; and (3) factors, such as
education or family background, that may influence the likelihood of
teen motherhood.

GAO noted that: (1) although the birth rate for teenage women decreased
41 percent from the late 1950s to 1995--paralleling the decline in the
U.S. birth rate--the number of babies born to teenagers is still high;
(2) births to unmarried teenage mothers, however, more than quintupled
as a proportion of total teen births over the same period; (3) as of
1995, the teen birth rate was about 57 per thousand; however, rates
varied considerably by subgroup; (4) the birth rates for black and
Hispanic teenage women are more than twice those for white teens; (5) in
1995, nearly half of teen mothers were white and most were aged 18 to 19
and unmarried; (6) about two-thirds of recent teen mothers did not
intend to get pregnant or have a child; however, about one-fifth of
women who gave birth already had one child; (7) teenage mothers also
graduate from high school at lower rates than all teen women; (8) 64
percent of teen mothers complete high school, compared with about 90
percent of all teen women; (9) research studies that have examined the
antecedents of teen motherhood have shown that limited involvement in
school and some family background characteristics--such as family
instability and declines in family income--are associated with increased
likelihood of teen motherhood; and (10) the effect of most factors
varies among racial and ethnic groups.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-98-141
     TITLE:  Teen Mothers: Selected Socio-Demographic Characteristics 
             and Risk Factors
      DATE:  06/30/98
   SUBJECT:  Women
             Teenagers
             Single parents
             Population statistics
             Disadvantaged persons
             Drug abuse
             Education or training
             Pregnancy
IDENTIFIER:  Aid to Families with Dependent Children Program
             Medicaid Program
             National Education Longitudinal Study of 1988
             National Longitudinal Survey of Youth
             NIDA National Household Survey on Drug Abuse
             National Survey of Family Growth
             AFDC
             
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Cover
================================================================ COVER


Report to the Honorable
Charles B.  Rangel

June 1998

TEEN MOTHERS - SELECTED
SOCIO-DEMOGRAPHIC CHARACTERISTICS
AND RISK FACTORS

GAO/HEHS-98-141

Profile of Teenage Mothers

(108339)


Abbreviations
=============================================================== ABBREV

  AFDC - Aid to Families With Dependent Children
  HHS - Department of Health and Human Services
  NELS:88 - National Education Longitudinal Study of 1988
  NHSDA - National Household Survey on Drug Abuse
  NLSY - National Longitudinal Survey of Youth
  NSFG - National Survey of Family Growth
  SAMHSA - Substance Aubse and Mental Health Services Administration
  SES - socioeconomic status

Letter
=============================================================== LETTER


B-280170

June 30, 1998

The Honorable Charles B.  Rangel
House of Representatives

Dear Mr.  Rangel: 

In 1995, 1 of every 8 of the almost 4 million babies born in the
United States was born to a woman aged 19 or younger.  Three-quarters
of those teenage mothers were unmarried.  Families started by
teenagers received an estimated $39 billion in federal assistance in
fiscal year 1995 through programs such as Aid to Families With
Dependent Children (AFDC), Medicaid, Food Stamps, and others.\1
Teenage parenting also has implications for the health and well-being
of the mother and the child.  Studies have shown that the children of
teen mothers are at greater risk for lower birth weights, lower
cognitive scores, and school failure.  Studies also show that
children of teen mothers have a greater likelihood of becoming
teenage parents themselves.  We reported in 1994 that a significant
percentage of teen mothers who receive welfare do not have high
school diplomas\2 and tend to have larger families\3
--characteristics associated with longer stays on welfare. 

Recognizing the importance of this issue, the Congress, federal and
state governments, and the private sector are encouraging and
implementing initiatives to prevent teen pregnancies and births.  The
Congress recently enacted welfare reform legislation\4 that contains
provisions directed at reducing out-of-wedlock childbearing and
welfare dependency and promoting abstinence education.  In addition,
the Department of Health and Human Services (HHS) is developing a
national strategy to prevent teen pregnancy; state and local
governments are implementing new strategies that they believe hold
promise for addressing the problem; and private entities, such as the
National Campaign to Prevent Teen Pregnancy, are supporting actions
related to teenage childbearing.  A better understanding of the
characteristics of teen mothers and antecedents of teen motherhood
could help these efforts as public and private entities try to
develop and implement more effective prevention strategies. 

Because of the impact of teen pregnancies and births and your
interest in teen mothers and their children, you asked us to provide
social and demographic information about teen mothers.  Specifically,
we agreed to (1) show the trends in birth rates for teens; (2)
provide a profile of teen mothers; and (3) identify factors, such as
education or family background, that may influence the likelihood of
teen motherhood.  To provide this information, we relied on national
birth certificate data and the most current analyses of four
nationally representative surveys:  the National Longitudinal Survey
of Youth (NLSY), the National Education Longitudinal Study of 1988
(NELS:88), the National Survey of Family Growth (NSFG), and the
National Household Survey on Drug Abuse (NHSDA).  Limitations and
lack of comparability among the various data sources restricted our
ability to make comparisons or report by race and marital status in
some cases.  (For more information on our methods and data, see the
appendix.) We conducted our work between July 1997 and May 1998 in
accordance with generally accepted government auditing standards. 


--------------------
\1 Advocates for Youth, Teen Pregnancy, the Case for Prevention:  An
Analysis of Recent Trends in Federal Expenditures Associated With
Teenage Pregnancy (Washington, D.C.:  Apr.  1998). 

\2 Families on Welfare:  Focus on Teenage Mothers Could Enhance
Welfare Reform Efforts (GAO/HEHS-94-112, May 31, 1994). 

\3 Families on Welfare:  Teenage Mothers Least Likely to Become
Self-Sufficient (GAO/HEHS-94-115, May 31, 1994). 

\4 Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (P.L.  104-193, Aug.  22, 1996). 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

Although the birth rate for teenage women decreased 41 percent from
the late 1950s to 1995--paralleling the decline in the U.S.  birth
rate--the number of babies born to teenagers is still high (about
512,000 in 1995).  Births to unmarried teenage mothers, however, more
than quintupled as a proportion of total teen births over the same
period.  As of 1995, the teen birth rate was about 57 per thousand;
however, rates varied considerably by subgroup.  The birth rates for
black and Hispanic teenage women are more than twice those for white
teens. 

In 1995, nearly half of teen mothers were white and most were aged 18
to 19 and unmarried.  About two-thirds of recent teen mothers did not
intend to get pregnant or have a child; however, about one-fifth of
women who gave birth already had one child.  Teenage mothers also
graduate from high school at lower rates than all teen women. 
Sixty-four percent of teen mothers complete high school, compared
with about 90 percent of all teen women. 

Research studies that have examined the antecedents of teen
motherhood have shown that limited involvement in school and some
family background characteristics--such as family instability and
declines in family income--are associated with an increased
likelihood of teen motherhood.  The effect of most other factors
varies among racial and ethnic groups. 


   TEEN BIRTH RATES HAVE DECLINED,
   BUT PROPORTION OF UNMARRIED
   MOTHERS HAS INCREASED
------------------------------------------------------------ Letter :2

Since the late 1950s, the birth rate of women aged 15 to 19 has
decreased by about 41 percent overall.  (One substantial increase
started around the mid-1980s, then reversed itself in the early
1990s).  The overall decrease in the teen birth rate parallels the
overall decline in the U.S.  birth rate as a whole, which has fallen
47 percent over the same time period.  In contrast, the proportion of
teen births outside of marriage has steadily increased over the same
period (1957-95) from 14 percent to 78 percent of all teen births.\5
(See fig.  1.)

   Figure 1:  U.S.  Birth Rates,
   1940-95

   (See figure in printed
   edition.)

Sources:  Data were derived from information found in S.J.  Ventura
and others, "Report of Final Natality Statistics, 1995," Monthly
Vital Statistics Report, Vol.  45, No.  11, Supp.  2 (Hyattsville,
Md.:  National Center for Health Statistics, 1997); and U.S.  Bureau
of the Census, Historical Statistics of the United States, Colonial
Times to 1970, Part 1, No.  003-024-001209 (Washington, D.C.:  Bureau
of the Census, 1975). 


--------------------
\5 The National Center for Health Statistics defines a mother's
marital status as follows:  Women who have never been married or are
divorced or widowed at the time of the birth are considered not
married; women who are married but separated at the time of the birth
are considered married. 


      DECLINE IN TEEN BIRTH RATE
      PARALLELS DECLINE IN BIRTH
      RATE FOR ALL WOMEN
---------------------------------------------------------- Letter :2.1

In 1995, the most recent year for which final data are available,\6
the annual birth rate for women aged 15 through 19 was approximately
57 per thousand, compared with 96 per thousand in 1957 when the rate
was at its peak.\7 (See fig.  1.) There was a similar decline in the
birth rate for all women over the same time period.  The rate fell
from 123 per thousand to 66 per thousand for women aged 15 through
44, a decline of 47 percent.\8

While the overall trend in the teen birth rate has been downward,
fluctuations have occurred.  The most dramatic increase began in 1986
after the teen birth rate had reached 50 per thousand, the lowest
point in 40 years.  Between 1986 and 1991, the rate increased by 24
percent before starting to decline again.\9


--------------------
\6 Final data on 1996 births is expected to be released by the
National Center for Health Statistics later this year. 

\7 Ventura, "Report of Final Natality Statistics, 1995."

\8 Ventura, "Report of Final Natality Statistics, 1995" and Bureau of
the Census, Historical Statistics of the United States, Colonial
Times to 1970. 

\9 Ventura, "Report of Final Natality Statistics, 1995."


      BIRTHS TO UNMARRIED TEENS
      HAVE STEADILY INCREASED
---------------------------------------------------------- Letter :2.2

The percentage of births to unmarried teen women has increased
substantially over the past several decades.  In 1995, 78 percent of
teen births were to unmarried women, compared with about 14 percent
in 1957.  This trend parallels a rise in births outside of marriage
for the general population of women.  Births to unmarried women of
all ages had risen to 32 percent of the total in 1995 from about 5
percent in 1957.\10


--------------------
\10 Ventura, "Report of Final Natality Statistics, 1995."


   BIRTH RATES VARY AMONG RACE AND
   AGE GROUPS AND BY GEOGRAPHIC
   AREA
------------------------------------------------------------ Letter :3

Teen birth rates in 1995 varied considerably by race, age, and
geography.  Rates for black and Hispanic teens were more than double
those of white teens,\11 and older teens constituted nearly
two-thirds of teens who gave birth in 1995.  Higher rates of teen
births were found in the southern and southwestern states. 


--------------------
\11 In this report "white" means non-Hispanic white and "black" means
non-Hispanic black.  "Hispanic" designates an ethnicity; Hispanic
individuals can be of any race. 


      BIRTH RATES ARE HIGHER FOR
      BLACKS AND HISPANICS THAN
      FOR WHITES
---------------------------------------------------------- Letter :3.1

In 1995, birth rates for Hispanic and black teens were 107 and 99 per
thousand, respectively--more than twice the rate for white teens at
39 per thousand.\12

Black and Hispanic women were also more likely to begin their
families at younger ages.  Compared with white teens, they were twice
as likely to give birth by age 20.\13


--------------------
\12 Ventura, "Report of Final Natality Statistics, 1995."

\13 Child Trends, Inc., Facts at a Glance (Washington, D.C.:  Oct. 
1997). 


      BIRTH RATES ARE HIGHER FOR
      OLDER TEENS
---------------------------------------------------------- Letter :3.2

In 1995, the birth rates for teen women aged 18 to 19 were more than
double the rates for those aged 15 to 17, regardless of race.  (See
table 1.) A similar pattern is evident among unmarried teens, where
older teens had birth rates about double those of younger teenage
women. 



                                Table 1
                
                 Birth Rate per Thousand Women by Age,
                     Race, and Marital Status, 1995

                                             All          Unmarried
                                        --------------  --------------
                                          Aged    Aged    Aged    Aged
Race                                     15-17   18-19   15-17   18-19
--------------------------------------  ------  ------  ------  ------
White                                       22      66      18      45
Black                                       70     142      69     131
Hispanic                                    73     158      56     118
======================================================================
Totals                                      36      89      31      68
----------------------------------------------------------------------
Note:  Rates are calculated per thousand women in a specified group
and are rounded. 

Source:  Ventura, "Report of Final Natality Statistics, 1995."


      TEEN BIRTH RATES ARE HIGHER
      IN THE SOUTHERN AND
      SOUTHWESTERN STATES
---------------------------------------------------------- Letter :3.3

In 1995, teen birth rates were the lowest in the northern states and
highest in the South and the Southwest.  (See fig.  2.) The states
with the lowest rates had 45 or fewer births per thousand teen women
while the states with the highest rates had 66 or more births per
thousand.  The 12 highest rates, which are concentrated in the
southern and southwestern states, are 1.5 times the lowest rates in
the northern states.\14 A recent analysis of these patterns shows
that teen birth-rate variations by geographic area correspond to the
racial and ethnic distributions in the United States--higher numbers
of blacks and Hispanics live in southern and southwestern states.\15

   Figure 2:  1995 Teen Birth
   Rates by State

   (See figure in printed
   edition.)

Note:  Birth rates are per thousand women, aged 15 to 19. 

Source:  Derived from information in Child Trends, Facts at a Glance. 

A comparison of 1990 urban and rural teen birth rates for eight
southeastern states shows that rural teen birth rates were higher
than urban rates in three of four race and age categories.\16 Among
white women aged 15 to 17 and 18 to 19 and black women aged 18 to 19,
those who lived in rural areas had higher birth rates than those who
lived in urban areas.  Only black women aged 15 through 17 had higher
rates in urban areas.  The study links the higher rural birth rates
to a relatively lower use of abortion in rural areas. 


--------------------
\14 Child Trends, Facts at a Glance. 

\15 "State-Specific Birth Rates for Teenagers--United States,
1990-96," Morbidity and Mortality Weekly Report, Vol.  46, No.  36
(Sept.  12, 1997). 

\16 T.  Bennett and others, "Rural Adolescent Pregnancy:  A View From
the South," Family Planning Perspectives, Vol.  29, No.  6 (Nov.-Dec. 
1997). 


   PROFILE OF TEEN MOTHERS
------------------------------------------------------------ Letter :4

This profile provides descriptive characteristics of teen mothers who
gave birth in the 1990s.  Of teens who gave birth in 1995, almost
half were white and most were age 18 or 19 and unmarried.  About
two-thirds of teen births were the result of an unintended pregnancy,
and many births (21 percent) were a second or later child.  About
two-thirds of teen mothers graduated from high school; however, teen
mothers graduated at substantially lower rates than teen women
without children.  (See table 2.) Furthermore, teen mothers reported
drug use in the past month that was similar to that of other women
their age.  Also, 28 percent of white teen mothers reported smoking
tobacco during their pregnancy, compared with 5 percent of black and
Hispanic mothers.\17



                          Table 2
          
            Profile of Teenage Mothers Who Gave
                     Birth in the 1990s

                    (Numbers in percent)

                         All     White     Black  Hispanic
------------------  --------  --------  --------  --------
Total number of     492,000\   233,000   137,000   122,000
 teen mothers              a

Age at time of birth\b
----------------------------------------------------------
Under 15                   2         1         4         3
15-17                     38        34        42        40
18-19                     60        65        53        57

Marital status at time of birth\b
----------------------------------------------------------
Married                   25        32         5        32
Unmarried                 75        68        95        68

First or later birth\b
----------------------------------------------------------
First birth               79        83        74        77
Later birth               21        17        26        23

Conception intended or unintended\c
----------------------------------------------------------
Intended                  35        33        25        54
Unintended \              65        67        75        46

High school completion\d
----------------------------------------------------------
Completed high            64
 school
Did not complete          36
 high school

Welfare receipt within 5 years of birth\e
----------------------------------------------------------
Received                  49
Did not receive           51

Insurance coverage for birth\f
----------------------------------------------------------
Medicaid                  69
Some private              26
Self                       4
----------------------------------------------------------
\a The data exclude about 21,000 births to races other than white,
black, and Hispanic and those of unknown race.  S.J.  Ventura and
others, "Report of Final Natality Statistics, 1995," Monthly Vital
Statistics Report, Vol.  45, No.  11, Supp.  2 (Hyattsville, Md.: 
National Center for Health Statistics, 1997). 

\b These characteristics reflect only 1995 natality data. 

\c J.C.  Abma and others, "Fertility, Family Planning, and Women's
Health:  New Data From the 1995 National Survey of Family Growth,"
Vital and Health Statistics, PHS 97-1995, Series 23, No.  19
(Hyattsville, Md.:  HHS, 1997).  The question asked about live births
to teenage women in the 5 years before the survey. 

\d National Center for Education Statistics, "The Relationship
Between the Parental and Marital Experiences of 1988 Eighth-Grade
Girls and High School Completion as of 1994," Statistics in Brief,
NCES 98-093 (Washington, D.C.:  1998).  The survey upon which this
study is based, NELS:88, represents U.S.  eighth-graders in 1988 who
should have graduated from high school in 1992. 

\e The Congressional Budget Office calculated welfare receipt (AFDC
only) from NLSY data.  Sources of Support for Adolescent Mothers,
U.S.  Congressional Budget Office (Sept.  1990). 

\f J.C.  Abma, "Fertility, Family Planning, and Women's Health." This
source presents insurance coverage for the most recent live birth in
the last 5 years.  "Medicaid" includes Medicaid and "other government
sources."


--------------------
\17 While earlier information in this report is based on birth rates
(numbers of births per thousand women), this table provides
percentage distribution of teen mothers across several background and
outcome characteristics. 


      NEARLY HALF OF TEEN MOTHERS
      ARE WHITE, AND MOST ARE AGE
      18 OR OLDER AND UNMARRIED
---------------------------------------------------------- Letter :4.1

Almost half of the 512,000 births\18 in 1995 (233,000) were to white
teen mothers.  The remainder included an almost even distribution of
births between blacks (137,000) and Hispanics (122,000).  (See fig. 
3.)

   Figure 3:  Number of Teen
   Mothers, by Race, in 1995

   (See figure in printed
   edition.)

Source:  Ventura, "Report of Final Natality Statistics, 1995."

Births to teen mothers were predominantly to older teens.  In 1995,
about 60 percent of all children born to teens--married and
unmarried--were born to 18- and 19-year-olds.  Of the remaining 40
percent born to younger teenage women, most were born to women aged
15 to 17, with just slightly more than 12,000 born to women under age
15.  (See table 2 and fig.  4.)

   Figure 4:  Number of Teen
   Mothers, by Age, in 1995

   (See figure in printed
   edition.)

Note:  This figure includes about 21,000 births to teenagers that
year for which the race or ethnicity is either unknown or is other
than black, white, or Hispanic. 

Source:  Ventura, "Report of Final Natality Statistics, 1995."

About three-fourths of all teenage women who gave birth were
unmarried at the time of the birth.  Black teen mothers were
predominantly unmarried (95 percent), while 68 percent of white and
68 percent of Hispanic teen mothers were unmarried at the time of the
birth. 


--------------------
\18 S.J.  Ventura and others, "Births to Unmarried Mothers:  United
States, 1980-92," Vital and Health Statistics, Series 21, No.  53
(Hyattsville, Md.:  National Center for Health Statistics, 1995) and
personal communication with the lead author.  This number includes
about 21,000 births to teenagers that year for which the race or
ethnicity is either unknown or is other than black, white, or
Hispanic. 


      MANY TEENS WHO GAVE BIRTH IN
      1995 ALREADY HAD AT LEAST
      ONE CHILD
---------------------------------------------------------- Letter :4.2

In 1995, more than one-fifth of all teen births in the United States
were to teenage women who had already given birth to at least one
child.  (See table 2.) The highest proportions of second or later
births were among 18- and 19-year-olds.  In this age group, 36
percent of black teen births, 30 percent of Hispanic teen births, and
21 percent of white teen births were a second or later child.  The
chance of the birth being a second or later birth was similar for all
teens, regardless of race, age, or marital status.  (See table 3.)



                          Table 3
          
           Percent and Number of Second or Later
             Teen Births by Age and Race, 1995

             Under age 15     Aged 15-17      Aged 18-19
            --------------  --------------  --------------
                      Numb            Numb            Numb
Race         Percent    er   Percent    er   Percent    er
----------  --------  ----  --------  ----  --------  ----
White              1    28         8  6,11        21  32,4
                                         9              57
Black              3   158        16  9,30        36  26,4
                                         3              91
Hispanic           3   100        14  6,68        30  20,9
                                         9              08
==========================================================
Total              2   286        12  22,1        27  79,8
                                        11              56
----------------------------------------------------------
Note:  Births for which birth order was not stated are counted as
first births in each race and age category.  Excluded are births for
which race is not known and births to other racial groups. 

Source:  Calculated from data in Ventura, "Report of Final Natality
Statistics, 1995."


      MOST TEEN BIRTHS ARE THE
      RESULT OF UNINTENDED
      PREGNANCIES
---------------------------------------------------------- Letter :4.3

A high percentage of births to teens in the United States result from
unintended pregnancies.\19 Between 1990 and 1995, 65 percent of
births to teenage mothers were reported as unintended, whereas about
one-third of all U.S.  births were reported as unintended in that
period.  From 1990 to 1995, about 75 percent of births to black teen
mothers, 67 percent to white teen mothers, and 46 percent to Hispanic
teen mothers were reported as unintended.  (See table 2 and fig.  5.)

   Figure 5:  Percentage of
   Intended and Unintended Births
   to Mothers Under Age 20, by
   Race

   (See figure in printed
   edition.)

Source:  J.C.  Abma and others, "Fertility, Family Planning, and
Women's Health:  New Data From the 1995 National Survey of Family
Growth," Vital and Health Statistics, Series 23, No.  19
(Hyattsville, Md.:  HHS, 1997). 


--------------------
\19 "Unintended births" result from mistimed and unwanted
pregnancies.  "Intended births," by contrast, are those that occurred
when the mother intended to have a child at the time she conceived. 


      ABOUT TWO-THIRDS OF TEEN
      MOTHERS COMPLETE HIGH SCHOOL
---------------------------------------------------------- Letter :4.4

Generally, women who give birth in their teens have substantially
lower high school graduation rates than those who do not.  A recent
education study shows that about 64 percent of teen mothers graduated
from high school or earned a general equivalency diploma within 2
years after the time they would have graduated, compared with about
94 percent of teenage women who did not give birth.\20 An older study
similarly found that less than 60 percent of teen mothers graduated
from high school by age 25, compared with 90 percent of women who did
not have a child in their teens.\21

Also, high school completion rates among teen mothers vary
considerably by race.  Black teen mothers--in both a 1990s study and
a 1970s study--had the highest high school completion rates compared
with whites and Hispanics. 


--------------------
\20 "The Relationship Between the Parental and Marital Experiences of
1988 Eighth-Grade Girls and High School Completion as of 1994,"
Statistics in Brief, NCES 98-093 (Washington, D.C.:  National Center
for Education Statistics, 1998).  This study used expected high
school graduation date as an approximation for age. 

\21 N.  Ahn, "Teenage Childbearing and High School Completion: 
Accounting for Individual Heterogeneity," Family Planning
Perspectives, Vol.  26, No.  1 (Jan.-Feb.  1994). 


      HALF OF TEEN MOTHERS RECEIVE
      WELFARE WITHIN 5 YEARS OF
      GIVING BIRTH
---------------------------------------------------------- Letter :4.5

Research shows that a large percentage of teenage mothers eventually
become welfare recipients.  Data from a 1990 Congressional Budget
Office report show that almost half of all teen mothers and
three-quarters of unmarried teen mothers received AFDC within 5 years
of giving birth.\22 By contrast, only about one-quarter of married
teen mothers received AFDC during the same time period.  In our 1994
report, we similarly found that women who gave birth as teenagers
made up nearly half of the unmarried AFDC caseload.\23 Also, survey
data from 1995 show that 69 percent of births to teens in a 5-year
period were paid for by Medicaid or other government sources. 


--------------------
\22 Sources of Support for Adolescent Mothers, U.S.  Congressional
Budget Office (Washington, D.C.:  Sept.  1990). 

\23 GAO/HEHS-94-115, May 31, 1994. 


      TEEN MOTHERS' DRUG USE IS
      SIMILAR TO OTHER TEEN WOMEN
---------------------------------------------------------- Letter :4.6

Substance use among teen mothers is comparable to that for other
women their age.  In a national survey, about one-sixth of teen
mothers aged 15 to 19 reported any illicit drug use in the past
month, while about one-third reported alcohol and one-third cigarette
use during that time.  Similar percentages of women without children
in those age groups reported using those substances in the past
month.\24



                          Table 4
          
             Percentage of Women Aged 15 to 19
           Reporting Past Month Drug Use, 1994-96

                                        With
                                    children
                                (standardize       Without
Drug type                Total          d)\a      children
----------------  ------------  ------------  ------------
Alcohol                     36            33            36
Cigarettes                  30            32            30
Any illicit                 14            16            14
----------------------------------------------------------
Note:  SAMHSA, Office of Applied Studies, supplied data upon request. 
Comparisons between women with and without children found no
statistically significant differences (.05). 

\a The standardized prevalence for women with children presents what
would happen if the relative number of women at ages 15, 16, 17, 18,
and 19 was the same as the number of women without children at those
ages. 

Smoking during the pregnancy, by contrast, appears lower for teens
than for their peers with children.  Compared with the one-third of
teen mothers aged 15 to 17 who smoke, about 17 percent of mothers
that age who gave birth in 1995 reported smoking while they were
pregnant.  However, smoking cigarettes during pregnancy varied by
race or ethnicity;\25 about 28 percent of white teen mothers reported
smoking during pregnancy, compared with about 5 percent of black or
Hispanic teenage mothers. 


--------------------
\24 These figures are from 3 years (1994-96) of the National
Household Survey on Drug Abuse, provided upon request by Substance
Abuse and Mental Health Services Administration (SAMHSA), Office of
Applied Studies.  Illicit drug use includes any nonmedical use of
marijuana or hashish, cocaine (including crack), inhalants,
hallucinogens (including PCP), heroin, or psychotherapeutic drugs. 
Rates of use of illegal drugs, alcohol, or tobacco may be low as a
result of standard survey methods that rely on the individual to
honestly report usage. 

\25 Ventura, "Report of Final Natality Statistics, 1995."


   SCHOOL INVOLVEMENT AND FAMILY
   BACKGROUND INFLUENCE THE
   LIKELIHOOD OF TEENAGE
   MOTHERHOOD
------------------------------------------------------------ Letter :5

Certain social factors, such as the teen's level of school
involvement or family background and income, appear to influence the
likelihood that a woman will give birth in her teenage years. 
Generally, lower school involvement, unstable family structure, and
declining family income are associated with an increased likelihood
of teen births.  According to one study, teens who experienced
multiple risk factors such as early school failure, poverty, or
family dysfunction were more likely to become teenage mothers.\26

Beyond a few factors, which had similar effects across the groups
studied, the impact of other social factors on the likelihood of teen
births varied by racial or ethnic group.  Family instability, such as
divorce and remarriage; declining family income, such as with job
loss; and lower standardized test scores were associated with an
increased likelihood of a teen birth,\27 while family stability,
increasing family income, and higher standardized test scores were
associated with a reduced likelihood of birth for each group studied. 
Staying in school and living in two-parent families were associated
with a lower risk of birth for white and Hispanic teens but had no
effect for black teens.  Socioeconomic status (SES) also had a mixed
effect across racial groups.  Lower SES was associated with an
increased likelihood of a teen birth for Hispanic teens, a decreased
likelihood for black teens, and had no effect on white teens.  Higher
SES had the opposite effect.  Living in female-headed single-parent
families was associated with an increased likelihood of a birth for
black teens but had no effect for white teens.  And only white teens
were more likely to become teen mothers if their mothers had also
been teen mothers.  (See fig.  6.)

   Figure 6:  Effects of School
   and Family Background Factors
   on the Likelihood of Teen
   Births

   (See figure in printed
   edition.)

Note:  Data for this figure are drawn from two recent studies based
on large-scale nationally representative longitudinal data.  We
report only their statistically significant findings.  These studies
use a multivariate analysis, that is, net of or controlling for
background factors in each analysis.  Wu's analysis, which covers
"Family Instability," "Mother-Only Household," and "Declining
Income," does not contain data for Hispanics. 

\a J.  Manlove, "The Influence of High School Dropout and School
Disengagement on the Risk of School-Age Pregnancy," Journal of
Research on Adolescence (1998).  School factors are based on an
analysis of women who were in the eighth grade in 1988 (NELS:88
data), and most factors were measured in the eighth grade.  By
contrast, dropping out was measured over the school years before a
school-aged pregnancy leading to a live birth. 

\b L.  Wu, "Effects of Family Instability, Income, and Income
Instability on the Risk of a Premarital Birth," American Sociological
Review, Vol.  61 (June 1996).  Dr.  Wu's data are from the 1979 NLSY
survey. 

\c The SES measure is a composite of family income and parental
education and occupation. 


--------------------
\26 Child Trends, Facts at a Glance.  A descriptive study of
eighth-graders found that those who did not demonstrate any of these
characteristics had the lowest probability of a teenage birth; as the
number of risk factors increased, the probability of a teenage birth
increased.  Teenage women with three or more of the risk factors had
a 50-percent chance of a teenage birth. 

\27 L.  Wu, "Effects of Family Instability, Income, and Income
Instability on the Risk of a Premarital Birth," American Sociological
Review, Vol.  61 (June 1996).  This analysis did not include
Hispanics. 


      LIMITED INVOLVEMENT IN
      SCHOOL IS ASSOCIATED WITH
      GREATER LIKELIHOOD OF TEEN
      BIRTH
---------------------------------------------------------- Letter :5.1

Research indicates a link between school involvement and teen births. 
A national study of girls who were eighth-graders in 1988, found
several measures of school involvement, including dropping out, were
associated with a greater risk of a subsequent teen birth.\28
However, only one measure--lower standardized test scores--was
consistently associated with an increased risk of a teen birth in all
racial and ethnic groups.  Other measures, such as lower grades or
limited postsecondary education plans, were associated with an
increased likelihood of a teenaged birth for one or more races but
not for all.  For example, lower grades in school were associated
with an increased likelihood of a school-aged pregnancy leading to a
birth for white and black teens.\29 (See fig.  6.)

Teenage women who dropped out of school were more likely than those
who stayed in school to become pregnant and give birth in their
teens.  However, an association between dropping out of school and
teen pregnancy was observed only among whites and Hispanics.  After
controlling for family background and measures of school involvement
and performance, white and Hispanic teens who dropped out of school
were about 1.5 times more likely to become a teenage mother than
white and Hispanic teens who stayed in school.  For black teens,
drop-out status had no effect on teen pregnancy.  Moreover, of
school-age teens who gave birth, more than one quarter (28 percent)
dropped out of school prior to pregnancy; an additional 30 percent
dropped out after the pregnancy or birth of a child, and 42 percent
stayed in school.  These findings are consistent with those of a
study of teen experiences in the 1970s and early 1980s. 

Limited postsecondary education plans were associated with a greater
likelihood of a school-aged birth for black and Hispanic teens. 


--------------------
\28 J.  Manlove, "The Influence of High School Dropout and School
Disengagement on the Risk of School-Age Pregnancy," Journal of
Research on Adolescence (1998).  Her sample from the NELS:88 study
comprises women who had a pregnancy before 12th grade leading to a
live birth. 

\29 J.  Manlove, "The Influence of High School Dropout and School
Disengagement." The age at pregnancy was constructed by subtracting 9
months from the date of the first birth. 


      UNSTABLE FAMILY STRUCTURE
      AND HOUSEHOLDS HEADED BY
      WOMEN ARE ASSOCIATED WITH
      GREATER LIKELIHOOD OF TEEN
      BIRTH
---------------------------------------------------------- Letter :5.2

Descriptive studies have generally found a lower risk of teen birth
in two-parent families than with other family types.\30 A study of
the effects of changes in family structure--such as divorce,
appearance of a stepparent, going to live with grandparents or in an
institution--on teen women found that the greater the number of such
changes, the greater the probability of an early teen birth,
regardless of family income.\31 (See fig.  6.)

The impact of family structure or family instability, however, varied
by race or ethnicity.  For example, one study found that being born
into and reared through early childhood in a single-parent family
headed by a woman was associated with higher likelihood of a birth
for black teens but not for white teens.\32 Another recent study
found that living in a two-parent "intact" family during the eighth
grade was associated with less risk of birth for white and Hispanic
teens--but not for black teens.\33 (See fig.  6.) Another factor
associated with teen births only among white teens was having a
parent who was also a teenage mother. 


--------------------
\30 K.A.  Moore and others, A Statistical Portrait of Adolescent Sex,
Contraception, and Childbearing (Washington, D.C.:  National Campaign
to Prevent Teen Pregnancy, 1998); and Sara McLanahan and Gary
Sandefur, Growing Up With a Single Parent:  What Hurts, What Helps
(Cambridge, Mass.:  Harvard University Press, 1994). 

\31 L.  Wu, "Effects of Family Instability, Income, and Income
Instability on the Risk of a Premarital Birth," American Sociological
Review, Vol.  61 (June 1996).  Dr.  Wu's analysis controls for
multiple family background characteristics, using data from NLSY. 

\32 Wu, "Effects of Family Instability."

\33 Manlove, "The Influence of High School Dropout and School
Disengagement."


      INFLUENCE OF FAMILY INCOME
      ON LIKELIHOOD OF BECOMING A
      TEEN MOTHER VARIES
---------------------------------------------------------- Letter :5.3

Some descriptive research suggests that teens from lower income
families have a greater likelihood of a having a teen birth than
teens from higher-income families.  However, recent multivariate
analysis shows that the effect of SES on teen births varies by race
and ethnicity.  For example, a descriptive analysis of 1988
eighth-graders found that less than 7 percent of those from families
with high incomes had had a child by the age of 20, compared with
about 37 percent of teenage women from low-income families.\34
However, after controlling for a number of family background
characteristics, lower SES was associated with an increased risk of
teen pregnancy for Hispanics, lower risk for blacks, but had no
effect for whites.\35 (See fig.  6.) Higher SES had the opposite
effect for Hispanics and blacks. 

An analysis of earlier data (1970s and early 1980s), which also
controlled for a number of family background characteristics, found a
relationship between a decline in family income and the risk of teen
births.  For example, job loss or other types of income losses were
associated with a higher likelihood of a birth among black and white
teens.\36 (See fig.  6.)


--------------------
\34 Child Trends, Facts at a Glance. 

\35 Manlove, "The Influence of High School Dropout and School
Disengagement."

\36 Wu, "Effects of Family Instability."


   COMMENTS FROM EXTERNAL
   REVIEWERS
------------------------------------------------------------ Letter :6

External experts on the data presented reviewed a draft of this
report.  We included their comments where appropriate. 


---------------------------------------------------------- Letter :6.1

As agreed with your office, unless you publicly announce its contents
earlier, we will make no further distribution of this report until 30
days from its issue date.  At that time we will send copies to the
Secretary of Health and Human Services and other interested parties. 
We will also make copies available to others upon request. 

Major contributors were James O.  McClyde, Assistant Director, and
Barbara Chapman, Evaluator-in-Charge.  Please contact me on (202)
512-7119 if you or your staff have any questions about this report. 

Sincerely yours,

Marsha Lillie-Blanton
Associate Director
Health Services Quality and
 Public Health Issues


SCOPE, METHODOLOGY, AND DATA
LIMITATIONS
==================================================== Appendix Appendix

We used studies based primarily on nationally representative data
sources to profile mothers who gave birth before age 20.  We relied
primarily on two types of data sources:  national birth certificate
information and the most current analyses and data tables from
longitudinal surveys and other recent surveys.  The national birth
certificate data--collected by states and then transmitted to the
National Center for Health Statistics for processing and
publication--provides comprehensive information on U.S.  birth rates
over time.\37 Much of the information in this report--including birth
rates and trends, marital status, first or later birth, and tobacco
use during pregnancy--was derived or calculated from the published
1995 natality statistics.\38 For example, we calculated the
percentage of teen births that were second or later births by racial
and ethnic group.  We requested that Substance Abuse and Mental
Health Services Administration (SAMHSA) do a special analysis of data
from the National Household Survey on Drug Abuse (NHSDA) 1994-96 in
order to compare the drug use of teen mothers with that of teen women
without children. 

To further develop a profile and identify factors associated with
teen motherhood, we reviewed studies of nationally representative
databases that link information regarding a teen birth to a mother's
education and family background.  Specifically, we used the National
Longitudinal Survey of Youth (NLSY) launched in 1979, which surveyed
a sample of 14- to 21-year-olds and reinterviewed them annually.  A
more recent survey, the National Education Longitudinal Study of 1988
(NELS:88), followed a nationally representative sample of eighth
graders to 1994.  We used data from this more recent cohort,
particularly in the discussion of education-related issues.  We
obtained additional information from the National Survey of Family
Growth (NSFG), conducted in 1995, as well as several of the NHSDAs
done in the 1990s and studies that used them.  (See table I.1.)



                         Table I.1
          
                 Major Information Sources

                    Years of data   Brief description of
Data source         used            source
------------------  --------------  ----------------------
NELS:88             1988, 1990,     A school-based study
                    1992, 1994      that followed girls
                                    who were eighth-
                                    graders in 1988

NLSY                1979-1989       A labor survey that
                                    followed a cohort of
                                    youth aged 14 to 21 in
                                    1979

NHSDA               1994-96         An annual household
                                    survey of drug use

NSFG                1995            A periodic fertility
                                    survey of women aged
                                    15 to 44

Birth certificate   Annual          Information for each
information                         birth compiled by HHS
                                    from state-submitted
                                    data
----------------------------------------------------------
Limitations and lack of comparability among the various data sources
restricted our ability to make comparisons or report by race and
marital status in some cases.  Because information was more readily
available on teen mothers as a whole, and three-quarters of teen
births in 1995 were to unmarried teens, we often present data on all
teen mothers in lieu of specific information on unmarried teen
mothers.  With few exceptions, the information we present represents
the experiences of U.S.  teen women in the 1990s. 


--------------------
\37 The birth certificate data are incomplete on pregnancies that
result in miscarriage or adoption and contain no information on
abortions. 

\38 All but five states record the mother's marital status on the
birth certificate.  To determine the mother's marital status in the
remaining five states, a more complex protocol was used.  S.  J. 
Ventura and others, "Report of Final Natality Statistics, 1995,"
Monthly Vital Statistics Report, Vol.  45, No.  11, Supp.  2
(Hyattsville, Md.:  National Center for Health Statistics, 1997). 


*** End of document. ***