Impact of social service and public health spending on teenage birth rates across the USA: an ecological study

OBJECTIVE: To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. DESIGN: Ecological study. SETTING: USA. PARTICIPANTS: 50 states. PRIMARY OUTCOME MEASURE: Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. RESULTS: The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). CONCLUSION: Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical.