Analyzing the contribution of community change to population health outcomes in an adolescent pregnancy prevention initiative

Few evaluations of community initiatives have established a link between intermediate outcomes, such as community or systems change, and more distant population-level health outcomes (e.g., estimated rates of employment or adolescent pregnancy). This article describes an analysis of the contribution of community changes facilitated by a community health initiative to prevent adolescent pregnancy to the population-level outcome of birth rates for teens. The authors examine a hypothesis that this link might be expected when community changes are of greater amount, intensity, duration, and exposure. The results showed reductions in birth rates in Target Area A, where there was a greater concentration of community changes and a slight increase where there were far fewer changes. This report provides a method for describing empirically the contribution of environmental change to more distant population-level outcomes.