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By controlling for a variety of social and biological factors (such as neighborhood socioeconomic status, marital status of mother, residential mobility, family structure changes, and mental health), and the use of a strong statistical design—propensity score matching with a large population-based dataset—this study aims to determine whether teenage pregnancy is more strongly predicted by having an older sister who had a teenage pregnancy or by having a mother who bore her first child before age 20.The setting of this study, Manitoba, is generally representative of Canada as a whole, ranking in the middle for several health and education indicators [12, 13].At the time of the 2011 Census, approximately 1.2 million people resided in Manitoba, with more than half (783,247) living in the two urban areas, Winnipeg and Brandon .
Mothers and older sisters are the main sources of family influence on teenage pregnancy; this is due to both social risk and social influence.
Family members both contribute to an individual’s attitudes and values around teenage pregnancy, and share social risks (such as poverty, ethnicity, and lack of opportunities) that influence the likelihood of teenage pregnancy [6, 7].
This study used linkable administrative databases housed at the Manitoba Centre for Health Policy (MCHP).
The original cohort consisted of 17,115 women born in Manitoba between April 1, 1979 and March 31, 1994, who stayed in the province until at least their 20 birthday, had at least one older sister, and had no missing values on key variables.
Research around the impact of sister’s teenage pregnancy has been limited to mostly qualitative studies using small samples of minority adolescents in the United States [5, 11].
To our knowledge, no previous studies have examined the impact of an older sister’s teenage pregnancy on the odds of her younger sister having a teenage pregnancy, and compared this effect with the direct effect of having a mother who bore her first child before age 20.
Propensity score matching (1:2) was used to create balanced cohorts for two conditional logistic regression models; one examining the impact of an older sister’s teenage pregnancy and the other analyzing the effect of the mother’s teenage childbearing.
The adjusted odds of becoming pregnant between ages 14 and 19 for teens with at least one older sister having a teenage pregnancy were 3.38 (99 % CI 2.77–4.13) times higher than for women whose older sister(s) did not have a teenage pregnancy.
Information on data linkage, confidentiality/privacy, and validity of the datasets used have been described elsewhere [20–22].
Children are linked to mothers using hospital birth record information; the mother was noted in essentially all cases .