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Cholecystitis in Teenage Girls

Adye, Bruce; Ryan, John A.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1983 Português
Relevância na Pesquisa
46.5%
Cholecystectomy was carried out in 17 teenage girls for cholecystitis at Virginia Mason Hospital, Seattle, between 1971 and 1980. The incidence increased with increasing age. Gallbladder disease was associated with recent pregnancy or birth control pill use (71%), obesity (65%) and family history of gallbladder disease (47%). All but one patient had at least one of these risk factors. No patient had congenital anomalies, blood dyscrasias or other underlying illness. Patients most commonly had recurrent attacks of abdominal pain; seven had symptoms for more than six months. Although the clinical presentations were often mild, six patients had jaundice, three had chemical pancreatitis, one had hemorrhagic pancreatitis, one had pancreatic pseudocyst and abscess and one had a common duct stone. One patient had cholesterosis and 16 had cholelithiasis. All patients were cured by operation. During the same time period, only two boys, both aged 14 years, nonobese and with no family history of gallbladder disease, underwent cholecystectomy, both for acaculous cholecystitis.

Chlamydia trachomatis among sexually active teenage girls: influence of sampling location and clinical signs on the detection rate.

Rahm, V A; Odlind, V; Gnarpe, H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1990 Português
Relevância na Pesquisa
46.59%
A total of 707 cultures for Chlamydia trachomatis were obtained from healthy teenage girls attending an adolescence clinic for family planning. Apart from sampling from the endocervix, specimens were also obtained from outside the squamocolumnar junction and from the posterior fornix and cultured separately in order to study whether it was possible to improve the detection rate of C trachomatis by sampling from outside the endocervix. In 91 (12.8%) of the girls a positive culture was found. Of the chlamydia positive samples, 83.5% were obtained from the endocervix and 95% from outside the squamocolumnar junction of the portio. Of the 91 positive cultures, 15 (16.5%) were positive only in the sample obtained from the portio surface. The results indicate that the detection rate of C trachomatis could be improved by extended specimen collection. C trachomatis was isolated significantly more often when there was an ectopy, irrespective of whether the specimens had been collected from the endocervix or from outside the squamocolumnar junction. C trachomatis was particularly common if there was an ectopy and a bleeding at specimen collection. If there was no bleeding at sampling, C trachomatis was equally common in women with as in those without an ectopy.

The relationship between knowledge about sexually transmitted diseases and actual sexual behaviour in a group of teenage girls.

Andersson-Ellström, A; Forssman, L; Milsom, I
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1996 Português
Relevância na Pesquisa
46.9%
PURPOSE: To assess longitudinally the relationship between knowledge about sexually transmitted diseases (STDs) and sexual behaviour, contraceptive use, STD protection and social class in a group of Swedish teenage girls. METHODS: Girls starting their upper secondary school education were invited to attend a teenage clinic during a period of 2 years (5 visits). Questions were asked about family situation, sexual activity, contraceptives, STD protection and knowledge about STD. Gynaecological examinations were performed on entry and completion, and when necessary during the observation period. RESULTS: Eighty-eight girls completed all visits during the observation period. At 16 years of age there were no significant differences in knowledge about various STD and STD protection between girls from different social classes or with respect to coital experience, age of coitarche and the subsequent number of sexual partners at 18 years of age. At 18 years of age there was a better knowledge about STDs and the need for STD protection (p < 0.01) among girls with coital experience compared with those who had no coital experience. Girls reporting many lifetime partners were best informed, but in spite of solid knowledge they did not protect themselves from infection. Even though 34% of the girls with coital experience were found to harbour a STD during the course of this study...

Diagnostic efficacy of chlamydial antibodies in cervical secretions from pregnant women and adolescent girls.

Thejls, H; Rahm, V A; Gnarpe, J; Gnarpe, H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1995 Português
Relevância na Pesquisa
37.07%
OBJECTIVE--To assess the prevalence of cervical antibodies to Chlamydia trachomatis in two different populations and to correlate the findings to culture, direct fluorescent antibody test (DFA) and serum antibodies. SETTING--Antenatal clinics and clinic for teenage counselling in Gävle. PATIENTS--1078 pregnant women attending for routine follow up in the third trimester of pregnancy and 256 teenage girls. OUTCOME MEASURES--Cervical IgG and IgA antibodies to Chlamydia trachomatis. Cervical cultures for chlamydia. Serum IgG antibodies. DFA tests were used only in the teenage group. RESULTS--The prevalence of positive culture was 2.0% in pregnant women and 8.6% in teenage girls. In pregnant women cervical IgG > or = 8 and IgA > or = 8 were found in 7.2% and 5.8% respectively and in teenage girls in 6.6% and 2.0% respectively. The agreement between cervical IgG > or = 8 and humoral IgG > or = 32 was 0.76 in the pregnant group and 0.95 in the teenage group. The sensitivity, specificity and positive predictive value (PPV) for cervix IgG > or = 8 to predict a positive culture was 0.64, 0.94 and 0.18 respectively in pregnant women and 0.41, 0.97, 0.53 respectively in teenage girls. Of 31 teenage girls with either positive culture or positive DFA 12 had cervical IgG > or = 8 while five of 225 with negative chlamydia tests had cervical IgG > or = 8 (sensitivity 0.40 and PPV of 0.71). Cervical IgG > or = 16 was found in eight of 31 with positive chlamydia tests and in one of 225 with negative tests (sensitivity 0.26 and PPV 0.89). CONCLUSIONS--The finding of cervical IgG > or = 16 predicts current chlamydia (culture or DFA) in nearly 90% in a teenage population. It might indicate current infection in spite of negative culture in some cases. For low titres and in a low prevalence pregnant population cervical IgG are not useful for the diagnosis of chlamydia. As the sensitivity is low cervical antibodies cannot be used for screening purposes.

Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies.

Smith, T
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 08/05/1993 Português
Relevância na Pesquisa
36.88%
OBJECTIVE--To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers. DESIGN--Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district. SETTING--Tayside, Scotland. SUBJECTS--Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90. MAIN OUTCOME MEASURES--Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence. RESULTS--The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas. CONCLUSIONS--Although there was a higher pregnancy rate in teenagers in more deprived areas...

Characteristics of Sexually Active Teenage Girls Who Would Be Pleased with Becoming Pregnant

Cavazos-Rehg, Patricia A.; Krauss, Melissa J.; Spitznagel, Edward L.; Schootman, Mario; Cottler, Linda B.; Bierut, Laura Jean
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/2013 Português
Relevância na Pesquisa
47%
To investigate factors associated with favorable pregnancy attitudes among teenage girls. Participants were sexually active teenage girls aged 15–18 years old (n = 965) who took part in the 2002 or 2006–2010 National Survey of Family Growth (NSFG). Multinomial multivariable logistic regression was used to assess the likelihood of being pleased with a teenage pregnancy. Sixteen percent of sexually active teenage girls (n = 164) would be pleased (11 % a little pleased, 5 % very pleased) if they became pregnant. In a multivariable model, participants who had not yet discussed sexual health topics (i.e., how to say no to sexual intercourse or birth control) or had only discussed birth control with a parent were more likely to be very pleased with a teenage pregnancy than participants who had discussed both topics with a parent. Prior pregnancy, racial/ethnic group status, older age, and having parents with a high school education or less also increased the odds of being pleased with a teenage pregnancy. Being pleased with a teenage pregnancy was correlated with a lack of discussion of sexual health topics with parents, prior pregnancy, and sociodemographic factors (having less educated parents, racial/ethnic group status). Pregnancy prevention efforts can be improved by acknowledging the structural and cultural factors that shape teenage pregnancy attitudes.

Development and preliminary evaluation of a behavioural HIV prevention program for teenage girls of Latino descent in the USA

Davidson, Tatiana M.; Lopez, Cristina M.; Saulson, Raelle; Borkman, April L.; Soltis, Kathryn; Ruggiero, Kenneth J.; de Arellano, Michael; Wingood, Gina M.; DiClemente, Ralph J.; Danielson, Carla Kmett
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.84%
National data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV with the rate of new infections being approximately 4 times higher compared to White women of comparable age (Centers for Disease Control and Prevention 2013). This paper highlights the need for an effective single-sex HIV prevention program for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living, and Empowering (SiHLE), an evidence-based HIV prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV program as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.

Neurofibroma at Unusual Locations: Report of Two Cases in Teenage Girls

Garg, Cheena; Agrawal, Arjun; Agrawal, Ranjan; Kumar, Parbodh
Fonte: JCDR Research and Publications (P) Limited Publicador: JCDR Research and Publications (P) Limited
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
46.5%
Solitary neurofibromas are rare occurrence in salivary gland region as well as mons pubis of females. We present two cases of teenage girls with swelling in parotid region and mons pubis. Fine needle aspiration cytology was inconclusive in both cases. They were both managed surgically and a diagnosis of neurofibroma was ascertained histopathologically and also confirmed with S-100 immunohistochemistry. The patients were followed up for a period of six months, however, no recurrence was noted. Though, one patient had a previous history of recurrence. We report these cases in view of their rarity of site and age as well as no correlation with neurofibromatosis and clitoromegaly.

Designing Cost-Effective Cash Transfer Programs to Boost Schooling among Young Women in Sub-Saharan Africa

Baird, Sarah; McIntosh, Craig; Ozler, Berk
Fonte: Banco Mundial Publicador: Banco Mundial
Português
Relevância na Pesquisa
46.81%
As of 2007, 29 developing countries had some type of conditional cash transfer program in place, with many others planning or piloting one. However, the evidence base needed by a government to decide how to design a new conditional cash transfer program is severely limited in a number of critical dimensions. This paper presents one-year schooling impacts from a conditional cash transfer experiment among teenage girls and young women in Malawi, which was designed to address these shortcomings: conditionality status, size of separate transfers to the schoolgirl and the parent, and village-level saturation of treatment were all independently randomized. The authors find that the program had large impacts on school attendance: the re-enrollment rate among those who had already dropped out of school before the start of the program increased by two and a half times and the dropout rate among those in school at baseline decreased from 11 to 6 percent. These impacts were, on average, similar in the conditional and the unconditional treatment arms. Although most schooling outcomes examined here were unresponsive to variation in the size of the transfer to the parents...

Teenage Pregnancy and Opportunities in Latin America and the Caribbean : On Teenage Fertility Decisions, Poverty and Economic Achievement

Azevedo, Joao Pedro; Favara, Marta; Haddock, Sarah E.; Lopez-Calva, Luis F.; Muller, Miriam; Perova, Elizaveta
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
47.08%
The pregnancy project sought to expose the existence, and challenge the validity, of stereotypes about Hispanic women. The charade explored the underlying motivations of the many who responded with a wide range of reactions. The specific objectives of this regional study are: to establish a thorough description of the magnitude of the issue and its potential implications for social advancement; to advance the understanding of the risk factors, motivations and impacts at the household level-as a determinant of poverty and a cause of intra-and intergenerational poverty traps; to illuminate the coping mechanisms and their individual and social implications; to highlight the gender-related issues that have historically provoked asymmetric costs to boys and girls; and to provide elements that support specific policies on this matter. In the last decade, Latin America and the Caribbean (LAC) have been moving in the right direction and the region has experienced important gains in gender equality of endowments (assets) and economic opportunities. In most LAC countries...

Enhancing Youth Skills and Economic Opportunities to Reduce Teenage Pregnancy in Colombia

Gimenez, Lea; Van Wie, Sara Hause; Muller, Miriam; Schutte, Rebecca; Rounseville, Megan Zella; Viveros Mendoza, Martha Celmira
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Trabalho em Andamento
Português
Relevância na Pesquisa
47.05%
The Government of Colombia (GoC) has identified teenage pregnancy as a priority issue. The current strategic framework to address teenage pregnancy in Colombia is outlined in the CONPES 147, effective from February 2012 until March 2014. The CONPES 147 establishes a multi-sectoral framework that aims to address the determining factors of teenage pregnancy within Colombia (Box 1). The national strategy outlined in the CONPES 147 was piloted in 192 municipalities for youth ages 10 through 19. Building on this strategy, the Commission for the Guarantee of Sexual and Reproductive Rights is developing a new framework to guide the government’s policy and activities to address this important policy issue in the coming years. Parallel to its work on teenage pregnancy, the GoC released a national strategic framework to generate opportunities for Colombian youth in July 2014. The note includes an overview of the WDR 2012 gender equality framework and World Bank regional study on teenage pregnancy; outlines the Colombian country context with regard to gender equality and youth labor market outcomes; reviews interventions that develop life skills; and highlights how these interventions might be relevant to the GoC policies and programs related to teenage pregnancy prevention (CONPES 147) and youth labor (CONPES 173).

Photograph of teenage girls

Fonte: Museum of Houston and the Houston Metropolitan Resource Center Publicador: Museum of Houston and the Houston Metropolitan Resource Center
Tipo: Image; photographs
Português
Relevância na Pesquisa
46.59%
Four teenage girls posing with tennis racquets in a backyard. The four girls are Mary Burgess, Georgia Natalie Cheatham, Clara Evelyn 'Jim' Cheatham, and Catherine Cheatham Lester.

Striking poses : an investigation into the constitution of gendered identity as process, in the worlds of Australian teenage girls / Geraldine F. Bloustien.

Bloustien, Geraldine
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado Formato: 816331 bytes; application/pdf
Publicado em //1999 Português
Relevância na Pesquisa
66.84%
Explores the intricacies of girls' micro-social lived realities within larger macro-social contexts and the notion of identity as process by centring on the process of 'self-making' by ten teenage girls, living in Adelaide, South Australia in the mid 1990s. The main hypothesis argues for the strategic role of play in the constitution of 'self-making'. This is contextualised within an analytical framework of 'social praxeology', highlighting the importance of social networks to the ways the teenage participants themselves perceived and negotiated subjectivities. Argues that the young participants in this study acquired their sense of cultural (self) identities through three aspects of 'bodily praxis' - place, space and play. While the understandings of the girls and their familial and social groupings provides the focal point to the analysis, these were framed within the perspectives of sixty-five other young people and over fifty significant adults in various social institutions and wider social networks and further contextualised by a reflexive analysis of the research process itself.; Thesis (Ph.D.)--University of Adelaide, Dept. of Anthropology, 1999; Bibliography: leaves 256-293.; xii, 293 leaves : col. ill. ; 30 cm.; Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.

Measuring the economic gain of investing in girls : the girl effect dividend

Chaaban, Jad; Cunningham, Wendy
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
36.95%
Although girls are approximately half the youth population in developing countries, they contribute less than their potential to the economy. The objective of this paper is to quantify the opportunity cost of girls' exclusion from productive employment with the hope that stark figures will lead policymakers to reconsider the current underinvestment in girls. The paper explores the linkages between investing in girls and potential increases in national income by examining three widely prevalent aspects of adolescent girls' lives: early school dropout, teenage pregnancy and joblessness. The countries included in the analysis are: Bangladesh, Brazil, Burundi, China, Ethiopia, India, Kenya, Malawi, Nigeria, Paraguay, Senegal, South Africa, Tanzania, and Uganda. The authors use secondary data to allow for some comparability across countries. They find that investing in girls so that they would complete the next level of education would lead to lifetime earnings of today's cohort of girls that is equivalent to up to 68 percent of annual gross domestic product. When adjusting for ability bias and labor demand elasticities...

Cash or Condition? Evidence from a Cash Transfer Experiment

Baird, Sarah; McIntosh, Craig; Ozler, Berk
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
36.96%
Conditional Cash Transfer programs are "...the world's favorite new anti-poverty device," (The Economist, July 29 2010) yet little is known about the specific role of the conditions in driving their success. In this paper, we evaluate a unique cash transfer experiment targeted at adolescent girls in Malawi that featured both a conditional (CCT) and an unconditional (UCT) treatment arm. We find that while there was a modest improvement in school enrollment in the UCT arm in comparison to the control group, this increase is only 43 percent as large as the CCT arm. The CCT arm also outperformed the UCT arm in tests of English reading comprehension. The schooling condition, however, proved costly for important non-schooling outcomes: teenage pregnancy and marriage rates were substantially higher in the CCT than the UCT arm. Our findings suggest that a CCT program for early adolescents that transitions into a UCT for older teenagers would minimize this trade-off by improving schooling outcomes while avoiding the adverse impacts of conditionality on teenage pregnancy and marriage.

Perceptions of leadership in adolescent girls, members of the Girl Guides of Canada

Downie, Ann Louise.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
Português
Relevância na Pesquisa
46.42%
Twenty-eight young women who were members of the Girl Guides of Canada as Rangers and Cadets from a convenience sample chose to participate in this case study. They were from four separate locations in Southern Ontario. The interviews and observations at unit meetings allowed an indepth look into the perceptions of leadership of these young women. The amount of time observing and interacting with each participant provided a snapshot of what they thought and how they responded to the questions asked at that particular time. Each girl responded to the question, "Are you a leader?" They then gave examples of their own leadership and described leaders they knew. Their responses are reported in relation to their definitions. Their identifications of effective and ineffective leaders were examined, as well as their views of the best and worst things a leader can do. This information is reported by unit, as some patterns in their responses emerged which were unique to each group. The responses of all of the girls to the leadership of Guiders, Rangers and Cadets and the hypothetical effect of male leaders and male Rangers in Guiding are reported. For these, the participants' views were sorted based on the common themes/ and regardless of their group affiliation...

Deconstructing a discourse : broadening understandings of teenage girls' "resistance"

Tredenick, Chelsey
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
Português
Relevância na Pesquisa
56.92%
Popular culture has a strong influence on youth, and the creation of meanings associated with youth. Representations within popular culture, specifically film, branch beyond entertainment and become discourses that construct how we perceive our world. Youth resistance is commonly represented in films geared towards the teenage gene{ation. Yet, the discourse of resistance has positioned females as non-resistors. This thesis addresses representations of teenage girl resistance within popular culture due to the strong influence film has on teenage girls today. This thesis will specificaIJy examine three films directed at North American teenage girls: Thirteen, Ghost World and The Sisterhood of the Travelling Pants. Through a feminist poststructurallens utilizing discourse analysis, this thesis will examine teenage girl resistance as it is represented in the aforementioned films. This thesis repositions teenage girl resistance as a multi-dimensional concept, allowing for resistance to branch beyond the traditional meaning associated with it.

Bullying in the Same-Sex Friendships of Young Adolescent Girls: A Qualitative Study

Stiller, Sajah
Fonte: Brock University Publicador: Brock University
Português
Relevância na Pesquisa
46.42%
This qualitative, narrative study explored the bullying experiences of young adolescent girls within their same-sex dyadic and group friendships. The participants were 5 female students, ages 11 and 12 years old, from 1 private, religious school in southern Ontario. Each girl participated in an audiotaped, 30-minute, personal interview based on an unstructured interview protocol. Interview transcripts were analyzed for bullying behaviors using Marini and Dane's (2008) subtypes of bullying, including the form, function, and involvement in bullying. Interview transcripts were also analyzed for common and emerging themes using aspects of L. M., Brown and Gilligan's (1992) "Listener's Guide." The findings of this study suggested that within their same-sex friendships girls assume the roles of all participants in bullying, including bullies, victims, bystanders, and bully-victims. The findings also suggested that bullying behaviors within young adolescent girls' same-sex friendships are mainly indirect in their mode of attack and that they are both proactive and reactive. The bully behaviors identified in this study were used to inform the major themes or salient features within the dynamics of girls' same-sex friendships also identified. These themes included acceptance...

Teenage girls’ first-person narratives about weight perception and dangerous weight loss practices: A study of five blogs from LiveJournal.com

Moscovitch, Erica Raina
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado
Português
Relevância na Pesquisa
37.04%
In Western cultures, social significations are associated with body weight and shape (Woolf, 1990, as cited by Malson, 1998). Thinness is especially valued and especially for women and girls. As a result, many teenage girls aim to be thinner. This thesis examines five blogs on the website LiveJournal that are written by teenage girls who perceive themselves as overweight and who use blogs to talk about their attempts to lose weight. All five of these girls say that they practice at least one extreme method of weight loss and all of them have dangerously low weight loss goals. Two research questions motivated this study: 1) how do teenage girls who perceive themselves as overweight use blogs in their journeys to lose weight? 2) Can LiveJournal, or any other personal blogging site, provide a useful source for researchers so that they can learn about eating disorders in girls’ own words? The blogs provided a tool by which I could discover first-hand experiences of teenage girls who are trying to lose weight. Essentially, the blogs were used as both the data and the mean by which the data was collected. My results suggest that girls rarely discuss their weight loss practices with family or friends and thus their blogs provide a space where they can share their experiences and receive support and encouragement from other members of their online community who will not judge or stigmatize them. The results of this study are useful for social science researchers in two ways. First...

A multivariate analysis of interstate variation in fertility of teenage girls.

Brann, E A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /07/1979 Português
Relevância na Pesquisa
46.71%
A multiple regression model was used to determine the correlates of state-to-state variation in fertility of teenage girls. The independent variables were the abortion-t0-live birth ratio, contraception/conception ratio, racial composition, adult personal income, per cent urban population, and adult educational attainment. The model explained 69 per cent of the interstate variation in 1974 fertility. Both the racial composition and the abortion ratio were significantly (p less than .01) correlated with fertility. With 1970--1974 change in fertility as the dependent variable, the model explained 80 per cent of the variation, with income as the most strongly correlated variable. The contraception/conception ratio was also significant (p less than .01), as was racial composition (p less than .05). Factor analysis of the independent variables showed that the six variables were well accounted for by three factors representing culture/education status, abortion availability, and contraception availability. The analysis showed that utilization of both contraception and abortion was important in determining the fertility of a state's teenagers. Increased availability of publicly subsidized contraception in low income areas and increased availability of abortion in low income and rural areas might be expected to result in decreased fertility of teenage girls.