A multi-level community-based systems dynamic approach to advance equitable adolescent sexual and reproductive health in Chicago.

BACKGROUND: Teenage pregnancy in the United States (U.S) continues to be a serious public health concern, despite the significant declines in birth rates documented over the last three decades. Risk factors leading to teen pregnancy go far beyond individual-level behavior, like engaging in risky sexual behaviors, and can be linked to a web of interconnected ecological influences outside of an adolescent's proximal locus of control. Individual behaviors, interpersonal relationships, community environments, and structural conditions interact in complex ways to shape adolescents' sexual and reproductive health (SRH) outcomes. These multi-level influences highlight the need for a systems approach capable of capturing the complexity of teen pregnancy and its associated risk factors. The Chicago Partnerships & Opportunities for Adolescent Health Preparation, Support & Services (POPSS) is a multi-level initiative that aims to improve adolescent sexual and reproductive health, support positive youth development, and advance health equity by expanding the use of medically accurate, age-appropriate, evidence-based teen pregnancy prevention programs. In this report, we describe the POPSS project, which addresses multi-level factors contributing to teen pregnancy in Chicagoland through a systems SRH initiative. CONTEXT: This project used community-based systems dynamics (CBSD) to conceptualize the challenges of teenage pregnancy. This was conducted through community listening sessions, annual iterative systems dynamic mapping, and continuous improvement integrated throughout the project to rapidly respond to changes. With an understanding of the system's complexity, the POPSS stakeholders identified diverse implementation settings, such as healthcare, schools, and community settings where adolescents congregate, and evidence-based teen pregnancy prevention programs to ultimately enhance adolescent SRH equity. CONCLUSION: Increasing equitable access to evidence-based teen pregnancy prevention programs hinges on a systems approach operationalized through strategic partnerships.