No abstract

OBJECTIVES-Assess whether adolescent health risk behaviors cluster, and whether resiliency factors are associated with observed clusters.

Supplementary data are available at Bioinformatics online.

M any women rely on publicly funded family planning and women's health clinics as their only recent source of care, including preventive care (Frost, Gold, and Bucek 2012; Guttmacher Institute 2016). Some of these organizations provide abortion services in addition to family planning and other reproductive health services. Consequently, such organizations may face politically motivated funding cuts, which may also impact important non-abortion outcomes and related services.One primary cause of women's health facility closures is the loss of public funding. In the past few years, several states have attempted and in some cases succeeded in cutting public funding for women's health organizations that provide (or are affiliated with provision of) abortion services. These policies are exogenous to our outcomes of interest: women's cancer screenings and routine checkups. This is clearly stated by one of the state legislators responsible for recent funding changes in Texas,

The government of Texas recently enacted multiple restrictions and funding limitations on women's health organizations that provide abortion services or are associated with those that do. These policies have caused numerous clinic closures throughout the state, drastically reducing access to care. We study the impact of these clinic closures on fertility by combining quarterly snapshots of health center addresses from a network of women's health centers with restricted geotagged data of all Texas birth certificates for 2007-2013. We calculate the driving distance to the nearest clinic for each ZIP code, and find that an increase of 100 miles to the nearest clinic results in a 1.2 percent increase in the birth rate. This increase is driven by fertility changes for unmarried women and those having their first or second child. It also reduces average maternal age.