{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:59:37Z","timestamp":1785387577131,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019s proximal locus of control. Individual behaviors, interpersonal relationships, community environments, and structural conditions interact in complex ways to shape adolescents\u2019 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 &amp;amp; Opportunities for Adolescent Health Preparation, Support &amp;amp; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increasing equitable access to evidence-based teen pregnancy prevention programs hinges on a systems approach operationalized through strategic partnerships.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1857998","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:47Z","timestamp":1785385307000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A multi-level community-based systems dynamic approach to advance equitable adolescent sexual and reproductive health in Chicago"],"prefix":"10.3389","volume":"14","author":[{"given":"Whitney R.","family":"Garney","sequence":"first","affiliation":[{"name":"Center for Community Health and Aging","place":["College Station, TX, United States"]},{"name":"Department of Health Behavior, School of Public Health, Texas A&M University","place":["College Station, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Wilson","sequence":"additional","affiliation":[{"name":"Center for Community Health and Aging","place":["College Station, TX, United States"]},{"name":"College of Nursing, Texas A&M University","place":["Bryan, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan","family":"Miller","sequence":"additional","affiliation":[{"name":"Center for Community Health and Aging","place":["College Station, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christi","family":"Esquivel","sequence":"additional","affiliation":[{"name":"Center for Community Health and Aging","place":["College Station, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kobi V.","family":"Ajayi","sequence":"additional","affiliation":[{"name":"Center for Community Health and Aging","place":["College Station, TX, United States"]},{"name":"Department of Health Behavior, School of Public Health, Texas A&M University","place":["College Station, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1007\/s10464-012-9531-9","article-title":"Enhancing teen pregnancy prevention in local communities: capacity building using the interactive systems 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Perspect"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"21501319241234586","DOI":"10.1177\/21501319241234586","article-title":"Adolescent healthcare access: a qualitative study of provider perspectives","volume":"15","author":"Garney","year":"2024","journal-title":"J Prim Care Community Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/00333549131282S102","article-title":"Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S","volume":"128","author":"Penman-Aguilar","year":"2013","journal-title":"Public Health Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e144","DOI":"10.26633\/RPSP.2021.144","article-title":"Adolescent pregnancy, public policies, and targeted programs in Latin America and the Caribbean: a systematic review","volume":"45","author":"Ribas","year":"2021","journal-title":"Rev Panam Salud Publica"},{"key":"ref15","volume-title":"National Vital Statistics 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Unpacking the \u2018comprehensive\u2019 in comprehensive sexuality education","volume":"79","author":"Miedema","year":"2020","journal-title":"Health Educ J"},{"key":"ref29","year":""},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e1233","DOI":"10.1002\/cl2.1233","article-title":"Evidence-informed vs evidence-based practice educational interventions for improving knowledge, attitudes, understanding and behaviour towards the application of evidence into practice: a comprehensive systematic review of undergraduate students","volume":"18","author":"Kumah","year":"2022","journal-title":"Campbell Syst Rev"},{"key":"ref31","year":""},{"key":"ref32","year":""},{"key":"ref33","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1177\/1090198119882989","article-title":"Success in long-standing community-based participatory research (CBPR) partnerships: a scoping literature review","volume":"47","author":"Brush","year":"2020","journal-title":"Health Educ Behav"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1080\/26395916.2022.2101531","article-title":"Community listening sessions: an approach for facilitating collective reflection on environmental learning and behavior in everyday life","volume":"18","author":"Ardoin","year":"2022","journal-title":"Ecosyst People"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-1-4614-8763-0","volume-title":"Community Based System Dynamics","author":"Hovmand","year":"2014"},{"key":"ref36","year":""},{"key":"ref37","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s11121-023-01517-1","article-title":"High school FLASH sexual health education curriculum: LGBTQ inclusivity strategies reduce homophobia and transphobia","volume":"24","author":"Kesler","year":"2023","journal-title":"Prev Sci"},{"key":"ref38","year":""},{"key":"ref39","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1136\/bmjqs-2013-001862","article-title":"Systematic review of the application of the plan\u2013do\u2013study\u2013act method to improve quality in healthcare","volume":"23","author":"Taylor","year":"2014","journal-title":"BMJ Qual Saf"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1093\/her\/cyab031","article-title":"Network analysis of a community-wide teenage pregnancy prevention initiative","volume":"36","author":"Panjwani","year":"2021","journal-title":"Health Educ Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1103834","DOI":"10.3389\/fpubh.2023.1103834","article-title":"Success of community-based system dynamics in prevention interventions: a systematic review of the literature","volume":"11","author":"Felmingham","year":"2023","journal-title":"Front Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1857998\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:48Z","timestamp":1785385308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1857998\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1857998"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1857998","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"1857998"}}