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Results. Of the 3,136 counties, 78.7% of rural counties were in the highest category of socio-demographic deprivation compared to about 21.1% of urban counties. 76.0% of rural counties were categorized as having shortages of primary care, dental, and mental health providers, compared to 24.0% of urban counties. Rural counties had an additional 7.4 births per 1,000 females aged 15-19 years (p <0.0001) when compared to urban counties. The highest level of sociodemographic deprivation had a strong positive association with teen birth rates (β = 17.46; SE = 0.53; p < 0.0001). Rural counties with the whole designation of a health professional shortage increased county-level teen births by 7.18 births per 1,000 females aged 15-19 years (p <0.0001), compared to urban counties with no designation. Rural counties with higher levels of sociodemographic deprivation and a designation of health professional shortages in at least one area had significantly higher teen births than their urban counterparts (p <0.0001).

Conclusions. Rural communities across different levels of deprivation and HPSA designated categories continue to have disproportionately greater teen birth rates. While these findings reveal the unique characteristics of sociodemographic and HPSA as a useful social determinant of teen birth, rural communities showed inherent vulnerabilities that contribute to poorer teen birth outcomes. Future research should examine the extent to which access to contraceptive services differs among rural and urban communities and the role of rural safety net providers in the provision of these services.