The use of formal and informal health care by female adolescents in eastern Nepal

I am presenting the background and interim results of an ongoing study in Eastern Nepal where at present the adolescent females do not use the formal health sector to the same extent as men. Suggested reasons for this include lack of awareness (literacy rates among women are 17%), lack of access, lack of time, and the cost and the quality of services offered. Women are more likely to visit traditional health practitioners, and very little research has been done to find out why this is the case. I also examine the access of rural adolescent females to health services and the policy process. The researcher involves the women in the research so that they can actively participate in the decision-making process and in setting health priorities. The research is based on a reconstituted form of participatory rural appraisal (PRA) known as participatory appraisal of needs and development of action (PANDA). This is a framework which has been developed out of PRA and has been used in developing countries to enable local people to obtain, share, and analyze their life conditions and to plan and act according to that knowledge.

Increased drug use among old-for-grade and dropout urban adolescents

INTRODUCTION

In tracking the epidemic of drug use in our communities, much emphasis has been placed on identifying predictive variables. In this study, we examine the relationship between drug use and school progress among a sample of inner-city adolescents.

METHODS

A blinded, anonymous questionnaire covering a variety of health risk behaviors was administered to 1,720 adolescent patients who visited our outpatient clinic. Participants were classified as age-appropriate for last school grade completed, older than normal for grade, or as a dropout. A urine specimen was also collected in a blinded, anonymous fashion from each participant, and tested for five common substances of abuse.

RESULTS

Nearly 12% of participants tested positive for drugs. Participants who were old for grade were over 40% more likely to be positive for drugs than grade-appropriate respondents, while school dropouts were more than twice as likely to test positive.

CONCLUSIONS

These results demonstrate that being old-for-grade (OFG) and being a dropout in our population are markers for being at higher risk of substance abuse.

Experiences of special gynaecological services for children and adolescents: a descriptive study

Gynaecological examination of girls during childhood is undertaken somewhat infrequently. These genital examinations should not be taboo or a frightening experience for the girl, for her parents or for the physician. Studies of children suspected of sexual abuse have paid attention to the wide variety of gynaecological conditions already present in childhood. In 1988 we founded a special gynaecological outpatient clinic for girls under 16 y of age at a university hospital to develop the special knowledge and skills needed in children's gynaecology. In this gynaecological clinic for children and adolescents we were able to gain and offer expert knowledge of the problems of this age group. In this special clinic for children, gynaecological examination by special techniques and sonography led to a diagnosis in 71% of the patients without any instrumentation. Children and adolescent girls in need of special gynaecological care should be recognized specifically. Particular attention should be paid to the gynaecological care of victims of child sexual abuse and mentally or physically handicapped girls. In good co-operation with the girl, a gynaecological examination can become a positive experience during the development of female identity.

Adolescents' access to care: teenagers' self-reported use of services and perceived access to confidential care

BACKGROUND

Most surveys on adolescents' use of health services rely on parental report, and this may underestimate adolescents' use of confidential services.

OBJECTIVE

To investigate adolescents' report of their own use of health services, access to care, and knowledge and use of confidential services.

METHOD

A random digit-dialed survey of 14- to 19-year-old adolescents was conducted in Monroe County, New York. We screened 11 800 numbers and identified 4449 households (40%) of which 393 families (8.8%) had eligible adolescents. Of these, 259 (66%) consented and completed an interviewer-administered survey.

RESULTS

Almost all adolescents (92%) rated their health as excellent or good and 90% had visited a health care provider within the year. Most (88%) identified a source of primary care. As many as 27% of adolescents had used more than one source of care. Many youth identify school personnel as important resources for health and counseling needs. Only 8.4% of respondents have used services confidentially, but nearly half of all youth did not know where they could obtain confidential care if they needed to. Adolescents were least likely to know where to obtain mental health or substance abuse and reproductive services.

CONCLUSIONS

While most youth have used primary care, a substantial minority have not. Many teenagers depend on multiple sources of care, and they rely on school personnel as important sources of health information. Many do not know where they could go to review confidential services or for other services that they may need. Managed care insurance and public health policies should recognize adolescents' access needs to meet them appropriately.

Mental health. Wait not, want not?

The rise in numbers of young people with mental health problems meant that one trust had a waiting list of 143 patients in this group, some of whom had been waiting for over a year. Only 30 per cent of parents of children on the list responded positively to a letter asking them if they wanted their child to remain on the list, resulting in 100 patients being removed. Of these patients, 10 were re-referred within two years, four of them with more severe symptoms. The average time of treatment was longer than for children who had remained on the list, requiring more clinical resources.

Do bereaved children consult the primary health care team more frequently?

It is known that 2% of all children are bereaved of a parent before the age of 18, but there is little support available for these bereaved children in the community. It is not known if these children consult the primary health care team more frequently than their non-bereaved peers. A record-based, case-controlled pilot study of 13 bereaved children over a 2-year period was carried out in a group general practice. All children had been bereaved of a father through malignant disease, and were from seven families. Children who had been bereaved of a parent attended the surgery more frequently than their age/sex-matched controls. There was an observed increase in the frequency of consultations both in the year preceding and following the bereavement. Post-bereavement, over one-third of consultations were for symptoms for which no organic cause could be found. The support needs of these bereaved children did not appear to be addressed. Further research is required to investigate the optimum means of providing support by the primary health care team for the small but significant number of children who are bereaved each year.

Measles-mumps-rubella and hepatitis B vaccination uptake in adolescents: a survey in metropolitan Melbourne

OBJECTIVE

To measure the uptake of preadolescent measles-mumps-rubella (MMR) and adolescent hepatitis B vaccinations and assess the influence of certain demographic factors on the uptake of these vaccines.

DESIGN

Prevalence surveys of uptake rates of preadolescent (school Year 6; age 10-11 years) MMR and adolescent (school Year 9; age 13-14 years) hepatitis B vaccination.

SETTING

City of Darebin, an inner northern metropolitan region of Melbourne, 1996.

SUBJECTS

1160 Year 6 school students (580 boys) and 1102 Year 9 school students (548 boys).

INTERVENTION

School-based vaccination program administered by Darebin Council.

RESULTS

83% of Year 6 students were vaccinated with the MMR vaccine (84.1% of girls and 81.9% of boys). 71.6% of Year 9 students completed the full course of hepatitis B vaccination (68.9% of boys and 74.2% of girls). There was a higher uptake of MMR in non-government primary schools, but no other demographic factors (sex, economic status, non-English-speaking background, parental education, school class size) were associated.

CONCLUSIONS

These uptake rates do not meet National Health and Medical Research Council (NHMRC) recommendations. Further study is required to determine and quantify the factors that affect vaccination uptake in adolescence. Programs may then be developed to improve vaccination uptake.

Telephone call reminders and attendance in an adolescent clinic

OBJECTIVE

To determine the effect of a single telephone call reminder on appointment compliance among adolescents in an inner city, hospital-based clinic.

METHODS

A randomized clinical trial was conducted at the Adolescent Clinic, a part of the Ambulatory Pediatric Practice Clinic in Cleveland, Ohio, from December 1995 to November 1996. A total of 703 routine adolescent ambulatory appointments were randomized to receive either a single telephone call reminder 1 day before the appointment or to receive no reminder. A single telephone call attempt was directed primarily to the parent or guardian of the patient in the assignment group. If not available, the reminder message was left with the patient or other family member, or on the answering machine. The study variables selected included age, gender, appointment time, distance from clinic, and payment source, and for the intervention group, the recipient of the reminder telephone call. The outcome measure was the attendance rate.

RESULTS

The intervention group (n = 347) and control group (n = 356) were well balanced for all study variables. The overall attendance rate was 49.8%. Only 204 (58.8%) of the 347 attempted intervention appointments were contacted successfully by telephone. In the attempted intervention analysis, the attendance rate of 55.6% in the intervention group (n = 347), regardless of whether subjects were successfully contacted by telephone, was 26.1% greater than the 44.1% attendance rate in the control group. In the completed intervention analysis, the attendance rate of 65.2% in the successfully contacted individuals within the intervention group (n = 204) was increased by 47.8% over that in the control group. In the univariate analysis, attendance for self-paying patients (25.4%) was worse than that for any group. In the logistic regression analysis, both the reminder telephone call intervention and the payment source were independent predictors of attendance. In the group that was called successfully (n = 204), there was no association between attendance and the recipient of the telephone call.

CONCLUSIONS

Telephone reminders are a very effective method of increasing attendance in a hospital-based adolescent clinic. The reminder is a consistently effective intervention whether the message is delivered to the patient, to the parent or other family member, or to a telephone answering machine. Adolescent patients whose visits are not covered by Medicaid or commercial insurance are least likely to attend their clinic appointments, and a telephone call reminder has no effect on this pattern.

Mental health care in a high school based health service

This paper describes the mental health services provided at a high school based health center that integrates mental health and medical services. Five years after the inception of the center in 1988, mental health visits had quadrupled. In 1992 alone, students made 1,002 mental health visits. Strikingly, one-third of these students reported problematic substance use among other family members. Other leading reasons for utilizing mental health services included pregnancy (19%), past or present suicidal ideation (14%), obesity (8.7%), ongoing depression (8%), and issues related to sexuality (7.5%).

Incarcerated adolescents in Washington state. Health services and utilization

This study describes the health services for incarcerated adolescents in Washington State and their utilization, in 12 juvenile detention facilities statewide, including six state (long-term, postadjudication) and six county (short-term, preadjudication) facilities. Findings differed by facility type, with youth at county facilities having more total visits to emergency rooms and more health care visits per inmate for health problems presenting acutely, such as sexually transmitted disease, pregnancy, urologic problems, and trauma. More were on suicide watch and on psychiatric medication. Health care used by youth at state facilities tended to be for more chronic conditions such as dental, dermatologic, nutritional, and respiratory problems. When utilization was analyzed by size of facility, small facilities had fewer health care visits and fewer nursing hours per inmate. According to our findings, there are at least 14 pregnant adolescents and 2 HIV-infected adolescents incarcerated in this state at any time.

Provision of adolescent services by Irish paediatricians

A postal questionnaire was undertaken to assess the current facilities available for adolescents in Irish hospitals. A previous survey showned that no facilities existed whereas this survey demonstrates some improvements but adolescents are still admitted to adult wards, have inappropriate waiting facilities at outpatients and a limited number of joint Paediatric-Adult clinics. The ability of paediatricians to assess risk taking behaviour and the provision of age appropriate information at ward and outpatient level was assessed. The results demonstrate there is need for improvement in all aspects of adolescent care in Irish hospital services. This needs to be addressed promptly as 66% of the paediatricians surveyed were considering the development adolescent services in their hospitals.

Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents

In our study of a tri-ethnic sample of 2528 junior and high school students, we examined utilization of outpatient mental health services in relation to a number of variables cited in the literature as leading to potential biases and barriers to care. These include: age, gender, ethnicity, socioeconomic status, family size and composition, and linguistic fluency in Hispanic youth. The impact of service availability was examined through differences between the two regions studied: a well-served region of coastal southeast Texas and the markedly under served lower Rio Grande Valley. The impact of symptomatology was evaluated using the total problem score on the Youth Self Report by Achenbach. Hispanic youth had significantly lower mean service utilization than non-Hispanic whites. Multiple regression analyses demonstrated that socioeconomic status and family composition had a greater relative impact on utilization than all other non-clinical factors, both for the total sample as well as for the Hispanic sample. Ethnicity may play a significant role in child mental health services utilization through its close association to socioeconomic status.

Caries extreme groups among adolescents, leaving organised dental care in Göteborg, Sweden

The aim was--in a longitudinal respect--to study whether 15-year-old children, in caries-free groups, and groups with high frequency of carious lesions, had a stable caries development from 15 to 19 years of age, when they left the organised Public Dental Care. Caries index values were analysed for the period 1986/7-1990/1 for patients born 1971-72 and residing in Göteborg. The groups of caries-free children seemed to be stable in their dental health in about 60-70% according to the prevalence indices used; and about 80% according to the incidence index DS-a. The caries prevalence index mean values of the 15-year-old patient groups with high frequencies of lesions showed between 1.5 to 3.5 percentile units higher mean values when the individuals were 19 years of age. However, the corresponding caries incidence index values were as low as half the size, indicating a possible treatment effect of the caries prevention programme used. Related to the DFS-a index, the 20% groups with the highest caries index values were registered for about 80% of all approximal lesions, of special interest for dental care costs.

Performance of Massachusetts HMOs in providing Pap smear and sexually transmitted disease screening to adolescent females

PURPOSE

To describe the extent to which health maintenance organizations (HMOs) provide preventive health services to female adolescent enrollees.

METHODS

All Massachusetts HMOs were asked to provide 1992 Papanicolaou (Pap) smear, gonorrhea, chlamydia, syphilis, and human immunodeficiency virus test rates for adolescents from medical records and claims data. The rates were compared with criterion standards and national utilization data from the National Survey of Family Growth. Seven of 14 Massachusetts HMOs agreed to provide data for female members aged 15-21 years on the Pap smear rate (n = 34,415) and sexually transmitted disease (STD) test rate (n = 33,701).

RESULTS

Papanicolaou smear rates for females in the HMOs ranged from 5% of 15-year-olds to 45% of 21-year-olds during 1992. Test rates for chlamydia and gonorrhea ranged from 2% and 3%, respectively, for 15-year-olds to 9% and 10% for 21-year-olds. Among 15-19-year-old females, only 18% received a Pap smear, and only 11% received an STD test through their HMO during 1992, despite professional guidelines recommending that all of the estimated 53% of sexually active females age 15-19 years should receive both Pap smears and STD tests. Among 18-21-year-old females, only 37% had had a Pap smear through their HMO during 1992, despite professional guidelines recommending Pap smears for all women age 18 years and over.

CONCLUSIONS

Efforts are needed within HMOs to ensure that STD screening, Pap smears, and other health screening services are provided for sexually active adolescent enrollees.

More hassle, more alone: adolescents with diabetes and the role of formal and informal support

Informal support is a vital part of diabetes care, for adolescents in particular. However, we have a poor appreciation of how adolescents characterize informal support relationships, and how they change over time. This article is based on qualitative, in-depth interviews and focus groups with 21 adolescents (14-19 years old) in Leicestershire. We studied the content and substance of relationships between adolescents with diabetes and their families and friends, how they change and develop over time, and how they interact with formal support from health professionals. We identify a key problem--progressive independence from family life and progressive withdrawal of formal health service input leaves some older adolescents feeling isolated, with possible implications for likely maintenance of contact with routine services.

Health status and service use. Comparison of adolescents at a school-based health clinic with homeless adolescents

OBJECTIVE

To examine the health status, risk-taking behaviors, and access-to-care issues of shelter-based homeless adolescents compared with a domiciled adolescent population from the same large US city.

SUBJECTS

The samples consisted of 109 youth (aged 12-17 years) in emergency shelters and 1010 youth using school-based inner-city clinics.

INTERVENTIONS

Adolescents completed a health history, which was followed by a physical examination.

RESULTS

Homeless youth began sexual activity at an earlier age (median, 12 vs 13 years for homeless vs school-based youth), were less likely to have used birth control at their first sexual experience, and were twice as likely to have ever been pregnant. Oral and anal sex, same-sex activities (boys only), multiple sex partners in the past 30 days, depression, and substance use behaviors were reported more often by the homeless sample. The homeless youth were twice as likely to have visited an emergency department in the past 12 months. After adjustment for other risk factors, homelessness was an independent predictor of depression (adjusted odds ratio [OR], 7.0; 95% confidence interval [CI], 3.9-12.6), emergency department use in the past 12 months (adjusted OR, 1.8; 95% CI, 1.2-2.7), and history of pregnancy (adjusted OR, 2.6; 95% CI, 1.3-5.2) in the final logistic regression models.

CONCLUSION

This study confirms and extends past research indicating that homeless youth exhibit more risk-taking behaviors and suffer from poorer overall health than do nonhomeless youth.

Managed care and school-based health centers. Use of health services

OBJECTIVE

To explore the use of physical and mental health services for adolescents who are enrolled in managed care and have access to a school-based health center (SBHC), compared with adolescents enrolled in managed care without access to an SBHC.

DESIGN

Retrospective cohort designed with age, sex, and socioeconomic status matching to compare the use of health services for adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs) with those with no access.

PARTICIPANTS

The study included 342 adolescents, resulting in 3394 visits that occurred during 3 academic years. During the study, 240 adolescents with access to an SBHC were compared with 116 adolescents without access to an SBHC.

MAIN OUTCOME MEASURES

The use of primary and subspecialty medical, mental health, and substance abuse treatment services; the use of after-hours (emergent or urgent) care; and comprehensive preventive health supervision visits and documentation of screening for high-risk health behaviors.

RESULTS

Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (P < .001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P = .04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate.

CONCLUSIONS

School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse.

Lessons from Project Northland: preventing alcohol problems during adolescence

Project Northland, an ongoing community trial aimed at reducing alcohol use and alcohol-related problems among adolescents, is nearing completion. The project combines individual-based strategies to encourage adolescents not to use alcohol with community-based strategies to both reduce alcohol availability and modify community attitudes concerning youth drinking. Project Northland has developed prevention programs and followed the same group of adolescents from sixth grade to high school graduation. This article discusses the rationale for this type of program, elements of the adolescents' social environment targeted for change, the unique challenges of working with high school students compared with younger adolescents, and areas for future research.

Adolescents report their need for and use of health care services

PURPOSE

The goals of this study were to describe student access to health care services, identify populations of students who remained in need of health care services, and highlight particular unmet needs for health care identified by these adolescents.

METHODS

Students in Grades 9-12 attending 50 schools in Oregon completed the Youth Risk Behavior Surveillance Survey (YRBS). Questions requesting adolescents to report their need for specific types of health care, and access to general and specific types of care were added to the core YRBS. Multivariate logistic regression analysis was used to determine independent relationships between student or community characteristics and health care access or unmet needs for care.

RESULTS

Almost 14,000 adolescents completed surveys, of whom 75% reported visiting one or more health care provider within the last 12 months. Nineteen percent of adolescents reported that they had not received 1 or more of 10 specific types of care when needed in the last year. Females, some racial/ethnic minorities, rural, and sexually active adolescents were more likely to report unmet needs for health care. Most frequently, adolescents reported they needed but did not receive care for an illness (7%) or for personal or emotional problems (6%). In addition, about 400 (3%) students reported they needed birth control that they did not receive.

CONCLUSIONS

A majority of high school-age adolescents had visited health care providers within the year prior to study. However, the number of adolescents who reported unmet specific health care needs within the same time period remained substantial.

The Sexual Health Help Centre: a service for young people

BACKGROUND

The Sexual Health Help Centre (SHHC) was opened in 1995 to provide treatment, advice and information on family planning and sexual health issues for young people under the age of 20 years, in a way which is open and non-threatening. This paper describes an evaluation conducted during the first 9 months of service operation.

METHODS

Young people's experience of the SHHC were elicited, and compared with their experiences of conventional family planning services in Glasgow.

RESULTS

The SHHC has been successful in attracting young people for help with family planning problems and provides a more acceptable environment than conventional family planning services. However, a greater number of young men and young people under the age of 16 should be encouraged to attend the service.

CONCLUSION

Young people are more likely to visit family planning services if they are offered a wide range of family planning and sexual health services in a non-judgmental, non-threatening environment.

Barriers to health care for street youth

This study investigates the barriers to health care faced by runaway adolescents. A convenience sample of 89 street youth located through community agencies was surveyed to elicit their perceptions of barriers to care. Results indicated that these youth experience a wide range of barriers to health care, both objective and subjective. They also experience fears with regard to receiving health care, many of which seem developmental in nature. The relative isolation of these youth compounds the objective barriers they face, yet many overcame these barriers and received needed care.

Child and adolescent psychiatry in-patient facility

The short-term in-patent facility of the Child and Adolescent Psychiatry Unit in the National Institute of Mental Health and Neurosciences, Bangalore is described. Its clientele over one year is reviewed. Totally 152 admissions were made. Hysterical neurosis (30.8%), Psychoses (25.2%), Conduct disorder (10.5%) and Hyperkinetic syndrome (9.8%) were the most common diagnoses observed in this population who needed short-term intervention. Average duration of stay was 4-12 weeks. All children were admitted with a parent. In 95.8% of the cases the treatment expenses were borne partially/fully by the hospital. The policy and functioning of the facility is discussed.

Health care access and utilization among pregnant adolescents

PURPOSE

To assess access to and use of health care by adolescents prior to their becoming pregnant.

METHODS

An interviewer-administered questionnaire was completed by all pregnant adolescents (n = 65) entering the Rochester Adolescent Maternity Program (RAMP) between January and June 1994. Questions addressed access and utilization issues including routine care and other services used, and existence of a regular source of care prior to pregnancy.

RESULTS

Sixty-one adolescents (94%) completed questionnaires. Almost all (93%) had made a doctor or clinic visit, and 77% had had a checkup in the prior year. Most had Medicaid (85%) or private insurance (13%). The median number of visits to a regular source of care was 2.0 (range 0-10). Most frequently reported sources of regular care were hospital clinics (43%), community health centers (26%), and private physician offices (15%). Two-thirds (66%) reported having used multiple sources of care. Of those who used other sources in addition to a primary care source, 40% used reproductive health clinics. Adolescents whose primary care source was a traditional physician's office were more likely to also use reproductive health clinics than those who reported using more comprehensive primary care sources.

CONCLUSIONS

Most pregnant adolescents in this sample had previously used routine primary care, usually in hospital clinics or health centers. Many of those adolescents also use multiple sources of care, most often for reproductive services. Access to reproductive health services does not seem to have been a problem for these adolescents prior to their pregnancies.

Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial

CONTEXT

Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.

OBJECTIVE

To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.

DESIGN

Randomized controlled trial.

SETTING

Three suburban public high schools in California.

PARTICIPANTS

The 562 participating adolescents represented 92% of students in mandatory classes.

INTERVENTION

After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality.

MAIN OUTCOME MEASURES

Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire.

RESULTS

Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (beta=.14, P=.001).

CONCLUSIONS

Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.

Programs and services to prevent pregnancy, childbearing, and poor birth outcomes among adolescents in rural areas of the southeastern United States

PURPOSE

To illustrate how rural adolescents' needs for pregnancy prevention and improved birth outcomes are currently being addressed, and to suggest strategies for future programs.

METHODS

Local and state-level informants knowledgeable about services to adolescents in the Southeastern United States were identified. Semistructured interviews were used to determine the program start date and time frame, funding sources, target population, participating counties, implementing agency or organization, specific program services, and status of program activities. These programs were categorized by the type of services offered and the population targeted.

RESULTS

The most common adolescent services in the rural Southeast attempt either to improve life options of youth, reduce sexual activity, or provide prenatal and postnatal care. Unlike urban areas where there are a variety of family planning providers, in the rural Southeast, health departments are the primary source of family planning for adolescents. There are no abortion providers in most rural areas of the Southeast. The majority of rural programs that include adolescents among the population served are developed for all women rather than specifically for adolescents. Programs specific to rural adolescents are described.

CONCLUSIONS

The majority of programs in the rural Southeast address only selected adolescent health issues. Successful interventions require locally supported, multipronged, intensive approaches with consistent messages targeted to high-risk populations. Evaluation tools are needed to determine the effectiveness of each component of prevention programs.