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Itriyeva K. Improving Health Equity and Outcomes for Children and Adolescents: The Role of School-Based Health Centers (SBHCs). Curr Probl Pediatr Adolesc Health Care 2024; 54:101582. [PMID: 38490819 DOI: 10.1016/j.cppeds.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
School-based health centers (SBHCs) provide a critical point of access to youth in low-resource communities. By providing a combination of primary care, reproductive health, mental health, vision, dental, and nutrition services, SBHCs improve the health, wellbeing, and academic achievement of the students they serve. SBHCs operate in collaboration with schools and community primary care providers to optimize the management of chronic health conditions and other health concerns that may result in suboptimal scholastic achievement and other quality of life measures. Conveniently located in or near school buildings and providing affordable, child- and adolescent-focused care, SBHCs reduce barriers to youth accessing high quality health care. SBHCs provide essential preventive care services such as comprehensive physical examinations and immunizations to students without a primary care provider, assist in the management of chronic health conditions such as asthma, and provide reproductive and sexual health services such as the provision of contraceptives, screening and treatment for sexually transmitted infections (STIs), and management of pregnancy. Additionally, some SBHCs provide vision screenings, dental care, and nutrition counseling to students who may not otherwise access these services. SBHCs have been demonstrated to be a cost-effective model of health care delivery, reducing both health care and societal costs related to illness, disability, and lost productivity.
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Affiliation(s)
- Khalida Itriyeva
- Cohen Children's Medical Center, Division of Adolescent Medicine, Northwell, New Hyde Park, NY.
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Krohn J, Bountogo M, Ouermi L, Sie A, Baernighausen T, Harling G. Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty. BMC Health Serv Res 2023; 23:1080. [PMID: 37821943 PMCID: PMC10566072 DOI: 10.1186/s12913-023-10052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Healthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake. METHODS We interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model. RESULTS 43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian's educational attainment. CONCLUSION Healthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.
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Affiliation(s)
- Joshua Krohn
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, Marsilius-Arkaden, 69120, Heidelberg, Germany.
| | | | | | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Till Baernighausen
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Im Neuenheimer Feld 130.3, Marsilius-Arkaden, 69120, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
| | - Guy Harling
- Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
- Institute for Global Health, University College London, London, UK
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Pham MD, Sawyer SM, Agius PA, Kennedy EC, Ansariadi A, Kaligis F, Wiguna T, Wulan NR, Devaera Y, Medise BE, Riyanti A, Wiweko B, Cini KI, Tran T, Fisher J, Luchters S, Azzopardi PS. Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100187. [PMID: 37383556 PMCID: PMC10305962 DOI: 10.1016/j.lansea.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 03/22/2023] [Indexed: 06/30/2023]
Abstract
Background Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs. Methods A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care. Findings A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay). Interpretation Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare. Funding Australia-Indonesia Centre.
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Affiliation(s)
- Minh D. Pham
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul A. Agius
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Elissa C. Kennedy
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Ansariadi Ansariadi
- Centre for Epidemiology and Population Health Studies, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yoga Devaera
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Bernie E. Medise
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Riyanti
- Department of Obstetrics and Gynaecology, Universitas Indonesia, Jakarta, Indonesia
| | - Budi Wiweko
- Research and Social Services, Universitas Indonesia, Jakarta, Indonesia
| | - Karly I. Cini
- Burnet Institute, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Thach Tran
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
- Centre for Sexual Health and HIV & AIDS Research (CeSHHAR), Harare, Zimbabwe
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Belgium
| | - Peter S. Azzopardi
- Burnet Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Ann. K, Murphy A. Would Universal General Practitioner Care impact Irish adolescents’ utilisation? Health Policy 2022; 126:652-660. [DOI: 10.1016/j.healthpol.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
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Tissot H, Pfarrwaller E, Haller DM. Primary care prevention of cardiovascular risk behaviors in adolescents: A systematic review. Prev Med 2021; 142:106346. [PMID: 33275966 DOI: 10.1016/j.ypmed.2020.106346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
Adolescence is associated with behavioral changes offering opportunities for prevention of cardiovascular risk behaviors. Primary care physicians are ideally placed to deliver preventive interventions to adolescents. The objective was to systematically review the evidence about effectiveness of primary care-led interventions addressing the main cardiovascular risk behaviors in adolescents: physical activity, sedentary behaviors, diet and smoking. PubMed, Embase, PsycINFO, CINAHL, Cochrane, ClinicalTrials.gov, and ISRCTN registry were searched from January 1990 to April 2020. Randomized controlled trials of interventions in primary care contexts on at least one of the cardiovascular behaviors were included, targeting 10-19-year old adolescents, according to the World Health Organization's definition. Two authors independently assessed risk of bias. Twenty-two papers were included in the narrative synthesis, reporting on 18 different studies. Interventions targeting smoking uptake seemed more effective than interventions targeting established smoking or the three other risk behaviors. Intervention components or intensity were not clearly associated with effectiveness. Risk of bias was mostly unclear for most studies. There is little evidence for specific interventions on adolescents' cardiovascular risk behaviors in primary care, mainly due to studies' methodological limitations. Further research should investigate the effectiveness of opportunistic primary care-based interventions as compared to more complex interventions, and address the methodological shortcomings identified in this review.
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Affiliation(s)
- Hervé Tissot
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Eva Pfarrwaller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of General Practice, The University of Melbourne, Melbourne, Australia.
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Wijlaars LPMM, Hardelid P, Guttmann A, Gilbert R. Emergency admissions and long-term conditions during transition from paediatric to adult care: a cross-sectional study using Hospital Episode Statistics data. BMJ Open 2018; 8:e021015. [PMID: 29934386 PMCID: PMC6020943 DOI: 10.1136/bmjopen-2017-021015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/19/2018] [Accepted: 05/17/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether changes in emergency admission rates during transition from paediatric to adult hospital services differed in children and young people (CYP) with and without underlying long-term conditions (LTCs). DESIGN Cross-sectional study. SETTING Emergency admissions between 2009 and 2011 recorded in the Hospital Episode Statistics Admitted Patient Care data in England. PARTICIPANTS 763 199 CYP aged 10-24 years with and without underlying LTCs (LTCs were defined using the International Classification of Diseases, 10th Revision codes recorded in the past 5 years). PRIMARY AND SECONDARY OUTCOME MEASURES We calculated emergency admission rates before (10-15 years) and after transition (19-24 years), stratified by gender, LTC and primary diagnosis. We used negative binomial regression to estimate adjusted incidence rate ratios (IRRs). RESULTS We included 1 109 978 emergency admissions, of which 63.2% were in children with LTCs. The emergency admission rate increased across the age of transition for all CYP, more so for those with LTCs (IRRLTC: 1.55, 99% CI 1.47 to 1.63), compared with those without (IRRnoLTC: 1.21, 99% CI 1.18 to 1.23). The rates increased most rapidly for CYP with mental health problems, MEDReG (metabolic, endocrine, digestive, renal, genitourinary) disorders, and multiple LTCs (both genders) and respiratory disorders (female only). Small or no increased rates were found for CYP without LTCs and for those with cancer or cardiovascular disease. Increases in length of stay were driven by long admissions (10+ days) for a minority (1%) of CYP with mental health problems and potentially psychosomatic symptoms. Non-specific symptoms related to abdominal pain (girls only), gastrointestinal and respiratory problems were the most frequent primary diagnoses. CONCLUSIONS The increased rates and duration of emergency admissions and predominance of non-specific admission diagnoses during transition in CYP with underlying LTCs may reflect unmet physical or mental health needs.
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Affiliation(s)
- Linda Petronella Martina Maria Wijlaars
- Population, Policy and Practice/Children's Policy Research Unit, University College London Great Ormond Street Institute of Child Health, London, UK
- Administrative Data Research Centre for England, University College London, London, UK
| | - Pia Hardelid
- Population, Policy and Practice/Children's Policy Research Unit, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Astrid Guttmann
- Health System Planning & Evaluation Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ruth Gilbert
- Population, Policy and Practice/Children's Policy Research Unit, University College London Great Ormond Street Institute of Child Health, London, UK
- Administrative Data Research Centre for England, University College London, London, UK
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Hof SN, Messoussi I, Schuijt MTU, de Goeij MCM, Kunst AE. Healthcare seeking behaviour of students living on their own compared to those living in the parental home: a cross-sectional study. Int J Adolesc Med Health 2017; 30:/j/ijamh.ahead-of-print/ijamh-2016-0095/ijamh-2016-0095.xml. [PMID: 28782343 DOI: 10.1515/ijamh-2016-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/26/2016] [Indexed: 06/07/2023]
Abstract
Objective This study aimed to investigate differences in healthcare seeking behaviour and barriers between students living in the parental home and those living on their own. Participants Five hundred and six second year students of the University of Amsterdam (UvA), interviewed in March and April 2015. Methods In a paper-and-pencil survey, questions were asked about the students' healthcare seeking behaviour and barriers. Differences according to residency were analysed with χ2-tests and regression models. Results The frequency of healthcare seeking behaviour varied according to residency, but none of the differences were statistically significant. Yet, a proportion of students living on their own visited primary healthcare providers less often after they changed residency (23.7% for general practitioner and 41.8% for dentist). Travel distance and lack of time were most often mentioned as barriers to students living on their own. Conclusion The barriers implicate the importance of encouraging students living on their own to switch to a new general practitioner or dentist.
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Affiliation(s)
- Samuel N Hof
- Academisch Medisch Centrum, University of Amsterdam, PO Box 22660, 1100 DDAmsterdam, The Netherlands
| | - Ilyes Messoussi
- Academic Medical Center (AMC), University of Amsterdam, North-Holland, The Netherlands
| | - Michiel T U Schuijt
- Academic Medical Center (AMC), University of Amsterdam, North-Holland, The Netherlands
| | - Moniek C M de Goeij
- Department of public health, Academic Medical Center (AMC), University of Amsterdam, North-Holland, The Netherlands
| | - Anton E Kunst
- Department of public health, Academic Medical Center (AMC), University of Amsterdam, North-Holland, The Netherlands
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Alderman EM, Freeman KL, Lobach KS. Improving adolescent access and services in a large primary care network: report of a 10 year project. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2016-0163/ijamh-2016-0163.xml. [PMID: 28598801 DOI: 10.1515/ijamh-2016-0163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/12/2017] [Indexed: 11/15/2022]
Abstract
This report describes a decade long initiative to bring a unified approach and improved quality to the process and content of adolescent health care in a large and complex urban primary care network within an academic health system. The moving force was a voluntary multidisciplinary group who comprised the Montefiore Adolescent Primary Care Initiative, known as MAPCI, led by a physician subspecialist in Adolescent Medicine. A series of needs assessments formed the basis for a multipronged effort to create policies and procedures, educational activities and materials, changes in record-keeping and billing practices, and modification of staff attitudes and behavior that would enhance access and ensure confidentiality of services for the adolescent age group. The commitment of medical center leadership contributed to overall progress which was accelerated in the second half of the decade by the addition of a full-time staff member, with the title Adolescent Program Manager. Progress in various arenas was assessed with a series of planned studies, whose positive results provided encouragement for continuing efforts. The example of this initiative and its accomplishments should provide useful and replicable methods that could be adapted for improvement of adolescent health services in some of the other large primary care networks that are an ever-expanding presence in the current health care environment.
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Berglas NF, Hucles K, Constantine NA, Jerman P, Rohrbach LA. Predisposing, enabling and need-for-care predictors of adolescents' intention to use sexual health services. Sex Health 2016; 13:540-548. [PMID: 27509555 DOI: 10.1071/sh16061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors. METHODS A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience). RESULTS Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402). CONCLUSIONS Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services.
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Affiliation(s)
- Nancy F Berglas
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, Oakland, CA 94607, USA
| | - Katherine Hucles
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, 2001N Soto Street, Los Angeles, CA 90032, USA
| | - Norman A Constantine
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, Oakland, CA 94607, USA
| | - Petra Jerman
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, Oakland, CA 94607, USA
| | - Louise A Rohrbach
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, 2001N Soto Street, Los Angeles, CA 90032, USA
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Connor C, Greenfield S, Lester H, Channa S, Palmer C, Barker C, Lavis A, Birchwood M. Seeking help for first-episode psychosis: a family narrative. Early Interv Psychiatry 2016; 10:334-45. [PMID: 25303624 DOI: 10.1111/eip.12177] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/22/2014] [Indexed: 01/27/2023]
Abstract
AIM Delayed help-seeking can have serious consequences for young people with first-episode psychosis (FEP), in terms of treatment response and outcome. Young people's narratives about help-seeking are important to understand why delays occur; however, as the majority of help-seeking is initiated by family members, through a general practitioner (GP), family narratives are also of interest. The aim of this study was to explore help-seeking for FEP, including first contact with a GP. METHOD A semistructured interview was developed using a topic guide. Framework analysis was used to analyse data and a deductive qualitative method for applied research. The study was set in Birmingham, UK. Participants were interviewed separately by researchers. Joint coding and identification of 14 complete family dyads was then explored for emerging patterns within the family context. RESULTS Family responses to FEP that had an impact on help-seeking behaviour included withdrawal, normalization, stigma, fear and guilt; poor knowledge of availability, and means of access to mental health services was also important. Help-seeking was usually instigated by a family member through a GP, although this was not the case for two of our families, and while contact with GP was generally described as a positive experience for several families, it was hindered by poor communication and lack of engagement. CONCLUSION Families play a key role in facilitating help-seeking for FEP, but attempts are often derailed by complex family responses to illness. Public mental health interventions should focus on increasing community awareness of psychosis and improving access and alternative routes to mental health services. However, improvements will have little impact unless primary care and other help-seeking sources engage in open and easy dialogue with the families and young people trying to access their specialist services.
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Affiliation(s)
- Charlotte Connor
- Birmingham and Solihull Mental Health, NHS Trust Research and Development Unit, Birmingham, UK.,Division of Health and Wellbeing, Warwick Medical School, University of Warwick, Birmingham, UK.,School of Psychology, University of Birmingham, Coventry, UK
| | - Sheila Greenfield
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Helen Lester
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sunita Channa
- Birmingham and Solihull Mental Health, NHS Trust Research and Development Unit, Birmingham, UK
| | - Colin Palmer
- Birmingham and Solihull Mental Health, NHS Trust Research and Development Unit, Birmingham, UK
| | - Clare Barker
- Birmingham and Solihull Mental Health, NHS Trust Research and Development Unit, Birmingham, UK
| | - Anna Lavis
- School of Life and Population Sciences, University of Birmingham, Birmingham, UK
| | - Max Birchwood
- Division of Health and Wellbeing, Warwick Medical School, University of Warwick, Birmingham, UK
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Knopf JA, Finnie RKC, Peng Y, Hahn RA, Truman BI, Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC, Phyllis Jones C, Fullilove MT. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med 2016; 51:114-26. [PMID: 27320215 PMCID: PMC5759331 DOI: 10.1016/j.amepre.2016.01.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. EVIDENCE ACQUISITION A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. EVIDENCE SYNTHESIS Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. CONCLUSIONS Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.
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Affiliation(s)
- John A Knopf
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Yinan Peng
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Robert A Hahn
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
| | - Benedict I Truman
- Office of the Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia
| | | | - Veda C Johnson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | | | | | - Carles Muntaner
- University of Toronto, Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | | | - Camara Phyllis Jones
- Satcher Health Leadership Institute at the Morehouse School of Medicine, Atlanta, Georgia
| | - Mindy T Fullilove
- Columbia University Mailman School of Public Health, New York, New York
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Michail M, Tait L. Exploring general practitioners' views and experiences on suicide risk assessment and management of young people in primary care: a qualitative study in the UK. BMJ Open 2016; 6:e009654. [PMID: 26758263 PMCID: PMC4716217 DOI: 10.1136/bmjopen-2015-009654] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs' perceived needs. DESIGN Qualitative focus group study using framework analysis. SETTING 5 inner city general practices in Nottingham. PARTICIPANTS 28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate. RESULTS 3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs' knowledge and clinical skills in this field. CONCLUSIONS The findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.
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Affiliation(s)
- Maria Michail
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - Lynda Tait
- School of Health Sciences, Jubilee Campus, University of Nottingham, Nottingham, UK
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Banfield M, McGorm K, Sargent G. Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program. BMC Nurs 2015; 14:21. [PMID: 25937818 PMCID: PMC4416321 DOI: 10.1186/s12912-015-0071-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/15/2015] [Indexed: 12/03/2022] Open
Abstract
Background Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions. Methods The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders. Results This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities. Conclusions Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework. Electronic supplementary material The online version of this article (doi:10.1186/s12912-015-0071-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Banfield
- Australian Primary Health Care Research Institute and National Institute for Mental Health Research, The Australian National University, 63 Eggleston Rd, Acton, ACT 2601 Australia
| | - Kelly McGorm
- Program Support Nurse Women Youth and Children Community Health Programs, ACT Health, Level 3, 1 Moore Street, Civic, ACT 2601 Australia
| | - Ginny Sargent
- National Centre for Epidemiology and Population Health, The Australian National University, 62 Eggleston Rd, Acton, ACT 2601 Australia
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Schneiderman JU, Kools S, Negriff S, Smith S, Trickett PK. Differences in caregiver-reported health problems and health care use in maltreated adolescents and a comparison group from the same urban environment. Res Nurs Health 2015; 38:60-70. [PMID: 25557881 PMCID: PMC4297563 DOI: 10.1002/nur.21634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2014] [Indexed: 11/10/2022]
Abstract
Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.
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Affiliation(s)
- Janet U. Schneiderman
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA 90089
| | - Susan Kools
- School of Nursing, University of Virginia, Charlottesville, VA
| | - Sonya Negriff
- School of Social Work, University of Southern California, Los Angeles, CA
| | - Sharon Smith
- School of Nursing, University of California, San Francisco, San Francisco, CA
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Obadeji A, Oluwole LO, Dada MU, Ajiboye AS. Pattern and predictors of alcohol use disorders in a family practice in Nigeria. Indian J Psychol Med 2015; 37:75-80. [PMID: 25722517 PMCID: PMC4341316 DOI: 10.4103/0253-7176.150824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary care has been identified as a key setting for the reduction of alcohol-related harm, while general practitioners are expected to play a significant role. The study aimed at identifying pattern of, and factors that are associated with alcohol use disorders (AUDs) among patients attending Family Medicine unit of State University Teaching Hospital. MATERIALS AND METHODS Sample was selected through a random sampling from a population of patients, aged 18-65 years, attending the general medical out-patients unit of the hospital from January to April 2013. A pretested, semi-structured questionnaire was administered, incorporating sociodemographics and the diagnoses made by the attending Physician. The participants also completed the alcohol use disorders identification test (AUDIT) questionnaire and the patient health questionnaire-9. RESULTS The prevalence of AUDs among the population of general out-patients was 9.7%. The AUDIT scores of the participants range from 0 to 29 with a mean of 1.3 (standard deviation = 4.08). AUDs were significantly associated with gender, level of education, occupational class, and the presence of significant depressive symptoms (P < 0.05). There was no statistically significant association found for age, employment status, marital status, and religion. CONCLUSION The prevalence of AUDs among population studied was lower compared with a similar study in similar setting, but however, significant. AUDs were predicted by gender, lower education level, occupational group, and the presence of significant depressive symptoms mostly in the mild to moderate form. Identifying the group at risk in clinical setting may go a long way in reducing the adverse effect of AUDs in our society.
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Affiliation(s)
- Adetunji Obadeji
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Lateef O Oluwole
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Mobolaji U Dada
- Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Adedotun S Ajiboye
- Department of Psychiatry, Psychology Unit, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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Secor-Turner MA, Randall BA, Brennan AL, Anderson MK, Gross DA. Rural adolescents' access to adolescent friendly health services. J Pediatr Health Care 2014; 28:534-40. [PMID: 25017940 DOI: 10.1016/j.pedhc.2014.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to assess rural North Dakota adolescents' experiences in accessing adolescent-friendly health services and to examine the relationship between rural adolescents' communication with health care providers and risk behaviors. METHODS Data are from the Rural Adolescent Health Survey (RAHS), an anonymous survey of 14- to 19-year-olds (n = 322) attending secondary schools in four frontier counties of North Dakota. Descriptive statistics were used to assess participants' access to adolescent-friendly health services characterized as accessible, acceptable, and appropriate. Logistic regressions were used to examine whether participant-reported risk behaviors predicted communication with health care providers about individual health risk behaviors. RESULTS Rural adolescents reported high access to acceptable primary health care services but low levels of effective health care services. Participant report of engaging in high-risk behaviors was associated with having received information from health care providers about the leading causes of morbidity and mortality. DISCUSSIONS These findings reveal missed opportunities for primary care providers in rural settings to provide fundamental health promotion to adolescents.
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Jesus LE, Dekermacher S, Frota J, Bragança JJ, Anderson KM. Adolescents and adults in pediatric urology clinics. J Pediatr Urol 2014; 10:408-11. [PMID: 23880326 DOI: 10.1016/j.jpurol.2013.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Adolescents represent a significant proportion of the patients seen by pediatric urologists (PU). Adolescents that require long-term follow-up (FU) eventually need to be transferred to adult care. This research aims to describe the disease profile of adolescent and adult patients from a referral PU clinic, in order to allow future medical education and cost planning. PATIENTS AND METHODS A retrospective review was made of cases seen in a PU referral clinic from January 1st to December 31st 2011. Patients were classified as child (≤12 years old), adolescent (12 < age ≤ 18 years old) or adult (>18 years old). Diagnoses and presentations were analyzed. RESULTS 521 patients were seen: 404 children (77.5%), 103 adolescents (19.8%) and 14 adults (2.7%). Clinical profiles differed between the three groups. 43.7% of the adolescents and all adults were FU cases or patients with late sequelae of congenital diseases. Some diseases predominated largely in adolescents. CONCLUSIONS Adolescents represent a significant proportion of our PU clinics. Half of them are FU cases or present sequelae from previous treatments/diseases. Some adolescents do not adapt to adult care, and persist being followed up by PU.
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Affiliation(s)
- Lisieux E Jesus
- Pediatric Surgery and Urology Division, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil.
| | - Samuel Dekermacher
- Pediatric Surgery and Urology Division, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil
| | - Júlia Frota
- Pediatric Surgery and Urology Division, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil
| | - Jailma J Bragança
- Pediatric Surgery and Urology Division, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil
| | - Kleber M Anderson
- Pediatric Surgery and Urology Division, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil
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Anthony I. Discreet and indiscreet barriers to adolescent health-seeking efforts. Clin Pediatr (Phila) 2014; 53:601-2. [PMID: 24817594 DOI: 10.1177/0009922813497426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Inger Anthony
- 1PCC Community Wellness Center-Austin, Chicago, IL, USA
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Receipt of sexual health information from parents, teachers, and healthcare providers by sexually experienced U.S. adolescents. J Adolesc Health 2013; 53:235-40. [PMID: 23743003 PMCID: PMC4034256 DOI: 10.1016/j.jadohealth.2013.03.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the extent to which sexually experienced adolescents in the United States receive sexual health information (SHI) from multiple of three sources: parents, teachers, and healthcare providers. DESIGN Descriptive analysis. SETTING 2006-2010 National Survey of Family Growth. PARTICIPANTS Heterosexually experienced, unmarried/non-cohabiting females (n = 875) and males (n = 1,026) ages 15-19 years. MAIN OUTCOME MEASURES Self-reported receipt of birth control, sexually transmitted infection/human immunodeficiency virus (STI/HIV), and condom information from parents, teachers, and healthcare providers. RESULTS Parent and teacher SHI sources were reported by 55% and 43% of sexually experienced female and male adolescents, respectively, for birth control information; and by 59% and 66%, respectively, for STI/HIV information. For sexually experienced adolescents reporting both parent and teacher sources, about one-third also reported healthcare provider as a source of birth control information, and one-quarter of females and one-third of males reported a healthcare provider as a source of STI/HIV information, respectively. For sexually experienced adolescents reporting no SHI from either parent or teacher sources, only one in ten reported healthcare providers as a source of birth control information, with a similar proportion reporting healthcare providers as a source of STI/HIV information. SHI receipt was found to vary by gender with more females than males reporting birth control information receipt from parents and teachers, and about one in six males reporting no birth control or condom information receipt from either source. CONCLUSIONS Study findings highlight gaps in sexual health information receipt from parents, teachers, and healthcare providers among sexually experienced adolescents, as well as gender differences across information sources.
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Korenblum C, Vandermorris A, Thompson G, Kaufman M. It is time to make the grade: Reaching Canadian youth through school-based health centres. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.5.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perspectives of youths and adults improve the care of hospitalized adolescents in Spain. J Pediatr Health Care 2012; 26:182-92. [PMID: 22525998 DOI: 10.1016/j.pedhc.2010.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to determine and compare the preferences and priorities of youths and adults about the best ways to improve hospitals to have an impact on the quality of life of hospitalized adolescents. METHOD Participants in this study were 364 adolescents between 14 and 17 years of age (96 hospitalized) and 148 adults (96 parents of patients and 52 health professionals). All the participants completed a questionnaire about their preferences and priorities with regard to hospitalization. RESULTS A high degree of agreement among the youths and the adults was observed, especially regarding the importance assigned to agreeableness of clinical staff to improveadolescents' experience of hospitalization. Some discrepancies also were observed. The youths granted more importance to issues related to filling in time, specifically to the leisure technology available for patients. The adults assigned more importance to the organization of the hospital stay, in particular, for adolescents to be admitted with patients of the same age and for them to receive academic support in the hospital. CONCLUSIONS Adolescents express a coherent perspective about the aspects that may help them feel better in the hospital that in some ways is different from the perspective of the adults who care for them.
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Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics. Matern Child Health J 2011; 14:910-7. [PMID: 19760162 PMCID: PMC2962886 DOI: 10.1007/s10995-009-0520-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14–20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03–2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20–5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18–3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.
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Coker TR, Sareen HG, Chung PJ, Kennedy DP, Weidmer BA, Schuster MA. Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents. J Adolesc Health 2010; 47:133-42. [PMID: 20638005 DOI: 10.1016/j.jadohealth.2010.01.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 01/05/2010] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the perspectives of publicly insured adolescents and their parents on ways to encourage adolescent utilization of preventive health services. METHODS We conducted eight focus groups with 77 adolescents enrolled in a large Medicaid managed care plan in Los Angeles County, California, and two focus groups with 21 of their parents. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. RESULTS Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care. They reported that incentives (e.g., cash, movie tickets, gift cards) might also be an effective way to increase preventive care utilization. To improve adolescent receipt of surveillance and guidance on sensitive health-related topics, most adolescents suggested that the best way to encourage clinician-adolescent discussion was to increase private face-to-face discussions with a clinician with whom they had a continuous and confidential relationship. Adolescents reported that the use of text messaging, e-mail, and Internet for providing information and counseling on various sensitive health-related topics would also encourage adolescent utilization of preventive health services. Parents, however, more often preferred that their teen receive these services through in-office discussions and clinician-provided brochures. CONCLUSIONS State agencies, health plans, clinics, and individual providers may consider focusing their efforts to improve adolescents' utilization of preventive services on basic structural and quality of care issues related to the clinician-patient relationship, access to services, and confidentiality.
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Affiliation(s)
- Tumaini R Coker
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA.
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Youngblade LM, Theokas C. The Multiple Contexts of Youth Development: Implications for Theory, Research, and Practice. APPLIED DEVELOPMENTAL SCIENCE 2010. [DOI: 10.1207/s1532480xads1002_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Perry RCW, Chien AT, Walker WJ, Fisher TL, Johnson WE. African American adolescent males' views on doctors and the health care system. J Natl Med Assoc 2010; 102:312-20. [PMID: 20437738 DOI: 10.1016/s0027-9684(15)30603-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE African American adolescent males have disproportionately high rates of morbidity and mortality and low levels of primary care use. To optimize health care for this group, there is a need to understand their views on doctors and health care, reasons for foregone care, and preferences regarding provision of health care. METHODS This was a pilot survey of African American adolescent males attending community groups in Chicago. RESULTS A majority of respondents agreed with declarative statements about doctors being considerate, truthful, and respectful (63%, 80%, and 80%, respectively). A majority also indicated that the health care system informs them of ways to stay healthy (65%), but fewer agreed that it meets the needs of adolescents and minorities (44% and 33%, respectively). Race/gender concordance with physicians did not seem to be a high priority. Significant reasons for foregone care included conflict with school hours, parents not having time, and lack of transportation. Despite access issues, only a minority of participants wanted health care services co-located with other aspects of their daily lives (school, community centers, church, and barbershops). CONCLUSION African American adolescent males may view doctors and the health care system positively. Eliminating barriers to care and ensuring positive interactions may create opportunities to improve health issues afflicting these at-risk adolescents.
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Affiliation(s)
- Raymond C W Perry
- Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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Use of school-based health centres for mental health support in Cape Breton, Nova Scotia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:319-28. [PMID: 20482959 DOI: 10.1177/070674371005500508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose. METHOD A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose. RESULTS One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support. CONCLUSIONS Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.
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Yeh HY, Chen YC, Su I, Chou LF, Chao HT, Chen TJ, Hwang SJ. Pattern and consequences of first visits to obstetricians/gynecologists by adolescents: a nationwide study in Taiwan. J Chin Med Assoc 2010; 73:144-9. [PMID: 20230999 DOI: 10.1016/s1726-4901(10)70029-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Some adolescents have special health care needs. Privacy concerns, unawareness or ethnical/cultural factors are barriers to women visiting obstetricians/gynecologists (OB/GYNs). The utilization of OB/GYN services by adolescent girls is seldom reported. The aim of this study was to investigate the pattern and consequences of first visits to OB/GYNs by adolescent girls within the National Health Insurance in Taiwan. METHODS From the 1-million cohort dataset of the National Health Insurance Research Database spanning from 1996 to 2007, adolescent girls visiting OB/GYNs for the first time were identified. The characteristics of first visits were analyzed. Their follow-up visits and admissions within 1 year after their first visits to OB/GYNs were traced. RESULTS In 2006, only 5.8% (n = 2,682) of 46,582 adolescent girls in our study cohort had their first visits to OB/GYNs: 46.7% with diagnoses of menstrual disorders and 14.8% with diagnoses related to inflammatory or infectious diseases of the genital organs. The examination most frequently ordered was pregnancy test (for 19.9% of these first visits). Very few (0.4%) first visits were for preventive services. Among the infrequent admissions (85 admissions of 75 girls) to obstetric/gynecology wards within 1 year after first visits, the majority (74 of 85 admissions) were pregnancy-related. CONCLUSION The leading motivating factor for first visits to OB/GYNs by adolescent girls was menstrual disorders. The majority of subsequent admissions were pregnancy-related, indicating that adolescent pregnancy deserves further attention.
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Affiliation(s)
- Hsiao-Yun Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Giannakopoulos G, Tzavara C, Dimitrakaki C, Ravens-Sieberer U, Tountas Y. Adolescent health care use: investigating related determinants in Greece. J Adolesc 2009; 33:477-85. [PMID: 19596423 DOI: 10.1016/j.adolescence.2009.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/28/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
The frequency of health care use is crucial for adolescent well-being and health systems. The present study was the first to test a set of variables in a representative sample of Greek adolescents in order to identify factors that predict health care use and contribute to improving health service planning. Questionnaires were administered to a random sample of adolescents (N=1 194) aged 11-18 years and their parents (N=973) in 2003. Data from 894 participants with full data were analyzed. Parents' education, adolescents' chronic health needs, physical well-being and emotional/behavioural problems as well as parent-child relationship were independent predictors of health care use, although some factors, such as gender, age, type of residence, family affluence, social support and parental health status that previous research identified as predictors were not confirmed. Beyond the need of health care, other factors also play an important role in the utilization of health services by adolescents and their families.
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Affiliation(s)
- George Giannakopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, Medical School, University of Athens, Athens, Greece
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Brief intervention addressing excessive cannabis use in young people consulting their GP: a pilot study. Br J Gen Pract 2009; 59:166-72. [PMID: 19275832 DOI: 10.3399/bjgp09x419529] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND When excessive cannabis consumption occurs in adolescence, the adverse consequences extend into adulthood. Interventions by GPs are effective in preventing harm associated with alcohol use. Similar interventions have potential in addressing cannabis use. AIM To develop and pilot test a brief intervention targeting excessive cannabis use (defined as > or = 1x/week) in young people in primary care. DESIGN OF THE STUDY Pilot intervention trial. SETTING Seven family practices in Switzerland. METHOD The team collaborated with GPs and young people to develop the intervention. Seven GPs piloted its use in their consultations. Patients aged 15 to 24 years consulting for any health problem were recruited before the consultation. Cannabis use, other substance use, and their psychosocial correlates were assessed with a short confidential questionnaire administered before the consultation and 1 month later. GPs, staff, and patients were asked to comment on the study and its feasibility. RESULTS Of 81 young people invited to participate, 78 (70% female) agreed (participation rate: 96%). One in seven (13.2%, 95% confidence interval = 7.5% to 18.9%) used cannabis at least once a week. Data at 1 month were available for 42% who had provided email contact details and 91% of those who had provided their mobile phone number (63% overall). In most cases, the intervention lasted no more than 5 minutes. Comments from participants added favourable data towards the feasibility of the study. CONCLUSION This pilot study provides a solid base on which to build a randomised trial of a brief intervention addressing cannabis use in young people consulting in family practice.
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Öngel K, Mergen H, Mergen BE. Is Medical Check-Up Useful for Physician among New University Students During Enrolling Time to University? a Survey of 640 New University Students. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2009. [DOI: 10.29333/ejgm/82643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Low NC, Lee SS, Johnson JG, Williams JB, Harris ES. The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Fam Pract 2008; 25:321-7. [PMID: 18753288 DOI: 10.1093/fampra/cmn049] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered. OBJECTIVE To test the association between current anxiety with alcohol versus cannabis abuse disorders. METHOD Cross-sectional, clinician-administered, structured assessment--using the Primary Care Evaluation of Mental Disorders--to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings. RESULTS Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse. CONCLUSION This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.
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Affiliation(s)
- Nancy C Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Vingilis E, Wade T, Seeley J. Predictors of adolescent health care utilization. J Adolesc 2008; 30:773-800. [PMID: 17141307 DOI: 10.1016/j.adolescence.2006.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 08/25/2006] [Accepted: 10/03/2006] [Indexed: 11/21/2022]
Abstract
This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process varies across physicians, non-physicians, and dentists. The results indicate that need and psychological factors were strong determinants of utilization. Predisposing factors were associated with utilization, although there were few enabling resources. Differences were found for utilization of different services. Females, adolescents who were older, from single parent families, with lower self-rated health, lower health status, higher disability, higher distress and involved in health compromizing practices were more likely to visit physicians and non-physicians. Higher dentist utilization was related to higher income, single parent status, being younger, having lower health status, and higher disability. Predisposing and enabling factors were not mediators of utilization. The findings suggest that health care providers could be an important source of counselling on psychological, lifestyle issues, and physical concerns.
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Affiliation(s)
- Evelyn Vingilis
- Population and Community Health Unit, Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Dr. Don Rix Clinical Skills Learning Building, Room 2711, London, Ont., Canada N6A 5C1.
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Fröjd S, Marttunen M, Pelkonen M, von der Pahlen B, Kaltiala-Heino R. Adult and peer involvement in help-seeking for depression in adolescent population: a two-year follow-up in Finland. Soc Psychiatry Psychiatr Epidemiol 2007; 42:945-52. [PMID: 17846696 DOI: 10.1007/s00127-007-0254-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 08/15/2007] [Indexed: 11/28/2022]
Abstract
Help-seeking among adolescents and adults is often perceived as a process involving only the health care system and the individual suffering from psychiatric symptoms. The present study attempted to create a model of help-seeking also including members of adolescents social networks. A prospective follow-up design included a school-based survey on all ninth grade students (mean age 15.5) during the academic year 2002-2003 in two Finnish towns (N = 3,278; response rate 94%); and a follow-up conducted two years later (N = 2,080; response rate 63%). The respondents were assessed for current depression and help-seeking for depression and other mental health problems each time. In the follow-up they were asked if they felt that they need help for depression and if their mother, father, sibling, peers, boy- or girl-friend or teacher had been worried about changes in their mood or behaviour. The associations of perceived need for help, help-seeking behaviour and concerns of different people, with depression at baseline were studied. Stepwise logistic regression models were computed to find the best predictors for help-seeking for depression. One third of the adolescents meeting R-BDI-13 criteria for depression at baseline still perceived a need for help for depression two years later but only a fifth of them had sought professional help. Depression at baseline was significantly associated with concerns about changes in mental health or behaviour among parents and significant others; and the concerns of mother, peers and teacher were among the best predictors of recent help-seeking for depression. To ensure adequate intervention for depressed adolescents without a social network capable of prompting referral, routine screening for depression should be applied in primary health care services and specialized services for adolescents.
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Affiliation(s)
- Sari Fröjd
- Tampere School of Public Health, University of Tampere, Tampere, 33014, Finland.
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Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007; 369:1565-1573. [PMID: 17482988 DOI: 10.1016/s0140-6736(07)60371-7] [Citation(s) in RCA: 396] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For developmental as well as epidemiological reasons, young people need youth-friendly models of primary care. Over the past two decades, much has been written about barriers faced by young people in accessing health care. Worldwide, initiatives are emerging that attempt to remove these barriers and help reach young people with the health services they need. In this paper, we present key models of youth-friendly health provision and review the evidence for the effect of such models on young people's health. Unfortunately, little evidence is available, since many of these initiatives have not been appropriately assessed. Appropriate controlled assessments of the effect of youth-friendly health-service models on young people's health outcomes should be the focus of future research agendas. Enough is known to recommend that a priority for the future is to ensure that each country, state, and locality has a policy and support to encourage provision of innovative and well assessed youth-friendly services.
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Affiliation(s)
- Andre Tylee
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK.
| | - Dagmar M Haller
- Department of Community and Primary Care Medicine, Geneva University Hospital, Switzerland
| | - Tanya Graham
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK
| | - Rachel Churchill
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London SE2 8AF, UK
| | - Lena A Sanci
- Department of General Practice, University of Melbourne, Victoria, Australia
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Lopez R, Baelum V. Factors associated with dental attendance among adolescents in Santiago, Chile. BMC Oral Health 2007; 7:4. [PMID: 17425778 PMCID: PMC1853081 DOI: 10.1186/1472-6831-7-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 04/10/2007] [Indexed: 11/22/2022] Open
Abstract
Background Dental treatment needs are commonly unmet among adolescents. It is therefore important to clarify the determinants of poor utilization of dental services among adolescents. Methods A total of 9,203 Chilean students aged 12–21 years provided information on dental visits, oral health related behavior, perceived oral health status, and socio-demographic determinants. School headmasters provided information on monthly tuition and annual fees. Based on the answers provided, three outcome variables were generated to reflect whether the respondent had visited the dentist during the past year or not; whether the last dental visit was due to symptoms; and whether the responded had ever been to a dentist. Aged adjusted multivariable logistic regression models were used to assess the influence of the covariates gender; oral health related behaviors (self-reported tooth brushing frequency & smoking habits); and measures of social position (annual education expenses; paternal income; and achieved parental education) on each outcome. Results Analyses showed that students who had not attended a dentist within the past year were more likely to be male (OR = 1.3); to report infrequent tooth brushing (OR = 1.3); to have a father without income (OR = 1.8); a mother with only primary school education (OR = 1.5); and were also more likely to report a poor oral health status (OR = 2.0), just as they were more likely to attend schools with lower tuition and fees (OR = 1.4). Students who consulted a dentist because of symptoms were more likely to have a father without income (OR = 1.4); to attend schools with low economic entry barriers (OR = 1.4); and they were more likely to report a poor oral health status (OR = 2.9). Students who had never visited a dentist were more likely to report infrequent tooth brushing (OR = 1.9) and to have lower socioeconomic positions independently of the indicator used. Conclusion The results demonstrate that socioeconomic and behavioral factors are independently associated with the frequency of and reasons for dental visits in this adolescent population and that self-perceived poor oral health status is strongly associated with infrequent dental visits and symptoms.
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Affiliation(s)
- Rodrigo Lopez
- Department of Community Oral Health and Pediatric Dentistry, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, Aarhus C 8000, Denmark
| | - Vibeke Baelum
- Department of Community Oral Health and Pediatric Dentistry, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, Aarhus C 8000, Denmark
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Sharma RK, McGinnis KA, Documèt PI. Disparities in health status and health-service utilization among Hispanic ethnic subgroups. SOCIAL WORK IN PUBLIC HEALTH 2007; 23:167-191. [PMID: 19306593 DOI: 10.1080/19371910802152026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Using nationally representative National Health Interview Survey (NHIS) data from 1999 through 2002, this study examines the health services access and utilization patterns of U.S. Hispanic adolescents under age 18 years classified as: Cubans, Puerto Ricans and Dominicans, Mexicans or Mexican Americans, Central and South Americans, and mixed Hispanic and non-Hispanic White. Consistent with previous studies on ethnic patterns in child and adult health, Hispanic American children do better than non-Hispanic Whites with respect to certain health status measures such as school absence. There is considerable heterogeneity in health status and health care utilization in the Hispanic subgroup, indicating the necessity of separating Hispanic subgroups for analytic purposes.
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Affiliation(s)
- Ravi K Sharma
- Department of Behavioral & Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 228 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Samargia LA, Saewyc EM, Elliott BA. Foregone mental health care and self-reported access barriers among adolescents. J Sch Nurs 2006; 22:17-24. [PMID: 16435926 DOI: 10.1177/10598405060220010401] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adolescents forego mental health care in spite of self-perceived needs for services; this presents a significant public health problem. Using data from the 2001 Adolescent Health Care Access Survey of 16-year-olds in Saint Louis County, Minnesota, we assessed barriers to mental health care among the 878 respondents who reported ever needing psychological or emotional counseling. Demographic characteristics were compared among those who had always, had sometimes, or had never received needed mental health care. Overall, 57% of the youths reported foregoing mental health care at least once. Girls and adolescents living with both parents were significantly more likely to have foregone care. Youths identified two common barriers to accessing care: "Thought or hoped the problem would go away" (50%) and "Didn't want parents to know" (36%). School-based interventions should be sensitive to mental health needs, especially among girls and teens living in two-parent families.
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Probst JC, Moore CG, Baxley EG. Update: health insurance and utilization of care among rural adolescents. J Rural Health 2006; 21:279-87. [PMID: 16294649 DOI: 10.1111/j.1748-0361.2005.tb00096.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
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Affiliation(s)
- Janice C Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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Marcell AV, Halpern-Felsher BL. Adolescents' health beliefs are critical in their intentions to seek physician care. Prev Med 2005; 41:118-25. [PMID: 15917002 DOI: 10.1016/j.ypmed.2004.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 09/20/2004] [Accepted: 10/19/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems. METHODS Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care. RESULTS Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001). CONCLUSIONS Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.
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Affiliation(s)
- Arik V Marcell
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Maryland School of Medicine, 120 Penn Street, Baltimore, MD 21201, USA.
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Sterling S, Kohn C, Lu Y, Weisner C. Pathways to chemical dependency treatment for adolescents in an HMO. J Psychoactive Drugs 2005; 36:439-53. [PMID: 15751482 DOI: 10.1080/02791072.2004.10524427] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private health plan. The study examines predictors of referral from different sources and of mental health treatment prior to CD treatment. Referral patterns, problem severity, and psychiatric comorbidity differed by gender. Being male (p < .05) and higher scores on the Youth Self-Report (YSR) externalizing scale (p < .01) predicted a justice system referral. Using more types of substances predicted referral by medical and mental health providers (p < .05) and self-referral (p < .01). Higher YSR internalizing scores predicted referral from mental health (p < .01) and self-referral (p <.01). Being White versus African American (p < .05) or Latino (p < .01), older (p < .05), and having higher YSR internalizing scores (p < .05), a conduct disorder (p < .01), or a family member with a substance use problem (p < .01) predicted a mental health visit prior to CD intake. The findings raise questions regarding the role of health plans, clinicians, families, schools, and community agencies in referring and treating adolescents with substance use problems. They suggest that improved coordination of care may promote more integrated treatment practices, which could decrease substance use, mental health, and medical problem severity.
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Affiliation(s)
- Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California 94612-2403, USA
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McKee MD, Karasz A, Weber CM. Health care seeking among urban minority adolescent girls: the crisis at sexual debut. Ann Fam Med 2004; 2:549-54. [PMID: 15576540 PMCID: PMC1466739 DOI: 10.1370/afm.124] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. METHODS We undertook a qualitative study using in-depth interviews of African American and Latina girls (n = 22) aged 13 to 19 years attending public high schools in the Bronx, NY. RESULTS Before the onset of sexual activity, most girls meet health needs within the context of the family, relying heavily on mothers for health care and advice. Many new needs and concerns emerge at sexual debut. Key factors modulating girls' ability to address their health needs and concerns include (1) the strategy of selective disclosure of information perceived to be harmful to close family relationships or threaten privacy; (2) the desire for personalized care, modeled on the emotional and physical care received from mother; and (3) relationships with physicians that vary in quality, ranging from distant relationships focused on providing information to close continuity relationships. Core values shaping these processes include privacy, a close relationship with the mother, and a perception of sexual activity as dangerous. No girl was able to meet her specific reproductive health needs within the mother-daughter relationship. Some find nonmaternal sources of personalized health care and advice for reproductive health needs, but many do not. CONCLUSIONS Adolescent girls attempt to meet reproductive health needs within a context shaped by values of privacy and close mother-daughter relationships. Difficulty balancing these values often results in inadequate support and care.
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Affiliation(s)
- M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA.
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Borders TF, Brannon-Goedeke A, Arif A, Xu KT. Parents' reports of children's medical care access: are there Mexican-American versus non-Hispanic white disparities? Med Care 2004; 42:884-92. [PMID: 15319614 DOI: 10.1097/01.mlr.0000135818.47100.8c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated whether there were Mexican-American versus non-Hispanic white disparities in parents' reports of problems with 4 dimensions of children's medical care access after controlling for a range of demographic, social, economic, and health status factors. METHODS Data were collected through a telephone survey of 5941 parents residing in Texas. The survey questionnaire included measures of the parent's demographic and socioeconomic status and the child's health-related quality of life. The behavioral model was used to guide the inclusion of factors in multivariate logistic regression analyses of parents' reports of their children's ability to obtain an appointment for routine/regular care, obtain care for illness/injury, obtain help/advice over the phone when calling the doctor's office, and having to wait more than 15 minutes in the doctor's office. RESULTS Mexican-American parents had worse reports of all 4 dimensions of their children's access even after controlling for predisposing, enabling, and need factors. Among Mexican-Americans, there were no differences between those who primarily spoke English versus Spanish. Other factors that were significantly associated with at least 2 reports of access were household income, the child's insurance status, and the child's health-related quality of life. CONCLUSIONS Mexican-American children face problems accessing medical care in a timely manner that are not fully explained by parents' demographic, social, and economic status or children's health-related quality of life. Health policy makers, managers, and clinicians should further consider how they could reduce the inequity of access to medical services among Mexican-American children.
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Affiliation(s)
- Tyrone F Borders
- Division of Health Services Research, Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
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Farrant B, Watson PD. Health care delivery: perspectives of young people with chronic illness and their parents. J Paediatr Child Health 2004; 40:175-9. [PMID: 15009544 DOI: 10.1111/j.1440-1754.2004.00333.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify and compare perceptions of health care service delivery held by young people with chronic illness and their parents. METHODS A convenience sample of young people with chronic illness and their parents were invited to complete a confidential self-report survey. The adolescents were aged 13-18 years inclusive and attended a specialist medical clinic. RESULTS Participants comprised 53 young people (response rate 88%, 53/60) and 45 parents (response rate 75%, 45/60). Both young people and their parents rate honesty, confidentiality, having good medical knowledge and good listening skills as the most important qualities for a health care provider. Compared to the parent group, fewer young people report the presence of these desired qualities in their current health care provider. A quarter of young people (25%, 13/53) report they do not always trust health professionals to keep their information confidential, and 19% (10/53) of young people report having withheld information from a health professional due to a lack of trust. Some parents and young people would like to discuss a wider range of health topics, including mental health issues, than they currently do with their health provider. Young people and their parents report limited planning with their current health provider for transition to adult health services. CONCLUSIONS Young people with chronic illnesses have significant levels of dissatisfaction with the health care they receive; this has the potential to impact on their use of health care services and their health outcomes. There is a need for increased provider awareness of the important qualities of health care service delivery to young people.
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Affiliation(s)
- B Farrant
- Starship Childrens Hospital and University of Auckland, Auckland, New Zealand
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Weathers A, Minkovitz C, O'Campo P, Diener-West M. Access to care for children of migratory agricultural workers: factors associated with unmet need for medical care. Pediatrics 2004; 113:e276-82. [PMID: 15060253 DOI: 10.1542/peds.113.4.e276] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the correlates of unmet need for medical care among migrant children. DESIGN AND SETTING A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina. PARTICIPANTS Three hundred adult caretakers of 1 (per household) randomly selected child <13 years old. RESULTS Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.16-0.61) and less than high school caretaker education (OR: 0.62; 95% CI: 0.39-0.98) and was associated directly with 1) having bed-days due to illness (OR: 2.46; 95% CI: 1.42-4.26), 2) lacking an annual well examination (OR:1.89; 95% CI: 1.12-3.20), 3) transportation dependence (OR:1.97; 95% CI: 1.24-3.13), 4) female gender (OR: 1.69; 95% CI: 1.07-2.67), 5) preschool age (OR: 2.24; 95% CI: 1.28-3.92), and 6) very high caretaker work pressure (OR: 5.01; 95% CI: 2.98-8.42). Adjustment using multiple logistic regression reveals unmet medical need to be independently associated with preschool age (OR: 2.08; 95% CI: 1.05-4.13) and very high caretaker pressure to work (OR: 5.93; 95% CI: 3.24-10.85). Of sampled children, 27% were preschool aged, and 40% had caretakers categorized with high work pressure. CONCLUSIONS Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications.
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Affiliation(s)
- Andrea Weathers
- Department of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina 27599-7445, USA.
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Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ. School-based health centers: accessibility and accountability. J Adolesc Health 2003; 32:98-107. [PMID: 12782448 DOI: 10.1016/s1054-139x(03)00069-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the current experience of school-based health centers (SBHCs) in meeting the needs of children and adolescents, changes over time in services provided and program sponsorship, and program adaptations to the changing medical marketplace. METHODS Information for the 1998-1999 Census of School-Based Health Centers was collected through a questionnaire mailed to health centers in December 1998. A total of 806 SBHCs operating in schools or on school property responded, representing a 70% response rate. Descriptive statistics and cross-tab analyses were conducted. RESULTS The number of SBHCs grew from 120 in 1988 to nearly 1200 in 1998, serving an estimated 1.1 million students. No longer primarily in urban high schools, health centers now operate in diverse areas in 45 states, serving students from kindergarten through high school. Sponsorship has shifted from community-based clinics to hospitals, local health departments, and community health centers, which represent 73% of all sponsors. Most use computer-based patient-tracking systems (88%), and 73% bill Medicaid and other third-party insurers for student-patient encounters. CONCLUSIONS SBHCs have demonstrated leadership by implementing medical standards of care and providing accountable sources of health care. Although the SBHC model is responsive to local community needs, centers provide care for only 2% of children enrolled in U.S. schools. A lack of stable financing streams continues to challenge sustainability. As communities seek to meet the needs of this population, they are learning important lessons about providing acceptable, accessible, and comprehensive services and about implementing quality assurance mechanisms.
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Affiliation(s)
- Claire D Brindis
- Department of Pediatrics, Division of Adolescent Medicine, University of California-San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936, USA
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Santelli JS, Nystrom RJ, Brindis C, Juszczak L, Klein JD, Bearss N, Kaplan DW, Hudson M, Schlitt J. Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers. J Adolesc Health 2003; 32:443-51. [PMID: 12782456 DOI: 10.1016/s1054-139x(03)00063-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States METHODS We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies. RESULTS Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access. CONCLUSIONS SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.
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Affiliation(s)
- John S Santelli
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, K22, Atlanta, Georgia 30341, USA.
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Yu SM, Bellamy HA, Schwalberg RH, Drum MA. Factors associated with use of preventive dental and health services among U.S. adolescents. J Adolesc Health 2001; 29:395-405. [PMID: 11728889 DOI: 10.1016/s1054-139x(01)00252-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine adolescents' use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care. METHODS Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents' demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN. RESULTS Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth. CONCLUSIONS Health insurance and family income are most consistently related to adolescents' use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children's Health Insurance Program.
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Affiliation(s)
- S M Yu
- Maternal and Child Health Bureau, Office of Data and Information Management, Rockville, Maryland 20857, USA
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Goodman E, Huang B. Socioeconomic status, depression, and health service utilization among adolescent women. Womens Health Issues 2001; 11:416-26. [PMID: 11566284 DOI: 10.1016/s1049-3867(01)00077-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article examines relationships among socioeconomic status (SES), depression, and health services utilization among 5,735 adolescent women. In cross-sectional analyses, effects of SES on having obtained a routine physical examination and use of psychological/emotional counseling in the past year are examined. Then, longitudinal analyses determine the effects of health service utilization on depression at 1 year follow-up (T2) controlling for baseline depression and SES. SES was associated with medical but not mental health service use. SES and health service use independently predicted T2 depression and an income x baseline depression interaction was noted. The findings and their implications are discussed.
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Affiliation(s)
- E Goodman
- Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Ackard DM, Neumark-Sztainer D. Health care information sources for adolescents: age and gender differences on use, concerns, and needs. J Adolesc Health 2001; 29:170-6. [PMID: 11524215 DOI: 10.1016/s1054-139x(01)00253-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess adolescents' sources of health care information, explore beliefs about topics which health care providers should address and about those which have been addressed, and identify topics that are embarrassing for adolescents to discuss with providers. METHODS Participants included a nationally representative sample of 3153 boys and 3575 girls in 5th through 12th grades who completed the Commonwealth Fund survey. Data were analysed by inspection of percentages and bivariate associations. RESULTS Boys (41.7%) and girls (58.4%) identified their mother as the primary resource for health care information. Younger boys and girls (grades five and six) were more likely than older boys and girls (grades 10 to 12) to ask their mother first about health issues (boys 54.4% vs. 35.2%; girls 71.7% vs. 46.4%). Doctors, nurses, or school nurses were also frequently identified as the first person asked about health issues (boys 23.9%, girls 18.2%). Most adolescents indicated that providers should address the following topics: drugs (65.0%); smoking (58.5%); sexually transmitted diseases (61.4%); alcohol use (56.2%); and good eating behaviors (56.8%). However, fewer adolescents reported that providers have actually discussed these issues with them; only 23.1% to 34.2% of adolescents reported having discussed the first four topics with them. Many youth noted that it would be embarrassing for them to discuss these issues with their providers. CONCLUSIONS Adolescents report that parents and health care providers are key sources of health-related information. Although adolescents may be embarrass having discussions with their health care providers, adolescents do believe that these topics should be addressed. Adolescents' embarrassment about discussing sensitive health topics highlights the importance of providers initiating and facilitating these discussions.
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Affiliation(s)
- D M Ackard
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
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Rew L, Resnick M, Beuhring T. Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents. J Adolesc Health 1999; 25:407-13. [PMID: 10608580 DOI: 10.1016/s1054-139x(98)00159-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender. METHODS All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3,596), 9th (n = 3,691), and llth (n = 2,772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression. RESULTS The majority of usual sources of medical care services were community clinics or private doctors' offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor's office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care. CONCLUSIONS The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.
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Affiliation(s)
- L Rew
- School of Nursing, University of Texas at Austin, USA
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