Many teenagers do not get medical care when they need it

December 13, 1999

CHICAGO - About one in five adolescents who feel they should have medical care do not get it, placing them at risk for health problems, according to an article in the December 15 issue of The Journal of the American Medical Association (JAMA).

Carol A. Ford, MD, from the University of North Carolina, Chapel Hill, N.C., and colleagues analyzed data from in-home interviews with 20,746 adolescents in grades 7 through 12. The interviews were conducted in 1995 throughout the United States as part of the National Longitudinal Study of Adolescent Health.

The researchers looked at the proportion of young people who reported foregoing medical care, their reasons for doing so, and their risk for health problems.

"On average, 2,268 (18.7 percent) of 12,079 adolescents reported at least one time over the past year when they thought they should get medical care, but did not," the authors write. "Uninsured adolescents were more likely to report foregone care than adolescents with continuous private or public insurance (23.9 percent vs. 17.0 percent vs. 15.7 percent respectively)."

Young people whose behavior placed them at risk for negative health outcomes were more likely to report foregone health care. "Adolescents who had a history of daily smoking were more likely to forego care than adolescents who did not (26.0 percent vs. 16.8 percent), and adolescents who frequently used alcohol were more likely to forego care than those who did not (30.3 percent vs. 18.1 percent)," the authors write.

"One fourth of sexually active adolescents reported foregone care in comparison to only 15.1 percent of those who were not sexually active," they continue. Disabled teenagers and those who experienced symptoms suggestive of serious physical or mental health problems were twice as likely to report foregone care as adolescents in comparison groups.

Adolescents who reported foregone health care gave these reasons:The authors suggest that the decision to forego care reflects the complexities of the parent-child relationship.

"On one hand, many adolescents want parents to be involved in health care, depend on parents for transportation, and need their parents' consent to obtain health care. On the other hand, some adolescents have important health issues that they want to keep private, and certain types of medical care can be provided without parents' consent," they write.

They point out that health care for emotional problems, substance abuse, and risk-associated behavior is particularly important, since the major causes of adolescent death, injury, and disease are related to motor vehicle crashes, inter-personal violence, suicide, alcohol and tobacco use, and sexual behavior.

"Approaches that have been suggested to increase adolescents' access to health care include increasing the availability of convenient, affordable, and developmentally appropriate health services," they write.

"This includes ensuring that private, confidential health services are available for sensitive health issues, thereby encouraging adolescents to seek and receive needed health care for concerns related to substance use, sexual behaviors, and mental health."

"Our results suggest that these strategies have the potential to increase clinicians' opportunities to address issues related to major causes of adolescent morbidity and mortality by decreasing the numbers of adolescents who forego health care," they conclude.
(JAMA. 1999; 282:2227-2234)

For more information: contact the AMA's Science News Department at (312) 464-5374 or visit the journal's website at .

Posted by the Center for the Advancement of Health < >. For information about the Center, call Petrina Chong, < > (202) 387-2829.

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