Researchers find one in five children not getting care they think they need

December 13, 1999

CHAPEL HILL - Each year, one in five U.S. teen-agers doesn't receive health care when he or she thinks it's needed, according to the nation's largest study of adolescent behavior. The study's lead researcher called the findings "worrisome."

Lack of health insurance, dealing with confusing health-care systems, being older and belonging to a minority group are among factors boosting the risk of what doctors term "foregone care."

The University of North Carolina at Chapel Hill research involved analyzing responses to questions asked of 20,000 U.S. teens in 1995 about their behavior and attitudes as part of the National Longitudinal Study of Adolescent Health, also known as the Add Health study. Participants were in grades 7 through 12 when asked to enter responses into computers to ensure confidentiality.

"The Add Health survey included questions designed to find out how commonly adolescents consider seeking health care but do not go to doctors or other health care professionals," said Dr. Carol A. Ford, assistant professor of pediatrics and medicine at the UNC-CH School of Medicine. "We also wanted to find out whether this was a problem or not. Were these kids really at risk of having health problems or were they basically healthy?"

A report Ford and colleagues wrote about the study appears in the Dec. 15 issue of the Journal of the American Medical Association. Co-authors are Drs. Peter Bearman, formerly professor of sociology at UNC-CH and now director of the Institute for Social and Economic Theory and Research at Columbia University, and James Moody, formerly at UNC-CH and now assistant professor at Ohio State University. Dr. J. Richard Udry, professor of sociology and of maternal and child health at the UNC-CH School of Public Health, directs the Add Health study.

"In general, we found that adolescents who did not go for health care were not the 'worried well,'" Ford said. "They were kids who engaged in behaviors that put them at significantly increased risk for diverse health problems, from depression to acquiring sexually transmitted diseases. They also were those who had insufficient access to health care mainly as a result of insufficient insurance."

Fifteen percent of virginal adolescents reported foregone care as compared with 25 percent of sexually active adolescents, she said. That's important because sexually active adolescents need to have doctors help them understand the risks of that behavior.

Teens who described symptoms suggesting serious physical or mental health problems such as depression were about twice as likely to report foregone care as teens with no symptoms (32-39 percent vs. 17-18 percent), Ford said. Adolescents most in need of health care were more likely not to get it.

Teens said that they did not receive care they needed because they couldn't pay, didn't know who to see, found it difficult to make appointments or had no transportation, the physician said. About 12 percent reported they did not go see a doctor or other health care professional because parents couldn't or wouldn't go with them. Another 12 percent said it was because they didn't want their parents to know.

"As health care professionals, parents, teachers, community leaders and government officials, we should all be concerned about these kids who are not getting health care and do everything we can to make sure they can and do get it," Ford said. "We need to change our health care system to the point where all adolescents can get affordable, convenient care."

Teens who have continuous health insurance and those who had a physical examination within the past year were much less likely than others to forego care, researchers found.

"Besides insurance availability, another key to change would be public health policies that guarantee confidentiality for adolescents who seek medical care," Bearman said.

Results of earlier Add Health analyses made national headlines in 1997 because they showed, among other things, that feeling connected with family, school and religious organizations helped steer adolescents away from unhealthy acts.

A graduate of Florida State University and the University of Florida's medical school, Ford directs UNC-CH's adolescent medicine program. She received postgraduate training at UNC-CH and the University of California at San Francisco and is a board-certified internist, pediatrician and specialist in adolescent medicine. She was one of 15 young U.S. doctors who earlier this year received a four-year, $240,000 Generalist Physician Faculty Scholar Program Award from the Robert Wood Johnson Foundation of Princeton, N. J.
-end-
Note: Ford can be reached through Lani Cartier at 919-966-2829 (w). Bearman can be reached at 212-854-3094.

Contact: David Williamson, 919-962-8596.

University of North Carolina at Chapel Hill

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