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.
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

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to