Not All Teenagers Get Medical Care They Need Children's Hospital at Strong Study Published Nationally

August 05, 1999

Almost one-third of adolescents nationally have needed health care and not received it, according to researchers at Children's Hospital at Strong of the University of Rochester. In addition, nearly half of adolescents haven't had the chance to talk to their doctor alone during an office visit.

These findings from Children's Hospital at Strong are detailed in the August issue of Journal of Adolescent Health, released this week.

This is the first national study to ask adolescents, rather than parents, about the health care they have received. Researchers found that some adolescents face significant barriers to getting care, including a lack of health insurance and lack of confidential care. Girls and minority adolescents were most affected.

Girls were more likely than boys to have missed out on needed care, and were less likely to have talked with their health-care provider in private. Minority teens also had less access to care and were less likely to have talked to their provider alone. Lack of money was an especially common barrier preventing some minority teens from getting the health care they need.

The study found that one of the biggest reasons teenagers don't receive needed medical treatment is because they lack health insurance. Teenagers with health insurance - even those from families that wouldn't be considered well off - were more likely than those without insurance to name a physician's office or clinic as their source for routine check-ups and care when they are sick.

"Adolescents who use health care can address their health concerns, and receive important preventive care including immunizations, and risk-prevention counseling," says Jonathan Klein, M.D., M.P.H, Associate Professor of Pediatrics at Children's Hospital at Strong, lead author of the study. "Doctors must have the right incentives to spend time talking to adolescents and their families. Parents and guardians also have an important role to play. They should be responsible for ensuring that teenagers have private, confidential time when they visit the doctor's office."

Having access to confidential health care is important because teenagers want to be able to discuss their concerns in private. Of those surveyed, only 58 percent of adolescents said they had time to talk to their provider alone. In addition, as many as 35 percent of adolescents who didn't receive care missed out because they didn't want their parents to find out about their health problem.

"Adolescents often have questions about topics like sex and substance use that they are uncomfortable discussing in front of their parents," says Karen Wilson, M.P.H., a researcher at Children's Hospital at Strong. "When they are alone with their doctors they may be more honest about risks to their health, whether it is riding a bicycle without a helmet, or engaging in unprotected sexual intercourse".

A total of 6,728 adolescents nationally were surveyed at school in 1997 for the Commonwealth Fund's Survey of the Health of Adolescents. Respondents were 12-18 years of age, and reflect the ethnic composition of the U.S. population.

The University of Rochester Division of Adolescent Medicine's Maternal and Child Health Bureau Leadership Education in Adolescent Health program is working on projects to improve adolescent preventive health care delivery in the Rochester area and throughout New York state. Rochester Area Blue Cross Blue Shield and the state Department of Health's Office of Managed Care are also participating.

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