Forgone Health Care among U.S. Adolescents: Associations between Risk Characteristics and Confidentiality Concern

Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States
Journal of Adolescent Health (Impact Factor: 3.61). 04/2007; 40(3):218-26. DOI: 10.1016/j.jadohealth.2006.09.015
Source: PubMed

ABSTRACT To examine risk characteristics associated with citing confidentiality concern as a reason for forgone health care, among a sample of U.S. adolescents who reported having forgone health care they believed was necessary in the past year.
The study used data from Wave I home interviews of the National Longitudinal Study of Adolescent Health. The generalized estimating equations method was used to account for the clustered nature of the data.
Prevalence of several risk characteristics was significantly higher among boys and girls who reported confidentiality concern, as compared with those who did not report this concern. Regression analyses for boys (n = 1123), which adjusted for age, race/ethnicity, parental education and insurance type showed that high depressive symptoms, suicidal ideation, and suicide attempt were each associated with increased odds of reporting confidentiality concern as a reason for forgone health care. In multivariate analyses for girls (n = 1315), having ever had sexual intercourse, birth control nonuse at last sex, prior sexually transmitted infection, past-year alcohol use, high and moderate depressive symptoms, suicidal ideation, suicide attempt, and unsatisfactory parental communication were each associated with increased odds of citing confidentiality concern as a reason for forgone care.
The population of U.S. adolescents who forgo health care due to confidentiality concern is particularly vulnerable and in need of health care services. Adolescents who report health risk behaviors, psychological distress and/or unsatisfactory communication with parents have an increased likelihood of citing confidentiality concern as a reason for forgone health care, as compared with adolescents who do not report these factors. Findings of this study suggest that if restrictions to confidentiality are increased, health care use may decrease among adolescents at high risk of adverse health outcomes.

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    • "Third, there are concerns about therapeutic drift if interventions become routine practice [21]. Finally, barriers existing at the patient and provider levels, include lack of comfort discussing sensitive topics like alcohol with a care provider [22] and lack of confidence, training and time to perform SBIRT among providers [23,24]. Given these barriers, innovative techniques are needed to improve adoption of SBIRT. "
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    ABSTRACT: Background Heavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown. Methods/Design We will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (≥4 drinks for women; ≥5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months. Discussion This study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of change. Trial registration NCT01688245
    Trials 04/2013; 14(1):93. DOI:10.1186/1745-6215-14-93 · 1.73 Impact Factor
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    • "SNSs may provide a new venue to identify adolescents who are considering or engaging in health-risk behaviors. As current methods fail to identify many adolescents who are at risk for or are engaging in health-risk behaviors, innovative approaches are clearly needed (Halper-Felsher et al. 2006; Mangione-Smith et al. 2007; McKee and Fletcher 2006; Lehrer et al. 2007). Given the popularity of SNSs among teens and the high prevalence of risk behaviors by profile owners, SNSs can be explored as a tool to identify, screen, and potentially intervene with adolescents who display risk behavior information. "
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    ABSTRACT: Social networking sites (SNSs) are immensely popular among adolescents. Adolescents display a variety of information, including health risk behaviors, on SNSs. The validity and impact of these displays is currently under investigation. SNSs present new risks to adolescents, as well as new opportunities for health promotion. I. ADOLESCENT HEALTH: MORBIDITY AND MORTALITY Many of the most important causes of morbidity and mortality in the U.S. adolescent population are associated with health-risk behaviors such as substance abuse, violence, and risky sexual behavior (DuRant and Smith 2002; Eaton et al. 2006; Loeber et al. 2005; Teplin et al. 2006; Baskin-Sommers and Sommers 2006; Busen, Marcus, and von Sternberg 2006; Camenga, Klein, and Roy 2006; Stephens 2006). Identifying adolescents who are at risk for morbidity and mortality related to engagement in these health-risk behaviors remains challenging. Adolescents are less likely to obtain regular care in a physician's office given that they are a generally healthy population, so opportunities for health screenings and early interventions are often missed (Halper-Felsher et al. 2006; Mangione-Smith et al. 2007; McKee and Fletcher 2006; Lehrer et al. 2007). Further, adolescents who engage in health-risk behaviors are even less likely to seek care at a clinic because of concerns about confidentiality * Megan A. Moreno, MD, MSEd, MPH is an Assistant Professor of Pediatrics at the University of Wisconsin-Madison. She is an adolescent medicine physician, an educator and a researcher. Her current research interests involve how adolescents interact with media and the impact of these interactions on adolescent health.
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    ABSTRACT: Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.
    The Annals of Family Medicine 01/2011; 9(1):37-43. DOI:10.1370/afm.1186 · 5.43 Impact Factor
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