Factors associated with use of preventive dental and health services among U.S. adolescents

Maternal and Child Health Bureau, Office of Data and Information Management, Rockville, Maryland 20857, USA.
Journal of Adolescent Health (Impact Factor: 3.61). 01/2002; 29(6):395-405.
Source: PubMed


To examine adolescents' use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care.
Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents' demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN.
Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth.
Health insurance and family income are most consistently related to adolescents' use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children's Health Insurance Program.

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    • "In the United States, researchers found that children in families with low socio-economic status were less likely to use health care (Ford et al., 1999; Weller, Minkovitz, & Anderson, 2003; Yu et al., 2001). On the contrary, in Canada, children from low socio-economic status families had higher health care utilization (Brownell et al., 2002). "
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    • "English proficiency was associated with dental visit in Hispanic adults but not in Asians [35]. Among adolescents of various origins, those born in other countries were less likely to visit dentists [36]. "
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    • "of U.S. adolescents does not routinely utilize preventive care [4] [5] [6] [7]; utilization may be especially low among African American youth, Latino youth, and youth living in poverty [4] [5] [6] [7]. Even when adolescents do attend preventive visits, studies suggest that most of them do not receive many recommended preventive health services, including counseling and guidance on risky health behaviors [8] [9] [10]. "
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    ABSTRACT: To examine the perspectives of publicly insured adolescents and their parents on ways to encourage adolescent utilization of preventive health services. We conducted eight focus groups with 77 adolescents enrolled in a large Medicaid managed care plan in Los Angeles County, California, and two focus groups with 21 of their parents. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care. They reported that incentives (e.g., cash, movie tickets, gift cards) might also be an effective way to increase preventive care utilization. To improve adolescent receipt of surveillance and guidance on sensitive health-related topics, most adolescents suggested that the best way to encourage clinician-adolescent discussion was to increase private face-to-face discussions with a clinician with whom they had a continuous and confidential relationship. Adolescents reported that the use of text messaging, e-mail, and Internet for providing information and counseling on various sensitive health-related topics would also encourage adolescent utilization of preventive health services. Parents, however, more often preferred that their teen receive these services through in-office discussions and clinician-provided brochures. State agencies, health plans, clinics, and individual providers may consider focusing their efforts to improve adolescents' utilization of preventive services on basic structural and quality of care issues related to the clinician-patient relationship, access to services, and confidentiality.
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