Recorded presentation

Elizabeth A. Shenkman, PhD¹, W. Bruce Vogel, PhD², and Lise M. Youngblade, PhD¹. (1) Dept. of Pediatrics and Institute for Child Health Policy, University of Florida, 5700 SW 34th Street, Suite 323, Gainesville, FL 32608, 352-392-5904 x222, eas@ichp.edu, (2) Health Policy and Epidemiology, University of Florida, PO Box 100177, Gainesville, FL 32610

Background: Adolescents have high morbidity and mortality from injuries, sexually transmitted diseases, substance abuse, and other conditions associated with risk-behaviors. Few adolescents visiting a physician are screened or receive information about health-risks. These findings suggest that adolescents entering SCHIP are likely to be underserved in terms of health care and to have received little or no counseling about risk-behaviors. The purpose of our study was to examine the impact of SCHIP on newly enrolled adolescents’ access to a usual source of care, receipt of preventive care, and receipt of counseling about risk-behaviors for those with visits.

Methods: A random sample of 918 adolescents enrolled in SCHIP for three months or less participated in a telephone survey about their usual source of care, preventive care use, and counseling during preventive care visits. Questions about their sociodemographic characteristics, risk-behaviors, and health status were included. They were re-interviewed one year later. Three logistic regression models were developed to examine the impact of program enrollment on having a usual source of care, preventive care visits, and risk-behavior counseling (conditional on having a visit). Covariates included age, income, gender, race/ethnicity, a time dummy, the presence of a chronic condition, and reported risk-behaviors (drinking, smoking, sex, depression, and failure to wear a seatbelt).

Findings: Enrollment in SCHIP increased adolescents’ odds of having a usual source of care by 61%. However, Hispanic adolescents odds of having a usual source of care were 0.43 that of White non-Hispanics. Program enrollment did not significantly increase the odds of having a preventive care visit. However, adolescents reporting feeling sad were over twice as likely as those without such reports to have a preventive care visit. For those with a preventive care visit, the odds of receiving risk-behavior counseling post-enrollment were 37% less than pre-enrollment. The counseling was significantly related to whether the visit was private (without parents, Odds Ratio=2.66) and whether the adolescent reported feeling said (Odds Ratio=2.61). Adolescents reporting sexual activity and failure to wear a seatbelt were more likely to receive counseling (Odds Ratios of 2.06 and 1.50; respectively) but these findings were only marginally significant.

Conclusions: Although access to a usual source of care increased, adolescents in SCHIP remain at risk for not receiving preventive care visits or counseling during those visits. Health care providers need to work with families to ensure visits are private for adolescents and target risk-behavior counseling toward all adolescents.

Learning Objectives:

• To understand access limitations for adolescents without insurance, and how recent public insurance expansions have affected access to care.

Keywords: Access and Services, Adolescent Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation