Adolescents’ Preventive Care Experiences Before Entry Into the State Children’s Health Insurance Program (SCHIP) Elizabeth Shenkman, PhD*‡§; Lise Youngblade, PhD*; John Nackashi, MD, PhD* ABSTRACT. Background. Adolescence has tradition- ally been thought of as a time of good health. However, adolescents comprise an important group with unique needs among State Children’s Health Insurance Program (SCHIP) enrollees. Throughout the 1990s, there was in- creasing evidence of unacceptably high morbidity and mortality among adolescents from injuries, suicide, sex- ually transmitted diseases, substance abuse, and other conditions associated with risk behaviors. The establish- ment of relationships with the health care system can ensure prompt treatment and help promote healthy be- haviors, assuming that the adolescent feels comfortable seeking help for his or her health-related concerns. How- ever, health care systems typically are not designed to ensure that adolescents receive the primary and preven- tive care that might ameliorate the negative conse- quences of health-damaging behaviors. Objectives. The purpose of this study was to examine the following hypotheses. 1) Adolescents with special health care needs, those engaging in risk behaviors, and those who were insured before program enrollment would be more likely than those who were healthy and those not engaging in risk behaviors to have a preventive care visit in the year preceding the interview. No differ- ences would be observed in the odds of preventive care visits based on age, race/ethnicity, and gender. 2) No differences would be observed in the receipt of risk- behavior counseling for those with a preventive care visit based on the adolescents’ sociodemographic and health characteristics. 3) Adolescents who were older would be more likely to engage in risk behaviors than younger adolescents. There would be no differences in reports of risk behaviors based on gender, race/ethnicity, and chil- dren with special health care needs status. Methods. Adolescents 12 to 19 years old and newly enrolled in SCHIP were eligible for the study. Telephone interviews were conducted within 3 months after enroll- ment with parents of adolescents to obtain sociodemo- graphic information and information about the adoles- cents’ health by using the Children with Special Health Care Needs screener. Interviews also were conducted with the adolescents themselves to obtain information about the adolescents’ risk behaviors and experiences with preventive care before SCHIP enrollment. Results. Interviews were completed with 1872 par- ents. In addition, a total of 918 interviews were com- pleted with adolescents. Approximately 73% of adoles- cents reported engaging in at least one risk behavior. Approximately 69% reported having a primary care visit during the last year with 46% of those reporting that the visit was private. Of those reporting a primary care visit, between 41% and 53% reported receiving counseling along 1 of the 5 content dimensions of anticipatory guid- ance. Older adolescents were more likely to engage in risk behaviors than younger adolescents. Hispanic ado- lescents were 30% less likely than white non-Hispanic adolescents to report engaging in risk behaviors. In terms of having a preventive care visit, adolescents with a spe- cial need were twice as likely to have a visit when com- pared with their healthy counterparts. Hispanics and black non-Hispanics were half as likely to have a pre- ventive care visit (odds ratios of 0.59 and 0.54, respec- tively) than white non-Hispanics. Those engaging in risk behaviors were almost 50% less likely to report private preventive care visits than those reporting no risk behav- iors. Privacy during the preventive care visit was associ- ated with a greater odds of receiving counseling for risk behaviors in general, sexual activity, and emotional health and relationships. Depending on the type of coun- seling, those with private preventive care visits were 2 to 3 times more likely to receive the counseling than those whose visits were not private. In addition, those engag- ing in risk behaviors were 1.45 to almost 2 times more likely to receive counseling than those not engaging in any risk behaviors. Conclusions and Implications. Based on our findings, health plans and providers involved in SCHIP are likely to serve adolescents who have had limited opportunities for private preventive care visits and counseling during such visits. The most underserved are likely to be black and Hispanic adolescents who may have had no preven- tive care at all compared with their white non-Hispanic counterparts. State agencies, health plans, and providers need to follow established guidelines for adolescent health care that emphasize the provision of counseling for risk behaviors for all adolescents, not just those en- gaging in risk behaviors or those with special health care needs. Moreover, providers need to seek opportunities to ensure privacy for the adolescents during their preven- tive care visits so that much-needed counseling can be provided. Particular attention needs to be given to ado- lescents from minority groups to encourage them to seek preventive care. Pediatrics 2003;112:e533–e541. URL: http: //www.pediatrics.org/cgi/content/full/112/6/e533; adoles- cents, risk behaviors, SCHIP, preventive care. ABBREVIATIONS. SCHIP, State Children’s Health Insurance Pro- gram; STD, sexually transmitted disease; CSHCN, children with special health care needs; FPL, federal poverty level; USC, usual source of care; YAHCS, Young Adult Health Care Survey. From the *Department of Pediatrics, University of Florida, ‡Institute for Child Health Policy, and §Institute for Child and Adolescent Research and Evaluation, Gainesville, Florida. Received for publication Jun 25, 2003; accepted Aug 4, 2003. Address correspondence to Elizabeth Shenkman, PhD, Institute for Child Health Policy, 5700 SW 34th St, Ste 323, Gainesville, FL 32608. E-mail: eas@ichp.edu. This article represents the views of the authors and not necessarily those of the funding agencies. PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- emy of Pediatrics. http://www.pediatrics.org/cgi/content/full/112/6/e533 PEDIATRICS Vol. 112 No. 6 December 2003 e533 by guest on April 5, 2017 Downloaded from