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Jonathan D Klein

Publications and source records attributed to Jonathan D Klein.

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PubMed2003

Youth tobacco control research and activities in the United States: the current national landscape.

This paper highlights the increasing level of collaboration, resource sharing, and consensus building in youth tobacco control taking place in the United States. Better knowledge of current research, activities, and collaborations in this area will help in the planning of activities and the rational allocation of funds for tobacco control programs, research, advocacy, and the counter-advertising activities. We defined three general classifications for organizations that had national youth tobacco control activities: Government centers and institutes, government organizations, and bridging organizations. We asked national experts in our own organization and all other included organizations to suggest additional groups for inclusion. After gathering available public information on each organization from Web sites and printed materials, we than solicited additional information by personal communication with individuals in leadership positions for youth tobacco control within each group. We developed a uniform framework to present a clear picture of each group in the areas of institutional conception, general goals, youth tobacco control research, and youth tobacco control activities. The tables provide a helpful reference guide presenting the institutional conception, goals, funding for research, activities, and Web sites for the institutions and organizations discussed here. Many groups have current youth tobacco control priorities in the United States. This synthesis of current research, funding sources, programmatic activities, and collaborations in the United States will be a valuable resource for clinicians, tobacco control advocates, researchers, and program planners.

Adolescent↗
PubMed2003

Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement.

OBJECTIVE: To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM). METHODS: Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (<or=18 years) that included clinician-reported counseling for tobacco use/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed. RESULTS: Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13-18 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5-33.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician's assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002-2.50; and odds ratio: 3.0; 95% confidence interval: 1.5-6.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty. CONCLUSIONS: Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.

Adolescent↗
PubMed2003

Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits.

OBJECTIVE: To describe prevention counseling on pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), received by sexually experienced youth in the primary care setting and to test associations between recent sexual risk behaviors and preventive counseling. METHODS: Using data from the 1999 Youth Risk Behavior Surveillance survey, a nationally representative survey (N = 15 349) of high school students, we analyzed responses to questions about sexual experience, time since last preventive health care visit, and discussion of STD, HIV, or pregnancy prevention with a doctor or nurse during their last preventive health care visit. Logistic regression was used to test associations; students' demographic characteristics were controlled. RESULTS: More than half of the US high school students surveyed reported a preventive health care visit in the 12 months preceding the survey: 60.4% (95% confidence interval [CI]: 57.2%-63.6%) of female students and 57.5% (95% CI: 53.9%-61.1%) of male students. For female students, sexual experience was positively associated with a preventive health care visit (odds ratio [OR]: 1.3; 95% CI: 1.1-1.6), but for male students, sexual experience had a negative effect (OR: 0.8; 95% CI: 0.7-0.9). Of the students who reported a preventive health care visit in the 12 months preceding the survey, 42.8% (95% CI: 38.6%-47.1%) of female students and 26.4% (95% CI: 22.7%-30.2%) of male students reported having discussed STD, HIV, or pregnancy prevention at those visits. Sexual experience was associated with a higher likelihood of engaging in a dialogue about sexual health once a student entered the health care system: female students (OR: 3.8; 95% CI: 3.0-4.9) and male students (OR: 1.9; 95% CI: 1.3-2.7). CONCLUSION: Primary care providers miss opportunities to provide STD, HIV, and pregnancy prevention counseling to high-risk youth.

Acquired Immunodeficiency Syndrome↗
PubMed2003

The state of office-based interventions for youth tobacco use.

Tobacco use is a serious pediatric health issue as dependence begins during childhood or adolescence in the majority of tobacco users. Primary care settings provide tremendous opportunities for delivering tobacco treatment to young tobacco users. Although evidence-based practice guidelines for treating nicotine dependence in youths are not yet available, professional organizations and the current clinical practice guideline for adults provide recommendations based on expert opinion. This article reports on the current tobacco treatment practices of pediatric and family practice clinicians, discusses similarities and differences between adolescent and adult tobacco use, summarizes research efforts to date and current cutting-edge research that may ultimately help to inform and guide clinicians, and presents existing recommendations regarding treating tobacco use in youths. Finally, recommendations are made for the primary care clinician, professional organizations, and health care systems and policies. Pediatricians and other clinicians can and should play an important role in treating tobacco dependence in youths.

Adolescent↗
PubMed2003

US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000-2001.

OBJECTIVE: A substantial proportion of homes and automobiles serve as settings for environmental tobacco smoke (ETS) exposure, and many public settings that children frequent are still not smoke-free. Tobacco control efforts are attempting to increase smoking bans. The objective of this study was to describe the knowledge, attitudes, and practices of smokers and nonsmokers regarding smoking bans and child ETS exposure in multiple public and private settings and to report changes from 2000-2001. METHODS: Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed for changes in knowledge, attitudes, and practices regarding tobacco. These data were collected via automated, random-digit-dialing telephone surveys that were conducted in the summers of 2000 and 2001. The samples were weighted by race and gender to be representative of the US population. RESULTS: Response rates for eligible adults actually contacted were 1501 (75%) of 1876 in 2000 and 3002 (84%) of 3566 in 2001. The majority of adults, both smokers and nonsmokers, support smoking bans in a wide variety of places. The percentage of all respondents reporting the presence of smoking bans in several public and private places increased from 2000-2001: the household (69%-74%), in the presence of children (84%-88%), convenience stores (68%-74%), fast-food restaurants (52%-58%), and non-fast-food restaurants (25%-28%). Support for smoking bans also increased in shopping malls (71%-75%), fast-food restaurants (77%-80%), and indoor sporting events (78%-80%). There were no significant changes in support for smoking bans in convenience stores, restaurants, or outdoor parks. Adults' knowledge of the harm caused by tobacco was unchanged, with the vast majority of adults recognizing the dangers of exposure to ETS from parental smoking (95%) and exposure to ETS in cars (77%). CONCLUSIONS: Small improvements in adult attitudes and practices regarding children's ETS exposure occurred from 2000-2001. However, a significant number of adults in the United States still report ignorance of the harmful effects of child ETS exposure, and there was no improvement in reported knowledge in this 1-year period. In contrast, a growing majority of smokers and nonsmokers favor restrictions on smoking in public settings, suggesting that states and communities have public support for broad public smoking restriction policies. There are significant roles that pediatricians can play in preventing children's ETS exposure, through both patient and family education and by moving smoking restriction policies forward on their community's agenda.

Adult↗
PubMed2003

Addressing parental smoking in pediatrics and family practice: a national survey of parents.

BACKGROUND: Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child's visit to primary care. OBJECTIVE: To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking. Design/Methods. Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based on 1999 US Census estimates to be representative of the US population. RESULTS: Of 3566 eligible respondents contacted, 3002 (84%) completed surveys; 902 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner reported that they had been asked about household member smoking status (52% vs 48%). More parents who visited pediatricians had been asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs 29%). Of 190 (21%) parents who were smokers, fewer than half reported being counseled by either specialty about dangers of second-hand smoke (41% vs 33%) or risks of modeling smoking behavior (31% vs 28%). Similarly, fewer than half of parental smokers received advice to quit (36% vs 45%). CONCLUSION: Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in primary care settings that serve children.

Adult↗
PubMed2003

Children with special health care needs enrolled in the State Children's Health Insurance Program (SCHIP): patient characteristics and health care needs.

BACKGROUND: Children with special health care needs (CSHCN) often require more extensive services than children without special needs. The State Children's Health Insurance Program (SCHIP) in many states typically provides less extensive benefits and services than do state Medicaid programs. To design SCHIP to address the needs of CSHCN adequately, it is important to measure the degree to which children who enroll in SCHIP have special health care needs and to assess their health status and unmet health care needs. Little is known about the characteristics or preenrollment experience of CSHCN who enroll in SCHIP. OBJECTIVES: To use data from the Child Health Insurance Research Initiative to measure the prevalence of CSHCN in SCHIP in 4 states, describe their demographic and health care features at enrollment, and compare their sociodemographic characteristics, health status, prior health care experiences, and unmet needs versus children without special health care needs. METHODS: Children (0-18 years old) newly enrolled in SCHIP in 4 states were eligible for the study: New York, Florida (adolescents only), Kansas, and Indiana (CSHCN only). Telephone interviews were conducted shortly after enrollment and identified CSHCN by using the Child and Adolescent Health Measurement Initiative CSHCN screener. A common set of core questions assessed demographic characteristics, health status, special health care need status, insurance experience, access, use, quality of health care, and unmet needs during the year before enrollment. Bivariate and multivariate analyses were used to compare characteristics of CSHCN with characteristics of children without special needs. RESULTS: Interviews were completed for parents of 5296 children enrolled in SCHIP in the 4 states. By using the Child and Adolescent Health Measurement Initiative CSHCN screener, the prevalence of CSHCN among SCHIP enrollees was 17% (New York), 18% (Florida), and 25% (Kansas), higher than the prevalence of CSHCN reported in the general population in those states. More than half of CSHCN reported the use of a chronic medication. Demographic characteristics of CSHCN were similar to those of children without special needs, although CSHCN were more likely to reside in single-parent households. Although CSHCN had poorer health status than children without special needs, many CSHCN were reported to be in good health, suggesting a wide spectrum of severity of illnesses within the CSHCN group. Although CSHCN were more likely than children without special needs to have been insured before SCHIP, a large proportion of CSHCN were nevertheless uninsured for at least 12 months before SCHIP (New York, 56%; Florida, 68%; Kansas, 24%; Indiana, 25%). Although most SCHIP enrollees had a usual source of care (USC) before SCHIP and there was some variation across states, between 4% and 13% of CSHCN lacked a USC on enrollment, and 23% to 38% of CSHCN changed their USC after enrollment in SCHIP. The majority of all SCHIP enrollees (including CSHCN) had used some health care during the year before SCHIP including preventive, acute, or specialty care. A high proportion of all SCHIP enrollees, including >30% to 40% of CSHCN, were reported to have unmet health care needs at enrollment in SCHIP. A variety of unmet needs were reported by CSHCN including specialty care, mental health care, dental care, and prescription medications. Nevertheless, the vast majority of CSHCN as well as children without special needs rated the quality of their medical care before SCHIP highly on several specific quality measures. Findings from multivariate analyses were similar to bivariate results with CSHCN in several states having higher use of care and more unmet health care needs before enrollment. CONCLUSIONS: SCHIP is enrolling many CSHCN, with the prevalence of these children occurring at least as high as the prevalence of CSHCN in the general population. CSHCN enrolled in SCHIP represent a heterogeneous population with a wide range of health status and health care needs. Although most CSHCN were already already connected to the health care system with a USC and prior health care visits, many had unmet health care needs before enrolling in SCHIP. IMPLICATIONS FOR MONITORING AND IMPROVING SCHIP FOR CSHCN ENROLLEES: 1) SCHIP benefit packages need to adequately cover services required by CSHCN such as prescription medications and specialty, mental health, developmental, and home services; 2) because utilization of care will be high among this large group of children, alternative methods of financing and managing care should be considered such as risk adjustment and special programs that involve case management and care coordination; 3) coordination of care across programs (such as between SCHIP and the state Title V Maternal and Child Health Services program, a component of which serves CSHCN) and ensuring adequate access to primary care and specialty providers might improve access to services for CSHCN; and 4) it is critical to monitor the quality of care for CSHCN enrolled in SCHIP, because these children are among the most vulnerable children covered by public health insurance programs and many of them are enrolling in SCHIP.

Adolescent↗
PubMed2003

The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?

BACKGROUND: Elimination of racial and ethnic disparities in health has become a major national goal. The State Children's Health Insurance Program (SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. OBJECTIVE: To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. SETTING: SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. DESIGN: Telephone interview (mailed survey in Alabama) about the child's health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. SAMPLE: New SCHIP enrollees (0-17.9 years old in Alabama, Kansas, and New York and 11.5-17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. MEASURES: Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any race]), prior health insurance, health care access and utilization, and health status. ANALYSES: Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. RESULTS: Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single-parent and lower-income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. CONCLUSIONS: SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. IMPLICATIONS FOR MONITORING AND IMPROVING SCHIP: SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program's impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.

Adolescent↗
PubMed2003

The evolution of the State Children's Health Insurance Program (SCHIP) in New York: changing program features and enrollee characteristics.

BACKGROUND: The State Children's Health Insurance Program (SCHIP) has been operating for >5 years. Policy makers are interested in the characteristics of children who have enrolled and changes in the health care needs of enrolled children as programs mature. New York State's SCHIP evolved from a similar statewide health insurance program that was developed in 1991 (Child Health Plus [CHPlus]). Understanding how current SCHIP enrollees differ from early CHPlus enrollees together with how program features changed during the period may shed light on how best to serve the evolving SCHIP population. OBJECTIVE: To 1) describe changes in the characteristics of children enrolled in 1994 CHPlus and 2001 SCHIP; 2) determine if changes in the near-poor, age-eligible population during the time period could account for the evolution of enrollment; and 3) describe changes in the program during the period that could be responsible for the enrollment changes. SETTING: New York State, stratified into 4 regions: New York City, New York City environs, upstate urban counties, and upstate rural counties. DESIGN: Retrospective telephone interviews of parents of 2 cohorts of CHPlus enrollees: 1) children who enrolled in CHPlus in 1993 to 1994 and 2) children who enrolled in New York's SCHIP in 2000 to 2001. The Current Population Survey (CPS) 1992 to 1994 and 1999 to 2001 were used to identify secular trends that could explain differences in the CHPlus and SCHIP enrollees. PROGRAM CHARACTERISTICS: 1994 CHPlus and 2001 SCHIP were similar in design, both limiting eligibility by age, family income, and insurance status. SCHIP 2001 included 1) expansion of eligibility to adolescents 13 to 19 years old; 2) expansion of benefits to include hospitalizations, mental health, and dental benefits; 3) changes in premium contributions; 4) more participating insurance plans, limited to managed care; 5) expansions in marketing and outreach; and 6) a combined enrollment application for SCHIP and several low-income programs including Medicaid. SAMPLE: Cohort 1 included 2126 new CHPlus enrollees 0 to 13 years old who were enrolled for at least 9 months, stratified by geographic region. Cohort 2 included 1100 new SCHIP enrollees 0 to 13 years old who were enrolled for at least 9 months, stratified by geographic region, age, race, and ethnicity. Results were weighted to be representative of statewide CHPlus or SCHIP new enrollees who met the sampling criteria. Samples of age- and income-eligible children from New York State were drawn from the CPS and pooled and reweighted (1992-1994 and 1999-2001) to generate a comparison group of children targeted by CHPlus and SCHIP. MEASURES: Sociodemographic characteristics, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic), prior health insurance, health care access, and first source of information about the program. ANALYSES: Weighted bivariate analyses (comparisons of means and rates) adjusted for the complex sampling design to compare measures between the 2 program cohorts and between the 2 CPS samples. We tested for equivalence by using chi2 statistics. RESULTS: As the program evolved from CHPlus to SCHIP, relatively more black and Hispanic children enrolled (9% to 30% black from 1994 to 2001, and 16% to 48% Hispanic), more New York City residents (46% to 69% from 1994 to 2001), more children with parents who had less than a high school education (10% to 25%), more children from lower income families (59% to 75% below 150% of the federal poverty level), and more children from families with parents not working (7% to 20%) enrolled. These socioeconomic and demographic changes were not reflected in the underlying age- and income-eligible population. A greater proportion of 2001 enrollees were uninsured for some time immediately before enrollment (57% to 76% had an uninsured gap), were insured by Medicaid during the year before enrollment (23% to 48%), and lacked a USC (5% to 14%). Although "word of mouth" was the most common means by which families heard about both programs, a greater proportion of 2001 enrollees learned about SCHIP from marketing or outreach sources. CONCLUSION: As New York programs for the uninsured evolved, more children from minority groups, with lower family incomes and education, and having less baseline access to health care were enrolled. Although changes in the underlying population were relatively small, progressively increased marketing and outreach, particularly in New York City, the introduction of a single application form for SCHIP and Medicaid, and expansions in the benefit package may have accounted, in part, for the large change in the characteristics of enrollees.

Adolescent↗
PubMed2002

Opportunities for appropriate care: health care and contraceptive use among adolescents reporting unwanted sexual intercourse.

BACKGROUND: Unwanted sexual contact, reported by 30% to 42% of young women and 10% to 34% of young men, has been associated with negative health outcomes and increased teenaged pregnancy. OBJECTIVE: To determine health services and contraceptive use among adolescents reporting unwanted sexual intercourse. METHODS: Random-digit dial methods were used to survey 1040 adolescents in Monroe County, New York; 389 (37%) were sexually active and answered a question about whether they had ever been forced or pressured to have sexual intercourse. The data were weighted to reflect the county population. RESULTS: Among sexually active adolescents, 20% of females and 7% of males reported unwanted intercourse (P<.001). For 37% of male and 17% of female adolescents, the survey was the first time they had disclosed the incident (P =.17). Among female adolescents reporting unwanted intercourse, 91% have a usual source of care and 62% reported a well visit in the previous 6 months. Female adolescents reporting unwanted sex were more likely to have wanted contraceptives but not gotten them because of fear their parents would find out (32% vs 11%; P =.01) and to have had sex without contraception (69% vs 52%; P =.05) than those who had not had unwanted sex. CONCLUSIONS: Many adolescents have been forced or pressured to have sexual intercourse. Although many have never told anyone about the incident, most have visited a primary care physician or clinician. Physicians and other clinicians should screen for a history of unwanted intercourse and provide needed referrals for counseling and/or contraceptive information.

Adolescent↗
PubMed2002

Prevention and risk of adolescent substance abuse. The role of adolescents, families, and communities.

Adolescents as young as 12 to 14 years of age are engaging in substance use [16]. Those who use substances are at risk for immediate and future consequences that affect morbidity and mortality. The theoretical models of substance use in adolescents provide a framework for understanding risk and protective factors. These risk and protective factors are pertinent to all contexts, including the individual traits, interpersonal relationships, and greater society. Knowledge of these factors should help the clinician in assessment of the individual adolescent. Knowledge of these factors also should help the clinician provide appropriate interventions. In the case of primary prevention, clinicians can advocate for families and communities to teach children how to be more goal-oriented, insightful, and in tune with their cultures and beliefs. Parents also can be encouraged to set clear limits, monitor their adolescents' behaviors, be good role models, and provide a loving and supportive environment. Advocacy to address some of the societal factors that are less easily changed also has its place. Addressing media portrayal of drug use, availability of substances, and poverty would have a broad impact on the problem of adolescent substance use and would help to improve the health status of many adolescents in the United States.

Adolescent↗
PubMed2002

Male adolescent use of health care services: where are the boys?

PURPOSE: To describe patterns of health care use by adolescent males in the United States and clinical practice characteristics associated with their use of adolescent-specific programs. METHODS: Secondary analysis of three national data sets to determine health care use by male adolescents: the National Ambulatory Medical Care Survey [NAMCS (1994): pediatric, family physician, internal medicine, and obstetric/gynecologic outpatient visits]; National Hospital Ambulatory Medical Care Survey [NHAMCS (1994): outpatient department (OPD) and emergency department (ED) visits]; and Comprehensive Adolescent Health Services Survey [CAHSS (1995)]. Both NAMCS and NHAMCS are representative national probability samples. Total visit estimates by adolescents in 1994 to NAMCS sites were 387,076,630, to OPD sites were 6,511,244, and to ED sites were 13,161,824. For CAHSS, 468 programs (60% of eligible) participated. Data analyses were performed using two-tailed Student's t-tests and correlation testing. RESULTS: Older male adolescents, aged 16-20 years, account for a lower percentage of total visits to NAMCS sites combined compared to younger males, aged 11-15 years (15.8% vs. 25.1%, p <.001), mainly owing to a significant decline in visits to pediatricians (3.2% vs. 14.9%, p <.001), despite significant increases in female health care use during the same time period. Younger males were seen at similar rates compared to females at NAMCS, NHAMCS-OPD and NHAMCS-ED sites, but older males account for a significantly lower percentage of total visits than females to all NAMCS sites combined (15.8% vs. 34.7%, p <.001), the NHAMCS-ED (26.4% vs. 31.5%, p <.05), and the NHAMCS-OPD (15.0% vs. 41.2%, p =.001). Among specialized adolescent sites (CAHSS), 13-19-year-old males account for fewer visits than females to all programs types: schools (40% vs. 60%), hospitals (33% vs. 67%), and community/health departments (25% vs. 75%) (all p's < or =.001). Clinical practice characteristics correlated with having a greater proportion of male adolescent visit varied depending on the types of adolescent program examined. CONCLUSIONS: Younger male adolescents make health care visits in relatively equal proportions to females at all NAMCS and NHAMCS locations and visits by older males are significantly reduced. Male adolescent visits are lower than females at all adolescent-specific programs; school-based clinics see the highest proportion of males. Greater understanding of male adolescents' transition between providers from adolescence to adulthood is needed to improve care to male adolescents who under-use health services.

Adolescent↗
PubMed2002

Delivering quality care: adolescents' discussion of health risks with their providers.

PURPOSE: To compare adolescents' report of topics they wanted to discuss with their providers with what they actually discussed, and whether they talked to their providers about their self-reported health risks. METHODS: We analyzed the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of 6728 in-school adolescent boys and girls in 5th through 12th grade. Respondents reported on health risks, whether they believed their provider should discuss certain topics, and whether their provider did talk about health-related topics. Logistic regression was used to compare proportions and assess the associations among variables. RESULTS: Adolescents most frequently discussed healthy dietary habits (49%), weight (43%), and exercise (41%) with their clinicians but most frequently wanted to discuss drugs (65%), smoking (59%), and healthy dietary habits (57%). Overall, 70.9% of the sample reported at least one of eight potential health risks, but 63% of these adolescents had not spoken to their doctor about any of these risks. Using logistic regression models, having a female provider (odds ratio [OR] 1.41), obtaining health care information from a doctor (OR 1.72) and from the Internet (OR 1.50), speaking privately with their provider (OR 1.45), and reporting more total risk factors (OR 1.59) were each associated with having discussed any risks. CONCLUSIONS: Adolescents want and need to discuss health care issues with their providers but often do not. Providing quality preventive care to adolescents will require increased physician screening and counseling about these issues.

Adolescent↗
PubMed2002

Adolescent girls' use of the Internet for health information: issues beyond access.

Whilst the "digital divide" in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illness episodes. This exploration with future health service users highlights important questions for further study.

Adolescent↗
PubMedDate not supplied

Community as laboratory: reflections from Rochester, New York, in celebration of the dedication of the Robert J. Haggerty child health services research laboratories.

The dedication of the Robert J. Haggerty Child Health Services Research Laboratories at the University of Rochester (New York) Medical Center in October 2004 provided an opportunity to reflect on the current state of child health services research. Dr Haggerty had a grand vision for using the community in which children live as a laboratory for studying the varied medical, psychosocial, and behavioral morbidities that affect them. He believed that the diverse problems faced by children were best studied by a multidisciplinary team, including both academic and community pediatricians, epidemiologists, sociologists, policy makers, and community leaders. Research done in the community involving front-line providers allows investigation into the most challenging and relevant problems faced by children. To this end, Dr Haggerty made collaboration and cooperation between the community and the academic medical center a priority during his tenure at Rochester. His vision of community as laboratory continues through the child health services research emanating from the Haggerty Laboratories. Nevertheless, many barriers remain that need to be overcome for the sake of improving the lives of children in the United States and throughout the world.

Child↗
PubMedDate not supplied

Adolescents' use of complementary and alternative medicine.

OBJECTIVE: To examine the prevalence of complementary and alternative medicine (CAM) use in a random sample of adolescents living in Monroe County, New York. METHODS: Questions about use of a variety of CAM therapies in the previous 6 months were asked of adolescents during a random-digit-dial telephone survey. RESULTS: A total of 54% of the 361 adolescents surveyed had used at least 1 CAM remedy. The most frequently used therapies were massage (13.2%), prayer or faith healing (13.1%), herbs (11.5%), megadose vitamins (10.6%), and special exercises (10.1%). Natural performance enhancers were used by 14.7% of the boys, but less than 1% of the girls (P <.001). Use of health care without parental knowledge, time spent in school clubs, and perceived parental use and friend use of CAM were all associated with CAM use in a logistic regression model. CONCLUSION: More than half of the adolescents in this county use CAM therapies, and a significant number use pharmacologically active substances. Physicians treating adolescents should ask adolescents about CAM use.

Adolescent↗
PubMedDate not supplied

SCHIP's impact in three states: how do the most vulnerable children fare?

This study provides consistent evidence, from three very diverse states with heterogeneous populations and distinct programs (Florida, Kansas, and New York), that the State Children's Health Insurance Program (SCHIP) increased access to and satisfaction with health care among enrolled low-income children and that vulnerable children-minorities, children and adolescents with special health care needs, and children who were uninsured for long periods of time-shared in these improvements. We highlight some areas to target for future improvement, such as reducing the high levels of unmet needs among special-needs children and increasing preventive care, especially for Hispanic children.

Adolescent↗