Adolescent Preventive Services: Disparities and Outcomes

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Rationale and Objectives: Significant racial/ethnic disparities in health care utilization exist among adolescents. When adolescents do access the system, the preventive services delivery is below the recommended levels. However, little is known about racial/ethnic disparities in preventive services delivery. Minority adolescents have higher rates of risky health behaviors and associated outcomes in several key areas that are preventable. The long-term research objective is to decrease racial/ethnic disparities in adolescent health behaviors and outcomes. Specific aims are to determine if: 1) There are racial/ethnic disparities in the delivery of adolescent preventive services; 2) An intervention to increase the delivery of preventive services in primary care reduces racial/ethnic disparities in the receipt of preventive services; 3) Receipt of preventive services has a similar effect on adolescents of different racial/ethnic backgrounds. Research Design: Population: 2 samples will be utilized: 1) UCSF Sample: 3369 adolescents participated in an evaluation of adolescent preventive services in a large managed care organization; and 2) CHIS sample: 2898 California adolescents participated in The California Health Interview Survey (CHIS) in 2001. Measures: UCSF adolescent participants completed surveys immediately following clinical well care visits that queried whether providers screened and counseled them during the visit in 3 target areas: substance use, safety, and sexual behavior. A UCSF subsample also participated in a longitudinal study of health behaviors, completing health outcome and self-efficacy surveys prior to well visits and one year later at a 2nd annual well visit. CHIS participants completed phone surveys that included their attendance of well visits and whether their providers screened them in target areas. Methods: Secondary data analyses of these established data sets will be conducted to test for the presence of racial/ethnic disparities in adolescent preventive services and outcomes. We will conduct multiple regression and logistic regression analyses to examine the proposed aims. Outcomes for aims 1 and 2 are provider screening and counseling during well visits. Outcomes for aim 3 are behavior change and self- efficacy in the longitudinal subsample of adolescents who received preventive services. We will control for covariation from variables including adolescent characteristics, such as age and gender, and family characteristics, such as socio-economic status. Public Health Relevance: The identification of racial/ethnic disparities in preventive services delivery could increase awareness and prompt improvements in healthcare for all adolescents. The identification of disparities in health behavior and self-efficacy outcomes as the result of preventive services could lead to increased focus on meeting the needs of adolescents of differing racial/ethnic backgrounds.