Adolescent Preventive Services: Disparities and Outcomes

说明(由申请人提供)：理由和目标：青少年在卫生保健利用方面存在明显的种族/族裔差异。当青少年确实进入该系统时，预防性服务的提供低于建议的水平。然而，人们对提供预防性服务方面的种族/族裔差异知之甚少。少数族裔青少年在几个可以预防的关键领域有更高的危险健康行为和相关结果。长期的研究目标是减少青少年健康行为和结果中的种族/民族差异。具体目的是确定：1)在提供青少年预防服务方面是否存在种族/族裔差异；2)在初级保健中增加提供预防服务的干预措施，减少接受预防服务方面的种族/族裔差异；3)接受预防服务对不同种族/族裔背景的青少年也有类似的影响。研究设计：人口：将使用2个样本：1)加州大学旧金山分校样本：3369名青少年参加了一家大型管理护理机构的青少年预防服务评估；2)CHIS样本：2898名加州青少年参加了2001年的加州健康访谈调查(CHIS)。措施：加州大学旧金山分校的青少年参与者在临床护理访问后立即完成调查，询问提供者在访问期间是否在3个目标领域对他们进行筛查和咨询：物质使用、安全性和性行为。加州大学旧金山分校的一个子样本还参与了一项健康行为的纵向研究，在探井前和一年后的第二次年度探井中完成了健康结果和自我效能调查。CHIS参与者完成了电话调查，包括他们参加探井的情况，以及他们的提供者是否在目标地区对他们进行了筛查。方法：将对这些已建立的数据集进行二级数据分析，以测试青少年预防服务和结果中是否存在种族/民族差异。我们将进行多元回归和逻辑回归分析，以检验拟议的目标。目标1和目标2的结果是在探井期间对提供者进行筛选和咨询。目标3的结果是接受预防服务的青少年纵向亚样本中的行为变化和自我效能。我们将控制变量的协变，包括青少年特征，如年龄和性别，以及家庭特征，如社会经济地位。公共卫生相关性：查明提供预防性服务方面的种族/族裔差异可以提高认识，促进改善所有青少年的保健。查明预防服务在健康行为和自我效能结果方面的差异，可使人们更加重视满足不同种族/族裔背景的青少年的需要。

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.