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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 291-297

Gender and Uninsurance Among Young Adults in the United States

S. Todd Callahan, MD, MPH* and William O. Cooper, MD, MPH{ddagger}

* Division of Adolescent Medicine and Behavioral Science, Vanderbilt University Medical Center, Nashville, Tennessee
{ddagger} Division of General Pediatrics and the Center for Health Services Research, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

Objective. Although one third of young adults in the United States are uninsured, lack of insurance in this age group has been the subject of few published studies. Because opportunities to obtain public and private insurance are likely to differ for men and women, the objective of this study was to describe the gender-specific relationship of sociodemographic variables and lack of insurance among young adults.

Methods. We examined data for 6884 young adults (aged 19–24 years) who completed the Sample Adult Questionnaire of the National Health Interview Survey for 1998, 1999, and 2000. Gender-stratified multiple logistic regression was used to estimate the odds of being uninsured associated with race/ethnicity, household income, major activity in the previous week, marital status, and pregnancy (women).

Results. Overall, 32% of male participants and 27% of female participants reported being uninsured at the time of the survey. Uninsured men outnumbered insured men in several sociodemographic categories, including Hispanic men (58% uninsured), men not attending high school (85%), and men employed in a workplace that did not offer health insurance (51%). High rates of uninsurance were reported by women not attending high school (65%), Hispanic women (46%), those who were keeping house (41%), and women with a household income between $10 000 and $20 000 (41%). In multiple logistic regression models, many of the sociodemographic variables studied were similarly correlated with health insurance for both men and women. Employment in a workplace where the young adult was not offered health insurance coverage, low household income, low educational attainment, and Hispanic ethnicity were associated with increased odds of being uninsured for both genders. Having attended college, higher household income, and being a student or employed in a workplace that offers health insurance coverage were associated with lower odds of being uninsured for both genders.

Conclusion. This study suggests that additional opportunities for health insurance coverage are needed for young adults—particularly men, Hispanics, and those in low- and middle-income households. Increasing the availability of employment-based health insurance, discouraging attrition from primary and secondary education, and the creation of insurance opportunities for minorities and near-poor and middle-income households are potentially important target areas for programs that seek to reduce the number of uninsured young adults.

Key Words: young adults • health insurance • adolescence • uninsurance • national health interview survey

Abbreviations: NHIS, National Health Interview Survey • GED, general educational development • AOR, adjusted odds ratio • CI, confidence interval

Received for publication Feb 18, 2003; Accepted May 28, 2003.




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