Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e565-e572 (doi:10.1542/peds.2008-2601)

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ARTICLE

Preventive Care for Adolescents: Few Get Visits and Fewer Get Services

Charles E. Irwin, Jr, MD^a, Sally H. Adams, PhD, RN^a, M. Jane Park, MPH^a and Paul W. Newacheck, DrPH^a,b

^a Department of Pediatrics
^b Center on Social Disparities in Health and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California

OBJECTIVE. Professional guidelines for adolescents recommend annual preventive visits with screening and anticipatory guidance for health-related behaviors. The objective of this study was to examine receipt of preventive services, including disparities in services received, by using a nationally representative sample of adolescents.

METHODS. Using data from the 2001–2004 Medical Expenditure Panel Survey (ages 10–17; N = 8464), we examined receipt of preventive care visits and several measures of the content of care, based on caregiver's reports, among adolescents who received a preventive care visit during the past 12 months. Content of care outcomes included physical parameters measurement (height, weight, and blood pressure); receipt of anticipatory guidance (dental care, seat belts, helmets, exercise, healthy eating, and secondhand smoke exposure); and, for 12- to 17-year-olds, whether adolescents had time alone with their provider during their most recent visit, a proxy for confidential services. We conducted logistic regression analyses to test for disparities in the outcomes on the basis of race/ethnicity, income, and insurance status.

RESULTS. Thirty-eight percent of adolescents had a preventive care visit in the previous 12 months. Low-income and full-year uninsured status were associated with higher risk for not receiving this visit. Most adolescents had height (87%), weight (89%), and blood pressure (78%) assessed. Rates for height and weight were lower in poor and uninsured adolescents. Anticipatory guidance rates were much lower, ranging from 31% for seat belts, helmets, and secondhand smoke to 49% for healthy eating. Only 10% had all 6 areas addressed. Multivariate analyses yielded few disparities in receipt of anticipatory guidance. Forty percent had time alone with their providers. Hispanic and the lowest-income adolescents were the least likely to have time alone.

CONCLUSIONS. Few adolescents received a preventive visit; among those who received this visit, provision of recommended anticipatory guidance was very low. Strategies are required to improve delivery of recommended preventive services to adolescents.

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Key Words: adolescent health • health insurance • preventive health care • health disparities

Abbreviations: AAP—American Academy of Pediatrics • NAMCS—National Ambulatory Medical Care Survey • MEPS—Medical Expenditure Panel Survey • FPL—federal poverty level

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Accepted Dec 23, 2008.

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