Losing Generations Adolescents in High-Risk Settings (1993) / Chapter Skim
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5 HEALTH AND HEALTH CARE
5 HEALTH AND HEALTH CARE
Pages 81-101
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From page 81... ...
Furthermore, the rates of teenage pregnancy, sexually transmitted diseases, and drug use have either increased or remained at high levels relative to that observed in other countries. Finally, it has become apparent that many adolescents who have one type of problem often have others; approximately 25 percent are considerec3 at high risk for a poor transition into adulthooc!
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From page 82... ...
using condoms can prevent pregnancy as well as sexually transmitted diseases. Moreover, evaluations of health service programs indicates that they can reduce the frequency of many conditions and ameliorate the severity of others, even when social factors weigh heavily in the genesis of the conditions {Starfield, 1985J.
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From page 83... ...
Health and Health Care / 83 TABLE 5-1 Deaths of People Aged 15 to 24, by Age and Cause of Death, 1965-1988 inumber per lOO,OOOJ Cause of Death 1965 1980 1988 15 to 19 years old All causes 95.1 97.9 88.0 Motor vehicle accidents 40.2 43.0 37.3 All other accidents 16.5 14.9 9.4 Suicide 4.0 8.5 11.3 Males, white 6.3 15.0 19.6 Females, white 1.8 3.3 4.8 Males, all other races 5.2 7.5 11.0 Females, all other races 2.4 1.8 2.6 Homicide 4.3 10.6 11.7 Males, white 3.0 10.9 8.1 Females, white 1.3 3.9 3.0 Males, all other races 30.6 43.3 64.4 Females, all other races 7.1 10.1 10.2 Cancer 7.6 5.4 4.4 Heart disease 5.3 2.3 2.2 Pneumonia/influenza 2.1 0.6 0.5 20 to 24 years old All causes Motor vehicle accidents All other accidents Suicide Males, white Females, white Males, all other races Females, all other races Homicide Males, white Females, white Males, all other races Females, all other races Cancer Heart disease Pneumonia/influenza 132.7115.4 46.839.7 18.812.4 16.115.0 27.827.0 5.94.4 20.920.0 3.63.0 20.619.0 19.914.8 5.44.7 109.4105.6 23.319.7 7.25.7 3.53.6 1.00.9 SOURCE: Office of Education Research and Improvement ~1991~.
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From page 84... ...
One-third of all high school seniors report having drunk at least five drinks in a row at least once during a 2week period, 17 percent report monthly use of marijuana, and about 19 percent smoke cigarettes on a daily basis [Bachman et al., 1991; National Institute on Drug Abuse, 19901. Among young women aged 15-17, the proportion who are sexually active has risen steadily over the past 20 years and was 38 percent in 1988.
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From page 85... ...
About 2.5 million adolescents contract a sexually transmitted disease each year, and prevalence rates have increased over the past decade especially for syphilis-to levels that were last seen in the 1940s {Sonenstein et al., 1990; Irwin et al., 1991~. Unprotected sexual intercourse also contributes significantly to the risk of AIDS.
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From page 86... ...
The services that do exist for adolescents are fragmented and oriented toward specific problems rather than toward the constellations of problems that characterize adolescents. Existing services for substance abuse, mental health, trauma {e.g., emergency carel, and reproductive and maternal health have developed largely in isolation from each other.
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From page 87... ...
Indeed, almost all aspects of adolescent development -~ WHAT lid= ~ri~`ArPr] ~ATithitl the nilrvieW of "health." For example, The Health of Adolescents, a text sponsored by the AMA, has chapters on substance abuse, sexually transmitted diseases, pregnancy and its outcomes chronic illness and disability, injuries, ball 11W VV Let V 10 VV ~ ~ ^~ ^ ~ disorders of self-image, depression, suicide, and maltreatment of adolescents tHendee, 1991~.
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From page 88... ...
In addition, many of the health issues of adolescents, such as drug use or sexual intercourse, are socially stigmatizing or difficult to discuss. Such issues make physicianpatient relationships particularly difficult; adolescents may be
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From page 89... ...
system permits and even encourages patients to seek care from specialists rather than generalists. No aspiring new specialty, including adolescent medicine, is required to specify whether its practitioners function as generalists for its target population or, rather, as a secondary {consultative or tertiary freferral)
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From page 90... ...
There is only one school psychologist per 2,500 students nationwide, and only about 2 percent of all adolescents receive service from school psychologists Meyers, 1989; Tremper, l991J. When preventive services are offered, they have been focused on the behavioral problems seen as being reflective
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From page 91... ...
By far the leading reason is that health insurance is too expensive {70 percents; an actu~t~ona~ ~ ~ percent report that they lost health insurance as a result of job loss in the family; only 6 percent lack insurance because they feel they do not need it or want it iNewacheck and McManus, 19891. The l98l Omnibus Budget Reconciliation Act, through federal and state actions, limited eligibility for Aid to Families with Dependent Children, which in turn decreased eligibility for coverage by Medicaid.
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From page 92... ...
· About one-third of privately insured adolescents are not covered for maternity-related services. · At least eight states restrict private health insurance coverage of abortion services, and four others require it to be optional and at additional cost to the receiver.
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From page 93... ...
States can limit the frequency and number of covered services, decree certain services as not medically necessary, or restrict the sites where services are provicled. Furthermore, like private health insurance, coverage of mental health services and substance abuse services is more extensive for inpatient than outpatient services, thus discouraging early or preventive care of these types of problems U.S.
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From page 94... ...
Access will continue to be through the family, so that teenagers will not be able to receive care on their own initiative. And even for adolescents who have their own Medicaid card, access to services is often only for certain conditions, such as family planning, sexually transmitted diseases, and pregnancy services.
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From page 95... ...
Patients who have a regular source of care are more likely to be recognized as needing services, and existing mental and behavioral problems Such as those common in adolescentsJ are far more likely to be recognized if the regular source of care is a person rather than a place. People with a regular source of care have fewer emergency hospitalizations and shorter hospitalizations.
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From page 96... ...
A few states require parental notification of services related to substance abuse, and a few require it for mental health treatment. Slightly more than one-half of the states require parental consent for outpatient mental health services {U.S.
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From page 97... ...
Other prevalent health problems include substance abuse, chronic illness and disability, sexually transmitted diseases, pregnancy and its outcomes, mental disorders {e.g., disorders of self-image, depression, suiciclei, and physical or sexual abuse. At the same time, however, adolescents are far less likely to visit a doctor's office or to have any regular source of medical care than are either younger children or adults.
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From page 98... ...
Rules regarding parental notification, which have a deterrent effect in the case of family planning and abortion, may also cleter adolescents from seeking other health care services, and inadequate reimbursement schedules may cause providers to limit the number of Medicaid patients that they will serve. Current trends do not bode well for adolescent health services.
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From page 99... ...
journal of Medical Education 62~5~:401-407. 1988 Health insurance and medical care; health of our nation's children, United States.
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From page 100... ...
Newacheck, P., and M McManus 1989 Health insurance status of adolescents in the United States.
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From page 101... ...
Advance Data. National Center for Health Statistics, No.
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