Current Trends: Availability of Comprehensive Adolescent Health Services - United States, 1990
Klein, J. D., Starnes, S. A., Kotelchuck, M., DeFriese, G. H., Loda, R. A., Earp, J. A., Journal of School Health
The national health objectives for the year 2000 target reduction of behaviors that place adolescents at risk for human immunodeficiency virus (HIV) infection and other sexually transmitted diseases, unintended pregnancies, and other health problems.|1~ Although clinical preventive services are an important component of health promotion and disease prevention programs required to achieve these objectives,|2~ adolescents and young adults are less likely to have access to health care than younger and older persons.|2,3~ To characterize comprehensive health service programs for adolescents (persons ages 13-19) and whether such programs provide targeted services to adolescents at risk for HIV infection or infected with HIV, the Center for Health Promotion and Disease Prevention at the University of North Carolina at Chapel Hill conducted a national survey of such programs in 1991. This report summarizes results of the survey.
Programs providing comprehensive health services to adolescents were identified through a review of publications, mailing lists, adolescent health experts, provider organizations, state and local maternal and child health directors, foundations, and other sources.|3~ A total of 664 such programs was identified nationwide; at least one program was identified in each state except Montana, Nebraska, North Dakota, South Dakota, Vermont, and Wyoming. To assess validity of the census, local experts reviewed the lists of identified programs in a sample of four states (Kentucky, Maryland, Mississippi, and Washington) and one large metropolitan area (San Francisco, Calif.) In each area, 85% to 90% of all programs had been identified.
A questionnaire was mailed to directors of the 664 programs. Of 435 (66%) programs that responded, 195 (45%) were based in schools, 96 (22%) in hospitals, 48 (11%) in health centers, 39 (9%) in community centers, 35 (8%) in public health departments, and 22 (5%) in other sites. Nonrespondents were distributed equally among geographical regions of the United States. Programs in rural counties were more likely to respond than programs in metropolitan statistical areas (MSAs) (78% versus 67%, p |is less than~ .01).
The highest proportion (201, 30%) of all 664 programs was located in nine northeastern states. Of 278 programs in urban communities, 83 (30%) were hospital-based programs, 110 (40%) school-based programs, and 10 (4%) health department programs. Of 115 responding programs in rural communities, 64 (56%) were school-based programs and 21 (18%) were health department programs.
In 1990, the 435 programs served 605,185 adolescents (median: 720 adolescents per program, range: 13-40,000 adolescents) -- approximately 2.5% of the 1990 U.S. adolescent population (24,336,100). These programs reported 2,175,561 patient encounters, for an average of 3.6 visits per adolescent. The ratio of adolescent health programs to the population of adolescents in each state varied widely.|3~
A total of 313 (72%) programs received federal funding from different sources, including Medicaid, Title V (Maternal and Child Health), Title X (Family Planning), and Title XX (Family Life Programs). In addition, 326 (75%) received state or local government funding, 109 (25%) received state or local health department funding, 17 (4%) received state education agency funding, and 129 (30%) programs received private foundation funding.
Almost all programs provided primary health care (396, 91%), health education (405, 93%), and HIV-prevention education (409, 94%). Some 200 (46%) provided services during evenings, and 91 (21%) provided services during the weekend. Although 187 (43%) programs targeted sexual risk behavior among adolescents, these programs were no more likely than other programs to provide family planning services (77% versus 70%, p = 0.14), contraceptives (62% versus 57%, p = 0.28), or HIV-antibody testing (50% versus 43%, p = 0.16) on site. Sixty-four (15%) programs targeted services to adolescents infected with HIV. …