Original article
Forgone Health Care among U.S. Adolescents: Associations between Risk Characteristics and Confidentiality Concern

https://doi.org/10.1016/j.jadohealth.2006.09.015Get rights and content

Abstract

Purpose

To examine risk characteristics associated with citing confidentiality concern as a reason for forgone health care, among a sample of U.S. adolescents who reported having forgone health care they believed was necessary in the past year.

Methods

The study used data from Wave I home interviews of the National Longitudinal Study of Adolescent Health. The generalized estimating equations method was used to account for the clustered nature of the data.

Results

Prevalence of several risk characteristics was significantly higher among boys and girls who reported confidentiality concern, as compared with those who did not report this concern. Regression analyses for boys (n = 1123), which adjusted for age, race/ethnicity, parental education and insurance type showed that high depressive symptoms, suicidal ideation, and suicide attempt were each associated with increased odds of reporting confidentiality concern as a reason for forgone health care. In multivariate analyses for girls (n = 1315), having ever had sexual intercourse, birth control nonuse at last sex, prior sexually transmitted infection, past-year alcohol use, high and moderate depressive symptoms, suicidal ideation, suicide attempt, and unsatisfactory parental communication were each associated with increased odds of citing confidentiality concern as a reason for forgone care.

Conclusion

The population of U.S. adolescents who forgo health care due to confidentiality concern is particularly vulnerable and in need of health care services. Adolescents who report health risk behaviors, psychological distress and/or unsatisfactory communication with parents have an increased likelihood of citing confidentiality concern as a reason for forgone health care, as compared with adolescents who do not report these factors. Findings of this study suggest that if restrictions to confidentiality are increased, health care use may decrease among adolescents at high risk of adverse health outcomes.

Section snippets

Study design

The study used Wave I home interview data from the National Longitudinal Study of Adolescent Health (Add Health). Details regarding the Add Health study design have been presented elsewhere [12]. In summary, a stratified random sample of 80 U.S. high schools was selected from a list of eligible high schools; high schools were stratified by factors including region, urbanicity, school size, school type, and race/ethnic composition. One feeder school for each high school was also randomly

Results

Descriptive statistics for the study sample are presented in Table 1. By construction of the sample, all subjects reported having forgone needed health care in the past year; 10.5% of boys and 14.3% of girls reported that this was due, in part or in whole, to confidentiality concern (Table 1). Girls were more likely than boys to report confidentiality concern as a reason for forgone health care (p < .01).

Discussion

This national study examined risk characteristics of adolescents for whom confidentiality concern prevented the seeking of health care. The study findings suggest that U.S. adolescents who forgo care due in whole or in part to confidentiality concern are a particularly high-risk population in need of health care services. Among boys, prevalence of mental health difficulties was significantly higher among those who cited confidentiality concern as a reason for forgone care, as compared with

Acknowledgments

This work was supported by a grant from the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Bureau of Maternal and Child Health – Leadership and Education in Adolescent Health Training. This research used data from Add Health, a program project designed by J. Richard Udry, Ph.D., Peter S. Bearman Ph.D., and Kathleen Mullan Harris, Ph.D., and funded by Grant P01-HD31921from the National Institute of Child Health and Human Development, with cooperative

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