title: Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care.
abstract: Adolescent girls face unique challenges in health care utilization, which can result in unmet needs. We sought to describe settings of usual care and primary care use, and to identify predictors of foregone care and experience of confidential care in a primarily racial/ethnic minority low-income sample. We conducted an anonymous computer-assisted self-administered survey of 9th-12th grade girls (n=819) in three Bronx public high schools, the majority of whom were Hispanic (69.8%) and Black (21.4%). Most (80%) reported having a usual source of care. Of these, 77.2% had a regular doctor. Those least likely to have a usual source of care were non-U.S. born girls (73.1% vs. 83.1%) and less acculturated girls. Predictors of foregone care in the last year include being sexually active, poor family social support, and low self esteem. Predictors of access to confidential care at last visit were age, self-efficacy for confidential care, having a regular doctor, setting of care, and having had a recent physical exam. Many urban adolescent girls, especially non-U.S. born girls, lack a usual source of care and regular health care provider. Continued attention to reducing both financial and non-financial barriers to care is required to ensure access to and quality of care for diverse populations.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, USA. mckee@aecom.yu.edu
authors.forename: Diane
authors.initials: D
authors.lastname: McKee
authors.forename: Jason
authors.initials: J
authors.lastname: Fletcher
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000328:Adult; D003219:Confidentiality; D003466:Cultural Characteristics; D004641:Emigration and Immigration; D005006:Ethnicity; D005260:Female; D006801:Humans; D009519:New York City; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014505:Urban Population