title: Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, San Francisco, California, USA. jlehrer1@gmail.com
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Lehrer
authors.forename: Robert
authors.initials: R
authors.lastname: Pantell
authors.forename: Kathleen
authors.initials: K
authors.lastname: Tebb
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Shafer
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000428:Alcohol Drinking / Q000453:epidemiology; D016001:Confidence Intervals; D003219:Confidentiality; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010287:Parent-Child Relations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D017678:Sex Distribution; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology