title: Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care.
abstract: Adolescents are low users of medical care. Psychological factors and perceived reasons to not seek routine medical care may increase risk of nonuse by adolescents with undiagnosed asthma. This study tests if psychological factors were associated with seeing a medical provider for asthma-like symptoms; identifies adolescents' perceived reasons for not obtaining care; explores if psychological factors are associated with these perceptions; and explores if asthma severity moderates the relationships with psychological factors.
  
  
  
  We analyzed cross-sectional data from a baseline assessment of 349 urban, primarily ethnic minority adolescents with moderate to severe asthma-like symptoms but no asthma diagnosis who were enrolled in a controlled trial.
  
  
  
  The odds of seeing a provider for their asthma-like symptoms were significantly higher for those with asthma-related anxiety (odds ratio [OR]: 1.644; 95% confidence interval [CI]: 1.242-2.176) and depressive symptoms (OR: 1.031; 95% CI: 1.004-1.059). The most commonly endorsed reason for noncare included a characterization of symptoms as not serious, past medical visits not diagnosed as asthma, fear of diagnosis, busy lifestyles, and not wanting medication. Psychological factors were not related to the number of reasons or to most of the commonly endorsed reasons. Adolescents with more asthma-related anxiety were less likely to characterize their breathing problems as serious (OR = .0583; 95% CI: .424-.802) and were more likely to report busy lifestyles (OR = 1.593; 95% CI: 1.122-2.261).
  
  
  
  Adolescent-perceived reasons for noncare were not pragmatic, but instead highlighted denial. Asthma-related anxiety was the most robust psychological factor associated with the decision to seek medical care.
authors: School of Nursing, Columbia University, New York, New York. Electronic address: jb3958@cumc.columbia.edu.
authors: Jean-Marie
authors: JM
authors: Bruzzese
authors: Department of Psychology, Dickinson College, Carlisle, Pennsylvania.
authors: Sharon
authors: S
authors: Kingston
authors: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York.
authors: Yihong
authors: Y
authors: Zhao
authors: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York.
authors: John S
authors: JS
authors: DiMeglio
authors: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York.
authors: Amarilis
authors: A
authors: Céspedes
authors: School of Nursing, Columbia University, New York, New York.
authors: Maureen
authors: M
authors: George
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001007:Anxiety / Q000523:psychology; D001249:Asthma / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012720:Severity of Illness Index; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Adolescents; Asthma; Barriers to medical care; Routine health care utilization; Urban