A large and rapidly growing share of US government expenditures pays for assistance to working-age people with disabilities. In 2008 federal spending for disability assistance totaled $357 billion, representing 12 percent of all federal outlays. The states' share of joint federal-state disability programs, more than 90 percent of it for Medicaid, was $71 billion. The increased cost of health care-which represented 55 percent of combined state and federal outlays for this population in 2008-is one of the two main causes of spending growth for people with disabilities. Health care is already likely to be a target of further efforts by states and the federal government to contain or reduce spending, and it is therefore probable that spending restraints will affect the working-age population with disabilities. In fact, unless ways can be identified to make delivery of health care to this population more efficient, policy makers may be unable to avoid funding cuts that will further compromise its well-being.
BACKGROUND The reproductive health of American adolescents has been, and continues to be, a matter of serious concern. America's teen birth rate-already one of the highest among developed nations-is again on the rise. Also, rates of sexually-transmitted infection (STI) among teens remain disconcertingly high, 1 with one-quarter of the 19 million new cases of STIs each year occurring to 15-to 19-year-olds. 2 In 2006, there were nearly 442,000 births to adolescents under the age of 20. 3 Many out-of-school time programs serving adolescents seek to reduce the occurrence of reproductive health problems, such as pregnancies and STIs, among program participants. Other programs, even if not directly concerned with improving participants' reproductive health, can still be attuned to reproductive health issues facing adolescents and may wish to monitor participant health and sexual risk-taking. This brief discusses adolescent reproductive health and provides program practitioners with questions that can be used to screen or monitor reproductive health among out-of-school time program participants.
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