Current Status and Approaches to Improving Preventive Services for Adolescents

Igra, Vivien

doi:10.1001/jama.1993.03500110076039

Cited by 89 publications

(51 citation statements)

References 19 publications

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“…23,42 These strategies will need to be linked to efforts to support physicians' delivery of high-quality adolescent clinical preventive services, such as STI/HIV testing and age-appropriate immunizations. [43][44][45] A major strength of this study is its prospective nature and the use of a racially and ethnically diverse national sample. This study also has several potential limitations.…”

Section: Discussionmentioning

confidence: 99%

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

et al. 2007

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OBJECTIVES-Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents. PATIENTS AND METHODS-We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990-1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2.RESULTS-On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in ≥2 other risk behaviors had neither a higher nor lower likelihood of a physical examination.CONCLUSIONS-Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care. Two modifiable factors that may influence adolescent male health care use have been largely ignored in the research literature. First, although parent-teen communication has been shown to be an important contributor to adolescent health, the relationship between parental communication and access to care for sons has received little attention. Second, the way in which men are socialized in the United States (eg, to be tough, competitive, and inexpressive), defined as beliefs about masculinity, has been shown to influence adult men's health care use 24-26 but has not been examined in adolescence.The National Survey of Adolescent Males (NSAM) provides a unique opportunity to address gaps in our knowledge. The main objective of this prospective study is to test the combined influence of modifiable and non-modifiable factors, organized around Andersen's Behavioral Model of Health Services Use framework, to predict the report of health care use by male adolescents. We also specifically focus on the relationship amo...

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Section: Discussionmentioning

confidence: 99%

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

et al. 2007

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“…23 Since adolescents view physicians as credible sources of health information23 and are willing to see health providers they perceive as respectful of teens,24 physician visits are an important opportunity to change destructive health habits. The reduced access to ambulatory care among Caribbean immigrant adolescents suggests that they may be at substantially increased risk of adverse health outcomes.…”

Section: Methodsmentioning

confidence: 99%

Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents.

Sonis

1998

Am J Public Health

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OBJECTIVES: The purpose of this study was to determine the association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents. METHODS: A cross-sectional survey of adolescents at a New York City high school was conducted. Multivariate modeling methods were used to adjust for demographic and socioeconomic covariates. RESULTS: Duration of residence was strongly and directly associated with access to ambulatory care after adjustment for ethnicity. CONCLUSIONS: Caribbean immigrant adolescents, particularly recent immigrants, have reduced access to ambulatory care.

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“…It is known that successful implementation of preventive services in practice requires systematic screening, 12 yet many clinicians do not use such systematic approaches, which potentially prevents patients from receiving recommended services. [13][14][15] The QI curriculum added to AHIPP was designed to encourage a disciplined approach to systematic screening through the experience of implementing the AHIPP research protocol. This ability to screen systematically could then be applied to other areas of clinical practice.…”

Section: Development Of a Qi Curriculummentioning

confidence: 99%

Maintenance of Certification Part 4 Credit and Recruitment for Practice-Based Research

Gorzkowski¹,

Klein²,

Harris

et al. 2014

Pediatrics

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BACKGROUND: Competing priorities in pediatric practice have created challenges for practice-based research. To increase recruitment success, researchers must design studies that provide added value to participants. This study evaluates recruitment of pediatricians into a study, before and after the development and addition of a quality improvement (QI) curriculum approved for American Board of Pediatrics Maintenance of Certification (MOC) Part 4 Credit as an enrollment incentive. METHODS: Researchers implemented multiple outreach methods to enroll pediatric practices over 28 months. Field note review revealed that many physicians declined enrollment, stating that they prioritized MOC Part 4 projects over research studies. A QI curriculum meeting standards for MOC Part 4 Credit was developed and added to the study protocol as an enrollment incentive. Enrollment rates and characteristics of practitioners enrolled pre- and post-MOC were compared. RESULTS: Pre-MOC enrollment contributed 48% of practices in 22 months; post-MOC enrollment contributed 49% of practices in 6 months. An average of 3.5 practices enrolled per month pre-MOC, compared with 13.1 per month post-MOC (P < .001). Clinicians in pre- and post-MOC groups were similar in age, gender, race, and time spent on patient care; practices enrolled post-MOC were more likely to be located in federally designated Medically Underserved Areas than those enrolled pre-MOC (28.6% vs 12%, P = .03). CONCLUSIONS: Addition of MOC Part 4 Credit increased recruitment success and increased enrollment of pediatricians working in underserved areas. Including QI initiatives meeting MOC Part 4 criteria in practice-based research protocols may enhance participation and aid in recruiting diverse practice and patient populations.

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Current Status and Approaches to Improving Preventive Services for Adolescents

Cited by 89 publications

References 19 publications

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents.

Maintenance of Certification Part 4 Credit and Recruitment for Practice-Based Research

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