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Carol A. Ford, MD; Peter S. Bearman, PhD; James Moody, PhD

JAMA. 1999;282:2227-2234.

Context  No annual national population estimates exist of the numbers of adolescents who think they need but do not receive health care or their risk of health problems.

Objective  To describe the proportion of adolescents who report foregone health care each year and the influence of sociodemographic factors, insurance status, past health care, and health risks/behaviors on foregone care.

Design  Cross-sectional analyses of data from wave 1 of the National Longitudinal Study of Adolescent Health, conducted during 1995.

Setting  In-home interviews conducted throughout the United States.

Participants  Of 27,000 adolescents in grades 7 through 12 who were invited to participate, 20,746 (76.8%) completed the in-home interview.

Main Outcome Measure  Reported foregone health care in the preceding year by individual and family characteristics, insurance status, past health care, health/behavior risk factors, and symptoms.

Results  On average, 2268 (18.7%) of 12,079 adolescents reported foregone health care within the past year. Factors associated with decreased risk of foregone care included continuous private or public insurance (adjusted relative risk [95% confidence interval], 0.64 [0.50-0.82] to 0.82 [0.70-0.96]), and having a physical examination within the past year (0.87 [0.78-0.97] for male and 0.79 [0.70-0.88] for female adolescents). Factors associated with increased risk of foregone care included older age (1.12 [1.06-1.15] for male), minority race/ethnicity (1.25 [1.06-1.46] to 1.50 [1.30-1.73]), single-parent home (1.31 [1.18-1.46] for female), and disability (2.03 [1.61-2.52] for male and 1.66 [1.20-2.10] for female). Adolescents participating in the following behaviors were more likely to report foregone care than those who did not: daily cigarette use (26.0% vs 16.8%; 1.34 [1.16-1.55]), frequent alcohol use (30.3% vs 18.1%; 1.34 [1.11-1.62] for male), and sexual intercourse (25.1% vs 15.1%; 1.23 [1.09-1.39] for male and 1.39 [1.23-1.56] for female). From 32.4% to 38.2% of adolescents with symptoms suggesting health problems reported foregone care (1.61 [1.13-2.26] to 2.03 [1.81-2.28]).

Conclusions  Our study suggests that adolescents who forego care are at increased risk of physical and mental health problems. Efforts to improve adolescent health through health care should address factors influencing foregone care.

Author Affiliations: Departments of Medicine and Pediatrics (Dr Ford) and Sociology (Drs Bearman and Moody), University of North Carolina, Chapel Hill. Dr Bearman is currently at Columbia University, New York, NY, and Dr Moody is currently at The Ohio State University, Columbus.

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