Barriers at the Frontline: Assessing and Improving the Teen Friendliness of South Bronx Medical Practices

Abstract

Despite improvements in New York City (NYC) residents’ health in the past decade,1 disparities exist between economically disadvantaged and advantaged neighborhoods.2 In 2002, the NYC Department of Health and Mental Hygiene (DOHMH) created three District Public Health Offices (DPHOs) in the impoverished neighborhoods of the South Bronx, East and Central Harlem, and North and Central Brooklyn. The DPHOs aim to promote health equity in these areas. The Bronx DPHO targeted teenage pregnancy rates, which are persistently higher in the South Bronx than in the United States. In 2007, the South Bronx teen pregnancy rate was 133 per 1,000 females aged 15 –19 years, compared with 72 per 1,000 in the U.S.3,4 We hypothesized that in addition to neighborhood determinants of poverty and education, the high teen pregnancy rate in the South Bronx was partly attributable to low hormonal contraceptive use. Findings from the 2005 Youth Risk Behavior Survey revealed that South Bronx students reported relatively high condom use (68%) but extremely low birth control pill use (6%) compared with U.S. teenagers (63% and 18%, respectively).5,6 A Bronx survey also found that teens with access to confidential services were three times as likely to initiate gynecologic care compared with teens who lacked such access.7 This article illustrates a novel approach taken by the New York City Department of Health and Mental Hygiene to rapidly test the efficacy of an intervention to improve teen friendliness of frontline staff working in South Bronx medical practices. It is not always clear exactly which aspects of poor access to care and poor utilization of services help drive high teen pregnancy rates in communities, but the authors have identified teen friendliness of services as an important intermediate outcome. Even when proved ineffective, their systematic efforts to achieve improvements are commendable as a way to target sexual and reproductive health care for teens. Lorna Thorpe Director, Epidemiology and Biostatistics Program City University of New York School of Public Health, Hunter College