Low-income Adolescents Research Articles

Outcomes from a randomized controlled trial of a multi‐component alcohol use preventive intervention for urban youth: Project Northland Chicago

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition. The study sample (n = 5812 students) was primarily African American, Hispanic and low-income. Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06). Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents

We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients. In this retrospective cohort study we used Denver Health electronic medical chart data, the Denver Health immunization registry, and Denver Public Schools enrollment data for the period from August 1, 2002, to July 31, 2003. The cohort included all 14- to 17-year-old Denver Public Schools high school enrollees who were active Denver Health patients and were either uninsured or insured by Medicaid or the State Children's Health Insurance Program. "School-based health center users" were those who had used a Denver Health school-based health center; "other users" were those who had used a Denver Health community clinic but not a school-based health center. Markers of quality included having a health maintenance visit and receipt of an influenza vaccine, tetanus booster, and hepatitis B vaccine if indicated. Multiple logistic regression analysis that controlled for gender, race/ethnicity, insurance status, chronic illness, and visit rate was used to compare school-based health center users to other users. Although school-based health center users (n = 790) were less likely than other users (n = 925) to be insured (37% vs 73%), they were more likely to have made > or = 3 primary care visits (52% vs 34%), less likely to have used emergency care (17% vs 34%), and more likely to have received a health maintenance visit (47% vs 33%), an influenza vaccine (45% vs 18%), a tetanus booster (33% vs 21%), and a hepatitis B vaccine (46% vs 20%). These findings suggest that, within a safety-net system, school-based health centers augment access to care and quality of care for underserved adolescents compared with traditional outpatient care sites.

No More 'Bois Ball

Over the past decade, tens of thousands of families have been relocated from public housing developments across the United States through HOPE VI redevelopment and demolition. The experiences of young people who, along with their families, are relocated from their homes are rarely given attention. In this article, the author analyzes qualitative interviews from 22 adolescents who were relocated from a public housing development 2 years before the interview. Themes drawn from the teens' narratives point to an overall loss in intergenerational connections and institutional ties in their new neighborhoods compared with their former neighborhoods. These findings have implications for how we view mixed outcomes for low-income adolescents in other relocation studies, such as the Moving To Opportunity demonstration.

Prior Health Care Experiences of Adolescents who Enroll in SCHIP

The State Children's Health Insurance Program (SCHIP) was designed to provide health insurance to low-income children and adolescents. Little is known about prior access to care and health care experiences of new SCHIP enrollees. We surveyed Florida and New York new adolescent SCHIP enrollees about their health status, prior health care utilization, access, and unmet needs. Most enrollees were younger (ages 12-16 years), Black or Hispanic, lived in poverty, and were without health insurance the year before SCHIP. Most had a usual source of care (USC) prior to enrollment; Blacks and Hispanics were less likely than Whites to have had a USC. Although 69% of Florida and 80% of New York adolescents reported seeing a physician the year before enrollment, 24% and 40%, respectively, reported unmet health care needs. Only 32% of Florida and 40% of the New York adolescents who were surveyed reported ever having met privately with their clinicians. Many new SCHIP enrollees report unmet needs, disparities in access, and sub-optimal care prior to enrollment. Adolescents' needs should be considered in SCHIP program and quality assurance efforts.

Socioeconomic status and medication prescription patterns in pediatric asthma in Canada

Purpose To investigate whether the socioeconomic status of children and adolescents with asthma is associated with optimal use of asthma medications in a health care system that provides free access to prescribed medications. Methods A cohort of 29,018 children (5–12 y) and adolescents (13–17 y) with asthma was reconstructed from the administrative health database of the Régie de l’assurance maladie du Québec in Canada. Adherence to the Canadian Asthma Guidelines was compared between low-income patients (patients living in families receiving social assistance) and higher-income patients (patients living in middle-class families with working parents). Both groups of patients had free, universal access to medical care and prescribed medications. Patients were considered adherent if they had: (1) 10 doses or fewer of a short-acting β 2-agonist (SABA) per week or (2) greater than 10 doses of a SABA per week plus greater than 1,000 μg of beclomethasone chlorofluorocarbon (CFC) per day. A second definition of adherence was used in which the 10 doses of SABA were replaced by 3 doses. Results Our cohort comprised 7,454 adolescents and 21,564 children. Within each definition, low-income adolescents had similar rates of adherence as higher-income adolescents ( p = .08–.4). Low-income children, however, had lower rates of adherence than higher-income children when the first definition of adherence was used (76% vs. 80%; p < .001). Conclusion Our study showed that socioeconomic status had a small influence on the likelihood of receiving treatment in adherence with the Canadian Asthma Guidelines among children, whereas no association was detected among adolescents.

Adolescents Coping with Poverty-Related Family Stress: Prospective Predictors of Coping and Psychological Symptoms

Examined prospective associations among poverty-related family stress, coping, involuntary stress reactivity, and psychological symptoms in a sample of 79 rural, low-income adolescents. Poverty-related family stress predicted adolescents’ anxious/depressed and aggressive behavior 8 months later, controlling for prior symptoms. Coping interacted with initial symptoms and involuntary stress reactivity to predict changes in symptoms over time, showing that primary and secondary control coping were most strongly associated with changes in symptoms for adolescents with low initial symptoms and involuntary stress reactivity. The only significant predictor of coping over time was prior coping, suggesting that coping is not symptom-driven and may be somewhat trait-like. Implications for interventions and additional research are offered.

Factors that influence adolescent reports of counseling by physicians on risky behavior

Purpose To determine factors that affect whether low-income adolescents report that their doctor talked with them about risky behavior. Methods Random digit-dial survey of low-income adolescents in New York City asking about depression, smoking, alcohol use, and sexual activity and the screening and counseling they received on these risk factors and risks during health visits. Results Prevalence of counseling by physicians was low, according to adolescent reports, ranging from 17% of adolescents counseled about depression to 52% about sexually transmitted diseases. Older adolescents were more likely than younger to receive counseling about all topics. In bivariate and multivariate models, having the risk factor was strongly associated with physicians counseling for depression (adjusted [adj.] OR = 4.42; p < 0.001); for sexual activity and counseling about condom use (adj. OR = 4.06; p < 0.01), and birth control (adj. OR = 2.76; p < 0.03). Still, many adolescents at risk had not received counseling. Many adolescents have not had a private and confidential visit with their provider. Having a private and confidential visit was also associated with receipt of counseling. Conclusions Adolescents are not receiving sufficient counseling about risks and risky behavior, according to their own reports. There is need to improve delivery of counseling and ensure that private and confidential visits are provided to youth.

The Role of Chaos in Poverty and Children's Socioemotional Adjustment

There are growing levels of chaos in the lives of American children, youth, and families. Increasingly, children grow up in households lacking in structure and routine, inundated by background stimulation from noise and crowding, and forced to contend with the frenetic pace of modern life. Although widespread, chaos does not occur randomly in the population. We document that low-income adolescents face higher levels of chaos than their more affluent counterparts and provide longitudinal evidence that some of the adverse effects of poverty on socioemotional adjustment are mediated by exposure to chaotic living conditions.

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments

Purpose To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. Methods Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of “no risk,” “lower risk,” and “higher risk” group classification. Results Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. Conclusions HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments

Purpose To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. Methods Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of “no risk,” “lower risk,” and “higher risk” group classification. Results Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. Conclusions HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

The impact of physical maltreatment history on the adolescent mother-infant relationship: mediating and moderating effects during the transition to early parenthood.

Using attachment theory as a framework, this paper examines how pregnant adolescents' experiences of physical maltreatment during childhood influence the subsequent mother-infant relationship in 203 low-income adolescents followed from the 3rd trimester of pregnancy through the 1st year of parenthood. The relation between physical maltreatment history and early difficulty in the mother-infant relationship was mediated by adolescents' evaluations of the relationship with their primary caretaker and the feelings they associated with motherhood measured prior to childbirth. In addition, a supportive romantic relationship during pregnancy acted as a protective factor by moderating the impact of maltreatment history on the quality of the subsequent mother-infant relationship. Findings support the importance of assessments and interventions that consider the social context and relational history of pregnant and parenting adolescents.

Out-of-school care and problem behavior trajectories among low-income adolescents: individual, family, and neighborhood characteristics as added risks.

Using a developmental systems approach, this study considered longitudinal links between adolescents' out-of-school care experiences and behavioral trajectories within a random sample of 819 adolescents ages 10 to 14 years at Wave 1 from low-income, urban families. Multiple aspects of context were considered, including the location, supervision, and structure of adolescents' care arrangements, as well as parenting practices and perceived neighborhood environments. Regression models indicated that out-of-home care, whether supervised or unsupervised, showed modest longitudinal relations with heightened rates of delinquency, drug and alcohol use, and school problems. Out-of-home care was linked with particularly deleterious outcomes for adolescents with high earlier rates of behavior problems, low parental monitoring, and low perceived neighborhood collective efficacy.

Reduced School Dropout Rates Among Adolescent Mothers Receiving School-Based Prenatal Care

Adolescent pregnancy is associated with increased school dropout rates. Dropping out amplifies the probability of persistent social and economic disadvantage. Whether school-based health centers might help reduce school absenteeism and dropout rates in this group has not been well studied. To examine the association of school-based prenatal services on school attendance and dropout rates. In this retrospective cohort study, using school rosters from an alternative school, we identified adolescents aged 18 years or younger who delivered a baby between July 1, 1995, and August 30, 1997, in Baltimore, Md. We linked school records spanning 3 years with medical records and birth certificates. School variables such as attendance and dropout rates were examined in relation to the teen's year of pregnancy and prenatal care setting (school-based vs non-school-based). Hierarchical logistic regression was used to examine effects of school-based prenatal care on dropout and promotion or graduation rates, with adjustment for baseline group differences. We identified 431 predominantly African American, low-income adolescents who attended the alternative school in their pregnancy school year. In the year prior to pregnancy, most performed poorly in school and had significant absenteeism. During their pregnancy school year, teens receiving school-based prenatal care were absent 12 fewer days, as compared with those receiving non-school-based care (P =.001), and their dropout rate was half that of those receiving non-school-based care (6% vs 15%; P =.02). Hierarchical logistic regression analyses, with adjustment for baseline prepregnancy differences, demonstrated that teens receiving school-based prenatal care were less likely to drop out of school during the pregnancy year (adjusted odds ratio, 0.39; 95% confidence interval, 0.15-0.99; P =.048). Absenteeism and dropout rates were reduced for pregnant adolescents receiving prenatal care at a school-based health center in an urban alternative school. Findings underscore the importance of funding and evaluating school-based health centers and other interventions that may ameliorate negative outcomes among childbearing adolescents.

Improving adolescents' standardized test performance: An intervention to reduce the effects of stereotype threat

Standardized tests continue to generate gender and race gaps in achievement despite decades of national attention. Research on “stereotype threat” (Steele & Aronson, 1995) suggests that these gaps may be partly due to stereotypes that impugn the math abilities of females and the intellectual abilities of Black, Hispanic, and low-income students. A field experiment was performed to test methods of helping female, minority, and low-income adolescents overcome the anxiety-inducing effects of stereotype threat and, consequently, improve their standardized test scores. Specifically, seventh-grade students in the experimental conditions were mentored by college students who encouraged them either to view intelligence as malleable or to attribute academic difficulties in the seventh grade to the novelty of the educational setting. Results showed that females in both experimental conditions earned significantly higher math standardized test scores than females in the control condition. Similarly, the students—who were largely minority and low-income adolescents—in the experimental conditions earned significantly higher reading standardized test scores than students in the control condition.

Use of health and mental health services by adolescents across multiple delivery sites

Purpose To assess the role that school-based health centers (SBHCs) play in facilitating access to care among low-income adolescents and the extent to which SBHCs and a community health center network (CHN) provide similar or complementary care. Methods A retrospective cohort design was used to compare health care service use among adolescents relying on SBHCs compared with adolescents relying on a CHN. The study sample consisted of 451 inner-city high school students who made 3469 visits between 1989 and 1993. Encounter data were abstracted from medical records. Frequency of use and reason for use are examined according to various sociodemographic and health insurance characteristics. Results SBHC users averaged 5.3 visits per year. Minority youth who used the SBHC had the highest visit rates (Hispanic, 6.6 visits/year; African-American, 10.6 visits/year). Visits to SBHCs were primarily for medical (66%, p < .001) and mental health services (34%, p < .001). Visits at CHN sites were 97% medical ( p < .001). Visits by adolescents were 1.6 times more likely to be initiated for health maintenance reasons ( p = .002; confidence interval [CI], 1.17–2.06) and 21 times more likely to be initiated for mental health reasons ( p = < .001; CI, 14.76–28.86) at SBHCs than at CHN facilities. Urgent and emergent care use in the CHN system was four times more likely for adolescents who never used a SBHC ( p < .001; CI, 3.44–5.47). Conclusions This study supports the view that SBHCs provide complementary services. It also shows their unique role in improving utilization of mental health services by hard-to-reach populations. The extent to which community health centers and other health care providers, including managed care organizations, can build on the unique contributions of SBHCS may positively influence access and quality of care for adolescents in the future.

Meeting the reproductive health care needs of adolescents: California’s Family Planning Access, Care, and Treatment Program

Purpose To examine the effect of the California Office of Family Planning’s Family Access, Care, and Treatment Program (Family PACT), which was established in 1997 to provide comprehensive, reproductive health services for low-income adolescents and adults. Program evaluation was used to measure access to services, develop a profile of users, identify service utilization patterns, and assess the sensitivity of the health care system to the needs of adolescents. Methods Data sources include baseline data on California’s previously established family planning services, enrollment, and claims data for the first 4 years of Family PACT, client exit interviews, and on-site observations. Results Adolescents represented 21% of all clients served by Family PACT in fiscal year 2000–2001 (FY 2000–2001). Adolescent clients served increased from 100,000 in FY 1995–1996 to more than 260,000 in FY 2000–2001(161% increase). The proportion of males has increased from 1% to 11%. In FY 2000–2001, Hispanics comprised 50% of adolescent clients, followed by 32% white, 9% African-American, and 6% Asian, Filipino, or Pacific Islander. Over one-half were aged 18 or 19 years, 42% were aged 15 to 17 years, and 5% were aged younger than 15 years. Contraceptive methods most often dispensed were barrier methods (55% for females, 72% for males), oral contraceptives (44%), contraceptive injections (16%), and emergency contraceptives (7%); 57% received sexually transmitted infection screening. Conclusions By linking eligibility determination to the delivery of services, removing cost barriers, increasing the numbers and types of providers offering publicly funded services, and ensuring confidentiality, greater numbers of adolescents obtained needed reproductive health care, thus ensuring an opportunity to reduce unintended pregnancies and sexually transmitted infections.

The Unique Health Care Needs of Adolescents

Health insurance coverage plays a key role in meeting adolescents' needs by increasing their access to health care, yet adolescents are more likely to lack coverage than younger children. (1) One in seven adolescents ages 10 to 18 has no form of public or private insurance. (2) Even higher rates of uninsurance are found among low-income, black, and Hispanic adolescents. For low-income adolescents, insurance through public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) is particularly important. Like younger children without coverage, adolescents without insurance use fewer health services, receive care less frequently, return for fewer follow-up appointments, and are more likely to seek care in an emergency room. (3,4) While most adolescents are healthy by traditional medical standards, a significant number of young people experience some serious physical or mental health problems or concerns. For example, approximately one in five adolescents suffers from at least one serious health problem, such as chronic conditions, asthma, or depression; and about one in four is believed to be at risk for early unprotected sexual intercourse or substance abuse. (5) Moreover, many health problems occur disproportionately among adolescents who are Medicaid and SCHIP eligible. Low-income adolescents, especially those of color, have higher rates of death, illness, and health risk behaviors in almost every category studied. (6) In addition, other subgroups of adolescents face special, heightened health risks and are more likely to have acute and complex health care needs. These groups include youth who have chronic physical or mental health conditions; live in foster or group homes; are homeless or have run away from home; are undocumented, migrant, or new immigrants; have limited English language skills; are incarcerated or involved in the juvenile justice system; or are pregnant or parenting. (7) Making adolescent health a priority is especially timely because significant demographic changes are occurring in the United States. While adolescents will represent a smaller proportion of the overall population, the number of adolescents ages 10 through 19 is expected to grow from 39.8 million in 2000 to 42.3 million in 2020, a 6.4% increase. (8) Moreover, adolescent population projections anticipate far greater numbers of young people of color, who are more likely to live in poverty, be uninsured, and underutilize primary and preventive health care services. (9) This article describes the particular health care needs of adolescents and explores the extent to which public health insurance programs are meeting those needs. It includes an overview of the coverage available to adolescents through Medicaid and SCHIP, how that coverage has evolved, the importance of providing comprehensive benefits to adolescents, and the need to adopt age-appropriate quality and performance measures to track progress over time. Throughout the article, recommendations are provided to strengthen health care services for adolescents, informed by the work of several national health care and policy organizations. (10) Special Health Care Needs of Adolescents Adolescence is a unique developmental stage of accelerated growth, when a number of physiological, cognitive, social, mad emotional changes occur simultaneously. Despite the lack of a formally established age range to define this developmental period, health professionals generally consider adolescence to include young people ages 10 through 19, or those ages 10 through 24. (11) During the transition from childhood into adolescence and again from adolescence into adulthood, youth have complex and important health care needs. Also, adolescence is a critical time to avoid the onset of health-damaging, risky, behaviors such as smoking and unsafe sexual activity that can lead to lifelong health problems. Thus, health care services for adolescents need to emphasize prevention, early intervention, mad education. …

Child Birth Education for Adolescents: Removing the Barriers That Prevent Attendance at Child Birth Classes

AbstractNearly half the families in a rural county in Southwestern Pennsylvania have annual incomes less than $35,000. Poverty, a predictor of adolescent sexual activity American Academy of Pediatrics. Adolescent pregnancy-current trends and issues: 1998. Pediatrics 1999; 103(2):516; Retrieved 06 15, 2002 Health Reference Center—Academic Web Site at http://web1.infotrac.galegroup.com/itw/infomark/1/1/1/purl=rc6_HRCA), may contribute to the adolescent pregnancy rate in this county. Twelve percent of clientele from a low-income pre/postnatal clinic in this county are adolescent mothers. Many low-income adolescents refrain from attending childbirth classes because there are no perceived benefits from these classes. The Health Belief Model is used to assess the extraneous and intrinsic variables that prevent this clientele from attending childbirth class and proposes an intervention plan addressing these variables.

Family Food Insufficiency, but Not Low Family Income, Is Positively Associated with Dysthymia and Suicide Symptoms in Adolescents

Food insufficiency has been shown to be associated with poor health, academic and psychosocial outcomes in American children, but the relationship between food insufficiency and depressive disorders in U.S. adolescents has not been studied. Further, there are no national estimates of the prevalence of depressive disorders for U.S. adolescents, nor investigation of associations with sociodemographic characteristics using national data. Therefore, we analyzed data for 15- and 16-y-old adolescents from the Third National Health and Nutrition Examination Survey (NHANES III). Depressive disorders and suicidal symptoms were assessed using the Diagnostic Interview Schedule. Adolescents were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not have enough to eat. The prevalence of depression outcomes is reported by sociodemographic characteristics. Odds ratios for associations with food insufficiency are reported, adjusted for sociodemographic factors. Overall, lifetime prevalence of major depressive disorder was 6.3% and of dysthymia, 5.4%. Almost 5% of 15- to 16-y-old adolescents reported that they had ever attempted suicide and 38.8% reported at least one suicidal symptom. Female adolescents were significantly more likely than males to have had dysthymia, any depressive disorder and all symptoms of suicide. Low income adolescents were less likely to report suicide ideation than high income adolescents, but there were no other differences by family income. Food-insufficient adolescents were significantly more likely to have had dysthymia, thoughts of death, a desire to die and have attempted suicide. There is a strong association between food insufficiency and depressive disorder and suicidal symptoms in U.S. adolescents.

Decision Making Correlates of Depressive Symptoms among African-American Adolescents: Implications for Prevention Approaches

Depression is the most common disorder of all mental illnesses. According to Healthy People 2010, one in five children and adolescents between the ages of 9 and 17 years has a diagnosable mental disorder in a given year. Adolescent depression is associated with impairment of functioning particularly in the domains of decision making and self-efficacy. The present investigation examined the relationship between depressive symptoms and decision making among a nonreferred, nonclinical community sample of 276 low-income African-American adolescents. The students ranged in age from 12 to 17 years. The Children's Depression Inventory (CDI) was used to assess depressive symptomatology among participants. The Flinders Adolescent Decision Making Questionnaire was used for assessing participants' decision making and decision coping patterns. The instrument was group-administered in classroom settings by a health educator and a clinical psychology graduate student. Findings indicated a significant correlation between adolescents' self-reported depressive symptomatology, as represented by their CDI scores, and inadequacy toward making decisions. Perhaps increasing competence in decision making may have beneficial effects on overall mood and depressive symptoms among at-risk adolescent populations.