Probst Janice C, Moore Charity G, Baxley Elizabeth G
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
J Rural Health. 2005 Fall;21(4):279-87. doi: 10.1111/j.1748-0361.2005.tb00096.x.
Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences.
To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents.
Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need.
Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes.
Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.
青春期对于养成成年人的健康习惯至关重要。农村与城市青少年之间以及少数族裔与白人青少年之间的差异可能会产生终身影响。
比较农村少数族裔青少年与白人和城市青少年的医疗保险覆盖情况及门诊医疗接触情况。
采用横断面设计，使用1999 - 2000年全国健康访谈调查的数据，该调查是美国家庭的全国代表性样本。分析仅限于12至17岁的白人、黑人及西班牙裔儿童（8503个观察对象）。结果指标包括医疗保险、过去一年的门诊就诊、通常的医疗来源（USOC）以及过去一年的健康检查。自变量包括种族、居住地、人口统计学特征、促进/有利特征和需求。
在所有种族中，农村青少年拥有保险的可能性与城市儿童相近（86.8%对87.7%），但报告进行预防性就诊的可能性低于城市儿童（60.1%对65.5%）；居住地并不影响就诊或有通常医疗来源的可能性。少数族裔农村青少年比白人青少年获得保险、报告就诊或有通常医疗来源的可能性更低。在多变量分析中，在保持生活状况、照顾者教育程度、收入和保险不变的情况下，大多数基于种族的差异并不显著。照顾者英语流利程度低几乎仅局限于西班牙裔，这对所有结果都有阻碍。
农村和少数族裔青少年获得医疗服务的大多数障碍可归因于医疗保健系统之外的因素，如语言、生活状况、照顾者教育程度和收入。需要开展外展活动以及改善农村学校和经济机会的项目相结合，以提高青少年的保险覆盖范围和医疗服务利用率。
