Van Eck Kathryn, Thakkar Madhuli, Matson Pamela A, Hao Lingxin, Marcell Arik V
Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Am J Prev Med. 2021 May;60(5):e221-e229. doi: 10.1016/j.amepre.2020.12.008. Epub 2021 Feb 27.
Well-care use can positively impact adolescents' current and future health. Understanding adolescents' longitudinal well-care use is critical to determine to whom and when to target engagement strategies to improve healthcare access. This study describes prospective well-care use patterns from childhood through adolescence stratified by sex.
The sample (N=6,872) was drawn from the Child/Young Adult component of the household-based 1979 National Longitudinal Survey of Youth consisting of biological children born to female respondents (1980-1997). Well-care use (routine checkup with a doctor within last year) data were assessed from age 5 years (1986-2003) until age 17 years (1998-2015). Conducted in 2019, latent class analyses stratified by sex identified well-care use patterns reported over 7 biennial time points adjusted for cohort, race/ethnicity, urbanicity, maternal education, and insurance.
A total of 4 well-care use classes emerged for female adolescents: the majority belonged to Engaged (37%) and Moderately Engaged (39%) classes and the remainder belonged to Gradually Re-engaged (14%) and Disengaged-with-Rebound (10%) classes. A total of 3 classes emerged for male adolescents: the majority belonged to the Persistently Disengaged (48%) class and the remainder belonged to Engaged (34%) and Gradually Re-engaged (18%) classes. For both sexes, comparing each cohort with the first, Engaged class membership increased for subsequent cohorts. Less engaged well-care use classes had more non-Hispanic White adolescents living in rural areas with lower insurance coverage. Maternal education differentiated well-care use classes for male but not for female adolescents, being higher for male adolescents in the Engaged class than in other classes.
These findings highlight that well-care use patterns for both sexes changed during the transition from childhood to adolescence and that class membership differed by covariates. These results suggest that sex-specific strategies may be needed to enhance adolescents' well-care use engagement over time.
定期健康护理的使用能够对青少年当前及未来的健康产生积极影响。了解青少年长期的定期健康护理使用情况对于确定针对何人以及何时采取参与策略以改善医疗保健可及性至关重要。本研究描述了从童年到青少年阶段按性别分层的前瞻性定期健康护理使用模式。
样本（N = 6872）取自1979年基于家庭的全国青年纵向调查中的儿童/青年成人部分，该部分由女性受访者（1980 - 1997年）生育的亲生孩子组成。定期健康护理使用情况（过去一年内与医生进行的常规体检）数据从5岁（1986 - 2003年）评估至17岁（1998 - 2015年）。于2019年进行的按性别分层的潜在类别分析确定了在针对队列、种族/族裔、城市化程度、母亲教育程度和保险进行调整后的7个两年期时间点上报告的定期健康护理使用模式。
女性青少年共出现4种定期健康护理使用类别：大多数属于积极参与类（37%）和适度参与类（39%），其余属于逐渐重新参与类（14%）和反弹后脱离类（10%）。男性青少年共出现3种类别：大多数属于持续脱离类（48%），其余属于积极参与类（34%）和逐渐重新参与类（18%）。对于两性而言，将每个队列与第一个队列进行比较，后续队列中积极参与类别的成员比例增加。参与度较低的定期健康护理使用类别中有更多非西班牙裔白人青少年居住在保险覆盖较低的农村地区。母亲教育程度区分了男性青少年的定期健康护理使用类别，但未区分女性青少年的类别，积极参与类别的男性青少年的母亲教育程度高于其他类别。
这些发现突出表明，从童年到青少年的过渡期间，两性的定期健康护理使用模式发生了变化，且类别成员因协变量而异。这些结果表明，可能需要针对性别的策略来随着时间推移提高青少年对定期健康护理使用的参与度。
