Original Articles
Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents

https://doi.org/10.1016/S1054-139X(98)00159-1Get rights and content

Abstract

Purpose: To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender.

Methods: All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3596), 9th (n = 3691), and 11th (n = 2772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression.

Results: The majority of usual sources of medical care services were community clinics or private doctors’ offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor’s office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care.

Conclusions: The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.

Section snippets

Research design

The results reported here are from a secondary analysis of survey data originally collected from 10,059 students in 7th (n = 3596), 9th (n = 3691), and 11th (n = 2772) grades in the state of Connecticut in 1996. A stratified random sampling strategy was used to ensure a sample that was representative of youth in public schools throughout this geographically and economically diverse state. The sampling frame used a set of geographic and socioeconomic criteria established by the state Department

Demographics

Roughly half of the subjects [n = 389 (54.3%)] were born on the U.S. mainland and two were born in Hawaii or Alaska. Of those remaining, twice as many [n = 216 (30.1%)] were born in Puerto Rico as were born in other countries [n = 107 (14.9%)]. There were three cases of missing data.

Enabling resources

The majority [n = 537 (74.9%)] reported that their mothers lived at home, while fewer [n = 390 (54.4%)] reported that their fathers lived at home. Over half responded that they lived with two parents [n = 387

Discussion

The finding that private physicians were the usual source of care for Hispanic subjects who were born in Puerto Rico and other countries, while emergency rooms and clinics were the usual sources of care for U.S.-born subjects, was somewhat surprising, as it is unlike reports about adults from Puerto Rico (15). These differences may be explained in part by differences in socioeconomic status, legal immigrant status of those born outside the United States, and general socialization of both groups

Acknowledgements

This study was supported in part by a grant to L.R. from the National Institute of Nursing Research, NIH (1 F33 NR07126-01), and by a grant to M.R. and T.B. from Voice of Connecticut Youth.

References (41)

  • S.M Saunders et al.

    Formal help-seeking behavior of adolescents identifying themselves as having mental health problems

    J Am Acad Child Adolesc Psychiatry

    (1994)
  • C Brindis

    Adolescent pregnancy prevention for Hispanic youthThe role of schools, families, and communities

    J Sch Health

    (1992)
  • E Ginzberg

    Access to health care for Hispanics

    JAMA

    (1991)
  • R.B Valdez et al.

    Improving access to health care in Latino communities

    Public Health Rep

    (1993)
  • D.C Warner

    Health issues at the US–Mexican border

    JAMA

    (1991)
  • T.V Ellerbrock et al.

    Epidemiology of women with AIDS in the United States, 1981–1990A comparison with heterosexual men with AIDS

    JAMA

    (1991)
  • R.T Rolfs et al.

    Epidemiology of primary and secondary syphilis in the United States 1981–1989

    JAMA

    (1990)
  • R.J DiClemente

    Epidemiology of AIDS, HIV prevalence, and HIV incidence among adolescents

    J Sch Health

    (1992)
  • P.K Pletsch

    HispanicsAt risk for adolescent pregnancy?

    Public Health Nurs

    (1990)
  • Hispanic health in the United States

    JAMA

    (1991)
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