Prior research has shown that adolescents in medically underserved areas do not often seek medical attention unless they suffer from an acute problem. Providing comprehensive health care to this population can therefore be a challenging task. Although methods to improve access to care for adolescents have been extensively documented, providers need to be aware of the specific needs of the adolescent population in their community and in the substantial variations that may exist among different racial/ethnic and cultural groups in the same region.
To define the specific health needs of an urban adolescent population and to stratify those needs based on race/ethnicity and gender, which will ultimately provide for more informed care.
A bilingual needs-assessment survey was completed as part of an American Academy of Pediatrics CATCH Grant. Surveys were distributed at 5 ambulatory pediatric clinic sites. Subjects 12-18 yrs of age were eligible.
141 of the 60-item surveys were collected. Females completed 59%, males 32%. The study sample was 67% Hispanic and 29% African American. Statistically significant responses (p< .05) included: 50% of Hispanic youth preferred the availability of after-school clinic hours, compared to 23% of African American youth. More Hispanics (32%) than African Americans (6%) had been admitted to the hospital. Hispanics were more likely to have friends who smoked (38%) and drank alcohol (51%) than their African American counterparts, (9% and 13% respectively). 76% of Hispanic adolescents reported having a trusted person to talk to (compared to 33% in African American), and Hispanic adolescents (34%) reported more depressive symptoms in the preceding weeks than African American adolescents (7%). Analyzed for gender, 32% of females reported depressive symptoms compared to 7% in their male counterparts.
These data suggest that providers should utilize appropriate tools such as a needs- assessment survey to better understand specific issues affecting a particular adolescent population. In this study, certain issues were more common in the Hispanic subset of our urban population than the African-American subset. While all adolescents must be screened for a range of medical and psychosocial issues, knowing the likelihood of certain conditions in the local adolescent population may allow the provider to more effectively screen and improve overall care. Limitations of the study include reporting bias of the subjects and relatively small sample size. More investigation is warranted to further delineate the needs of this urban adolescent population and to develop programs tailored to address these needs.
Adolescents everywhere need access to medical care that is convenient, confidential and age-appropriate. Adolescents are often resistant to being seen as either children or adults, and shy away from medical care that sees them as such. Health care providers may be able to improve access to medical care if these issues, along with specific issues that may pertain to a certain community, are addressed. 1
In the Bronx, adolescents are also significantly less likely to have access to a medical home that can provide comprehensive, year-round care, less likely to have insurance coverage (even if they are eligible for State Child Health Insurance Program (CHIP)), and less likely to speak the language of their Primary Care Provider. Current alternatives for health care for adolescents in the area include school based clinics, which are not open year round, and Planned Parenthood, which offers comprehensive family planning, but not comprehensive health care. A formal needs assessment of the adolescents in our community was developed in order to clearly define the health needs of this at-risk population and develop a plan to improve access to a medical home for Bronx adolescents.
A needs assessment survey was developed to help advance the health status of adolescents in our Bronx community. By defining the barriers to care, we will be able to implement a practical and comprehensive health program for the adolescents of the Crotona-Tremont neighborhood. A driving force behind this initiative included the report “Healthy Youth 2010: Supporting 21 Critical Adolescent Objectives”. 2
St Barnabas Hospital serves a densely populated, ethnically diverse area of the Bronx. According to 2000 U.S. Census statistics, the total population in the Bronx is 1,332,650. The Bronx can be subdivided into seven neighborhoods based on the United Hospital Fund (UHF) designations. The area in which St Barnabas Hospital is located is referred to as Crotona-Tremont and includes 199,530 persons. The population in the Crotona-Tremont area is largely comprised of persons of Hispanic descent (62% vs. 27% compared to NYC as a whole) and African-American (32% vs. 25% compared to NYC as a whole). The percentage of births to women less than 20 years old is higher than NYC overall (16% vs. 8.6%). The percentage of adults 25 years and older without a high school diploma (52% vs. 32%) and those in a linguistically isolated household (22% vs. 12%) are substantially higher in the Crotona-Tremont area of the Bronx than the rest of New York City.
Our target population includes children and young adults aged 10-24 years. In the Crotona-Tremont section of the Bronx, 47% of the population is less than 25 years old (compared to 34% in all of NYC) and 43% of the population is living in poverty (compared to 19% in all of NYC). Hospitalization rates per 100,000 persons in this neighborhood for asthma and pregnancy (and related complications) are much higher for this population, when compared to total NYC rates.
A 60-item, three-paged, needs assessment survey was developed. The survey was offered in both English and Spanish. The needs assessment survey was based on other similar survey tools that have been used in the adolescent population. 3 The needs assessment survey was distributed at five pediatric/adolescent clinic sites of the Department of Pediatrics in the Bronx. Four of the clinic sites are located in hospital ambulatory buildings and one site was located at Theodore Roosevelt High School. The registrars at each clinic site were enlisted to act as Needs Assessment Survey Coordinators. The Coordinator was responsible for asking each adolescent (defined as 12-18 years) who came in if they would like to fill out an anonymous survey while they (or their family member) waited to been seen. The registrars were instructed to emphasize the survey was anonymous and optional, and that no health care providers would see it that day. The registrar received $1 for each completed survey collected.
A total of 141 surveys were returned during a 6-month study period from July 2003 through December 2003. Of the completed surveys, 83 (59%) were completed by females and 45(32%) by males (13, 9% blank). The age range was 11-18 years (5 blank), with the majority (42%) of surveys completed by adolescents aged 16 or 17. The zip codes in which 8 or more adolescents reside are 10451, 10453, 10455, 10456, 10457, 10458 and 10467. 64.5% reported Hispanic heritage, 20% African American and 7% West Indian. English is the primary language spoken in 34% of homes; Spanish in 17% of homes and both English & Spanish are spoken in 39% of homes.
56% of teens reported coming to the clinic for a physical, 29% for a problem, and 8% reported they were coming for both. 88% of teens felt that their clinic was convenient and easy to get to. 52% would prefer after school hours. 9% reported a history of having been ill in the past and not seeking out medical care due to lack of insurance or money. 93% of teens reported feeling safe at home, but only 78% felt safe at school. Almost 50% of adolescents reported being in a physical fight, attacked or ‘jumped’. 14% carry a weapon for protection. 26% of adolescents live in a household where someone smokes. 36% have friends who smoke and 49% have friends who drink alcohol, but only 21% of kids reported smoking themselves and 34% reported drinking alcohol. 12% of kids worry that someone in the family uses drugs or too much alcohol.
35% of adolescents reported having had sex, 25% said they use condoms. 6% of girls reported having been pregnant. Almost 30% of adolescents replied, “Yes” to the question, “During the past few weeks, have you felt very sad or down as though you have nothing to look forward to?”
Data was further analyzed using the SPSS program. Statistically significant responses (p< .05) included: More Hispanic (32%) patients than African American (6%) patients had been admitted to the hospital. Hispanic patients were more likely to have friends who smoked (38%) and drank alcohol (51%) than their African American counterparts, (9% and 13% respectively). 76% of Hispanic adolescents reported having a trusted person to talk to (compared to 33% in African American), and Hispanic adolescents (34%) reported more depressive symptoms in the preceding weeks than African American adolescents (7%). Analyzed for gender, 32% of females reported depressive symptoms compared to 7% in their male counterparts.
National data on percentages of adolescents that are involved in risk-taking behaviors is well documented, but it is useful to define these risk-taking behaviors in the community in which one practices. These data suggest that providers should utilize appropriate tools such as needs- assessment surveys to better understand specific issues affecting a particular adolescent population. In this study, certain issues were more common in the H subset of our urban population than the AA subset. While all adolescents must be screened for a range of medical and psychosocial issues, knowing the likelihood of certain conditions in the local adolescent population may allow the provider to more effectively screen and improve overall care. More investigation is warranted to further delineate the needs of this urban adolescent population and to develop programs tailored to address these needs in the diverse Bronx community served by St Barnabas Hospital.
The National Longitudinal Study of Adolescent Health. (1998) Codebooks. Retrieved from http://www.cpc.unc.edu/projects/addhealth/codebooks