The physical health status of young Australian offenders

AIMS: To describe the socio-economic background and physical health status of young offenders in custody in New South Wales (Australia). DESIGN: Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003. METHODS: Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections. RESULTS: The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody. CONCLUSIONS: Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services.     

Access to primary health care for Australian adolescents: How congruent are the perspectives of health service providers and young people,and does it matter?

OBJECTIVE: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. METHODS: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. RESULTS: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their 'domain of treatment'. There was reasonable congruence in regard to 'ideal service model' with some differences relating to methods of information delivery. However, for 'barriers to accessing services' there were major discrepancies. CONCLUSIONS: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider-adolescent interaction and the willingness of adolescents to access services. IMPLICATIONS: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies.     

Rural adolescents' help-seeking intentions for emotional problems: the influence of perceived benefits and stoicism

Objective: This study explores the factors that influence adolescents' help‐seeking intentions. Specifically, the study investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. Design and setting: A cross sectional self‐report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. Participants: A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and 18 years of age. Main outcome measure(s): Participants completed an anonymous self‐report questionnaire designed to measure help‐seeking intentions in the advent that they were to experience emotional problems, psychological distress symptoms, perceived benefits of help seeking and stoicism. Results: In all, 17% of male participants and 29% of female participants reported they would be likely to seek help from doctors if they were to experience emotional problems. In total, 15% of male participants and 23% of female participants reported they would be likely to seek help from other health care professionals. Multiple regression analysis suggested that adolescents are more likely to seek help from professionals if they perceive help seeking as beneficial (t = 12.91; P < 0.001). Female particpants reported that they were more likely to seek help than male participants (t = 2.69; P = 0.01). Conclusions: Findings suggest that adolescents are reluctant to seek professional help if experiencing emotional problems, because they do not believe professional help seeking is beneficial. Improving adolescents' beliefs about the benefits of professional help seeking might be a key strategy for increasing their use of professional health services to address mental health problems.     

Teenagers' views on general practice consultations and other medical advice. The Adolescent Working Group, RCGP

BACKGROUND: The provision of health services for teenagers is of current interest in relation to primary care. OBJECTIVES: The main objective of the study was to look at satisfaction with the teenager's last consultation and any reasons for dissatisfaction. A further objective was to look at common teenage health concerns to identify how many teenagers had been concerned about them, where they sought advice, and to look at ratings of this advice. METHOD: Questionnaires were completed as part of a continuing evaluation of a novel sex education programme in 38 schools in 1997 and provided the data. The particular items reported in this study were related to satisfaction with the last GP consultation and reasons for dissatisfaction, health concerns and who (if anybody) was approached to address these concerns, and comments on services used. 5152 teenagers (51.8% male and 47.8% female) completed the questionnaires in a school lesson under conditions of complete confidentiality. RESULTS: Over 86% of adolescents were apparently satisfied with their last consultation with a GP, although several possible reasons were identified for any dissatisfaction. Health concerns were identified and sources of help were considered and compared; no obvious levels of relative dissatisfaction with services were noted. A large number of teenagers identified apparent concerns but did not seek help for these concerns. CONCLUSIONS: Adolescents are largely satisfied with the services available in primary care. A number of teenagers do not seek help for their own individual concerns. Encouraging teenagers to attend when they perceive a health problem may help provide a more sensitive primary care service.     

Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?

BACKGROUND: Despite enormous public sector expenditures, the effectiveness of universal coverage for health care in reducing socioeconomic disparities in health has received little attention. STUDY OBJECTIVE:s: To evaluate whether universal coverage for health care reduces socioeconomic disparities in health. DESIGN: Information on participants of the 1990 Nova Scotia Nutrition Survey was linked with eight years of administrative health services data and mortality. The authors first examined whether lower socioeconomic groups use more health services, as would be expected given their poorer health status. They then investigated to what extent differential use of health services modifies socioeconomic disparities in mortality. Finally, the authors evaluated health services use in the last years of life when health is poor regardless of a person's socioeconomic background. SETTING: The Canadian province of Nova Scotia, which provides universal health care coverage to all residents. PARTICIPANTS: 1816 non-institutionalised adults, aged 18-75 years, from a two stage cluster sample stratified by age, gender, and region. Main results: People with lower socioeconomic background used comparatively more family physician and hospital services, in such a way as to ameliorate the socioeconomic differences in mortality. In contrast, specialist services were comparatively underused by people in lower socioeconomic groups. In the last three years of life, use of specialist services was significantly higher in the highest income group. CONCLUSIONS: Universal coverage of family physician and hospital services ameliorate the socioeconomic differences in mortality. However, specialist services are underused in lower socioeconomic groups, bearing the potential to widen the socioeconomic gap in health.     

Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthma

Objective:  To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area.
Design:  Qualitative semistructured interviews.
Setting:  Small rural centre in New South Wales.
Participants:  General practitioners, pharmacists and people with asthma in a rural area.
Results:  General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency.
Conclusions:  General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care.     

Gender double standards in young people attending sexual health services in Northern Thailand

Concern about the sexual and reproductive health of young people has been mounting recently in Thailand. Unequal gender relations have a considerable influence on the lives of young people, especially young women, yet few studies have explored the ways in which they have impacted on provision of sexual health care. Drawing upon data from a qualitative study in Northern Thailand, this paper explores the views and experiences of young people in seeking health care, highlighting the kinds of gender double standards and power imbalances that may pose obstacles to their use of sexual and reproductive health services. Findings reveal the vulnerability of sexually active young women in seeking support and care from partners, parents, and service providers. Those who experience adverse outcomes of sexual activity, such as unwanted pregnancy or infection, report facing indifference, victim blaming, or the threat of abandonment by their partners. Because of their fear of disclosure to their parents and communities, of their sexual activity, they opt for clandestine and unsafe abortion and seek the counsel of peers and drugstores rather than parents and providers. At the service provider level, young women report facing threatening and judgemental attitudes, indifferent counselling, and possible violation of confidentiality. This is in marked contrast to the treatment of young men, who generally meet with a more sympathetic and accepting response.     

Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents.

The aim of the study was to examine the effect of socioeconomic status (SES), age, weight and gender on the body image and weight control practices of children and adolescents, and to investigate whether health education about weight issues should target low socioeconomic groups. The study participants were a randomly selected group of school children who completed a questionnaire, and had their height and weight measured. Participants (n = 1131) were aged 6-19 years from 12 schools in New South Wales. SES, age, gender, body weight, body image, skipping breakfast, physical self-esteem, attempts to lose or gain weight, and dietary and weight control advice received from others were examined. Log-linear, chi 2 and MANOVA analyses were used to determine interactions between variables. Low SES children were more likely to be overweight, to skip breakfast, to perceive themselves as 'too thin', to be trying to gain weight and less likely to receive dietary or weight control advice. Physical self-esteem was lowest among overweight girls of middle/upper SES and greatest among boys of low SES, despite the latter being more likely to be overweight. Being overweight does not appear to adversely affect the physical self-esteem of children of low SES, particularly boys. Health educators should examine these issues with young people to help make health education and nutrition education most relevant and appropriate.     

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age‐ and gender‐related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro‐rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey & O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first place.     

The market for nurse practitioner services among women 18 to 40 years of age

Telephone interviews were conducted with a stratified random sample of 331 greater New Haven, Connecticut area residents to examine factors associated with using nurse practitioner (NP) services. About 81% of women aged 18 to 40 (N = 109) said they would seek NP care if services were covered under health insurance. Women who said they would seek care were more likely to be dissatisfied with their present health care, to have less education, and to be from lower income families with two or more members. Women in this age group were more likely to use NP services and to seek NP care if care cost the same or less than MD care than all others in the original study sample. They were also more likely to demonstrate innovative purchase behavior and to have knowledge of nurse practitioners, and less likely to perceive NP care as different from MD care. Analysis of the characteristics, attitudes, and values of women aged 18 to 40 years reveals that they are the most likely target market for NP services.     

Older people's mental health in rural areas: Converting policy into service development,service access and a sustainable workforce

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the “older old,” while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as “hub and spoke” models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.     

Analysis of clinic attendances by under-14s to sexual health clinics in Gwent, South Wales, UK

OBJECTIVES: To determine the gender, sexual history and reason(s) for visit for under-14s (young people) attending the authors' sexual health clinics. METHODS: Analysis of case notes of 242 young people who made a total of 598 visits to a sexual health clinic in Gwent, South Wales, UK between 1 January and 31 December 2003. RESULTS: Of the 242 young people studied, 41% were male and males were responsible for 42% of visits. There was no written record relating to 7% of the total visits. Median age at both first registration and first heterosexual intercourse (when recorded) was 12 years for males and 13 years for females. Some 57% of females and 30% of males were already sexually active at first registration. Details relating to a young person's partner and their experience of sex (e.g. willingness, autonomy and consensual nature of sex) were infrequently recorded, especially for males. 96% of males requested condoms and 99% received them, whilst 72% of females requested condoms and/or hormonal contraception and 86% received them. 35% of females were seen for the consequences of sex (i.e. pregnancy testing, emergency contraception, screening and/or treatment of sexually transmitted infections and unplanned pregnancies). 80% of these subsequently received condoms and/or hormonal contraception. The majority of young people saw a nurse exclusively (96% males, 71% females). CONCLUSIONS: Of the young clients seen, 41% are male. Sexual history details are infrequently recorded, particularly for males. The majority of young people accessing the authors' service are taking action to protect their sexual health and most will see a nurse exclusively.     

Young people who attend specialist alcohol treatment: who are they and do they need special treatment?

OBJECTIVE: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). METHODS: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. RESULTS: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. CONCLUSIONS: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment.     

Improving the evidence‐base for access to primary health care in Canterbury: a panel study

Objective : Despite many reforms and initiatives, inequities in access to primary health care remain. However, the concept of ‘access’ and its measurement is complex. This paper aims to provide estimates of general practice visit frequencies for ‘attenders’ (those who seek consultation) and the proportion of ‘non‐attenders’ (those who never seek consultation) of primary health care services. Methods : A panel study of people enrolled within a large primary health care organisation of affiliated general practices. Standard and zero‐inflated regression models were assessed. Results : 980,918 visits were made by 388,424 people, averaging 2.64 visits/person/year. The zero‐inflated negative binomial model was superior, and significant age, gender and ethnic differences were observed in attender and non‐attender profiles. More Asian (21.0%), Pacific (19.6%) and Māori (17.1%) people were non‐attenders than European/Other (9.0%) people. Among attenders, males, Asian and Pacific people, and young to middle‐aged adults, generally had relatively lower visit rates. Conclusions : Interpretation of utilisation data must be made with caution because of two distinct characteristics: the differential rates of non‐attenders and the highly dispersed distribution of attenders. Implications : Improved understanding of differential non‐attender rates and attender visit distributions by demographic factors needs to be considered when addressing improved access to general practice services.     

Coming up in the boogie down: the role of violence in the lives of adolescents in the South Bronx.

This article presents data gathered from young people in a poor urban community in New York City, the South Bronx. It seeks to help public health professionals better understand young people's perceptions of violence in the context of their daily lives. Sources of data include a street survey, five focus groups, interviews with incarcerated young males, and observations of several youth programs. These data suggest that violence is pervasive in the lives of both young men and women, although gender plays an important role in shaping the experience of violence. Other factors that influence the experience of violence include patterns of substance use, availability and use of weapons, and a perception that the police do not respect young people. Despite numerous challenges, many young people do take actions to reduce violence. The article suggests actions public health professionals can take to strengthen the ability of families, schools, youth organizations, and young people themselves to reduce violence in low-income urban communities.     

The family and nurse in partnership: providing day-to-day care for rural cancer patients

OBJECTIVE: To explore demands made on family members in managing symptoms and providing for the day-to-day care of relatives with cancer in rural New South Wales and how specialist palliative care nurses support these family members. DESIGN: Cross sectional qualitative study. SETTING: Seven health centres across rural New South Wales that cover a broad geographical area and reflect the diversity in economic conditions, population density and distance from three major urban centres in New South Wales. SUBJECTS: The study involved two groups of participants. The first group consisted of one or more members of families of oncology patients who were accessed through health workers at the seven centres. Nineteen family members from 17 families were interviewed. The second group comprised 10 nursing staff working as specialist palliative care nurses across the same geographical area as the families. MAIN OUTCOME MEASURES: Physical care and symptom management were the two main areas of interest. RESULTS: The rural experience of caring for palliative care patients was challenging, with support nurses needing to take into consideration all aspects of the patients' and families' living environments. CONCLUSION: There is a need for equipment and basic resources to be readily available to practitioners, funding for ongoing education and 24-h care.     

Recording what happens in the under-16 consultation

BACKGROUND: Clinical staff offering sexual health services to young people need to balance the rights of the young person to confidentiality and good quality advice with the need to protect their wider interests. The needs of young clients may be complex and raise ethical and medico-legal questions for the staff involved in their care. METHODS: In our large, integrated sexual health service, a 'recording form' was introduced to prompt staff to record data systematically pertinent to consultations in clients under 16 years of age, to understand what kind of presentations dominate in these consultations, and to establish how common child protection concerns are. RESULTS: From April to October 2004, more than 500 forms were completed in our service. The age range for female clients was 12-15 years, with the median age of first sexual intercourse 14 years. Most respondents were in consensual relationships with partners of around their own age, but 10% had been in relationships of less than a week's duration. Most had not told their parents of their sexual activity and did not intend to. Child protection issues did occur, although not commonly. CONCLUSIONS: Most clients initially present requesting emergency contraception or pregnancy testing, and the inference is that unprotected sexual intercourse is common in this group of clients before they seek our services. The data collected give a valuable overview of the type of issues dealt with in the clinical context and can help to target training and teaching, in addition to potentially highlighting child protection issues.     

Investigating the longer-term health consequences of work-related injuries among youth

PURPOSE: To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records. METHODS: A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors. RESULTS: Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location. CONCLUSION: Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.     

Adolescent Relationship Violence: Help-Seeking and Help-Giving Behaviors among Peers

Young people tend to disclose relationship violence experiences to their peers, if they disclose at all, yet little is known about the nature and frequency of adolescent help-seeking and help-giving behaviors. Conducted within a sample of 1,312 young people from four New York City high schools, this is the first paper to ask adolescent help-givers about the various forms of help they provide and among the first to examine how ethnicity and nativity impact help-seeking behaviors. Relationship violence victims who had ever disclosed (61 %) were more likely to choose their friends for informal support. Ethnicity was predictive of adolescent disclosure outlets, whereas gender and nativity were not. Latinos were significantly less likely than non-Latinos to ever disclose to only friends, as compared to disclosing to at least one adult. The likelihood of a young person giving help to their friend in a violent relationship is associated with gender, ethnicity, and nativity, with males being significantly less likely than females to give all forms of help to their friends (talking to their friends about the violence, suggesting options, and taking action). Foreign-born adolescents are less likely to talk or suggest options to friends in violent relationships. This study also found that Latinos were significantly more likely than non-Latinos to report taking action with or on behalf of a friend in a violent relationship. This research shows that adolescents often rely on each other to address relationship violence, underlining the importance of adolescents’ receipt of training and education on how to support their friends, including when to seek help from more formal services. To further understand the valuable role played by adolescent peers of victims, future research should explore both which forms of help are perceived by the victim to be most helpful and which are associated with more positive outcomes.     

Do lower socioeconomic groups use more health services, because they suffer from more illnesses?

BACKGROUND: The more diseases one suffers from, the higher the number of health care services attended. This study aims to examine the role this association plays in socio-economic differences in multiple health care utilization. METHODS: The study population derived from the Netherlands Health Interview Surveys (1990-1998) and was 25 years or older (N=53,339). Socio-economic position was indicated by educational level. Comorbidity was defined as the concurrence of multiple health conditions in the same person. Multiple health care utilization was measured by the number of different health care services contacted in the preceding year. Logistic multiple regression was used, adjusted for age, gender and year of interview. RESULTS: The lower the socioeconomic status, the more often people used multiple health care services (OR 1.46) and the higher the prevalence of comorbidity (OR 2.47). CONCLUSIONS: Lower socioeconomic groups use more health care services, partly because they suffer from more illnesses.