Changes in health insurance coverage and health care access as teens with disabilities transition to adulthood

BackgroundPre-ACA, less than 6% of children with disabilities were uninsured, compared with more than 42% of young adults with disabilities ages 19–25. Individuals with disabilities face greater barriers to health care access upon transition into adulthood.ObjectivesWe examined whether the ACA dependent coverage provision and Medicaid expansion improved the transition from pediatric to adult healthcare systems by reducing the gap in insurance coverage and access to care between teens and young adults with disabilities.MethodsUsing cross-sectional data from the 2006–2009 and 2011–2015 National Health Interview Survey (n = 10,136), we estimate the change in insurance coverage and access to care from pre-to post-ACA time periods for teens (ages 13–18) and young adults (ages 19–25) with disabilities in a difference-in-differences model. We completed the same analyses for these groups in Medicaid expansion and non-expansion states.ResultsBoth teens and young adults with disabilities made significant gains in insurance coverage (4.55 and 8.96% point gains respectively, p < .001) and access to care (4.01 and 3.14% points decline in delayed care due to cost, p < .05) under the dependent coverage provision and Medicaid expansion.ConclusionsMedicaid expansion had a greater impact on both insurance coverage and on access to care than did the dependent coverage provision. The benefits of these changes flowed primarily to young adults with disabilities, reducing the gaps in insurance coverage between teens and young adults, and expanding access to care for both groups, providing a more seamless transition from pediatric to adult health care systems, post-ACA.     

Risk profile of homeless pregnant adolescents and youth

Pregnant homeless young women have special service needs. This article examine those needs by comparing the risk profiles of 55 pregnant homeless youths and 85 pregnant youths who live with their families. These young women were seen in a primary health care clinic and underwent extensive lifestyle interviews during their physical examinations. Clinical social workers provided social services and follow-up. The homeless pregnant youths were younger, primarily white, and from outside Los Angeles County. They were more likely to be diagnosed as depressed, to have previously attempted suicide, to have histories of sexual and physical abuse, and to be diagnosed as drug abusing. Review of pregnancy outcomes showed the difficulty of serving homeless pregnant youth and the lack of services for them. Following this study, the clinic instituted new monitoring procedures and established a team case management approach to serving homeless pregnant teens and youths.     

Vulnerability, human rights, and comprehensive health care needs of young people living with HIV/AIDS

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.     

"Eyes Wide Shut": narratives of women living with hepatitis C in Australia

Hepatitis C is the leading notifiable infectious disease in Australia and in the last few years, the number of new diagnoses among young women is beginning to outnumber men. For many, infection with hepatitis C virus (HCV) results in a chronic condition, which, in addition to a range of symptoms, carries with it the stigma attached to injecting drug use. Despite the growing prevalence of HCV, women's health has barely begun to address the gender specific impact of this illness on women. We report the results of a qualitative study of young women's experiences of living with HCV with a specific focus on the meaning of this condition and its impact on their lives. In 1999--2000, twenty-five in-depth interviews were conducted with women between the ages of 18 and 43 years, who were current or past injecting drug users and who had been diagnosed with HCV. One focus group discussion was held with health workers who provide treatment and care to this population. A number of key issues were identified that women believed impacted negatively on their lived experiences of HCV. Of most concern was the meaning of HCV and the social stigma attached. Stigma coupled with the lack of knowledge and awareness among health professionals and the high cost of treatment contributed to women's reluctance to seek support and care. HCV has yet to be taken up by the women's health movement as a key issue, especially for young women and we argue that this trend needs to be reversed.     

Young People with Learning Disabilities Living in State Care: Their Emotional, Behavioural and Mental Health Status

Young people with learning disabilities are significantly more at risk of developing mental health difficulties than their non-disabled peers, with prevalence rates of around 40% commonly reported. Nevertheless, high levels of mental health problems also exist among young people living in state care. However, few studies have examined the mental health of these young people with learning disabilities who also live away from home in state care. This paper examines the emotional, behavioural and mental health status of a group of young people with and without learning disabilities residing in state care. Data were collected from social worker reports and the Strengths and Difficulties Questionnaire on these two cohorts who were living in state care for a minimum of one year. The young people with learning disabilities had a higher prevalence of emotional and behavioural problems and were also significantly more likely to score within the abnormal range of the Total Difficulties Score of the SDQ (77.1%) compared with their non-disabled peers (49.6%). There is a need for greater recognition of young peoplewith learning disabilities who live in state care in order to identify emotional, behavioural and mental health needs and to develop more appropriate and effective care plans/therapeutic interventions.     

"Being in a funk": teens' efforts to understand their depressive experiences

Although there is literature about adults' experiences of depression, little research has focused on teenagers' experiences. In this article, the authors describe how a sample of adolescents makes sense of depression and responds to a depression diagnosis. Twenty-two adolescents participated in in-depth individual or focus group interviews. Teens discussed their experiences with depression and getting health care for depression, and described a trajectory similar to that found among adults: a slow growth of distress, a time of being in a funk, and a time of consideration of whether they are depressed. Teens who received a diagnosis from a medical provider then sought to make sense of their depression. Teens understood a depression diagnosis as a helpful label, a chronic medical problem, or a significant part of their identity. Understanding the subjective experience of adolescents who are depressed might increase health care providers'empathy and improve their communication with teens.     

Addressing the critical health problem of adolescent substance use through health care, research, and public policy

The use of addictive substances-tobacco, alcohol, and other drugs-during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: America's #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care.     

Relative reductions in health care utilization among young adults before aging out of extended dependent coverage

The 2010 Affordable Care Act extended dependent coverage for adult children up to age 26 in the USA. Since then, considerable studies have assessed its various impacts among young adults. However, little is known about whether there is any change in health care use when young adults age out of dependent coverage. This study examines health care consumption changes among young adults prior to their aging out process. I used data from a large insurance claim database and studied health care utilization of young adults under parents' coverage during a 2‐year period in a difference‐in‐difference framework. I found that young adults had relative reductions in health services use, except ER visits, compared with individuals who stayed under parents' coverage. This pattern was the same for both male and females. Individuals with regular medical needs had greater relative reductions compared with those without regular medical needs. The relative reductions in health care use during the aging out process may have an important impact on young adults' health, especially for those with regular medical needs. More efforts could be made to help them maintain regular medical utilization during the transition.     

An Epidemiologic Approach to Assessing Primary Care Needs in Rural Illinois

One persistent problem that faces state and federal health policy-makers is determining the level of primary care needs of the citizens they serve. To refine the decision making process in Illinois, a model was developed to compare the 84 rural counties of Illinois and their potential need for additional primary care interventions. Using expert panel methods, a group of public health professionals selected a set of 31 health status indicators that were available at the county level throughout the state. Next, the panel developed a weighting system for those indicators. These weighted values were then applied to the demographic and epidemiologic data from each of the counties to rank the counties on the basis of need. Indicators having the highest correlation with the weighted sum were the percent of the population enrolled in Medicaid, lung cancer mortality rate, general population mortality rate, proportion of population at poverty level, and percent of births to teens. Data also showed that the rural counties with the greatest needs clustered in five geographic regions. The identification of these five geographic clusters may facilitate collaborative efforts in meeting the primary care needs of these populations.     

A national overview of reproductive health care services for girls in juvenile justice residential facilities.

PURPOSE/RESEARCH QUESTIONS: Adolescent girls involved in the juvenile justice system face a substantially higher risk for a host of reproductive health problems. This study is the first national overview of the extent to which Juvenile Justice Residential Facilities (JJRFs) are meeting their reproductive health needs. The primary focus is whether all girls/young women receive gynecologic services. METHODS: Data are from the 2004 Juvenile Residential Facility Census, an ongoing national institution-level data collection. Respondents include facility administrators and facility health care providers. Mixed-gender and girls-only facilities are included in these analyses (n = 1,255). MAIN FINDINGS: Full population testing for pregnancy and sexually transmitted diseases occurs in <18% of all facilities. Although about 25% of all JJRFs report housing > or =1 pregnant teens, an equal number offers no obstetric services. Most JJRFs (about 85%) report that only some girls receive care from a gynecologist, largely "as necessary" and based on self-reports of sexual activity or suspected pregnancy. Provision of gynecologic services to all girls/young women is significantly more likely in all-female, state-owned, large population, and longer stay facilities and less likely in short stay, mixed-gender, crowded, and locally and privately owned facilities. CONCLUSIONS: Results indicate that most facilities can garner a few necessary services. However, contrary to recommendations of national organizations, the services tend to be provided in an ad hoc manner rather than to the full population of young women. Results of multivariate models predicting facility types most likely to provide full population services should be useful as leaders in the area retarget their recommendations to address this gap in services.     

Parental education and children's online health information seeking: Beyond the digital divide debate

Research has shown that increasing numbers of teenagers are going online to find health information, but it is unclear whether there are disparities in the prevalence of online health seeking among young Internet users associated with social and economic conditions. Existing literature on Internet uses by adults indicates that low income, less educated, and minority individuals are less likely to be online health seekers. Based on the analysis of data from the Pew Internet and American Life Project for the US, this study finds that teens of low education parents are either as likely as or even more likely than teens of high education parents to seek online health information. Multiple regression analysis shows that the higher engagement in health seeking by teens of low education parents is related to a lower prevalence of parental Internet use, suggesting that some of these teens may be seeking online health information on behalf of their low education parents. Implications of these findings are discussed in relation to the issues of the digital divide and digital empowerment.     

Better adaptation of the Tunisian adolescent health care system

Classical health indicators are insufficient to account for adolescent health. With the majority of young people's health problems being linked to social and behavioural factors, the compartmentalised and biomedical approaches to their health are inept. Can the totality of adolescents' health needs receive an appropriate response in a health care system which articulates itself based upon a parceled vision of health? Health professionals seem to experience difficulties in situating themselves above the expressed symptom, and therefore become aware of the real needs linked to the emotional, familial and educational contexts and integrate a global, multi-disciplinary approach to adolescent and young adult health into their everyday practice. Their reduced consumption of care is not only linked to the fact that adolescents in general enjoy good health, but it is also linked to the difficulties of the health care system to recognise their true health needs. It thus emphasises the need to develop competencies in the field of adolescent health and organise the work in a multi-disciplinary network. In order to accomplish this, it is essential that the medical schools and public health schools offer a multi-disciplinary approach to adolescent health allowing for future health professionals to be able to address fields which are not uniquely bio-medically dependent. Furthermore, the regional medical study and university centres must evolve to become welcome centers and care centers for adolescents, adopting a multi-disciplinary approach going beyond the simple juxtaposition of diverse disciplines.     

Improving intergenerational health care communication

The relationship between health care providers and their older adult patients may suffer from miscommunication problems stemming from agist stereotyping. Stereotypes of older adults by younger adults may be revealed through patronizing speech--or elder-speak, which is the overaccommodation of speech interaction. Over- and underaccommodation strategies based on these stereotypes are often used by young health care providers when communicating with older adults. As the population ages and the demand for health care services increases, health care providers must improve their communicative effectiveness with their older patients. Attention to the individual needs of health care consumers, cognizance of age or role stereotyping, and proper training of health care providers would increase communicative effectiveness and enhance the patient-provider relationship.     

A comparison of young women's psychosocial status based on age of their first childbirth

This 12-year longitudinal study examined the psychological status; social relationships; and home, work, and parenting stress and satisfaction in their young adulthood for a sample of rural women who were teen mothers compared to their cohort who had their first child in their twenties. Differences in depression, loneliness, and self-esteem were explained by prior psychological status as teens. Home stress/satisfaction factors and parenting satisfaction and efficacy were also similar after controlling for number of children. Service providers need to understand psychosocial outcomes of first childbirth in order to more effectively meet the physical and mental health needs of all young mothers.     

Caring for a young adult with cancer: the impact on mothers' health

That the carers of people with cancer are profoundly affected by their caring role is well established, yet the needs of one particular cohort, i.e. the parents of young adults with cancer, have not been well understood. The majority of carers in this situation are mothers, and it is the impact of the emotional and physical labour entailed by the care of young adults that is the focus of the present paper. Through the analysis of qualitative narrative data contributed by the mothers of young adults with cancer, the aim of this paper is to examine the health effects for women of caring for a young adult son or daughter with a life-threatening illness. The results suggest that there is an impact on the mother's health that results in unspecific, low-grade and chronic psychological and somatic symptoms which the mothers rank as a low priority. The mothers' attempts to appear to be managing may serve to mask their own health needs from health professionals whose primary concern is the health of the son or daughter. Where psychological distress is admitted, the resulting use of prescribed antidepressants may not be experienced as helpful. The conclusions are that, because of the particular circumstances of caring for a young adult son or daughter with cancer, health professionals' attention to the mothers' health throughout the cancer journey may act as a preventative measure for later and more serious ill health.     

Change in Health Status and Access to Care in Young Adults With Special Health Care Needs: Results From the 2007 National Survey of Adult Transition and Health

BackgroundDespite over 500,000 adolescents with special health care needs transitioning to adulthood each year, limited information is available on their health status or their access to care after transition.ObjectiveTo describe the change in health status and access to care of a nationally sampled, longitudinal cohort of young adults with special health care needs (ASHCN).MethodsWe analyzed follow-up data collected in the 2007 Survey of Adult Transition and Health on young adults who were 14–17 years of age when their parents participated in the 2001 National Survey of Children with Special Health Care Needs. We describe changes in access to care and health status over time, and used logistic regression to identify characteristics that were associated with declining health status in this cohort.Results1,865 participants, aged 19–23 years, completed the Survey of Adult Transition and Health. Between 2001 and 2007, there was a 3.6 fold increase in the proportion experiencing delayed or forgone care; 10% reported a decline in health status. There was a 7.7-fold increase in the proportion reporting no insurance. In regression analysis, factors associated with declining health status between 2001 and 2007 included underlying disease severity and delayed or forgone care in young adulthood.ConclusionsWe found significant deterioration in insurance coverage, usual source of care and receiving timely health care as ASHCN aged into adulthood, and that this was associated with decline in health status. Our findings suggest that further population-based analyses of health outcomes are needed to plan for interventions to assist this vulnerable population.     

Perceptions of Health Care and Access to Preventive Services Among Young Adults

The enactment of the Affordable Care Act increased the emphasis on health promotion and disease prevention by making preventive care accessible for many Americans, especially young adults, who could remain on their parents or legal guardians’ health insurance until the age of 26. Yet, many Americans receive only half of the recommended preventive care services, which highlight the need for the improvement of health promotion and prevention services. The aim of this study was to assess the relationship among access to health care insurance, perceptions about health insurance, and use of preventive care services among young adults. Nine hundred and forty-six participants ages 19–34 completed a 40 question web-based survey. Data analysis suggested that while the majority of participants had health insurance, there were significant differences in opinions about the ACA, health insurance, and use of preventive services by gender, education level, and health insurance status. Overall, participants with health insurance were more likely to have received at least three of the basic preventive care services; however, most of them were not getting the preventive care as recommended. Results reaffirm the need for further studies on the impact of health insurance among young adults and the need for the emphasis on health promotion to educate young adults about the importance of disease prevention and preventive services.     

Responding to adolescent women's reproductive health concerns: empowering clients through health literacy

Adolescents have particular needs in health care that are often not met. Health care providers can help overcome barriers that hinder adolescents' effective use of health services by incorporating health literacy strategies that are developmentally and contextually appropriate, and that actively involve adolescents in their own learning. Based on extensive practice and research experience in Canada with rural and urban high school adolescent women, we offer suggestions for how health care providers can respond to adolescent women's reproductive health concerns by teaching these young women how to increase their skills in functional, communicative/interactive, and critical health literacy.