Adolescents' Receipt of Care in a Medical Home: Results From a National Survey.

PURPOSE: Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS: Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS: Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION: Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.

Health Care Transitions for Adolescents.

The transition from pediatric to adult models of care poses many challenges to adolescent and young adult (AYA) patients. Several academic societies have established clinical reports to help providers prepare patients for this transition, facilitate the transfer of care between providers, and integrate patients into adult models of care. Furthermore, several novel care delivery models have been developed to expand health care transition (HCT) services. Despite this, a minority of patients receive transition services meeting the goals of these clinical reports and few data exist on their effectiveness. Given this, ongoing research and clinical innovation in the field are imperative. This article aims to summarize the current landscape of HCT for AYAs, outline the contemporary imperative for its integration into preventive health care given the unique challenges of the COVID-19 pandemic, and expand the current literature by providing a summary of novel emerging strategies being used to meet the health care transition (HCT) needs of adolescent and young adult (AYA) patients.

Young Adult Anxiety or Depressive Symptoms and Mental Health Service Utilization During the COVID-19 Pandemic.

PURPOSE: Young adult anxiety/depression (mental health) symptoms have increased from prior to the COVID-19 pandemic. This study assessed young adult (aged 18-25 years) anxiety/depressive symptoms, mental health care utilization (prescription drug use, counseling, and/or either), and unmet counseling/therapy needs utilizing the national Household Pulse Survey data from June to July 2021. METHODS: Young adult (n = 2,809) rates and subgroup differences in mental health symptoms (Generalized Anxiety Disorder-2 and/or Patient Health Questionnaire-2) were assessed, as were mental health care utilization and unmet counseling/therapy needs. RESULTS: In total, 48% of young adults had mental health symptoms. Among those, 39% received treatment and 36% reported unmet mental health counseling/therapy needs. DISCUSSION: These findings highlight young adults' ongoing mental health needs and low services receipt. Interventions and further research to reduce barriers to seeking and utilizing mental health care and to increase the capacity of providers to deliver culturally appropriate mental health care are needed.

Young Adult Perspectives on COVID-19 Vaccinations.

PURPOSE: Young adults have the highest cumulative incidence of COVID-19 infection in the country. Using March 2021 Household Pulse Survey data, an ongoing, cross-sectional nationally representative survey, we examined U.S. young adult intention to accept COVID-19 vaccines. METHODS: Young adult (ages 18-25 years) Household Pulse Survey participants were queried on intention to receive a COVID-19 vaccine and related perspectives (N = 5,082). RESULTS: Most unvaccinated respondents (76%) indicated an intention to become vaccinated. The most frequently cited reasons for potentially rejecting vaccination included desire to wait and see if the vaccine is safe (56%); concerns over side effects (53%); and believing others are in greater need of the vaccine (44%). CONCLUSIONS: With 24% of young adults hesitant to accept a COVID-19 vaccine, public health interventions should target reasons for hesitancy, address concerns about safety and side effects, and underscore the importance of vaccinations for this population.

Monitoring Adolescents' Receipt of Time Alone From Two National Surveys.

PURPOSE: Despite professional endorsement and research supporting time alone with a clinician for adolescents, low rates and disparities persist. The purpose of the present analysis was to provide detailed monitoring of time alone estimates in two national surveys that assess time alone for adolescents aged 12-17 years: the National Survey of Children's Health (NSCH) and the Medical Expenditure Panel Survey (MEPS). METHODS: Time alone assessments in the NSCH and the MEPS have different definitions. The NSCH assessed time alone within the most recent preventive visit, and the MEPS assessed it within the most recent health care visit. We analyzed these within the subsample of 12- to 17-year-olds who had any past-year preventive visit: MEPS 2016-2017, n = 2,689; and NSCH 2016-2017, n = 24,085. We developed time alone estimates for full and subgroup samples and conducted multivariable logistic regressions to determine differences by age, sex, race/ethnicity, income, insurance, and region. RESULTS: Overall time alone receipt was 49% (NSCH) and 29% (MEPS). Overall rates are not comparable because their definitions differ. Some subgroup differences were similar across datasets: younger adolescents (p < .01) and females (p < .05) had lower rates. CONCLUSIONS: Among adolescents with a past-year preventive visit, time alone rates are low. Lower rates for females versus males and younger versus older adolescents persist. Detailed monitoring results can help to shape promising strategies including clinic-based interventions, such as provider training and educating parents, in efforts to improve the provision of time alone in clinical practice.

Medical Vulnerability of Young Adults to Severe COVID-19 Illness-Data From the National Health Interview Survey.

PURPOSE: COVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring vulnerability to severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. METHODS: A young adult subsample (aged 18-25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016-2018. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention medical indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. RESULTS: Medical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7-.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2-1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples-full sample: white (31%) versus Hispanic (24%; 95% CI: .6-.9) and Asian (18%; 95% CI: .4-.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06-.9) and Asian (10%; 95% CI: .3-.8). CONCLUSIONS: Notably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.