Racial and ethnic disparities in health care for adolescents: a systematic review of the literature.

OBJECTIVE: To identify the extent of racial and ethnic disparities in primary care, mental health care, reproductive health care, and asthma care for adolescents independent of socioeconomic status (SES). DATA SOURCES: Systematic review of the scientific literature using standard bibliographic databases. STUDY SELECTION: Inclusion criteria were (1) studies published in the past 12 years, (2) analyses included children and adolescents aged 17 years and younger, and (3) data analyzed by racial/ethnic groups while accounting for SES. A total of 203 studies were reviewed, of which 31 met the criteria for inclusion: 14 of 65 studies on primary care, 11 of 61 studies on mental health care, 2 of 50 studies on reproductive health, and 4 of 27 studies on asthma services. DATA EXTRACTION: Data from tables in the selected studies were used to determine whether minority children and adolescents received fewer, greater, or the same health care services as white children and youth after taking into account SES. DATA SYNTHESIS: Black youth received fewer primary care services in 8 studies, whereas in 4 studies no disparity was noted. Hispanic youth received fewer primary care services in 6 studies, whereas no disparity was noted in 5. One study did not include Hispanic subjects. In 2 studies minority youth, combined into a single category, received fewer services than did white youth. In a total of 6 studies black youth received fewer mental health services, whereas in 3 studies no disparity was noted and in 1 study black youth received a greater number of services. In 3 studies Hispanic youth received fewer mental health services, and in 3 studies there were no group differences. In 1 study, with racial and ethnic groups combined in a single category, minority children and youth received fewer mental health services than white subjects. Three studies did not include Hispanic subjects. Too few studies of reproductive and asthma care were available to draw conclusions. CONCLUSIONS: These results suggest that racial and ethnic disparities, independent of SES, exist in selected areas of adolescent health care. More studies are needed to better understand the extent and causes of these findings.

Reactions to a concept for physician intervention in adolescent alcohol use.

PURPOSE: This study was designed to understand adolescent and parental perceptions, receptivity, and reactions to the concept of screening and brief intervention that primary care physicians can use to reduce alcohol consumption by their non-alcohol-dependent adolescent patients. METHODS: A total of six nation-wide computer-assisted telephone focus groups were conducted; three with low-to-moderate risk for alcohol problems adolescents aged 15-17 years and three with parents of such adolescents. RESULTS: Parents and adolescents held similar views on the prevalence and harms of adolescent alcohol consumption, but different levels of concern about them. After initial surprise and needed dispelling of misconceptions, all groups expressed interest, support, and suggestions for the concept of a physician-initiated, office-based intervention to address younger adolescent alcohol use. CONCLUSIONS: Because both adolescents and parents of adolescents expressed interest in this type of intervention, physicians should be aware of this receptivity and consider focus group findings in how to structure development of a potential counseling-based intervention. Prior education about the target and nature of the intervention is necessary, lest adolescents and parents assume--incorrectly--that it is about doctors preaching to high-risk adolescents to stop drinking.