Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?


  • Paul W. Newacheck,

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    • Address correspondence to Paul W. Newacheck, Dr.PH., Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118. Paul W. Newacheck, Dr.PH., Claire D. Brindis, Dr.PH., and Charles E. Irwin, Jr., M.D., are with the Institute for Health Policy Studies and the Department of Pediatrics, University of California, San Francisco. Yun Yi Hung, Ph.D., is a Programmer, Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of California, San Francisco. M. Jane Park, M.P.H., is a Senior Research Associate, Department of Pediatrics, University of California, San Francisco.

  • Yun Yi Hung,

  • M. Jane Park,

  • Claire D. Brindis,

  • Charles E. Irwin Jr.

  • We appreciate the financial support of the W. T. Grant Foundation, Project 2077, and the Maternal and Health Bureau, HRSA, U.S. Department of Health and Human Services, 6U93 MC00023. The analyses and interpretation are those of the authors and do not necessarily reflect the views of the funders.


Data Collection/Extraction Methods. National household survey.

Data Sources/Study Setting. We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey.

Study Design. We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs.

Principal Findings. After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care.

Conclusion. Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.