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Well health visits among adolescents
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POSTER PRESENTATIONS
J O U R N A L O F A D O L E S C E N T H E A L T H Vol. 20, N o . 2
COMPLIANCE WITH THE HEPATITIS B VACCINATION SERIES. Amy B. Middleman, M.D.,
M.P.H., M.S.Ed., Laura M. Robertson, B.A., Robert H. DuRant, Ph.D., and S. Jean Emans, M.D. Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA OBJECTIVE: To determine the level of compliance and to identify factors associated with increased compliance with the dosing schedule for hepatitis B (HBV) vaccination among adolescents. DESIGN: 827 patients from a hospital-based adolescent clinic and 116 from a school-based clinic who had not received the vaccine and were not pregnant were enrolled in the study between December, 1994 and October, 1995. They were given standardized information about HBV and the vaccine. Participants then completed a questionnaire assessing demographic factors, family/friend experience with HBV and the vaccine, knowledge about HBV and the vaccine, risk factors for acquiring HBV, other high risk behaviors, chronic illness, and transportation mode and time to clinic. Median income was determined using zip code analysis~ Participants had blood drawn before each vaccination. They received a postcard if they were 5 months late for a vaccine and a postcard at 12 months for a follow-up visit offering a $20 reimbursement. If noncompliant patients came to clinic for a sick visit, they received a vaccination at that time. Because participants have not had equal time periods to complete the vaccination series, length of time to series completion was analyzed using KaplanMeier Survival Analysis (Breslow test and linear trend test) and Cox Regression Analysis. RESULTS: 73% of participants were female, 43% black, 19% white, 22% Hispanic, 5% Asian. The mean age was 16.4 years (range 11.1-24.9). 17% were self-pay, 32% Medicaid, 13% free care, 38% private insurance. To date, 84% have completed 2 vaccinations, 52% within 61 days. 63% have completed 3 vaccinations, 38% within 274 days. Factors associated with greater compliance with the dosing schedule (less time for completion) included: a chronic illness (P:0.014), female gender (P<0.001), knowing the correct time interval to vaccination 2 (P=0.013), having had a well medical visit within 1 year (P=0.009), not having smoked marijuana in the past 30 days (P=0.020), not having Medicaid (P<0.001), white race (P<0.001), increased travel time to the clinic (P=0.010), and reporting a greater understanding of the immunization schedule (P=0.018). After adjusting for the effect of median income (P-0.048) and the interaction between gender and well visit within I year (P-0.024), Cox Regression analysis found that female gender (OR=2.15, 95% CI=1.64-2.83), younger age (0.96, 0.93-0.99), white race (1.31,1.02-l.68), and not having Medicaid (1.29, 1.06-1.57) were the most important predictors of less time to HBV vaccination series completion. CONCLUSIONS: Site of care, risk factors associated with acquiring HBV, and knowledge, experience with, and understanding of HBV disease had no association with compliance with the vaccination series. Additional efforts are particularly needed to enhance understanding and compliance with hepatitis B vaccination among older adolescents of lower socioeconomic status, non-white race, and male gender.
W E L L H E A L T H V I S I T S A M O N G A D O L E S C E N T S . A m y B. Middleman, M.D., M.P.H., M.S.Ed. and Victoria Chiou, B.A. Children's Hospital, Boston, M A O B J E C T I V E : To identify factors associated with annual well visits to health care providers during adolescence. DESIGN: 827 patients from a hospital-based adolescent clinic and 116 from a school-based clinic completed questionnaires as part o f a study on hepatitis B vaccination. In addition to assessing whether participants had had a well visit within a year, the survey assessed participants' age, race, gender, presence o f a chronic illness, medication use, travel time and mode o f transportation to the clinic, academic achievement, sexual activity, c o n d o m use, history o f STDs, smoking, and other substance use. Statistical analyses included chi square analyses, Kruskal-Wallis A N O V A s , t-tests, and Spearman correlations followed by a logistic regression analysis. RESULTS: 73% were female, 43% black, 19% white, 22% Hispanic, 5% Asian. The mean age was 16.4 years (range 11.1-24.9). 52% o f males and 64% o f females reported well visits within one year (P=0.001). The remainder o f the analysis was stratified by gender. N o factors were found to be associated with males reporting a well visit within 1 year. Factors positively associated with female well visits within 1 year included: alcohol (P=0.00002), cigarette (P=0.03) and marijuana use (P=0.003), iron pill use (P=0.0001), white race (P=0.0002), sexual activity (P<0.00001), history o f a STD (P=0.006), increased travel time to the clinic (P=0.0009), presence o f a chronic illness (P=0.03), OCP use (P<0.00001), and older age (P<0.00001). Alcohol was highly correlated with cigarette (r=0.43) and marijuana use (r=0.45) (P<0.0001). Logistic regression revealed that age (OR=1.13, 95% CI=1.05-1.22), alcohol use (1.56, 1.01-2.41), O C P use (2.53, 1.474.36), iron pill use (3.08, 1.51-6.28), and white race (2.21, 1.37-3.57) correctly classified 70.1% o f the females w h o had had a well visit within 1 year. C O N C L U S I O N S : More female than male adolescents reported well health visits within 1 year. Older females engaging in higher risk behaviors were more likely to have had a visit within 1 year; no factors were associated with male visits. More targeted interventions are required to encourage all youth, especially males engaging in health risk behaviors, to seek annual health visits.
POSTER PRESENTATIONS
J O U R N A L O F A D O L E S C E N T H E A L T H Vol. 20, N o . 2
COMPLIANCE WITH THE HEPATITIS B VACCINATION SERIES. Amy B. Middleman, M.D.,
M.P.H., M.S.Ed., Laura M. Robertson, B.A., Robert H. DuRant, Ph.D., and S. Jean Emans, M.D. Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA OBJECTIVE: To determine the level of compliance and to identify factors associated with increased compliance with the dosing schedule for hepatitis B (HBV) vaccination among adolescents. DESIGN: 827 patients from a hospital-based adolescent clinic and 116 from a school-based clinic who had not received the vaccine and were not pregnant were enrolled in the study between December, 1994 and October, 1995. They were given standardized information about HBV and the vaccine. Participants then completed a questionnaire assessing demographic factors, family/friend experience with HBV and the vaccine, knowledge about HBV and the vaccine, risk factors for acquiring HBV, other high risk behaviors, chronic illness, and transportation mode and time to clinic. Median income was determined using zip code analysis~ Participants had blood drawn before each vaccination. They received a postcard if they were 5 months late for a vaccine and a postcard at 12 months for a follow-up visit offering a $20 reimbursement. If noncompliant patients came to clinic for a sick visit, they received a vaccination at that time. Because participants have not had equal time periods to complete the vaccination series, length of time to series completion was analyzed using KaplanMeier Survival Analysis (Breslow test and linear trend test) and Cox Regression Analysis. RESULTS: 73% of participants were female, 43% black, 19% white, 22% Hispanic, 5% Asian. The mean age was 16.4 years (range 11.1-24.9). 17% were self-pay, 32% Medicaid, 13% free care, 38% private insurance. To date, 84% have completed 2 vaccinations, 52% within 61 days. 63% have completed 3 vaccinations, 38% within 274 days. Factors associated with greater compliance with the dosing schedule (less time for completion) included: a chronic illness (P:0.014), female gender (P<0.001), knowing the correct time interval to vaccination 2 (P=0.013), having had a well medical visit within 1 year (P=0.009), not having smoked marijuana in the past 30 days (P=0.020), not having Medicaid (P<0.001), white race (P<0.001), increased travel time to the clinic (P=0.010), and reporting a greater understanding of the immunization schedule (P=0.018). After adjusting for the effect of median income (P-0.048) and the interaction between gender and well visit within I year (P-0.024), Cox Regression analysis found that female gender (OR=2.15, 95% CI=1.64-2.83), younger age (0.96, 0.93-0.99), white race (1.31,1.02-l.68), and not having Medicaid (1.29, 1.06-1.57) were the most important predictors of less time to HBV vaccination series completion. CONCLUSIONS: Site of care, risk factors associated with acquiring HBV, and knowledge, experience with, and understanding of HBV disease had no association with compliance with the vaccination series. Additional efforts are particularly needed to enhance understanding and compliance with hepatitis B vaccination among older adolescents of lower socioeconomic status, non-white race, and male gender.
W E L L H E A L T H V I S I T S A M O N G A D O L E S C E N T S . A m y B. Middleman, M.D., M.P.H., M.S.Ed. and Victoria Chiou, B.A. Children's Hospital, Boston, M A O B J E C T I V E : To identify factors associated with annual well visits to health care providers during adolescence. DESIGN: 827 patients from a hospital-based adolescent clinic and 116 from a school-based clinic completed questionnaires as part o f a study on hepatitis B vaccination. In addition to assessing whether participants had had a well visit within a year, the survey assessed participants' age, race, gender, presence o f a chronic illness, medication use, travel time and mode o f transportation to the clinic, academic achievement, sexual activity, c o n d o m use, history o f STDs, smoking, and other substance use. Statistical analyses included chi square analyses, Kruskal-Wallis A N O V A s , t-tests, and Spearman correlations followed by a logistic regression analysis. RESULTS: 73% were female, 43% black, 19% white, 22% Hispanic, 5% Asian. The mean age was 16.4 years (range 11.1-24.9). 52% o f males and 64% o f females reported well visits within one year (P=0.001). The remainder o f the analysis was stratified by gender. N o factors were found to be associated with males reporting a well visit within 1 year. Factors positively associated with female well visits within 1 year included: alcohol (P=0.00002), cigarette (P=0.03) and marijuana use (P=0.003), iron pill use (P=0.0001), white race (P=0.0002), sexual activity (P<0.00001), history o f a STD (P=0.006), increased travel time to the clinic (P=0.0009), presence o f a chronic illness (P=0.03), OCP use (P<0.00001), and older age (P<0.00001). Alcohol was highly correlated with cigarette (r=0.43) and marijuana use (r=0.45) (P<0.0001). Logistic regression revealed that age (OR=1.13, 95% CI=1.05-1.22), alcohol use (1.56, 1.01-2.41), O C P use (2.53, 1.474.36), iron pill use (3.08, 1.51-6.28), and white race (2.21, 1.37-3.57) correctly classified 70.1% o f the females w h o had had a well visit within 1 year. C O N C L U S I O N S : More female than male adolescents reported well health visits within 1 year. Older females engaging in higher risk behaviors were more likely to have had a visit within 1 year; no factors were associated with male visits. More targeted interventions are required to encourage all youth, especially males engaging in health risk behaviors, to seek annual health visits.