The role of community health centers in providing preventive care to adolescents

Objectives: To (1) compare preventive health visits by poor and nonpoor adolescents, (2) describe adolescent users of community health centers (CHCs), (3) investigate adolescent preventive visits to CHCs, and (4) determine factors independently associated with timely preventive visits. Design: Analysis of the nationally representative sample of 6635 adolescents aged 11 to 17 years in the Child Health Supplement to the 1988 National Health Interview Survey. Results: Overall, 4% of US adolescents used CHCs for routine health care, and the percentage was higher for poor compared with nonpoor adolescents (11% vs 3%, P<.01). Although CHC users were more likely to be poor (41% vs 10%, P<.001), uninsured (23% vs 10%, P<.001), and to have behavior (16% vs 9%, P=.02) and school problems (56% vs 43%, P<.001), they were as likely to have had timely preventive visits (83% vs 81%, P=.61) as adolescents who used private practices. Using logistic regression, timely adolescent preventive visits were independently associated with having a source for routine care (odds ratio, 4.1; 95% confidence interval, 3.3-5.2), a chronic health condition (odds ratio, 1.2; 95% confidence interval, 1.0- 1.5), and the use of seat belts all or most of the time (odds ratio, 1.4; 95% confidence interval, 1.2-1.6), but no independent association was observed between poverty status and timely preventive visits. Conclusions: Community health centers are an important source of preventive care for impoverished adolescents. Although those who use CHCs have greater psychosocial problems, they seek preventive care as regularly as those using private practices. Thus, periodic comprehensive visits may be an effective strategy for CHCs to provide preventive services to adolescents.