Factors that influence adolescent reports of counseling by physicians on risky behavior.

PURPOSE: To determine factors that affect whether low-income adolescents report that their doctor talked with them about risky behavior. METHODS: Random digit-dial survey of low-income adolescents in New York City asking about depression, smoking, alcohol use, and sexual activity and the screening and counseling they received on these risk factors and risks during health visits. RESULTS: Prevalence of counseling by physicians was low, according to adolescent reports, ranging from 17% of adolescents counseled about depression to 52% about sexually transmitted diseases. Older adolescents were more likely than younger to receive counseling about all topics. In bivariate and multivariate models, having the risk factor was strongly associated with physicians counseling for depression (adjusted [adj.] OR = 4.42; p < 0.001); for sexual activity and counseling about condom use (adj. OR = 4.06; p < 0.01), and birth control (adj. OR = 2.76; p < 0.03). Still, many adolescents at risk had not received counseling. Many adolescents have not had a private and confidential visit with their provider. Having a private and confidential visit was also associated with receipt of counseling. CONCLUSIONS: Adolescents are not receiving sufficient counseling about risks and risky behavior, according to their own reports. There is need to improve delivery of counseling and ensure that private and confidential visits are provided to youth.

Costs of enrolling children in Medicaid and SCHIP.

As a way of saving Medicaid dollars, many states are reintroducing administrative hurdles into the enrollment process to deter people from enrolling. This study finds that administrative tasks associated with enrollment absorb sizable amounts of funds. We estimate that it costs approximately dollars 280 to enroll a child in Medicaid or the State Children's Health Insurance Program (SCHIP) in the New York City area. This amount could be reduced by approximately 40 percent if documentation requirements were simplified. In an era of scarce resources, the case for simplification is more compelling than ever.