Adolescents who don’t get the healthcare they need become adults with poor health outcomes-and the problem doesn’t only boil down to cost.
There has been a lot of focus on securing healthcare coverage for children and adolescents, but a new study reveals that even when there are no financial hurdles, some teenagers refuse to take care of their health-and may later become adults with poor health outcomes.
The study, published in Pediatrics, outlines a progression of health practices from adolescence through adulthood. Nearly 15,000 subjects were studied from their adolescent years (media age 15.9) to adulthood (median age 29.6), and the project measured how unmet health needs during teenage years were related to 5 self-reported health measures-fair/poor general health, functional impairment, missed school/work time, depressive symptoms, and suicidal tendencies-in adulthood.
Study authors found that 19.2% of adolescents reported unmet health needs and predicted worse general health, functional impairment, depressive symptoms, and suicide risk. No association was found between unmet health needs in the adolescent years and missed school/work time as an adult.
Adolescence is a time of transition and establishing life-long behaviors, but for those whose formative years are spent without access to basic health services, the chance to teach good health practices and preventive care can be lost. As those adolescents age, this lost opportunity becomes more-poor health attitudes and behaviors than can last a lifetime.
Both in the United States and beyond, cost can be a huge barrier to healthcare services, and the World Health Organization has labeled universal healthcare for adolescents as a global health priority. Still, even when access is provided, a number of adolescents still go without healthcare, citing fears about confidentiality, judgment, and other stigmas, according to the study.
The study found that adolescents who have unmet health needs or who have refused care-particularly because they were worried about confidentiality-had poor health outcomes as adults.
In a breakdown of the reasons why adolescents had unmet healthcare needs, 37.2% believed that their health issue was not very important; 32% had access problems that were unrelated to finances; 22.7% cited negative consequences of healthcare; and 14.8% cited cost as a factor.
For each measure studied-depression, missed work time, etc.-the response given in the adolescent cohort was the strongest indicator of the response in the adult cohort.
Good health practices in adolescence are key to heading off poor health outcomes in adulthood, according to the report. Adverse adult health outcomes were 13% to 52% higher in participants who reported unmet health needs during their teenage years compared to their peers in the same sociodemographic groups with no unmet health needs.
“The same pattern was seen regardless of the reason for unmet need. Although some unmet need was due to inability to pay, the majority was due to non-financial or non-access reasons; unmet health care need was prevalent in all sociodemographic groups and in all categories of insurance coverage,” the report states.
One idea is that unmet health needs in adolescence reflect low health literacy/health engagement that lead to poor health outcomes in adulthood in other ways, like risky behavior.
Since adolescence is typically a period in which a person develops their lifelong behaviors and habits, it is likely that unmet health needs during that time will lead to more unhealthy behaviors and a lower likelihood to access healthcare services in the future, the report states.
“However, health outcomes are known to be influenced by a wide range of individual, family, peer, and societal factors, as well as healthcare, and adult behavior may be influenced by experiences in childhood as well as in adolescence,” the report sates. “A focus on adolescent health engagement reinforces the importance of health promotion among both children and adolescents, for example, through school health services and national campaigns.”
Although the measures used to gauge health outcomes in the study were self-reported, the study authors say they believe this leads to a more subjective, yet more insightful view of the participants’ health needs.
“Self-reported measures of unmet need may be particularly useful in studying an adolescent population, which has relatively high perceived barriers to accessing healthcare (consistent with the increasing focus on opportunistic health promotion during all adolescent consultations),” the authors write.
The report highlights the importance of early intervention and investment in adolescent health programs, as well as in reducing unmet health needs for pregnant women and young children.
The study also notes that, while cost is a contributing factor in some cases of unmet health needs, policymakers must look beyond financial barriers to address the bigger picture of health engagement and access for all adolescents.
“We found that unmet health care need was common in all insurance categories and sociodemographic groups. Policies that aim to increase insurance coverage alone are not sufficient to ensure high-quality healthcare that meets the needs of patients and improves long-term health outcomes,” the study authors write. “United States and international evidence shows that adolescents forgo healthcare for many reasons, including concerns about confidentiality, cost, being treated with lack of respect, staff unfriendliness, and poor communication.”
Lead author Dougal S. Hargreaves, MBBChir, MD, of the Institute of Child Health at University College London, says he hopes the report will raise awareness of unmet healthcare needs among adolescents from all walks of life.
“Understandably, the policy and media focus is often on the healthcare needs of children and adolescents who don't have health insurance or live in low-income households; in this study, however, a high proportion of adolescents from all income and insurance groups reported that they didn't get the care they needed at some point over the previous year,” Hargreaves says.
The study also reveals how adolescent health practices follow individuals through to adulthood, eventually becoming life-long habits-good or bad.
Particularly, adolescents with mental health needs may perceive barriers to care, and healthcare providers must work to engage and communicate with these populations in order to achieve successful treatment, the report states.
Hargreaves says it is important for those providing healthcare to adolescents to realize the impact of the care they provide.
“Our data shows that unmet healthcare need in adolescence-for any reason–is an important and independent predictor of adult health. So getting services right for adolescents is not only the right thing to do in the short term; it may also be an effective long-term investment in improving health and reducing the need for health services among adults,” Hargreaves says, adding that a third of participants who reported unmet health needs cited poor accessibility while a quarter of them were worried about how their doctor would respond to them or care for them.
“These findings also highlight the important role that pediatricians and others can play in engaging young people in their health,” Hargreaves says. “This includes educating them about how and when to seek medical care, as well as supporting them to value their health and make health lifestyle choices.