摘要：Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents. Sexually active adolescents and young adults have the highest rates of sexually transmitted diseases (STDs) in the United States, yet they are less likely to seek and receive health care than any other age group. 1– 3 If young people delay or avoid seeking health care, they may be at increased risk of transmitting infections to sexual partners and experiencing long-term negative sequelae such as infertility, chronic pelvic pain, and cancer. 4 Even when adolescents seek care, they are much less likely to undergo comprehensive preventive health assessments that include screening for STDs. Here we describe the outcomes of an intervention designed to increase health care seeking behaviors among adolescents and young adults in 2 communities with high rates of STD endemicity. There are many benefits associated with increasing preventive health care seeking on the part of adolescents, including early diagnosis and treatment of illness and the opportunity for preventive health education. Adolescents who use preventive health services have been shown to engage in fewer risk behaviors and more health promoting behaviors and to be in better health. 2, 5– 7 In addition, establishing the habit of seeking preventive health services during this age period can build health behaviors that may continue throughout adulthood. Adolescents may face structural, social, or psychological barriers to seeking health care. Family income and access to health insurance are consistently related to use of preventive health care in this age group. 7– 10 However, even adolescents with health insurance coverage seek preventive health care less frequently than adults. 11 Psychosocial barriers to seeking care include concerns about confidentiality, a sense of invulnerability, and, among adolescent girls, embarrassment and not wanting their parents to know they are seeking sexual health care. 7, 9 Despite the public health benefits of use of periodic preventive services, minimal attention has been directed at community-based interventions designed to promote preventive health care seeking behaviors among adolescents. 12 A recent school-based intervention was found to have produced no significant increases in health care seeking among an intervention group relative to a control group, and almost 50% of participants in both groups reported not having received needed care. Thus, there is a critical need for effective interventions designed to increase health care use among this vulnerable population. The present study involved a randomized controlled trial of a skill-building intervention intended to increase preventive health care seeking among adolescents. The intervention, offered through the facilities of community-based organizations (CBOs) providing after-school educational and sports programs, promoted positive beliefs and attitudes regarding preventive health care visits, skills and self-efficacy in regard to seeking health care, and communication with others regarding the importance of undergoing checkups. The study was conducted as part of a larger project—the Gonorrhea Community Action Project—involving complementary interventions targeting health care providers, STD clinic patients, and community awareness in 3 communities with high rates of STDs. The interventions shared a common theoretical framework and common measures of key constructs (M. Hogben, N. VanDevanter, C. K. Malotte, et al., unpublished data, 2003).
