trauma (e.g., perineal lacerations) during delivery among all females and are 35 percent more likely than older females to experience such trauma without instrument assistance (Owens et al., 2003).

Medicaid bears a larger burden of care for pregnant adolescents than private insurance—more than two-thirds of all adolescent admissions for pregnancy or childbirth are billed to state Medicaid programs, while one-fourth are billed to primary insurance—the converse of the distribution of pregnancy expenses for adult women (Owens et al., 2003). While adolescent deliveries are more likely to involve diagnoses of early or threatened labor, hypertension complicating pregnancy, and excess amniotic fluid, pregnant adolescents with no health insurance coverage are the least likely to deliver by Caesarian section, a fact that raises questions about the influence of insurance status on the choice of procedures (Owens et al., 2003).

Mental health disorders (primarily depression) are one of the ten main reasons for hospitalization among children. By age 13–17, affective disorders are the most common cause of hospitalization for conditions not related to pregnancy (Owens et al., 2003). Injuries, including leg injuries, medication poisonings, and head injuries, are also a primary reason for hospital stays among those aged 13–17 (Owens et al., 2003). Adolescents from low-income families are more likely to be admitted to the hospital through the emergency department than are adolescents from higher-income areas (Owens et al., 2003).


Understanding the extent to which adolescents report access to and use of health services in various settings is useful in identifying differences between service capacity and utilization rates. Such information can also be helpful in understanding variations in unmet need and the quality of care available to young people.

Usual Sources of Medical Care

Most adolescents (aged 11–17) have a usual source of medical care—92 percent according to parental reports—while 75 percent of young people aged 18–21 report that they have a usual source of care (Schuchter and Fairbrother, 20084) (see Figure 3-1). This is an important sign of access to health services and is a key indicator to monitor.


Schuchter and Fairbrother (2008) use 2005 National Health Interview Survey (NHIS) data that are based on adolescents aged 18 and over reporting for themselves and parents reporting for those under age 18. This is the standard methodology for most national household surveys.

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