2004). Similarly, these findings could not be explained by such factors as center size, age, or renal diagnosis.

In a review of 31 studies that spanned asthma services, mental health care, reproductive health services, and primary care, racial and ethnic disparities that could not be explained by socioeconomic status were found in all service areas (Elster et al., 2003). The authors offer four findings: (1) there is less utilization of health services among racial and ethnic minority adolescents, after controlling for insurance status and socioeconomic status; (2) despite the absence of differences in the prevalence of mental disorders among black, Hispanic, and white adolescents, there is less utilization of mental health services among minority adolescents; (3) minority youths receive more reproductive health services than white adolescents; and (4) socioeconomic status has a modest impact on health service delivery but does not completely account for the disparities seen.

Health disparities and biases are a persistent feature of the health care delivery system for racial and ethnic minority adolescents, although little research has been focused on this particular age group. Disparities have been reported in studies of mental health services and emergency department care, as well as in research on adolescents who receive hemodialysis and asthma treatment. While social and economic differences account for some of these disparities, researchers have found that these differences alone cannot explain significant variations in rates of utilization of health services and health outcomes.

The extent to which visits with health care providers are kept confidential between adolescents and their providers can impact adolescents’ utilization of health services. While some young people may be comfortable sharing their health care needs and information with their parents, others may find it embarrassing or fear disapproval or punishment, particularly for health services related to sexual activity, mental health, or substance use. Additionally, there is a body of overlapping and sometimes conflicting stat-