The impact of SCHIP enrollment on adolescent-provider communication

PURPOSE: Effective communication between physicians and adolescents is critical to convey health information, provide counseling and identify emerging health problems. This article addressed two questions: (a) After an adolescent enrolls in a State Children's Health Insurance Program (SCHIP), is there a change reported in communication between the adolescent and his/her health care provider; and (b) Is there a relationship between respondent's characteristics and change observed within specific content areas?

METHODS: Adolescent preventive care guidelines developed by national organizations provided the study framework. Surveys were mailed to 3472 12-19-year-olds in a SCHIP; 1689 responded (response rate = 49%). Frequencies described the study population, chi-square analysis explored differences in adolescent-provider communication before and after enrollment, and multiple linear regressions were used to determine relationships between respondents' characteristics and provider communication topics.

RESULTS: There were substantial increases after enrollment in SCHIP in the general area of communication between adolescents and their health care providers. Specifically, the presence of a special health care need had a significant influence on most communication areas. Further, females were more likely than males to talk about sexual health (p = .049) and diet and exercise (p < or = .001); older more likely than younger to discuss sexual health (p = .026) and mental health feelings (p = .023); and white more likely than nonwhite to have better overall communication with the provider after enrollment (p = .029) but Whites also were more likely to experience more negative mental health feelings after enrollment in SCHIP (p = .029).

CONCLUSIONS: Practice guidelines define the content of preventive services; but, it appears that many adolescents do not receive adequate guidance from their physicians. For the group of adolescents in this study who had recently enrolled in SCHIP, there was a reported increase in their communication with their health care provider. The positive changes in communication suggest that encouraging providers and adolescents to discuss risky behaviors is a feasible, achievable goal.