The authors report on part of a study that identifies barriers to timely entry into gynecologic care among adolescent girls. Using self-administered surveys of predominantly minority adolescent girls at three inner-city schools, they find that 34 percent of adolescent girls in this setting had foregone health care in the prior year (compared with 19% in a national sample). Those least likely to have a usual source of care were non-U.S. born girls (73.1% versus 83.1%), and less acculturated girls. Predictors of foregone care included being sexually active, poor family social support and low self-esteem. At sexual debut, reasons given for foregone care shift to suggest that confidentiality concerns are a barrier. To ensure access for diverse populations, especially immigrant youth, financial and non-financial barriers to care need to be reduced. Efforts also are needed to increase awareness of the right to confidential care and to teach girls the skills necessary to access confidential care.
According to the authors, development of novel approaches could help improve access to confidential care and counseling on sexuality-related health topics for the majority of urban youth who receive primary care in community health centers and clinics.