| Adolescence is a transitional period spanning anywhere from ages 11 to 24 years. It is a period of heightened physical, cognitive, and social role development. Adolescence can also be a period of vulnerability where a significant proportion of youth experience physical and sexual abuse, broken homes, and unsafe neighborhoods. In addition, risk behaviors, such as substance use, emerge, potentially leading to short term consequences such as increased risk of unintentional injuries or to long-term consequences such as smoking-related mortality and morbidity in adulthood. One aspect of preventing the initiation of and consequences following from participation in risk behaviors is the healthcare system and a continual relationship with a primary care practitioner.; This dissertation critiques the applicability of the Behavioral Model of Health Service Use in explaining adolescents' use of ambulatory care services. A new framework is proposed addressing adolescents' healthcare needs within a developmental context and their experiences obtaining healthcare. The validity of the framework is examined empirically by two studies. The first study assesses substance use and depressive symptoms as determinants of the use of medical and mental health services. The second study identifies specific characteristics of the primary care practitioner associated with use of medical and mental health services.; The studies used a cross-sectional, observational design with nationally representative survey data. The data source chosen was the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. The study population is in-school adolescent males and females ages 11 to 18, grades 5–12. There were 6,748 students who participated from 299 public, private, and parochial schools in the United States.; Findings from these studies support the development of a model of utilization that recognizes the unique health needs and experiences of adolescents in using healthcare services. They also justify inclusion of risk behaviors in conceptualizing adolescent need for healthcare services. Without the consideration of behavior, evaluations of the appropriateness, comprehensiveness, and need for health services for adolescents is limited in scope. This project provides evidence of the importance of having a regular relationship with a primary care practitioner and confidentiality specifically for adolescents' healthcare. |
