Twenty-somethings opt out of health care

U. ROCHESTER (US)—Young adults are far less likely than adolescents to visit the doctor or use ambulatory or preventive care despite an increase in risky behaviors such as drug use and unprotected sex.

“Young adults are generally a healthy population, but many risky behaviors peak in young adulthood and few resources are available for this population,” says Robert Fortuna, senior instructor in pediatrics and internal medicine at the University of Rochester Medical Center.

“Despite having the highest rate of many preventable diseases, young adults garner relatively little attention from advocacy groups, researchers, or policymakers.”

To characterize ambulatory medical care among young adults age 20 to 29 years, the researchers used data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey between 1996 and 2006.

The study broke down health care patterns and preventative care use, based on sex, race, and ethnicity. Overall, it found that young adults, especially black and Hispanic males, underuse ambulatory medical care and infrequently receive preventive care.

Young men had nearly half the preventive care visits compared with adolescents (age 15 to 19 years) and older adults (age 30 to 39 years). Young men also had less than one-fourth the rate of preventive care visits than young women did.

On average, young men were seen less than once every 9 years for preventive care and young men without insurance were seen once every 25 years, according to the study.

Young black and Hispanic men received less care in general than young white men and half the amount of care for chronic conditions compared to white men. The researchers say this finding is particularly troubling because the risk for death of young black and Hispanic men is considerably higher than the risk for young white men.

The study says ambulatory care may be relatively underused by this age group for a number of reasons, including limited access to care, lack of health insurance, and low self-perceived risk.

Young adults are the most likely age group to be uninsured, with nearly one-third lacking medical coverage. The study found that young adults without insurance had one-fourth as many visits as those with insurance.

When young adults did receive counseling at ambulatory care visits, it was most often concerning exercise and diet, rather than topics that were the greatest risk to their health, including substance abuse, sexually transmitted diseases (STDs), homicide, and motor vehicle crashes, which all peak in young adulthood.

Counseling on those issues remain infrequent, the researchers say, despite the fact that it has been shown to effectively improve tobacco cessation rates, modify high-risk sexual behaviors, and decrease drug abuse.

“Greater awareness is needed among health care providers and policymakers to improve access to care and ensure that young adults receive appropriate preventive services,” Fortuna says.

“During a time when many risks peak and unhealthy lifestyle habits form, routine medical care and preventive counseling can improve both immediate and long-term health.”

The study was published in the bi-monthly edition of Annals of Internal Medicine.

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