Use of health services by urban youth: A school-based survey to assess differences by grade level, gender, and risk behavior

Purpose: The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care. Methods: A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes. Results: A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months. A physical examination was the most common reason for seeking care. Younger teenagers, males, and those not under care were less aware of teen clinics, thought it more difficult to access care, and had less intention to seek care within the next year (P<.001). Older students had greater knowledge and self-efficacy concerning sexual matters, were less positive about abstinence, and had higher life and sex risk scores (P<.001). Females reported greater self-efficacy regarding sexual matters, were more positive about abstinence, and had lower life risk scores (P<.001). Adolescents receiving care had higher knowledge and self-efficacy scores, were more positive about condoms, had greater intention to seek care, but had higher life and sex risk scores. Conclusions: Awareness and use of health care remain low for a sizable number of at risk urban youth, especially younger and male teenagers. The school is a setting in which adolescents not under care can be reached for provision of information about health care.