URMC study provides a new focus on health care in young adulthood

New study breaks down ambulatory care among young adults

When adolescents graduate to young adulthood, their preventive care tends to fall by the wayside. A recent study has found that young adults are much less likely to use ambulatory or preventive care, even though their mortality rate is more than twice that of adolescents.

"Young adults are generally a healthy population, but many risky behaviors peak in young adulthood and few resources are available for this population," said Robert J.Fortuna, M.D., M.P.H., senior instructor in Pediatrics and Internal Medicine at the University of Rochester Medical Center (URMC). "Despite having the highest rate of many preventable diseases, young adults garner relatively little attention from advocacy groups, researchers or policymakers."

Before the study was published in the most recent bi-monthly edition of Annals of Internal Medicine, little was known about how young adults use ambulatory care. The study's findings provide a new focus on health care in young adulthood, breaking down patterns based on sex, race and ethnicity, in addition to rates of preventive care in young adults.

Fortuna conducted the study with two other URMC researchers, Brett W. Robbins, M.D., associate professor in Pediatrics and Internal Medicine, and Jill S. Halterman, M.D., M.P.H, associate professor in Pediatrics.

The study 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 authors expressed concern over this finding, since the risk for death of young black and Hispanic men is considerably higher than the risk for young white men.

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, explained the authors. 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.

The prevalence of substance abuse, sexually transmitted diseases (STDs), homicide and motor vehicle crashes all peak in young adulthood. Yet the study's findings show that when young adults were offered counseling, which occurred at about one third of all ambulatory care visits, they infrequently received counseling directed at the greatest threats to their health.

The counseling that was offered to young adults was most often concerning exercise and diet, rather than more immediate threats to their health. Young adults have higher rates of tobacco use, alcohol use, illicit drug use and STDs than both adolescents and older adults. The authors wrote that counseling on these issues remained infrequent, despite the fact that counseling 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," said Fortuna. "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."

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

The authors pointed to the goals of Healthy People 2010, a set of national objectives provided by the U.S. Department of Health and Human Services, as an important reason to evaluate how ambulatory care is used by young adults. The set objectives aim to reduce mortality, motor vehicle crashes, the incidence of STDs and alcohol- and drug-related injuries among young adults. The study concludes that to reach these goals, young adults need to have access to resources that will help them receive appropriate preventive care, especially given the current underuse of ambulatory care services and insufficient amount of counseling available to young adults.