Abstract
This study examines how state public health agencies report using Title V Maternal and Child Health Block Grant funds to improve the health of adolescents. The Title V Information System was analyzed to identify state level expenditures allocated to pediatric primary and preventive care and to identify measures that monitor adolescents' primary and preventive health care as defi ned by adolescent clinical preventive guidelines such as Bright Futures and Guidelines for Adolescent Preventive Services. Most states do not report expending 30 percent or more on primary and preventive care, nor do they report measuring adolescents' receipt of primary or preventive health services.
A significant proportion of adolescents (children aged 11-21) experience preventable health problems, particularly low-income adolescents.1,2 The most serious, costly, and widespread adolescent health problems-unintended pregnancy, sexually transmitted infections, violence, suicide, unintended injuries, and the use of alcohol, tobacco, and other drugs-are potentially preventable. Indeed, nearly three-quarters of adolescent mortality is due to preventable causes.3 In part, these indicators refl ect the fact that adolescents are the age group of children most likely to be uninsured, despite Medicaid and SCHIP coverage expansions.4,5 Adolescents also underutilize physician offi ces, and preventive counseling is not a uniform component of care.6 the incidence of preventable morbidity and mortality among vulnerable adolescents.7 To improve the content, quality, and delivery of primary and preventive health services provided to adolescents, several medical and public health organizations have developed primary and preventive care guidelines and standards, including the American Medical Association,8,9 the American Academy of Pediatrics,10 and the U.S. Health Services and Resources Administration. All these guidelines recommend annual health supervision visits, confidential care, health guidance and preventive counseling, screening for health-risk behaviors and biomedical conditions, immunizations, access to affordable reproductive and mental health care, and developmentally competent providers.11 Clinical preventive services have had documented success with adolescents in areas including tobacco, drug, and alcohol abuse prevention, and pregnancy prevention.12