The unique health care needs of adolescents

Future of Children

Volumn 13, Issue 1, 2003, Pages 117-135

  Brindis, Claire D ^a   Morreale, Madlyn C ^b   English, Abigail ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b Center for Adolescent Health and the Law   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGE; CHILD WELFARE; CONFIDENTIALITY; DENTAL CARE; FAMILY PLANNING; HEALTH CARE ACCESS; HEALTH CARE NEED; HEALTH CARE QUALITY; HEALTH INSURANCE; HEALTH PROGRAM; HIGH RISK BEHAVIOR; HUMAN; IMMIGRANT; INCOME; LEGAL ASPECT; MENTAL HEALTH SERVICE; PREGNANCY; PREVENTIVE HEALTH SERVICE; PREVENTIVE MEDICINE; PRIMARY MEDICAL CARE; REVIEW; SEXUALLY TRANSMITTED DISEASE; SUBSTANCE ABUSE; UNITED STATES; ADOLESCENT; ARTICLE; CHILD; CHILD HEALTH CARE; HEALTH SERVICE; STATISTICS;

ADOLESCENT; ADOLESCENT HEALTH SERVICES; CHILD; CHILD HEALTH SERVICES; CHILD WELFARE; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; UNITED STATES;

EID: 0242304463     PISSN: 10548289     EISSN: 15501558     Source Type: Journal    
DOI: 10.2307/1602643     Document Type: Review

References (125)

1. See the article by Holahan, Dubay, and Kenney in this journal issue.
2. Newacheck, P., Brindis, C., Cart, C., et al. Adolescent health insurance coverage: Recent changes and access to care. Pediatrics (1999) 104:195-202.
3. Newacheck, P., Hughes, D., and Cisternas, M. Children and health insurance: An overview of recent trends. Health Affairs (Spring 1995):244-54.
4. Lieu, T., Newacheck, P., and McManus, M. Race, ethnicity and access to ambulatory care among US adolescents. American Journal of Public Health (1993) 83:960-65.
5. U.S. Congress Office of Technology Assessment. Adolescent health volume I: Summary and policy options. Washington, DC: U.S. Government Printing Office, 1991.
6. See note 3, Newacheck, et al.
7. Irwin, C., Brindis, C., Holt, K., et al., eds. Health care reform: Opportunities for improving adolescent health. Arlington, VA: National Center for Education in Maternal and Child Health, 1994.
8. U.S. Census Bureau, Population Division, Population Projections Branch. National population projections, summary files. 2002. Available online at http://www.census.gov/population/www/projections/natsum-T3.html.
9. Ozer, E., Brindis, C., Millstein, S., et al. America's adolescents: Are they healthy? San Francisco: National Adolescent Health Information Center, University of California, San Francisco, 1998.
10. These organizations include the American Academy of Pediatrics; the Association of Maternal and Child Health Programs; the Center for Adolescent Health and the Law; the Maternal and Child Health Policy Research Center; and the National Adolescent Health Information Center and Policy Information and Analysis Center for Middle Childhood and Adolescence of the University of California, San Francisco.
11. For example, the Forum on Adolescence of the National Research Council and the Institute of Medicine describe adolescence as including three developmental phases: early adolescence (ages 10 through 14), middle adolescence (ages 15 through 17), and late adolescence (ages 18 through the early 20s). The Society for Adolescent Medicine includes young people ages 10 through 24 in its definition, and the World Health Organization defines an adolescent as a person between ages 10 and 19. Forum on Adolescence, National Research Council and Institute of Medicine. Risks and opportunities: Synthesis of studies on adolescence. Washington, DC: National Academy Press, 1999;
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13. World Health Organization. Adolescent health and development. 2000. Available online at http://www.who.int/child-adolescent-health/OVERVIEW/AHD/ adh_over.htm.
14. Kann, L., Warren, C., Harris, W., et al. Youth risk behavior survey - United States, 1997. Atlanta: Surveillance and Evaluation Research Branch, Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1998.
15. National Center for Health Statistics, Centers for Disease Control and Prevention. Death: Preliminary data for 2000. October 9, 2001. Available online at http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_12.pdf.
16. Weinstein, N.D. Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. Journal of Behavioral Medicine (1987) 10:481-500.
17. For example, Growing Up Smoke Free, a 1994 report by the Institute of Medicine, urged Congress to increase the federal tax on tobacco products in light of evidence indicating that children and adolescents are more price-sensitive than adults. See also Bonnie, R.J. Tobacco and public health policy: A youth-centered approach. In Smoking: Risk, Perception and Policy. P. Slovic, ed. Thousand Oaks, CA: Sage Publications, 2001.
18. English, A., Kapphahn, T., Perkins, J., and Wibbelsman, C.J. Meeting the health needs of adolescents in managed care. Journal of Adolescent Health (1998) 22:278-92.
19. Park, J., MacDonald, T., Ozer, E., et al. Investing in clinical preventive health services for adolescents. San Francisco: Policy Information and Analysis Center for Middle Childhood and Adolescence and National Adolescent Health Information Center, University of California, San Francisco, 2001.
20. See note 9, Ozer, et al.
21. Fox, H., McManus, M., and Reichman, M. Private health insurance for adolescents: Is it adequate? Journal of Adolescent Health. In press.
22. The Health Plan Employer Data and Information Set (HEDIS) was developed by the National Committee for Quality Assurance (NCQA). For information about HEDIS, see the NCQA Web site at http://www.ncqa.org/Programs/HEDIS/index.htm.
23. Brindis, C.D., VanLandeghem, K., Kirkpatrick, R., et al. Adolescents and the State Children's Health Insurance Program (SCHIP): Healthy options for meeting the needs of adolescents. Washington, DC: Association of Maternal and Child Health Programs, and San Francisco: Policy Information and Analysis Center for Middle Childhood and Adolescence and National Adolescent Health Information Center, University of California, San Francisco, September 1999.
24. English, A., Morreale, M., and Stinnett A. Adolescents in public health insurance programs: Medicaid and CHIP. Chapel Hill, NC: Center for Adolescent Health and the Law, December 1999.
25. American Academy of Pediatrics. Section report: Improving the implementation of State Children's Health Insurance Programs for adolescents, report of an invitational conference sponsored by the American Academy of Pediatrics, section on adolescent health. September 26-27, 1999. Pediatrics (April 2000) 105(4):906-12.
26. Fox, H.B., McManus, M.A., and Limb S.J. Access to care for SCHIP adolescents. Washington, DC: Maternal and Child Health Policy Research Center for the Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Foundation, December 2000.
27. See the article by Holahan, Dubay, and Kenney in this journal issue.
28. See the article by Mann, Rowland, and Garfield in this journal issue.
29. Perkins, J., and Somers, S. An advocate's guide to the Medicaid program. Los Angeles: National Health Law Program, June 2001.
30. Kaiser Commission on Medicaid and the Uninsured. Medicaid "mandatory" and "optional" eligibility and benefits. Washington, DC: KCMU, Henry J. Kaiser Family Foundation, June 2001.
31. The Medicare Catastrophic Coverage Act of 1988 (Public Law 100-360) mandated coverage of pregnant women and infants in families with incomes up to 100% of the FPL. The Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) mandated coverage for pregnant women and children under age 6 in families with incomes up to 133% of the FPL. The Omnibus Reconciliation Act of 1990 (Public Law 101-508) mandated that states phase in eligibility for children ages 6 through 18 in families with incomes up to 100% of the FPL.
32. For the purposes of Medicaid and SCHIP eligibility, family income is measured as a percentage of FPL, where "poor" is defined as 100% of the FPL. FPL refers to the federal poverty guidelines that the Department of Health and Human Services issues each year and publishes in the Federal Register. The guidelines vary by family size and jurisdiction. In 2002, for example, 100% of the FPL for a family of four living in the 48 contiguous states and the District of Columbia was $18,100. See Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. The 2002 HHS poverty guidelines. 2002. Available online at http://www.aspe.hhs.gov/poverty/02poverty.htm.
33. Social Security Act, Title XIX, 42 U.S.C. § 1396a(l)(D) and 42 U.S.C. § 1396a(l)(2)(C) (LEXIS 2002), requires states to phase in eligibility to children in families with incomes less than or equal to 100% of the FPL who were born after September 30, 1983 (or, at the option of a state, after any earlier date), and are between ages 6 and 18.
34. The Foster Care Independence Act of 1999 (Public Law 106-169) increased federal funds for programs to assist youths in the transition from foster care to independence and created a new option for states to expand Medicaid to this vulnerable population.
35. This option, commonly called the "1902(r)(2) option," allows states to use less-restrictive income and resource methodologies to determine Medicaid eligibility for certain groups. For additional information, see Center for Medicare and Medicaid Services. Medicaid eligibility groups and less restrictive methods of determining countable income and resources. May 11, 2001. Available online at http://www.cms.gov/medicaid/eligibility/elig0501.pdf.
36. Centers for Medicare and Medicaid Services. MSIS statistical report for federal Fiscal Year 1999, table 2, Medicaid eligibles-Fiscal Year 1999, by age group, all states. (National total revised June 25, 2002.) Available online at http://www.cms.gov/medicaid/msis/99total.pdf.
37. Social Security Act, Title XXI, 42 U.S.C. § 1397jj(b)(1)(B)(i) and (ii)(I) (LEXIS 2002), permit states that had previously raised their Medicaid eligibility levels above 150% of the FPL to extend SCHIP eligibility to children and adolescents in families with incomes up to 50 percentage points higher than the state's Medicaid eligibility cutoff as of March 31, 1997, for children of the same age.
38. Social Security Act, Title XXI, 42 U.S.C. §§ 1397jj(b)(1)(C) and 1397jj(b)(4) (LEXIS 2002); and Public Health Service Act, Title XXV, 42 U.S.C. § 300gg-91 (LEXIS 2002).
39. Social Security Act, Title XIX, 42 U.S.C. § 1396d(b) (LEXIS 2002).
40. Morreale, M.C., and English, A. Eligibility and enrollment of adolescents in Medicaid and SCHIP: Recent progress, current challenges. Journal of Adolescent Health. In press.
41. See note 38, Morreale and English.
42. See note 38, Morreale and English.
43. See note 38, Morreale and English.
44. Calculation based on data provided by the Center for Medicare and Medicaid Services (CMS), Center for Medicaid and State Operations, Family and Children's Health Program Group, August 2002. Data do not include missing data (not reported to CMS) from Alabama and Illinois.
45. See note 38, Morreale and English.
46. Rosenbaum S., and Smith, B. Policy brief #1: State SCHIP design and the right to coverage. Washington, DC: Center for Health Services Research and Policy, 2001. Available online at http://www.gwhealthpolicy.org/brief_1.pdf.
47. Once a state's SCHIP allotment is exhausted, the state receives payments at the regular Medicaid matching rate. Centers for Medicare and Medicaid Services. The administration's responses to questions about the State Children's Health Insurance Program. 2002. Available online at http://www.cms.hhs.gov/ schip/qandaintro.asp.
48. See note 42, Center for Medicare and Medicaid Services.
49. For additional information, see Centers for Medicare and Medicaid Services. Medicaid Services. 2002. Available online at http://www.cms.gov/ medicaid/mservice.asp;
50. and Centers for Medicare and Medicaid Services. Medicaid and EPSDT. 2002. Available online at http://www.cms.gov/medicaid/epsdt/default.asp.
51. Social Security Act, Title XIX, 42 U.S.C. § 1396d(r) (LEXIS 2002).
52. See the article by Szilagyi in this journal issue.
53. Prior to passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193, also known as PRWORA), immigrants who were in the United States lawfully were generally eligible for Medicaid on the same basis as citizens. With the enactment of PRWORA, Medicaid eligibility for immigrants is now based on citizenship status rather than legal status. See Fremstad, S. Immigrants and welfare reauthorization. Washington, DC: Center on Budget and Policy Priorities, February 2002;
54. and Centers for Medicare and Medicaid Services. State Medicaid manual. 2002. Available online at http://www.cms.gov/manuals/pub45/pub_45.asp.
55. U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. The AFCARS report: Interim FY 2000 estimates as of August 2002. Available online at http://www.acf.hhs.gov/programs/cb/ publications/afcars/report7.pdf.
56. U.S. General Accounting Office. Foster care: Effectiveness of independent living services unknown. Washington, DC: GAO/Health, Education and Human Services Division, November 1999.
57. English, A., and Grasso, K. The Foster Care Independence Act of 1999: Enhancing youth access to health care. Clearinghouse Review/Journal of Poverty Law (July-August 2000):217-32.
58. English, A., Morreale, M.C., and Larsen, J. Access to health care for youth leaving foster care: Medicaid and SCHIP. Journal of Adolescent Health. In press.
59. See note 51, U.S. Department of Health and Human Services.
60. See note 54, English, et al.
61. Snyder, H.N., Sickmund, M., and Bilchik, S. Juvenile offenders and victims: 1999 National report. National Center for Juvenile Justice, Office of Juvenile Justice and Delinquency Prevention, September 1999. Available online at http://www.ncjrs.org/html/ojjdp/nationalreport99/index.html.
62. See note 57, Snyder, et al.
63. Austin, J., Krisberg, B., and DeComo, R. Juveniles taken into custody: Fiscal Year 1993. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, 1995.
64. See note 57, Snyder, et al.
65. Soler, M. Health issues for adolescents in the justice system. Journal of Adolescent Health. In press.
66. Council on Scientific Affairs, American Medical Association. Health status of detained and incarcerated youths. Journal of the American Medical Association (1990) 263:987-91.
67. Society for Adolescent Medicine. Health care for incarcerated youth: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health (2000) 27:73-75.
68. See note 61, Soler.
69. See note 62, Council on Scientific Affairs.
70. See note 63, Society for Adolescent Medicine.
71. See note 61, Soler.
72. U.S. Census Bureau. Current population survey annual demographic survey, March supplement, detailed health insurance (P60) Package. Available online at http://ferret.bls.census.gov/macro/032002/health/h10_000.htm.
73. U.S. Census Bureau. Health insurance coverage: 2001. September 2002. Available online at http://www.census.gov/prod/2002pubs/p60-220.pdf.
74. For example, several bills would allow states to provide Medicaid and SCHIP coverage through age 22 or 24 (rather than 19) and/or to extend coverage to children and adolescents in families with incomes up to 250% or 300% of the FPL. See the Start Healthy, Stay Healthy Act of 2001, S. 1016; the SCHIP Enhancement Act of 2001, S. 1266; the Family Care Act of 2001, H.R. 2630/S. 1244; the Leave No Child Behind Act of 2001, H.R. 1990/S. 940; the Dylan Lee James Act, H.R. 600/S. 321; and the MediKids Health Insurance Act of 2002, H.R. 1733/S. 827.
75. See note 22, English, et al.
76. See note 21, Brindis, et al.; note 22, English, et al.; and note 23, American Academy of Pediatrics.
77. See note 22, English, et al.
78. See note 48, Social Security Act.
79. See note 17, Park, et al. However, although professional guidelines for clinical preventive services recommend annual health assessments for adolescents, only 16 of 47 states responding to a recent survey specify the recommended annual visits for adolescents in their EPSDT periodicity schedules.
80. See McNulty, M. Medicaid, managed care and adolescent health: State prevention policies. Rochester, NY: University of Rochester. Monograph in press.
81. See General Accounting Office. Medicaid: Stronger efforts needed to ensure children's access to health screening services. Washington, DC: Government Printing Office, July 2001;
82. Olson, K., Perkins, J., and Pate, T. Children's health under Medicaid: A national review of Early and Periodic Screening, Diagnosis and Treatment. Los Angeles: National Health Law Program, 1998;
83. and Stinnett, A., Perkins, J., and Olson, K. Children's health under Medicaid: A national review of Early and Periodic Screening, Diagnosis and Treatment-1997-1998 update. Los Angeles: National Health Law Program, 2001.
84. Gold, R.B., and Sonfield, A. Reproductive health services for adolescents under the State Children's Health Insurance Program. Family Planning Perspectives (March/April 2001) 33(2):81-87.
85. National Conference of State Legislatures. Providing reproductive health services for adolescents: State options. No date. Available online at http://www.ncsl.org/programs/health/forum/pub6768.htm.
86. U.S. Department of Health and Human Services. Mental health: A report of the surgeon general. Rockville, MD: DHHS, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
87. Stateserv, Health Policy Tracking Service. Table 5. Mental health benefits in non-Medicaid SCHIP plans, September 30, 2000, and Table 6. Substance abuse treatment benefits in non-Medicaid SCHIP plans, September 30, 2000. May 10, 2001. Available online at http://stateserv.hpts.org.
88. Gehshan, S. Substance abuse treatment in State Children's Health Insurance Programs. Denver: National Conference of State Legislatures (February 2001). Available online at http://www.ncsl.org/programs/health/forum/saschip. htm.
89. See note 24, Fox, et al.
90. Howell, E.M., Buck, J.A., and Teich, J.L. State report: Mental health benefits under SCHIP. Health Affairs (November/December 2000) 19(6):291-97.
91. See note 22, English, et al.; and note 21, Brindis, et al.
92. U.S. Department of Health and Human Services. Oral health in America: A report of the surgeon general. Rockville, MD: DHHS, National Institutes of Dental and Craniofacial Research, National Institutes of Health, 2000.
93. See note 85, U.S. Department of Health and Human Services.
94. Yu, S.M., Bellamy, H.A., Schwalberg, R.H., and Drum, M.A. Factors associated with use of preventive dental and health services among U.S. adolescents. Journal of Adolescent Health (2001) 29(6):395-405.
95. Stateserv, Health Policy Tracking Service. Table 4. Dental benefits in non-Medicaid SCHIP plans, September 30, 2000. May 10, 2001. Available online at http://stateserv.hpts.org.
96. See note 24, Fox, et al.
97. Newacheck, P.W., and Halfon, N. Prevalence and impact of disabling chronic conditions in childhood. American Journal of Public Health (1998) 88(4):610-17, Table 1.
98. Fox, H.B., Graham, R.R., McManus M.A., and Chen, C.Y. An analysis of states' CHIP policies affecting children with special health care needs. Washington, DC: Maternal and Child Health Policy Research Center, 1999.
99. Fox, H.B., McManus, M.A., and Limb, S.J. Access to care for SCHIP children with special health care needs. Washington, DC: Maternal and Child Health Policy Research Center for the Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation, December 2000.
100. Rosenbaum, S., Shaw, K., and Sonosky, C. Policy Brief #3: Managed care purchasing under SCHIP: A nationwide analysis of freestanding SCHIP contracts. Washington, DC: Center for Health Services Research and Policy, George Washington University, December 2001.
101. Stateserv, Health Policy Tracking Service. Table 3. Optional benefits and services in non-Medicaid SCHIP plans, September 30, 2000, and Table 7. Selected benefits for children with special health care needs (CSHCN) in non-Medicaid SCHIP plans, September 20, 2000. May 10, 2001. Available online at http://stateserv.hpts.org.
102. See note 92, Fox, et al.
103. Gans, J., ed. Policy compendium on confidential health services for adolescents. Chicago: American Medical Association, 1994.
104. American Medical Association, Council on Scientific Affairs. Confidential health services for adolescents. Journal of the American Medical Association (1993) 269:1420-24.
105. Society for Adolescent Medicine. Confidentiality for adolescents: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health (1997) 21:408-15.
106. Ford, C.A., Millstein, S., Halpern-Felsher, B., and Irwin, C. Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. Journal of the American Medical Association (1997) 278:1029-34.
107. See also Cheng, T.L., Savageau, J., Sattler, A., and DeWitt, T. Confidentiality in health care: A survey of knowledge, perceptions, and attitudes among high school students. Journal of the American Medical Association (1993) 269:1404-07.
108. Ford C.A., Bearman, P., and Moody, J. Forgone health care among adolescents. Journal of the American Medical Association (1999) 282:2227-34.
109. The Federal Privacy Rule, issued under the Health Insurance Portability and Accountability Act of 1996, was made final in December 2000. See Standards for Privacy of Individually Identifiable Health Information: Final Rule, 65, Federal Register 82461 (28 December 2000), codified at 45 Code of Federal Regulations Parts 160, 164.
110. Standards for Privacy of Individually Identifiable Health Information: Final Rule, 67, Federal Register 53182 (14 August 2002).
111. 45 Code of Federal Regulations § 164.502(g).
112. Public Health Service Act, Population Research and Voluntary Family Planning Programs, 42 U.S.C. §§ 300 et seq. (LEXIS 2002); 42 Code of Federal Regulations § 59.11 (LEXIS 2002); and 42 Code of Federal Regulations §§ 2.1-2.63 (LEXIS 2002).
113. Social Security Act, Title XIX, 42 U.S.C. § 1396a(a)(7) (LEXIS 2002); 42 Code of Federal Regulations §§ 431.300-431.306; 438.224; 457.1110 (LEXIS 2002).
114. Health Privacy Project. The state of health privacy: An uneven terrain. Washington, DC: Health Privacy Project, Institute for Health Care Research and Policy, Georgetown University, 1999. Available online at http://www. healthprivacy.org/resources/statereports/contents.html.
115. English, A., Morreale, M.C., Stinnett, A., et al. State minor consent laws: A summary, 2d ed. Chapel Hill, NC: Center for Adolescent Health and the Law, 2003. Depending on the state, minors may be allowed to give their own consent if they are mature minors, legally emancipated minors, married minors, minors in the armed forces, minors living apart from their parents, minors over a certain age, high school graduates, pregnant minors, or minor parents. Also, depending on the state, they may be able to consent to one or more services, such as emergency care, pregnancy-related care, contraceptive services, diagnosis and treatment of venereal or sexually transmitted infections, HIV/AIDS testing and/or treatment, treatment or counseling for drug or alcohol problems, collection of medical evidence or treatment for sexual assault, inpatient mental health services, or outpatient mental health services.
116. See note 107, English, et al.
117. See, for example, Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press, 2001;
118. Institute of Medicine, Board on Health Care Services. Envisioning the national health care quality report. Washington, DC: National Academy Press, 2001;
119. Agency for Health Care Research and Quality. Child health toolbox: Measuring performance in child health programs. Uses of performance measurement. March 2001. Available online at http://www.ahrq.gov/chtoolbx;
120. and Schmid, M. Health plan performance measurement: What is it, how it impacts CHIP and Medicaid, and why child advocates should care. Washington, DC: National Association of Child Advocates, November 1999.
121. See, for example, the Health Plan Employer Data and Information Set (HEDIS), developed by the National Committee for Quality Assurance (see the NCQA Web site at http://www.ncqa.org/Programs/HEDIS/index.htm);
122. the Young Adults Health Care Survey developed by the Foundation for Accountability (see the FACCT Web site at http://facct.org);
123. and Bethell C., Klein J., and Peck C. Assessing health system provision of adolescent preventive services: The Young Adults Health Care Survey. Medical Care (2002) 39(5):478-90.
124. One study, conducted by the American Public Human Services Association (APHSA), found that among enrollees of nearly 170 Medicaid managed care plans in 31 states and Puerto Rico, surveyed in 1999, approximately 29% of adolescents received an annual well-care visit, compared with 51% of children ages 3 through 6, and that only a little more than half (51%) of 13-year-old adolescents received the recommended second dose of measles/mumps/rubella immunization. See Partridge, L. The APHSA Medicaid HEDIS database project, report for the third project year (data for 1999). American Public Human Services Association, December 2001. Available online at http://www.cmwf.org/programs/quality/ partridge_aphsa_hedis_1999.pdf.
125. Center for Adolescent Health & the Law. Analysis of Title XXI annual reports from FY 2001. Unpublished 2002.