The contribution of the neighborhood context to social disparities in access to health care among sexually experienced adolescent females

Access to health care is an important resource for sexually experienced adolescent females in the prevention of unintended pregnancy and sexually transmitted infections, including HIV. However, a paucity of research exists regarding the extent to which social disparities in access to health care exist among this vulnerable population of adolescents, including the potential contribution of the neighborhood context. Therefore, the primary aims of this dissertation were to examine (1) the extent to which racial and socioeconomic disparities in access to health care exist among sexually experienced adolescent females, (2) the extent to which access to health care among sexually experienced adolescent females varies across neighborhoods, and (3) the extent to which the neighborhood racial and socioeconomic context contribute to racial and socioeconomic disparities in access to health care among sexually experienced adolescent females. A multilevel design was employed for this dissertation utilizing secondary data from Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Analyses included hierarchical generalized linear modeling to examine the receipt of a routine physical, the receipt of contraceptive services, and reported unmet health needs among the dissertation sample of 1,526 sexually experienced Non-Hispanic Black and Non-Hispanic White adolescent females between 15 years to 19 years of age who were dispersed across 546 neighborhoods. After adjusting for a variety of factors that may influence access to health care, the findings revealed no racial disparities and few socioeconomic disparities in access to health care among this sample of adolescents. No significant relationship was noted between the neighborhood racial and socioeconomic context and access to health care or social disparities in access to health care among this sample of adolescents. However, the findings revealed that access to health care among this sample of sexually experienced adolescent females varied across neighborhoods, above and beyond the individual composition of the neighborhood. Further studies are indicated to explore the underlying factors that contribute to socioeconomic disparities in access to health care among sexually experienced adolescent females, and the potential neighborhood characteristics that may contribute to differential access to health care across neighborhoods among this vulnerable population of adolescents