Medicaid plays several different roles of significance to Native Americans. Through its purchase of managed care products, Medicaid is reshaping the health care delivery system for many Native Americans and other underserved low-income populations. Medicaid also assists low-income elderly and disabled Indians who are eligible for Medicare in meeting their premium and cost-sharing obligations. Finally, Medicaid offers coverage for nursing home care and other long-term care services needed by frail elderly and disabled Native Americans. This report provides an overview of Medicaid from the standpoint of Native Americans with an emphasis on Medicaid as an insurance program and a purchaser of managed care

• Report
• Report

The State Children’s Health Insurance Program, enacted as part of the Balanced Budget Act of 1997, provides over $20 billion in federal funds over five years to cover low-income uninsured children. This policy brief examines how many children will participate and the public costs per covered child.

Panorama General: Medicare proporciona servicios de salud a casi 39 millones de norteamericanos, incluyendo aproximadamente a 34 millones de ancianos y a 5 millones de discapacitados. La gran mayoria de estas personas cubren sus gastos medicos directamente mediante el programa tradicional de “pago por servicio,” mientras que el 15 porciento restante (mas de 5 millone de beneficiarios) estan cubiertos bajo algun plan de servicio medico contratado con Medicare, principalmente las organizaciones de administracion de la salud (HMO por sus siglas en ingles).

• Fact Sheet: Servicios De Salud Administrados Por Medicare

Teen Sex, Contraception and Pregnancy

• Fact Sheet: Teen Sex, Contraception and Pregnancy

• Resource List: Covering Mental Health: A Resource Guide for Reporters and Editors

Child Health Facts: National and State Profiles of Coverage

Appendix 2

Medicaid Enhanced Matching Rate Matching Rate Alabama 69.3% 78.5% Alaska 59.8% 71.9% Arizona 65.3% 75.7% Arkansas 72.8% 81.0% California 51.2% 65.9% Colorado 52.0% 66.4% Connecticut 50.0% 65.0% Delaware 50.0% 65.0% District of Columbia 70.0% 79.0% Florida 55.7% 69.0% Georgia 60.8% 72.6% Hawaii 50.0% 65.0% Idaho 69.6% 78.7% Illinois 50.0% 65.0% Indiana 61.4% 73.0% Iowa 63.8% 74.6% Kansas 59.7% 71.8% Kentucky 70.4% 79.3% Louisiana 70.0% 79.0% Maine 66.0% 76.2% Maryland 50.0% 65.0% Massachusetts 50.0% 65.0% Michigan 53.6% 67.5% Minnesota 52.1% 66.5% Mississippi 77.1% 84.0% Missouri 60.7% 72.5% Montana 70.6% 79.4% Nebraska 61.2% 72.8% Nevada 50.0% 65.0% New Hampshire 50.0% 65.0% New Jersey 50.0% 65.0% New Mexico 72.6% 80.8% New York 50.0% 65.0% North Carolina 63.1% 74.2% North Dakota 70.4% 79.3% Ohio 58.1% 70.7% Oklahoma 70.5% 79.4% Oregon 61.5% 73.0% Pennsylvania 53.4% 67.4% Rhode Island 53.2% 67.2% South Carolina 70.2% 79.2% South Dakota 67.8% 77.4% Tennessee 63.4% 74.4% Texas 62.3% 73.6% Utah 72.6% 80.8% Vermont 62.2% 73.5% Virginia 51.5% 66.0% Washington 52.2% 66.5% West Virginia 73.7% 81.6% Wisconsin 58.8% 71.2% Wyoming 63.0% 74.1%

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Child Health Facts: National and State Profiles of Coverage

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Table A2 Table One Table Two Table Three Table Four Table Five Table Six Table Seven Table Eight Table Nine Table Ten Table Eleven Table Twelve Table Thirteen Table Fourteen Table Fifteen Table Sixteen Table Seventeen Table Eighteen Table Nineteen Table TwentyTable A1 Table A3 Table A4

Medicare Beneficiaries & HMO’s: A Case Study of the Los Angeles Market

Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option.

The Entertainment Media as “Sex Educators?”

And, Other Ways Teens Learn About Sex, Contraception, STDs, and AIDS

June 24, 1996

What Sources Do Teenagers Rely on for Information About Sex and Birth Control?

According to a 1996 Kaiser Family Foundation Survey of teens, teens say they currently get information about sex and birth control from a variety of sources including: their parents (72%); teachers, school nurses, or sex education classes (69%); their friends (other than boy/girlfriends) (60%); and the media, such as TV shows or movies (53%) and magazines (39%).

What Media Are Teens Exposed To?

In today’s “information age,” teens are bombarded with information from many media sources. Television and music are among those most popular with teens. According to one study, the average teen spends more time watching television than doing any other activity besides sleeping (Davies, 1993). As teens get older, however, they show a growing preference for music over TV (Arnett, 1992; Larson, Kubey, & Colletti, 1989). In one focus group study, 11-15 year-olds listened to music four hours a day as a primary activity (not including as background music), compared to three hours a day of watching TV (Liming, 1987). The Kaiser Teen Survey also found that seventy percent of teenage girls say they “regularly” read magazines, particularly those targeted to them such as Seventeen, YM, and Teen.

To What Extent Do These Media Deal With Sex and Related Issues, Such as Contraception, STDs, and AIDS?

A study that looked at TV shows most popular among those under 17 during the 1992-1993 broadcast season found that one in four interactions among characters per episode conveyed a sexual message. In three weeks of programming studied, only two of the ten shows included messages about sexual responsibility (Ward, 1995). Two Kaiser Family Foundation studies also found high rates of sexual references and incidents with few mentions of adverse consequences in soap operas and TV talk shows. (Comparatively fewer studies have been done of print media coverage of sexuality issues, although the Kaiser Family Foundation currently has a study underway to look at the coverage in special interest magazines, such as those targeted to women, men, and teens).

Do the Media Have an Impact on Teenagers’ Attitudes and Behaviors Toward Sex?

One of the issues at the crux of the debate over sex in the media is to what extent the media affects teens’ attitudes and behaviors related to sex. After reviewing the existing research about impact of the media on behavior, Jane Brown and Jeanne Steele at the School of Journalism and Mass Communications at the University of North Carolina at Chapel Hill, both experts on the media and sexuality, concluded that in response to the question of whether the media might affect teens’ sexual behaviors, the answer is a “qualified yes.” “Qualified” because research on the effects of sex in the media is sparse and because it is very difficult to document the effects of media on people’s behavior. However, based on what is known about the effects of sexual media content, along with the larger body of research on the effect of the media on violence and anti-social behavior, they found that entertainment media do play an important role in shaping American youths’ sexual beliefs, attitudes, and behaviors. (From a study prepared for the Kaiser Family Foundation entitled Sex and Mass Media).

In the Kaiser Teen Survey, three-quarters of teens say they think portrayals of teen sex on television and in the movies is one of several possible factors affecting teen sexual activity. There is also evidence that the media can be used effectively to increase awareness and knowledge about reproductive and sexual health issues and possibly to change behavior toward reducing unplanned pregnancy and HIV and other STD infection rates.

What Teenage Pregnancy and STD Prevention Approaches Appear to Have Had a Positive Effect on Risk-Taking Behavior?

Many wide-ranging attempts have been made to affect teenage sexual and reproductive behavior but many of these programs have not been rigorously evaluated. Although numerous studies have attempted to measure the effectiveness of teenage pregnancy intervention programs, scientific research has not yet provided definitive answers about their success. However, much has been learned from the experiences of the few pregnancy prevention programs that have been designed and implemented with a rigorous, scientific evaluation component. A recent review by The Alan Guttmacher Institute of the impact of five rigorously evaluated adolescent pregnancy prevention programs shows that some intervention programs are successful in helping teenagers delay intercourse, and improving contraceptive use among teenagers who are sexually active. Furthermore, some programs can effectively combine an emphasis on delaying sexual activity with education regarding contraception. The most effective programs appear to be those that combine innovative, comprehensive sexuality education; skills for making decisions about having intercourse and for communicating with partners; and access to family planning services. Measuring the impact of community programs on sexual behavior and pregnancy rates is very difficult for several reasons including the lack of information on rates of sexual activity and birth control use at the local level.

What is “Entertainment-Education”? And, How is it Being Used?

International reproductive health organizations have long used mass media entertainment for educational purposes in some developing countries. Entertainment-education involves presenting educational content in entertaining formats with the primary goal of increasing knowledge. Mass media’s pervasiveness allows it to reach a large number of people, sending messages repeatedly in a variety of forms. Television soap operas/dramas and films are widely used in entertainment-education. Radio is also used widely because of its relatively low production cost, accessability and extensive reach. However, assessing the impact of such programs is complex — usually done with pre- and post-intervention surveys; comparison of exposed and non-exposed groups; and tracking of clinic data. Though it is unclear whether entertainment-education changes behavior, it has been proven to be an effective way to increase knowledge and awareness about an issue. Evaluations have demonstrated positive results in terms of increased knowledge about HIV transmission and the need for family planning, and increases in visits to local family planning clinics. Setting up such programs is easier outside the U.S. for a number of reasons, including less competition on the airways.

Here in the United States, there have also been some recent efforts by individuals within the entertainment industry to improve the way in which sex and its possible consequences are portrayed. A significant difference is that these efforts involve changes made to programming that is meant to be entertaining, and not meant specifically to be educational. A few examples of such efforts include:

• Following a summit of soap opera producers and writers which highlighted the lack of portrayals of the consequences of sexual behavior on soap operas two years ago, three top-rated daytime dramas, “General Hospital,” “One Life to Live,” and “The Bold and the Beautiful,” adopted story lines on teen pregnancy and HIV/AIDS (Olson, 1994).

• MEE (Motivational Educational Entertainment) Productions produced an educational video targeted at inner city youth “at risk” of dropping out of school. The program uses high profile rap artists including KRS One, Public Enemy, and Black Sheep, along with interviews with teens, to encourage youth to stay in school and graduate.
• “ER,” a popular Prime Time drama, has focused several episodes on issues related to teen sexuality and reproductive health. One episode dealt with a 14 year old girl who had a positive pregnancy test and didn’t want her mother to know the results. Another episode showed “Dr. Ross” awkwardly dealing with a gay high school athlete.

What is the “V-Chip”? And, What Role are Government and Others Likely to Have in Addressing the Media’s Portrayal of Sex and Related Issues?

After much debate and numerous revisions, a telecommunications bill (S 652) was enacted by Congress on February 8, 1996. While the legislation focuses on de-regulation to promote competition among cable television and telephone services, it also introduces restrictions on sexual and violent content on television and the Internet. The law mandates a ratings system that would use a “V-chip” or equivalent technology to allow parents to screen out material they do not want their children to watch. Under this new law, the V-chip must be installed in all new TV sets with screens larger than 13 inches, as of January 1998. The law also mandates that a federally designed, voluntary ratings system be implemented by February 1997 if a satisfactory ratings system isn’t already in place — giving the entertainment industry a year to set up its own rating system. Since talks began March 1, the industry has agreed that each entertainment program will be rated by its distributor (the network or independent station carrying the program) and guidelines will be put in place to ensure consistency across networks.

Several issues surrounding the ratings system remain unresolved, particularly in regard to the forms ratings will take, and the logistical challenges of rating all relevant programming. For example, excluding news and sports programs which won’t be rated, the industry would need to rate an overwhelming 100,000 hours of programming per year — as compared to the 1,200 hours of film the Motion Picture Association of America rates each year. Some believe using a letter or number rating system may prove to be impractical and think a content description would be more effective. Another suggestion is that a single rating be assigned to each series for an entire season, while assigning different ratings to especially “objectionable” episodes. The biggest challenge may be defining the ratings for particular actions or behaviors and differentiating jokes from “responsible” discussions of topics such as teen pregnancy.

Is Contraceptive Product Advertising Restricted in the U.S.?

Although there are no laws or government regulations prohibiting contraceptive advertising in the United States, several major obstacles hinder contraceptive advertising, including: some FDA restrictions on prescription drug advertising, inconsistent efforts by advertisers, and fear of public disapproval and reprisal. While the public supports advertising of family planning methods, the minority opinion has prevailed in the decisions that broadcast media, and to some degree, print media have made regarding contraceptive advertising policies.

Television and radio. The broadcast media have historically resisted the advertising of contraceptive products, and through its National Association of Broadcasters until 1982 had a code on programming and advertising. Although the television networks ABC, CBS, FOX and NBC continue to reject contraceptive advertising, all networks have relaxed their ban on condom advertising in public service announcements as long as those commercials emphasize the prevention of disease and not pregnancy prevention.

Newspapers and Magazines. The print media do not face the same sort of industry self­regulation as the broadcast media. Yet, until the 1980s, magazines and newspapers also resisted contraceptive advertisements seemingly due to perceived public disapproval of such advertising. Magazines now generally are open to contraceptive advertising, with the women’s magazines taking the lead. Newspapers, however, generally will not give space to public service advertising and only recently (in the wake of the AIDS epidemic) have accepted advertisements that promote condoms for disease prevention.

The Advertisers. Commercial companies, particularly the condom manufacturers, have attempted to conduct advertising campaigns. The campaigns for prescription contraceptives, however, have been limited efforts, directed mostly to the print media.

The Public. In one of the few studies of public attitudes toward contraceptive advertising on television conducted by Louis Harris and Associates in the late 1980s, it was shown that a majority of Americans believe that television stations should be permitted to advertise contraceptive products. In fact, the study found that there was more support for contraceptive advertising (53% in favor) than there was for beer and wine advertising (45% in favor). Eight of 10 Americans believed that advertising on television would encourage more teenagers to use contraceptives, and more than three-quarters of all adults felt that if teenagers saw television stars they admire use birth control, that they would be more likely to use it themselves. Seven of 10 people said that they would not be offended by contraceptive advertising. In a parallel study, Harris and Associates surveyed 259 television station managers about the same issue. Seven of 10 station managers believed that commercials for contraceptives would offend many people; however, more than seven of 10 also said that stations should air these commercials if they do not cause offense.

Teenage Sexual and Reproductive Behavior in the United States

The Changing Face of Teen Sexual Activity and Unplanned Pregnancy

Over the past two decades, the pregnancy rate among sexually experienced teenage girls aged 15-19 has declined by 19%, indicating that many are doing a better job at using contraception. But, because the percentage of teens who have had sex has been steadily increasing at the same time, in real terms, the problem of teen pregnancy is getting worse. In addition, as of the late 1980s, a higher proportion of teenage girls who get pregnant are giving birth and, over the last three decades, dramatically fewer are getting married when they become teen mothers, resulting in more children in households with single teen mothers.

Sexual Activity

• The proportion of 15- 19-year-old girls who are sexually active rose from 47% in 1982 to 55% in 1990.
• Fifty-six percent of teenage girls and 73% of teenage boys today have had sexual intercourse by their18th birthday. In the early 1970s, 35% of girls and 55% of boys had had sex by that age.
• Most very young teenage boys and girls have not had intercourse — 84% of 13-year-olds, 77% of 14-year-olds and 70% of 15-year-olds.
• While the likelihood of having intercourse increases steadily with age, 1 in 5 teenagers do not have intercourse during their teenage years.
• Seven in 10 girls who had sex before age 14 and 6 in 10 of those who had sex before age 15 report having sex involuntarily.
• Most teenagers begin having intercourse in their mid-to-late teens, about 8 years before they marry.
• Among the most common reasons teens have sex, according to 55% of teens, is that “they think they’re ready.”
• Six out of ten teenage girls say another reason why teen girls may have sex is because a boyfriend is pressuring them.

Contraceptive Use

• Five out of ten (48%) teens say they use birth control “all the time,” an additional 24% say they use it “most of the time,” and 15% say they use it “sometimes.” Only 11% of sexually active teens say they never use birth control, approximately the same percentage as sexually active adults who don’t.
• The contraceptive most frequently used by teens is the condom (44%), followed by birth control pills (40%). One-quarter of the teenagers who use the pill also use the condom.
• Two-thirds of teenagers use some contraceptive method — usually a condom — the first time they have intercourse.
• Teenage girls’ birth control use at first intercourse rose from 48% to 65% during the 1980s, almost entirely because of a doubling in condom use (from 23% to 48%).
• A sexually active teenage girl using no contraception over one year has a 90% chance of becoming pregnant.

Sexually Transmitted Diseases (STDs)

• Three million teenagers — about 1 in 4 sexually experienced teenagers — acquire an STD every year.
• In a single act of unprotected sex with an infected partner, a woman has a 1% risk of acquiring HIV, a 30% risk of getting genital herpes, and a 50% chance of contracting gonorrhea.
• Chlamydia is more common among teenagers than among older men and women; in some studies, up to 30% of sexually active teenage girls and 10% of teenage boys tested for STDs have been found to have chlamydia.
• Teenagers have higher rates of gonorrhea than sexually active men and women aged 20-44. In some studies, up to 15% of sexually active teenage girls have been found to be infected with HPV, the virus that causes genital warts, many with a strain of this virus linked with cervical cancer.
• By the end of 1995, there were more than 2,300 teenagers known to have AIDS.
• Teens are worried about getting AIDS or other STDs. Four out of ten teens say they worry at least some about getting AIDS someday or another STD.

Teenage Pregnancy

• About one million teenage girls — 11% of all girls aged 15-19 (112 per 1,000) and 20% of those who have had sexual intercourse (204 per 1,000) — become pregnant each year.
• Eighty-five percent of teenage pregnancies are unplanned, accounting for one-quarter of all unplanned pregnancies each year.
• Fifty-four percent of teenage pregnancies each year (960,000 in 1992) end in birth (most of which are unplanned); about one-third end in abortion (32%) and the rest in miscarriage (14%).
• Among sexually experienced teenagers, about 16% of 14-year-olds, 17% of 15- 17-year-olds and 23% of 18- 19-year-olds become pregnant each year.
• Teenage pregnancy rates are much higher in the United States than in many other developed countries — twice as high as in England and Wales, France and Canada; and 9 times as high as in the Netherlands or Japan.
• Of all births to U.S. women, 13% are to teenagers.
• Twenty percent of U.S. abortions each year are to teenagers.
• A majority of teens (55%) say when teens have unplanned pregnancies, it’s “often” a result of having sex when drunk or on drugs. Forty-six percent say it’s “often” because teens have sex when they don’t have birth control with them.

Sources of Data:

The data in this fact sheet are from research conducted by the Kaiser Family Foundation, The Alan Guttmacher Institute, the National Center for Health Statistics, and/or were published in Family Planning Perspectives.

For More Information:

Kaiser Family Foundation Survey on Teens and Sex: What They Say Teens Today Need to Know, And Who They Listen To,1996.

Centers for Disease Control and Prevention.

Sex and America’s Teenagers, The Alan Guttmacher Institute, 1994.

Testing Positive: Sexually Transmitted Disease and the Public Health Response, The Alan Guttmacher Institute, 1993.