In 1995, 17.5 million children — one-quarter of all children under age 18 — had Medicaid coverage for health care services. Medicaid, the federal/state health program for the poor, pays for a broad range of services for children including well-child care, immunizations, prescription drugs, doctor visits, and hospitalization, and a range of long-term care services for children with disabilities.

Medicaid plays a particularly strong role for low-income children, covering two-thirds (64%) of all poor children and a quarter( 27%) of children with incomes between 100% and 199% of the federal poverty level (FPL). While employer-based insurance coverage of children declined from 1987 to 1995, expansions in Medicaid have resulted in greater coverage of children in low-income families (Figure 1). During this same period, Medicaid enrollment grew from about 10 million — 15.5% of all children — to 17.5 million children (23.2%).

Despite the importance of Medicaid today, about 10 million children are uninsured. Lack of insurance is particularly high among low-income children. Seventy percent of uninsured children are in families with incomes below 200% of poverty. The new State Child Health Insurance Program, enacted as part of the Balanced Budget Act of 1997, is intended to provide coverage to this group.

Eligibility

Being poor does not automatically qualify a child for Medicaid. In the past 15 years, Medicaid eligibility for children has been broadened considerably through federal legislation and state optional expansions. Prior to 1986, Medicaid primarily served children who received AFDC cash assistance. Today, children qualify for Medicaid based on their age and income.

Medicaid coverage is especially prominent among young children, covering 33% of infants and 29% of children ages 1 to 5. Because recent expansions focused on young children, older children are less likely to qualify for Medicaid. Medicaid covers 22% of children between the ages of 6 to 12 years and 17% of teens between the ages of 13 to 18 years.

Medicaid Coverage of Children:

States are mandated to cover certain groups of children based on age and income criteria. By 2002, all states will be required to have phased-in coverage of children under age 19 with incomes below poverty. States can choose to expand Medicaid eligibility beyond federal minimum standards by raising age and income levels for children (Figure 2). They can also use Section 1115 research and demonstration waivers to broaden eligibility. In total, 41 states have expanded Medicaid coverage to children in one or more age or income levels. Federal coverage requirements for children are as follows:

• Up to age 6 with family incomes up to 133% FPL. For infants, 35 states have chosen to expand coverage beyond 133% FPL and 13 have expanded for children age one to six.

• Age 6 to 14 with family incomes below 100% FPL. Fifteen states have opted to expand eligibility beyond 100% FPL.
• Age 15 to 19 if family income meets the AFDC criteria of August 1996 (state average is 41% of FPL) with coverage phased-in for poor children born before 9/30/83. 25 states have opted to accelerate this phase-in to cover older children up to age 18 with income below 100% FPL (Figure 2).
• Children with disabilities also qualify for Medicaid assistance on the basis of SSI eligibility. Medicaid covers about 1 million additional children with physical or mental disabilities.

Because states established varied Medicaid income eligibility levels for children, and because of state variations in per capita income there is considerable variation in Medicaid coverage, ranging from 13% of children in Colorado to 47% in West Virginia. Similarly, Medicaid pays for 39% of all births nationally, but coverage varies from 21% of births in Massachusetts to 61% in Georgia.

The Balanced Budget Act (BBA) of 1997 creates new options for states to strengthen and expand Medicaid coverage for children. The new State Children’s Health Insurance Program (CHIP) was enacted as part of the Balanced Budget Act (BBA) of 1997. This new capped federal program allocates $20.3 billion over five years in the form of a matched grant to states to expand coverage to uninsured low-income children through either a separate state program or by broadening Medicaid — or both. The funds became available on October 1, 1997 and are targeted to uninsured children under 19 with income below 200% of poverty who are not eligible for Medicaid or not covered by private insurance.

Provisions of the Balance Budget Act also included some important changes to Medicaid. It clarifies the state Medicaid option to accelerate the phase-in for children born before September 30, 1983. In addition, the new law gives states the option to extend presumptive eligibility to children, meaning that services provided to low-income uninsured children will be covered by Medicaid before the Medicaid eligibility determination process is complete. States can also offer 12 month continuous eligibility to children, regardless of any changes in family income during that period.

Services and Costs

Federal guidelines require that Medicaid cover a comprehensive set of services with nominal or no cost-sharing for children. Access to these services is important because poor children experience more health problems than more affluent children. Children with Medicaid are eligible to receive physician and outpatient services, prescription drugs, inpatient hospital care, and long-term care services.

Medicaid coverage also entitles children to early and periodic screening, diagnostic, and treatment (EPSDT) services including a comprehensive health and developmental history and physical exam, immunizations, laboratory tests including blood lead levels, and health education. Children found to have conditions requiring further attention are covered for needed treatment.

The importance of health insurance in securing access to health care services is well documented. Despite their complex health and social needs, children with Medicaid coverage have access to care that is similar to higher income privately insured children (Figure 3).

In 1995, Medicaid spent $25.4 billion on health care services for 17.5 million children in low-income families and about $7.1 billion for one million disabled children. The majority (93%) of the expenditures for non-disabled children are for acute care services, with one third for inpatient hospital care.

While low-income children represent half of the 35 million Medicaid beneficiaries, they account for only 16.7% of overall Medicaid spending. In 1995, Medicaid spent an average of $1,175 per low-income child enrolled in the program. On average, children cost less to care for than older Medicaid beneficiaries, but some disabled children have very costly health and long-term care needs. Medicaid spent an average of $6,421 per year per child qualifying on the basis of disability (Figure 4).

Issues and Challenges

Expanding Coverage.

To broaden coverage of low-income uninsured children, Congress enacted the new State Child Health Insurance Program and included provisions to allow states to facilitate enrollment and continuity of coverage under Medicaid. Key issues facing state Medicaid agencies include how the new children’s program will be structured, financed, and implemented, as well as how it will be integrated with or build on the state’s existing Medicaid program.

Participation.

An estimated 3 million of the 9.8 million uninsured children are eligible for but not enrolled in Medicaid. This is largely due to enrollment barriers or lack of awareness of the program. States can streamline the eligibility process and facilitate enrollment. For example, 25 states allow mail-in eligibility applications and 29 states have dropped the asset test. Medicaid eligibility policy has also changed markedly as a result of the 1996 welfare law, which eliminated the automatic link between cash assistance and Medicaid. Ongoing and intensified outreach and educational efforts will be necessary to assure that all the children who are eligible for assistance under Medicaid are enrolled.

Managed Care.

In 1996, 40% of beneficiaries were enrolled in managed care, mostly low-income children and their parents. The BBA of 1997 expands state flexibility by allowing states to mandate Medicaid managed care enrollment without requiring states to obtain a Section 1115 or 1915(b) waiver. States will still need a waiver to mandatorily enroll special needs children, but will be able to enroll other non-disabled children. Managed care has the potential to improve access to preventive and primary care, but given the vulnerable nature of the Medicaid population, it requires careful implementation and monitoring to assure quality and access.

Medicaid Facts: Medicaid’s Role for Children

This fact sheet provides an overview of children’s eligibility and coverage under Medicaid, summarizes Mediciad benefits and expenditures for children, and highlights key issues facing the program as it continues to serve children.

• Fact Sheet
• Fact Sheet

A booklet to help health care consumers understand managed care.

• A Consumer’s Guide: Understanding Managed Care

The September/October 1997 edition of the Kaiser Family Foundation/Harvard Health News Index includes questions about major health stories covered by news media, including questions about AIDS, Condoms in Schools and Tobacco Companies. The survey was based on a national random sample of 1,007 Americans conducted October 17-21, 1997 which measures public knowledge of health stories covered in the news media the previous month. The Health News Index is designed to help the news media and people in the health field gain a better understanding of which health stories in the news Americans are following and what they understand about those health issues. Every two months, Kaiser/Harvard issues a new index report.

• Report: A Comparison of the Medicaid Provisions in the Balanced Budget Act of 1997 (P.L. 105-33) w-Prior Law

Background

Health care benefits had been offered to active employees for a long period of time before health coverage became a retiree benefit offered by employers. The key event that made employer-sponsored retiree health care a possible benefit for retirees was the enactment of Medicare in 1965. It was then felt possible to provide a widely desired benefit at a relatively low cost, since the Medicare program would pay the majority of the costs.

Millions of Retirees Have Employer-Sponsored Coverage

Based on the 1995 Medicare Current Beneficiary Survey⁵ analysis by Physician Payment Review Commission (PPRC), about 12 million individuals (37 percent of Medicare aged and disabled beneficiaries) have employer-provided supplemental coverage, including about 2 million with employer-provided coverage and Medigap.

Retiree Health Is a Highly Valued Medicare Supplement

As with other matters related to retirement, the appreciation of retiree health benefits increases with age. For example, based on a Hewitt database of employee surveys, there is a twelve-fold increase in value assigned to retiree health care benefits for employees age 55 and over compared to the group age 25 to 34.⁶

The availability of employer-provided coverage is more critical for the pre-65 retirees because they will generally not have access to other insurance or it will be very expensive for them to purchase, if it is available at all. Post-65 retirees at least have Medicare if they have no other health insurance.

Even Medicare, however, provides a relatively low level of benefit when compared to the typical employer plan for active employees. Comparing the Medicare level of benefits to 250 large employers participating in the 1996 Hewitt Health Value Initiative^TM who offer indemnity type benefits, the Medicare design falls in the lowest quartile measured by plan value (18th percentile). That is, 82 percent of the indemnity plans offered by large employers to active employees provide richer or better benefit levels than traditional Medicare. Most of the employers participating in the 1996 Hewitt Health Value Initiative have more than 5,000 employees. Employers with fewer employees will tend to provide a lower level of benefit.

Assuming that the typical employer medical plan considers about 65 percent of total health care costs as a cost covered by the medical plan (excluded costs include items such as over-the-counter drugs, dental care and eye glasses)⁷, and that the average indemnity medical plan reimburses about 83 percent of covered costs⁸, the typical employer plan will pay 54 percent (0.83

State Reforms of Small Group Health Insurance

Between 1989 and 1995, 45 states enacted laws to make health insurance more accessible and attractive to small businesses. The small group market was targeted for reform because about half of all uninsured workers are either self-employed or working in firms with fewer than 25 employees (EBRI, 1996).

The problem is that only about half of all small firms offer health insurance (Figure 1). In 1995, 53% of small businesses (<50 employees) offered health benefits, and while this is up from 1989 when only 41% offered coverage, it is still much lower than health coverage among larger firms.

Many insurers are willing to sell coverage to small firms, but some insurer practices in the small group market have drawn concern. Some companies refused to sell policies to businesses in specific “high-risk” industries for example, or to firms with fewer than 10 employees. Also, because insurers tended to base premiums for small groups on the medical histories of prospective enrollees, some small businesses have reported that the poor health of their employees or employees’ dependents resulted in their inability to qualify for coverage.

Although these problems exist, they are not widespread. Most small firms say that they can get coverage if they want it. More than three-quarters (of both insured and uninsured small firms) say that they have been solicited to buy health insurance in the last six months, and more than a third indicate that they have received at least six or more inquires.

Three General Types of Small Group Reform

“Bare-bones” policies.

These laws allow insurers to sell “bare-bones” insurance to certain classes of small firms, typically those newly entering the group coverage market. The policies are dubbed “bare-bones” because they are usually exempt from most mandated benefit laws and premium taxes, which allows small firms to purchase basic coverage at lower premiums.

Premium regulations.

Premium rating bands or requirements that insurers follow community rating are two examples of such regulations. These rules are intended to narrow the range in premiums, so that coverage will be more affordable for higher-risk firms.

Standards for underwriting and contracting practices.

These are designed to make coverage both more attractive and available to employers. Included under this category are laws which:

• limit the non-issue of policies to certain types of firms,
• guarantee the renewability of employer coverage,
• allow insured persons to move between plans without having to satisfy new pre-existing condition clauses, and
• limit initial waiting periods that workers must satisfy for coverage of their pre-existing conditions.

The most common reforms are listed in Figure 2 with the number of states that have enacted them. In many cases, the state enacted a small package of measures in 1991 or 1992 and then adopted additional reforms a couple of years later. By 1995, most states had enacted all of the reforms listed here.

Figure 2Small Group Reforms at the State Level Number of States with the Measure as of: Type of State Legislative Reform: ’89 ’91 ’93 ’95 Bare-Bones Insurance Plans Can be Sold 1 9 31 43

To provide an independent source of information about the cost of covering uninsured children in California, the Henry J. Kaiser Family Foundation commissioned an analysis by the Actuarial ResearchCorporation (ARC), which provides actuarial assistanceto a variety of public and private clients. ARC’s analysis suggests that expanding California’s Medicaid program (which is called Medi-Cal) would be substantially less expensive than developing a new private insurance program as proposed.

• Report
• Report

Now I am going to ask you a series of questions about sexually transmitted diseases other than HIV or AIDS, such as gonorrhea, syphilis, herpes, and chlamydia. We want to learn from you how the topic of sexually transmitted diseases, also called STDs, was handled in your visit so that we can help doctors do a better job of addressing STDs with their patients.

Again, please remember that your answers to these questions will be kept completely confidential, and your responses will be shown only in combination with those of the other people we survey.

28. Now, thinking back to this last visit, were there any patient education materials like brochures or videos, about STDs in the (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Single response)

Yes 61 No 30 Don’t know 9 Refused 0 29. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss sexually transmitted diseases, other than AIDS, with you at this visit? (Single response)

Yes 15 No 85 Don’t know * Refused 0 30a. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Single response)

Based on those who discussed STDs. (n=72)

You 17 Someone in your doctor’s office/clinic 83 Don’t know 0 Refused 0 30b. Please tell me whether each of the following apply to how you felt when the health professional raised the subject of STDs with you? Did you feel (insert list)? (Single response) (Record Yes/No/DK/Ref for each) (Rotate first two statements only)

Based on those who discussed STDs. (n=72)

Yes No Don’t know Refused Relieved 47 47 4 1 Offended or insulted 4 94 1 0 It was expected 86 14 0 0 30c. Where did this discussion take place? (Do not read list) (Multiple response) (If respondent says “examining room” probe with: Was that while you were dressed or undressed?)

Based on those who discussed STDs. (n=72)

In examining room while you were dressed 44 In doctor’s personal office 36 In examining room while you were undressed 17 In counseling room 4 All other 3 In waiting room 1 Don’t know 0 Refused 0 30d. Where would you have preferred this conversation took place? Would you say (read list)? (Single response)

Based on those who discussed STDs. (n=72)

In doctor’s personal office 46 In examining room while you were dressed 42 Doesn’t matter 6 In examining room while you were undressed 4 Don’t know 1 Refused 1 31a. Please tell me whether each of the following apply to how you would have felt if the health professional had talked about STDs with you? Would you have felt (insert list)? (Single response) (Record Yes/No/DK/Ref for each) (Rotate first two statements only)

Based on those who did NOT discuss STDs. (n=408)

Yes No Don’t know Refused Relieved 24 72 4 * Offended or insulted 6 93 1 0 It was expected 64 36 0 * 31b. Do you think the health professional should have raised the subject with you? (Single response)

Based on those who did not discuss STDs. (n=408)

Yes 33 No 66 Don’t know 2 Refused 0 31c. Do you think you should have raised the subject of STDs? (Single response)

Based on those who did NOT discuss STDs. (n=408)

Yes 15 No 85 Don’t know 1 Refused 0 32. Why not? (Do not read list) (Multiple response)

Based on those who did not believe they or health professional should have raised STDs. (n=255)

Don’t feel at risk for STDs/only one partner/married 77 Discussed with doctor or health professional before 7 Visit was for other reason 7 No reason to (unspec.) 6 Already know about STDs/Office knows my history 2 Already been tested 2 Don’t know what STDs are 1 Don’t know 0 Refused 0 33. In general, do you think STDs should be discussed as part of seeing a new doctor orhealth professional for gynecological care? (Single response)

Yes 83 No 6 Depends 9 Don’t know 2 Refused 0 34. Who do you think has the primary responsibility for raising the subject of STDs, the health professional or the patient? (Do not read list) (Single response)

Health professional 64 Patient 23 Both 12 Neither 0 Don’t know 1 Refused 0 35. Who would you prefer talk to you about STDs, a doctor, a nurse, a counselor, or someone else in the doctor’s office? (Do not read list) (Single response)

Doctor 71 Nurse 12 Doesn’t matter 12 Counselor 2 Either a doctor or nurse 2 All other * No one * Don’t know * Refused 0 36. Did you feel you and your health professional had enough time to discuss STDs? (Single response)

Based on those who discussed STDs. (n=72)

Yes, had enough time 94 No, not enough time 6 Don’t know 0 Refused 0 37a. Did the health professional seem embarrassed or uncomfortable during your discussion about STDs? (Single response)

Based on those who discussed STDs. (n=72)

Yes 4 No 96 Don’t know 0 Refused 0 37b. Were you embarrassed or uncomfortable during this discussion? (Single response)

Based on those who discussed STDs. (n=72)

Yes 7 No 93 Don’t know 0 Refused 0 38. Did the health professional seem like he or she was judging you during this discussion? (Single response)

Based on those who discussed STDs. (n=72)

Yes 6 No 94 Don’t know 0 Refused 0 39. Did the health professional suggest to you that you should be tested for any STDs? (Single response)

Based on those who discussed STDs. (n=72)

Yes 32 No 67 Don’t know 1 Refused 0 40. Which, if any, specific STDs did the health professional recommend you get tested for? (Read list) (Rotate) (Multiple response) Probe: Can you think of any others?

Based on those for whom health professional suggested STD testing. (n=23)

Gonorrhea 74 AIDS/HIV 70 Chlamydia 65 Syphilis 52 Herpes 35 Human Papilloma Virus, or genital warts 30 Trichomonas 13 All others 13 No specific STDs mentioned 9 41. Omitted

42. Would you say the subject of STDs was discussed in a way that made you feel very comfortable, somewhat comfortable, not very comfortable, or not at all comfortable? (Single response)

Based on those who discussed STDs. (n=72)

Very comfortable (4) 76 Mean: 3.7 Somewhat comfortable (3) 21 Not very comfortable (2) 3 Not at all comfortable (1) 0 Don’t know 0 Refused 0 43. Did you feel that the health professional asked you enough questions, and knew enough about you, to be able to tell whether or not you were at risk for STDs? (Single response)

Total Among womenwho did not talkabout STDs(n=408) Yes 80 80 No 19 20 Don’t know 1 * Refused 0 0 44. Next I’m going to describe different issues that might affect how comfortable a patient feels about discussing STDs with a doctor or other health professional. Please rate how important each one is to you, very important, somewhat important, not very important or makes no difference.

The first [next] is (insert list). (Single response)

Where the conversation takes place, such as the exam room or in a private office:

Very important (4) 26 Mean: 2.5 Somewhat important (3) 25 Not very important (2) 20 Makes no difference (1) 29 Don’t know 0 Refused 0 Whether you are certain that the conversation is completely confidential:

Very important (4) 80 Mean: 3.7 Somewhat important (3) 15 Not very important (2) 2 Makes no difference (1) 4 Don’t know 0 Refused 0 Whether you feel the health professional might be judging you:

Very important (4) 46 Mean: 3.1 Somewhat important (3) 27 Not very important (2) 14 Makes no difference (1) 13 Don’t know * Refused 0 Whether the health professional is a [rotate] woman or man/man or woman:

Very important (4) 19 Mean: 2.1 Somewhat important (3) 19 Not very important (2) 19 Makes no difference (1) 43 Don’t know 0 Refused 0

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Talking About STDs With Health Professionals: Women’s Experiences:Press Release Report Survey Part One Part Two Part Three

Talking about STDs with Health Professionals: Women’s Experiences

Glamour/Kaiser Family Foundation National Survey

Methodology

Talking about STDS with Health Professionals: Women’s Experiences was conducted for the Kaiser Family Foundation and Glamour by Market Facts, Inc. The results are based on telephone interviews conducted between May 27 through June 1, 1997 with a sample of 482 women ages 18-44 who had been to a new doctor within the last year for gynecological or obstetrical care. These women were selected using Market Facts’ Consumer Mail Panel, a nationally balanced sample of households. All interviews were conducted by female interviewers. The margin of sampling error for results based on the total sample is plus or minus 5 percentage points at the 95 percent level of confidence.

Final Topline Data

Hello, may I please speak to (Ask for panel member)? This is ______ calling on behalf of Marie Brighton of the Consumer Mail Panel. Today I’d like to speak with the female aged (Insert age from sample) in your household. Would that be you?

Yes (Continue with remainder of Introduction) No (Ask to speak with that person, reintroduce and continue with remainder of Introduction — If not available, arrange callback) No one that age (Ask: Are you, or any other female in your household between the ages of 18 and 44? If Yes — Ask to speak with a female 18-44 and continue with remainder of Introduction; If No, terminate) Today I have a few questions regarding doctors and screening for sexually transmitted diseases. I’d like to remind you that your responses will be kept strictly confidential and that your responses here will be combined with that of approximately 700 other women we are interviewing and shown only as percentages.

1. My first question is… in general, how would you describe your own health? Is it excellent, good, only fair, or poor? (Single response)

Excellent 47 Good 48 Only Fair 3 Poor 1 Don’t know 0 Refused 0 2. Do you have a doctor or other health care professional who you see regularly for gynecological care that is, for annual exams, birth control, or other reproductive health care? (Interviewer Note: If respondent has a regular place to go for care, but no regular provider at that place, record as “no.”) (Single response)

Yes 93 No 7 Don’t know 0 Refused 0 3. When was the last time you visited a doctor or clinic for gynecological or pregnancy-related care? Would you say your last visit was within (read list)? (Single response)

The past month 24 1-3 months ago 30 4-6 months ago 23 7 months to 1 year ago, or 23 More than 1 year ago Terminate) Never Been (Don’t read) (Terminate) 4. And was this most recent visit for prenatal care or gynecological care? (Single response)

Prenatal/Pregnancy-related care 18 Gynecological 82 Don’t know * Refused 0 4b. Was this most recent visit at a private doctor’s office, a family planning clinic, or some other type of clinic? (Single response)

Private doctor’s office 75 Family planning clinic 10 Some other type of clinic 15 Don’t know 0 Refused 0 5. Was this most recent visit your first appointment with this (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) or had you been there before? (Single response)

First visit 46 Been there before 54 Don’t know 0 Refused 0 5b. How long ago was your first appointment with this (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Read list) (Single response)

Based on those whose most recent appointment was not their first appointment. (n=261)

The past month 2 1-3 months ago 15 4-6 months ago 21 7 months to 1 year ago, or 62 More than 1 year ago (Terminate) Never Been (Don’t read) (Terminate) [If “been before” at Qu. 5 say:] For the remainder of this survey, we are going to ask about your first visit to this (doctor’s office [If private “doctor’s office” or “DK/REF” AT Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])

6. What type of doctor or health professional did you see at (this visit [If first at Qu. 5] / your first visit [If been before at Qu. 5])? Was it an ob/gyn, a general practitioner, some other type of doctor, or health professional? (Single response)

Ob-gyn/Gynecologist/Obstetrician 70 General Practitioner/Family Practice Doctor/Internist 18 Other type of doctor, such as a specialist or a surgeon 3 Other, such as a nurse practitioner, a nurse midwife, or physician’s assistant 9 Don’t know * Refused 0 7. Was the health professional a man or woman? (Single response)

Male 49 Female 51 Don’t know 0 Refused 0 8. Why did you go to a new health professional? (Do not read list) (Multiple response)

I changed health insurance coverage/health plans 20 I moved 17 Because of current problem or question 11 Referred to this doctor by another health professional or clinic 10 I got pregnant 8 Previous doctor closed/moved 8 Didn’t like previous doctor 6 I got health insurance coverage 6 For a pelvic exam or pap smear 5 To get established with a doctor in case of need 4 My first gynecological visit 3 Just wanted change/Other general change mentions 3 Wanted doctor closer/More convenient 3 Regular doctor not available 2 Wanted female doctor 2 Friend/relative/co-worker recommended 2 Less expensive 1 I lost health insurance coverage 1 Previous doctor too expensive * I am planning to get pregnant * I don’t have a regular doctor * Refused * 9. Thinking about this first visit, were you asked to fill out a form with questions about your medical history? (Single response)

Yes 92 No 7 Don’t know * Refused 0 10. Did this form have specific questions on it about current or past sexual activity, such as number of sexual partners, contraceptive use, or sexually transmitted diseases? (Single response)

Based on those asked to fill out a form. (n=445)

Yes 54 No 40 Don’t know 7 Refused 0 11. Were you worried about whether your answers to the questions on this form would be keptconfidential? Would you say you were (read list)? (Single response)

Based on those who filled out a form with sexual history questions on it. (n=239)

Very worried 1 Somewhat worried 2 Not too worried, or 16 Not at all worried 81 Don’t know 0 Refused 0 Now I am going to ask you some questions about what you and your health professional discussed at this first visit. Your answers to these questions will be kept completely confidential, and your responses will be shown only in combination with the many other women we survey.

12. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss pap smears with you at this visit? (Single response)

(If respondent says the doctor did a pap smear, probe with: Did he or she just perform the pap smear, or did they have a discussion with you about pap smears?)

Yes 74 No 26 Don’t know * Refused 0 13. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed pap smears. (n=357)

You 16 Someone in your doctor’s office/clinic 81 Don’t know 3 Refused 0 14. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss breast self-exams with you? (Single response)

(If respondent says the doctor did a breast exam, probe with: Did he or she just perform the breast exam, or did they have a discussion with you about breast self-exams?)

Yes 74 No 26 Don’t know * Refused 0 15. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed breast self-exams. (n=357)

You 6 Someone in your doctor’s office/clinic 94 Don’t know 1 Refused 0 16. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss mammograms with you? (Single response)

(If respondent says the doctor did a mammogram, probe with: Did he or she just perform the mammogram, or did they have a discussion with you about mammograms?)

Yes 41 No 58 Don’t know 1 Refused 0 17. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed mammograms. (n=197)

You 16 Someone in your doctor’s office/clinic 83 Don’t know 1 Refused 0 18. Have you ever had a mammogram yourself? (Single response)

Yes 34 No 66 Don’t know 0 Refused 0 19. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss birth control with you? (Single response)

Yes 54 No 46 Don’t know 0 Refused 0 20. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed birth control. (n=259)

You 37 Someone in your doctor’s office/clinic 62 Don’t know 1 Refused 0 21. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss alcohol use with you? (Single response)

Yes 25 No 73 Don’t know 2 Refused 0 22. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed alcohol use. (n=121)

You 5 Someone in your doctor’s office/clinic 95 Don’t know 0 Refused 0 23. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) discuss AIDS or HIV with you? (Single response)

Yes 21 No 78 Don’t know 1 Refused 0 24. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed AIDS or HIV. (n=101)

You 10 Someone in your doctor’s office/clinic 89 Don’t know 1 Refused 0 25. Did someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b]) ask you about your sexual history and current sexual activity? (Single response) (Do not read list)

Yes 38 No 59 Asked about sexual history, but not current sexual activity * Asked about current sexual activity, but not sexual history 1 Don’t know 2 Refused 0 26. Who initiated this conversation, you or someone in your (doctor’s office [If private “doctor’s office” or “DK/REF” at Qu. 4b] / clinic [If “family planning” or “other type of clinic” at Qu. 4b])? (Do not read list) (Single response)

Based on those who discussed sexual history or sexual activity. (n=188)

You 7 Someone in your doctor’s office/clinic 92 Don’t know 1 Refused 0 27a. Where did the discussion take place? (Do not read list) (Multiple response) (If respondent says “examining room” probe with: Was that while you were dressed or undressed?)

Based on those who discussed sexual history or sexual activity. (n=188)

In doctor’s personal office 42 In examining room while you were dressed 41 In examining room while you were undressed 14 In counseling room 3 In waiting room 2 All other 2 Don’t know 1 Refused 0 27b. Where would you have preferred this conversation took place? Would you say (read list)? (Single response)

Based on those who discussed sexual history or sexual activity. (n=188)

In doctor’s personal office 45 In examining room while you were dressed 43 Doesn’t matter 4 In examining room while you were undressed 3 Don’t know 5 Refused 1

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Talking About STDs With Health Professionals: Women’s Experiences:Press Release Report Survey Part One Part Two Part Three