OBJECTIVE: To assess the growth and stability of adolescent health services delivery programs in the United States between 1990 and 1995.

DESIGN: We conducted a national census of comprehensive adolescent health services delivery programs in 1990 and again in 1995. We identified sites providing comprehensive or integrated health services to adolescents by soliciting nominations from adolescent health experts, national organizations, state and local MCH directors, foundation staff, and from previously identified programs. Growth and survival of programs was assessed by comparing the programs identified in the two sampling periods.

RESULTS: Of 812 adolescent health service delivery sites identified in 1995, 61% were based in schools, 16% in hospitals, 8% in health or community centers, 7% in public health departments, and 8% in other sites. Among current programs, 495 (61%) remained unchanged from 1990, 86 (11%) were related to growth of 1990 programs into additional delivery sites, and 25 programs (3%) had closed or restricted their adolescent services. School-based clinics were more likely to have started since the previous census than other program types(p=0.05), and 65% of all new program were in schools. However, school-based clinics and health department programs also were more likely to have closed between 1990 and 1995 than other program types (Odds of closing = 2.12; 95% C.I. = (0.95 - 4.69; p=0.06).) Program closings were almost always attributed to financial pressure.

CONCLUSION: Adolescent health programs in the US continue to increase in number, mainly due to growth in the number of school-based clinics. Several programs that existed in 1990 had closed or reduced their adolescent-oriented services by 1995. Stable financing for adolescent health services remains elusive.