Young adolescents' comfort with discussion about sexual problems with their physician.

OBJECTIVE: To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician. DESIGN: Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations. SETTING: Five primary care pediatric practices at health maintenance organizations in Washington, DC. PATIENTS: A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated. MAIN OUTCOME MEASURE: Adolescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial. RESULTS: Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%), but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (43%) [corrected]. Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians. CONCLUSIONS: This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns.

Ability to measure sensitive adolescent behaviors via telephone.

INTRODUCTION: Difficulty in measuring sensitive behaviors in 12-15-year-old adolescents is a barrier to research. This study determined whether early adolescents reported substance use and sexual activity similarly in assisted paper-and-pencil versus touch-tone telephone responses. METHODS: Adolescents 12-15 years old completed confidential, interviewer-assisted questionnaires first in a physician office by paper-and-pencil and then at home by touch-tone approximately 3 months later. Adolescents were from a high-risk urban area, 71% were minority, and all had parent consent to participate. RESULTS: The follow-up participation rate was 94% (follow-up n = 207). Test-retest stability was generally poor for low-frequency behaviors such as injection drug use, anal intercourse, and sexual behaviors in 12-13-year-olds. Test-retest stability was fair to good for common substance use items. Test-retest stability was generally good among females and 14-15-year-old adolescents, and poor to fair among males and 12-13-year-olds, for common sexual experiences in the last 3 months. Test-retest stability was generally good to excellent for all lifetime sexual experiences except among 12-13-year-olds in which it was generally poor. Internal consistency of the self-esteem scale was high using both response technologies. Both response technologies reproduced correlations between substance use and lifetime sexual experience. CONCLUSION: A high participation rate and reliable data capture were achieved when assessing sensitive behaviors of 14-15-year-olds using touch-tone telephone response. Sexual behaviors were more reliably captured using a "lifetime" versus "last 3-month" reference period. Low prevalence contributed to poor reliability in 12-13-year-olds.

A STD/HIV prevention trial among adolescents in managed care.

OBJECTIVE: To determine if sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, risk assessment, and education tools provided as part of office-based primary care reduce adolescent risky sexual behaviors. DESIGN: A randomized intervention trial with 3- and 9-month follow-up. SETTING: Five staff-model managed care sites in Washington, DC (n = 19 pediatricians). PATIENTS: Consecutive 12- to 15-year-olds receiving a general health examination; 81% minority. Participation rate = 215/432 (50%). Nine-month follow-up rate = 197/215 (92%). INTERVENTION: Audiotaped STD risk assessment and education about staying safe (safer = condoms, safest = abstinence). MAIN OUTCOME MEASURES: Adolescent-reported sexual intercourse and condom use. RESULTS: More intervention adolescents reported pediatrician discussion on 11/13 sexual topics. Although more vaginal intercourse (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.04-5.84) was reported in the intervention group at 3 months, this was not true of overall sexual intercourse (OR = 1.55, 95% CI =.73-3.32). More sexually active adolescents reported condom use in the intervention group at 3 months (OR = 18.05, 95% CI = 1.27-256.03). At 9 months, there were no group differences in sexual behaviors; however, more signs of STD were reported by the control (7/103) than the intervention group (0/94). CONCLUSIONS: STD risk assessment and education tools administered in a single office visit facilitated STD/HIV prevention education. Any impact on sexual activity and condom use was short-lived. Further research is needed to develop brief, office-based sexual risk reduction for young adolescents.