Sexuality talk during adolescent health maintenance visits

Stewart C. Alexander, J. Fortenberry, Kathryn I. Pollak, Terrill Bravender, J. Kelly Davis, Truls Ostbye, James A. Tulsky, Rowena J. Dolor, Cleveland G. Shields

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

IMPORTANCE Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality. OBJECTIVE To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents. DESIGN, SETTING, AND PARTICIPANTS Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53%female; 40% white; 47%African American) and 49 physicians (82%pediatricians; 84%white; 65%female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area. MAIN OUTCOMES AND MEASURES Total time per visit during which sexuality issueswere discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35%0 seconds; 30% 1-35 seconds; and 35% 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95%CI, 1.53-4.36), older patients (OR = 1.37; 95%CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95%CI, 2.58-7.28), African American adolescents (OR = 1.58; 95%CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95%CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95%CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation. CONCLUSIONS AND RELEVANCE Our study may be the first to directly observe sexuality talk between physicians and adolescents.We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making.

Original languageEnglish
Pages (from-to)163-169
Number of pages7
JournalJAMA Pediatrics
Volume168
Issue number2
DOIs
StatePublished - Feb 2014

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Sexuality
Physicians
Odds Ratio
Sexual Development
African Americans
Adolescent Health
Patient Participation
Information Services
Confidentiality
Health
Risk Reduction Behavior
Sexual Behavior
Observational Studies
Cluster Analysis
Decision Making
Logistic Models

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Alexander, S. C., Fortenberry, J., Pollak, K. I., Bravender, T., Davis, J. K., Ostbye, T., ... Shields, C. G. (2014). Sexuality talk during adolescent health maintenance visits. JAMA Pediatrics, 168(2), 163-169. https://doi.org/10.1001/jamapediatrics.2013.4338

Sexuality talk during adolescent health maintenance visits. / Alexander, Stewart C.; Fortenberry, J.; Pollak, Kathryn I.; Bravender, Terrill; Davis, J. Kelly; Ostbye, Truls; Tulsky, James A.; Dolor, Rowena J.; Shields, Cleveland G.

In: JAMA Pediatrics, Vol. 168, No. 2, 02.2014, p. 163-169.

Research output: Contribution to journalArticle

Alexander, SC, Fortenberry, J, Pollak, KI, Bravender, T, Davis, JK, Ostbye, T, Tulsky, JA, Dolor, RJ & Shields, CG 2014, 'Sexuality talk during adolescent health maintenance visits', JAMA Pediatrics, vol. 168, no. 2, pp. 163-169. https://doi.org/10.1001/jamapediatrics.2013.4338
Alexander SC, Fortenberry J, Pollak KI, Bravender T, Davis JK, Ostbye T et al. Sexuality talk during adolescent health maintenance visits. JAMA Pediatrics. 2014 Feb;168(2):163-169. https://doi.org/10.1001/jamapediatrics.2013.4338
Alexander, Stewart C. ; Fortenberry, J. ; Pollak, Kathryn I. ; Bravender, Terrill ; Davis, J. Kelly ; Ostbye, Truls ; Tulsky, James A. ; Dolor, Rowena J. ; Shields, Cleveland G. / Sexuality talk during adolescent health maintenance visits. In: JAMA Pediatrics. 2014 ; Vol. 168, No. 2. pp. 163-169.
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abstract = "IMPORTANCE Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality. OBJECTIVE To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents. DESIGN, SETTING, AND PARTICIPANTS Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53{\%}female; 40{\%} white; 47{\%}African American) and 49 physicians (82{\%}pediatricians; 84{\%}white; 65{\%}female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area. MAIN OUTCOMES AND MEASURES Total time per visit during which sexuality issueswere discussed. RESULTS One hundred sixty-five (65{\%}) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35{\%}0 seconds; 30{\%} 1-35 seconds; and 35{\%} 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95{\%}CI, 1.53-4.36), older patients (OR = 1.37; 95{\%}CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95{\%}CI, 2.58-7.28), African American adolescents (OR = 1.58; 95{\%}CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95{\%}CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95{\%}CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation. CONCLUSIONS AND RELEVANCE Our study may be the first to directly observe sexuality talk between physicians and adolescents.We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making.",
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