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Original Investigation |

Sexuality Talk During Adolescent Health Maintenance Visits

Stewart C. Alexander, PhD1,2; J. Dennis Fortenberry, MD, MS3; Kathryn I. Pollak, PhD4,5; Terrill Bravender, MD, MPH6; J. Kelly Davis, BA1; Truls Østbye, MD, PhD5; James A. Tulsky, MD1,2; Rowena J. Dolor, MD1; Cleveland G. Shields, PhD7
[+] Author Affiliations
1Department of Medicine, Duke University Medical Center, Durham, North Carolina
2Health Services Research and Development Service, Durham VA Medical Center, Durham, North Carolina
3Department of Pediatrics, Indiana University School of Medicine, Indianapolis
4Cancer Prevention, Detection, and Control Research Program, Duke Cancer Institute, Durham, North Carolina
5Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
6Division of Adolescent Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus
7Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana
JAMA Pediatr. 2014;168(2):163-169. doi:10.1001/jamapediatrics.2013.4338.
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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 issues were 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.

Trial Registration  clinicaltrials.gov Identifier: NCT01040975

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