title: Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits.
abstract: OBJECTIVE
  To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits.
  
  
  METHODS
  A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression.
  
  
  RESULTS
  Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing.
  
  
  CONCLUSIONS
  Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues.
authors.affiliation: Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Merzel
authors.forename: Nancy L
authors.initials: NL
authors.lastname: VanDevanter
authors.forename: Susan
authors.initials: S
authors.lastname: Middlestadt
authors.forename: Amy
authors.initials: A
authors.lastname: Bleakley
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ledsky
authors.forename: Peter A
authors.initials: PA
authors.lastname: Messeri
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D000328:Adult; D001294:Attitude to Health; D044383:Black People; D016009:Chi-Square Distribution; D002648:Child; D003268:Contraception Behavior / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D009519:New York City; D011320:Primary Health Care; D000297:Psychology, Adolescent; D012725:Sexual Behavior / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000523:psychology*; D011795:Surveys and Questionnaires; D001741:Black or African American