title: Predictors of timely initiation of gynecologic care among urban adolescent girls.
abstract: OBJECTIVE
  To determine whether or not critical sexual health services are delivered to low-income girls, and to identify predictors of timely initiation of gynecologic care for sexually active adolescent girls. Few studies have addressed the interval between sexual debut and risk-appropriate primary care services.
  
  
  METHODS
  We conducted an anonymous, cross-sectional, laptop-based, self-administered branching survey of 9th-12th grade girls in three Bronx public high schools (n = 819).
  
  
  RESULTS
  Over half (60.0%) had an opportunity for confidential care at last clinical visit. Only 27% of sexually active girls had informed any clinician that they had been sexually active; 45% had ever had a pelvic exam. The mean interval between sexual debut and initial pelvic exam (our proxy for gynecologic care) was 13.3 months (range = 0-70 months, SD = 11.8 months). Cox proportional hazard modeling identified four predictors of time to first pelvic exam: experience of sexually transmitted infection (STI) or pregnancy (hazard ratio [HR] = 1.9), having disclosed sexual activity to any clinician (HR = 1.7), access to confidential care (HR = 3.1), and high self-efficacy for accessing confidential care (HR = 2.1).
  
  
  CONCLUSIONS
  Most sexually active girls have not told a clinician that they are sexually active and many have not had counseling related to sexual health. Delay between sexual debut and initial pelvic exam is substantial for low-income urban girls, and often occurs in reaction to pregnancy or STI. Setting of usual care does not predict timely gynecologic care, but access to confidential care does.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. mckee@aecom.yu.edu
authors.forename: M Diane
authors.initials: MD
authors.lastname: McKee
authors.forename: Jason
authors.initials: J
authors.lastname: Fletcher
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000328:Adult; D003219:Confidentiality; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D006176:Gynecology / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D009518:New York; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014342:Truth Disclosure; D014505:Urban Population