title: Masculine beliefs, parental communication, and male adolescents' health care use.
abstract: OBJECTIVE
  Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents.
  
  
  METHODS
  We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990-1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2.
  
  
  RESULTS
  On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in > or = 2 other risk behaviors had neither a higher nor lower likelihood of a physical examination.
  
  
  CONCLUSIONS
  Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University, 200 N Wolfe St, Room 2062, Baltimore, MD 21287, USA. amarcell@jhsph.edu
authors.forename: Arik V
authors.initials: AV
authors.lastname: Marcell
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ford
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Pleck
authors.forename: Freya L
authors.initials: FL
authors.lastname: Sonenstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003142:Communication; D005783:Gender Identity; D015438:Health Behavior / Q000208:ethnology; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010287:Parent-Child Relations / Q000208:ethnology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012309:Risk-Taking; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States