title: Sexuality talk during adolescent health maintenance visits.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01040975.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina2Health Services Research and Development Service, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
authors.forename: J Dennis
authors.initials: JD
authors.lastname: Fortenberry
authors.affiliation: Cancer Prevention, Detection, and Control Research Program, Duke Cancer Institute, Durham, North Carolina5Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.affiliation: Division of Adolescent Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus.
authors.forename: Terrill
authors.initials: T
authors.lastname: Bravender
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Davis
authors.affiliation: Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Truls
authors.initials: T
authors.lastname: Ostbye
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina2Health Services Research and Development Service, Durham VA Medical Center, Durham, North Carolina.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.affiliation: Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana.
authors.forename: Cleveland G
authors.initials: CG
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D016015:Logistic Models; D009657:North Carolina; D010358:Patient Participation; D010817:Physician-Patient Relations; D012307:Risk Factors; D019529:Sexuality; D013997:Time Factors