title: The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males.
abstract: OBJECTIVE
  To explore perceptions of facilitators/barriers to sexual and reproductive health (SRH) care use among an urban sample of African-American and Hispanic young men aged 15-24 years, including sexual minorities.
  
  
  METHODS
  Focus groups were conducted between April 2013 and May 2014 in one mid-Atlantic U.S. city. Young men aged 15-24 years were recruited from eight community settings to participate in 12 groups. Moderator guide explored facilitators/barriers to SRH care use. A brief pregroup self-administered survey assessed participants' sociodemographics and SRH information sources. Content analysis was conducted, and three investigators independently verified the themes that emerged.
  
  
  RESULTS
  Participants included 70 males: 70% were aged 15-19 years, 66% African-American, 34% Hispanic, 83% heterosexual, and 16% gay/bisexual. Results indicated young men's perceptions of facilitators/barriers to their SRH care use come from multiple levels of their socioecology, including cultural, structural, social, and personal contexts, and dynamic inter-relationships existed across contexts. A health care culture focused on women's health and traditional masculinity scripts provided an overall background. Structural level concerns included cost, long visits, and confidentiality; social level concerns included stigma of being seen by community members and needs regarding health care provider interactions; and personal level concerns included self-risk assessments on decisions to seek care and fears/anxieties about sexually transmitted infection/HIV testing. Young men also discussed SRH care help-seeking sometimes involved family and/or other social network members and needs related to patient-provider interactions about SRH care.
  
  
  CONCLUSIONS
  Study findings provide a foundation for better understanding young men's SRH care use and considering ways to engage them in care.
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: amarcell@jhu.edu.
authors.forename: Arik V
authors.initials: AV
authors.lastname: Marcell
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Morgan
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: Renata
authors.initials: R
authors.lastname: Sanders
authors.affiliation: Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lunardi
authors.affiliation: Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Nanlesta A
authors.initials: NA
authors.lastname: Pilgrim
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: Department of Medicine, The Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, Maryland.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Page
authors.affiliation: Division of STD Prevention, The Johns Hopkins University, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Penny S
authors.initials: PS
authors.lastname: Loosier
authors.affiliation: Division of STD Prevention, The Johns Hopkins University, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Dittus
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D001294:Attitude to Health / Q000208:ethnology*; D003142:Communication; D003657:Decision Making; D017144:Focus Groups; D005102:Health Expenditures; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054525:Minority Health / Q000191:economics; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012647:Self-Assessment; D000074384:Sexual Health / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data; D000072339:Sexual and Gender Minorities / Q000523:psychology / Q000706:statistics & numerical data; D014504:Urban Health / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Access to care; Barriers to care; Male adolescents; Sexual and reproductive health care use; Young adult men