Improved preventive care visits needed for adolescents

Many pediatricians’ annual preventive care visits for adolescents fell short of addressing important sexual and reproductive health issues — such as routine HIV testing, proper condom use and homosexuality — that could preclude high-risk behaviors in this population, according to survey results.

Researchers from the Stroger Hospital of Cook County/CORE Center in Chicago and others examined data from the 63rd Periodic Survey of Fellows to assess pediatricians’ ability to identify and offer services to adolescents who are likely to exhibit high-risk behaviors. They included 468 responses from pediatricians who offered preventive health care to patients aged 11 years or older.The results indicated the following:

62% of pediatricians discussed abstinence;
61% discussed condoms;.
61% discussed STDs;
54% discussed HIV;
82% rarely/never discussed homosexuality/sexual identity;
Less than 40% discussed violence prevention or physical or sexual abuse;
71% identified high-risk behaviors through clinical interviews.

About 30% of the surveyed pediatricians recommended condom use, according to the researchers, although only 22% distributed condoms and 19% provided demonstrations of proper use. Pediatricians practicing in hospitals or clinics and those located in the inner city were more likely to make condoms and condom demonstrations available to their adolescent patients, the researchers noted.

The researchers reported that these pediatricians were also more likely to recommend HIV/STD testing for sexually active adolescents. Overall, 46% of survey respondents recommended STD tests in this population, and only 28% recommended HIV tests. Additionally, most pediatricians were only “somewhat” or “vaguely” familiar with AAP policies or CDC recommendations on routine HIV testing for adolescents.

The most common difficulty with STD/HIV counseling was a lack of sufficient time, according to the survey respondents, although language barriers; inaccurate adolescent patient responses; physician discomfort discussing sexual issues; and adolescents’ fear of parental notification about high-risk behaviors were also problematic, according to the researchers.

“The data indicate that additional training to address identified barriers is needed and could result in improved health for adolescents,” they wrote.

Henry-Reid LM. Pediatrics. 2010;125:e741-e747.