Few adolescents report speaking with their doctors about sexual health

Other than conversations about puberty, less than one-third of adolescents reported discussing sexual and reproductive health topics with their health care provider, according to a study published in Pediatrics.

Renee E. Sieving, PhD, RN, FAAN, FSAHM, director of the Center for Adolescent Nursing at the University of Minnesota School of Nursing, and colleagues studied data from a national internet survey of adolescents and their parents to identify missed opportunities for conversations on sexual and reproductive health.

In June 2019, a research firm sent email invitations to 2,495 parents or guardians of adolescents aged 11 to 17 years who could read English or Spanish. Eligible parents were asked to allow their children to participate in the survey. The final sample consisted of 1,005 parent-adolescent dyads — a response rate of 61.4%.

Among the adolescents, 54% were white, 15% Black, 24% Hispanic and 7% were from other racial groups. The sample was 49% female, 91% were heterosexual, and 17% lived in nonmetropolitan areas. Participants aged 11 to 14 years were dubbed “younger adolescents,” and those aged 15 to 17 years were labeled “older adolescents.”

According to the study, 24% of younger adolescents and 42.3% of older adolescents reported ever speaking to their provider about confidentiality. Among parents, 31.2% of parents of younger adolescents and 35.7% of parents of older adolescents reported having a provider speak with them about the confidentiality of adolescent services.

At their most recent visit, 20% of younger adolescents and 44.1% of older adolescents reported having time alone with their provider, and just 14% of younger adolescents and 38.7% of older adolescents reported that their provider asked them about their sexual activity. This included 19.4% of younger girls and 9% of younger boys who noted that their provider asked about their sexual activity.

A greater percentage of younger girls (52.7%) reported that their provider discussed puberty compared with younger boys (40%). Among older adolescents, a greater percentage of girls (37.3%) reported discussions of birth control compared with boys (18.1%).

According to the study, 40% of older adolescents reported thinking discussions about puberty were important but did not discuss the topic. Similarly, 85.6% of younger adolescents reported that sexual orientation was important, but they did not discuss the topic.

“Likewise, substantial gaps in provider-adolescent discussions existed on the basis of parent perceptions,” the authors wrote. “The percentage of parents who perceived a given topic to be important but whose adolescents did not discuss that topic at their most recent preventive visit ranged from 44.7% for puberty among parents of older adolescents to 87.2% for where to get [sexual and reproductive health (SRH)] services among parents of younger adolescents. Gaps between importance and actual provider-adolescent discussions were significantly greater among parents of younger adolescents than parents of older adolescents on seven of eight topics assessed.”

Gaps were generally similar among boys and girls, the authors said.

“However, parents of younger boys had a significantly greater gap regarding discussion of puberty (59.8% of parents of younger boys versus 46.2% of parents of younger girls; P = .02), and parents of older boys had a significantly greater gap regarding discussion about methods of birth control (76.9% of parents of older boys versus 55.6% of parents of older girls; P = .002),” they wrote.

“Our findings suggest clear gaps between parent and adolescent perceived importance of discussing SRH topics and adolescents’ actual experience,” the authors wrote. “These gaps are particularly notable for younger adolescents. Similar gaps have been found with other potentially sensitive adolescent health topics. Thus, even though parents and adolescents think that provider-adolescent conversations about [sexual and reproductive health] are important, providers frequently miss opportunities to engage around these topics.”