Sexuality Talk During Adolescent Health Maintenance Visits
Sexuality Talk During Adolescent Health Maintenance Visits
复制标题
DOI：
10.1001/jamapediatrics.2013.4338
复制
发表时间：
2014-02-01
期刊：
影响因子：
26.1
通讯作者：
Shields, Cleveland G.
中科院分区：
文献类型：
--
作者：
Alexander, Stewart C.;Fortenberry, J. Dennis;Shields, Cleveland G.
医生可能是性信息和预防性服务的重要来源，建议在健康维护访问期间一对一的保密时间，以便讨论性发展，行为和降低风险。然而，关于医生与青少年关于性的讨论的发生和特点，我们知之甚少。目的研究早期和中期青少年健康维护就诊期间讨论性行为的时间、青少年参与程度以及与性行为讨论相关的医生和患者特征的预测因子。设计、环境和参与者观察性研究，对253名青少年（平均年龄14.3岁，女性53%，白人40%，非裔美国人47%）和49名医生（儿科医生82%，白人84%，女性65%，平均年龄40.9岁，平均执业时间11.8[8.7]年）在北卡罗莱纳州罗利/达勒姆地区11家诊所（3家学术诊所和8家社区诊所）对性行为内容进行编码。主要结果和测量方法每次访问期间讨论性问题的总时间。结果165份（65%）的病历中含有性内容。性话题的平均时间为36秒（35% 0秒；30% 1-35秒；35% >= 36秒）。序贯逻辑回归（结果持续时间：0,1 -35，或>= 36秒），调整了医生内患者的聚类，发现女性患者（优势比[or] = 2.58; 95% CI, 1.53-4.36）、老年患者（or = 1.37; 95% CI, 1.13-1.65）、明确的保密讨论对话（or = 4.33; 95% CI, 2.58-7.28）、非裔美国青少年（or = 1.58; 95% CI, 1.01-2.48）和较长的总体就诊时间(or = 1.07；95% CI, 1.03-1.11)与更多的性话题相关，而亚洲医生与较少的性话题相关（OR = 0.13; 95% CI, 0.08-0.20）。此外，青少年、医生和访问特征之间同样显著的关联与更多的青少年参与显著相关。结论和意义我们的研究可能是第一个直接观察医生和青少年之间性话题的研究。我们发现，三分之一的青少年每年都去看医生，但没有提到性问题；当谈到性的时候，它是简短的。需要进行研究，以确定医生可以使用的成功策略，使青少年参与有关性的讨论，以帮助促进健康的性发展和决策。
IMPORTANCE 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.DESIGN, SETTING, AND PARTICIPANTS 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.MAIN OUTCOMES AND MEASURES 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 AND RELEVANCE 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.