Adolescent males in the United States do not routinely receive reproductive health services such as counseling by a medical professional and testing for HIV or for other sexually transmitted diseases (STDs), even though they are likely to receive other health care services.1 In a nationally representative sample of 15-19-year-olds, 71% had had a physical examination in the past year, but only 39% had received any reproductive health services. Even among those who were sexually active, 71% had recently undergone a physical, yet only half had received reproductive health services. Black teenagers had increased odds of receiving every type of reproductive health service examined--an encouraging finding, the investigators note, that contradicts results of other research and suggests that these young men are able to overcome barriers to health care.
The 1,652 adolescents in the sample were identified in the 1995 National Survey of Adolescent Males, which was conducted among a population-based sample of 15-19-year-olds. The youths completed an interview and questionnaire concerning demographic characteristics and sexual behaviors. They were asked whether in the past year they had had a physical examination, an HIV test, another STD test or a discussion with a physician or nurse about any of four reproductive health topics (condoms and the prevention of pregnancy, AIDS and other STDs).
The investigators tested the influence of several types of factors on the receipt of reproductive health services. They selected variables that might reflect knowledge about and attitudes toward health and the health care system (e.g., race and ethnicity, parents' education, receipt of public assistance and knowledge of various reproductive topics), accessibility of health care (e.g., area of residence, health insurance status and typical source of care) and the need for services (whether respondents had had a serious illness or injury, whether they had exhibited symptoms of an STD and the number of female sexual partners they had had in the last 12 months).
In the sample as a whole, 73% of youths were non-Hispanic whites, 14% were non-Hispanic blacks and 13% were Hispanics. Roughly 70-80% were not dependent on public assistance, were covered by private insurance and had no contact with anyone who had AIDS; nearly nine in 10 had a regular source of health care. Only 20% of the sample had been ill or injured during the past year, and 10% had had STD symptoms; 50% had had a female sexual partner.
Although 71% of the young men had had a physical examination in the past year, only 39% had received reproductive health services. In all, 17% had had an HIV test, 11% had been tested for another STD and 29% had discussed at least one reproductive issue with a physician or nurse. Notably, only 14% had discussed all four reproductive issues with a professional. Even among sexually active teenagers, 71% had had a physical, but half had had no testing or relevant discussions with a professional.
Using logistic regression analyses, the investigators examined the relationship of each variable to the receipt of reproductive health services while controlling for all of the other variables studied. They found that adolescents' odds of having had a reproductive health discussion were roughly doubled if they had had symptoms of an STD or had engaged in sexual activity with more than one woman (odds ratios, 1.9-2.3). Odds also were elevated among adolescents who were black, had learned about sexual topics in school or from parents, received Medicaid or had had a recent illness or injury (odds ratios, 1.2-1.6). Young men from the Midwest had reduced odds of having talked with a medical professional about reproductive health (0.5).
Adolescents became increasingly likely to have had an HIV test as they grew older (1.2), and their odds of having received this service roughly doubled if they knew a person with AIDS, received Medicaid or had had 1-2 sexual partners in the previous year (1.7-2.2). The odds also were elevated for adolescents who had recently had three or more sexual partners (4.7). Additionally, relative to white youths who had not had a physical, white teenagers who had had an examination were more likely to have been tested for HIV, and black teenagers had elevated odds of HIV testing, regardless of whether they had had a physical.
The odds of STD testing differed by ethnicity, and the researchers therefore conducted separate analyses for non-Hispanic and Hispanic young men. Among non-Hispanic adolescents, blacks were significantly more likely than whites to have been tested for STDs in the past year (odds ratio, 1.6). Non-Hispanic teenagers also had elevated odds of STD testing if they were receiving public assistance, knew a person with AIDS, were covered by Medicaid, had no regular source of health care or had recently had 1-2 sexual partners (1.8-2.9). Those who recently had had three or more sexual partners or had undergone a physical examination were even more likely to have had an STD test (4.4-5.6).
Hispanic adolescents had increased odds of STD testing if their parents had a college education (2.9), if they had had a recent physical examination (7.2) or if they reported three or more sexual partners (9.0). Hispanic young men living in a rural community and those without health insurance were significantly less likely than others to have been tested for STDs (0.1 and 0.2, respectively).
The investigators emphasize that despite some encouraging results from their analyses, few adolescent males receive reproductive health care. Noting that services such as birth control counseling still are not considered an integral part of routine medical visits for young men (as they generally are for young women), they urge physicians to remedy this problem in accordance with current guidelines. They conclude by recommending that "given the high rates of STDs and unintended pregnancy among U.S. teens and their receptiveness to sexual health counseling in a clinical context, it should be common practice to incorporate reproductive health education into the routine health services of all adolescents."--L. Ninger
1. Porter LE and Ku L, Use of reproductive health services among young men, 1995, Journal of Adolescent Health, 2000, 27(3):186-194.