Youth in grades 5-12 obtain information about health care from a wide variety of sources, and parents head the list; roughly three in five females and two in five males say that their mother is the first person they would consult about a health-related question. The majority of young people think that health care providers should discuss sexually transmitted diseases (STDs), smoking, and drug and alcohol use with them, but much smaller proportions report that a provider actually has done so. These are among the main findings of a 1997 survey of a nationally representative sample of nearly 7,000 public and private school students.1
The survey, which was sponsored by the Commonwealth Fund, was carried out in 297 schools by means of a self-administered questionnaire. Of the total sample of 3,153 males and 3,575 females, 18% were in fifth or sixth grade, 43% were in grades 7-9 and 39% were in grades 10-12. Some 54% of respondents were white, 14% black, 9% Hispanic and 7% members of other racial or ethnic groups; 16% did not provide information on their race or ethnicity. Analysts weighted responses in terms of these characteristics and examined bivariate associations with youths' reports of their sources of health care information and level of comfort discussing various health-related topics.
When asked to select from a list the person they would go to first for information about health care issues, 58% of female respondents chose their mother. The next most common responses were a friend (18%) and a doctor or nurse (16%). Other choices (their father, a sibling, another adult female relative, a teacher, a school nurse, another male relative and nobody) each accounted for 1-8% of responses.
Like females, male respondents most often said that their mother would be their first choice as a source of health care information; 42% gave this response. Health care providers and fathers were the next most frequent choice among males (22% and 21%, respectively); 2-10% of males selected each of the remaining choices. A significantly smaller proportion of males than of females said that their primary resource would be their mother, a friend or another adult female relative; a significantly larger proportion selected a doctor or nurse, their father, a teacher or nobody.
Among both females and males, the proportion whose primary source would be their mother was highest among students in grades 5-6 (72% and 54%, respectively) and lowest among those in grades 10-12 (46% and 35%). The proportion who would consult friends first was lowest in the early grades (7% among females and 5% among males) and highest among the oldest students (26% and 15%, respectively).
Given a broader list of possible sources of information and asked to indicate all that they would use, young people most frequently said their parents (72% of females and 60% of males). Health care providers were the only other source cited by more than half of students (62% of females and 52% of males). The differences between males and females were statistically significant for these sources, as well as for several other responses: Larger proportions of females than of males reported that they would get information from health education class, magazines and other adults; larger proportions of males than of females said that they would use newspapers, the Internet and toll-free telephone numbers. Sixteen percent of males, but only 7% of females, reported not knowing where they would get information about health care.
Young people think that health care pro-viders should discuss a wide range of topics with them, but relatively few say that they have had such conversations. For example, 56-65% of females indicated that providers should talk to youth about drugs, STDs, smoking, drinking, good eating habits, weight, stress, exercise, eating disorders and pregnancy prevention, but only 23-53% report ever having had such conversations. Males' responses fell into a similar pattern.
At the same time, respondents indicated that they would be too embarrassed, afraid or uncomfortable to discuss some issues with a health care provider. Roughly half of females reported feeling this way about discussing sexuality, body changes and menstruation; four in 10 placed "private health concerns," physical or sexual abuse, and contraception in this category; and about one-quarter felt this way about pregnancy and STDs. Males were concerned about the same issues, although the proportions reporting discomfort (except for private matters and STDs) were significantly lower than among females (about 20-40%).
For several topics, reports of discomfort or embarrassment were significantly less common among students in higher grades than among younger respondents. This pattern was apparent with regard to body changes, menstruation (for females only), contraception, pregnancy, STDs and eating disorders.
The analysts acknowledge that because of several limitations of the survey, the results should be interpreted with caution: The survey did not explore any issue in great depth and did not address access to or availability of various information sources. Furthermore, providers' perceptions of whether an issue has been discussed may differ from young people's. Nevertheless, the analysts conclude that the findings highlight the need for health care providers to initiate discussions on sensitive topics with youth, "and to do so in such a manner as to relieve potential discomfort." They also recognize the need to ensure that providers are adequately trained for, and comfortable with, this task, and to keep parents up to date on "topics pertinent to adolescent health care" by offering them educational materials and opportunities to discuss relevant issues with professionals.--D. Hollander
1. Ackard DM and Neumark-Sztainer D, Health care information sources for adolescents: age and gender differences on use, concerns, and needs, Journal of Adolescent Health, 2001, 29(3):170-176.