Arik V. Marcell

Male adolescent use of health care services: where are the boys?

PURPOSEnTo describe patterns of health care use by adolescent males in the United States and clinical practice characteristics associated with their use of adolescent-specific programs.nnnMETHODSnSecondary analysis of three national data sets to determine health care use by male adolescents: the National Ambulatory Medical Care Survey [NAMCS (1994): pediatric, family physician, internal medicine, and obstetric/gynecologic outpatient visits]; National Hospital Ambulatory Medical Care Survey [NHAMCS (1994): outpatient department (OPD) and emergency department (ED) visits]; and Comprehensive Adolescent Health Services Survey [CAHSS (1995)]. Both NAMCS and NHAMCS are representative national probability samples. Total visit estimates by adolescents in 1994 to NAMCS sites were 387,076,630, to OPD sites were 6,511,244, and to ED sites were 13,161,824. For CAHSS, 468 programs (60% of eligible) participated. Data analyses were performed using two-tailed Students t-tests and correlation testing.nnnRESULTSnOlder male adolescents, aged 16-20 years, account for a lower percentage of total visits to NAMCS sites combined compared to younger males, aged 11-15 years (15.8% vs. 25.1%, p <.001), mainly owing to a significant decline in visits to pediatricians (3.2% vs. 14.9%, p <.001), despite significant increases in female health care use during the same time period. Younger males were seen at similar rates compared to females at NAMCS, NHAMCS-OPD and NHAMCS-ED sites, but older males account for a significantly lower percentage of total visits than females to all NAMCS sites combined (15.8% vs. 34.7%, p <.001), the NHAMCS-ED (26.4% vs. 31.5%, p <.05), and the NHAMCS-OPD (15.0% vs. 41.2%, p =.001). Among specialized adolescent sites (CAHSS), 13-19-year-old males account for fewer visits than females to all programs types: schools (40% vs. 60%), hospitals (33% vs. 67%), and community/health departments (25% vs. 75%) (all ps < or =.001). Clinical practice characteristics correlated with having a greater proportion of male adolescent visit varied depending on the types of adolescent program examined.nnnCONCLUSIONSnYounger male adolescents make health care visits in relatively equal proportions to females at all NAMCS and NHAMCS locations and visits by older males are significantly reduced. Male adolescent visits are lower than females at all adolescent-specific programs; school-based clinics see the highest proportion of males. Greater understanding of male adolescents transition between providers from adolescence to adulthood is needed to improve care to male adolescents who under-use health services.

Where does reproductive health fit into the lives of adolescent males

CONTEXTnTo develop interventions to promote responsible sexual behaviors and design reproductive health services for adolescent males, we need a better understanding of the context of reproductive health in adolescent males lives.nnnMETHODSnA total of 32 males (mean age, 15.5 years) were recruited from two urban high schools. At each school, three group sessions, consisting of both individual free-listing activities and focus group discussions, were conducted; each addressed issues related to one of three domains-masculinity, responsibility and priorities. Data from the focus groups were examined through standard content analyses.nnnRESULTSnParticipants identified school, family, future career and sports as their current life priorities; health was not a top concern. Pregnancy and sexually transmitted infections (STIs) were not seen as interrelated health concepts. STIs were considered a health issue, whereas pregnancy was perceived as a negative event that could prevent achievement of specific life goals. At times, notions regarding how a male behaves reflected traditional masculine beliefs: that violence is justified as a way to protect oneself, that having sex is part of a males role in a relationship and that males should handle health issues by themselves.nnnCONCLUSIONSnTo meet the reproductive health needs of adolescent males, program developers should consider how other life priorities and traditional masculine beliefs may serve as barriers to care and how to ensure that services reflect the adolescent males perspective.

Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents

BACKGROUNDnPrimary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated.nnnOBJECTIVESnTo examine (1) physicians attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents.nnnMETHODSnA national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Associations Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents.nnnRESULTSnOn average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented.nnnCONCLUSIONSnPhysician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.

The Other Half of the Equation: Serving Young Men In a Young Women's Reproductive Health Clinic

CONTEXTnEfforts to improve reproductive health typically target women. Family planning agencies serving high-risk young women may be particularly suited to integrating young men in their health promotion efforts.nnnMETHODSnIn 2001, a family planning clinic in San Francisco serving primarily young women opened a male clinic as part of a male involvement program that includes education and outreach components. Client volume was assessed by reviewing billing data. New male clients completed questionnaires on their demographic characteristics, sexual and health-seeking behavior, and reason for clinic visit. Before and after the male clinic opened, female clients completed questionnaires assessing their satisfaction with services and their attitudes on males being served at the clinic. Data were analyzed by using descriptive and chi-square statistics.nnnRESULTSnIn the first year of the male clinic, the number of adolescent and adult male clients served at the facility increased by 192% and 119%, respectively, over the previous year. Among 110 males making first visits, 88% came for sexually transmitted disease testing or treatment. Three-quarters had learned of the clinic by word of mouth--from a sexual partner (37%), friend (29%) or sibling (6%)--rather than directly from outreach efforts. The proportion of female respondents very or mostly satisfied with their care was similarly high before (98%) and after (92%) the male clinic opened.nnnCONCLUSIONSnIncreasing capacity within the female reproductive health model to serve males is feasible. To reach at-risk males, in-reach efforts with female clients may be as important as targeted outreach efforts.

Health care of adolescent males: overview, rationale, and recommendations.

Overlooked amid the advances made in womens health over the past decade strategies for improving the health status of men and the quality of health care that they receive are now emerging. The importance of this is made clear from national data indicating that at birth the life expectancy for men is an average 5.4 years less than that for women (5.2 years for non-Hispanic Caucasians and 6.7 for African Americans). The age adjusted death rates for leading causes of premature mortality such as heart disease malignant neoplasm and motor vehicle crashes are also substantially greater for men than for women (32% 32% and 56% greater respectively). Greater emphasis on the value of prevention is also emerging. In the medical model attention is directed traditionally toward early detection and treatment of conditions such as heart disease hypertension cancer and hyperlipidemia. Using the public health model of prevention attention is directed toward antecedent factors that contribute to disease. The need for this approach was made clear in a seminal study which concluded that personal behaviors such as tobacco diet and physical activity alcohol firearms sexual behavior motor vehicles and illicit use of drugs accounted for approximately 42% of the 2.148 millions deaths during 1990. (excerpt)

Providing anticipatory guidance and counseling to the adolescent male.

During a clinical day a health care provider may find it refreshing to see an adolescent male because he will be quick and easy to see with an uncomplicated physical examination and clinical history. This attitude may be in part due to the fact that adolescent males have the reputation of being nontalkative difficult to engage or not interested when it comes to clinical care. Yet adolescent males experience many preventable health issues that place them at significant risk for morbidity and mortality (see earlier article). Also despite their reputation adolescent males do want to discuss their health. The primary care provider should not shortchange the adolescent male during his medical encounter but instead should take the time to engage him in anticipatory guidance and counseling. The fact that adolescent males are seen in a variety of clinical settings including ambulatory care emergency department school-based and juvenile detention makes it important for all types of care providers to become familiar with how to counsel adolescent males and to use counseling approaches that work. To provide a rationale for effective counseling a framework is first presented to enhance the understanding of the adolescent male in context of his development family friends and community/school. Equipped with the right set of tools clinicians of either gender can have much success communicating with and counseling adolescent male patients. (excerpt)

Gender differences in health care use: Are male adolescents being seen? 25

Background: Adult males use health services less often than females; these gender differences likely begin in adolescence but are not well studied.