Communication between adolescents and physicians about sexual behavior and risk prevention

Objectives: To assess the extent to which adolescents in a nonclinical community-based population have talked with a physician about sexual behavior and risk prevention and to examine whether adolescents value these discussions and trust physicians to protect their confidentiality. Design: Self-administered anonymous survey. Setting: Urban California school district. Participants: A total of 2026 students in 9th to 12th grade, 98% of the eligible students present on the survey day. Outcome Measures: Discussions with physicians about sexual matters, helpfulness of discussions, trust in physicians to protect confidentiality, and knowledge about confidentiality laws. Results: Thirty-nine percent of adolescents reported discussions with physicians about how to avoid getting acquired immunodeficiency syndrome from sex, 37% about using condoms for vaginal intercourse, 13% about how to use condoms, 15% about the adolescent's sex life, 13% about how to say no to unwanted sex, and 8% about sexual orientation. In addition, 8% of adolescents had been given a condom by a physician. Adolescents were more likely to report most of these topics if they had ever had vaginal intercourse or if they had a regular physician. Most adolescents (80%-90%) would find it at least a little helpful to talk with a physician about various sexual matters. Most would trust a physician to keep secret that they asked questions about sex (15%), that they were having sex (65%), or that they were using contraception (68%). Fewer would trust physicians to keep secret a sexually transmitted disease (44%) or pregnancy (44%). For adolescents who knew that physicians in their state do not have to tell parents about sexually transmitted diseases or pregnancy, levels of trust rose, but only to 54%. Conclusions: Although professional medical organizations recommend that physicians discuss sexual matters and risk prevention with their adolescent patients, most adolescents report not having received these services. Physicians should be more aggressive about discussing these topics.