Confidentiality and adolescents' use of providers for health information and for pelvic examinations

Objective: To examine the relationship between adolescents' perception of the confidentiality of care provided by their regular health care provider and their reported use of this provider for private health information and for pelvic examinations. Design: Anonymous, self-report survey. Setting: Thirty-two randomly selected public high schools in Massachusetts. Participants: Of 2224 students in systematically selected 9th and 12th grade classrooms, 1715 (50% male) had a regular provider and a checkup within the last year. Results: Of teens surveyed, 76% wanted the ability to obtain confidential health care, but only 45% perceived their regular provider to provide this, and only 28% had discussed it explicitly. Logistic regression analyses revealed strong relationships between confidentiality and all outcomes studied. Among adolescents, the likelihood of having discussed sexually transmitted diseases, pregnancy prevention, and/or facts about sex with their provider was greater among teens who received a confidentiality assurance than that for teens who did not (odds ratio [OR] =2.7; 95% confidence interval [CI], 2.2-3.4). A similar relationship for teens' likelihood of having discussed substance use with the provider was found (OR=1.8; 95% CI, 1.4-2.3). Among sexually active females, the likelihood of a recent pelvic examination for those who received a confidentiality assurance was greater than for those who did not (OR=3.3; 95% CI, 2.1-5.5). Conclusions: This study furthers evidence of an important link between teens' perception of confidentiality and use of health care services and information. Because teens' health risks lie largely in potential risks from health-related behaviors, confidentiality in health care may be a critical factor in disclosure and discussion of risky behaviors, and ultimately in appropriate use of health care services. Efforts should be made to increase teens' access to confidential health care sources.