McKee M Diane, Fletcher Jason, Schechter Clyde B
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
J Adolesc Health. 2006 Aug;39(2):183-91. doi: 10.1016/j.jadohealth.2005.11.022.
To determine whether or not critical sexual health services are delivered to low-income girls, and to identify predictors of timely initiation of gynecologic care for sexually active adolescent girls. Few studies have addressed the interval between sexual debut and risk-appropriate primary care services.
We conducted an anonymous, cross-sectional, laptop-based, self-administered branching survey of 9th-12th grade girls in three Bronx public high schools (n = 819).
Over half (60.0%) had an opportunity for confidential care at last clinical visit. Only 27% of sexually active girls had informed any clinician that they had been sexually active; 45% had ever had a pelvic exam. The mean interval between sexual debut and initial pelvic exam (our proxy for gynecologic care) was 13.3 months (range = 0-70 months, SD = 11.8 months). Cox proportional hazard modeling identified four predictors of time to first pelvic exam: experience of sexually transmitted infection (STI) or pregnancy (hazard ratio [HR] = 1.9), having disclosed sexual activity to any clinician (HR = 1.7), access to confidential care (HR = 3.1), and high self-efficacy for accessing confidential care (HR = 2.1).
Most sexually active girls have not told a clinician that they are sexually active and many have not had counseling related to sexual health. Delay between sexual debut and initial pelvic exam is substantial for low-income urban girls, and often occurs in reaction to pregnancy or STI. Setting of usual care does not predict timely gynecologic care, but access to confidential care does.
确定是否为低收入女孩提供了关键的性健康服务，并确定性活跃的青春期女孩及时开始接受妇科护理的预测因素。很少有研究探讨首次性行为与风险适配的初级保健服务之间的间隔。
我们对布朗克斯区三所公立高中9至12年级的女孩（n = 819）进行了一项基于笔记本电脑的匿名横断面自填式分支调查。
超过一半（60.0%）的女孩在上次临床就诊时有机会接受保密护理。只有27%的性活跃女孩告知过任何临床医生她们有性行为；45%的女孩曾接受过盆腔检查。首次性行为与首次盆腔检查（我们将其作为妇科护理的替代指标）之间的平均间隔为13.3个月（范围 = 0至70个月，标准差 = 11.8个月）。Cox比例风险模型确定了首次盆腔检查时间的四个预测因素：性传播感染（STI）或怀孕经历（风险比[HR] = 1.9）、向任何临床医生披露过性行为（HR = 1.7）、获得保密护理（HR = 3.1）以及获得保密护理的自我效能感高（HR = 2.1）。
大多数性活跃女孩未告知临床医生她们有性行为，许多人也未接受过与性健康相关的咨询。对于低收入城市女孩来说，首次性行为与首次盆腔检查之间的延迟时间很长，且通常是在怀孕或感染性传播感染后才进行检查。常规护理环境并不能预测及时的妇科护理，但获得保密护理则可以。
