Department of Medicine, Duke University Medical Center, Durham, North Carolina2Health Services Research and Development Service, Durham VA Medical Center, Durham, North Carolina.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
JAMA Pediatr. 2014 Feb;168(2):163-9. doi: 10.1001/jamapediatrics.2013.4338.
Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality.
To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents.
DESIGN, SETTING, AND PARTICIPANTS: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area.
Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation.
Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making.
clinicaltrials.gov Identifier: NCT01040975.
医生可能是性知识和预防服务的重要来源，建议在健康维护就诊期间进行一对一的保密时间，以允许讨论性发育、行为和降低风险。然而，对于医生与青少年讨论性行为的发生和特征，我们知之甚少。
研究青少年早期和中期接受健康维护就诊时，与医生和患者特征相关的讨论时间、青少年参与程度以及与性讨论相关的特征，以探讨讨论性问题的时间、青少年参与度、以及与性讨论相关的预测因素。
设计、地点和参与者：这是一项在北卡罗来纳州罗利/达勒姆地区的 11 个诊所（3 个学术诊所和 8 个社区诊所）进行的观察性研究，对 253 名青少年（平均年龄 14.3 岁；53%为女性；40%为白人；47%为非裔美国人）和 49 名医生（82%为儿科医生；84%为白人；65%为女性；平均年龄 40.9 岁；平均[SD]从业年限为 11.8[8.7]年）之间的音频记录对话进行了分析，这些对话的内容涉及性问题。
每次就诊期间讨论性问题的总时间。结果：165 次就诊（65%）中有部分内容涉及性问题。性话题的平均讨论时间为 36 秒（35%为 0 秒；30%为 1-35 秒；35%为≥36 秒）。对医生内患者聚类进行调整的有序逻辑回归（结果为持续时间：0、1-35 或≥36 秒）发现，女性患者（比值比[OR] = 2.58；95%置信区间[CI]，1.53-4.36）、年龄较大的患者（OR = 1.37；95% CI，1.13-1.65）、明确保密性讨论的对话（OR = 4.33；95% CI，2.58-7.28）、非裔美国青少年（OR = 1.58；95% CI，1.01-2.48）和整体就诊时间较长（OR = 1.07；95% CI，1.03-1.11）与更多的性话题相关，而亚裔医生与较少的性话题相关（OR = 0.13；95% CI，0.08-0.20）。此外，青少年、医生和就诊特征之间的相同显著关联与青少年的更多参与度显著相关。
我们的研究可能是首次直接观察医生和青少年之间的性话题。我们发现，三分之一的青少年每年就诊都没有提到任何性问题；当涉及性话题时，讨论时间很短。需要研究确定医生可以使用哪些成功策略来让青少年参与有关性的讨论，以帮助促进健康的性发育和决策。
clinicaltrials.gov 标识符：NCT01040975。
