The majority of the youths felt comfortable with their origins and planned to obtain their donor's identity, although not necessarily at age 18.

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Families were relatively open and positive about their use of DI and that their child could obtain the donor's identity. Disclosure did not appear to have a negative impact on the families, regardless of parental sexual orientation and relationship status.

PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confi dential services. METHODSWe undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTSThe annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal confl ict about providing confi dential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confi dential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen.CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Offi ce systems should be developed that enhance the consistency of delivery of confi dential services.

Objective The intrauterine contraceptive device (IUD) is one of the most effective contraceptive methods but it remains under-utilized, especially among adolescents. Little is known about how adolescents perceive IUDs. The objective of this study is to explore urban, minority female adolescents' attitudes and beliefs about IUDs and to identify barriers to IUD use. Study Design Qualitative semi-structured interviews were conducted with twenty-one adolescents aged 14 to 21 years who had heard about the IUD but never used one personally. Participants were recruited from two urban school-based health clinics and one community health center. Individual interviews were audio-taped and transcribed. Themes were identified by two independent researchers through line-by-line analysis of interview transcripts. Results Fear of the IUD predominated. Respondents related fears about pain, expulsion, foreign body, and the potential for physical harm. Common themes in support of the IUD included the IUD's superior efficacy compared to other contraceptive methods and the ability to use this method long term. Despite identifying IUD benefits, most respondents did not appear to think the method would be well-suited for them. Conclusion Though the IUD is safe and effective for adolescents, we found that urban female adolescents have many device related concerns which must be addressed to make this method more acceptable. Implications Understanding urban, minority adolescents' perspective on IUDs and their specific concerns about IUD method use can help clinicians provide targeted and relevant contraceptive counseling.