Discussion of Potentially Sensitive Topics With Young People

Abstract

OBJECTIVES: To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation. METHODS:We used data from a national internet survey of adolescents and young adults (13-26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher's Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed. RESULTS: Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85-2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78-1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models).CONCLUSIONS: Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider.WHAT'S KNOWN ON THIS SUBJECT: Discussions about sensitive health issues are important opportunities for health promotion for adolescents and young adults. Current US national surveillance systems do not collect data on the prevalence of adolescent and young adult-provider discussions or the factors associated with these discussions. WHAT THIS STUDY ADDS:We identify health care provider, youth, and health system factors independently associated with youthprovider discussions; these include previous discussions of confidentiality, use of health checklist and/or screening questionnaires, and increasing length of the office visit.

What’s PrEP?: peer navigator acceptability among minority MSM in Washington

“…In our study, having a regular medical provider was associated with lower peer navigator acceptability, although this factor was not significant in multivariable analysis. In a study by Santelli et al among adolescents in the United States, confidential visits with a medical provider were associated with discussions about sensitive topics, including sexual orientation and HIV, suggesting that having a trusted regular provider increases access to HIV prevention services [48]. Similarly, although the association was not significant, peer navigator acceptability in our study was lower among participants who had disclosed their sexual orientation to a regular provider.…”

What's PrEP?: Peer Navigator Acceptability among Minority MSM in Washington

“…In our study, having a regular medical provider was associated with lower peer navigator acceptability, although this factor was not significant in multivariable analysis. In a study by Santelli et al among adolescents in the United States, confidential visits with a medical provider were associated with discussions about sensitive topics, including sexual orientation and HIV, suggesting that having a trusted regular provider increases access to HIV prevention services [47]. Similarly, although the association was not significant, peer navigator acceptability in our study was lower among participants who had disclosed their sexual orientation to a regular provider.…”

Young people’s advisory groups in health research: scoping review and mapping of practices

“…The corresponding authors of all 27 studies were contacted; 21 authors replied. From these, 15 of the 21 studies confirmed they included a YPAG [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] ; the remaining 6 either did not use a YPAG (n=3) [28][29][30] or had YPAG members who were all aged over 18 years (n=3). 31,32,33 For the six studies where authors did not respond, we assumed a YPAG was used based on information provided in the paper.…”