Identification of Sexual Minority Youth in Pediatric Primary Care Settings Within a Large Integrated Healthcare System Using Electronic Health Records

Abstract

The aim of the study was to estimate the prevalence of sexual minority youth (SMY) within an integrated health care system using a standardized questionnaire. Methods: This study assessed SMY status in youth aged 12.5e18 years using a previsit Well Check questionnaire at Kaiser Permanente Northern California facilities in 2016. SMY was defined as selfreported attraction to the same sex or both sexes. Results: A total of 93,817 youth (87.3%) self-reported sexual attraction, and 5% (n ¼ 5,329) of respondents (N ¼ 107,532) identified as SMY: 1.7% were attracted to same sex, and 3.2% were attracted to both sexes. There were youth who responded neither (1.5%) and unsure (2.4%). Females were 2.8 times (95% confidence interval 2.6e2.94) more likely to be SMY than males. SMY status significantly increased with age. Nonwhite youth were significantly less likely to be SMY compared with white youth. Conclusions: This is the first study to examine SMY prevalence in pediatric primary care. Primary care providers can use previsit screening before preventive visits to identify and support sexual minority adolescents, facilitate family acceptance, and promote healthy behaviors with care coordination.

Screening for Gender Identity in Adolescent Well Visits: Is It Feasible and Acceptable?

“…Our study found that the TGD reporting among adolescents differed by age. Similar to self-report of sexual attraction and orientation, younger adolescents may be less likely to report as TGD because they are exploring their gender identity, unwilling to answer, or simply do not understand the question [18,31]. Tailoring of questions about gender identity by age may be warranted, as well as exploring how best to ask the question about gender to ensure both comfort and gender affirmation (e.g., allowing a patient to identify as "male" or "female" while also indicating they are "transgender").…”

“…Few studies have examined approaches to gender identity screening in adolescents. Using a previsit questionnaire to ask adolescents about their sexual health and to screen for psychosocial issues has been found to help normalize and promote discussions of sensitive topics [17,18]. A recent study found that adding a standardized gender identity screening question to a previsit questionnaire increased the documentation of gender identity for adolescents presenting for annual adolescent physicals [19].…”

Opportunities and Challenges for Previsit Screening for Sexual and Gender Identity Among Adolescents in Primary Care

“…To address this gap between recommendations and practice, some pediatric providers are incorporating questions about sexuality into electronic or other previsit screening tools [4]. In this issue of the Journal of Adolescent Health, Parmar et al [5] are the first to report findings from a large-scale implementation of a standardized assessment of sexual attraction at adolescent health supervision visits.…”