Sexual Orientation Differences in Adolescent Health Care Access and Health-Promoting Physician Advice

Abstract

Purpose Physician screening and advice on health-related behaviors are an integral part of adolescent health care. Sexual minority adolescents encounter more barriers to health services, yet no prior research has examined whether they also experience disparity in physician screening and advice. We examined possible sexual orientation disparities in health care access, physician screening and advice on six health-related behaviors. Methods Data were from a national sample of U.S. adolescents who participated in Wave 2 of the NEXT Generation Health Study (n = 2023). Poisson regressions were conducted separately for males and females to estimate sexual orientation differences in health care access and health-related screening and advice. Results Compared to heterosexual males, sexual minority males were more likely to report unmet medical needs in the past year (ARR = 2.23), but did not differ with respect to receiving physician advice concerning health-related behaviors. Compared to heterosexual females, sexual minority females were more likely to report no routine physical check-up in the past year (ARR = 1.67), but were more likely to receive physician advice to reduce or stop drinking, smoking, drug use, increase physical activity, and improve diet (ARRs = 1.56–1.99), even after controlling for corresponding health-related behaviors. Sexual minority females were also more likely to receive advice about risk associated with sexual behavior (ARR = 1.35) and advice to avoid sexually transmitted diseases (ARR = 1.49). Conclusions Both sexual minority males and females experienced disparities in aspects of health care access. Improved health-promoting advice would better serve sexual minority males. Implications and Contribution Clinical guidelines recommend physician screening and advice as part of routine care. Compared to heterosexual females, sexual minority females received more health-promoting advice and did not report greater unmet medical needs. The reverse pattern was found among males, highlighting the potential benefits of increasing health-promoting advice targeting sexual minority males.

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

“…Females were more likely to acknowledge SMY identification in adolescence, similar to findings from previous research [6]. Research on sexual identity development has described that females accept SMY status and labels earlier than SMY males [5]. In this study, racial/ethnic minority youth were less likely to identify as SMY compared with white youth.…”

“…Estimates in small, specialized clinical settings are reported as high as 23% [4]. National school-based samples have estimated self-reported SMY prevalence at 4%e8% [1,5,6]. Among high schoolers, 1%e8.4% identified as homosexual, 1%e8% as bisexual, and 4.5% reported same-sex sexual attraction [5,7].…”

“…National school-based samples have estimated self-reported SMY prevalence at 4%e8% [1,5,6]. Among high schoolers, 1%e8.4% identified as homosexual, 1%e8% as bisexual, and 4.5% reported same-sex sexual attraction [5,7]. These studies used a variety of measures to assess SMY status, including attractions, relationships, behaviors, and self-identified labels.…”

Sexual Orientation and Depressive Symptoms in Adolescents

“…23 -25 The smaller but growing literature on adolescents and young adults reveals that sexual minority youth tend to report more unmet medical needs and may be more afraid of what their providers would say or do, be more worried about sexual identity disclosure to their parents, and are more likely to feel embarrassed to use mental health services than their heterosexual peers. [26][27][28] The lack of a secure environment for disclosing sexual orientation may be an important barrier to quality health care and the effective screening of depression. 29 Critically, no previous study has documented unmet medical needs as a mediator of sexual orientation disparities in depressive symptoms.…”

Disclosure Matters: Enhancing Patient-Provider Communication is Necessary to Improve the Health of Sexual Minority Adolescents

“…The work of Luk et al [8] in this month's Journal of Adolescent Health addresses a current challenge within health-care systems-developing lesbian, gay, bisexual, and transgender (LGBT)-sensitive care to proactively meet the unique needs of sexual minority adolescents. This work has helped to evaluate sexual orientation differences in health-care access and healthpromoting physician advice received by a population that remains under-resourced and underserved.…”