Less Than Half of U.S. Youth Discuss Sensitive Topics With Their Doctors

Study shows that modifications to healthcare delivery practices may improve youth-provider discussions

January 16, 2019

Fewer than half of young people in the United States are having discussions of sensitive topics with their regular healthcare providers, according to a new study published in Pediatrics. This new research led by researchers at the Columbia Mailman School of Public Health suggests that modifying healthcare delivery practices may improve discussions between youth and their healthcare providers. Youth-provider discussions are important opportunities to promote health for young people.   

The paper is accompanied by a commentary written by Jeanne Van Cleave, MD, a pediatrician at Children’s Hospital Colorado, that calls the research findings, a rich opportunity to improve the delivery of adolescent preventive services.

While access to care has increased under the Affordable Care Act, this research suggests that the content of healthcare for young people is often not meeting professional recommendations. Young people were asked if they and their provider had discussed 11 specific topics recommended by national medical guidelines, spanning alcohol and other drug use, use of tobacco, sexual health, mental health, school performance, gun safety, and physical/sexual abuse. For 10 of the 11 topics, fewer than half of young people reported discussing that topic with their provider at their last visit. The topics that were discussed the least were gun safety, sexual orientation, and sexual or physical abuse.

The study found that discussions are shaped by healthcare delivery factors such as having had a youth-provider talk about confidentiality, providing private time with young people during office visits, using health screening questionnaires, and having enough time for youth and healthcare providers to interact. These factors were associated with increases of 50 percent or more in the likelihood of a youth-provider discussion at their last healthcare visit. 

“The good news is that some basic changes to healthcare practice could greatly improve opportunities for young people to discuss health with their care providers,” said adolescent medicine specialist John Santelli, MD, professor of Population and Family Health at Columbia Mailman and the lead author of the study. “Describing confidentiality to a young person, providing private one-to-one time, using health questionnaires in the office, and taking time to listen to young people—all are things that providers can do to improve dialogue with young people. Talking about confidentiality can create safe spaces for discussion. Health questionnaires can signal to young people that a healthcare provider is interested in discussing sensitive issues.” 

Data was collected from 1,509 adolescents and young adults through a 2016 national internet survey. Young people in the survey were 13-26 years of age and had seen their regular provider within the past two years. Surveys were offered in both English and Spanish.

The authors found that multiple social and personal factors were associated with youth-provider discussions about sensitive topics. Rates of discussion were similar by gender but often declined with age. Rural youth reported fewer discussions compared to urban/suburban youth. Youth from higher income families also reported fewer discussions. Youth desires to discuss specific topics were also associated with an increased likelihood of a discussion of that topicas was youth involvement in health risk behaviors.

Dr. Santelli concluded: “Discussions between young people and their healthcare providers can be important first steps towards better health.” 

Co-authors include Jonathan D. Klein, Xiaoyu Song, Jennifer Heitel, Stephanie Grilo, Mengru Wang, Hanying Yan, Kristen Kaseeska, Julie Gorzkowski, Madeline Schneider, Alexandra E. Dereix, and Marina Catallozzi. The study was funded by an unrestricted research grant from the Merck Foundation and sponsored by the Adolescent Health Consortium, a collaboration among four national medical societies to improve preventive healthcare for young people.

the adolescent health consortium

The Adolescent Health Consortium (AHC) is a collaboration to improve preventive healthcare for young people of four national medical societies: the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, and the University of Illinois at Chicago. The project aims to improve parental, adolescent, and young adult awareness of the importance and value of preventive health care services for young people. It also aims to increase the number of young people who receive preventive health care services, including confidential services and private time with a clinician, within professional, ethical, and legal guidelines. Formative research conducted by Columbia University’s Mailman School of Public Health for the AHC included focus group discussions with young people, parents, and health care providers as well as a National Internet Survey administered to a population-based sample of young people and parents of adolescents in the U.S. The AHC is taking a multi-pronged approach to disseminating findingsincluding peer-reviewed manuscripts, message development to target providers, parents, and adolescents, as well as the development of clinician education training.