PEDIATRICS Vol. 111 No. 5 May 2003, pp. 996-1001
Missed Opportunities for Sexually Transmitted Diseases, Human Immunodeficiency Virus, and Pregnancy Prevention Services During Adolescent Health Supervision Visits
* Division of HIV and AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Department of Pediatrics, University of Rochester, Rochester, New York
|| Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
--> Objective. To describe prevention counseling on pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), received by sexually experienced youth in the primary care setting and to test associations between recent sexual risk behaviors and preventive counseling.
Methods. Using data from the 1999 Youth Risk Behavior Surveillance survey, a nationally representative survey (N = 15 349) of high school students, we analyzed responses to questions about sexual experience, time since last preventive health care visit, and discussion of STD, HIV, or pregnancy prevention with a doctor or nurse during their last preventive health care visit. Logistic regression was used to test associations; students’ demographic characteristics were controlled.
Results. More than half of the US high school students surveyed reported a preventive health care visit in the 12 months preceding the survey: 60.4% (95% confidence interval [CI]: 57.2%–63.6%) of female students and 57.5% (95% CI: 53.9%–61.1%) of male students. For female students, sexual experience was positively associated with a preventive health care visit (odds ratio [OR]: 1.3; 95% CI: 1.1–1.6), but for male students, sexual experience had a negative effect (OR: 0.8; 95% CI: 0.7–0.9). Of the students who reported a preventive health care visit in the 12 months preceding the survey, 42.8% (95% CI: 38.6%–47.1%) of female students and 26.4% (95% CI: 22.7%–30.2%) of male students reported having discussed STD, HIV, or pregnancy prevention at those visits. Sexual experience was associated with a higher likelihood of engaging in a dialogue about sexual health once a student entered the health care system: female students (OR: 3.8; 95% CI: 3.0–4.9) and male students (OR: 1.9; 95% CI: 1.3–2.7).
Conclusion. Primary care providers miss opportunities to provide STD, HIV, and pregnancy prevention counseling to high-risk youth.
Key Words: adolescence • health supervision visit • prevention counseling • sexually transmitted diseases • human immunodeficiency virus • teen pregnancy
Abbreviations: STD, sexually transmitted disease • HIV, human immunodeficiency virus • YRBS, Youth Risk Behavior Surveillance (survey) • CDC, Centers for Disease Control and Prevention • AIDS, acquired immune deficiency syndrome • OR, odds ratio • CI, confidence interval
Received for publication Aug 23, 2002; Accepted Nov 12, 2002.
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