Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e966-e975 (doi:10.1542/10.1542/peds.2006-1683)
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ARTICLE

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

Arik V. Marcell, MD, MPHa, Carol A. Ford, MDb, Joseph H. Pleck, PhDc and Freya L. Sonenstein, PhDd

a Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
b Departments of Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina
c Department of Human and Community Development, University of Illinois, Urbana, Illinois
d Center for Adolescent Health Promotion and Disease Prevention, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

OBJECTIVES. Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents.

PATIENTS AND METHODS. We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990–1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2.

RESULTS. On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in ≥2 other risk behaviors had neither a higher nor lower likelihood of a physical examination.

CONCLUSIONS. Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care.

Key Words: male • health services accessibility • men's role • parent-child relations

Abbreviations: STI—sexually transmitted infection • NSAM—National Survey of Adolescent Males • RR—relative risk • CI—confidence interval

Accepted Oct 10, 2006.


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