Doctors missing opportunity to talk with teens about sex

January 8, 2014  

WEST LAFAYETTE, Ind. — Many physicians are missing an opportunity to listen to teens and educate them about sexual health, according to a new study in the Pediatrics journal.

"We found a third of the time that sex was not discussed during annual physicals for young teens, and when sexuality was mentioned, it was brief - discussed for less than 35 seconds during a 20-minute appointment," said Cleveland Shields, a Purdue University associate professor in the Department of Human Development and Family Studies and the study's senior author. "Sexuality and sexual development are critical topics that physicians should be addressing with teenagers. The brevity of many discussions is not enough to cover the risk of teen pregnancy, sexually transmitted infections or overall wellness."

The study, led by Stewart Alexander, an associate professor of medicine at Duke University, was published online Dec. 30. Alexander is a 1989 Purdue alumnus.

The research was funded by the National Heart, Lung, and Blood Institute, and the data was collected at 11 clinics in the Raleigh/Durham, N.C., area as part of the Duke Teen CHAT project. The analysis is based on recorded conversations between 49 physicians and 253 adolescents, ages 12-17 with the average age of 14.

None of the teenagers brought up the topic, and when it was discussed about half of the teens responded to yes-or-no questions with limited answers. Only 4 percent had prolonged conversations about sexual issues with the doctors. 

"Even if adolescents are reluctant discuss the topic, physicians initiating such conversations sends a clear message to adolescents that sexuality is an appropriate and normal discussion," Stewart said. "We know that physicians may not be comfortable with these discussions, but more resources and research is needed to improve communication strategies. If teenagers are not getting their information from trusted medical providers then where are they are learning and is that information accurate?"

The American Medical Association and the American Academy of Pediatrics both recommend that early adolescence is the time to begin discussions about sexual health.

This study also found that sexual health discussions were more likely to take place with female patients and African-American patients, and that for each year of age, adolescents were 49 percent more likely to hear from the doctor regarding sexual health.

Shields, who studies communication between physicians and patients, also received a $2.7 million grant from the National Institutes of Health to lead a five-year study on patient and physician communication to improve interactions during physician visits and empower patients to participate actively in their care. 

Writer: Amy Patterson Neubert, 765-494-9723,

Sources: Cleveland Shields,

 Alexander Stewart, 

Related websites:

Relationships and Healthcare Lab

College of Health and Human Sciences

Note to Journalists: Journalists interested in a copy of the journal article can contact Amy Patterson Neubert, Purdue News Service, at 765-494-9723,


Sexuality Talk During Adolescent Health Maintenance Visits

Stewart C. Alexander, PhD; J. Dennis Frontenbbery, MD, MS; Kathryn I. Pollak, PhD; Terrill Bravender, MD, MPH; J. Kelly Davis, BA; Trulsostbye, MD, PhD; James A. Tulsky, MD; Rowena J. Dolor, MD; Cleveland G. Shields, PhD

IMPORTANCE: Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality.

OBJECTIVE: To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents.

DESIGN, SETTING AND PARTICIPANTS: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53 percent female; 40 white; 47 percent African American) and 49 physicians (82 percent pediatricians; 84 percent white; 65 percent female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community based-practices) located throughout the Raleigh/Durham, North Carolina, area.

MAIN OUTCOMES AND MEASURES: Total time per visit during which sexuality issues were discussed.

RESULTS: One hundred sixty-five (65 percent) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35 percent 0 seconds; 30 percent 1-35 seconds; and 35 percent ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio) [OR] = 2.58; 95 percent CI, 1.53-4.36), older patients (OR=1.37; 95 percent CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR=4.33; 95 percent CI, 2.58-7.28), African American adolescents (OR=1.58; 95 percent CI, 1.01-2.48), and longer overall visit (OR=1.07; 95 percent CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95 percent CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation.

CONCLUSIONS AND RELEVANCE: Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decisions making. 

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