Do adolescents want to hear preventive counseling messages in outpatient settings?

In response to the high prevalence of health-risk behaviors among adolescents, policy agencies have urged primary care clinicians to discuss these behaviors with all adolescents. Yet such discussions frequently do not take place. A commonly mentioned barrier is the clinician perception that patients are not interested in, or are embarrassed by, such discussions. The purpose of this study was to assess the accuracy of this perception by conducting a survey of adolescents.

Self-administered questionnaires were distributed to 305 adolescents, ages 11 to 16 years, waiting to be seen in three community health centers and three private practices. The questionnaire queried adolescents' willingness to talk about eight preventive counseling topics with health care practitioners, and information was collected on variables that might influence willingness. Descriptive frequencies were generated. Chisquare analysis and stratification assessed differences between groups.

A majority of adolescents felt that it is a clinician's job to discuss health risk behaviors. On the current visit, however, fewer than 20% wanted to talk about drugs, alcohol, cigarettes, or depression; fewer than 40% about sex; and fewer than 55% about diet or exercise. Adolescents reporting previous conversations on a topic were more likely to want to talk about that issue at the current visit. Willingness to talk did not vary by visit type (well care vs acute care).

This study confirms that adolescents are hesitant to discuss health risk behaviors with clinicians, but the findings also suggest that receptivity increases if clinicians address these topics on repeat occasions.