Citation
Marcell, Arik V.; Matson, Pam; Ellen, Jonathan M.; & Ford, Carol A. (2009). The relationship between adolescents? sexual activity and routine health care use over time. Journal of Adolescent Health. vol. 44 (2; suppl. 1) pp. S33-S33Abstract
Purpose: Variation in health care use across developmental levels has been documented for boys, but not girls. Further, during adolescence the majority of teens become sexually active resulting in significant reproductive health morbidities. Studies examining teens' sexual status as a determinant of health care use over time are lacking. In this study, we examine the relationship between sexual activity status and health care use over time by gender among U.S. adolescents controlling for known factors of teens' care use.Methods: Longitudinal cohort analysis was conducted using data collected from 4328 males and 4911 females aged 12 to 18 years who completed the Add Health survey and had no missing data at baseline (1994/95) and follow-up (1996, retention rate = 71%). Guided by Andersen's Behavioral Model of Health Care Use, we used logistic regression analysis with random effects to examine the relationship between individual-level sexual activity and routine health care use from baseline to follow-up controlling for predisposing (e.g., race/ethnicity, region of residence), enabling (health insurance, socioeconomic status) and need factors (health status) stratified by gender and age group at baseline (12-14-year-old early; 15-16-year-old middle; 17-18-year-old late adolescence).
Results: On average between baseline and follow-up, report of consistent sexual activity was low for early teens (4%) and increased for late teens (21%); consistent non-sexual activity was high for early teens (80%) and decreased for late teens (40%); and an increase in sexual activity was reported by 14% early, 28% middle, and 35% late teens, respectively. On average from baseline to follow-up, consistent routine health care use was reported by 42% of teens; consistent non-use by 20%; increased use by 20%, and decreased use by 11%. Using repeated measures within gender and age group and controlling for other known factors, logistic regression analyses with random effects revealed sexual activity was significantly associated with routine health care use over time for girls but not boys, where the majority of girls go from not being sexually active to sexually active. Specifically, a sexually active early teen girl was 1.51 times (95% CI: 1.11-2.06), middle teen 1.53 times (1.13-2.07), and late teen 2.33 times (1.64-3.31) significantly more likely to report a visit between baseline and follow-up, respectively.
Conclusions: A relationship was found between individual sexual activity status and health care use over time for girls but not boys in the U.S. Unlike girls, boys do not engage in health care with sexual activity which puts them at risk for morbidity and mortality associated with sexual risk-taking behavior. Future efforts should be employed to raise boys' awareness about reproductive health needs as well as mechanisms to increase their care use with sexual activity.
URL
http://dx.doi.org/10.1016%2Fj.jadohealth.2008.10.092Reference Type
Journal ArticleJournal Title
Journal of Adolescent HealthAuthor(s)
Marcell, Arik V.Matson, Pam
Ellen, Jonathan M.
Ford, Carol A.