Three modifiable factors (masculine beliefs, parent-teen communication, and insurance status) prospectively influence health care use among male adolescents in the United States. These findings can be used to inform interventions to improve adolescent male health through increased use of health care.
To our knowledge, this is the first report linking adolescents’ beliefs about masculinity and male roles to health care use behaviors. Our findings that male adolescents with more traditional masculine beliefs are less likely to get health care is consistent with research focused on adult men.26
Our findings demonstrate that such attitudes may hinder adolescent male use of health care and may be consistent with Courtenay’s33
suggestion that boys’ lack of help seeking can itself be considered a risk behavior. Within this context, additional research is needed to better understand how masculine beliefs influence adolescent male care-seeking behaviors. Programs that promote health and gender equity among boys are currently under evaluation.34,35
These programs are designed, in part, to target mythology that suggests that care-seeking is a sign of weakness and to promote the belief that care seeking can be consistent with the male role and seen as a sign of strength. An alternative strategy that warrants investigation among male youth populations may be to promote health and target services in a manner that is more congruent with traditional male gender roles.36,37
Parent-teen communication has long been accepted as an important contributor to adolescent health.22,38,39
Studies that examine parent-teen communication about sex have reported gender-specific issues (that mothers are more likely than fathers to talk with their children about sex and that mothers talk more to daughters than to sons).40,41
Also, the influence of mothers has been shown to outweigh that of fathers as it relates to the sexual behaviors of their teenage sons and daughters.38
Our findings provide new insight into the relationship between parent-son communication about reproductive health and health care use and highlight the unique importance of father-son communication. In this study, communication with both mothers and fathers predicted increased health care use for male adolescents regardless of age and for sons with either more or less traditional masculine beliefs. For adolescent sons with either more or less traditional beliefs, talking with fathers about reproductive health issues seems to be particularly important. Isolated mother-son communication did not predict health care use in our study. Future research is needed to examine the content and quality of parent-son communication as it relates to male use of health care and to further explore parental communication within the context of single-parent households.
Consistent with existing literature, insurance plays a major role in whether male adolescents get health care. The proportion of male adolescents in our study who reported that they were uninsured (14.6%) is similar to that of more recent national samples (F. L. Sonenstein, PhD, written communication, 2006 [data from the National Survey of Family Growth]).13
Newacheck et al13
recently reported that adolescents who reside in regions outside the Northeast are more likely to be uninsured. Our study shows that regional variation in health care use persists after controlling for insurance status. Strategies to reduce adolescent male barriers to care may, thus, include extending insurance coverage to all adolescents and young adults, developing equitable insurance plans for male adolescents and young adults that are comparable to reproductive health care services available for female adolescents and young adults (eg, family planning) and improving access to care in all of the US regions.
It is important to highlight that male adolescents who are at higher risk of health problems on the basis of reported risk-related behaviors (eg, sexual intercourse, substance use, and truancy) are equally likely to have a physical examination in the last year when compared with lower-risk adolescents after controlling for serious illness or injury. This is unfortunate, because male adolescents engaging in risk-related behaviors may benefit the most from connections to the health care system. Strategies to identify and connect this population to care are needed and may involve collaboration with allied professionals (eg, teachers, counselors, and community leaders) and the juvenile justice system.23,42
These strategies will need to be linked to efforts to support physicians’ delivery of high-quality adolescent clinical preventive services, such as STI/HIV testing and age-appropriate immunizations.43-45
A major strength of this study is its prospective nature and the use of a racially and ethnically diverse national sample. This study also has several potential limitations. First, self-report measures have inherent limitations, although adolescent reports of their own health care behaviors are probably at least as accurate as those of parental report. Second, there are limitations with our main outcome variable. We are unable to determine the reason that respondents had a physical examination by their regular care provider, so we cannot distinguish acute from routine visits. Furthermore, we are unable to independently test the influence of having a regular source of care on health care use, because these variables were linked in the original survey instrument. This combined measure does decrease the risk of overestimation of adolescent male health care, because it described examinations linked to a regular source of care from examinations provided in group settings as part of sports clearance events.46
Third, bias based on attrition between waves is possible. The risk for bias is expected to be small, because previous analyses have shown no attrition bias in the areas of sexual or contraceptive behaviors47
or in any of the other the main study variables except for age (older boys were less likely to follow-up at wave 2; P
< .04). Next, the internal reliability of the masculine beliefs scale is somewhat lower than that traditionally found for scales used in behavioral research. Although this scale may not fully capture masculine beliefs, it is able to prospectively differentiate adolescent male health care use, thus demonstrating construct validity. Finally, NSAM is an older data set, but we believe our findings are still relevant given the expected stability of our main study predictor and outcome variables. NSAM remains a seminal prospective data set to examine adolescent male reproductive health. This data set provides us a unique opportunity to examine prospectively whether modifiable factors, including masculine beliefs and parental communication, within the context of an organized framework are related to adolescent male health care use.