December 28, 2006
A survey of lesbian, gay and bisexual teenagers found that 70 percent said most people they knew were aware of their sexual orientation, but only 35 percent reported that their doctor knew, according to a new study by the RAND Corporation and UCLA.
The American Academy of Pediatrics, the American Medical Association and the Society for Adolescent Medicine all recommend that physicians discuss sexuality with all adolescents and provide nonjudgmental communication about sexual orientation. This is important because if a physician is aware of an adolescent patient's sexual orientation, the doctor can offer appropriate health education and counseling, identify individual risk, and perform targeted screening tests and treatment.
Dr. Garth D. Meckler, lead author of the study and an assistant professor of emergency medicine and pediatrics with the Oregon Health and Science University in Portland, Ore., said the survey results surprised researchers because the subjects were interviewed at an empowerment conference for lesbian, gay and bisexual youth.
“We knew that the sample that we chose was going to be a very ‘out' sample,” Meckler said. “We figured they would have a higher disclosure rate than most youth, and yet, despite being out to almost everyone in their lives, only 35 percent had told their doctor about their sexual orientation.”
Dr. Mark A. Schuster, senior author of the study and director of health promotion and disease prevention at RAND Health, added: “This is a reminder to physicians who take care of teens to try to create a comfortable, safe environment for young people to be open about their orientation, as well as other aspects of their sexuality.” Schuster is also a professor of pediatrics and public health at UCLA.
The study by RAND — a nonprofit research organization — and UCLA was published in the December issue of the Archives of Pediatrics & Adolescent Medicine. Meckler worked on the study while at the UCLA/RAND Center for Adolescent Health Promotion, which Schuster also directs.
Researchers surveyed 131 participants at the Models of Pride Youth Conference hosted by a southern California campus in October 2003 for this study. Meckler said the researchers knew the survey sample would not be representative of all lesbian, gay or bisexual youth, because 70 percent said they were “out” to everyone or nearly everyone in their lives, and many had to travel to attend the conference.
“One advantage (of the sample) is that it gives us a best-case scenario for kids having disclosed,” Meckler said. “Another thing that's different is that this is a non-clinical sample: we weren't recruiting (participants) at a STD clinic or a nightclub or other places that would have had different biases.”
Ninety percent of the teens had been to see a doctor in the past two years, and nearly two-thirds had gone within the past 12 months. But despite the fact that 66 percent thought it was very or somewhat important that their doctor know their sexual orientation in order to provide the best health care possible, only 35 percent said their physician knew their sexual orientation. Of those teens whose physician knew their sexual orientation, only 21 percent said their doctor had raised the topic.
“One of the strongest predictors of whether or not the teens disclosed their sexual orientation was whether the physician had discussed sex with them at all,” Meckler said. “Very few physicians were regularly discussing sexuality, even though sex is one of the major developmental challenges and health risks at that age.”
Physician bias also may play a role, Meckler said. Doctors are human beings, too, and “even though we have become a more open society in general, I think there's a lot of stigma around non-heterosexual orientations.”
Other reasons the teenagers gave for not disclosing their sexual orientation included: the fact that their parents were in the exam room with them; fear that the doctor would tell their parents their orientation; embarrassment; and fear that their doctor would disapprove.
Schuster said doctors are supposed to let teens and their parents know up front that part of the examination will include time when the teen can talk to the doctor without a parent being in the room.
“We want them to have a private time when they can open up, and discuss sex, drugs, violence, problems with their parents, anything,” said Schuster, a pediatrician. “That's when they tell us, ‘I think I might be pregnant.' A teen might say she has a headache to get her mom to bring her in, but the real reason comes out when mom steps into the waiting room.”
Sixty-four percent of the teens said physicians should “just ask me” about their sexual orientation, but Meckler and Schuster said this might not be the best tactic for teens who are not open about their sexual orientation.
“Doctors can create a safe environment by not assuming the teen is heterosexual,” Schuster said. “Rather than ask a boy if he's dating any girls, we should be open to all possibilities. That will send a message to a gay teen that this is a doctor who understands sexual orientation. It will also send a message to all teens that this is a doctor who will likely be comfortable talking about whatever the teen wants to discuss.”
Putting lesbian, gay and bisexual literature in the waiting rooms and posting a sign indicating that the office does not discriminate and is a safe place to discuss any and all health concerns confidentially are other things doctors can do. Teens also reported that they would be more likely to disclose their sexual orientation if they were assured the doctor would not put it on their charts or tell their parents.
Further research also needs to be done to get a more up-to-date estimate of physician bias, Meckler said, noting that the most recent studies were done at the beginning of the AIDS epidemic, “when fear and prejudice may have been heightened.” Researchers also need to study whether or not physician knowledge of a patient's sexual orientation leads to better care overall.
Other authors of the study include Marc N. Elliott and David E. Kanouse, both with the UCLA/RAND Center for Adolescent Health Promotion; and Kristin P. Beals, with the California State University, Fullerton's Department of Psychology. Funding for the study was provided by the National Research Scientist Award Training Grant, and grants from the U.S. Centers for Disease Control and Prevention.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.