Masculine beliefs, parental communication, and male adolescents' health care use.

Most causes of adolescent male morbidity and mortality are preventable.1,2 This is the basis for practice guidelines that recommend clinical preventive services for all adolescents as part of annual or tailored visits.3-7 Two adolescent clinical preventive services supported by research include that physicians provide reproductive health services (eg, sexually transmitted infection [STI]/HIV screening, counseling, and testing) to male patients between 11 and 21 years of age and age-appropriate immunizations.3-8 Whether physicians are able to provide preventive health services to adolescent male patients depends on this populations’ involvement in the health care system. Male adolescents frequently become disconnected from health care, especially as they get older.9,10 A better understanding of modifiable factors that influence adolescent male health care use would improve our ability to develop interventions to increase adolescent male connections to health care. The Andersen’s Behavioral Model of Health Services Use has been used to examine factors that influence health care use and proposes that use is influenced by enabling factors that provide resources, predisposing factors that provide motivation, and health needs that provide actual stimulus to engage in care.11 Previous studies show that enabling factors that represent adolescent barriers to care include lower socioeconomic status,12 lack of health insurance,13,14 and lack of a regular source of care,15 whereas factors that promote adolescent male access to care include the availability of confidential services,16,17 gender of the provider,18 assistance with appointment making,19,20 and school-based health clinics.9 Predisposing factors associated with the lower use of health care by male adolescents include being older in age,9 being of minority race/ethnicity,21 and lacking knowledge/sources of health care information.22 Few studies have examined how adolescent male health needs23 and. in particular. needs related to reproductive health, influence their health care use. Two modifiable factors that may influence adolescent male health care use have been largely ignored in the research literature. First, although parent-teen communication has been shown to be an important contributor to adolescent health, the relationship between parental communication and access to care for sons has received little attention. Second, the way in which men are socialized in the United States (eg, to be tough, competitive, and inexpressive), defined as beliefs about masculinity, has been shown to influence adult men’s health care use24-26 but has not been examined in adolescence. The National Survey of Adolescent Males (NSAM) provides a unique opportunity to address gaps in our knowledge. The main objective of this prospective study is to test the combined influence of modifiable and non-modifiable factors, organized around Andersen’s Behavioral Model of Health Services Use framework, to predict the report of health care use by male adolescents. We also specifically focus on the relationship among beliefs about masculinity, parental communication, and health care use while controlling for other factors.