Less Adolescents May Use STD Services Fearing Parents Could Find Out

With STD Awareness Month coming up, the Centers for Disease Control and Prevention (CDC) are taking a closer look at incidence of sexually transmitted diseases (STD) in the United States, a statistic which has reportedly reached an “unprecedented high.”

In an effort to cut down on these infections and expand prevention efforts, CDC researchers are looking into why sexually active adolescents and young adults may not be taking advantage of STD services, despite being covered for them under their parents’ health insurance plans. Their findings? Even though most healthcare plans cover these services for adolescents and young adults, many delay seeking care or do not seek it at all because of confidentiality concerns; chief among these concerns is their parents finding out.

Researchers from the CDC analyzed data from the 2013-2015 National Survey of Family Growth, which included 10,205 respondents and had a 69.3% response rate. Data were collected for this report using “audio computer-assisted self-interviewing.” Researchers only included respondents between the ages of 15 and 25 who reported being sexually active.

According to the CDC, the confidentiality concerns that were addressed in the survey included:

• Whether all respondents aged 15-17 years and those respondents aged 18-25 years who were on a parent’s private health insurance plan would ‘ever not go for sexual or reproductive health care because their parents might find out’;
• Whether respondents aged 15-17 years had ‘time alone with a provider in the past 12 months without a parent, relative, or guardian in the room’; and
• Current health insurance status, including being on a parent’s insurance plan.

The researchers found that confidentiality concerns are a real issue: during 2013-2015, 12.7% of sexually active adolescents (15-17 years) and young adults (18-25) covered by their parent’s health insurance plan “would not seek sexual and reproductive health care because of concerns that their parents might find out.” In fact, a total of 22.6% of adolescents between the ages of 15 and 17 years were particularly concerned when it came to confidentiality, a “significantly higher percentage” than those between the ages of 20 and 22 (8.2%) and those between 23 and 25 years of age (5.4%). Furthermore, females who had confidentiality concerns “reported a lower prevalence” of receiving chlamydia screening in the past 12 months (17.1%) than females who did not report confidentiality concerns (38.7%).

The researchers also found that more adolescents between the ages of 15 and 17 who had spent time alone with a healthcare provider reported “significantly higher prevalence” of receiving a sexual risk assessment (71.1%) than those who did not spend time alone (36.6%). Females who spent time alone with a healthcare provider “were significantly more likely” to have been tested for chlamydia in the past 12 months (34.0%), than those who did not spend time alone (14.9%).

The results suggest that these confidentiality concerns “were associated with less reported use of some STD services, especially for younger persons and females.” This is not new; spending time alone with a healthcare provider has been associated in the past with “higher reported delivery of sexual health services, an association that has also been suggested by the American Academy of Pediatrics and Society for Adolescent Health and Medicine. However, the finding that younger females may not be seeking sexual and reproductive healthcare, such as being tested for chlamydia, due to confidentiality concerns is particularly troubling. According to the CDC, “This finding is concerning because chlamydia is often asymptomatic, and chlamydia testing is a recommended preventive service for adolescent and young adult females.”

For males, there was not a significant difference in prevalence of those who would not receive sexual and reproductive healthcare due to parents finding out (13%) compared with those who would (16.7%). Furthermore, “the prevalence also did not differ significantly among males aged 15-17 years who had time alone with a provider in the past 12 months (13.6%) and those who did not (9.5%).” They did note that the males who were on public health insurance had a “significantly higher” prevalence of receiving STD testing than those who either did not have insurance at all (24.7%) or those with private insurance (16.2%-19.4%). The researchers posit that these males “might be seeking services from safety net providers (i.e. those who provide healthcare to uninsured or underinsured populations) who have reduced or no fees.”

Two limitations to the study are noted. Because the information pertaining to receipt of STD services were self-reported, the information “might be subject to social desirability and recall biases.” Furthermore, due to the fact that the survey was cross-sectional and questions pertaining to confidentiality “were not directly linked” to questions regarding STD services, “a causal relationship between confidentiality concerns and receipt of STD services cannot be inferred.”

Confidentiality concerns may limit the use of much-needed STD services. With the numbers of those those infected rising, prevention efforts are important. CDC researchers suggest that healthcare practitioners consider different ways to cut back on these concerns and increase the use of STD services; one such solution may lie in adolescent patients having time alone with their healthcare provider during a visit, free of a parent’s watchful eye.