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. Author manuscript; available in PMC: 2018 Nov 1.
Published in final edited form as: J Adolesc Health. 2017 Aug 19;61(5):555–561. doi: 10.1016/j.jadohealth.2017.05.032

Sexual orientation differences in adolescent health care access and health-promoting physician advice

Jeremy W Luk a, Stephen E Gilman a,b,c, Denise L Haynie a, Bruce G Simons-Morton a
PMCID: PMC5657259  NIHMSID: NIHMS884887  PMID: 28830797

Abstract

Purpose

Physician screening and advice on health-related behaviors are an integral part of adolescent health care. Sexual minority adolescents encounter more barriers to health services, yet no prior research has examined whether they also experience disparity in physician screening and advice. We examined possible sexual orientation disparities in health care access, physician screening and advice on six health-related behaviors.

Methods

Data were from a national sample of U.S. adolescents who participated in Wave 2 of the NEXT Generation Health Study (n = 2023). Poisson regressions were conducted separately for males and females to estimate sexual orientation differences in health care access and health-related screening and advice.

Results

Compared to heterosexual males, sexual minority males were more likely to report unmet medical needs in the past year (ARR = 2.23), but did not differ with respect to receiving physician advice concerning health-related behaviors. Compared to heterosexual females, sexual minority females were more likely to report no routine physical check-up in the past year (ARR = 1.67), but were more likely to receive physician advice to reduce or stop drinking, smoking, drug use, increase physical activity, and improve diet (ARRs = 1.56–1.99), even after controlling for corresponding health-related behaviors. Sexual minority females were also more likely to receive advice about risk associated with sexual behavior (ARR = 1.35) and advice to avoid sexually transmitted diseases (ARR = 1.49).

Conclusions

Both sexual minority males and females experienced disparities in aspects of health care access. Improved health-promoting advice would better serve sexual minority males.

Implications and Contribution

Clinical guidelines recommend physician screening and advice as part of routine care. Compared to heterosexual females, sexual minority females received more health-promoting advice and did not report greater unmet medical needs. The reverse pattern was found among males, highlighting the potential benefits of increasing health-promoting advice targeting sexual minority males.

Introduction

Compared to heterosexual adolescents, sexual minority adolescents report higher rates of substance use and disordered eating, lower rates of physical activity, as well as more sexual risk behaviors.1–3 Sexual orientation disparities in multiple core domains of adolescent health are concerning because these disparities may persist across development, leading to higher rates of substance use disorders, obesity, hypertension, and heart disease in adulthood.4,5 Adequate access to health care, with appropriate routine screening and feedback on health-related behaviors, may provide one route to addressing the formation of sexual orientation health disparities. However, equal access to health care continues to be a concern among sexual orientation minorities, and it remains unknown whether sexual minority adolescents receive adequate physician screening and advice on health-related behaviors. Thus, research is needed to examine the full range of possible sexual orientation disparities from health care access to physician screening and advice on health-related behaviors among adolescents.

Barriers to health care access are well documented among sexual minority adults.6 Compared to heterosexual adults, sexual minority adults are more likely to delay seeking health care due to cost and experience more difficulty in finding a provider.4,7 Past research suggests that disparities in health care access are more evident among female sexual minority adults. Among young adults aged 18–26 years, unmet medical needs were higher among sexual minority females than heterosexual females, whereas unmet medical needs did not differ by sexual orientation among males.8 Among young adults aged 24–32 years, sexual minority females were less likely to receive a physical examination than heterosexual females, even though they had higher rates of adverse health conditions.9 Taken together, sexual minority adults, particularly females, experience disparities in various aspects of health care access.

Among adolescents, research on health care preferences suggests that sexual minority youth consider access to health care to be highly important.10 However, relatively few studies have examined disparities in health care access among sexual minority adolescents. The most relevant investigation to date was conducted by Williams and Chapman.11 Utilizing baseline data from the National Longitudinal Study of Adolescent Health, these researchers found that sexual minority adolescents reported higher subjective ratings of unmet medical needs despite scoring higher on indicators of physical and mental health problems. Moreover, sexual minority adolescents were more likely than their peers to have forgone medical care due to worries that their parents would know, or being afraid of what their doctor would say or do. These findings suggest that sexual minority adolescents encounter more barriers to health services, but common indicators of health care access disparities such as having no health insurance coverage or routine physical check-up in the past year were not examined. Moreover, gender differences in these associations were not explored.

Health care access provides an opportunity for appropriate screening and physician advice or referral, which are critical avenues through which adolescents’ developmental and medical needs could be met. Importantly, health care access alone is not sufficient as the range and quality of health care received also matter. Indeed, adolescents regardless of sexual orientation report a greater desire to discuss substance use, healthy dietary habits, exercise, and sexual behaviors with their health care providers than what they actually discuss.12–15 This discrepancy reflects potential missed opportunities for prevention. For example, while health care providers are ideally positioned to deliver sexual risk prevention services,16–18 sexually experienced adolescents are more likely to obtain sexual health information from parents and teachers than from health care providers.19 In addition, sexual minority adolescents may be especially prone to experience or anticipate rejections from physicians,11,15 which may hinder access and self-disclosure of sexual orientation and sexual behaviors to providers and thus limit access to optimal care.

Screening of health-related behaviors in the primary care setting is a highly promising strategy to identify at-risk adolescents, tailor personalized health information, and engage adolescents in behavior change.20,21 According to the American Academy of Pediatrics’s (AAP) policy statement on substance use, pediatricians are recommended to screen all adolescents for substance use behaviors and provide brief advice and appropriate referrals based on the indicated risk level as part of routine care.22 Similarly, screening and prevention of obesity through promoting healthy eating patterns and encouraging increased physical activity are recommended by both the Society for Adolescent Health and Medicine (SAHM) and the AAP.23,24 According to the position paper published by SAHM, comprehensive sexual and reproductive health information and services should be provided to all adolescents in a culturally sensitive and developmentally appropriate manner.18 In addition, adolescent health care providers are particularly encouraged to attend to the specific needs of sexual minority adolescents, screen for possible mental health issues, and provide tailored health information and/or intervention as appropriate.25

Although physician screening and advice are increasingly recognized as a recommended prevention approach, no prior study has examined whether physician screening and advice on health-related behaviors differ according to sexual orientation and gender. Utilizing a nationally representative sample, we examined (1) whether sexual minority adolescents were more likely to report no current health insurance coverage, no past-year routine physical check-up, and endorse past-year unmet medical needs; and (2) possible sexual orientation differences in physician screening and two types of advice (advice on associated risks and health-promoting advice) about drinking, smoking, drug use, physical activity, diet, and sexual behaviors.

Method

Participants

Data were drawn from the NEXT Generation Health Study,26 a nationally representative longitudinal study of U.S. adolescents enrolled in 10th grade between 2009–2010. This study utilized a 3-stage stratified design to recruit a diverse sample of 2785 adolescents enrolled in U.S. high schools from 22 states. Sexual orientation was measured at wave 2 of this study, and so we utilized data from wave 2 participants (n = 2439; 87.6% of the full sample). The current analytic sample consisted of 2023 adolescents (82.9% of wave 2 NEXT sample) who provided valid responses to all study variables. Parents provided written consent and participants provided assent to participate in this study; upon turning 18 years of age, participants provided consent. The study was approved by the Institutional Review Board of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Measures

Sexual Orientation

Past research indicated that adolescents consider sexual attraction as the core element of sexual orientation and think that it is easier to respond to questions regarding sexual attraction than to questions on sexual behavior or identity.27–29 Accordingly, adolescent participants in the current study were asked “Which of the following best describes your sexual orientation?” Response options were: (1) “Attracted to opposite gender”; (2) “Attracted to same gender”; (3) “Attracted to both genders”; and (4) “Questioning”. Because of their relatively low frequencies, the last three categories were combined for analyses.

Disparities in Health Care Access

Health insurance status was categorized as currently having health insurance coverage through parents or all other sources (reference group) versus currently having no health insurance coverage. Routine check-up was categorized as having a routine check-up with their pediatrician, primary care doctor, or family physician in the past year (reference group) versus not having a routine check-up in the past year. Unmet medical needs was categorized as having no past-year unmet medical needs (reference group) versus needing medical care that they did not get in the past 12 months.

Screening for Health-Related Behaviors

Participants provided a dichotomous response to indicate whether a doctor or nurse asked them about the following health-related behaviors at their last physical examination: (1) drink alcohol, (2) smoke, (3) use drugs, (4) exercise, (5) nutrition, and (6) sexually active.

Physician Advice about Associated Risks

Participants provided a dichotomous response to indicate whether they were given advice by a doctor or nurse about the risks associated with the following health-related behaviors at their last physical examination: (1) drinking, (2) smoking, (3) using drugs, (4) not exercise, (5) a poor diet, and (6) sexually behaviors.

Physician Advice to Promote Health-Related Behaviors

Participants provided a dichotomous response to indicate whether they were given advice by a doctor or nurse at their last physical examination about: (1) reducing or stopping drinking; (2) reducing or stopping smoking; (3) reducing or stopping drug use; (4) increasing physical activity; (5) improving diet; and (6) avoiding sexually transmitted diseases.

Covariates

Age, race/ethnicity, and family affluence were included as covariates. We utilized the Health Behaviour School-Aged Family Affluence Scale30 to measure adolescent socioeconomic inequalities using items related to family car and computer ownership, frequency of family holidays, and whether the adolescent had his/her own bedroom. For physician screening and advice on the three types of substance use behaviors, we respectively controlled for any alcohol use in the past 30 days, any cigarette smoking in the past 30 days, and any marijuana use in the past year (dichotomous variables with no substance use treated as the reference group). For physician screening and advice on exercise/physical activity, we controlled for weekly vigorous physical activity (defined as any activity that increases the participant’s heart rate and makes the participant get out of breath or sweat some of the time, and was coded as 0 = “2 hours or more” vs. 1 = “less than 2 hours”). For physician screening and advice on nutrition/diet, we controlled for the number of fruit and vegetable consumption per day (0 = “5 or more times per day” vs. 1 = “less than 5 times per day”).

Data Analyses

Analyses were conducted separately for males and females and utilized the survey analysis procedures in STATA 14, which accounted for clustering, weighting, and stratification of NEXT study design at wave 2. First, we obtained weighted percentages of health care access, physician screening, and physician advice variables according to sexual orientation. Next, because most outcomes in this study were common (>10%), odds ratios would overestimate relative risks,31 and so we used Poisson regression models to directly estimate unadjusted and adjusted relative risks.32 Demographic characteristics (age, race/ethnicity, and family affluence) were controlled for in all final adjusted models. To examine whether the associations between sexual orientation and physician screening and advice were independent of health-related behaviors, substance use behaviors, physical activity, and fruit and vegetable consumption were also included as a covariate in the corresponding final adjusted models.

Results

Sample characteristics for the complete NEXT Wave 2 sample and the analytic subsample were largely similar and are presented in Table 1. Participants who were included and excluded from the analytic sample differed by race/ethnicity and family affluence (African American, Hispanic, and low affluence adolescents were more likely to be excluded), but did not vary by age, gender, or sexual orientation. Among males, 96.0% (n = 846) reported opposite gender attraction, 1.8% (n = 16) reported same gender attraction, 1.1% (n = 10) reported both genders attraction, and 1.0% (n = 9) were questioning. Among females, 89.3% (n = 1020) reported opposite gender attraction, 1.4% (n = 16) reported same gender attraction, 7.4% (n = 84) reported both genders attraction, and 1.9% (n = 22) were questioning. In summary, 4.0% of males and 10.7% of females in the analytic sample were categorized as sexual minority adolescents.

Table 1.

Sample characteristics for the complete Wave 2 NEXT sample and the analytic subsample

Wave 2 NEXT sample
(n = 2439)		 Analytic subsample
(n = 2023)
Mean SD / Range Mean SD / Range t p
Age 17.2 0.53 / 15.0–21.0 17.2 0.52 / 15.2–21.0 1.67 0.11
Frequency Weighted percentage Frequency Weighted percentage χ2 p
Gender
  Male 1076 44.9% 881 45.1% 1.17 0.69
  Female 1363 55.1% 1142 54.9%
Race/Ethnicity
  White 986 58.6% 925 62.2% 5.86 0.02
  African Americans 611 17.5% 367 14.2%
  Hispanic 715 19.6% 627 19.2%
  Other 120 4.3% 104 4.4%
Family affluence
  Low 775 23.1% 606 21.6% 5.02 0.02
  Medium 1148 49.8% 974 51.0%
  High 516 27.1% 443 28.5%
Sexual orientation
  Attracted to opposite gender 2196 93.7% 1866 94.0% 1.14 0.30
  Attracted to same gender 45 1.2% 32 1.1%
  Attracted to both genders 119 3.7% 94 3.5%
  Questioning 42 1.4% 31 1.4%
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The t-test and chi-square tests presented on the last column represent bivariate comparisons of demographic characteristics between Wave 2 participants who were included and excluded from the analytic subsample.

Weighted percentages according to sexual orientation, along with the unadjusted and adjusted relative risks are presented in Table 2 for males and in Table 3 for females. For both males and females, no sexual orientation disparities were found in health insurance coverage and physician screening for all health-related behaviors. Several sexual orientation differences in other aspects of health care access and physician advice were found.

Table 2.

Male adolescents’ reports of health care access, physician screening, and advice by sexual orientation (n = 881)

Weighted percentages Unadjusted Adjusted
Heterosexual Sexual Minority RR 95% CI RR 95% CI
Health care access:
  1. No current health insurance 7.5% 6.2% 0.83 (0.21, 3.34) 0.92 (0.22, 3.87)
  2. No routine check-up in past year 24.5% 44.5% 1.82 (0.80, 4.12) 1.60 (0.80, 3.20)
  3. Unmet medical needs in past year 17.5% 47.6% 2.72 (1.53, 4.84) 2.32 (1.21, 4.47)
Physician screening for:
  1. Drinking 56.8% 64.5% 1.13 (0.68, 1.89) 1.07 (0.63, 1.84)
  2. Smoking 60.7% 65.3% 1.08 (0.65, 1.77) 1.04 (0.62, 1.75)
  3. Drug use 56.2% 65.3% 1.16 (0.70, 1.92) 1.16 (0.67–1.99)
  4. Exercise 70.5% 69.4% 0.98 (0.59, 1.65) 0.97 (0.58, 1.62)
  5. Nutrition 67.2% 62.7% 0.93 (0.53, 1.63) 0.91 (0.52, 1.61)
  6. Sexually active 57.4% 66.8% 1.16 (0.68, 1.99) 1.14 (0.68, 1.91)
Physician advised about risks of:
  1. Drinking 43.7% 41.7% 0.95 (0.47, 1.95) 0.90 (0.41, 1.97)
  2. Smoking 44.6% 46.2% 1.04 (0.48, 2.22) 1.01 (0.45, 2.26)
  3. Drug use 43.1% 43.4% 1.01 (0.52, 1.95) 0.93 (0.43, 2.04)
  4. No exercise 48.6% 45.0% 0.93 (0.49, 1.77) 0.85 (0.41, 1.77)
  5. Poor diet 49.3% 66.5% 1.35 (1.00, 1.81) 1.21 (0.90, 1.63)
  6. Sexual behavior 41.4% 46.4% 1.12 (0.60, 2.10) 1.04 (0.50, 2.14)
Physician advised to:
  1. Reduce or stop drinking 19.1% 10.3% 0.54 (0.22, 1.31) 0.69 (0.33, 1.45)
  2. Reduce or stop smoking 19.6% 10.3% 0.53 (0.23, 1.21) 0.64 (0.32, 1.30)
  3. Reduce or stop drug use 17.9% 10.3% 0.57 (0.25, 1.31) 0.72 (0.32, 1.62)
  4. Increase physical activity 29.7% 26.8% 0.90 (0.38, 2.14) 0.87 (0.33, 2.27)
  5. Improve diet 31.7% 25.4% 0.80 (0.32, 1.99) 0.73 (0.28, 1.90)
  6. Avoid sexually transmitted diseases 32.0% 28.8% 0.90 (0.40, 2.03) 0.84 (0.33, 2.14)
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RR = Relative Risk. Age, race/ethnicity, and family affluence were included as covariates in the adjusted models. Substance use, physical activity, and fruit and vegetable consumption were also included as covariates in the corresponding adjusted models for physician screening and advice.

p < 0.05 are in bold.

Table 3.

Female adolescents’ reports of health care access, physician screening, and advice by sexual orientation (n = 1142)

Weighted percentages Unadjusted Adjusted
Heterosexual Sexual Minority RR 95% CI RR 95% CI
Health care access:
  1. No current health insurance 6.0% 13.4% 2.23 (0.91, 5.46) 1.79 (0.67, 4.79)
  2. No routine check-up in past year 17.5% 32.5% 1.86 (1.14, 3.04) 1.67 (1.01, 2.77)
  3. Unmet medical needs in past year 20.3% 24.0% 1.18 (0.71, 1.97) 1.29 (0.76, 2.19)
Physician screening for:
  1. Drinking 67.4% 56.0% 0.83 (0.55, 1.25) 0.85 (0.58, 1.24)
  2. Smoking 71.1% 61.4% 0.86 (0.58, 1.28) 0.87 (0.59, 1.28)
  3. Drug use 69.5% 59.5% 0.86 (0.58, 1.27) 0.88 (0.60, 1.31)
  4. Exercise 70.0% 59.6% 0.85 (0.61, 1.19) 0.90 (0.67, 1.21)
  5. Nutrition 71.6% 59.7% 0.83 (0.59, 1.17) 0.83 (0.60, 1.15)
  6. Sexually active 71.7% 75.0% 1.05 (0.88, 1.24) 1.06 (0.91, 1.24)
Physician advised about risks of:
  1. Drinking 36.4% 41.4% 1.14 (0.78, 1.65) 1.11 (0.77, 1.60)
  2. Smoking 39.4% 42.6% 1.08 (0.77, 1.52) 1.03 (0.75, 1.42)
  3. Drug use 37.1% 41.8% 1.13 (0.80, 1.58) 1.11 (0.79, 1.56)
  4. No exercise 44.4% 52.3% 1.18 (0.89, 1.58) 1.21 (0.93, 1.57)
  5. Poor diet 44.4% 56.2% 1.27 (1.01, 1.59) 1.28 (1.04, 1.57)
  6. Sexual behavior 44.1% 60.0% 1.36 (1.12, 1.66) 1.35 (1.10, 1.66)
  Physician advised to:
  1. Reduce or stop drinking 16.8% 36.3% 2.16 (1.59, 2.94) 1.87 (1.42, 2.47)
  2. Reduce or stop smoking 17.1% 36.3% 2.13 (1.59, 2.85) 1.72 (1.32, 2.23)
  3. Reduce or stop drug use 15.8% 34.5% 2.18 (1.64, 2.90) 1.99 (1.48, 2.64)
  4. Increase physical activity 30.5% 52.3% 1.71 (1.32, 2.23) 1.60 (1.28, 2.00)
  5. Improve diet 34.0% 55.3% 1.63 (1.31, 2.04) 1.56 (1.27, 1.94)
  6. Avoid sexually transmitted diseases 36.9% 58.9% 1.60 (1.21, 2.10) 1.49 (1.13, 1.95)
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RR = Relative Risk. Age, race/ethnicity, and family affluence were included as covariates in the adjusted models. Substance use, physical activity, and fruit and vegetable consumption were also included as covariates in the corresponding adjusted models for physician screening and advice.

p < 0.05 are in bold.

Among males, sexual minority adolescents had 2.72 times the risk of reporting unmet medical needs in the past year relative to heterosexual adolescents (47.6% vs. 17.5%; 95% CI = 1.53, 4.84). This difference remained significant after controlling for demographic covariates (ARR [Adjusted Relative Risk] = 2.32, 95% CI = 1.21, 4.47). Physician advice on risk associated with a poor diet was more frequently given to male sexual minority adolescents (66.5%) compared to male heterosexual adolescents (49.3%; RR [Relative Risk] = 1.35, 95% CI = 1.00–1.81), although this association was attenuated after covariates were controlled for (ARR = 1.21, 95% CI = 0.90, 1.63).

Among females, sexual minority adolescents had 1.86 times the risk of having no routine check-up in the past year relative to heterosexual adolescents (32.5% vs. 17.5%; 95% CI = 1.14, 3.04). This difference remained significant after controlling for demographic covariates (ARR = 1.67, 95% CI = 1.01, 2.77). Moreover, associations between sexual minority status and receipt of health-promoting physician advice were consistently found. Compared to heterosexual females, sexual minority females were more likely to receive physician advice to reduce or stop drinking (RR = 2.16, 95% CI = 1.59–2.94), smoking (RR = 2.13, 95% CI = 1.59–2.85), drug use (RR = 2.18, 95% CI = 1.64–2.90), increase physical activity (RR = 1.71, 95% CI = 1.32–2.23), and improve diet (RR = 1.63, 95% CI = 1.31–2.04). These associations remained significant after controlling for demographics and recent substance use, physical activity, or dietary behavior (ARRs ranging from 1.56 to 1.99). In addition, sexual minority females were also more likely to receive advice about risk associated with poor diet (RR = 1.27, 95% CI = 1.01, 1.59) and sexual behavior (RR = 1.36; 95% CI = 1.12–1.66), as well as advice to avoid sexually transmitted diseases (RR = 1.60, 95% CI = 1.21, 2.10). Similarly, these associations were not attenuated by covariates (ARRs were 1.28, 1.35, and 1.49, respectively).

Discussion

This study extends prior research on barriers to health care and service utilization among sexual minority adolescents11 by examining alternative indicators of health care access disparity, including the lack of health insurance coverage and no routine physical check-up in the past year. In contrast to the parallel adult literature,33 sexual orientation disparity in health insurance coverage was not found in our sample of U.S. adolescents, possibly reflecting that the majority of adolescents were still covered by parents’ insurance. Despite this finding, there is evidence for gender-specific sexual orientation disparities in other aspects of health care access. Consistent with a prior study among young adults,9 sexual minority females were more likely to have no routine check-up in the past year relative to heterosexual females. On the other hand, sexual orientation disparity in unmet medical needs was found among males only, with over 45% of sexual minority males reporting such needs. This pattern contradicts findings from a recent study among young adults,8 potentially reflecting a developmentally-specific need for younger sexual minority males. Research on sexual identity development suggests that sexual minority females tend to accept sexual minority labels earlier than sexual minority males.34 It may be that more adolescent sexual minority males were still exploring their sexual identity during this developmental stage. Consequently, they may be more reluctant to endorse sexual minority status during a clinic visit, leading to more unmet medical needs.

Multiple clinical guidelines recommend screening of health-related behaviors in the domains of substance use, weight-related, and sexual risk behaviors,18,22,24 as well as tailoring clinical care for sexual minority adolescents,25 as part of routine care. Our study was the first to examine possible sexual orientation disparities in physician screening. We found that sexual minority and heterosexual adolescents reported similar screening rates (ranging from around 55% to 75%) across all health-related behaviors examined in the current study. While unable to assess directly in our sample, past research indicated that sexual orientation is one of the least discussed topics in interactions between adolescents and their physicians.35,36 Two-thirds of sexual minority young adults reported that they have never discussed sexual orientation with their health care provider.37 One possible explanation for similar screening rates for health-related behaviors across sexual minority and heterosexual adolescents could reflect this general lack of discussion about sexual orientation for a sizable group of adolescents.

In terms of physician advice, a consistent pattern was found such that female sexual minority adolescents were more likely than female heterosexual adolescents to receive health-promoting physician advice to change six different health-related behaviors, along with a greater likelihood of receiving physician advice about risks associated with poor diet and sexual behaviors. These findings are novel and may reflect something special about the adolescent-physician interaction among female sexual minority adolescents which has largely been unexplored in existing literature. Past studies suggest that sexual minority females are at particularly elevated risks for substance use behaviors, unhealthy diet, and less physical activity.1,38 Interestingly, our analyses controlling for these corresponding health-related problems did not attenuate any of the associations involving sexual minority status, ruling out engagement in risk-taking and unhealthy behaviors as a primary mechanism that explains the observed differences by sexual orientation. Another possible explanation could be related to gender differences in medical communication. Specifically, female adolescents may be more likely seen by female physicians,39,40 and female physicians tend to engage in greater behavioral counseling and preventive services than male physicians.14,17 Within the context of delivering these services, sexual orientation and associated risks may be discussed,36 leading to increased health-promoting physician advice given to sexual minority females. These possible explanations should be empirically tested in future research with direct measures of assessment and disclosure of sexual orientation and evaluation of their impact on the type and quality of physician advice provided.

This study has several limitations. First, sexual orientation was assessed using a single item about sexual attraction. While a focus on sexual attraction as the core element of sexual orientation among adolescents has received some empirical support,28,29 the inclusion of additional measures of sexual behavior and/or identity could have strengthened this study.27 Second, despite a fairly large sample, sexual minority subgroups were small and could not be disaggregated for analyses. In light of growing research suggesting diversity among sexual minority subgroups,1,3 future research is needed to better understand the unique health care needs of lesbian, gay, bisexual, and questioning adolescents. Third, although the current analytic sample is largely similar to the Wave 2 NEXT sample in terms of sample characteristics, attrition and missing data which varied by race/ethnicity and family affluence could have introduced bias to the analytic sample. Fourth, unlike other health-related behaviors, sexual behaviors were not assessed and could not be controlled for in the final adjusted models. Finally, our study did not include other variables such as the physicians’ gender, the quality of adolescent-physician relationship, and physicians’ knowledge about participants’ sexual orientation, all of which could be relevant to understanding the dynamics and effectiveness of provider-patient communication.

Despite these limitations, the current study addresses multiple gaps in the literature and has important clinical and policy implications. Notably, our findings suggest that male sexual minority adolescents may have unrecognized unmet medical needs relative to male heterosexual adolescents, even though sexual minority and heterosexual males did not differ in health insurance coverage and routine physical check-up. These findings point to the need to better understand the nature and extent of unmet medical needs among male sexual minority adolescents, and underscore the importance of targeted prevention and intervention for this group of adolescents. Consistent with recommendations by SAHM,25 it is important to more fully incorporate sensitive assessment of sexual orientation as part of routine care, such that physicians and health care providers may better serve sexual minority males by addressing possible health-related and/or sexual orientation-related questions or needs that they may have.

Physicians and health care providers should be encouraged by our findings regarding health-promoting physician advice received by female sexual minority adolescents, as we show that female sexual minority adolescents are better served in at least one aspect of health care. These findings are particularly important in the context of past research suggesting that sexual orientation-related health disparities may be more pronounced among females.1–3,38 Structural and policy approaches aimed at increasing the rates of annual routine physical check-up could further reduce sexual orientation-related health disparities among female adolescents.

To extend the current study, more work is needed to assess not only the overall rates of physician screening and advice, but also the way advice was given and whether these patterns may vary by geographical regions and the adolescent’s social environment. Optimally, access to culturally sensitive health care services that foster a safe environment for disclosure of sexual orientation would be made available to all sexual minority adolescents. Training for physicians to enhance sensitivity in service delivery and support for sexual minority adolescents to minimize perceived rejection may enhance patient-provider communication15 and facilitate tailored physician screening and advice that best address sexual minority adolescents’ medical, psychosocial, and developmental needs.

Acknowledgments

Funding Source: This project (contract HHSN275201200001I) was supported in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute on Drug Abuse; and the Maternal and Child Health Bureau of the Health Resources and Services Administration.

Abbreviations

AAP

American Academy of Pediatrics

ARR

adjusted relative risk

CI

confidence intervals

RR

relative risk

SAHM

Society for Adolescent Health and Medicine

Footnotes

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Conflict of Interest: The authors have no conflict of interest relevant to this article to disclose.

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