Comprehensive Assessment of Health Needs of Young Minority Males Attending a Family Planning Clinic

Abstract

The objective of this study was to assess the overall health, including sexual and reproductive health (SRH) knowledge and needs, sexual behaviors, and testicular health practices among young minority males. Anonymous questionnaires were administered to 18- to 25-year-old males receiving services at health clinics in a large southwestern U.S. city. The survey was completed by 258 males with a mean age of 20.8 years. Most young males (67.1%) identified as African American, and 32.9% as Hispanic. Results suggest study participants lack SRH knowledge related to pregnancy and condom effectiveness, and engage in risky sexual behavior including not using birth control at their last sexual encounter. Although 21.6% of participants had a sexually transmitted infection (STI) in the past year, approximately 80% perceived their STI/HIV risk as very low or low. Respondents had low engagement and lack of knowledge of testicular health practices. The majority of respondents (71.1%) reported having been in a physical fight one or more times and 18.1% reported being victims of intimate partner violence. These data support a need for comprehensive health services for minority young males.

Introduction

Disparities in health care access and outcomes continue to affect individuals in the United States. Despite substantial progress since the 1980s, there continue to be prominent differences in health status based on gender (Frieden, 2011). Great strides have been made in addressing health outcomes for women. However, men remain at increased risk for numerous negative health-related outcomes, including motor vehicle accidents, suicide, coronary heart disease, preventable hospitalization, hypertension and its sequelae, and sexually transmitted infections (STIs; Frieden, 2011).

Racial minorities, specifically Hispanics and African Americans, are affected by health disparities including lack of health insurance and access to care when compared with Whites (Frieden, 2011; Russell, 2010). For example, racial minorities experience higher rates of cancer, heart disease, and stroke than Whites (Russell, 2010). Hispanic and African Americans, compared with Whites, also have higher rates of adverse sexual and reproductive health (SRH) outcomes—outcomes related to the state of an individual’s reproductive system. Disparities in SRH outcomes include a higher percentage of Hispanic and African Americans contracting STIs and human immunodeficiency virus (HIV) than Whites (Conklin, 2012; Frieden, 2011). Adolescent pregnancy rates for Hispanics and African Americans are three and two and a half times those of Whites, respectively (Frieden, 2011). African American youth, both males and females, report first sexual intercourse at earlier ages than other racial groups (; Conklin, 2012). Early sexual intercourse and a relatively large number of sexual partners increase youths’ risk for STIs including HIV (Davies et al., 2014).

While minorities in general are affected by poor health outcomes, young minority males are especially vulnerable (Ashton, Hutchesson, Rol lo, Morgan, & Collins, 2014). Young minority males experience higher rates of homicide, coronary heart disease, obesity, motor vehicle accidents, and asthma in comparison with White and female counterparts (Centers for Disease Control and Prevention [CDC], 2011b). Minority men also suffer from adverse SRH outcomes (Kalmuss & Tatum, 2007). They are also more likely than other subgroups to engage in risky sexual behavior such as early initiation of sex and sex with multiple partners, increasing their risk of genitourinary disease (Kalmuss, Armstrong, Franks, Hecker, & Gonzalez, 2008; Ohalete, 2007; Ott, 2010). From 2010 to 2011, young males 20 to 24 years old experienced higher rates of chlamydia and gonorrhea infections than their female counterparts (CDC, 2011a). Urologic issues in young males that are not properly treated can increased SRH needs over time (CDC, 2014a, 2014b). STIs can progress to permanent urologic conditions affecting fertility and general health. Testicular cancer diagnosis is often delayed in uninsured, underserved men. Evaluating men for infertility or subfertility may help preemptively identify pathologies that these men may be at risk for later in life (Eisenberg, Li, Brooks, Cullen, & Baker, 2015; Lerro, Robbins, Fedewa, & Ward, 2013).

A great number of adolescents are affected by violence, specifically intimate partner violence (IPV) and mental health issues, and many lack sexual health knowledge (Fonagy et al., 2015; Gressard, Swahn, & Tharp, 2015; Lassi, Salam, Das, Wazny, & Bhutta, 2015). About 3% to 8% of all adolescents suffer from depression, with the first major depressive episode occurring between 15 and 24 years of age (Zuckerbrodt, Cheung, Jensen, Stein, & Laraque, 2007). A national survey of college-aged persons identified that 8.9% of males reported depressive symptoms within the 12 months prior to the survey (American College Health Association, 2015). One study reported that 32% of young adults reported victimization and 24% perpetration of IPV (Halpern, Spriggs, Martin, & Kupper, 2009). Furthermore, 59.1% of males experienced IPV in some relationships and 8.4% experienced IPV in all relationships (Johnson, Manning, Giordano, & Longmore, 2015). These factors play a role in influencing behavior and overall health outcomes (Fonagy et al., 2015). However, the associations are not well studied or understood.

Young men who have sex with men (MSM) are a subpopulation with increased risk for sexual health adversities. Although they are approximately 4% of the population, in 2010, they accounted for 78% of new HIV infections among males (CDC, 2012a). Minority MSM are especially at risk for HIV infection (CDC, 2012b). Factors including stigmatization, sexual violence, mental illness, social marginalization, and gender role strain contribute to increased HIV rates among MSM (Fields et al., 2015; Finneran & Stephenson, 2013; Lloyd & Operario, 2012).

Public health studies are not generally focused on men’s health (Chege, 2005; Kalmuss et al., 2008; Kalmuss & Tatum, 2007; Saewyc, 2012). Studies focusing on increasing youths’ knowledge and health care access have cited the need for more research to better determine evidence-based solutions, barriers, and facilitators for improving access to and quality of youth-friendly reproductive health services (Morris & Rushwan, 2015; Oman, Merritt, Fluhr, & Williams, 2015; Romero, Middleton, Mueller, Avellino, & Hallum-Montes, 2015). Clinician, government, and parental concerns regarding SRH needs are typically biased toward women, despite the association between male health and the health of their partner(s), families, and community members.

Due to the unbalanced focus and lack of knowledge of men’s health care needs, there is a need to close the knowledge gap in order to guide politicians and medical professions in implementing evidence-based practices to alleviate young males’ SRH issues (Morris & Rushwan, 2015). The present study was undertaken to examine the comprehensive health needs of underserved minority young males seeking health care services in a large metropolitan area, a population not well studied. Closing the knowledge gaps surrounding young males’ overall health can help clinics focus on health care services young minority males need.

Method

Sample

The study was conducted in free-to-low cost comprehensive family planning and reproductive health clinics in a large metropolitan inner city in the Southwestern United States. The system included 10 clinic locations serving approximately 1,500 young males per year. Study surveys were disseminated among male clinic patients 18 years and older who accessed care from July 2012 to August 2014. Surveys were only written in English and only patients who were proficient in English were asked to participate. The study’s convenience sample consisted of 258 males 18 to 25 years old who sought services in family planning clinics or participated in community events organized by the clinics. Community samples are highly useful in exploring understudied topics with niche populations, such as SRH and overall health needs among young minority males. Based on clinic data, approximately 22% of male clinic patients did not have health insurance. Paper copies of the survey were also handed out to participants during the clinics’ semiannual basketball health fair tournaments. Tournament participants completed the survey upon entering the facility, limiting their ability to share information with other tournament participants. Approximately 10% of those approached to participate in the study declined participation, citing lack of time as the reason for declining to participate.

Conceptual Framework

The social ecological theory (Bronfenbrenner, 1979) is a useful framework to guide the study of the multiple correlates that affect health behaviors. This model considers the complex interplay between individual, interpersonal, community, and societal factors that can compromise or enhance individuals’ health. Individual factors can include age, education, income, gender, substance use, or history of abuse. Interpersonal factors include the social networks, partners, and family members that influence individuals’ behavior and contribute to their range of experiences. Community factors include settings such as schools, workplaces, and neighborhoods in which social relationships occur and can affect health. Societal factors include the health, economic, educational, and social policies that help maintain economic or social inequalities between groups in society and affect health. Due to the complexity of factors that affect health, the present study used a socioecological framework to examine individual, interpersonal, and community correlates associated with health among a group of 18- to 25-year-old males receiving health services at family planning clinics. Considering the poor health outcomes of minority young males and lack of knowledge about their health care needs, it is important to identify the various correlates contributing to their health.

Survey Instrument

The survey utilized several measures from adolescent risk behavior surveys, such as the National Youth Risk Behavior Survey (CDC, 2011b). Several questions in the study survey were previously used by the authors (Buzi, Smith, & Weinman, 2009; Small, Weinman, Buzi, & Smith, 2009). The multiple health facets examined in the survey permit a greater understanding of factors influencing SRH. Following the socioecological model, the survey included the following domains: demographic information, individual correlates, interpersonal correlates, and community correlates.

Demographic Information

The survey queried for general demographic information, such as age, race/ethnicity, and educational attainment.

Individual Correlates

Health knowledge

Eight true/false questions made up the sexual health knowledge section. The questions asked about the effectiveness of condoms, modes of HIV transmission, pregnancy risk, and HIV symptoms. Knowledge is a prerequisite to sexually risky behaviors, with the assumption being that accurate knowledge is essential in motivating individuals to engage in protective health behaviors.

Sexual risk behaviors

This section included 12 questions about engaging in oral, anal, and vaginal sex during the 3 months prior to taking the survey, age at first sexual intercourse, condom use during the last sexual encounter, type of contraceptive used, intent to use birth control or condoms during the next sexual encounter, history of STIs, and familiarity with and intent to consider a vasectomy as a birth control method.

Perception of personal HIV/AIDS and STI risk

Two items asked whether participants perceive themselves to be at risk for HIV/AIDS and STIs. Responses included five categories: very high, high, low, very low, no chance, and were selected to capture the extent the participants may distort their HIV/AIDS and STI risk assessments, which influence their engagement in sexually risky behaviors.

Sexual partnering

Three questions about gender of partner preference, and number of lifetime and recent sex partners were asked.

Mental health

Four questions about feeling low in energy or blue during the 2 weeks prior to survey completion, body image, and self-esteem were asked.

Urologic health

This section included nine questions related to knowledge about testicular health, performing self-testicular exams, and seeing a urologist.

Interpersonal Correlates

Partner communication

One question asked whether participants discussed the use of birth control with partners prior to having sex.

Peer norms

Two questions queried participants about whether their friends encourage or discourage them to use condoms and other birth control methods.

Violence

One question asked participants about their history of IPV, specifically hitting or being hit by their partner.

Community Correlates

Exposure to community violence

This was assessed by five items asking about participants’ history of trauma or injury, having been involved in a physical fight, carrying a weapon for protection, being shot or stabbed, and being affected by IPV.

Access to health care

Two questions asked participants if they needed to see a doctor or go the hospital in the year prior to completing the survey and about barriers to accessing health care. One question asked where participants received testicular health information, and two questions asked whether participants have easy access to birth control and where they get birth control from.

Statistical Analysis

All analyses were conducted using SPSS, version 20.0 (IBM Corporation, Somers, NY). Frequencies were calculated to compile descriptive statistics and cross-analyses of the five survey domains. Bivariate analyses were used to identify significant characteristics within SRH knowledge and sexual risk behaviors. Chi-square analyses were performed to make comparisons within partner sex preferences and races for categorical variables. Student’s t tests were performed to analyze continuous variables. Significance was set at alpha = 0.05.

Results

Demographic Information

A total of 258 males with mean ± SD age of 20.8 ± 2.0 (range 18-25) years completed the survey (Table 1). Most respondents (67.1%) identified as African American, while 32.9% identified as Hispanic. Half (50.8%) of the participants reported having a high school diploma, while about 10% reported having either a bachelor’s degree or higher.

Table 1.

Demographics (N = 258).

Characteristics	N (%)
Race
Hispanic	85 (32.9)
African American	173 (67.1)
Age
Mean ± SD	20.8 ± 2.0
Education level
8th Grade or less	3 (1.2)
9th Grade	3 (1.2)
10th Grade	14 (5.4)
11th Grade	16 (6.2)
12th Grade	50 (19.4)
High school diploma	131 (50.8)
GED	14 (5.4)
Bachelors/associates	23 (8.9)
Graduate school	4 (1.5)

Individual Correlates

Health Knowledge

The findings suggest substantial gaps in SRH knowledge among participants, with 5% to 50% answering SRH-related questions incorrectly (Table 2). The most notable gaps in knowledge were related to questions about the chances of partner pregnancy after ejaculation and during menstruation, and the effectiveness of condoms past their expiration date. Almost 24% of young men incorrectly believed that all sperm die inside a woman after 6 hours, 15.1% believed a woman cannot get pregnant if a man does not ejaculate inside her, 27% thought women cannot get pregnant while on their period, and 49.8% believed a woman is most likely to get pregnant during her period. Gaps in knowledge were less often observed with questions related to STIs and modes of HIV transmission and prevention.

Table 2.

Individual Correlates (N = 258).

Question
Health Knowledge				Correct N (%)
Sexually transmitted infections (STIs) could be prevented through the use of condoms				213 (82.6)
It is possible that persons are HIV positive without showing any symptoms				241 (94.1)
When a woman has sexual intercourse, almost all sperm die inside her body after about 6 hours				195 (76.5)
Even if the man pulls out before he ejaculates (even if ejaculation occurs outside of the woman’s body), it is still possible for the woman to become pregnant				220 (84.9)
Women cannot get pregnant while on their period				185 (73.1)
In general, a woman is most likely to get pregnant if she has sex during her period, as compared with other times of the month				125 (50.2)
HIV is passed via blood, semen, and vaginal fluids				224 (95.3)
Condoms can be stored for more than 3 years without decreasing their protective ability				169 (66.5)
Sexual Risk Behaviors				Yes N (%)
Have you engaged in sexual intercourse (penis–vagina penetration in the past 3 months?				216 (83.7)
Have you engaged in oral sex in the past 3 months?				183 (70.7)
Have you engaged in anal intercourse in the past 3 months?				53 (20.6)
Did you or your partner use any method of birth control the most recent time you had sexual intercourse?				97 (37.7)
In the past year, were you told that you had an STI?				57 (22.4)
In the past year, were you told that you had an HIV infection or AIDS?				10 (3.9)
Perception of Personal HIV/AIDS and STI Risk
What do you think your chances are of getting HIV/AIDS?
Very high				59 (22.3)
High				63 (23.9)
Low				85 (32.2)
Very low				30 (11.4)
No chance				17 (6.4)
What do you think your chances are of getting an STI such as gonorrhea or genital herpes?
Very high				35 (13.3)
High				53 (20.1)
Low				106 (40.2)
Very low				36 (13.6)
No chance				24 (9.1)
Sexual Partnering
If you’ve ever engaged in vaginal, anal, or oral sex, what is your partner preference?
Male				41 (15.9)
Female				196 (76.0)
Both				7 (2.7)
Mental Health
	Generally, you have a good opinion of yourself	You think that you have a body that is pleasant to look at	In the past 2 weeks, how often have you been feeling low in energy, slowed down?	In the past 2 weeks, how often have you been feeling blue or down?
None or little of the time	12 (4.8)	16 (6.4)	113 (45.6)	131 (53.5)
Some of the time	27 (10.8)	62 (24.9)	106 (42.7)	86 (35.1)
Most of the time	89 (35.5)	86 (34.5)	16 (6.5)	16 (6.5)
All of the time	123 (49.0)	85 (34.1)	13 (5.2)	12 (4.9)
Urology Health				Yes N (%)
Have you heard that men can get testicular cancer?				170 (67.7)
If so, how did you hear about testicular cancer? (Mark all that apply)
Personal reading				88 (51.8)
Professional experience				40 (23.5)
Friend/relative with testicular cancer				31 (18.2)
Have you ever been shown how to perform a testicular self-examination?				83 (33.5)
Do you currently have regular/annual physical exams with a doctor including examination of your private parts?				72 (28.7)
Have you heard of vasectomy as a form of permanent birth control?				92 (36.4)
Would you consider having a vasectomy performed after you are done having children?				56 (22.0)
Do you currently examine your testicles regularly? If so, how often?
Do not perform testicular self-examination				97 (39.0)
One time per week				60 (24.1)
Occasionally, but not at regular intervals				54 (21.7)

Sexual Risk Behaviors

In the 3 months prior to taking the survey, most men reported engaging in sexual activity—83.7% reported having vaginal intercourse, 70.7% oral sex, and 20.6% anal intercourse (Table 2). Approximately 20% of men indicated having first intercourse at 13 years old or younger, whereas the majority (51.4%) had first intercourse between 14 and 16 years old; age at first intercourse did not differ between Hispanics and African Americans. African American males were less likely to have had anal intercourse than Hispanic males (15.0% vs. 30.6%, respectively, p = 0.00, relative risk [RR] = 0.40, confidence interval [CI 0.21, 0.75]; Table 3). The mean ± SD number of lifetime sexual partners within the sample was 10.0 ± 10.6. African American males reported a higher mean number of lifetime sexual partners than Hispanic males (11.4 vs. 7.2, respectively, p = 0.01).

Table 3.

Health Correlates by Race.

Questions	African American (n = 173), n (%)	Hispanic (n = 85), n (%)	p	Relative risk	Confidence interval
Have you engaged in anal intercourse in the past 3 months? Yes	25 (15.0)	26 (30.6)	.004	0.4	[0.213, 0.748]
Where do you get your birth control from?
Clinic	123 (71.1)	49 (57.6)	.23	0.322	[0.322, 0.951]
Has your partner ever hit, slapped, or physically hurt you on purpose? Yes	131 (78.9)	75 (89.3)	.041	2.226	[1.015, 4.884]
Have you ever been in a physical fight one or more time? Yes	136 (78.7)	49 (57.3)	.001	2.745	[1.544, 4.879]
You think that you have a body that is pleasant to look at? Yes	125 (77.2)	45 (54.2)	.000	2.853	[1.619, 5.027]
Over the past 2 weeks, how often have you been feeling blue or down? Most of the time or All of the time.	11 (6.9)	16 (19.8)	.003	0.300	[0.132, 0.682]
Have you ever had the need to see a urologist, the medical surgical specialty that focuses on the urinary tract and reproductive systems of males? Yes	19 (11.7)	2 (2.5)	.016	5.182	[1.176, 22.830]

Most men (58.8%) indicated they had not used birth control during their most recent sexual encounter (Table 2). When men or their partners used birth control, 61.4% used male condoms, 4.2% female condoms, 1.5% a hormonal implant (Implanon®), 6.8% medroxyprogesterone acetate (Depo-Provera®), and 3.4% oral contraceptives. While many men did not use birth control at their last sexual encounters, 63.5% indicated intent to use it during next sexual intercourse.

Perception of Personal HIV/AIDS and STI Risk

A substantial number (22.4%) of men reported having an STI during the previous year, and 3.9% reported having HIV/AIDS (Table 2). There were no ethnic differences related to a history of STI. When asked how they perceived their risk for contracting HIV/AIDS or STIs, 122 (46.2%) men responded either “very high” or “high” with regard to HIV/AIDS and 88 (33.3%) saw their chances of getting an STI as “very high” or “high”; the majority of men believed their risk of getting an STI/HIV was “low” or “very low.”

Sexual Partnering

The majority of the participants reported having a preference for female partners (76.0%) and others had preference for men, both men and women, or did not engage in sexual activities with either men or women (15.9%, 2.7%, vs. 5.4%, respectively; Table 2). Fewer participants with a preference for only men reported having used a method of birth control at last sexual intercourse than participants with a preference for only women (23.1% vs. 42.3%, respectively, p = 0.00; Table 4). Furthermore, fewer participants with a sexual preference for only men intended to use a form of birth control the next time they had sex than participants with a preference for only women (51.3% vs. 67.4%, respectively, p = 0.03). Birth control was defined as using any of the birth control methods listed in a previous question about specific birth control use.

Table 4.

Differences in Responses Between Sexual Preference.

Question	Gender preference				p
	Male (N = 39), N (%)	Female (N = 193), N (%)	Both (N = 7), N (%)	Do not engage in vaginal, anal, or oral sex (N = 14), N (%)
Did you or your partner use any method of birth control the most recent time you had sexual intercourse?	9 (23.1)	83 (42.3)	3 (42.9)	2 (14.3)	.000
Do you or your partner plan on using a form of birth control the next time you have sex?	20 (51.3)	130 (67.4)	5 (71.4)	7 (50.0)	.026

Mental Health

A substantial percentage of respondents (15.5%) indicated they have a good opinion of themselves “none or little of the time,” or “some of the time,” and 31.3% found their body pleasant to look at “none or little of the time,” or “some of the time” (Table 2). African American participants were more likely than Hispanics to think they had pleasant bodies to look at (77.2% vs. 54.2%, respectively, p = 0.00, RR = 2.85, CI [1.62, 5.03]; Table 3). When asked about psychological symptoms, few participants endorsed signs of depression, with 11.7% reporting feeling low in energy or slowing down “most of the time” or “all of the time.” Similarly, 11.4% responded feeling blue or down “most of the time” or “all of the time.” African American men were less likely to report feeling blue or down when compared with Hispanic men (6.9% vs. 19.8%, respectively, p = 0.00, RR = 0.30, CI [0.13, 0.68]).

Urologic Health

Only 36.4% of men had knowledge of a vasectomy as a permanent form of birth control, and only 22.0% would consider having one (Table 2). Forty percent of those saying they would not consider having a vasectomy cited not wanting a permanent form of birth control as the reason. Among those with testicular cancer knowledge, 51.8% received information through personal reading and 23.5% from professional experience. Only 67.7% of young men reported knowing that men can get testicular cancer. Additionally, 39.0% reported not performing testicular self-examination (TSE), with an additional 21.7% performing examinations occasionally, but not at regular intervals.

Interpersonal Correlates

Partner Communication

Only 57% of men discussed birth control with their partners prior to having sex (Table 5).

Table 5.

Interpersonal Correlates (N = 258).

Question	Yes N (%)
Partner Communication
Did you discuss use of birth control with your partner prior to having sex?	143 (57.0)
Peer Norms
Do your friends ENCOURAGE you to use condoms or other forms of birth control?	212 (83.5)
Do your friends DISCOURAGE you from using condoms or other forms of birth control?	23 (9.1)
Violence
Has your partner ever hit you, slapped, or physically hurt you on purpose?	46 (18.1)

Peer Norms

The majority of peers (83.5%) encourage participants to use condoms or other forms of birth control, while only a minority of peers (9.1%) discourage participants from using condoms or other forms of birth control.

Violence

Eighteen percent of participants reported having been physically hurt by their partner at some point during their relationship.

Community Correlates

Exposure to Community Violence

The majority of men (71.2%) reported having been in a fight (Table 6). African Americans were more likely than Hispanics to have been in a fight (78.7% vs. 57.3%, respectively, p = 0.00, RR = 2.75, CI [1.54, 4.88]) and physically hurt by their partner (78.9% vs. 89.3%, respectively, p = 0.04, RR = 2.23, CI [1.02, 4.88]; Table 3). A significant proportion of men (31.1%) reported having carried a weapon, and 13.0% indicated having been shot or stabbed.

Table 6.

Community Correlates (N = 258).

Question	Yes N (%)
Exposure to Community Violence
Have you ever been in an accident or suffered some form of trauma or injury?	53 (21.0)
Have you ever been in a physical fight one or more times?	178 (71.2)
Have you ever carried a weapon at least one day?	78 (31.1)
Have you ever been shot or stabbed?	33 (13.0)
Access to Health Care
In the past year, did you ever need to go to the doctor or hospital but had difficulty? If so, why so difficult? (Mark all that apply)	40 (15.9)
Payment	28 (10.6)
Identification issues	9 (3.4)
Transportation	11 (4.2)
Hours of the clinic/hospital	7 (2.7)
I have not had to go to the doctor/hospital in the past year	111 (42.0)
Other	1 (0.4)
Do you have access to condoms or other forms of birth control?	223 (87.5)

Access to Health Care

When grouped by age, 92.7% of 18- to 20-year-olds had access to birth control, significantly higher than the 81.3% of 21- to-25-year-olds who had access to birth control (p = 0.01). Most men (87.5%) had access to some form of birth control, with 33.0% getting it from a clinic and 43.6% from a pharmacy (Table 6). African Americans were more likely to report using a clinic to get their birth control when compared with Hispanics (71.1% vs. 57.6%, respectively, p = 0.23, RR = 0.32, CI [0.32, 0.95]). When asked about health care access, only 15.9% of young men reported having difficulty accessing health care, with the most common factor preventing access having been payment for health services (70.0%), followed by lack of transportation (27.5%).

Discussion

The purpose of this study was to examine the overall health needs among a group of underserved minority males attending family planning health services. The results suggest that young males have significant gaps in SRH-related knowledge, specifically pertaining to the likelihood of pregnancy in female partners and condom effectiveness. Results also suggest that young males do not discuss contraception with their sexual partners prior to sexual activity. This finding is supported by prior studies (Marcell & Ellen, 2012) and may be related to male perceptions that women are responsible for providing contraception, and to the influence of masculinity in male sexual behavior (Chege, 2005; Ott, 2010; Smith, Fenwick, Skinner, Merriman, & Hallett, 2011).

The high percentage of males in this study who reported a preference toward male sexual partners is surprising in light of a national rate of 4% (Purcell et al., 2012), but is consistent with previous observations in the study’s clinical settings (Buzi, Smith, & Haas, 2016). These findings may suggest that the clinics in this study were effective in reaching out to males, specifically minority young MSM, by providing free to low-cost services and promoting safe and supportive family planning and reproductive health facilities for young men. MSM appear to be especially vulnerable to adverse health outcomes—fewer reported having used any method of birth control at last sexual intercourse or intent to use birth control in the future—as compared with men with a female sexual partner preference. The clinic setting, which was perceived as serving the general population, may also be attractive to men who have not yet publically identified as gay.

There is a dearth of information and studies around the overall health of affluent minority men and low-income nonminority men, making it difficult to accurately compare this sample of participants with other populations (Master et al., 2013; Molina, Alegria, & Chen, 2012). One health assessment, The National College Health Assessment (NCHA), focused on college students and stratified data by gender (American College Health Association, 2015). Although NCHA is a college sample of males, the age ranges of the two samples are similar. NCHA participants had overall higher education levels and the majority were White non-Hispanics. A comparison between the male participants in the NCHA and the present study suggests that fewer NCHA participants engaged in sexual intercourse (68.1% vs. 83.7%, respectively) and more reported using a form of birth control at last sexual encounter, as compared with the males in the current study (51.1% vs. 37.7%, respectively).

Additionally, the proportion of young men in the NCHA survey who reported physical altercations (8.2%) and physical harm by their partner (1.8%) is lower than that observed in the present study (71.2% and 18.1%, respectively). However, more participants in the NCHA survey reported feeling very sad any time within the past 12 months as compared with males in the present study (54.2% vs. 46.5%, respectively). The difference between physical and mental health reporting is consistent with prior studies, suggesting that young minority men may manifest depression differently than the general population. Rather than reporting symptoms such as feeling low energy and blue, young minority men may show signs of depression by engaging in physical altercations (Buzi, Weinman, & Smith, 2010; CDC, 2004; “Link Between Relationship,” 2013). This comparison suggests young males in the present study are affected by multiple challenges that can compromise their health.

This study’s findings also demonstrated a lack of TSE education in young males. While the U.S. Preventive Services Task Force has recommended against TSE, young minority men may represent a population in which TSE and genitourinary health education may be beneficial. Considering that males often do not seek health care early in the course of disease, and with only 22% of the male clinic population insured, it is reasonable to educate and screen for testicular malignancy in this population of young men (Farrow, 2009; Kalmuss & Tatum, 2007; Moul, 2007).

Expanding comprehensive health services could contribute to lowering STI and HIV rates in low-income areas by providing male youth-friendly family planning and reproductive health services such as SRH education and urologic screenings. Improving access to family planning clinics is essential to increasing the overall health in young minority males, as utilization of these services decreases health outcome gaps (Guttmacher Institute, 2015; Laski & Wong, 2010).

This study has several limitations. The survey assessed SRH needs of young men in a single large metropolitan area, which limited the generalizability of the findings to a broader population. Additionally, although several of the questions used had been extracted from validated questionnaires, the study’s questionnaire as a whole has not been validated. Despite these limitations, this study improves the understanding of SRH in young men by highlighting gaps in SRH knowledge and access to care, and by providing insight into the comprehensive needs of minority young males.

Conclusion

The results of the present study indicate that young minority males engage in high-risk sexual behaviors, lack SRH knowledge and risk perception, and are not involved in their personal health. These findings are consistent with other studies suggesting the presence of risk behaviors among minority young males (Brindis, 2002). This study also highlights the needs of MSM to engage in safe sex practices such as condom use and accessing SRH services. In order to address the needs of young males, providers should establish guidelines to ensure consistent and thorough health monitoring in this population of men (Marcell & Ellen, 2012). Marcell and Ellen (2012) recommend increasing health awareness, involving more youth-focused services, providing SRH education, institutionalizing programs, and providing guidance and referrals. From the results of this study, it appears that young minority males are also affected by violence that may further compromise other aspects of their health. The study’s high rates of physical IPV suggest that more attention should be focused on screening for physical and emotional health within young male relationships. Engagement in IPV, whether as a victim or perpetrator, can lead to risky sexual behaviors such as inconsistent condom use, STIs, early sexual debut, and multiple sexual partners (Seth, DiClemente, & Lovvorn, 2013). The results from this present study and past studies suggest regular evaluation of physical health in young minority men could also serve to identify mental health conditions. Overall, these data support a need for comprehensive services and education among minority young males that address mental health, body image, and relationships to promote positive sexual behaviors and reduce adverse social, economic, and health consequences. However, additional investigation is required to further understand the optimal approach to young males’ overall health.