Gaps between Adolescent Risk Behaviors and Disclosure during Outpatient Visits

Objective. The purpose of this study was to determine the gaps between disclosed high-risk behaviors in low-income, mainly Hispanic youth and the identification of these risks by health care providers. Methods. This cross-sectional study included youth 13–19 years old who participated in a study on latent tuberculosis treatment. Youth were interviewed at baseline by bilingual research assistants; the provider visit was assessed by the chart review. Results. Of 221 youth, the majority (96%) were identified as Hispanic, 45% were foreign-born, and 46% were male. A total of 399 risk behaviors were revealed to research staff by the participants; only 24 risk behaviors were revealed to providers. Conclusions. The majority of risk behaviors based on the chart review were neither queried nor disclosed to the physicians. Physicians providing care to adolescents should consider strategies to improve disclosure as a necessary precursor to interventions. 1. Introduction Adolescence is characterized by evolving personality, impulsivity, rebellion, and deviation from established adult norms, often leading adolescents to take higher personal risks without realizing short- or long-term consequences [1–3]. This behavior is age appropriate to some extent, reflecting the neurodevelopmental chronology of the human brain [4]. This risk taking translates into many arenas of preventable adverse health outcomes including motor vehicle accidents, tobacco use, alcohol and drug use, unsafe sexual activity, and interpersonal violence. The developmental changes that define the teenage years occur across all demographic and culture groups in the USA and globally. According to the USA Census Bureau (2005), 33.9% of the Latino population was under 21 years of age, making health care of Latino youth an important and relevant issue [5]. Yet, Latino youth, in particular, face systemic language and cultural barriers to accessing care and information, making it increasingly difficult to make healthy personal decisions. Not only are minority adolescents at higher risk of health and behavioral problems during adolescence, but they also face several barriers in accessing care that are inadequately addressed within the health system, including no insurance, lack of knowledge about the medical system, and limited transportation [6]. An estimated 9 million adolescents are uninsured; those in low-income families, single-parent households, and Latino are at the highest risk for being medically uninsured [7–9]. Compared with their insured counterparts, uninsured adolescents were five times as