Health Provider Checklist for Adolescent and Young Adult Males

Health History and Screening  

Key Points

  • Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting.
  • Compared with females, males in high-income countries such as the United States are more likely to die of all major causes of mortality, including unintentional injuries, suicide, and homicide.
  • Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviors and mental health issues.
  • Male adolescents should be encouraged to talk with their health care provider about general health and, in particular, sex, relationships, and prevention of STIs/HIV and pregnancy.
  • A range of non-clinical issues surround care of adolescent and young adult males.

Overview

Compared with females, young adult males are less likely to have a usual source of health care (63% vs 78%), are less likely to have visited a doctor in the past 12 months (59% vs 81%), and are less likely to have had an emergency department visit in the past 12 months (19% vs 27%.1,2 (as cited in3)

This is related to both individual factors and the health care system itself, which is not always encouraging and set up to provide comprehensive male health care. Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviors and mental health issues. The ability to engage the young male patient is critical, and the professional must be comfortable in initiating conversation about a wide array of topics with the teen boy, who may be reluctant to discuss his concerns. It is important to take every opportunity with adolescent boys to talk about issues beyond the presenting complain, and let them know about confidential care. The physician can educate teens about the importance of regular checkups, and that they are welcome to contact the physician if they are experiencing any concerns about their health or well-being. Parents of preadolescent and adolescent boys should be educated on the value of regular health maintenance visits for their sons begin ning in their early teen years.4

Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting. Male adolescents should be encouraged to talk with their health care provider about general health and, in particular, sex, relationships, and prevention of STIs/HIV and pregnancy. Male adolescents cite their mothers, doctors, and nurses as their principle resources for general health care concern 6 and cite doctors and other health care providers as 1 of their top 4 sources of sexual health information inclusive of parents, health classes, and television.5

Masculinity

Masculinity can be defined as a set of shared social beliefs about how men should present themselves. Traditional beliefs about masculinity includes the beliefs that young men should be self-reliant, physically tough, not show emotion, dominant and sure of themselves, and ready for sex.6,7 Homophobia can be an important part of enacting masculinity.8,9 Among adults, traditional masculine beliefs are associated with poor health outcomes across a variety of areas, from cardiovascular disease to care seeking.10,11 Among adolescents and young adult males, traditional masculine beliefs have not only been associated with poor sexual health outcomes, but also poorer mental health  outcomes and lower levels of engagement with health services.12,13,14,15 Thus traditional beliefs about masculinity have has implications for both engaging young men in health care and for maximizing their health status. (as cited in 16)

Interviews with high school freshmen have demonstrated a tension between the enactment of traditional masculinity beliefs and relationship desires.17  In contrast to conventional wisdom, younger adolescent males desire intimacy, do not strongly ascribe to traditional masculine beliefs, and hold less relationship power than young women. Peers and families can either support or undermine a young man’s healthy sexual development. Health care providers may have more influence than they presume.18

Mortality, Injury, and Violence

The United States has the sixth highest adolescent male mortality rate among high-income countries.19 (as cited in 20) Mortality increases rapidly across adolescence. Although males have seen marked improvements over the past 20 years, their mortality remains unacceptably high.21 Compared with females, males in high-income countries such as the United States are more likely to die of all major causes of mortality, including unintentional injuries, suicide, and homicide.22 Unintentional injury alone, which includes motor vehicle injuries (which constitute 71% of all unintentional injuries), unintentional poisoning, drowning, and unintentional discharge of a firearm, account for 75% of all mortality.23 Among AYA males suicide is the third leading cause of death.  Marked gender differences also exist in violence-related mortality, with adolescent and young adult males over twice as likely to die of violence as females.24 (as cited in 25)

A recent study (September 2, 2013) also found that across all ages, infancy to age 20, and across all causes, boys and young men were 44 percent more likely to die than girls.26

Below is a recommendation from Bell et al on a general approach to adolescent and young adult males, grounded in data and best practices (the full list of recommendations can be found here). These recommendations are fundamentally based on positive youth development models and a “strength-based” approach.

Positive youth development is a growing field promoting the healthy development and positive outcomes of young people versus focusing solely on traditional problem-focused views of youth.27 Clinical care often focuses on risk behaviors, which often define young males.28  A positive youth development approach changes the focus to acknowledge and promote their strengths.29,30 For example, the new interest adolescents have in interpersonal relationships and intimacy can lead to high risk sexual behavior, STIs and pregnancy.  However, it can also lead to enhanced ability to emphasize and to shift one’s focus from the self to how one’s actions affect others. Adolescents tend to take risks, but these can be positive, such as engaging in new extracurricular activities and applying for jobs or to college despite the real risk of failure (Rafferty).

In a psychosocial history, the positive youth development model suggests that clinicians begin with questions that identify strengths and assets.31,32 This contributes to a relationship that nurtures, empathizes, and builds a more positive self for the young man, which influences behavior changes and decreases risk.33 As part of a strength-based approach, clinicians can acknowledge gender role stereotypes and the conflicting role expectations that males are taught.34 This can result in an opportunity for the young man to share any concerns in a confidential setting. (as cited in 35)

From Bell et al: general approach for AYA males:

  • Engage male youth in care. Assess and build upon strengths.
  • Provide time and a safe space for confidential conversations about sensitive topics.
  • Approach sensitive topics in respectful 2-way conversations, rather than in a lecture style. Motivational-interviewing–based approaches are recommended for engaging with all adolescents, despite the focus of its use with specific risk behaviors.
  • Involve parents; they can support healthy adolescent development.36

Special Considerations

A range of non-clinical issues surround care of adolescent and young adult males. These include discussions about patient autonomy, importance of assenting to medical decisions (and in some cases being able to consent without parental permission, such as with sexual health), confidentiality limits, emancipated minors, and evaluating when to meet with adolescents without a parent present (and how to keep parents involved). Other important considerations are the sociocultural barriers and stigma that prevent adolescent males from seeking preventative care.

Confidentiality is very important with adolescent boys, and they may need reassurance, more than once, that the physician’s conversations with them will remain private. Of course, an explanation of the limits of confidentiality should precede the interview. These include when the adolescent reports that he is going to hurt himself or others and in those instances, such as STIs, where reporting to a state agency is mandatory.37  As with young women, health care providers need to be cognizant of minor consent laws in the states in which they practice and educate patients about specific state laws as appropriate.38 (as cited in 39)

Although it would be impossible to discuss the health issues of all special populations of teenage boys, there are several groups that have the potential to experience marginalization and victimization more often than ‘mainstream’ boys. These special groups, depending on circumstance, may experience health and mental health difficulties more often than their peers. These young men include incarcerated youth, street youth, gay or transgendered youth, inner-city youth, recent immigrants, and youth victims of abuse, violence or neglect. Clinicians should also be cognizant of both racial/ethnic and cultural differences among AYA males, both of which impact the types and levels of risk these males face.40

Tools and Resources

References

Balsara SL, Faerber JA, Spinner NB, Feudtner C.Pediatric Mortality in Males Versus Females in the United States, 1999-2008. Pediatrics. 2013;132(4):631-638.

Bell DL, Breland DJ, Ott MA.Adolescent and young adult male health: a review. Pediatrics. 2013;132(3):535-46.

Ham P, Allen C.Adolescent health screening and counseling. Am Fam Physician. 2012;86(12):1109-16.

Centers for Disease Control and Prevention. 10 Leading Causes of Death by Age Group, United States – 2010. 2012.

World Life Expectancy. USA Teen Death Rate. 2012.

Marcell AV, Wibbelsman C, Seigel WM.Male adolescent sexual and reproductive health care. Pediatrics. 2011;128(6):e1658-76.

Add Health
The National Longitudinal Study of Adolescent Health (Add Health) is a longitudinal study of a nationally representative sample of adolescents in grades 7-12 in the United States during the 1994-95 school year. The Add Health cohort has been followed into young adulthood with four in-home interviews, the most recent in 2008, when the sample was aged 24-32*. Add Health combines longitudinal survey data on respondents’ social, economic, psychological and physical well-being with contextual data on the family, neighborhood, community, school, friendships, peer groups, and romantic relationships, providing unique opportunities to study how social environments and behaviors in adolescence are linked to health and achievement outcomes in young adulthood. The fourth wave of interviews expanded the collection of biological data in Add Health to understand the social, behavioral, and biological linkages in health trajectories as the Add Health cohort ages through adulthood.

Westwood M, Pinzon J.Adolescent male health. Paediatr Child Health. 2008;13(1):31-6.

Youth Risk Behavior Surveillance System, 2011, Centers for Disease Control and Prevention


1 Adams SH, Newacheck PW, Park MJ, Brindis CD, Irwin CE Jr. Health insurance across vulnerable ages: patterns and disparities from adolescence to the early 30s. Pediatrics. 2007;119(5).

2 Kirzinger WK, Cohen RA, Gindi RM.Health care access and utilization among young adults aged 19–25: Early release of estimates from the National Health Interview Survey, January -September 2011. Na- tional Center for Health Statistics. May 2012.

3 Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

4 Westwood, Michael, MB and Pinzon, Jorge, MD.  Adolescent male health. Paediactics and Child Health. January 2008

5 Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

7 Thompson EH , Jr, Pleck JH, Ferrera DL.Men and masculinities: scales for masculinity ideology and masculinity-related constructs. Sex Roles. 1992;27(11-12): 573–607

9 Thompson EH , Jr, Pleck JH, Ferrera DL.Men and masculinities: scales for masculinity ideology and masculinity-related constructs. Sex Roles. 1992;27(11-12): 573–607

11 Galdas PM, Cheater F, Marshall P.Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005;49(6):616–623

12 Pleck JH, Sonenstein FL, Ku LC.Masculinity ideology: its impact on adolescent males’ heterosexual relationships. J Soc Issues. 1993;49:11–29

13 Marcell AV, Ford CA, Pleck JH, Sonenstein FL.Masculine beliefs, parental communication, and male adolescents’ health care use. Pediatrics. 2007;119(4). Available at: www.pediatrics.org/cgi/content/full/119/4/e966

14 Tyler RE, Williams S.Masculinity in young men’s health: Exploring health, help-seeking and health service use in an online environment. [published online ahead of print March 14, 2013]. J Health Psychol

15 Vogel DLH-ES, Heimerdinger-Edwards SR, Hammer JH, Hubbard A.“Boys don’t cry”:

16 Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

17 Ott, Mary A.Examining the Development and Sexual Behavior of Adolescent Males. J Adolesc Health. 2010 April; 46(4 Suppl): S3–11.

18 Ibid

19 Singh GK, Azuine RE, Siahpush M, Kogan MD. All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns. J Urban Health. 2013;90(3):388–405.

20Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

21 Ibid

24 Sorenson SB. Gender disparities in injury mortality: onsistent, persistent, and larger than you’d think. Am J Public Health. 2011;101(suppl 1):S353–S358.

25Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

26 Balsara, Sheri L., Faerber, Jennifer A., Spinner, Nancy B., and Feudtner, Chris .Pediatric Mortality in Males Versus Females in the United States, 1999−2008. Pediatrics. originally published online September 2, 2013.

27 Vo DX, Park MJ. Helping young men thrive: positive youth development and men’s health. Am J Men Health. 2009;3(4):352–359.

28 Bell DL, Ginsburg KR. Connecting the adolescent male with health care. Adolesc Med. 2003;14(3):555–564.

29 Duncan PM, Garcia AC, Frankowski BL, et al. Inspiring healthy adolescent choices: a rationale for and guide to strength promotion in primary care. J Adolesc Health. 2007;41(6):525–535.

30 Ozer EM.The adolescent primary care visit: time to build on strengths. J Adolesc Health. 2007;41:519–520

31 Vo DX, Park MJ. Helping young men thrive: positive youth development and men’s health. Am J Men Health. 2009;3(4):352–359.

32 Ginsburg K. Engaging adolescents and building on their strengths.  Adolesc Health Update. 2007;19:1–8.

33 Bell DL, Ginsburg KR. Connecting the adolescent male with health care. Adolesc Med. 2003;14(3):555–564.

34 Ibid

35 Bell, David L., Breland, David J.. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatrics; originally published online August 12, 2013; DOI: 10.1542/peds.2012-3414.

36 Ibid

37 Westwood, Michael, MB and Pinzon, Jorge, MD.  Adolescent male health. Paediactics and Child Health. January 2008

38 Ford C, English A, Sigman G. Confidential health care for adolescents: position paper for the society for adolescent medi cine. J Adolesc Health. 2004;35(2):160 –167.

39 Marcell , Arik V. et al Male Adolescent Sexual and Reproductive Health Care. Pediatrics.  December 2011.

40 Ibid


Many of the disorders AYA males face are closely related to other co-morbid disorders.  As in other areas of medicine, disease co-morbidity is an area of increasing inquiry and exploration within the scientific community.  In screening and counseling of the AYA male it is important for providers to understand  the relationships of various disorders to others as well as how symptoms associated with certain disorders may be caused by other underlying conditions.

Common morbidities include mental conditions, eating disorders, chronic diseases, substance abuse, back pain, allergies, sinus infections, strep throat, asthma, ear infections, carpal tunnel, fractures,  high  blood  pressure,  high  cholesterol,  chronic  fatigue, warts, sexually transmitted infections, and many other conditions that can develop during young adulthood. 41