Physicians in primary care may not be counseling adolescent patients adequately, particularly in areas involving sexuality. One reason is that teenagers do not routinely see physicians; they visit the office-based physician less than do any other age group, and their visits usually are short (Office of Technology Assessment, 1991; Society for Adolescent Medicine, 1992). These circumstances do not lend themselves to the comprehensive assessment needed for meeting adolescents' physical and psychosocial needs (Gans, McManus, & Newacheck, 1991). Additionally, some physicians do not want to counsel adolescents. Residents have admitted deficiencies in their counseling skills and that they lack interest in additional training to improve them (Figuerora, Kolasa, Hover, Murphy, Dent, Aushman, & Irons, 1991). Another study reported that adolescents were not receiving counseling on their health care interests (Malus, LaChance & Lamy, 1987). Teenagers are often uncomfortable talking about their sexuality, and if the physician fails to introduce the subject, a valuable counseling opportunity is likely to be missed. (Marks, Fisher, & Lasker, 1990; Stewart, 1987). Approximately one million teenagers become pregnant each year and approximately 2.5 million contract a sexually transmitted disease (Olsen, Weed, Ritz, & Jenson, 1991; Koop, 1988). Sexual activity at earlier ages has proven to adversely affect many teenagers' sense of self-worth (Lenaz, Callahan, & Bedney, 1991). With such serious consequences and the alarming numbers of both adolescent pregnancy and sexually transmitted diseases, the medical community has a responsibility to advocate responsible sexual behavior (Pastorek, 1992). Stewart (1987) suggests that the goals of sexuality counseling should be to help adolescents sort out their feelings, make them aware of the consequences of their choices, and finally, guide them in making appropriate decisions.
In order to improve the training of physicians in counseling teenagers on sexuality it is important to understand their current behaviors. It is also important to know how effective physicians believe their interventions can be. To this end pediatricians and family physicians were surveyed about these behaviors and beliefs, with particular emphasis on physicians' attitudes toward attempts to counsel sexual abstinence.
The physicians surveyed were faculty members of the East Carolina University School of Medicine, residents in pediatrics or family practice at Pitt County Memorial Hospital, and community pediatricians and family practitioners. The survey was self-administered and distributed in the physicians' hospital mail boxes or mailed with a stamped, return envelope. A follow-up mailing was sent to nonresponders. The survey was designed to elicit (1) demographic data and practice characteristics; (2) clinical practices pertinent to the adolescent (sexual development, contraception, sexual peer pressure, and other sexuality topics); (3) opinions regarding the effectiveness of physician counseling about sexuality and the value of additional training. Questions included matters related to abstinence and contraception counseling, sexual habits, sexually transmitted diseases, ways to deal with peer pressure relating to sex, normal sexual development, and sexual abuse. The study was approved by the Institutional Committee on Research with Human Subjects. Responses were coded and computer tabulated. The data were analyzed for differences, using SAS, and based on professional status, specialty, gender, political characterization, marital status, and whether there were children in the physician's home.
Completed questionnaires were returned by 53 physicians, for an overall response rate of 42.7% (Table 1). No statistical differences were found in the physicians' responses based on gender, professional status, specialty, age, political characterization, marital status, or whether there were children in the home (Table 1). …