Objectives: The objectives of this study were to examine 1) gender differences in disclosure of health concerns among high school students in a predominantly Hispanic community in a southwestern state and 2) gender differences in experience of specific health concerns identified by the study population. Without exception, all the national risk factors for adolescents are higher in this state. The three leading causes of death for 15-24 year olds are motor vehicle accidents, suicide and homicide. The first step in addressing adolescent health is to hear the concerns. However, little is known about disclosure of health concerns in this population.
Design: This was an observational, cross-sectional epidemiological study.
Sample & Setting: The sample was obtained from a single high school, which was one of four in a county, where 27% of the population is below the poverty level. The county high schools are predominantly Hispanic (60%). Thirty-two percent of the students in the county qualify for the free lunch program. There were 2,226 students registered at the study high school; 1,616 students attending 94 different classes were anonymously surveyed during third period.
Methods: The Dartmouth COOP (adolescent version) was used to collect data about health concerns. This 26-item instrument includes dichotomous questions regarding disclosure of health concerns about family, feelings, risky behaviors, pain, social support, physical fitness, and school. It allowed for the addition of three questions tailored to the population. Twelve student promotores (health promotors) participated in several focus groups to evaluate the Dartmouth COOP and determine which content would be added. They added 3 questions regarding: harassment; riding in a car when the driver was drinking; and access to health care. The promotores were involved in distributing and collecting the Dartmouth COOP. Only students reporting gender [N=1470 (752 males; 718 females)] were used for these Chi-square and descriptive analyses.
Variables Studied: Gender and disclosure of health concerns.
Findings: Prior to disclosure analysis, the number of adolescents reporting concerns during the previous month (all of the time or most of the time) was calculated for each concern category: family (n=484), feelings (n=251), risky behaviors (n=241), pain (n=298), social support (n=198), physical fitness (n=124) and school (n=210). Gender was significantly related to disclosure of concerns about family (p < .05), feelings (p < .01), pain (p < .01) and school (p < .01). More girls than boys disclosed family concerns (41% vs. 33%), feeling concerns (55% vs. 39%) and concerns about pain (59% vs. 47%). More boys than girls disclosed concerns about school (48% vs. 33%). Regardless of whom adolescents spoke with they found the information useful less than 26% of the time. There was not a significant relationship between gender and access to care or gender and riding in a car when the driver had been drinking. However, 389 males and 370 females reported riding in a car when the driver had been drinking. There was a significant relationship between gender and the occurrence (p < .05) and type of harassment (p < .01). More girls experienced harassment than boys (21 vs. 17%), predominantly through verbal and sexual harassment. Boys experienced more threat of physical harm then did girls (45% vs. 17%).
Conclusions: There are gender differences in adolescent disclosure of health concerns about family, feelings, pain and school with girls being more likely to talk to someone about each of these except school. Girls were more likely to experience harassment but boys were more likely to experience the threat of physical harm.
Implications: Improved understanding of methods that encourage adolescent health concern disclosure is needed. Attention must be directed to support boys' disclosure about family, feelings and pain concerns. Boys' increased disclosure of school concerns offers a potential approach for practice and future research. Exploration of school problems with boys might be the key to improved disclosure on other important health issues. The study also highlights the issues of harassment and physical threat experienced differentially by boys and girls. It would be useful to know who adolescents talked to about this concern and what might help them deal with it. Future research using structured encounters, inviting the voice of adolescent girls and boys about health concerns is warranted.
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