Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use

In this study from Pediatrics, Vol. 119 No. 4 April 2007, researchers examined data on factors influencing the likelihood of adolescent males to get a health examination. They tested the ability of modifiable and non-modifiable factors to prospectively predict health care use by male adolescents. Modifiable factors include: beliefs about masculinity, parental communication, sex education, and health insurance. Non-modifiable factors include: age, race/ethnicity, and region of residence.


The study used a prospective analysis of data from 1,677 male participants aged 15-19 years who completed the (United States - US) National Survey of Adolescent Males, a household probability survey conducted throughout the US in 1988 (wave 1, participation rate: 74%) and in 1990–1991 (wave 2, follow-up rate: 89%). On average, 66% of male adolescents at reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Of these, there were three modifiable factors that prospectively influence health care use among male adolescents in the US: masculine beliefs, parent-teen communication, and insurance status.

A predisposing factor, among others, was found to be: male adolescents who communicated about reproductive health with both parents (73.7%) were more likely to have a physical examination than male adolescents who had no communication with either parent (55.6%) or who communicated with only 1 parent (59.8%). Analyses by family composition found that, among male adolescents who live in 2-parent households, those who communicate with both parents separately, are more likely to have a physical examination than male adolescents who do not communicate with either parent. Parental communication did not influence the use of health care among male adolescents in single-parent households. Looking at another modifiable factor, analyses by masculine beliefs found that, among male adolescents with more traditional beliefs, those who communicated with their father only, or both parents together, were more likely to have a physical examination than male adolescents who did not communicate with either parent. A nearly identical pattern was found for male adolescents with less traditional masculine beliefs.

The masculinity link (male adolescents with more traditional masculine beliefs are less likely to get health care) is consistent with research focused on adult men. Findings demonstrate that such attitudes may hinder adolescent male use of health care and may be consistent with the suggestion that boys' lack of "help seeking" can itself be considered a risk behaviour. Within this context, additional research is needed to better understand how masculine beliefs influence adolescent male care-seeking behaviours. As stated here, programmes that promote health and gender equity among boys are currently under evaluation. "These programmes are designed, in part, to target mythology that suggests that care-seeking is a sign of weakness and to promote the belief that care seeking can be consistent with the male role and seen as a sign of strength. An alternative strategy that warrants investigation among male youth populations may be to promote health and target services in a manner that is more congruent with traditional male gender roles."

Studies that examine parent-teen communication about sex have reported gender-specific issues (that mothers are more likely than fathers to talk with their children about sex and that mothers talk more to daughters than to sons). Also, the influence of mothers has been shown to outweigh that of fathers as it relates to the sexual behaviours of their teenage sons and daughters. This study's findings provide new insight into the relationship between parent-son communication about reproductive health and health care use and highlight the importance of father-son communication. In this study, communication with both mothers and fathers predicted increased health care use for male adolescents regardless of age and for sons with either more or less traditional masculine beliefs. For adolescent sons with either more or less traditional beliefs, talking with fathers about reproductive health issues is cited by the researchers as particularly important. Isolated mother-son communication did not predict health care use in the study. The document states that future research is needed to examine the content and quality of parent-son communication as it relates to male use of health care and to further explore parental communication within the context of single-parent households.

The study suggests that efforts to enhance adolescent male health through health care should include work to modify masculine stereotypes, increase mothers' and fathers' communication about health with their sons, and expand health insurance coverage. Specific efforts to connect male adolescents at high risk of health problems to health care are needed, as stated here. Further, the research points out that primary care providers should encourage mothers and fathers to talk with their sons about general and reproductive health and the importance of connections with health services. Whether establishing better connections between male adolescents and health care can subsequently lead to better connections between adult men and health care (and improved men's health) is a question cited in the study as an important area of future longitudinal research.

(Footnotes have been removed by the editor.)