Parent and Adolescent Attitudes Towards Preventive Care and Confidentiality



      Little is known about whether parents and adolescents agree in their attitudes towards preventive care, private time, and confidentiality for adolescent care.


      We surveyed a nationally representative sample of 1,209 13–18 year-old U.S. adolescents and their parents. Parent and adolescents attitudes towards preventive services, private time, and confidentiality were compared. Parent-youth dyad agreement was measured using Cohen's kappa and Spearman coefficients and modeled for association with demographic variables.


      Parents are more likely than adolescents to think preventive services are important (71% vs. 48%; p < .001). Parent-youth attitudes were weakly to moderately correlated (Cohen's kappa coefficient = .22; p < .001). Parents and adolescents report similar ages for when teens should start having private time (median 16 years for both) and many think this age should be at 18, the legal age of adulthood). Fewer than half believe confidentiality should be provided for 10 services, ranging from routine care to abortion care (parents range: 12.8%–52.3%; adolescents: 24.0%–58.8%). While most adolescents agreed with their parents, teens were more likely to report wanting confidential access than parents. Older age, Hispanic ethnicity, having divorced parents and higher family income were associated with both adolescent/parent and adolescent endorsement of confidentiality.


      Adolescents and parents generally agree about the importance of preventive services, private time, confidentiality, and what should and should not be confidential. On average, parents value clinical preventive services more than youth, and youth value confidentiality more than parents. Both believe private time should start at ages older than those recommended in clinical guidelines.



      CPS (Clincial Preventive Services), AYA (Adolescents and Young Adults)
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        • Elster A.
        The American Medical Association guidelines for adolescent preventive services.
        Arch Pediatr Adolesc Med. 1997; 151: 958-959
        • Hagan J.F.
        • Shaw J.S.
        • Duncan P.M.
        Bright futures: guidelines for health supervision of infants, children, and adolescents.
        4th ed. American Academy of Pediatrics, Itasca, IL2017
        • Ford C.
        • English A.
        • Sigman G.
        Confidential health care for adolescents: position paper for the society for adolescent medicine.
        J Adolesc Health. 2004; 35: 160-167
      1. Adolescent Health Care, Confidentiality. American Academy of Family Physicians website, 2018. Available at: Accessed May 7, 2018.

      2. Adolescent confidentiality and electronic health records. Committee Opinon No. 599, vol. 123. Washington, DC: The American College of Obstetricians and Gynecologists; 2014. p. 1148--50.

        • Carlisle J.
        • Shickle D.
        • Cork M.
        • McDonagh A.
        Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration.
        J Med Ethics. 2006; 32: 133-137
      3. National and state vaccination coverage among adolescents aged 13-17 years–United States, 2012.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 685-693
        • Heijne J.C.
        • Tao G.
        • Kent C.K.
        • Low N.
        Uptake of regular chlamydia testing by U.S. women: a longitudinal study.
        Am J Prev Med. 2010; 39: 243-250
        • Mangione-Smith R.
        • DeCristofaro A.H.
        • Setodji C.M.
        • et al.
        The quality of ambulatory care delivered to children in the United States.
        N Engl J Med. 2007; 357: 1515-1523
        • Marcell A.V.
        • Matson P.
        • Ellen J.M.
        • Ford C.A.
        Annual physical examination reports vary by gender once teenagers become sexually active.
        J Adolesc Health. 2011; 49: 47-52
        • McKee M.D.
        • Rubin S.E.
        • Campos G.
        • O'Sullivan L.F.
        Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives.
        Ann Fam Med. 2011; 9: 37-43
        • Nguyen T.Q.
        • Ford C.A.
        • Kaufman J.S.
        • Leone P.A.
        • Suchindran C.
        • Miller W.C.
        HIV testing among young adults in the United States: associations with financial resources and geography.
        Am J Public Health. 2006; 96: 1031-1034
        • Reagan-Steiner S.
        • Yankey D.
        • Jeyarajah J.
        • et al.
        National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2014.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 784-792
      4. San Francisco C. National Adolescent Health Information Center. San Francisco: University of California, San Francisco.

        • Torio C.M.
        • Encinosa W.
        • Berdahl T.
        • McCormick M.C.
        • Simpson L.A.
        Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.
        Acad Pediatr. 2015; 15: 19-35
        • Yeung L.F.
        • Coates R.J.
        • Seeff L.
        • Monroe J.A.
        • Lu M.C.
        • Boyle C.A.
        Conclusions and future directions for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents-United States.
        MMWR Surveill Summ. 2014; 63: 9
        • Solberg L.I.
        • Nordin J.D.
        • Bryant T.L.
        • Kristensen A.H.
        • Maloney S.K.
        Clinical preventive services for adolescents.
        Am J Prev Med. 2009; 37: 445-454
        • Irwin C.E., Jr.
        • Adams S.H.
        • Park M.J.
        • Newacheck P.W.
        Preventive care for adolescents: few get visits and fewer get services.
        Pediatrics. 2009; 123: e565-e572
        • Lau J.S.
        • Adams S.H.
        • Irwin C.E., Jr.
        • Ozer E.M.
        Receipt of preventive health services in young adults.
        J Adolesc Health. 2013; 52: 42-49
        • Neppl T.K.
        • Dhalewadikar J.
        • Lohman B.J.
        Harsh parenting, deviant peers, adolescent risky behavior: understanding the meditational effect of attitudes and intentions.
        J Res Adolesc. 2016; 26: 538-551
        • Sedlander E.
        • Brindis C.D.
        • Bausch S.H.
        • Tebb K.P.
        Options for assuring access to confidential care for adolescents and young adults in an explanation of benefits environment.
        J Adolesc Health. 2015; 56: 7-9
        • Cheng T.L.
        • Savageau J.A.
        • Sattler A.L.
        • Dewitt T.G.
        Confidentiality in health-care - a survey of knowledge, perceptions, and attitudes among high-school-students.
        J Am Med Assoc. 1993; 269: 1404-1407
        • Ford C.A.
        • Bearman P.S.
        • Moody J.
        Foregone health care among adolescents.
        J Am Med Assoc. 1999; 282: 2227-2234
        • Reddy D.M.
        • Fleming R.
        • Swain C.
        Effect of mandatory parental notification on adolescent girls' use of sexual health care services.
        J Am Med Assoc. 2002; 288: 710-714
        • Coker T.R.
        • Sareen H.G.
        • Chung P.J.
        • Kennedy D.P.
        • Weidmer B.A.
        • Schuster M.A.
        Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents.
        J Adolesc Health. 2010; 47: 133-142
        • Ford C.A.
        • Millstein S.G.
        • Halpern-Felsher B.L.
        • Irwin C.E.
        Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care: a randomized controlled trial.
        J Am Med Assoc. 1997; 278: 1029-1034
        • Duncan R.E.
        • Vandeleur M.
        • Derks A.
        • Sawyer S.
        Confidentiality with adolescents in the medical setting: what do parents think.
        J Adolesc Health. 2011; 49: 428-430
        • Sasse R.A.
        • Aroni R.A.
        • Sawyer S.M.
        • Duncan R.E.
        Confidential consultations with adolescents: an exploration of Australian parents' perspectives.
        J Adolesc Health. 2013; 52: 786-791
      5. KnowledgePanel Recruitment and Sample Survey Methodology. Available at: Accessed April 6, 2018.

      6. Current Population Survey (CPS). United States Census Bureau 2015. Available at: Accessed February 10, 2018.

      7. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) Fact Sheet Atlanta, GA: offices of surveillance, epidemiology, and laboratory services. Available at:

      8. Stata Statistical Software: Release 13 [computer program]. College Station, TX: StataCorp LP.; 2015.

        • Kincaid C.
        • Jones D.J.
        • Sterrett E.
        • McKee L.
        A review of parenting and adolescent sexual behavior: the moderating role of gender.
        Clin Psychol Rev. 2012; 32: 177-188
      9. Couper M.P. Web surveys: a review of issues and approaches. Public Opinion Quarterly, vol. 64, No. 4 (Winter, 2000). Oxford: Oxford University Press; pp. 464-94. Accessed Mar. 26, 2018. 15:56 UTC.