This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (131)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Social Bookmarking   What's this?

A Randomized Controlled Trial

Carol A. Ford, MD; Susan G. Millstein, PhD; Bonnie L. Halpern-Felsher, PhD; Charles E. Irwin, Jr, MD

JAMA. 1997;278(12):1029-1034.

Abstract
Context.
—Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.

Objective.
—To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.

Design.
—Randomized controlled trial.

Setting.
—Three suburban public high schools in California.

Participants.
—The 562 participating adolescents represented 92% of students in mandatory classes.

Intervention.
—After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality.

Main Outcome Measures.
—Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire.

Results.
—Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (β=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (β=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (β=.14, P=.001).

Conclusions.
—Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.

Author Affiliations
From the Division of Adolescent Medicine, Department of Pediatrics, University of California at San Francisco. Dr Ford is now with the Division of Community Pediatrics, Adolescent Medicine Section, Department of Pediatrics, University of North Carolina at Chapel Hill.

Footnotes
The Patient-Physician Relationship section editor: Richard M. Glass, MD, Deputy Editor, JAMA.

Reprints: Carol A. Ford, MD, Department of Pediatrics, Division of Community Pediatrics, Adolescent Medicine Section, C 7225, University of North Carolina, Chapel Hill, NC 27599-7225.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Assuring Adolescents About Medical Confidentiality
Pamela Sankar, Jon F. Merz, Carol A. Ford, Susan G. Millstein, Bonnie L. Halpern-Felsher, and Charles E. Irwin, Jr
JAMA. 1998;279(2):116-117.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adolescent Consent and Confidentiality
Pediatr. Rev. 2009;30:457-459.
FULL TEXT  

The challenging adolescent
McDonagh and Kaufman
Rheumatology (Oxford) 2009;48:872-875.
ABSTRACT | FULL TEXT  

Primary Care Follow-up Plans for Adolescents With Substance Use Problems
Hassan et al.
Pediatrics 2009;124:144-150.
ABSTRACT | FULL TEXT  

Please Don't Call My Mom: Pediatric Consent and Confidentiality
Bruce et al.
CLIN PEDIATR 2009;48:243-246.
 

Confidentiality in the Age of HIPAA: A Challenge for Psychosomatic Medicine
Mermelstein and Wallack
Psychosomatics 2008;49:97-103.
ABSTRACT | FULL TEXT  

Alcohol and Cigarette Use Among Adolescent and Young Adult Males
Park and Breland
Am J Mens Health 2007;1:339-346.
 

Voices of Asian American Youth: Important Characteristics of Clinicians and Clinical Sites
Vo et al.
Pediatrics 2007;120:e1481-e1493.
ABSTRACT | FULL TEXT  

Chlamydial Screening in Urgent Care Visits: Adolescent-Reported Acceptability Associated With Adolescent Perception of Clinician Communication
Miller et al.
Arch Pediatr Adolesc Med 2007;161:777-782.
ABSTRACT | FULL TEXT  

Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use
Marcell et al.
Pediatrics 2007;119:e966-e975.
ABSTRACT | FULL TEXT  

Nondisclosure of Sexual Orientation to a Physician Among a Sample of Gay, Lesbian, and Bisexual Youth
Meckler et al.
Arch Pediatr Adolesc Med 2006;160:1248-1254.
ABSTRACT | FULL TEXT  

Primary care confidentiality for Spanish adolescents: fact or fiction?
Perez-Carceles et al.
J. Med. Ethics 2006;32:329-334.
ABSTRACT | FULL TEXT  

Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration.
Carlisle et al.
J. Med. Ethics 2006;32:133-137.
ABSTRACT | FULL TEXT  

Growing up and moving on. A multicentre UK audit of the transfer of adolescents with juvenile idiopathic arthritis from paediatric to adult centred care
Robertson et al.
Ann Rheum Dis 2006;65:74-80.
ABSTRACT | FULL TEXT  

Health Care Maintenance in Female Adolescents
Boatwright et al.
Mayo Clin Proc. 2005;80:1641-1650.
ABSTRACT  

To Tell or Not to Tell: Primary Care Patients' Disclosure Deliberations
Sankar and Jones
Arch Intern Med 2005;165:2378-2383.
ABSTRACT | FULL TEXT  

Adolescent medicine in paediatric practice
Payne et al.
Arch. Dis. Child. 2005;90:1133-1137.
ABSTRACT | FULL TEXT  

Changing Parental Opinions About Teen Privacy Through Education
Hutchinson and Stafford
Pediatrics 2005;116:966-971.
ABSTRACT | FULL TEXT  

Parental Notification Laws for Minors' Access to Contraception: What Do Parents Say?
Eisenberg et al.
Arch Pediatr Adolesc Med 2005;159:120-125.
ABSTRACT | FULL TEXT  

Projected Economic Costs Due to Health Consequences of Teenagers' Loss of Confidentiality in Obtaining Reproductive Health Care Services in Texas
Franzini et al.
Arch Pediatr Adolesc Med 2004;158:1140-1146.
ABSTRACT | FULL TEXT  

Measuring Public Costs Associated With Loss of Confidentiality for Adolescents Seeking Confidential Reproductive Health Care: How High the Costs? How Heavy the Burden?
Brindis and English
Arch Pediatr Adolesc Med 2004;158:1182-1184.
FULL TEXT  

Health Care Preferences and Priorities of Adolescents With Chronic Illnesses
Britto et al.
Pediatrics 2004;114:1272-1280.
ABSTRACT | FULL TEXT  

Efficacy of an HIV Prevention Intervention for African American Adolescent Girls: A Randomized Controlled Trial
DiClemente et al.
JAMA 2004;292:171-179.
ABSTRACT | FULL TEXT  

The Right of Minors to Confidentiality and Informed Consent
Weisleder
J Child Neurol 2004;19:145-148.
ABSTRACT  

Smoking Cessation Counseling With Young Patients: The Practices of Family Physicians and Pediatricians
Kaplan et al.
Arch Pediatr Adolesc Med 2004;158:83-90.
ABSTRACT | FULL TEXT  

Effect of Patient Priming and Primary Care Provider Prompting on Adolescent-Provider Communication About Alcohol
Boekeloo et al.
Arch Pediatr Adolesc Med 2003;157:433-439.
ABSTRACT | FULL TEXT  

Availability of Adolescent Health Services and Confidentiality in Primary Care Practices
Akinbami et al.
Pediatrics 2003;111:394-401.
ABSTRACT | FULL TEXT  

Health promotion, the family physician and youth: Improving the connection
Malik et al.
Fam Pract 2002;19:523-528.
ABSTRACT | FULL TEXT  

Limiting Confidentiality of Adolescent Health Services: What Are the Risks?
Ford and English
JAMA 2002;288:752-753.
FULL TEXT  

Internists and Adolescent Medicine
Schmidt and White
Arch Intern Med 2002;162:1550-1556.
ABSTRACT | FULL TEXT  

Improving the Delivery of Adolescent Clinical Preventive Services Through Skills-Based Training
Lustig et al.
Pediatrics 2001;107:1100-1107.
ABSTRACT | FULL TEXT  

Commentary: Consensual Adolescent Sexual Activity With Adult Partners{---}Conflict Between Confidentiality and Physician Reporting Requirements Under Child Abuse Laws
Madison et al.
Pediatrics 2001;107:16e-16.
FULL TEXT  

Confidentiality and Adolescents' Use of Providers for Health Information and for Pelvic Examinations
Thrall et al.
Arch Pediatr Adolesc Med 2000;154:885-892.
ABSTRACT | FULL TEXT  

Violence Prevention in the Emergency Department: Clinician Attitudes and Limitations
Fein et al.
Arch Pediatr Adolesc Med 2000;154:495-498.
ABSTRACT | FULL TEXT  

Are adolescents being screened for sexually transmitted diseases? A study of low income African American adolescents in San Francisco
Ellen et al.
Sex. Transm. Infect. 2000;76:94-97.
ABSTRACT | FULL TEXT  

Adolescent Patients--Healthy or Hurting?: Missed Opportunities to Screen for Suicide Risk in the Primary Care Setting
Frankenfield et al.
Arch Pediatr Adolesc Med 2000;154:162-168.
ABSTRACT | FULL TEXT  

Preventive Services in a Health Maintenance Organization: How Well Do Pediatricians Screen and Educate Adolescent Patients?
Halpern-Felsher et al.
Arch Pediatr Adolesc Med 2000;154:173-179.
ABSTRACT | FULL TEXT  

Foregone Health Care Among Adolescents
Ford et al.
JAMA 1999;282:2227-2234.
ABSTRACT | FULL TEXT  

Features of Sexually Transmitted Disease Services Important to African American Adolescents
Lane et al.
Arch Pediatr Adolesc Med 1999;153:829-833.
ABSTRACT | FULL TEXT  

Direct Observation of Health-Habit Counseling of Adolescents
Goodwin et al.
Arch Pediatr Adolesc Med 1999;153:367-373.
ABSTRACT | FULL TEXT  

Preventive Services Received by Adolescents With Cystic Fibrosis and Sickle Cell Disease
Britto et al.
Arch Pediatr Adolesc Med 1999;153:27-32.
ABSTRACT | FULL TEXT  

Screening Adolescents for Sexually Transmitted Infections
Orr and Fortenberry
JAMA 1998;280:564-565.
FULL TEXT  

Assuring Adolescents About Medical Confidentiality
Sankar et al.
JAMA 1998;279:116-117.
FULL TEXT