Arik Marcell, associate professor of pediatrics, sees patients at the Center for Adolescent/Young Adult Health at Johns Hopkins’ Harriet Lane Clinic. An expert in the health of adolescent males, Marcell has a particular interest in improving their reproductive and sexual health care, services that are routinely overlooked in primary care well visits for this group. While primary care for adolescent girls is likely to include information about contraception and reproductive and sexual health — often when they have their first period — Marcell says the same isn’t true for male adolescents.

Why are adolescent males underserved when it comes to health care?

What’s interesting is that it’s a flip. In the first couple of years of life, boys tend to have greater morbidity and mortality than girls. They tend to be a little bit sicker through the childhood period. But I think once they hit school age, as long as boys appear healthy, often parents just deem them to be healthy. And starting in the pubertal period, there aren’t the same touch points that are triggers for girls to be brought in for care. Then, of those boys who do make it in, providers may not necessarily offer them what’s recommended around family planning and sexual health care.

Using one of the few datasets that follow adolescents’ well-visit attendance from ages 5 through 17, we showed the majority of adolescents attended well visits over this period. However, over one-third of adolescents became disengaged after the age 5 visit, especially boys, with three-quarters of this group becoming persistently disengaged, which is very concerning. Even in the more recent birth cohorts, those born in the last 10 to 15 years, still about a quarter of boys became disengaged after the age 5 well visit.

What information are they missing out on when these visits don’t take place?

It’s twofold. It’s very clear that preventive or well visits can help prevent or delay the start of risk behaviors — or behaviors that we might deem as risky — during adolescence, as well as prevent adult onset behaviors and related morbidity and mortality connected to cardiovascular disease, smoking, substance use, etc.

These visits are opportunities to address sexual behavior risks — the majority of STI cases occur between 15- and 24-year-olds — and other issues like substance use, smoking, mental health, nutrition and physical activity, preventable accidents, including driving and other safety issues, many of which affect males more than females. Missed well visits are lost opportunities to deliver preventive care to young males.

How are you working on a project to change that?

We’re developing a pre-doctor-visit app, with National Institutes of Health funding, that we’ll be trialing next year, for young males ages 12 to 21, to learn about sexual health and family planning. We hope to demonstrate behavior change for condom use and health care, and to use the tool to prime the clinician who will be seeing them in delivering quality family planning and sexual health care.

Before a visit, a young male will be able to use the app to learn about condoms and preventing sexually transmitted infections and HIV, including the use of PrEP [pre-exposure prophylaxis, which can reduce the chance of getting HIV from sex or injection drug use]. Then based on his answers to questions, the provider will get a summary report of health needs and tailored guidance about services to provide. The tool will also have information for young males to learn about topics like sexual function, consent, and how to have conversations about sexual health with their doctor.

Read the full interview.