Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners.

OBJECTIVES: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). METHODS: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. RESULTS: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (chi2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. CONCLUSIONS: Implications for designing interventions for adolescent males and females are discussed.

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Can it be done? Implementing adolescent clinical preventive services.

OBJECTIVE: To evaluate the implementation of an intervention to increase the delivery of adolescent preventive services within a large managed care organization. Target health areas were tobacco, alcohol, sexual behavior, and safety (seat belt and helmet use). DATA SOURCE/STUDY DESIGN: Adolescent reports of clinician screening and counseling were obtained from adolescents who attended well visits with their primary care providers. A prepost study design was used to evaluate the preventive services intervention. The intervention had three components: (1) 89 clinicians from three outpatient pediatric clinics attended a training to increase the delivery of preventive services; (2) customized adolescent screening and provider charting forms were integrated into the clinics; and (3) the resources of a health educator were provided to the clinics. DATA COLLECTION: Following a visit, adolescents completed surveys reporting on clinician screening and counseling for each of the target risk areas. Preimplementation (three months), 104 adolescents completed surveys. Postimplementation of the training, tools, and health educator intervention, 211 adolescents completed surveys (five months). For 18 months postimplementation clinicians delivered services and 998 adolescents completed surveys. PRINCIPAL FINDINGS: Chi-square analyses of changes in screening from preimplementation to postimplementation showed that screening increased in all areas (p < .000), with an average increase in screening rates from 47 percent to 94 percent. Postimplementation counseling in all areas also increased significantly, with an average increase in counseling rates from 39 percent to 91 percent. There were slight decreases in screening from postimplementation to follow-up. CONCLUSIONS: This study offers support for the efficacy of providing training, tools, and resources as a method for increasing preventive screening and counseling of adolescents across multiple risky health behaviors during a routine office visit.

Preventive services in a health maintenance organization: how well do pediatricians screen and educate adolescent patients?

OBJECTIVE: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services. DESIGN: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. RESULTS: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services. CONCLUSIONS: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.

Features of sexually transmitted disease services important to African American adolescents.

OBJECTIVE: To determine the relative importance of various features of health clinics when African American adolescents consider seeking care for sexually transmitted diseases (STDs). DESIGN: Confidential interviewer-administered telephone survey. SETTING: A predominantly low-income, African American neighborhood in San Francisco, Calif. PARTICIPANTS: Random sample of African American adolescents aged 12 to 17 years; 302 (76.6%) of 394 identified eligible adolescents participated. MAIN OUTCOME MEASURES: Items and scales measuring adolescents' sense of the importance of the attributes of the provider (alpha = .58), availability of services (alpha = .61), and perceived confidentiality of health services from family (alpha = . 72) when deciding where to seek care for possible STDs. RESULTS: More than 90% (90.4%) of subjects rated items relating to provider attributes as being highly important when they consider where they would seek care for an STD; between 62.5% and 82.7% rated availability items as being highly important; and between 38.6% and 60.8% rated items pertaining to confidentiality as being highly important. Greater importance was placed on provider attributes and confidentiality by female than male adolescents. The importance placed on provider attributes and confidentiality increased as adolescents aged. CONCLUSIONS: Low-income, African American adolescents place great importance on provider attributes, less importance on availability, and even less importance on confidentiality when deciding where to seek health care for a possible STD. Health care providers and organizations need to be aware of these adolescent preferences to better promote screening and treatment of STDs in this population.

What leads to sex? Adolescent preferred partners and reasons for sex.

83 African-American and White male and female adolescents, ages 16-20 years old, were asked to list preferred partner qualities and reasons to have or not have sex as measures of their perceptions of antecedents of sex. High frequency items were placed on cards and sorted separately by an additional four gender and racial subsamples (n = 79). Data were analyzed using multidimensional scaling and cluster analysis. Health-related antecedents to sex were not predominant in responses. Both African-American female and male adolescents mentioned "nice body" as criteria for evaluating partner attractiveness and associated this with good looks, whereas White adolescents did not mention "nice body". African-American male adolescents associated love relationships with marriage and parenthood whereas others did not. African-American and White male adolescents indicated sexual arousal as a reason for sex, whereas African-American and White female adolescents did not, with African-American male adolescents associating sexual arousal with an attractive partner and White male adolescents associating sexual arousal with drinking. Implications for sexually transmitted disease prevention are considered.

Primary care physicians' screening of adolescent patients: a survey of California physicians.

PURPOSE: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor. METHODS: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use. RESULTS: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting. CONCLUSIONS: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.

Determinants of adolescents' satisfaction with health care providers and intentions to keep follow-up appointments.

OBJECTIVE: To better understand the determinants of adolescents' satisfaction with their health care providers and to examine the relationship among satisfaction, intention to return for follow-up, and appointment-keeping behavior. METHODS: One hundred and twenty-four adolescent patients attending a university-based general adolescent medicine clinic were surveyed prior to the visit about their attitudes regarding provider behavior. After the visit, subjects completed a questionnaire on provider behavior during the visit, satisfaction with the visit, and intention to keep their follow-up appointment. RESULTS: Multivariate regression analysis revealed that pre-visit attitudes about providers' style of behavior predicted satisfaction (beta = 0.252; p < 0.01). After controlling for pre-visit attitudes, perceptions about providers' style of behavior proved to be a strong predictor of visit satisfaction (beta = 0.512; p < 0.01). Visit satisfaction was associated with intention to keep scheduled follow-up appointments (r = 0.327; p < 0.01). However, subjects with greater intention to return were not more likely to keep their follow-up appointments. CONCLUSION: Provider behavior is an important determinant of adolescents' satisfaction with their health care.

Adolescents' knowledge of their health insurance coverage.

PURPOSE: To determine the accuracy of adolescents' self-report of health insurance coverage, using parents' report as a comparison standard. METHODS: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent-parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (> 14 years) versus younger (< or = 14 years) adolescents. RESULTS: In Sample 1, 33% of adolescent respondents responded "don't know" to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered "don't know," with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% of subjects agreed with parents' report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with "don't know," we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance. CONCLUSIONS: Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.

The gamesmanship of sex: a model based on African American adolescent accounts.

This article examines adolescent understanding of the social context of sexual behavior. Using grounded theory to interpret interviews with 39 African American male and female adolescents, the article builds a model of sex-related behavior as a set of interrelated games. A courtship game involves communication of sexual or romantic interest and, over time, formation of a romantic relationship. A duplicity game draws on conventions of a courtship game to trick a partner into having sex. A disclosure game spreads stories about one's own and other's sex-related activities to peers in a gossip network. Finally, a prestige game builds social reputation in the eyes of peers, typically based on gender-specific standards. The article concludes by examining the meanings that sex-related behavior may have for adolescents and the potential use of social knowledge for facilitating adolescent health.

Fidelity Management: African-American Adolescents' Attempts to Control the Sexual Behavior of their Partners.

This qualitative study examined how adolescents conceptualize sexual behavior. Open-ended interviews about sex were conducted with a sample of 21 male and 18 female African- American adolescents. Topics related to health risk virtually never emerged in their responses. The topic of partner infidelity and concerns about control of infidelity, on the other hand, were mentioned extensively. Informants described a cycle in which commitment to a partner often leads to suspicion of infidelity and jealousy. The jealous partner then performs acts of surveillance which can lead either to reassurance or to discovery of infidelity. The article concludes by discussing the degree of uniqueness of fidelity management to African- American adolescents and possible relevance to design of AIDS risk-reduction interventions.

Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial.

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) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.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) (beta=.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.

Screening for adolescent smoking among primary care physicians in California.

OBJECTIVES: This study determined how often primary care physicians ask adolescents about smoking. METHODS: We surveyed a stratified random sample of community-based, board-certified California physicians, using a mailed questionnaire. RESULTS: Overall, physicians (n = 343; 77% response rate) screened younger adolescents for regular smoking during 71.4% (95% confidence interval [CI] = 67.9, 74.9) of routine physical exams and older adolescents during 84.8% (95% CI = 82.3, 87.4) of such visits. For acute-care visits, the screening rates were 24.4% (95% CI = 20.6, 28.1) for younger and 40.2% (95% CI = 36.4, 44.0) for older adolescents. Physicians asked 18.2% (95% CI = 15.2, 21.3) of younger and 35.6% (95% CI = 32.0, 39.1) of older adolescents about experimental smoking. Screening varied by specialty. CONCLUSIONS: These data imply that physicians are missing opportunities to screen adolescents for smoking.

Delivery of confidentiality assurances to adolescents by primary care physicians.

OBJECTIVE: To investigate physicians' practices in assuring confidentiality to adolescent patients. DESIGN: Mail survey. SETTING: California. PARTICIPANTS: Seven hundred eighty-six board-certified physicians in family practice, internal medicine, obstetrics and gynecology, or pediatrics (response rate, 65%). MAIN OUTCOME MEASURES: Physicians were asked the percentage of adolescent patients (15 to 18 years old) with whom they discuss confidentiality during routine visits and the content of their assurances of confidentiality. A clinical vignette assessed physicians' knowledge of legal guidelines for confidential treatment of adolescents. RESULTS: Physicians reported discussing confidentiality with 53% (on average) of their adolescent patients. Eleven percent of physicians did not discuss confidentiality with any adolescent patients. Hierarchical linear regression used to control for other physician demographic and practice factors showed that female physicians were more likely to discuss confidentiality than were male physicians (R2 change = 0.03, P < .001). There was also an association between specialty and discussing confidentiality (R2 change = .04, P < .001); obstetricians and gynecologists were more likely to discuss confidentiality than were other primary care physicians (beta = .21, P < .001). Among physicians who discussed confidentiality, 64% assured unconditional confidentiality and 36% assured conditional confidentiality. When asked about legal guidelines for managing a 15-year-old patient with a sexually transmitted disease, 63% of physicians responded correctly, 5% responded incorrectly, and 31% were unsure of management guidelines. CONCLUSIONS: Physicians do not consistently discuss confidentiality with their adolescent patients. Most of the physicians who discuss confidentiality, with adolescents assure unconditional confidentiality, which is inconsistent with professional guidelines or the legal limitations of confidentiality.

Adolescent sexual strategies.

PURPOSE: The aim of this study has been to survey adolescents' strategies to promote sexual encounters and to compare those used by males and females. We examined the predictions that sexual strategies of young adolescents are fewer and less adult-like and that those of male adolescents are more coercive. We also examined the predictions from evolutionary psychology that suggest in sexual strategies, males communicate emotional involvement, long-term interest, and resource investment, whereas females communicate sexual availability and fertility. METHODS: The sample consisted of 153 African-American, white, Chinese-American, and Mexican-American adolescents. A strategy inventory was developed and mention of strategies by males and females were compared. RESULTS: Significant gender differences in mention of strategies were found. Males mentioned a higher percentage of coercive strategies such as pressuring and raping as well as a higher percentage of strategies such as lying and getting a partner drunk or high. Males and females both mentioned a higher percentage of strategies communicating commitment and investment. Females mentioned more strategies which signaled sexual availability. Adolescent strategies were fewer than those reported by adults and less focused on appearance enhancement and the intricacies of dating. CONCLUSIONS: Findings suggest the need for special targeting of coercive situations, use of sexual strategies as a prompt for counterstrategies aimed at abstinence, use of sexual strategies as a context for condom use promotion, and reinforcement of female preparatory strategies.

PIP: 153 sexually active 11th and 12th graders attending two inner-city high schools in San Francisco participated in a study of strategies adolescents use to secure sexual intercourse with a partner. The study sample comprised 20 male and 16 female African-Americans, 21 male and 22 female Caucasians, 17 male and 18 female Chinese-Americans, and 19 male and 20 female Mexican-Americans aged 14-19 years (mean age, 16.96 years). Non-English-speaking and special education students were excluded from study. Relative to females, males reported using a higher degree of pressure, rape, lying, and getting a partner drunk or high to encourage sexual involvement. Both sexes reported suggesting interest in developing commitment and a relationship with the intended sex partner to achieve the goal of intercourse. Females mentioned more strategies than males which signaled sexual availability. Relative to adults, the study participants reported fewer strategies and were less focused upon appearance enhancement and the intricacies of dating.

Relationship of alcohol use and risky sexual behavior: a review and analysis of findings.

In this review article, three methodologic approaches that have been used to examine the association between adolescents' alcohol use and their involvement in risky sex are discussed: global correlation studies, situational covariation studies, and event analyses. The strengths and limitations of each of these research methods are discussed. An extensive review of the most rigorous studies, which used event analysis to examine the alcohol-risky sex link, reveals positive results for first-time sexual events but equivocal findings for other types of sexual relationships. It is argued that differences in the types of sexual relationships studied have been confounded, limiting our ability to evaluate the extent to which alcohol has a causal influence on adolescents' condom use. It is suggested that future investigations consider the nature of the sexual relationship, and go beyond studying the length or status of the relationship to explore how variation in relationship dimensions such as trust and intimacy affect adolescents' sexual behavior.

PIP: Research on the association between alcohol use and high-risk sexual practices among US adolescents has been compromised by methodological flaws. Global correlation studies, situational covariate studies, and event-history analyses have examined the impact of alcohol on adolescents' condom use. Although the correlation studies have found an association between alcohol consumption and risky sexual behavior, they can not identify potential causal effects. Situational covariate studies have examined effects from the use of alcohol during sexual events, but they also obscure the important temporal relationship between variables. Both global correlation and situational covariation studies fail to address the possibility that alcohol use and risky sexual behavior are caused by a third factor such as a general tolerance for deviance or a predisposition to risk taking. Critical incident or event analyses are limited by the recall bias inherent in retrospective data. Support for an alcohol-risky sex association emerges most consistently from studies that examined first-time sexual intercourse events, but this finding may not generalize to later experiences with new partners. Recent studies have recognized the importance of examining how sexual relationships themselves influence condom use. It is possible that alcohol will affect condom use only at specific points in the relationship. To control for the potentially confounding effects of the partner relationship on the alcohol-risky sex link, the natural history of these behaviors over the course of a relationship should be examined. The use of diaries is likely to yield more reliable information than retrospective questioning.

Delivery of STD/HIV preventive services to adolescents by primary care physicians.

PURPOSE: To document the rates of STD/HIV preventive services delivered to adolescents by primary care physicians in California, and to identify variation owing to physician and practice-related factors. METHODS: A stratified random sample of California internists, family physicians, obstetricians-gynecologists, and pediatricians was drawn from the AMA Masterfile and surveyed by mail about their practices with regard to STD/HIV prevention for 15-18-year-old adolescent patients. Sixty percent of eligible physicians responded; the final sample was 1217 physicians. RESULTS: Results showed that 40% of physicians reported screening all of their adolescent patients for sexual activity and 31% reported educating all of their adolescent patients about STD/HIV transmission. For their sexually active adolescent patients, 36% of physicians always provided STD/HIV education, 17% always screened for number of previous sexual partners; 12% always screened for sexual orientation; and 10% always screened for frequency of casual sex. Four percent of the physicians reported that they always provided condoms for their sexually active adolescent patients; 81% never provided condoms. Higher levels of preventive services delivery were associated with female physician gender, specialization in obstetrics-gynecology, and more recent date of medical school graduation. Physicians practicing in health maintenance organizations reported providing significantly higher rates of preventive services to sexually active adolescents than did physicians in private practice. CONCLUSIONS: Primary care physicians provide STD/HIV preventive services to adolescents at rates far below those recommended by current guidelines. Areas where additional research would be informative are highlighted.

Anticipatory guidance regarding sex: views of virginal female adolescents.

PURPOSE: To explore virginal female adolescents' perceptions of potential discussions with physicians regarding sexuality. METHODS: Twenty-seven virginal female adolescents from an urban high school completed a semistructured interview that explored perceptions of: (1) physicians as resources for discussions about sexuality; (2) content of potential sexuality discussions with physicians; and (3) risks and benefits of sexuality discussions with physicians. The relative emphasis of responses across the sample are described by mean proportional scores (MPS). RESULTS: Health care professionals were spontaneously identified by 33% of participants as potential resources for discussions about sexuality issues. Participants' perceptions of the potential content of sexuality discussions with physicians emphasized prevention of pregnancy and sexually transmitted infections (STIs) (MPS = .37), and physician counseling (MPS = .22). These topics included alternatives to sex and sex refusal skills. The perceived benefits of such discussions were gaining information or assistance regarding pregnancy and STI prevention (MPS = .32), talking with an expert (MPS = .19), and having a supportive relationship with a caring adult (MPS = .16). Lack of confidentiality was perceived as the major risk of adolescent-physician sexuality discussions (MPS = .29). CONCLUSION: Virginal female adolescents perceive a range of topics regarding sexuality as appropriate for discussions with physicians. This should be considered when providing anticipatory guidance counseling to virginal patients regarding sex. Concerns about confidentiality need to be addressed.

Utility of the theories of reasoned action and planned behavior for predicting physician behavior: a prospective analysis.

The utility of the theory of reasoned action (TRA) and the theory of planned behavior (TPB) for prospectively predicting physicians' delivery of preventive services was compared. Primary care physicians (N = 765) completed 2 mail surveys at periods 6 months apart. The addition of perceived behavioral control to the TRA model significantly increased the variance accounted for in behavioral intention and subsequent behavior (p < .001). TPB constructs were related to physicians' intentions to educate adolescents about sexually transmitted disease transmission (R = .52, p < .001) and to their subsequent delivery of this service (R = .63, p < .001). Perceived behavioral control had direct effects on behavior and interacted with social norms and behavioral intentions. Applications of models such as the TRA or TPB have focused primarily on predicting the behavioral intentions and behaviors of patients. Results suggest that these models have relevance for studying the behavior of health care providers as well.