S PR I NG 2 010
A D O L E S C E N T
M A T T E R S
Issues Focus
Baltimore’s Young meN:
in their prime?
Frequent exposure to violence. Drug use.
Three times the poverty rate as that of Maryland as a whole.1 Significant mental health
and sexual health issues. Obesity and lack of
opportunities for physical activity. Limited or
no access to regular medical care.
Health-wise, youth is traditionally considered the prime of life, but often that is not the
case for the men of Baltimore City. Disparities in health carry physical and psychological
consequences for young men, and also inf luence the health of their families and sexual
partners.
This issue brief examines the harsh world
in which these young men live every day,
identifies reasons why their health needs are
not being met, and offers recommendations on
how to reach this vulnerable population and
give them the medical and reproductive health
care they so urgently require.
Violence & Young Males (2007):
Crime’s a punishing way of life
69%
Baltimore
City
of deaths are caused by assault/
homicide among 15-24 yr-old
Baltimore males.2
Rate of violent
deaths per
100,000 juvenilesa
50% 55%
Male
students in ab
physical fight
30%
Male
Male students
students who
carrying weapons
carried a weaponb
on schoolb
property
31.2%
26%
10%
0%
United
States
Male students
who did not go to
school becauseb
they felt unsafe
46.4% 44% 44.4%
40%
20%
Maryland
27.7% 28.5%
13.2%
N/A
7.3% 9%
9.2% 6.7%
5.4%
SOURCES:
a
Maryland Department of Health and Mental Hygiene. (2007). Vital Statistics Annual Report 2007. Retrieved September 12, 2008 from: http://
www.vsa.state.md.us.
b
Centers for Disease Control and Prevention. (2008). Youth Risk Behavior Surveillance System (YRBSS). Baltimore, Maryland, United States,
Retrieved September 12, 2008 from: http://apps.nccd.cdc.gov/yrbss/sellocation.asp.
AC K NOW L E D G E M E N T S
The Center for Adolescent Health is a member of the Prevention Research Centers Program, supported by the Centers for Disease Control and Prevention cooperative agreement number 1-U48-DP-000040. Authors: David Popiel, MD, MPH; Arik V. Marcell, MD, MPH; Jayne Blanchard.
Issues Focus
S PR I NG 2 010
A D O L E S C E N T M A T T E R S
Substance Abuse & Mental Health (2007):
High rates of alcohol, suicide among male high school students
use marijuana
regularly
currently
drink alcohol
attempted
suicide
currently
smoke cigarettes
0%
10%
20%
30%
6.5% 4.6%
10.3%
40%
40.3%
50%
17.4%
22.4%
25.7% 23%
28.4%
10.4%
21.3%
Baltimore City
19.5% of
44.7%
Maryland
young male students in
Baltimore report feeling SAD and HOPELESS
United States
SOURCE:
Centers for Disease Control and Prevention. (2008). Youth Risk Behavior Surveillance System (YRBSS). Baltimore, Maryland, United States, Retrieved
September 12, 2008 from: http://apps.nccd.cdc.gov/yrbss/sellocation.asp.
Sexual Activity (2007):
Male students more likely to be sexually active
high school students in Baltimore
75.8% Male
who have ever had sexual intercourse
80%
70%
60%
50%
40%
30%
20%
10%
0%
81.5%
68.5%
57.3%
45.1%
34.3%
have been sexually
active in the last
3 months
31.5%
17.9%
had sexual
intercourse with 4
or more persons
during their life
10.1%
used a
condom at last
sexual intercourse
were sexually
active before the
age of 13
Baltimore City
United States
SOURCE:
Centers for Disease Control and Prevention. (2008). Youth Risk Behavior Surveillance System (YRBSS). Baltimore, Maryland, United States, Retrieved
September 12, 2008 from: http://apps.nccd.cdc.gov/yrbss/sellocation.asp.
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Issues Focus
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A D O L E S C E N T M A T T E R S
STI and HIV/AIDS Rates (2007):
Young Men at Risk for Disease
2500
2409.3
2100
1675
1250
1,278.6
825
775.3
545.1
400
330.1 279.1
24
Baltimore City
Maryland
United States
7
0
3.1
Syphilis in men
ages 15-19 years.
Cases/100,000
population 2007
Gonorrhea in men
ages 15-19 years.
Cases/100,000
population 2007
Chlamydia in men
ages 15-19 years.
Cases/100,000
population 2007
SOURCE:
STD Division-EDCP. DHMH. 2007 Population preliminary numbers from Maryland Office of Planning (Mar 2008). United States Rates from CDC STD Surveillance 2006.
Barriers to care
0
What’s keeping young men from seeking regular medical health care?
Lack of insurance is a primary reason, but other factors figure in as well.
6
The number of
questions a man
asks during
a 10-minute
doctor’s consult.
Insurance Young adults (18-
The number of
questions a 3
woman asks.
Male stereotypes Unlike
to-24 years old) in the United
States are the least likely of
any age group to have health
insurance—28.1 percent were not covered in 2007.4 African American, Latinos, high school absentees, poor and
near-poor young males are at the highest risk for being
uninsured.5 These men may delay medical care or not fill
a prescription because of cost.6
women, who are socialized to
use facilities related to women’s
health needs, males do not have
similar incentives.9 The culture of masculinity often falsely exaggerates young men as tough, independent, competitive beings who do not talk about their problems or ask
for help.10 Young men also generally feel healthy and may
not consider themselves at-risk for health problems.11
Inadequate access Uninsured or underinsured
Stigma Young men worry about image and some may
young men across America also report having no regular
source of health care or contact with a medical professional—unless it is the emergency room.7 In Baltimore,
the use of emergency rooms is even more striking when
you consider it is a city of distinct neighborhoods where
people tend not to venture beyond their own communities, especially for health care.8
perceive that clinics are either only for girls with reproductive health needs or persons with STDs. Free or
low-cost clinics widely known to provide care to HIV
patients and those with STD-related conditions may also
be avoided by young men because they are embarrassed or
do not want to be identified.12
Page 3
Issues Focus
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A D O L E S C E N T M A T T E R S
Steps You Can TakE
easily overheard, having private corridors separating the exam rooms from
waiting areas, and using pass-through
services directly from the bathroom to
laboratories so men do not have to carry
urine samples to a drop-off location.16
Make facilities male friendly
Health care facilities can make their facilities more male-friendly by using neutral
color schemes, artwork depicting males in
positive roles, brochures and publications
specifically discussing male health issues, recreational games and magazines
in the waiting area of interest to men,
male health care providers and volunteers present at the clinic or office and a
clinic name that is inclusive of men.14
Reach out Outreach efforts need to
4%
of family planning
clinics offer special hours
for male patients.13
Expand health care options Making school-based health services more
friendly and accessible to adolescent
males directly addresses Baltimore’s
geographical distinction as a city of
self-contained neighborhoods. Clinics
in the community could also consider
more flexible or extended hours to
keep more men from using emergency
rooms exclusively for health care and meet
the needs of men who are balancing work
schedules.
Respect privacy Concerns about
privacy are important to many men.15 Privacy can be respected by choosing written
communication over verbal in public
areas where conversations may be
target young men and inform them
about their options for health insurance as well as available clinical settings. Consider venturing outside of the
clinic setting and go where the boys
are—sports teams, gyms, malls, school
events—to engage them in health and
familiarize them with clinics in the
community. Such outreach can inform
them about services and highlight how
confidentiality and privacy are maintained.17 Consider using new technologies favored by youth, such as text
messaging or Web-based applications
(e.g. Facebook) to facilitate connection
and care use.18
Young Male Health ResourceS
H ealth Insurance
C linical S ettings
Primary Adult Care (PAC) for low income adults
age 19 and older www.dhmh.state.md.us/mma
MCHP
www.dhmh.state.md.us/mma/mchp
MHIP
www.marylandhealthinsuranceplan.state.md.us
Baltimore Health Care Access
www.bhca.org
P o pulati o n S e rv e d
STD Low-Cost
Teens Adults Primary
Care Care Care
Harriet Lane Center Teen Clinic
200 N. Wolfe St.
Healthy Teens & Young Adults
1374 W. North Ave.
Druid Family Health Center
1515 W. North Ave.
Druid STD Clinic
1515 W. North Ave.
410-955-5710
l
<25
l l
l
410-396-0353
l
<25
l l
l
Eastern STD Clinic
620 N. Caroline St.
Men’s Health Center
1515 W. North Ave.
410-396-0186
l
l
l
410-396-0176
l
l
l
410-396-9410
l
l
l
410-396-6367
l
l
l
Make facilities male friendly Ways to attract more males to health care facilities include neutral color schemes with artwork depicting males in positive roles, brochures
REFERENCES
and publications specifically discussing male health issues, recreational games and magazines in the waiting area of interest to men, and having male health care providers and
volunteers present at the clinic or office.18
Baltimore City Data Collective. (2008). Accessed
March 12, 2009 from: http://www.baltimorekidsdata.org.
1
Maryland Department of Health and Mental
Hygiene. (2008). Maryland Vital Statistics Annual
Report 2008. Accessed April 8, 2009 from: http://
www.vsa.state.md.us.
2
Centers for Disease Control and Prevention.
(2008). Youth Risk Behavior Surveillance System
(YRBSS). Baltimore, Maryland, United States,
Retrieved September 12, 2008 from: http://apps.
nccd.cdc.gov/yrbss/sellocation.asp.
3
4
Ibid.
5
Ibid.
Kaplan, S.H., Greenfield, S. (1991). Gender
differences in physician-patient communication
for patients seeing the same and opposite gender
physicians. Clin Res, 39(2), 627A.
6
DeNavas-Walt, C., Proctor, C.B. & Smith, J.
(2007). Income, Poverty, and Health Insurance
Coverage in the United States: 2007. U.S. Census
Bureau, August 2008.
7
Irwin, C.E., Burg, S.J. & Cart, C.U. (2002). America’s adolescents: where have we been, where are we
going? Journal of Adolescent Health. 31, 91-121.
8
Callahan, S.T. & Cooper, W.O. (2005). Uninsurance and health care access among young adults in
the United States. Pediatrics.116, 88-95.
9
10
Ibid.
Charmane Baker. Baltimore City Health Department, Personal interview, 2007.
11
Raine, T., Marcell, A.V., Rocca, C.H., & Harper,
C.C. (2003). The other half of the equation: Serving
young men in a young women’s reproductive health
clinic, Perspectives on Sexual and Reproductive
Health, 35(5), 208-214.
12
Marcell, A., Ford, C., Pleck, J. & Sonenstein, F.
(2007). Masculine beliefs, parental communication,
and adolescent males’ health care use. Pediatrics,
119(4), e965-974.
13
Cathy Watson. Baltimore City Health Department. Personal interview, 2007.
14
Gerry Wakefield. Lake Clifton, Patterson, and
Dunbar High Schools’ School-Based Health Cen15
Johns Hopkins Bloomberg School of Public Health
Department of Population, Family and Reproductive Health
615 N. Wolfe Street, Baltimore, MD 21205 Phone 443.287.3012
www.jhsph.edu/adolescenthealth
Page 4
ters. Personal interview, 2007.
Guttmacher Institute. (2008). Facts on young
men’s sexual and reproductive health. Accessed July,
2008 from: www.guttmacher.org.
16
Raine, T., Marcell, A.V., Rocca, C.H., & Harper,
C.C. (2003). The other half of the equation: Serving
young men in a young women’s reproductive health
clinic, Perspectives on Sexual and Reproductive Health,
35(5), 208-214.
17
Brewer, Benjamin. (2006). Virtual house calls
can cut costs without hurting quality of care Wall
Street Journal, August 8, 2006. Retrieved July 8, 2008
from: http://online.wsj.com/public/article_print/
SB115490123782128151,html.
18