Background: Adult males use health services less often than females; these gender differences likely begin in adolescence but are not well studied.

Objective: We describe gender differences in adolescent health care use from three national surveys on adolescents & their care.

Methods: A comparison of adolescent office visits by gender was conducted for the National Ambulatory Medical Care & National Hospital Ambulatory Care Surveys (NAMCS & NHACS, 1994), & the Comprehensive Adolescent Health Services Survey (CAHSS, 1995).

Results: In the NAMCS & NHACS, females aged 16-20 account for more visits than males to pediatricians (58% vs. 42%), family physicians (58% vs. 42%), emergency dept (ED) (54% vs. 46%) & hospital-based outpatient clinics (73% vs. 27%) (p<0.0001). Among 11-15 yr olds, females account for more visits to family physicians (55% vs. 45%), but males had more visits to pediatricians (54% vs. 46%), internists (80% vs. 20%) (p<0.001), & the ED (53% vs. 47%) (p=0.037). No gender differences were found in use of hospital-based outpatient clinics. Among teen programs described in 413 sites in the CAHSS (ages 13-19), the proportion of visits by females was higher than those for males in all program types: school-based health centers (60% vs. 40%), community health centers (69% vs. 31%), hospital-based programs (66% vs. 34%), & health dept programs (79% vs. 21%) (p<0.006). Few of these programs (28%) report serving more than forty five percent male teen patients.

Conclusions: Male adolescents are seen in most care settings through mid-adolescence, yet use of services by males declines in older adolescents, especially compared to female counterparts. Many adolescent programs serve a majority of female patients; only school-based clinics see a more comparable proportion of males and females. These results provide first steps to understand adolescent gender differences in health service use. Better understanding of what motivates males to use health services & how to keep older male adolescents engaged with care is needed to ensure that appropriate services are delivered to teens of both sexes.