OBJECTIVE: Adolescents may avoid using needed care if services are not provided confidentially. This study compares providers' and adolescents' view of whether confidentiality has been discussed during preventive care visits. DESIGN: We surveyed: 1) all primary care providers in five community health centers (CHCs), and 2) 14-19 year old adolescents interviewed by telephone after preventive service visits at these CHCs. RESULTS: Of 82 providers, 73(89%) completed surveys. Overall, 67% of providers reported having discussed confidentiality with the last adolescent patient they had seen, and 78% reported usually discussing confidentiality with adolescent patients and their families. The proportion of providers who reported having discussed confidentiality with their last patient was 20% to 75% across CHCs (p=0.02). The proportion of providers who reported ever discussing confidentiality with adolescent patients was 50% to 75% (p=ns). Male and female and physician and non-physician providers were equally likely to have discussed confidentiality with adolescents. Of 239 eligible adolescents, 221 (92%) consented, and 149(67%) interviews were completed. Many adolescents (82%) reported discussing confidentiality with their providers at the current visit, and 13% more reported discussing it at prior visits. Among 100 patients whose providers usually discussed confidentiality, 88% reported discussing confidentiality at the current visit. Among 31 patients whose providers reported not usually discussing confidentiality, 71% reported discussing confidentiality at the current visit (p=0.03). Adolescents whose providers did not discuss confidentiality reported having withheld information about their health behaviors more than those whose providers discussed confidentiality (10% vs. 2%; p=0.05). CONCLUSIONS: Most CHC adolescent patients recall discussing confidentiality with their providers during preventive care visits. However, some providers do not discuss confidentiality with all of their patients, and this may result in omission of important health information. Confidentiality and consistent discussion of confidentiality are needed for adolescents to receive appropriate preventive care.