Teens want sexual health discussions with providers but talks often don't happen

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By Marilynn Larkin

NEW YORK (Reuters Health) - Most adolescents and their parents say discussions with their provider about sexual and reproductive health (SRH) are important, but such conversations do not occur routinely during preventive visits, survey results suggest.

"Our findings suggest clear gaps between parent and adolescent perceived importance of discussing sexual and reproductive health topics with primary care providers and adolescents' experiences during preventive visits," Dr. Renee Sieving of the University of Minnesota told Reuters Health by email. "While most parents and many youth that were surveyed noted the importance of providers discussing these topics, these discussions do not routinely occur."

"Discussions about SRH and other sensitive topics are most likely to happen as a part of confidential one-on-one conversations between adolescents and their providers," she noted. Yet, "'time alone' between adolescents and their providers during preventive visits was infrequent among adolescents in this study."

As reported in Pediatrics, Dr. Sieving and colleagues analyzed data from an online U.S. survey of 11- to 17-year-olds and their parents, including youth who self-identified as non-Hispanic white (54%), non-Hispanic Black (15%), Hispanic (24%), and other racial groups (7%). About half (49%) were female, 91% identified as heterosexual, and 17% lived in non-metropolitan areas.

Among parents, 54% identified as the mother or stepmother of the adolescent respondent, and 53% were ages 40 to 50.

Adolescents who had a preventive visit in the previous two years and their parents reported on the perceived importance of provider-adolescent discussions about such SRH topic as puberty, safe dating, gender identity, sexual orientation, sexually transmitted infections, and methods of birth control.

Whereas a majority of adolescents and parents deemed SRH discussions important, fewer than one-third of adolescents reported such discussions - other than about puberty - at their most recent preventive visit.

Discussions were particularly uncommon among younger adolescents. For example, at their most recent preventive visit, 14% of younger adolescents and 38.7% of older adolescents reported that providers asked about their sexual activity.

Within age groups, discussions about several topics varied by sex. For example, 19.4% of younger girls, versus 9% of younger boys, said providers asked about their sexual activity. Also among younger adolescents, a greater percentage of girls said providers discussed puberty (52.7% vs. 40% of boys). Among older adolescents, a greater percentage of girls reported discussions about birth control methods (37.3% vs. 18.1%).

Dr. Sieving said, "Providers need systems-level supports (e.g., routine use of health screeners) and guidance in implementing these recommendations within the healthcare systems and the communities in which they work."

"Our findings have important implications for training future healthcare providers in how to have conversations with adolescents and their parents about sensitive topics, including sexual and reproductive health," she concluded.

Dr. John Steever, a pediatrician at the Mount Sinai Adolescent Health Center in New York City, commented in an email to Reuters Health, "The study findings did not surprise me. It's pretty clear that with primary care, physicians are often pressed for time and have to focus on immediate medical concerns rather than health education. There's so much to cover--many important topics don't get covered."

"It's fascinating and sad how some of these super critical services are not done in the context of a primary care visit," he said. "This is a real opportunity, now that this is documented, to explore how to encourage physicians to do more education on these topics."

"These discussions are critical for young people's health," he noted. "Ultimately, physicians need more time with their patients. Pediatricians are trying to have these complex conversations during a 15-minute visit where they're also covering other issues."

"Pediatricians and others who treat children should have their time paid for preventive care," he added. "Prevention is ultimately better for the patient and significantly more cost-effective."

SOURCE: https://bit.ly/3itMS4n Pediatrics, online July 12, 2021.

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