Sanford Clinic Women's Health

Communicating With Your Child: The Birds, Bees, and STDs

Topics Covered Include:

STATISTICS

  • 1 in 4 teens will get an Sexually Transmitted Disease/ Sexually Transmitted Infection by the time they are 21 (15)
  • 50% of reported STI's occur in individuals age 15-24 (15)
  • American teenagers are contracting HIV at the rate of 2 per hour (14)
    • New cases of HIV and AIDS are not increasing significantly in the United States, but a greater percentage of new cases are being transmitted by sex (rather than by contaminated needles or blood). Approximately 75% of HIV infections are transmitted sexually. Approximately half of new HIV infections occur among youth ages 15-24 (2)
  • AIDS is one of the top ten leading causes of death for youth age 15-24 (www.kff.org )
    • The three highest risk groups to contract HIV are (in descending order) = homosexual males, minority ethnic groups, and youth

STATISTICS

  • Nationwide, nearly half of all high school students have had sex, and approximately 14% have had four or more partners (2)
  • Only 4 in 10 sexually active American teenagers use contraceptives (7)
    • The typical short-duration partner relationships of adolescence reduce the probability of consistent contraceptive and condom use.
    • A perceived lack of confidentiality can prevent adolescents from seeking and/or using birth control methods consistently or correctly.
    • Concerns about menstrual irregularities and side effects with use of hormonal contraceptive methods, as well as fears or misconceptions about having a pelvic examination, developing weight gain, and prevention of future fertility, can discourage adolescents from using steroid contraception successfully (5)
  • The U.S. has the highest STI and teenage pregnancy rate of any industrialized country (3)
    • Adolescents in most other developed countries (i.e. Sweden, France, Canada, England) have similar rates of abstinence and sexual activity as US adolescents but much lower pregnancy rates because of higher contraceptive utilization (1)
  • In South Dakota, the most prevalent STD's are Chlamydia and Herpes infections
    • Chlamydia (in the United States)= new cases for youth ages 15-24 in 2000 were estimated to be 1.5 million, or 54% of the total cases (2)
    • Herpes (in the United States) = for youth ages 15-24, it is estimated that there are 640,000 new infections per year. The estimated prevalence for youth in 2000 was over 4 million, or 15% of sexually active youth (2)
    • S.D. follows both of these National averages (www.state.sd.us )
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What raises the risk of teens becoming sexually active?

  • Lack of family support
  • Alcohol and drug use
  • Low self-esteem and depression
  • Fear of talking with a partner about sexual topics
  • Having a partner who is 3 or more years older (2)
    • Of same age relationships among those aged 12-14, 13% include sexual intercourse
    • If the partner is two years older, 26% of the relationships include sex
    • If the partner is three or more years older, 33% of the relationships include sex
  • Youth who do not believe they could become pregnant or acquire an STI (5)
    • Youth between the ages of 12-14 usually do not perceive any negative consequences of sexual activity.
    • By age 15-17, most teens understand the consequences of unprotected sex, but believe they themselves won't become pregnant or acquire an STI.
    • Not until age 18 do teens understand that the risks associated with sexual activity apply to them.
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What reduces the risk of teens becoming sexually active?

  • Close parent-child relationships
    • Overall closeness between parents and their children, shared activities, parental presence in the home, and parental caring and concern are all associated with a reduced risk of early sex and teen pregnancy (10)
    • Teens say their parents (37%) influence their decisions about sex more than friends (33%), the media (5%) or siblings (6%) (www.teenpregnancy.org )
    • The overall quality of the relationship appears to be more “protective” than specific conversations about particular sexual issues (10)
  • Frequent parent-teen communication
    • Parental disapproval of teens becoming sexually active is one of the top reasons teens list for remaining abstinent (11)
  • Parental monitoring (i.e. know where young people are and what they are doing)
  • Friends who support safer sexual behaviors
  • Participation in youth organizations
    • Of those teens who have not had sex, the primary reason for their decision was that it was “against religion or morals” (www.teenpregnancy.org )
  • Youth who believe they could get pregnant or get an STI
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Prepare Yourself to Talk with Your Child

  • Educate yourself
    • Educate yourself/ be prepared- Rehearse how you want to respond if any subject that is sensitive for you would come up.
  • Clarify your own sexual attitudes and values
    • To do this, you may want to think about the following kinds of questions:
      • What do you really think about school-aged teenagers being sexually active- perhaps even becoming parents?
      • What do you think about encouraging teenagers to abstain from sex?
      • What about educating teenagers concerning STI's and contraception?
      • With these last two questions, can we talk about both abstinence and contraception OR is it a mixed message?
        • The overwhelming weight of scientific evidence suggests that addressing abstinence and contraception does not: hasten the onset of sex; does not increase the frequency of sex; nor does it increase the number of sexual partners (10)
        • By teaching children about both abstinence and sexual health, when they are in situations where there is temptation to act in ways that may be risky, they have the ability to consider alternatives and to look at the consequences of various decisions.
  • Be a parent with a point of view- don't be reluctant to say such things as:
    • “Because sex should be associated with commitment, I think high school-age teens are simply too young to have sex”.
    • “Individuals who have sex should always use protection until they are ready to have a child”.
    • “Our family's values and/or religion say that sex should be an expression of love within a marriage…therefore, I hope you will choose to wait”.
    • Use the above statements to lead into further discussion
  • Don't let their silence, silence you
    • Do not assume a silent child knows everything they need to know.
    • Try asking for information indirectly.
      • “What do most kids in school do if they feel pressured to do something”
      • Ask what your child thinks or feels about what the other kids are choosing to do/ not to do.
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Getting started

  • Talk with your child early and often about sex
    • Age-specific guidelines: www.advocatesforyouth.org
    • Age-appropriate conversations about relationships and intimacy should begin early in a child's life and continue through adolescence. Resist “the talk”-make it an 18-year conversation.
    • Remember that you communicate with your kids all the time about relationships and sexuality, simply by the way you live your life. By the way you treat, appreciate and relate to others.
  • Share your own feelings and values
  • Listen carefully
    • Be sure to have a two-way conversation, not a one-way lecture
  • Avoid assumptions
    • Don't jump to conclusions.
    • The fact that a teen asks about sex does not mean they are having or thinking about having sex.
  • Arm your child with information
    • GOAL= want them to have the ability to make reasoned choices about sexuality based on knowledge
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Educate Your Child

  • Acknowledge that:
    • Abstinence is normal and healthy
      • Make sure your child understands that sexual involvement can be a wonderful, loving experience in the future, but it also:
        • Brings a lot of emotional responsibilities, such as caring for the needs and feelings of their partner and
        • Being willing and prepared to take responsibility for the consequences of sexual intercourse
    • Sexual development is healthy and natural
      • Educate your child on the changes that will take place in their body during puberty
      • Discuss together the factors that you believe should be a part of sexual choices (i.e. age, mutual consent, protection, contraceptive use, love, intimacy, etc.)
    • There are many ways to express sexuality that do not include sexual intercourse
  • Discuss the feeling of being “swept away”
    • Many teens say they had sex because they “just got swept away” and often this means no protection. Be clear with them that this is not okay. They need to have a plan in order to know how to react in such situations.
    • If they find themselves in a passionate situation, they should control this passion by allowing their mind to take over and help make decisions.
  • Identify how to avoid/ get away from sexual situations that feel uncomfortable or dangerous

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  • Encourage Teens To:
  • Wait to date, be friends first
    • Help them understand that if someone really loves them, they will wait until they are ready.
  • Date someone with the same values
  • Date someone their own age
  • Agree on certain boundaries with their partner
  • Plan ahead
    • Finding yourself in a sexually charged situation is not unusual; you need to think about how you'll handle it in advance.
      • Have a plan. Will you say “no”? Will you use contraception? How will you negotiate all this?
  • Avoid stimulation & intimate environments
    • Avoid being alone with a boyfriend or girlfriend
    • Go out with other couples
  • Think of what to say in advance if someone tries to pressure them into sex:
    • “Everyone is doing it, why can't we? You're the only one I'll ever love”
      • “If I am the only one you'll ever love, we'll have lots of time later”
    • “It's o.k., I have a condom”
      • “I am glad you are thinking about protection, but I still do not want to risk it. The condom could break or fall off”.

Encourage Teens To:

  • Consider their values
    • Teach them that if they are thinking about doing something, but it doesn't feel right—it is probably because it doesn't match their values
  • Identify their future goals
    • Teens who are hopeful about their futures and have high aspirations are more likely to avoid becoming pregnant
    • Goals can help them stay focused on what they want for themselves and reinforce positive behaviors.
  • Think through all of the possible consequences of sex:
    • How will becoming infected with Herpes affect my future relationships?
    • How realistic are my idea's about raising a child?
    • Do I want to pay child support for the rest of my life?
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Parental Monitoring

  • Know what your kids are watching, reading, and listening to
    • As we all know, sex in the media often: has no meaning; unplanned pregnancy and STI's seldom happen; and few people in the media having sex ever seem to be married or even especially committed to each other.
      • Is this consistent with your expectations and values? If not, it is important to talk with your children about what the media portray, what you think about it, and to understand what your children think about it.
  • Know where they are and what they are doing
    • If your children get out of school at 3 pm and you don't get home from work until 6 pm, who is responsible for making certain that your children are not only safe during those hours, but also engaged in useful activities?
  • Know your children's friends and their families
    • Where are they when they go out with friends?
    • Are there adults around who are in charge?
  • Establish rules, curfews and standards of expected behavior
    • Meet with the parents of your children's friends so that you can get to know them and establish common rules and expectations.
      • It is easier to enforce a curfew that your entire child's friends share rather than one that makes him or her different.
    • Establish rules early, so your child does not associate the rules with you not liking their partner. For example:
      • Tell your child that he/ she will not be able to date one-on-one until a certain age, and will have to date with other couples until then.
      • It should be noted, however, that there is a happy median here and that “very strict” monitoring by parents is associated with a greater risk of teen pregnancy (10)
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Teachable Moments

  • A teachable moment is an opportunity that you find to say something brief about sexuality that might affirm a value important to you, or provide accurate information, or express the way you feel about a sexual situation
  • A friend's pregnancy, news article or a TV show can help start a conversation
    • Write it down or record it.
    • Send it by e-mail or post a cartoon/ article where he/she will see it.
  • Your child may be most open to conversations about sexual health near bedtime (i.e. when he/she is processing everything they have seen and heard throughout the day)
  • In the car ‘take prisoners'
    • In the car, neither one of you needs to make eye contact and there are fewer interruptions
  • Identify with your child other trusted adults with whom they can talk
  • Allow for your child to have private sessions with a health care provider
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Outline Adapted from “Parent Presentation” (2004)

Downtown Women's Healthcare Clinic

Laurie Kruse, RN

References

  1. Boonstra, H. (February, 2002). Teen pregnancy: Trends and lessons learned. The Guttmacher Report on Public Policy.
  2. Cates, J.R., Herndon, N.L., Schulz, S.L., & Darroch, J.E. (2004). Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases. Chapel Hill, NC: School of Jounalism and Mass Communication, University of North Carolina at Chapel Hill.
  3. Centers for Disease Control. (2001). Births to Teenagers in the United States, 1940-2000. 49(10, PHS, 2001-1120).
  4. Cothran, H. (2001). Teen Pregnancy and Parenting. San Diego, CA: Greenhaven Press.
  5. Davis, M.D. & Sulak, M.D. (2004). Adolescent Sexual Health. Dialogues in Contraception, 8(7), 5-8.
  6. DiCenso, A., Guyatt, G., Willan, A. & Griffith, L. (2002). Interventions to reduce unintended pregnancies among adolescents: Systematic review of randomized controlled trial. British Medical Journal, 324(7351), 1426-1431.
  7. High U.S. Teen Pregnancy Rate. (2002, February). Family Practice News, 32(4), 24.
  8. Kmietowicz, Z. (2002). US and UK are top in teenage pregnancy rates. British Medical Journal, 324(7350), 1354.
  9. National Campaign to Prevent Teen Pregnancy: 1 in 5 teens have had sex before age 15. (2003). Contemporary Sexuality, 37(6), 10.
  10. National Campaign to Prevent Teen Pregnancy. (May, 2003). Parent power: What parents need to know and do to help prevent teen pregnancy. Johnson & Johnson.
  11. Resnick, M.D., Peter, S.B., Robert Wm. Blum, et al. (1997). Protecting Children from Harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA, 278, 823-832.
  12. Smith, P.B., Buzi, Ruth, S. & Weinman, M.L. (2002). Programs for young fathers: Essential components. North American Journal of Psychology, 4(1), 81-89.
  13. Somers, C.L., Johnson, S.A. & Sawilowsky, S.S. (2002). A measure for evaluating the effectiveness of teen pregnancy prevention programs. Psychology in the Schools, 39(3), 337-342.
  14. Starkman, J.D. & Rajani, M.A. (2002). The case for comprehensive sex education. Aids Patient Care & STDs, 16(7), 313-318.
  15. STD Quarterly. (May, 2004). Youth are at risk for sexually transmitted diseases: What can providers do to stem the tide? Contraceptive Technology Update.
  16. U.S. Department of Health and Human Services. (2001). Births: Preliminary Data for 2001. 50 (10,PHS, 2002-1120).
  17. Warner, V. (1998). Abstinence: Why sex is worth the wait. Concerned Women for America, 10.
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Websites:

Kaiser Family Foundation's Youth and HIV/STDs.

U.S. Department of Health & Human Services: Office of Public Health & Human Services (“Teen Talk”, 2003)

American social Health Association. STD statistics (2001)

  • MSNBC.com/ Nearly 3 in 10 young teens ‘sexually active': NBC News, PEOPLE, Magazine commission landmark national poll.

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