Today’s adolescents are engaging in risky sexual behaviors at earlier ages than ever before, resulting in nearly 250,000 teen births in 2014 and nearly 10 million new sexually transmitted infections annually. Sexually transmitted infections are a significant public health problem in the United States and of particular concern in the adolescent and young adult population. A big factor contributing to the spike is that often times, teens are reluctant to discuss their sexual health with their care team since information about sexual health related behaviors and risk factors has the potential to appear in care summaries, patient portals, insurance explanation of benefits and the like—all which adolescent and young adult patients worry can be viewed by parents and guardians. The lack of communication results in an increased risk for undiagnosed and untreated STIs, missed opportunities for behavioral health interventions, including guidance on managing risk and addressing social determinants of health, and increased disease burden in the community.
In order to improve sexual health screening and behavioral counseling in primary care, Possibilities for Change teamed up with the National Association of Community Health Centers (NACHC), the Health Center Network of New York (HCNNY), and four participating health centers across New Jersey and New York for a pilot project using the ACT Sexual Health System.
With today’s earlier onset of sexual activity comes an increased incidence of high-risk behaviors such as:
- Early sexual intercourse (before the age of 13 years)
- Multiple sexual partners (history of 4 or more lifetime partners)
- Inconsistent condom and contraceptive use
- Drug or alcohol use prior to sex
Research suggests that several key factors have a significant influence on sexual decision-making including: substance use prior to sex, depression and low self-esteem, homelessness, school failure, sexting, and history of abuse and dating violence. Our nation’s public health institutions have recognized the need to improve adolescent health care in the United States and are calling attention to this important issue. The Institute of Medicine (IOM), National Research Council, Pediatric Health 2011 Report concluded that “improving health outcomes for adolescents is essential to achieving a healthy future for the nation.”
In 2014, the Journal of the American Medical Association published a study that reported one-third of all adolescent health maintenance exams were completed without any discussion of sexual health. For those providers who did introduce the subject, an average of 36 seconds was spent discussing sexual health. It was concluded that strategies need to be utilized to engage adolescents in open discussions around sexuality, promoting healthy sexual development and decision-making:
- Prioritize adolescent sexual health and ensure that all adolescents are screened and counseled on their risk behaviors using standardized, validated tools – according to nationally-recognized guidelines;
- Become educated and aware of the inter-relationship between adolescent sexual health, high risk behaviors, and other population disparities;
- Participate in continuing education on effective adolescent counseling strategies that will actively engage youth in the behavior change process (such as Motivational Interviewing);
- Develop policies and processes to ensure adolescent engagement and comfort with disclosure of sexual feelings, behaviors and experiences; and
- Address necessary workflow modifications to ensure risk screening and behavioral counseling is consistently incorporated.
To learn more about the disparities and behaviors that contribute most to sexual risk and how primary care practices and school-based health centers can meet the needs of adolescents to positively impact their sexual health, download and view the recorded webinar.
How do you talk to adolescents about safe sex decisions? Share your experiences in the comments below!