Adolescent sex education: Making it a priority

Abstract

Adolescence is a tough time for many teens; these young people face many pressures from themselves, their peers, their parents, and the society in which they live. In early and middle adolescence, a strong desire for many adolescents is to be like their peers in as many ways as possible. It often seems contradictory that they want to flaunt their individuality and personality through their clothes, hairstyle, and music, yet want/need so much to be like their peers. Indeed, in early adolescence, that peer group is a critical influence in the evolving sense of identity of the adolescent. One aspect of development occurring during adolescence is their sexual development as the teen develops their secondary sex characteristics and sexual maturity. The hormones are fluctuating and emotional lability is common. This is a challenging time for the teen, the parent, and for us, the health care provider. One particular area that must be addressed in our ongoing work with adolescents is promoting comprehensive sex education. This education may be given by the PNP or, better yet, by the parents, but whomever is the educator, the important point is that sex education is mandatory for all teens.Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. The National Campaign to Prevent Teen Pregnancy just released a report “14 and Younger: The Sexual Behavior of Young Adolescents” (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar), a must-read for all health care providers who work with teens. It is good information for parents and teachers as well. The report, a compilation of seven papers on teen sexual behavior, provides some important data to consider in the development and implementation of sex education programs for teens. For me, some of the important findings included the fact that while the incidence of sexual intercourse in girls 15-19 has decreased, it has increased in girls 14 and younger (18-19% of 14 year-olds; 14-20% of girls and 20-22% of boys) (Terry, E., & Manlove, J., 2000Terry E Manlove J Trends in sexual activity and contraceptive use among teens. The National Campaign to Prevent Teen Pregnancy, Washington, DC2000Google Scholar). Although many of these young teens were not having sexual intercourse regularly or frequently, the long-term consequences are still important. Teens who engage in such early sexual activity have a greater risk of adolescent pregnancy (Kirby, D., 2001Kirby D Emerging answers: Research findings on programs to reduce teen pregnancy. The National Campaign to Prevent Teen Pregnancy, Washington, DC2001Google Scholar), as well as sexually transmitted diseases (STDs) (Miller, H., et al., 1999Miller, H., Cain, V., Rogers, S., Gribble, J., & Turner, C. (1999). Correlates of sexually transmitted disease infections among U.S. women in 1995. Family Planning Perspectives, 31, 4-9, 23.Google Scholar). Other important findings included the fact that the use of contraception in teens 12-14 years ranged from 50-75% for the first time they had sexual intercourse; further, one in seven of “sexually-experienced” 14 year-olds had been pregnant. Many of these teen girls had relationships with older teens and more than 10% of the girls described their first sexual experience as non-voluntary (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar).Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. As the report notes, such findings give important implications for those working with teens. First, we can see from these national studies that many teens in early adolescence are in “romantic” relationships and are sexually active. Second, many young teens are dating older teens and those girls dating boys three or more years older are more likely to be in a sexual relationship. Third, sex education needs to begin early (middle school or younger). Finally, many current sex education programs are not sufficient (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar). Teens need more than information on anatomy, physiology, and contraception.So, given these alarming facts, where do we go? Certainly, as advocates for teens, we must do more. We need to be sure we are providing good sexual education to the teens we provide care for. First, we need to be sure we are taking good sexual histories, and begin early, in the late school-age/early teen years. We must not just ask if the teen is having “sex,” but be specific in our questioning and don't try to guess by appearance, socioeconomic status, or prior knowledge of the teen and family which teens may be sexually active. If we ignore asking questions because a teen “wouldn't be likely to have sex,” we may be at risk for neglecting the health care needs of that patient. Recently, I read the book Epidemic: How Teen Sex Is Killing Our Kids by Dr. Meeker. I found this to be an excellent overview of teen sexuality, the problems, issues, and how to educate and support our teens. The message of this book is the importance of helping teens abstain from sexual activity or at least to wait until early adulthood. This is an excellent resource for teens and their parents. Dr. Meeker well explains the risks of STDs in young teens, addressing the effects on later health as well as child-bearing. She directly addresses issues regarding contraception, “safe sex,” and the emotional aspects of sexual behavior.There are many good resources for information on teen sexual behavior and education. Unfortunately some, if not many, groups have their own agendas to promote. Thus, it is important for the health care provider to read any materials and understand the viewpoint that is being proposed before recommending them. It is crucial to ensure teens and their parents receive accurate information. This information can be the basis for important decisions in the teen's life—decisions that may have long-term, if not life-and-death, consequences. We know that the risks of sexual intercourse in teens is no longer just pregnancy (as if that's not bad enough), but now teens need to understand that sexual behavior can have significant long-term implications.We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations. Many topics in health education seem to be cyclical—in one day, out the next—and sex education is certainly one of these topics. When HIV/AIDS was finally acknowledged and recognized as a significant threat to teens, sex education programs received lots of attention. Unfortunately, such attention tends to fade with time. We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations.Fall is a time of year when we often see teens for physical examinations; this is an excellent time to talk to teens and their parents about sex education. We can play a key role in supporting the long-term health of these young people; we can also play an important role influencing community and school programs aimed at providing sex education for teens. Although education is not sufficient, it is important to be knowledgeable about what sex education programs are available and their outcomes (see www.advocatesforyouth.org/programsthatwork/ for a report on research on the effectiveness of current sex education programs). However, teens need more than facts and figures provided at school, they need to communicate with their parents, and we can help parents teach their teens their values and beliefs as well as the knowledge the teens need. Sexuality is an important aspect of the developing teen and we can play an important role in this aspect of development. Adolescence is a tough time for many teens; these young people face many pressures from themselves, their peers, their parents, and the society in which they live. In early and middle adolescence, a strong desire for many adolescents is to be like their peers in as many ways as possible. It often seems contradictory that they want to flaunt their individuality and personality through their clothes, hairstyle, and music, yet want/need so much to be like their peers. Indeed, in early adolescence, that peer group is a critical influence in the evolving sense of identity of the adolescent. One aspect of development occurring during adolescence is their sexual development as the teen develops their secondary sex characteristics and sexual maturity. The hormones are fluctuating and emotional lability is common. This is a challenging time for the teen, the parent, and for us, the health care provider. One particular area that must be addressed in our ongoing work with adolescents is promoting comprehensive sex education. This education may be given by the PNP or, better yet, by the parents, but whomever is the educator, the important point is that sex education is mandatory for all teens. Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. The National Campaign to Prevent Teen Pregnancy just released a report “14 and Younger: The Sexual Behavior of Young Adolescents” (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar), a must-read for all health care providers who work with teens. It is good information for parents and teachers as well. The report, a compilation of seven papers on teen sexual behavior, provides some important data to consider in the development and implementation of sex education programs for teens. For me, some of the important findings included the fact that while the incidence of sexual intercourse in girls 15-19 has decreased, it has increased in girls 14 and younger (18-19% of 14 year-olds; 14-20% of girls and 20-22% of boys) (Terry, E., & Manlove, J., 2000Terry E Manlove J Trends in sexual activity and contraceptive use among teens. The National Campaign to Prevent Teen Pregnancy, Washington, DC2000Google Scholar). Although many of these young teens were not having sexual intercourse regularly or frequently, the long-term consequences are still important. Teens who engage in such early sexual activity have a greater risk of adolescent pregnancy (Kirby, D., 2001Kirby D Emerging answers: Research findings on programs to reduce teen pregnancy. The National Campaign to Prevent Teen Pregnancy, Washington, DC2001Google Scholar), as well as sexually transmitted diseases (STDs) (Miller, H., et al., 1999Miller, H., Cain, V., Rogers, S., Gribble, J., & Turner, C. (1999). Correlates of sexually transmitted disease infections among U.S. women in 1995. Family Planning Perspectives, 31, 4-9, 23.Google Scholar). Other important findings included the fact that the use of contraception in teens 12-14 years ranged from 50-75% for the first time they had sexual intercourse; further, one in seven of “sexually-experienced” 14 year-olds had been pregnant. Many of these teen girls had relationships with older teens and more than 10% of the girls described their first sexual experience as non-voluntary (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar).Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. Recent reports of teen sexual behaviors are frightening and certainly give impetus to our education of teens. As the report notes, such findings give important implications for those working with teens. First, we can see from these national studies that many teens in early adolescence are in “romantic” relationships and are sexually active. Second, many young teens are dating older teens and those girls dating boys three or more years older are more likely to be in a sexual relationship. Third, sex education needs to begin early (middle school or younger). Finally, many current sex education programs are not sufficient (Albert, B., et al., 2003Albert B Brown S Flanigan C 14 and younger: The sexual behavior of young adolescents (Summary). National Campaign to Prevent Teen Pregnancy, Washington, DC2003Google Scholar). Teens need more than information on anatomy, physiology, and contraception. So, given these alarming facts, where do we go? Certainly, as advocates for teens, we must do more. We need to be sure we are providing good sexual education to the teens we provide care for. First, we need to be sure we are taking good sexual histories, and begin early, in the late school-age/early teen years. We must not just ask if the teen is having “sex,” but be specific in our questioning and don't try to guess by appearance, socioeconomic status, or prior knowledge of the teen and family which teens may be sexually active. If we ignore asking questions because a teen “wouldn't be likely to have sex,” we may be at risk for neglecting the health care needs of that patient. Recently, I read the book Epidemic: How Teen Sex Is Killing Our Kids by Dr. Meeker. I found this to be an excellent overview of teen sexuality, the problems, issues, and how to educate and support our teens. The message of this book is the importance of helping teens abstain from sexual activity or at least to wait until early adulthood. This is an excellent resource for teens and their parents. Dr. Meeker well explains the risks of STDs in young teens, addressing the effects on later health as well as child-bearing. She directly addresses issues regarding contraception, “safe sex,” and the emotional aspects of sexual behavior. There are many good resources for information on teen sexual behavior and education. Unfortunately some, if not many, groups have their own agendas to promote. Thus, it is important for the health care provider to read any materials and understand the viewpoint that is being proposed before recommending them. It is crucial to ensure teens and their parents receive accurate information. This information can be the basis for important decisions in the teen's life—decisions that may have long-term, if not life-and-death, consequences. We know that the risks of sexual intercourse in teens is no longer just pregnancy (as if that's not bad enough), but now teens need to understand that sexual behavior can have significant long-term implications.We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations. We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations. We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations. Many topics in health education seem to be cyclical—in one day, out the next—and sex education is certainly one of these topics. When HIV/AIDS was finally acknowledged and recognized as a significant threat to teens, sex education programs received lots of attention. Unfortunately, such attention tends to fade with time. We need to be sure that each and every teen we provide care for receives comprehensive sex education, and that the adolescent is really informed about the risks and consequences (emotionally and physically) in a manner that gives accurate knowledge and full explanations. Fall is a time of year when we often see teens for physical examinations; this is an excellent time to talk to teens and their parents about sex education. We can play a key role in supporting the long-term health of these young people; we can also play an important role influencing community and school programs aimed at providing sex education for teens. Although education is not sufficient, it is important to be knowledgeable about what sex education programs are available and their outcomes (see www.advocatesforyouth.org/programsthatwork/ for a report on research on the effectiveness of current sex education programs). However, teens need more than facts and figures provided at school, they need to communicate with their parents, and we can help parents teach their teens their values and beliefs as well as the knowledge the teens need. Sexuality is an important aspect of the developing teen and we can play an important role in this aspect of development.