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Close Parental Relationships Could Delay Adolescent Sex

One of the tasks parents dread most is talking to their children about sex. Yet with the rates of teenage pregnancy soaring, along with an alarming rise in sexually transmitted diseases (STDs), the need to communicate has never been more urgent. And not just the old birds and bees talk � kids as young as 7 already know where babies come from and how they get there � but regular, frequent conversations about sex and the consequences.

A number of recent studies confirm that parents may not be aware their adolescent children are sexually active.

A study just published in early September in The Journal of Adolescent Sex noted that half the mothers whose teenagers were having sex were unaware. Another study cited in the report observed that close relationships with mothers seemed to discourage youngsters from sexual activity, especially through junior high school.

That fits in with the experience of LuAnn Moraski, DO, Assistant Clinical Professor of Pediatric Internal Medicine at the Medical College of Wisconsin and Program Director for the Internal Medicine-Pediatrics residency program at the Medical College. �We know that about 1 kid in 3 has had sex by the time they enter high school, and 3 out of 5 by the 12th grade,� says Dr. Moraski.

Let the Doctor Help
Many of Dr. Moraski�s patients with adolescent children turn to her for advice or hope she will take over the job of telling their teenagers about the risks associated with sex at an early age. �I deal with it every day,� she says. �I have a lot of parents who ask me, �Do you preach abstinence?� I tell them my job is to keep them healthy, and I discuss issues that affect their health.�

�It�s a different world out there than when we grew up,� she says. �It�s the information age and that, coupled with what kids see on TV and in movies, means they�re bombarded with information � a lot of which is explicit. They�re presented with information they�re not emotionally or cognitively prepared to deal with. Adolescents reason differently than adults do.�

The research published in The Journal of Adolescent Sex noted that close relationships with mothers seemed to discourage youngsters from sexual activity. And although the vast majority of mothers surveyed strongly disapproved of their teenager's having sex, many of those teens did not realize how their mothers felt.

Adolescence is also an age where kids challenge the authority of their parents and other adults, Dr. Moraski points out. �Kids will push you away. It�s a natural part of their maturing process. They�re developing their own sense of self. They separate, and they turn to their peers for support and information. The problem is, the information they get from their peers isn�t always good information,� she says.

Another recent research study, published in the health affairs journal Milbank Quarterly, showed that teens whose parents smoked were about 50% more likely to have had sex by the time they were 15 years old. They were also more likely to drink, associate with substance-using peers and participate in delinquent activity, it reported. The study used data from the National Longitudinal Study of Adolescent Health, which includes information on sexual behavior for 19,000 13- to 18-year-olds.

Boys were more likely to have sex if their parents failed to use seatbelts � but not girls. "If parents engage in risky behavior, it encourages kids to engage in risky behavior,� Dr. Moraski says. �Kids start smoking in the 5th grade, so I start discussing smoking with them when they�re in the 3rd grade.�

Adolescents by nature start taking risks, and that can includes risky sexual behavior. Parents realize that, and they often ask their pediatricians for help. �I can often break the ice when they can�t,� Dr. Moraski says. �It�s never easy. I talk to parents and their child together, then I ask the parents to leave. When the child and I are alone, that�s often where I learn they know more than their parents might have suspected.�

Kids Deserve Medical Confidentiality
�I assure them of confidentiality,� she adds. �Every patient, regardless of age, deserves confidentiality. I tell my adolescent patients the only reason I�ll violate that confidentiality is if their health is in imminent danger.� Danger means acute risk of injury or death to themselves or others.

Does her pledge of confidentiality include providing teens with contraception if they are sexually active? �My whole job is keeping people healthy,� she says. �I explain the risks and consequences of sex. Ideally, they won�t be having sex, but if they are or intend to, the next best thing is that they understand the importance of protecting themselves against pregnancy, HIV and STDs.� Today, many new and highly effective lower-dosage prescription contraceptives are on the market in addition to the birth control pill, along with non-prescription methods. Condoms, which do not require a prescription, are readily available and provide the safest protection from pregnancy and STDs when used correctly. Nothing is 100% safe, however, and that is something they need to know.

Although she assures her adolescent patients of confidentiality, she also tells them that physical examinations, lab tests (such as pap smears) and prescriptions do leave paper trails, and their parents or other responsible adults may find out about them.

Dr. Moraski says she wasn�t at all surprised by the recent research showing that sexually active girls under the age of 18 were less likely to seek out health-care services if their parents were going to be notified when they try to get birth control pills or other contraceptives. The study, published in the August 14 edition of the Journal of the American Medical Association, polled 950 sexually active girls in Wisconsin who received sexual health care at 33 Planned Parenthood clinics in 1999. Most of the Milwaukee girls who said they would stop using sexual health-care services if their parents were told, also said they would continue having sex nevertheless.

�It was no surprise, but it�s helpful to have objective data to clarify the issue,� said Dr. Moraski, who along with most medical organizations strongly opposes mandatory parental consent legislation. She has done legislative advocacy work for the American Academy of Pediatrics. The medical community has taken a firm stand against notification laws, but Congress is again considering a bill that would require states that receive federal health care funds to legislate mandatory parental "consent or notification" for minors who buy "prescription drugs or devices." During the past five years, at least 10 states have attempted to mandate parental notification for girls requesting access to prescribed contraceptives, according to the study. Twenty-four states currently have such notification and consent laws; Wisconsin is among the states that do not.

�I do understand why some people want parental consent laws,� Dr. Moraski says. They think it�s in the best interest of the child. But kids are having sex, and if we change the law, their health will be adversely affected.�

She urges parents to bring their daughters in for a pelvic exam and Pap smear before they become sexually active to serve as a baseline for future exams after they do start having sex.

Being a parent today is tough, agrees Dr. Moraski, herself the mother of a girl and a boy, 4 and 2. �But you have to deal with it. For a parent to simply express disapproval of sex is not enough. If you�re not telling them how it works and the consequences someone else will, and it might not be sound information. Start a dialog with your kids about sex and its consequences by the time they�re 10. Continue discussing it, even if they don�t want to. Ask specific questions. Admit you went through this during puberty, too. But tell them frankly, �I don�t know what it�s like being a kid today.� �

Finally, she says to parents: �Give yourself some credit. If you�ve done your best to give them good values, they have them.�

This article includes information from:
Medical College of Wisconsin Department of Pediatrics

Article Created: 2002-09-13
Article Updated: 2002-09-13

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.

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