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Discussing Sexual and Reproductive Health During Preventive Visits: Missed Opportunities :

July 13, 2021

The Bright Futures Guidelines of the American Academy of Pediatrics recommend that health maintenance visits integrate topics regarding sexual and reproductive health (SRH) beginning in the pre-teen years continuing through adolescence.

The Bright Futures Guidelines of the American Academy of Pediatrics recommend that health maintenance visits integrate topics regarding sexual and reproductive health (SRH) beginning in the pre-teen years continuing through adolescence. How well are we following this recommendation? Sieving et al (10.1542/peds.2020-049411) share with us an analysis of a nationally representative survey of adolescents between 11 and 17 years of age and their parents who were part of the confidential adolescent health services study. More than 800 parent-teen dyads responded to surveys regarding how important SRH topics are for discussion during a health maintenance visit, whether confidentiality was discussed at any point, and what topics were covered in the most recent visit they had within the past two years.

The results of this study are quite concerning. For example, only 14% of the 465 younger teens (ages 11-14) and only 39% of the 388 older teens (15-17) surveyed were asked if they were sexually active. Puberty was the most commonly discussed topic and that was only discussed 46% of the time for the younger teens and 54% of the time for older teens. Only 24% of younger adolescents and 42% of older adolescents reported having confidentiality discussed during a visit and the data was similarly concerning for parents (31% of younger teen parents and 36% of older teen parents). Most concerning were the many topics that youth and parents felt were important and hoped to discuss but were not, such as whether to have sex, sexual identity, and where to get SRH services if needed.

So what can we learn from this study and act upon? We asked adolescent specialists Drs. David Bell and Samantha Garbers to share in an accompanying commentary (10.1542/peds.2021-050447). They point out the importance of this study and call our attention to the main finding that both parents and teens are very interested in talking about SRH with us. The commentary authors realize that we can only cover so many topics in one visit but remind us that this is not about one visit, but a continuum of visits that should start in pre-adolescence with a conversation about confidentiality. If you are covering the topics noted in this study, we salute you, and if not, then perhaps linking to this study and commentary will help you start to include SRH as more of a mainstay in annual preventive visits with your adolescent patients.

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