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Adolescent Sexual Health

Angela Oswalt Morelli , MSW, edited by C. E. Zupanick, Psy.D.

sex education on blackboardAll adolescents who are sexually active should get regularly tested for sexually transmitted infections including but not limited to HIV/AIDS, syphilis, gonorrhea, Chlamydia, and Hepatitis B. If an infection is detected, the doctor can treat the youth for the infection and educate them about how to not spread the disease to others. These regular tests with medical professionals can also offer teens and older adolescents an opportunity to talk about their protection methods against sexually transmitted infections and unplanned pregnancy. Youth can learn about the different options available to them ranging from abstinence, condoms and other barrier methods, and the birth control pill and other medical interventions to prevent pregnancy. More information about teen sexual health can be found in the Adolescent Development article. Furthermore, all sexually active youth and any female age 18 years or older should receive an annual gynecological pelvic exam and Pap smear to monitor reproductive health and detect any changes in the cervical cells. During these exams, young women should also receive physical breast exams to identify any changes in breast tissue or lumps.

Parental Guidelines for Promoting Adolescent Health

Parents can help their teens get the medical care they need by monitoring their children's overall physical and emotional condition. Parents should discuss any concerns they have about changes in their children's moods, behaviors, and physical functioning since the last exam. Likewise, parents can encourage their children to be open and honest with their healthcare provider about their own concerns. Many healthcare providers encourage their patients to prepare for their appointment by writing out a list of questions or concerns. This enables the healthcare provider to structure the appointment time in the most beneficial manner. Parents may want to remind their youth of an upcoming appointment and ask them to prepare such a list. Eventually youth will need to take over the management of their own healthcare and this sort of preparation teaches them it is the patient's right and responsibility to initiate a frank discussion with their healthcare provider about any health concerns they may have.

In order to manage their own healthcare, adolescents must acquire several important skills. They must gradually become more responsible for independently meeting the needs of their body (exercise, nutrition, adequate rest, and basic hygiene); for monitoring and reporting symptoms; and for following the prescribed treatment plan for any medical conditions they may have. For example, youth with chronic medical conditions need to remember to take their prescribed medications, in the correct amount, at the right time; and they must remember to fill their prescriptions before they run out. Youth also need to learn how to monitor their symptoms on their own, and must determine when to seek medical help and when to manage symptoms without additional help. Youth also need to learn how to avoid triggers that will make their condition worse, and to develop a lifestyle that helps them feel their best.

They key to empowering youth to independently manage their own healthcare is to gradually give youth more and more control over their healthcare, while teaching them the skills they need for self-care. In early adolescence, youth should be taught when to take their medications and should be expected to come ask their parents for their medications on time instead of having their parents come to them with the medications. This way, parents can still monitor the medications and make sure the youth are taking the correct dose while simultaneously communicating to their youth that it is the youth's responsibility for remembering to take their own medication.

As mentioned, parents should encourage youth to come up with a written list of questions and concerns for their doctor before an annual checkup to highlight the importance of the patient's responsibility for their own healthcare. When teens are younger, their parents usually participate in their healthcare appointments. Parents can model responsible behavior by being prepared themselves and verbalizing their own questions and concerns. But even young teens should be encouraged to actively participate in their medical appointments. For instance, parents may need to refrain from answering for the child when the doctor asks a question. When parents do attend medical appointments with their child, they should be prepared to allow the doctor to speak privately with the child.

As well, parents of young adolescents shouldn't just nag their youth or constantly remind them what they should, or should not be doing with respect to managing their health. This includes lecturing them about what they should have done to prevent exacerbating their condition, or constantly pleading with them to make healthier choices. Instead, parents should listen to their youth talk about health concerns and then pose questions in such a way to enable the youth to stop and reflect on the choices they made that might be negatively impacting their health. Parents can also help youth explore solutions that enable them to make healthier choices. Let's use an example to illustrate what this approach might look like:

Grady is a 14-year-old with chronic acid reflux (GERD) he's had since he was young. In order to prevent painful stomachaches, "heartburn" and gas, Grady needs to avoid spicy, greasy, and acidic foods and must take medication every morning in order to keep his acid reflux symptoms under control. Since Grady is now getting older, his Mom wants him to start taking more responsibility for his GERD. One day she tells Grady that it will now be his responsibility to come ask her for his pill before he grabs breakfast and heads out the door in the morning. She also informs Grady that while he's adjusting to this change, she will provide him a total of three reminders. After that, if he forgets to ask for his pill, she won't chase after him anymore. Grady did need a few reminders at first, but soon Grady remembered to ask Mom for his pill every morning when he kissed Mom goodbye on the way to the bus. However, during one busy month, he began to run off to the bus without taking his medication, and one week, he forgot three days in a row. On top of that, Grady stopped paying much attention to what he was eating. When he was out with his friends he ate pizza and hot wings, and in the morning for breakfast, he drank orange juice every day. By Friday night, Grady was looking pretty sickly. Mom was tempted to holler at him about all the bad habits she's noticed this week. Instead, she just asks him how he's feeling, and he responds by telling her how absolutely horrible he feels tonight. Mom asks, "Oh, sweetie, do you think your acid reflux is flaring back up again?" Grady responds, "Oh, yeah, I've had heartburn almost constantly for the last two days straight." Once again, Mom avoids the temptation to nag and merely replies, "What do you think has made it so bad again? Do you think the medicine isn't helping anymore?" This question prompts Grady to reflect about whether he took his medication. In response, Grady says, "Well, hmmm…actually, I don't know if I remember taking it since Tuesday….Did I come get it from you?" Mom responds, "Hmm, I don't think so." Grady thinks some more, "Man, I haven't had my meds and I ate pizza today at lunch." Mom builds on this and says, "Yeah, and didn't you say you and Mike shared a bucket of hot wings last night?" This gives Grady the room to realize how important it is for him to take care of himself. "I need to make sure I don't forget my medicine this weekend or next week, and no more greasy fast food for a while!" Mom might offer some additional assistance, "Is there anything I can do to help you get back on track?"

By middle to late adolescence, parents should give their children even more responsibility for managing their own healthcare. Perhaps parents can supervise their youth carefully filling a weekly pill box. Since these boxes have separate compartments for each day of the week, youth can keep track of daily medications, and will know if they forgot to take medication one day (because the pills will still be in the box). Youth can be expected to access the pill box and to take their medication each day. This way, parents are still able to monitor children's adherence to their medication regime while making sure they are not misusing or abusing medication. For example, some medications, such as some medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), are frequently shared or sold between students because students misuse these drugs to stay awake all night to study for a big exam, or they use these drugs to get high.

Parents can also empower youth to practice making their own medical appointments by making it a habit to sit down together with both the parent's and teen's calendar and have the teen call the doctor's office to practice making the appointment and practice negotiating an appointment day and time that works with everyone's schedule. On the day of the appointment, teens can check themselves in at the check-in counter, and pay the co-pay at the end of the appointment. Likewise, teens can learn to call the pharmacy for refills, and can learn to arrange transportation to pick up and pay for their prescriptions, provided these are not drugs of abuse. As a general guideline, teens with a history of suicidal thoughts, or suicidal attempts should not be permitted to handle or manage their own medications unless directed by their healthcare professional that it is safe for them to do so.

By late adolescence, many youth are often living on their own and therefore need to be fully responsible for their healthcare. However, gentle inquiries and periodic check-ins on health-related topics from Mom and Dad can help the youth make the transition to completely independent self-care. In fact, many adolescents will welcome some assistance from parents at this stage, especially if youth have moved away and need to choose new healthcare providers or need to obtain healthcare insurance coverage. Even youth who remain at home may need to choose new healthcare providers. These youth may have received treatment from pediatric specialists, but as youth develop adult bodies, it becomes more appropriate for them to have specialists in adult medicine (called Internists). Parents can help youth think about the things that are important when choosing a new doctor such as: the proximity to their home, recommendations from others, the size of the practice, quality of the hospital where they have privileges, acceptance through their health insurance, or even the sex of the doctor. Adolescents that attend a college or university will usually have access to routine, outpatient healthcare through the campus's medical center. However, these campus services do not usually include emergency medical treatment, surgical procedures, or other inpatient services. Parents can help their youth by making sure youth know how to schedule routine appointments and how to access urgent care. Furthermore, parents should educate their youth about health insurance as discussed in the next section.