12 Aug Youth STD Prevention Program Focuses on Parents
MedicalResearch.com Interview with:
Vincent Guilamo-Ramos, PhD
MPH, LCSW, RN, ANP-BC, PMHNP-BC, AAHIVS, FAAN
Vincent Guilamo-Ramos is dean and professor at the Duke University School of Nursing, vice chancellor for nursing affairs, Duke University, and director of the Center for Latino Adolescent and Family Health (CLAFH) at Duke.
Dr. Guilamo-Ramos served as a member of the National Academies of Sciences, Engineering, and Medicine (National Academies) Committee on Prevention and Control of STIs in the U.S. that wrote the recent consensus study report. He also serves as a member of the Presidential Advisory Council on HIV/AIDS (PACHA) and the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents.
MedicalResearch.com: What is the background for this study?
Response: The National Academies of Sciences, Engineering, and Medicine (National Academies) recently released a consensus study report on prevention and control of sexually transmitted infections (STIs) in the United States. The report entitled “Sexually Transmitted Infections: Adopting a Sexual Health Paradigm” includes a strong emphasis on adolescents and young adults as an important priority population for the response to record-level STI rates that have reached an all-time high for the sixth year in a row in 2019. The report also highlights the well-supported and crucial role of parents in addressing STIs and promoting sexual health among adolescents and young adults. In this new Viewpoint article, my co-authors and I, who contributed to the National Academies report as committee members or consultants, discuss the practical implications for health care professionals of engaging parents in adolescent sexual health services.
MedicalResearch.com: What are the main findings? Has the attitude that HIV and most other STDs are treatable, reduced the urgency to use condoms?
Response: The National Academies report reviews a large body of evidence for the influential role of parents in shaping adolescent sexual decision-making, behavior, and sexual health outcomes. However, programmatic and clinical approaches for addressing adolescent sexual health and for preventing STIs too often focus solely on the adolescent directly, without engagement of parents in adolescent sexual health promotion. In clinical practice, health care providers often report confidentiality concerns in adolescent sexual health services as barriers for greater efforts to engage parents. It is important to note that these concerns are valid—adolescents are more likely to receive important sexual health services if they spend time alone with their provider.
Of note is that effective programs for appropriate parental engagement in adolescent sexual health services exist. Novel triadic intervention approaches serve as formal frameworks to facilitate parent-adolescent–health care provider partnerships without compromising adolescent patient confidentiality or interrupting clinic flow. Broader adoption of existing and effective triadic intervention programs designed to engage parents in adolescent and young adult STI prevention and sexual health promotion is therefore warranted. The Families Talking Together (FTT) triadic intervention represents one example of such a program. FTT has recently been highlighted by the US Prevention Services Task Force as an effective parent-based behavioral counseling intervention for STI prevention.
In regard to attitudes toward HIV and STIs, it is important to note that for too long the dominant perspectives have viewed sexual health as a collection of discrete health outcomes, such as HIV, STIs, and unplanned pregnancies, that warrant specific and separate approaches to prevention and care. A major focus of the National Academies report is the call for a paradigm shift toward recognition of sexual health as an integral component of overall health and wellbeing that warrants a much more holistic and comprehensive approach to programs, service delivery, and workforce.
MedicalResearch.com: What should readers take away from your report? What should be done for youth who do not have parents able to teach and promote sexual health?
Response: The key takeaway is that parents matter in addressing STIs and promoting sexual health among adolescents and young adults. In our research, we define “parent” as any adult primary caregiver—who may or may not be a biological parent. What is striking is that despite the well-supported role of parents in shaping adolescent sexual health outcomes and the availability of effective programs for engaging parents in sexual health promotion, parents have to date only played a small role in the national strategy for addressing STIs and sexual health more generally. Broader prioritization of parent-based approaches for adolescent and young adult sexual health promotion is sorely needed.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Implementation science research to accelerate the uptake of triadic interventions such as FTT is needed. As discussed above, effective programs to engage parents in adolescent sexual health promotion, such as FTT, exist, but uptake in adolescent primary care clinics and health systems has to date been suboptimal. Research is needed to develop best practices for integration of these programs into clinical practice at a larger scale. In addition, more empirical data is needed to further strengthen the case for broad adoption.
MedicalResearch.com: Is there anything else you would like to add?
Response: Beyond greater engagement of parents in sexual health promotion among adolescents, other innovative models for delivery of sexual health and STI services are needed to reduce long-standing sexual health disparities, including among ethnic and racial, sexual, and gender minority youth. Decentralized service delivery models in community settings or pharmacies, represent a particularly important opportunity for increasing the reach of sexual health services in communities that are disproportionately affected by STIs, but underserved by traditional healthcare systems. In this context, steps to enable providers to deliver sexual health services to the full scope of their training and practice represents an important first steps. Too often, regulatory or administrative barriers to the delivery of sexual health services exist—for example for nurses, nurse practitioners, physician assistants, and pharmacists. Steps to ensure these highly trained providers can be fully leveraged for sexual health promotion and the response to STIs are essential.
Dr. Guilamo-Ramos is the primary developer of Families Talking Together.
Guilamo-Ramos V, Thimm-Kaiser M, Prado GJ. Parent-Based Sexual Health Promotion and Sexually Transmitted Infections Prevention for Youth. JAMA Pediatr. Published online August 09, 2021. doi:10.1001/jamapediatrics.2021.2429
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