Monday, November 26, 2007

Strategies for Decreasing Teen Pregnancy and Sexually Transmitted Diseases

"According to the Center for Disease Control (CDC) report Trends in Reportable Sexually Transmitted Diseases in the United States (2005), 19 million new sexually transmitted infections were diagnosed in 2005 with almost half of them being among young adults ages 15-24. Also, despite recent declines, the teen pregnancy rate in the United States is still one of the highest among the industrialized nations.

Due to this increase in sexually transmitted diseases and teenage pregnancy, nurses as leaders in patient education, should campaign for better sex education by offering parent education classes, classes for adolescents in a relaxed or non-regulated environment, and reproduction support for sexually active teens.
Currently sex education in our schools is abstinence based but has recently been
brought to the attention of the state and will soon include other topics including
pregnancy prevention and sexually transmitted disease information. The literature is not yet available to reference at this time but has been discussed in the news recently. According to the CDC , Recent Trends in Teenage Pregnancy in the United States 1990- 2002, there were 757,000 pregnancies among teenagers ages 15-19. These staggering numbers, including the statistics on sexually transmitted diseases in the prior paragraph, indicate that our current system of sexual education is not working. Funding is always an issue for any program but if multiple agencies work together they could share the costs. The other issue faced by sex education programs is regulations of the curriculum. If nurses work together with a multi-faceted approach that involves the parents, but also provides classes away from a regulated environment, we could help decrease teen pregnancy and sexually transmitted diseases. Parents need to have accurate information when discussing sex education with their children. Some parents may have misconceptions about birth control and/or sexually transmitted diseases from their younger years an may not be aware of current changes in these issues (Harrison, 2005). Nurses can host classes for parents and discuss these misconceptions as well as providing strategies for making it easier to talk to the children about sex. Nurses have the medical knowledge to dispel myths and the resources for helping parents find literature or other teaching tools for sex education. With knowledge comes the confidence to discuss a subject. When someone is uncomfortable with a subject then the intended receiver is likely to mimic the speakers embarrassment and the whole line of communication is interrupted (Taylor & Davis, 2006). Confidence leads to making informed, conscious decisions over your body and your actions (Harrison, 2005).
Classes for adolescents at school, designed through a collaborative approach of
parents, school nurses and educators, are also important in improving confidence and self esteem. Separate sexual education classes in school for boys and girls allows more freedom to ask questions that might be embarrassing to ask in front of the opposite sex. Adding an anonymous question and answer system might also be a way of decreasing anxiety and increasing confidence. Spiraled education classes can be implemented to provide a consistent curriculum with details added as is age appropriate. Increasing self esteem, knowledge and confidence through these classes may make young people look to other outlets rather than making a sexual connection or having a baby to gain affection. Adolescents need to understand that pregnancy, as well as sexually transmitted diseases,can be life altering. They need to understand that some diseases are untreatable and/or fatal and that pregnancy can be detrimental for the young man, young woman and child involved (Richardson-Todd,2006).
Since most school programs are geared towards abstinence, nurses can help
establish outside programs for sexual health. These programs can be designed to be an open door program as well as having structured forums. The programs would involve a collaborative approach with an MD or nurse practitioner to include testing and prescriptions, and also counselors to discuss the associated emotional issues (Richardson-Todd 2006) Sexual health is a matter of perception and nurses need to realize that sexuality falls within the realm of holistic nursing. Research quoted by Taylor and Davis (2006) states that “patients do not voice their concerns about sexuality and sexual health because they want someone to raise the subject first” ( Waterhouse & Metcalfe, 1991,Waterhouse, 1996, Gott & Hinchcliff, 2003). Providing literature and advertising to school nurses, health rooms, community centers and other teen hang outs, about this program can help target teens and give them another opportunity for sexual health discussion.
Nurses have a bank of resources to draw from that includes therapeutic
communication as well as detailed education in reproductive health. Working in a
collaborative effort with parents and school educators, nurses can help to reduce the number of teenage pregnancies and sexually transmitted diseases. Helping to give parents an opportunity to participate in their child’s sexual education, providing school educators with a consistent and factual curriculum, and establishing public health clinics for teens are just three small ways nurses can play a part in helping to eliminate a national epidemic.
Addendum to Nursing Strategies for Decreasing Teen Pregnancy and Sexually Transmitted Diseases
Intervention I
I suggested that in order to increase sexual education and decrease teen pregnancy and sexually transmitted diseases that we need to change our abstinence only school curriculum to include prevention tactics and STD information. These programs are usually taught by the school nurse.
Disadvantage I
One reason this tactic might not work is that according to a recent article Abstinence-Only funding set to expire – But don’t applaud quite yet (2007), funding for sex education programs have typically been run by political conservatives. The politicians believe that comprehensive sex education only leans towards giving permission to have sex. Most of the conservative funded abstinence only programs are centered towards instilling fear of death “from AIDS or some undiscovered super STD that manifests years down the road” and the article suggests that you will also “take your spouse and one or more of your children with you”. Rather than let young people make informed decisions the government makes the choice for them.
Disadvantage II
Another reason sex education fails in school is due to the controversy with religion. The Catholic Church’s opposition to contraception is usually at the center of these discussions but other conservative religions have the same views. Sex and the Catholic Church in Guatemala (2005) discusses the fact that the church officially “condemns contraceptives, abortion and homosexuality”. With the official position of the church listing sex education as taboo then the children and their parents will probably not get the information necessary to make an informed decision. Since sex education in school is an optional program it stands to reason that these families do not let their children participate in this class, nor are they likely to have the sex discussion at home.
Intervention II
One of the other interventions I suggested in my paper was that parents need to be involved in the sexual education of their children. I feel the old saying is accurate that says “I would rather give my children the right information then have them get the wrong information from someone else”.
Disadvantage I
The problem is that according to Menstruation, menarche, and sexuality in the public school curriculum: School nurses perceptions (1995), the majority of parents do not get involved with what the school is teaching. Nor do they reinforce the curriculum at home. The study shows 72% of parents do not participate. The 28% of the parents that do participate only contribute to activities pertaining to menstruation. This could be related to the fact that some parents may be lacking in their knowledge of the subject or are uncomfortable discussing the subject. Parents may have misconceptions about birth control and/or sexually transmitted diseases from their younger years and they may not be aware of current issues. (Harrison 2005)
Disadvantage II
Parents may also not be involved in sexuality related discussions due to the religion in which they were raised. The article Sex and the Catholic Church in Guatemala relates how the church sponsored HIV education program is not allowed to even suggest that HIV is a sexually transmitted disease. Anyone raised in a strict church can tell you that the threat of “eternal damnation” for discussing taboo subjects is likely to derail said conversation. With that said it is no wonder that we have research according to Project Reality: A collaborative effort toward teenage pregnancy prevention (2000) showing that only 44-48% of fifth to eighth graders feel that they are able to communicate with their parents easily about sex related issues.
REFERENCES

Bruggink, H. (2007). Abstinence-only funding (finally) set to expire - but don’t applaud quite yet. The Humanist, 67, 7-8. Retrieved October 26, 2007 from ProQuest database.

Harrison, S. (2005). Under-12’s have sex one night and play with Barbie dolls the next: in a world where some youngsters value their mobile phone more than their virginity, it is no wonder that teenage pregnancy is rife. Nursing Standard, 19.39, 14. Retrieved April 18, 2007, from Expanded Academic ASAP database.

Richardson-Todd, B. (2006). Providing a sexual health service for young people in the school setting. Nursing Standard, 20.24,41. Retrieved April 18, 2007, from Expanded Academic ASAP database.

Replogle, J. (2005). Sex and the Catholic Church in Guatemala. The Lancet, 366,622- 623. Retrieved October 26, 2007 from ProQuest database.

Swenson, I.E., Foster, B., & Asay, M. (1995). Menstruation, menarche, and sexuality in the public school curriculum: School nurses perceptions. Adolescence, 30, 677. Retrieved October 24, 2007 from ProQuest database.

Taylor, B., & Davis, T. (2006). Using the Extended PLISSIT model to address sexual healthcare needs. Nursing Standard, 21.11,35. Retrieved April 18, 2007, from Expanded Academic ASAP database.

United States. Center for Disease Control. (2005) Trends in Reportable Sexually Transmitted Diseases in the United States. Retrieved April 18, 2007 from http://www.cdc.gov/std/stats/trends2005.htm

United States Center for Disease Control. (2007). Recent Trends in Teenage Pregnancy in the United States 1990-2002. Retrieved April 18, 2007 from http://www.cdc.gov/nchs/products/pubs/pubd/hestats/teenpreg1990- 2002/teenpreg1990-2002.htm

Wilson-Sweebe, K., & Bond-Zelinski, C. (2000). Project reality: A collaborative effort toward teenage pregnancy prevention. Journal of Family and Consumer Sciences, 92,27-28. Retrieved October 24, 2007 from ProQuest database.

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