Recently, the CDC issued a press release regarding the relationship between sexual and reproductive health services – including STD/STI screening, and contraceptive measures, and sexual health risk assessment – in individuals aged 15-25, and confidentiality issues.1
Confidentiality Concerns
Because individuals may be eligible to be covered by their parents’ health insurance plan(s) until the age of 26, issues of confidentiality often play a role in care when dealing with adolescents and young adults. In other words, when teens and young adults think their parents will find out about their medical history, they hide things from their doctors. A perceived lack of confidentiality leads to a drastic decrease in percentage of individuals screened for chlamydia (the primary STD screening surveyed), also in sexual health risk assessment. Roughly 13% of sexually experienced young people (aged 15-25), who were on their parent’s insurance plan, reported not seeking sexual and reproductive health care out of a fear that their parents would find out. This percentage is higher when adjusted for individuals aged 15-17 (22.6%), with females (concerned with confidentiality) reporting a much lower rate of chlamydia screening (17.1%) than females without such a concern (38.7%). This finding is concerning because chlamydia often presents asymptomatically, and chlamydia testing is recommended as preventative health measure for adolescents and young women under 25.
Patient + Practioner, Minus the Parent = Improved Sexual Health
Spending time alone with a practitioner (without a parent in the room) seemed to be the greatest factor in increasing receipt of sexual risk assessment and chlamydia screening. 71.1% of adolescents (15-17) who reported spending time alone with a provider received a sexual risk assessment, and among females, 34% received chlamydia testing (versus 36.6% and 14.9% respectively). Risk assessment was simply the inquiry into 1) sexual orientation of sex of partners; 2) number of sexual partners; 3) use of condoms; and 4) types of sex (vaginal, oral or anal). It is likely that other behavior, such as drug/alcohol use would also be more forthcoming in visits without parents present (presenting the same confidentiality issues).
Recommendations to overcome these obstacles in optimal care include teens and young adults spending time alone (without a parent present) and parents confirming with their children that their records are confidential. Counseling with the medical provider in regards to who has access to records may be an appropriate step parents could take to ensure their children are getting the care they need.
Source:
- Leichliter JS, Copen C, Dittus PJ. Confidentiality Issues and Use of Sexually Transmitted Disease Services Among Sexually Experienced Persons Aged 15–25 Years — United States, 2013–2015. MMWR Morb Mortal Wkly Rep 2017;66:237–241. DOI: http://dx.doi.org/10.15585/mmwr.mm6609a1
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.