Last week, the CDC issued a press release regarding the relationship between sexual and reproductive health services – including STD/STI screening, contraceptive measures, and sexual health risk assessment – in individuals aged 15-25, and confidentiality issues.1 The release comes out of information compiled from the 2013-2015 National Survey of Family Growth, which included 10,205 respondents with a 69.3% response rate.
Confidentiality Concerns & Health Risk
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. 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 a preventative health measure for adolescents and young women under 25.
Increase One-on-One Time with Practitioner
Spending time alone with a practitioner (without a parent in the room) seemed to be the greatest factor for 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 to care, include spending time alone (without a parent present), and specifically addressing concerns about confidentiality during the visit.
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.
