New York University: Helping Parents Talk to Their Adolescent Children about Sexual Health is a Key to Stemming STIs, NYU Researcher Shows in National Academies Report

Sexually transmitted infections (STIs) impose billions of dollars in medical costs in the U.S., but STI prevention and control is chronically underfunded, stigmatized, and siloed from efforts to promote overall health and well-being, says a new report from the National Academies of Sciences, Engineering, and Medicine’s Committee on Prevention and Control of STIs, on which New York University’s Vincent Guilamo-Ramos served as an expert on the role of parents in sexual health promotion among adolescents.

Despite parents being influential in shaping adolescent decision-making and sexual behavior, parents receive little guidance on how to talk to their children about sexual health, the report says, drawing on Guilamo-Ramos’ research as a professor at the NYU Center for Latino Adolescent and Family Health (CLAFH).

The National Academies report, Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, calls for a greater focus on parents in national efforts to promote sexual health in the United States—particularly given that adolescents and young adults acquire roughly half of all new STIs. To support parents in effectively talking with their adolescents about sexual health, the report emphasizes the need for evidence-based guidance for parents to engage in developmentally appropriate, comprehensive sexual health education and dialogue.

The committee recommends several mechanisms to deliver this support to parents, including through a national, parent-focused communication campaign; parent programming in schools, faith communities, community-based organizations, and workplaces; and parent education and skills training as an extension of regular adolescent health care.

Families Talking Together (FTT), an evidence-based parent intervention developed by Dr. Guilamo-Ramos that can be delivered in health care settings, represents one such approach for reducing adolescent behaviors associated with STI risk. FTT Clinic is designed to build partnerships between parents, adolescents, and health care providers for sexual health promotion and is effective for delaying sexual debut and increasing condom use.

In addition, the report calls for a more holistic approach that promotes sexual health as an integral component of overall health and wellbeing and focuses on the social and structural determinants of sexual health — rather than focusing exclusively on individual behaviors or STIs risk factors. The committee also recommends modernizing national STI surveillance and monitoring systems; broadening the STI workforce, for example by expanding the role of nurses—the largest segment of the U.S. health care workforce—in sexual health services; developing and scaling up structural and behavioral interventions; and accelerating the development of vaccines, diagnostics, and therapeutics. Taking these strategic actions would also better position the U.S. to respond to COVID-19, HIV/AIDS, and future infectious disease outbreaks, the report says.

One in five people in the United States had an STI on any given day in 2018. Many cases can be asymptomatic, and therefore go undiagnosed, untreated, and unreported. Left untreated, STIs can lead to chronic pelvic pain, infertility, miscarriage or newborn death, increased risk of HIV infection, genital and oral cancers, and neurological and rheumatological consequences. The COVID-19 pandemic has also set back efforts to control STIs, the report notes. People are delaying routine STI screenings and may have undiagnosed and more advanced cases. Furthermore, STI clinic staff and resources have been diverted to the COVID-19 response.

Despite the economic burden and alarming increase of STI rates over the last 20 years, the Centers for Disease Control and Prevention’s STI funding has remained flat. The report emphasizes the need for easier access points for STI care. Specifically, the U.S. Department of Health and Human Services (HHS) and state governments should ensure that STI prevention and treatment is available through multiple venues, such as comprehensive sexual health clinics, pharmacies, urgent care settings, and telehealth visits. These settings should also address concerns about confidentiality, particularly among adolescents and young adults on their parents’ health insurance plans.

HHS should also broaden no-cost care options for STI prevention and treatment, as many individuals experience financial barriers to STI services. The report recommends HHS consider implementing approaches such as Medicaid expansion incentives, expanding eligibility for Medicaid family planning services, and updating program guidance of the 340B Drug Pricing Program to expand access to HIV PrEP and expedited partner therapy (i.e., providing prescriptions to sex partners of individuals with STIs without a doctor visit).

The report recommends several additional actions to improve STI control for the future.

The report acknowledges the important leadership and commitment of the CDC and its state, local, and tribal health department partners. It recommends actions that CDC can take to update existing STI programs and services, apply lessons learned from HIV and the COVID-19 response, and provide more prescriptive accountability targets for state and local grantees.

The study — undertaken by the Committee on Prevention and Control of Sexually Transmitted Infections in the United States — was sponsored by the Centers for Disease Control and Prevention through the National Association of County and City Health Officials. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.