Yes to the HPV vaccine!

I just had a driveway moment.  I wish I had coined the term but I cannot take credit.  I first heard it on NPR and coincidentally, that is exactly what I was listening to in my car when I pulled into my driveway but couldn’t get out of the car because I needed to hear the end of the news article. Host Robin Young was interviewing pediatrician Allison Kempe from the University of Colorado.  Dr. Kempe is the lead author of an article published this month in Pediatrics about her study that found many pediatricians do not recommend the Human Papillomavirus (HPV) vaccine to adolescents despite that it is well documented as being safe and highly effective in the prevention of the most common strands of HPV known to cause certain cancers.

Fact: HPV is transmitted through sexual contact.

Myth: Providing accurate information about the various aspects of sex encourages kids to be sexually active.

Dr. Kempe’s study found that doctors do not educate their adolescent patients and their parents about the importance of the HPV vaccine because they are concerned that parents feel it will encourage sexual activity. This is the same reason that often interferes with parents and school curricula addressing sex education head on.  Adults in this camp are concerned that talking about sexuality and sharing important factual information is the same as giving permission for their young audience to become sexually active. Numerous studies have indicated the opposite: they found that comprehensive sex education is more effective than abstinence-only education across a number of measures.

The Centers for Disease Control and Prevention recommends that girls and boys receive the three-dose series starting around age 12, well before they are sexually active.  Just as we immunize our babies and toddlers against a host of diseases in the name of prevention, HPV should be part of the current adolescent panel which includes vaccines for meningitis, tetanus, diphtheria, and whooping cough.  If doctors weren’t so pressed for time, they could offer proper education about the HPV vaccine to help clear the misunderstanding that is too prevalent. I encourage readers to take 10 minutes and listen to the full radio article.  Meanwhile, I have a 12 year to go talk to now….

 

More than two

At a group I recently facilitated, the agenda I planned focused on methods of birth control. Before delving into an enthusiastic educational talk about the different options available, I did a quick assessment of my group participants:

“How many birth control methods do you think are out there?” I posed.

“Two” replied one girl. “A pill and condoms” she added.

I scanned the faces of the other participants and observed subtle nodding around the table suggesting reserved agreement.

And we were off to the races. A vibrant discussion ensued as I launched into an interactive talk about the various contraceptive methods that exist and explained the difference between barrier and hormonal methods, varied levels of effectiveness when used correctly, and whether they offer disease protection. We talked about abstinence. We talked about which methods require a medical provider to prescribe, fit, inject, insert, remove.  We talked about reversibility, ease of use, and access.  We ran out of time!

With more than 15 contraceptive methods available today, there was a lot of information to share in a two-hour group meeting and I can say with confidence that I barely scratched the surface.  A single discussion does not allow for a comprehensive lesson of the various birth control options available and the need for this information is obviously great. What a WONDERFUL first step this was in raising awareness about an important, complicated topic. But so much is yet to be addressed; I merely offered the introduction to birth control.  Contraception 101: An Overview.

Now, I urge all readers to explore this further for your own education and for the benefit of others with whom you can share such information.  More contraceptive options exist now than ever before and many that have been around awhile have been modified and improved. Below are a couple of links to get you started. Please read. Please share.

Office on Women’s Health/USHHS/birth control methods

FDA Birth Control Guide

 

A group of one’s own

On an almost daily basis, I observe how media aimed at children and teens incorporate sex as a way to deliver a message.  To be clear, these are not public health service announcements or educational news bites touting developmentally appropriate health messages. These are songs with explicit lyrics on the radio or advertisements for products geared towards this age group. Television shows and movies may include implied or blatant sexual scenes with no reference to birth control or safe sex practices.

Contrast this with the sex education that is provided in public schools.  In one scenario, students receive age-appropriate lessons starting in elementary school that continue through middle and high school annually or bi-annually such that over time, they gain a comprehensive education on anatomy and reproduction, sexually transmitted infections, HIV, contraception, sexual identity, healthy relationships, etc etc etc.  In another scenario, schools devote limited lesson time to sex education and emphasize abstinence-only, concerned that teaching a comprehensive curriculum will lead to greater sexual activity and subsequent consequences (despite numerous research studies that prove otherwise). The third scenario describes those schools that avoid the subject matter altogether.

So if schools are not teaching sex education, who is?  Where are kids getting their information?  Parents and guardians are hopefully talking with their children, starting at a young age.  Numerous small conversations throughout a child’s development are the way to address this.  And who better to give information than a trusted parent who, while sharing information, can weave the family’s values into the conversation. This is true even if a school district offers any level of sexuality education. Parents should be at the center of their children’s sexuality education.  Simple as this might sound, this is challenging for many parents.  Many of us start to hyperventilate at the mere thought.

Besides schools and parents, what other options exist to help our kids reach their potential in making informed decisions as they grow up and become more independent? Community settings are another option. One example is the Unitarian Universalist Church which offers a lifespan sexuality education called Our Whole Lives (OWL) using a holistic approach. This comprehensive curriculum is tailored by age group and though secular, is value-based and involves parents, recognizing them as primary educators.  Planned Parenthood is another example of a community resource for education.  They can provide sexuality educators to schools or other organized groups as well as offer their comprehensive curriculum entitled Get Real for middle and high schools to use.

Perhaps OWL isn’t available near you or the schedule doesn’t work for your family. Maybe there are not any other community options and despite your best intentions, you need a little boost to get the conversations started with your child.  This describes why I began Girls’ Group. My approach was created to broach and maintain an open dialogue with a group of girls in a safe, informal environment (see Welcome to “I Saved You a Seat”). The premise of the group is to empower girls through an interactive discussion on a topic that changes each meeting.  I always encourage the girls to share the discussion with their parents. I also frequently touch base with parents to tell them the topic of the day.

In re-reading my blog post back when I was preparing for my first group meeting almost three years ago (see Preparing for Girls Group #1), I was reminded that I originally thought I would hold approximately five meetings with this cohort.  In reality, we have met more than two dozen times and my current plan is to continue meeting with them until they graduate high school.  That means we will have been meeting from 7th – 12th grade. However, one of the strengths of this model is that it is completely flexible. It can be developed with a pre-established number of meetings planned; or it can evolve with the participants and be open-ended, addressing the needs of the group. My girls were 12 and 13 when we started meeting; now they are 15 and 16. The same girls have been in the group since it’s inception, but they have grown into young women and the topics of discussion have matured as have the girls.

I have had numerous requests for additional Girls’ Groups.  The need is there.  Parents of tween and teen girls who learn about my model often ask me, with an undertone of desperation in their voice, if their daughter can join. While I wish my response was an enthusiastic YES, thus far I have had to decline because of my own commitments and schedule. However, this model is so easily replicated and its adaptability makes it very user-friendly.  We need more facilitators – – more parents, guardians, grandparents, more trusted adults.  There is no shortage of materials available and all can be adapted to fit the particular needs of a newly formed group.  Some of my more frequent “go-to” resources are the Sexuality Information and Education Council of the U.S. (SIECUS), Family Life and Sexual Health (FLASH), Our Bodies Ourselves (OBOS), Advocates for Youth, and Planned Parenthood League of Massachusetts (PPLM). These are but a few of the excellent resources available.

I would be remiss if I did not mention the need for a boys group. As a parent of a teen and tween boy myself, I recognize the need is equally important that boys have a similar group option available to them. Parents have asked me for this as well and this is certainly something I would like to work on in the future.

I invite readers to share experiences with similar informal groups aimed at adolescents that was created as a complement to or in response to a need for sexuality education in your community.

Love thy body

A new school year is well underway.  Students everywhere have had to get used to their new classes, teachers, and schedules, as well as navigate their afterschool activities/sports, homework, and possibly jobs. This time of year is also when my Girls’ Group resumes.  The group I started three years ago for six tween girls still gathers around my dining room table throughout the school year to discuss a range of issues while we sip tea.  Now, these young women are 15 years old.  Their interests and concerns are more varied, intellectual, and emotional than the younger versions of themselves.

To kickoff the new year, our first session will focus on body image.  As I sit and think about my approach to start the conversation, I find myself replaying a conversation I had with a friend more than 15 years ago. After “Alice” (a fictional name) returned from a winter escape to a warm and sunny destination, she was sharing some of the highlights she experienced on her trip.  Amid the description of the local culture, food, and beautiful beaches she enjoyed was her criticism of some of the tourists who, to her dismay, donned bikinis.

“What exactly was your problem with the bikini wearers?” I asked.

“They did not all have bikini bodies,” declared Alice.

“What’s a bikini body,” I asked incredulously.

“You know, one that is thin and doesn’t have fat hanging out,” stated Alice nonchalantly.

“Are you kidding me?” I replied a bit too loudly.  “I couldn’t feel more opposite.  I’m impressed when women feel comfortable wearing a two-piece swimsuit as so many of us are plagued with some degree of self-loathing that it actually impacts our behavior such as enjoying a day at the beach.  If anything, we should be in awe of the self-confidence of the bikini-clad rather than critical.”

My surprise about Alice’s reaction was enhanced by the fact that she is a medical doctor. A role model.  She is a family practitioner who surely handles a broad spectrum of health issues and I would assume some emotional and mental health issues too.

Starting at a very young age, children hear messages that strongly suggest if you are not thin and attractive (females) or fit and muscular (males), you are “less than.”  These messages are delivered via classic children’s books, movies, music videos, advertisements, and “reality” television, and are often perpetuated by our own family and friends. Learning how to resist these influences is a challenge at any age, but certainly one that young children are not equipped to handle.

As I prepare for the first session of Girls’ Group after our summer hiatus, I am excited for our reunion and looking forward to having a lively discussion and hearing their perspectives on body image. I found a perfect complement to our discussion adapted from Courtney Martin, author of “Perfect Girls, Starving Daughters,”  on Our Bodies Ourselves website.  Looking forward to a great kick-off to the new year.

 

What’s in a name?

Dear ______,

For many decades (almost a century in fact), you have been a game changer for women by empowering them to make choices regarding when and if to start a family. You have provided access to cervical cancer screenings as well as offer a plethora of other reproductive health services. What started as a place where women could obtain birth control has grown so that today, you are a vital resource –  – sometimes the only one depending on the community – –  for women and men who need STD and HIV screening/testing and treatment. You provide much-needed sexuality education to teens and young adults through your evidence-based curriculum.

I’m talking about you, Planned Parenthood. You have been in the news a great deal the past month – negative publicity so extreme that it threatens to shut down the federal government in the near future.  This isn’t the first time you have been the subject of negative media attention. Historically, there have been many adversarial groups and individuals who believe that Planned Parenthood is evil.  Such folks tend to share the same views on sex outside of marriage, use of birth control, homosexuality and pregnancy termination.

It’s time for you to consider a new name, Planned Parenthood.  On the one hand, your current appellation is steeped in historical milestones that we shall always remember. The work of Margaret Sanger and her colleagues opened doors for so many women whose opportunities would have otherwise been quite limited. On the other hand, your name reflects only a small percentage of all that you do.  It does not capture the critical access you offer to hundreds of thousands of individuals who might not have a means to obtain health care. You are in communities all over the USA providing affordable health services and health education.

Re-brand.  Don’t change your mission; don’t diminish your accessibility, nor your affordability.  Simply consider a new moniker.  One that reflects more accurately all that you do.  Maybe a fresh name will help announce to the world how critical your role is in the preservation of health for women and men everywhere.

An evolving case study

Crane, Texas is a small town located in the western part of the state that made headlines last month. With a public high school population of just under 300, the superintendent issued a letter to warn parents about a chlamydia outbreak in the school – more than 20 cases, or one in fifteen students, had chlamydia.  Incidentally, this school district offers a three-day, abstinence-only sex education curriculum in middle school.

Since the story originally broke, the Texas Department of Health announced a correction.  They stated the number of confirmed chlamydia cases was only three, as opposed to twenty, in the three-week period leading up to the recent outbreak news. However, they acknowledged many people had been tested and were still awaiting results which could increase the actual number of cases.  Also, the Health Department did not indicate the age of the three cases that tested positive or those waiting for test results.

Even if the number of confirmed cases of chlamydia is lower than originally reported in this small community, this story raises an important issue that historically brings out strong opinions on both sides: What, if anything, should be taught in a school district’s sex education curriculum?  What can be done to prevent the spread of sexually transmitted infections (STIs)?

Many studies, including those overseen by the Centers for Disease Control and prevention (CDC), support the finding that abstinence-only curricula do not, in fact, reduce the rates of teen pregnancy rates or STIs.  Several evidence-based comprehensive health education programs  (i.e. those that promote abstinence while also providing factual information about contraception and STI prevention) have proven to be effective.  However, there remains a strong misconception by many people in the U.S. that providing developmentally appropriate, accurate information will increase sexual behaviors among teens.  Unfortunately, school districts that take this stance are missing an important opportunity to impart factual information to teens, rationalizing that avoiding the discussion will prevent them from engaging in risky behaviors.  Unfortunately, this hush hush approach is not grounded in research, nor does it offer protection to teenagers who do not heed their lessons in abstinence.

 

Billboard kudos

I do not recall what prompted this memory, but I recently remembered an online debate that took place a couple of years ago on a listserv of which I am a member. One parent was complaining about the placement of a billboard adjacent to the highway that dissects her town and is located en route to a couple of elementary and middle schools. The advertisement was for condoms. This particular woman was dismayed that such an ad would be placed in a visible spot where kids might see it. Other people on the listserv responded, some defending the placement of the ad, others worrying what conversation they might have with their kids if they saw it.

Parents: perfect conversation prompt! What a great opportunity to talk to your kids whether they ask you about the billboard or (gasp),  you bring up the subject with “Did you see that billboard?” This ideal opportunity allows you to have a discussion with your child that reflects your personal/ family values.

Size does matter

Parents, if you have not talked with your kids recently about puberty, sex, drugs, (or whatever your tough subject might be), think about how you might change that.

Kids, if there is something you want to talk or learn about but don’t know how to begin, try writing it down and slipping your parent a note.  While face-to-face conversations are best, even texting your parent a question is better than not asking it all.  It is very normal to feel uncomfortable talking about personal topics that you have not discussed before.

I have learned from reading and observation that parents/adults sitting their kids down for a rehearsed, long talk about the birds and the bees or other topic du jour is not always the best strategy.  Your audience is less likely to hear you (by tuning you out if it feels interminable) and might not engage. Let me illustrate with a true story:

A couple of years ago, my husband went into our then 10 year old son’s room, excited to have a heart to heart talk about the metamorphosis his gangly body would soon begin and new feelings he would experience with increased hormones surging through his body.  Feeling pretty good about having shared such intimate information with our son, he concluded the discussion with the predictable “Is there anything you want to ask me?”

After a seemingly endless pause and in obvious deep thought, our son replied:  “Dad, who do you think is a better pitcher, Tim Lincecum from the San Francisco Giants or Jon Lester from the Red Sox?”

Parent Lesson: Keep it brief.  Instead of a single long discussion, try having a series of mini conversations (e.g. 3 minutes) either when the opportunities present themselves or when you feel your child is ready (and this will likely be sooner than you might be ready). Many of these talks will be impromptu, sparked by a news item on the radio when you are driving together, or an event at school your child shares with you. There are so many opportunities in our daily lives that offer great conversation starters….a commercial on television for sanitary products or erectile dysfunction elixirs are examples of good starting points. Once you open your eyes and ears, you will notice that there are ample opportunities to (courageously) start addressing a variety of important subjects that are not being taught anywhere else.

Kids:  If you are watching television or hear something on the radio or school bus that you are curious about but feel embarrassed to bring up, you are not alone.  Most kids and many grown-ups have a tough time talking about certain subjects.  Yet parents and other trusted adults in your life are the best sources of information for these discussions.  Try to muster up the courage to bring up your questions with your parent one way or another.  Parents are sometimes distracted with other things and don’t realize you might be curious about some of these important topics.  Asking them is a good way of letting them know you are ready to learn.  Chances are, you will both feel relieved.

Our sons need us too!

Over the course of my discussions about my plans for this blog and my focus on girls, several people asked me “Are you doing a boy’s group too?”  While the answer is “No,” I want to underscore how much it is needed to help boys develop into healthy young men.  Let me describe a true story that recently happened to me:

A mother from my local community whom I’ve always respected for her organized household, common sense outlook and humorous attitude approached me.  She was inquiring if my 12 year old son could join a small group of boys she was going to take out for dinner to celebrate her son’s birthday.

“Sure,” I replied.  “Where are you going?”

“That’s just it, I want to take them to HOOTERS; they have really good wings.”

I burst into laughter at her quick humor until I registered the expression on her face.  She wasn’t joking.  For me, Hooters sends all the wrong kinds of messages about women’s sexuality being used to sell unrelated products, in this case food.   But for her, it was a family-friendly, appropriate place to bring a group of adolescent boys.  She must have known that some parents wouldn’t approve which is why she was checking with us in advance.

I reflexively yelled “No, he can’t go.”

It is puzzling to me that Hooters doesn’t bother all women when it offends me so much. What am I conveying to my son if I allow him, at 12, to patronize a restaurant where the servers are required to flaunt their “goods” (and I don’t mean food).  How does this help my son learn to respect women without objectifying them?  This does not support the values I am trying to impart on him.

This experience- – not really an experience but a mere conversation – – got me thinking.  I found my thoughts kept returning to Gloria Steinem when she did her anthropological study as a Playboy Bunny at New York’s famed Playboy Club.   I encourage you to read the full account of her 1963 experience.  It is quite remarkable and makes me question how much we have or have not progressed in the last 50 years.

Parents, while this blog focuses on girls, I would be doing a disservice if I did not address that boys need our help in developing into healthy young men.  I used the Hooters invitation as an opportunity to have a candid discussion with my son about why I was not going to let him go.  Please share your experiences and information links if you have them.

Meet them where they are

“Let’s do a quick review of the changes that occur at puberty” I said to the group, “And then we can move on to some other material that might be new to you.”

In my mind, we would not need to spend too much time on the nuts and bolts of pubescent changes.  As I led the group in a multiple choice trivia game on the topic, I quickly realized that my original lesson plan needed to be adapted.   I was operating under the assumption that the participants were more or less at the same place with regard to their baseline knowledge of male and female anatomy and the corresponding vocabulary for terms associated with puberty.   Interestingly, the level of awareness varied considerably.   No problem.  I can be flexible. I would simply delve into the facts in more detail than originally planned.

This was a great lesson for me on a couple of levels.  1) It reminded me that I cannot make any assumptions about the knowledge an individual person possesses on a given topic; 2) Although the girls had technically gone through the same formal sex/health ed lessons at school, they were not receiving enough education on some of the fundamentals.  Until this point, the public school education consisted of two lessons during fifth grade gym class, led by the physical education teacher.  That was almost two years ago among this group of individuals.

What this particular Girls Group meeting left with me was the realization about just how much we rely on schools to teach our children about sex (in this case, the developmentally appropriate topic of puberty).   When I think about all of the ways I help my two kids make healthy choices in their lives – e.g. the amount of screen time they have or the timing and contents of a snack between school and dinner – – I know that talking about sex in developmentally appropriate ways is no different.    School districts vary tremendously in both the quality and breadth of their curricula in this area.  Many of us, as parents, benignly rely on our schools, exclusively, to share information about sex.   What a great wake up call for us all that we need to be continuously talking and checking-in with our kids.