Give teens more info to bridge information gap

Your next patient is a 17-year-old female who is interested in contraception. While she says she knows about the contraceptive patch and the vaginal ring, when you ask her about their effectiveness in preventing sexually transmitted diseases (STDs), she gives you a puzzled look.

Results from a recent Menlo Park, CA-based Kaiser Family Foundation/Seventeen magazine survey show that while teens ages 15-17 have a fairly high degree of awareness about various contraceptive methods, there are significant gaps in their actual knowledge.1 About one in five of teens surveyed who had heard of new hormonal methods such as the patch and the ring thought these new methods were either "not too" or "not at all" effective at pregnancy prevention, even though both the patch and the ring have levels of effectiveness comparable to combined oral contraceptives.

When it comes to knowledge of STD protection, adolescents surveyed were even less informed: While more than 75% said they had heard of birth control pills, more than one in four didn’t know that oral contraceptives offer no protection against sexually transmitted diseases.1

Why is it so important that teens get the message when it comes to protection? Recent research estimates that by the time they reach 25, one in two sexually active young people will have contracted an STD.2,3

How can you help teens bridge the information gap? Start by looking at how they think, suggests Eduardo Lara-Torre, MD, a pediatric and adolescent gynecologist in private practice in Milford, DE. Lara-Torre presented information on new contraceptive methods for adolescents at the recent annual clinical meeting of the Hockessin, DE-based North American Society for Pediatric and Adolescent Gynecology (NASPAG) in San Diego.

It is hard for adolescents to grasp the concept that the one single thing they use — contraception — only protects against one certain thing and doesn’t cover the rest, he explains. Teens believe that by protecting themselves against pregnancy, everything else is going to be fine, he notes.

When seeing an adolescent patient, Lara-Torre explains that while current contraceptive methods are good at preventing pregnancy, there still is a chance for method failure, especially if they are not used consistently and correctly. He then asks, "if there is a way that you could do something to guarantee that it is even less likely you will get pregnant, would you do it?" Most teens say, "Yes," which Lara-Torre follows up with an explanation of condom use. During this point in the dialogue, he mentions the condom’s role in STD protection and specifically talks about HIV/AIDS prevention.

"Teens don’t think of gonorrhea or chlamydia as such bad diseases, but when you mention AIDS, it clicks in their mind that maybe the condom isn’t such a bad idea," he states.

Let adolescents tell you what they know about contraceptive methods, says Melanie Gold, DO, associate professor of pediatrics at the University of Pittsburgh School of Medicine. When misconceptions come up, Gold says she asks the teen for permission to offer information that is different from has been heard and follows up with the statement, "it might help you make better decisions for yourself."

If the teen is interested in receiving information, she provides medically accurate information, then asks what the teen makes of the new information and if it changes anything for her/him. If the teen does not want the information, Gold notes, "it sounds like you are not ready to hear about the information now, but when you change your mind, I am always open to giving you medically accurate information." This approach helps the teen to know that she is not there to lecture on contraception.

When it comes to STDs, Gold will ask if the teen has had a previous infection and what she/he perceives as her/his chances of getting an STD in the future. "When there is a past history of an STD, I ask whether getting diagnosed with an STD was a surprise or if she suspected she had one," explains Gold, who presented on motivating reproductive behavior at the NASPAG meeting. "Most often, there were no symptoms, and we talk about the fact that it is really hard to tell when one has an STD."

When a teen expresses confidence that risk to STD exposure from a monogamous partner is little or none, Gold discusses condoms in the context of added pregnancy protection rather than trying to convince the teen that risks do exist.

"What is important is the condom use and finding the teen’s individual motivation for using condoms, not trying to make her own up to the fact she might be at risk for an STD when she is not ready to acknowledge that," she notes.

When it comes to emergency contraception (EC), results from the Kaiser Family survey show about six in 10 teen-agers have heard of the method.1 However, among those who had heard of EC, about 25% said it causes an abortion. Check Gold’s approach in providing factual information on EC:

  • Ask a teen to describe the way EC works.
  • If the teen says EC causes an abortion or miscarriage, ask the teen to explain how a girl gets pregnant.
  • If there is misinformation, ask permission to review the process of getting pregnant in terms of ovulation, fertilization, tubal transport, and implantation, using a anatomical diagram that shows these steps.
  • Explain that EC works mostly by preventing ovulation (point to the ovary on the diagram), but note there is a possibility it might work some of the time by preventing the fertilized egg from sticking to the lining of the uterus.
  • Reinforce the fact that once the egg is stuck to the uterus lining and starts growing there (which is called a pregnancy), that EC no will longer work and will not "unstick" the pregnancy from the lining. Explain that the "unsticking the pregnancy from the lining" is called an abortion or a miscarriage.

"I ask whether the way EC works is consistent with her beliefs about what is acceptable to use to prevent pregnancy and what is not," Gold concludes.

References

1. Kaiser Family Foundation and Seventeen magazine. National Survey of Teens: Birth Control and Protection. Menlo Park, CA; July 2004.

2. Weinstock H, Berman S, Cates Jr. W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.

3. Cates JR, Herndon NL, Schulz SL, et al. Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases. Chapel Hill, NC: School of Journalism and Mass Communication, University of North Carolina at Chapel Hill; 2004.