Analysis Sexual Health

36 Seconds Is Not Enough Time for Doctors to Discuss Sex With Teens

Martha Kempner

A new study suggests that many doctors are not talking to their teenage patients about sexuality, and those who are spend an average of just over half a minute on this important topic.

A new study suggests that many doctors are not talking to their teenage patients about sexuality, and those who are spend an average of just 36 seconds on this important topic.

The study, published in JAMA Pediatric, found that teens—even those who want birth control—will not bring up the topic, and that physicians often fail to do so as well. Apart from school-based sex education, regular checkups with physicians may be one of the best opportunities for young people to have their sexuality questions answered by experts. Unfortunately, this study suggests that more often than not the opportunity is being wasted.

As part of the study, researchers audio-taped the visits of 253 teens at 11 clinics in North Carolina and then analyzed the recordings for “sexuality talk,” which was defined as any discussion, comment, or question linked to sexual activity, sexuality, dating, or sexual identity. They found that only 65 percent of the visits included any sexuality content. This means not only that one-third of teens are leaving their health-care visit having received no information about sexuality, but that physicians often have no idea of the sexual health risks their patients might be taking.

Perhaps more disturbing, however, is the finding that even when these topics were brought up, the average conversation lasted just over half a minute. Stewart Alexander, lead author on the study, told NPR that he ran through the American Academy of Pediatrics’ checklist of questions that providers should ask adolescents about sex, and there is no way to even ask all the questions in such a short period of time, let alone wait for them to be answered. In truth, it is hard to imagine what can be thoroughly (or even minimally) discussed in 36 seconds. As J. Dennis Fortenberry, co-author on the study, pointed out to Rewire, “Asking a young woman about her menstrual periods does not constitute ‘sex talk.’”

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Part of the problem is the short amount of time doctors spend with adolescents in total. The average length of a visit in the study was just nine minutes, and a lot of things need to get covered in that time. Alexander told NPR, “For boys, you only get them for health maintenance visits for sports or camps. If a boy comes in and has a problem with acne or ADHD medicine, that may override the preventive health stuff. There are other topics that are getting in the way.” Still, physicians need to make time to engage in in-depth discussions about sexuality with their teenage patients. Alexander noted, “It’s easy for things to get lost in the shuffle. I don’t want to bash doctors. They’re required to do so much. They should do this. But it’s hard.”

One reason it is so difficult may be that teenage patients are too reluctant to bring up any sexuality topics themselves. In fact, all of the conversations about sex that did occur between physicians and adolescent patients in the study were initiated by the physician. Fortenberry, however, reminds us that “just because young people don’t initiate conversations with physicians about sex, doesn’t mean that they aren’t interested in being asked.” Proof of this may be in the study’s finding that even some of the young people included in the study who wanted birth control didn’t start a conversation on the topic. This suggests that if their physicians hadn’t brought it up, they would have left their appointment without a prescription and may have gone on to have (or continued to have) unprotected sex. It also suggests that there were likely adolescents among the one-third that didn’t discuss sexuality with their physician who also wanted birth control but were afraid to ask. Again, they left the visit unprotected.

Both Alexander and Fortenberry believe that one of the key issues stopping youth from asking questions about sexuality is confidentiality. Their research found that having a time for confidential conversations without the patient’s parents in the room made discussions of sexuality more likely, but only one-third of the visits in the study included such one-on-one time. As Alexander told NPR, “It’s hard to get the parent out of the room.” He added that some doctors explain the need for confidential time with the teenager up front, which can make it easier to ask parents to leave later in the visit. Fortenberry also noted that many teenagers are not aware of their right to physician-patient confidentiality. He told Rewire, “This matters to young people and should be addressed near the beginning of every visit. Not all young people fully understand physicians’ legal and ethical commitments to confidentiality and these have to be explained.” Knowing that what they say when they are alone with their provider cannot be repeated to their parents may go a long way in getting young people to talk about sex.

Parents also have a role to play in fostering a confidential relationship between their teens and a trusted health-care provider. Understandably, it can be hard for a parent who has been in charge of their child’s health since their first well-baby appointment at two weeks to step away, both literally and figuratively, but it is important to give young people the opportunity to ask their own questions.

At the same time, parents can help in a number of different ways, explained Bradley Boekeloo, a professor of behavioral and community health at the University of Maryland School of Public Health, who wrote an editorial accompanying the study. He told NPR that parents can make it easier for their children to get the information they need by talking with them about sexual development early on and answering questions as they come up. It makes sense that kids who have become more comfortable discussing sex with their parents will also be more comfortable discussing it with a health-care provider. Boekeloo says parents also can play a direct role during the visit by encouraging both their teen and the doctor to tackle sexuality. “The physicians probably need as much support as the youth in a visit, in terms of logistics,” he said. Of course, the next and possibly most important step is for parents to get up and leave the room.

Fortenberry says that the conversation that happens next “does not have to be embarrassing, time consuming, or especially detailed. Many young people have fairly clear ideas about their sexual boundaries and are quite willing to discuss these if asked.” Still, these conversations have to happen so that young people can have their questions answered and physicians can assess threats to their patients’ health. Only then can we make sure that young people leave their health-care visits armed with the information and tools, such as birth control, they need to protect their sexual heath now and in the future.

Commentary Politics

Milwaukee Officials: Black Youth, Single Mothers Are Not Responsible for Systemic Failings—You Are

Charmaine Lang

Milwaukee has multiple problems: poverty, a school system that throws out Black children at high rates, and lack of investment in all citizens' quality of life. But there's another challenge: politicians and law enforcement who act as if Black youth, single mothers, and families are the "real" reasons for the recent uprising and say so publicly.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

On the day 23-year-old Sylville Smith was killed by a Milwaukee police officer, the city’s mayor, Tom Barrett, pleaded publicly with parents to tell their children to come home and leave protests erupting in the city.

In a August 13 press conference, Barrett said: “If you love your son, if you love your daughter, text them, call them, pull them by the ears, and get them home. Get them home right now before more damage is done. Because we don’t want to see more loss of life, we don’t want to see any more injuries.”

Barrett’s statement suggests that parents are not on the side of their sons and daughters. That parents, too, are not tired of the inequality they experience and witness in Milwaukee, and that youth are not capable of having their own political ideologies or moving their values into action.

It also suggests how much work Milwaukee’s elected officials and law enforcement need to do before they open their mouths.

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Barrett’s comments came after Smith fled a traffic stop and was shot by authorities on Milwaukee’s northwest side. The young Black man’s death sparked an urban uprising in the Sherman Park neighborhood, an area known for its racial and religious diversity. Businesses were burnt down, and the National Guard was activated in a city plagued by racism and poverty.

But Milwaukee parents and families need more than a directive thinly disguised as a plea. And Mayor Barrett, who was re-elected to a fourth term in April, should know well that Milwaukee, the nation’s most racially stratified city, needs racial equity in order for there to be peace and prosperity.

I live in Milwaukee, so I know that its residents, especially its Black parents, do love their children. We want more for them than city-enforced curfews and a simplistic solution of returning to their homes as a way to restore calm. We will have calm when we have greater investment in the public school system and youth services; easy access to healthy food; and green spaces, parks, and neighborhoods that are free from police harassment.

In fact, according to staggering statistics about Milwaukee and Wisconsin as a whole, Black people have been consistently denied their basic human rights and health. Wisconsin has the highest rate of incarceration of Black men nationwide; the Annie E. Casey Foundation has found it is the worst state for racial disparities affecting Black childrenand infant mortality rates are highest among Black women in the state.

What we absolutely don’t need are public officials whitewashing the facts: that Milwaukee’s young people have much to protest, including Wisconsin’s suspending Black high-school students more than any other state in the country.

Nor do we need incendiary comments like those coming from Milwaukee County Sheriff David Clarke, who drew national attention for his “blue lives matter” speech at the Republican National Convention and who is a regular guest on CNN and Fox News. In an August 15 op-ed published by the Hill, Clarke has called the civil unrest “the rule of the jungle,” “tribalism,” and a byproduct of “bullies on the left.”

He went even further, citing “father-absent homes” as a source of what he calls “urban pathologies”—leaning on old tropes used to stigmatize Black women, families, and the poor.

Single mothers are not to be blamed for young people’s responses to a city that ignores or criminalizes them. They should not be shamed for having children, their family structure, or for public policy that has made the city unsafe for parenting.

Creating justice—including reproductive justice—in Milwaukee will take much more than parents texting their teens to come home. The National Guard must leave immediately. Our leaders must identify anti-Black racism as a root cause of the uprisings. And, lastly, creating justice must start with an end to harmful rhetoric from officials who lead the way in ignoring and dehumanizing Milwaukee residents.

Sheriff Clarke has continued his outrageous comments. In another interview, he added he wouldn’t “be satisfied until these creeps crawl back into their holes so that the good law-abiding people that live in the Milwaukee ghetto can return to at least a calm quality of life.”

Many of Milwaukee’s Black families have never experienced calm. They have not experienced a city that centers their needs and voices. Black youth fed up with their treatment are not creeps.

And what hole do you think they should crawl back into? The hole where they face unemployment, underemployment, police brutality, and racism—and face it without complaint? If that’s the case, you may never be satisfied again, Sheriff.

Our leaders shouldn’t be content with Milwaukee’s status quo. And asking the citizens you serve to be quiet in the ghetto is an insidious expectation.

Analysis Politics

Experts: Trump’s Proposal on Child Care Is Not a ‘Solution That Deals With the Problem’

Ally Boguhn

“A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals," Hunter Blair, a tax and budget analyst at the Economic Policy Institute told Rewire.

In a recent speech, GOP presidential nominee Donald Trump suggested he now supports policies to made child care more affordable, a policy position more regularly associated with the Democratic Party. The costs of child care, which have almost doubled in the last 25 years, are a growing burden on low- and middle-income families, and quality options are often scarce.

“No one will gain more from these proposals than low- and middle-income Americans,” claimed Trump in a speech outlining his economic platform before the Detroit Economic Club on Monday. He continued, “My plan will also help reduce the cost of childcare by allowing parents to fully deduct the average cost of childcare spending from their taxes.” But economic experts question whether Trump’s proposed solution would truly help alleviate the financial burdens faced by low- and middleincome earners.

Details of most of Trump’s plan are still unclear, but seemingly rest on addressing child care costs by allowing families to make a tax deduction based on the “average cost” of care. He failed to clarify further how this might work, simply asserting that his proposal would “reduce cost in child care” and offer “much-needed relief to American families,” vowing to tell the public more with time. “I will unveil my plan on this in the coming weeks that I have been working on with my daughter Ivanka … and an incredible team of experts,” promised Trump.

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An adviser to the Trump campaign noted during an interview with the Associated Press Monday that the candidate had yet to nail down the details of his proposal, such as what the income caps would be, but said that the deductions would only amount to the average cost of child care in the state a taxpayer resided in:

Stephen Moore, a conservative economist advising Trump, said the candidate is still working out specifics and hasn’t yet settled on the details of the plan. But he said households reporting between $30,000 and $100,000, or perhaps $150,000 a year in income, would qualify for the deduction.

“I don’t think that Britney Spears needs a child care credit,” Moore said. “What we want to do is to help financially stressed middle-class families have some relief from child-care expenses.”

The deduction would also likely apply to expensive care like live-in nannies. But exemptions would be limited to the average cost of child care in a taxpayer’s state, so parents wouldn’t be able to claim the full cost of such a high-price child care option.

Experts immediately pointed out that while the details of Trump’s plan are sparse, his promise to make average child care costs fully tax deductible wouldn’t do much for the people who need access to affordable child care most.

Trump’s plan “would actually be pretty poorly targeted for middle-class and low-income families,” Hunter Blair, a tax and budget analyst at the Economic Policy Institute (EPI), told Rewire on Monday.

That’s because his tax breaks would presumably not benefit those who don’t make enough money to owe the federal government income taxes—about 44 percent of households, according to Blair. “They won’t get any benefit from this.”

As the Associated Press further explained, for those who don’t owe taxes to the government, “No matter how much they reduce their income for tax purposes by deducting expenses, they still owe nothing.”

Many people still may not benefit from such a deduction because they file standard instead of itemized deductions—meaning they accept a fixed amount instead of listing out each qualifying deduction. “Most [lower-income households] don’t choose to file a tax return with itemized deductions,” Helen Blank, director of child care and early learning at the National Women’s Law Center (NWLC), told Rewire Tuesday. That means the deduction proposed by Trump “favors higher income families because it’s related to your tax bracket, so the higher your tax bracket the more you benefit from [it],” added Blank.

A 2014 analysis conducted by the Congressional Research Service confirms this. According to its study, just 32 percent of tax filers itemized their deductions instead of claiming the standard deduction in 2011. While 94 to 98 percent of those with incomes above $200,000 chose to itemize their deductions, just 6 percent of tax filers with an adjusted gross income below $20,000 per year did so.

“Trump’s plan is also not really a solution that deals with the problem,” said Blair. “A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals.”

Those costs are increasingly an issue for many in the United States. A report released last year by Child Care Aware® of America, which advocates for “high quality, affordable child care,” found that child care for an infant can cost up to an average $17,062 annually, while care for a 4-year-old can cost up to an average of $12,781.

“The cost of child care is especially difficult for families living at or below the federal poverty level,” the organization explained in a press release announcing those findings. “For these families, full-time, center-based care for an infant ranges from 24 percent of family income in Mississippi, to 85 percent of family income in Massachusetts. For single parents the costs can be overwhelming—in every state annual costs of center-based infant care averaged over 40 percent of the state median income for single mothers.”

“Child care now costs more than college in most states in our nation, and it is an actual true national emergency,” Kristin Rowe-Finkbeiner, CEO and executive director of MomsRising, told Rewire in a Tuesday interview. “Donald Trump’s new proposed child care tax deduction plan falls far short of a solution because it’s great for the wealthy but it doesn’t fix the child care crisis for the majority of parents in America.”

Rowe-Finkbeiner, whose organization advocates for family economic security, said that in addition to the tax deduction being inaccessible to those who do not itemize their taxes and those with low incomes who may not pay federal income taxes, Trump’s proposal could also force those least able to afford it “to pay up-front child care costs beyond their family budget.”

“We have a crisis … and Donald Trump’s proposal doesn’t improve access, doesn’t improve quality, doesn’t lift child care workers, and only improves affordability for the wealthy,” she continued.

Trump’s campaign, however, further claimed in a statement to CNN Tuesday that “the plan also allows parents to exclude child care expenses from half of their payroll taxes—increasing their paycheck income each week.”

“The working poor do face payroll taxes for Social Security and Medicare, so a payroll tax break could help them out,” reported CNN. “But experts say it would be hard to administer.”

Meanwhile, Democratic presidential nominee Hillary Clinton released her own child care agenda in May, promising to use the federal government to cap child care costs at 10 percent of a family’s income. 

A cap like this, Blank said, “would provide more help to low- and middle-income families.” She continued, “For example, if you had a family with two children earning $70,000, if you capped child care at 10 percent they could probably save … $10,000 a year.”

Clinton’s plan includes a promise to implement a program to address the low wages many who work in the child care industry face, which she calls the “Respect And Increased Salaries for Early Childhood Educators” program, or the RAISE Initiative. The program would raise pay and provide training for child-care workers.

Such policies could make a major difference to child-care workers—the overwhelming majority of which are women and workers of color—who often make poverty-level wages. A 2015 study by the EPI found that the median wage for these workers is just $10.31 an hour, and few receive employer benefits. Those poor conditions make it difficult to attract and retain workers, and improve the quality of care for children around the country. 

Addressing the low wages of workers in the field may be expensive, but according to Rowe-Finkbeiner, it is an investment worth making. “Real investments in child care bring for an average child an eight-to-one return on investment,” she explained. “And that’s because when we invest in quality access and affordability, but particularly a focus on quality … which means paying child-care workers fairly and giving child-care workers professional development opportunities …. When that happens, then we have lower later grade repetition, we have less future interactions with the criminal justice system, and we also have a lower need for government programs in the future for those children and families.

Affordable child care has also been a component of other aspects of Clinton’s campaign platform. The “Military Families Agenda,” for example, released by the Clinton campaign in June to support military personnel and their families, also included a child care component. The former secretary of state’s plan proposed offering these services “both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS).” 

“Service members should be able to focus on critical jobs without worrying about the availability and cost of childcare,” said Clinton’s proposal.

Though it may be tempting to laud the simple fact that both major party candidates have proposed a child care plan at all, to Rowe-Finkbeiner, having both nominees take up the cause is a “no-brainer.”

“Any candidate who wants to win needs to take up family economic security policies, including child care,” she said. “Democrats and Republicans alike know that there is a child care crisis in America. Having a baby right now costs over $200,000 to raise from zero to age 18, not including college …. Parents of all political persuasions are talking about this.”

Coming up with the right way to address those issues, however, may take some work.

“We need a bold plan because child care is so important, because it helps families work, and it helps them support their children,” the NWLC’s Blank said. “We don’t have a safety net for families to fall back on anymore. It’s really critical to help families earn the income their children need and child care gives children a strong start.” She pointed to the need for programs that offer families aid “on a regular basis, not at the end of the year, because families don’t have the extra cash to pay for child care during the year,” as well as updates to the current child care tax credits offered by the government.

“There is absolutely a solution, but the comprehensive package needs to look at making sure that children have high-quality child care and early education, and that there’s also access to that high-quality care,” Rowe-Finkbeiner told Rewire. 

“It’s a complicated problem, but it’s not out of our grasp to fix,” she said. “It’s going to take an investment in order to make sure that our littlest learners can thrive and that parents can go to work.”

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