Parents, Speak Up! A Guide for Discussing Relationships and Waiting to Have Sex U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES This document was created by the Office of Population Affairs (a division of the Office of Public Health and Science) in collaboration with the Family and Youth Services Bureau and the Office of the Assistant Secretary for Planning and Evaluation, with assistance from The National Clearinghouse on Families & Youth. This document was updated in Spring 2007. For more information go to: www.4parents.gov PARENTS, SPEAK UP!: A GUIDE FOR DISCUSSING RELATIONSHIPS AND WAITING TO HAVE SEX Parents, Speak Up! A Guide For Discussing Relationships and Waiting to Have Sex You want the best for your teen. You want them to be healthy and happy now and in the future. Did you know that the choices they make now will affect their health and happiness for years to come? This guide will help you talk with your teen about choices and about why waiting to have sex is a healthy choice for them. This guide will: * Help you provide your child with the information, encouragement and support they need to make healthy decisions. * Make suggestions about what to talk about with your teen, when to talk about it, and how to talk about it. * Help you understand how your child feels and how you can encourage healthy behaviors. * Provide you with important information on sexually transmitted diseases (STDs), teen pregnancy, and other problems. You are the best person to help your child understand and make good choices. Sharing what you think and what you expect of them does make a difference. The time, attention, and support you give them makes a difference. Remember that all discussions do not have to be just about sex; you should also talk about character, values, and making good decisions in all aspects of their lives. You want to be prepared when you talk to your teen. Here are four helpful tips. They are easy to remember because they spell WISE. W is for Welcome: Your teen needs to know that you are eager to talk. They need to feel secure talking to you. No one enjoys dinner, activities, or conversations that are tense. Your teen is more likely to talk and listen if neither of you is angry or upset. If your teen feels calm and supported, it will be easier for both of you to talk about things like sex, peer pressure, setting goals, building relationships, preparing for marriage, and being a parent. So how do you create a supportive, safe environment so you can talk? First, you must show respect for each other. Second, your teen needs to be able to trust you. If you want your teen to make good choices, you have to be honest and reliable and expect the same. Third, you have to be available. You have to be there when your teen wants to talk(in the morning, after school, or at dinnertime. Studies show that teens who eat five to seven meals together with their parents during the week make healthier choices.1 Talking Tip: You are watching TV with your teen and sex comes up. Take the opportunity to discuss that aspect. You might relate it to peer pressure, teen pregnancy, STDs, and what’s happening in your community. I is for Interest: Show your interest by asking questions in a comfortable order and style. If you ask your teen, Do you think there’s a lot of pressure to have sex at your school? they are more likely to open up and talk to you than if you warn, You’d better not be having sex! Adults generally introduce topics gently when they are talking to other adults. But sometimes they are not as gentle with their own children. Here are a few important guidelines to help you talk with your teen: Start with a general question or observation. Let your teen be the expert on his or her world. Ask about peer pressure. Ask how you can help. For example, ask your teen: Is there someone you really like? What kinds of things do you do together? Are you ever alone together? Have you ever felt pressured or felt like you wanted to have sex? If you’ve felt pressured or wanted to have sex, how did you handle that? S is for Support Good Goals: If your teen son or daughter has hope for the future, they are more likely to make healthy choices. Do you know if your teen has goals? Do you know what they are? Ask your teen about their goals for marriage, family, and a career. Ask them about their goals for jobs now and in the future and what their plans are to prepare; then listen and offer support. E is for Encourage, Educate, and Empower: Educate and encourage your teen to make healthy decisions. When topics come up about sex, you don’t need to know all the answers. Be honest and offer to help find the facts together. Share your hopes and values. Goals, values, and beliefs are important to teens. They are some of the most powerful reasons for the sexual choices teens make. You can guide your teen to develop the values of honesty, responsibility, and caring. Share your family’s values with your teen and encourage service to others and the community. When parents are clear about their own values and clearly communicate them to their children in an open manner, their children are more likely to delay having sex.2 Values about education, marriage, and trust are more easily caught than taught. You and your behavior are the most valuable values educators! Many of today’s parents were teens when they began having sex. If you made poor sexual decisions when you were young, you can still guide your own teen to healthier decisions. We know more today than we did then about STDs and the consequences of sex at an early age. Studies have shown that religion and spirituality influence goals and values in many families. If your family is involved with a church, mosque, synagogue, or other faith organization, encourage your teen to participate. Teens who are actively involved in religious activities are less likely to have sex early.3 1. Why Is It Important to Talk With Your Teen About Relationships and Waiting to Have Sex? Because making good choices when it comes to relationships and waiting to have sex can prevent many heartaches and problems. It is important to help your teen deal with the risks they face in today’s world. Some issues, like teen pregnancy, are similar to when you were a teenager. Others, like HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome), are very different and can have lifelong consequences. Your child can really benefit from hearing what your values are. Parents and guardians are role models for youth. You can be a positive role model to your child by sharing with them and showing them what you expect through your actions. Setting goals in life is an important step in growing. You can help your child have goals related to healthy relationships and education. Early sex can get in the way. You can help them wait. It’s important to be there for your teen, and talk with them about the future. An STD is an infection that is passed from one person to another during sexual contact. STDs are much more common than you may think. About 19 million Americans get an STD every year. And, although most teens do not think they are at risk, teens actually have higher rates of STDs than adults.4 Most people who have one don’t even know they have one unless they get tested or until the infection is advanced. It’s important that your teen understands that they can get an STD even if they don’t have sex. They don’t have to have intercourse to get one. They can get some STDs by simply touching infected areas of the skin (HPV, syphilis, herpes).5 And teenage girls get some kinds of STDs like chlamydia, gonorrhea and HIV easier than women who are older.6 Teen pregnancy rates have been going down over the past several years, but they are still very high. If your teen becomes a parent, they will face many tough challenges. For example, they will be more likely to be poor, even when they get older7 and they will be less likely to graduate from high school or college.8 Their children will also be at greater risk for developmental problems.9 Teens are still developing physically and emotionally. They may not be prepared to deal with some of the physical or emotional consequences of sex. That’s why waiting to have sex is a healthy choice for teens. Waiting to have sex means avoiding voluntary, intimate sexual contact (oral, anal or vaginal). When sex isn’t involved in a relationship, teens learn how to form healthy friendships that are the basis for future healthy relationships. They learn self control and self respect, and they learn to accept responsibility for their choices and actions. You owe it to your teen to talk to them about relationships and waiting to have sex. Helping them learn to make the healthy choices will benefit them for a lifetime. Did you know that10: .. Every day thousands of teens contract an STD? .. Many STDs don’t have symptoms, so infected teens may not know they have an STD? .. You usually can’t tell by looking at someone if they have an STD, so teens may be fooled? .. STDs can cause serious, lifelong problems? .. STDs in the United States cost up to $14.1 billion in direct medical costs every year? 2. And There Is Good News Teens want their parents to talk to them. Even though it may be difficult to talk to your teen about sex, if your teen is like most teens, they want you to. Your opinions and counsel matter to them. In a survey, more teens said their parents have the most influence on their sexual decisions than teens who said that the media, friends, health teachers or religious leaders have the most influence.11 Most teens say that their parents are their role models. Almost sixty percent of teens said that when it comes to healthy, responsible relationships their parents are their primary models.12 Nearly 9 out of 10 teens surveyed agreed that it would be much easier to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents.13 Teens who feel connected to their parents make healthier decisions. Research found that teens who felt closely connected to their parents (meaning that they felt warmth, support, and closeness to their parents) were much less likely to be involved in risky behaviors like drugs, alcohol, tobacco use, and violence.14 Teens whose parents disapproved of early sex waited longer to have sex.15 It’s clear that teens want to talk with you about sex, values, and relationships. You can have a strong, positive influence on your teen’s decisions about sex. Are you a (connected( parent? These are some things you can do: .. Share your teen’s dreams and hopes .. Be receptive and available .. Know about your teen’s activities and friends .. Enjoy meals and family time with your teen .. Demonstrate strong values .. Listen to your teen .. Encourage values and faith .. Discuss tough topics and share opinions with your teen .. Set guidelines for your teen and maintain high expectations Who has the most influence on teens’ sexual decisions?16 .. Parents 37% .. Friends 33% .. Religious Leaders 7% .. Siblings 6% .. Media 5% .. Teachers and sex educators 4% 3. Why Parents Don’t Talk, but Should You may worry that you don’t know what to say or how to say it when you talk with your teen about sex and relationships. Although sex is a big topic in the media, it’s not something you normally talk about at home. You may hesitate to talk about sex because: It’s embarrassing. You think your teen won’t listen. You think you don’t know as much about sex, development and STDs as their health teachers and school nurses. You’re overwhelmed with the responsibilities of parenting and feel like you can’t do it all. You worry your teen will think you’re being judgmental. Maybe you made different choices when you were young and don’t want to seem like a hypocrite. While all these reasons are understandable, you still owe it to your teen to put them aside. Healthy choices will better prepare your teen to deal with sex; and you need to help your teen make healthy choices. To make healthy choices teens need to: Be involved in family activities and share family responsibilities; Be involved in school and community activities; Have goals and a plan to reach them; Know they are important to their parent(s) and the other adults in their lives; Feel that their parent(s), grandparent(s), teachers, and/or other adults in their lives support their good decisions; Know the facts about sex, teen pregnancy, teen parenthood, STDs, drugs and alcohol; Know why and how to say (no.( 4. Tips for Talking With Your Teen You don’t have to know everything about teens and sex. What you really need to know is how to talk to your child, pre-teen or teen about what you believe. You should talk early and often. It is never too late to start the conversation, and it is a conversation that continues over many years. Talking about sex is not just one big talk. It is something you need to do early, and often. Tips for Talking: Welcome: Be available; treat each other with respect and trust. Interest: Ask your teen questions about their opinions, friends, school, or movies, but let your teen tell their story. Support Good Goals: Ask what your teen’s goals are, both for the long range and for the short term, and share your support. Encourage, Educate and Empower: Give your teen the guidance, information, and skills to be successful. (If I tell you not to do what I am doing, I am a hypocrite. If I tell you not to do what I have done, I am a teacher.( (Author Unknown House rules are a good way to let your teen know what you expect. They should be clear, fair, and consistently followed. Your teen may complain about the rules, but do not give in. House rules protect and encourage. And even though most teens may not admit it, they like to have rules that are enforced. Rules give structure to their lives and help them feel loved and secure. HOUSE RULES: ..Encourage supervised group activities. Know and support the groups your teen participates in. ..Set an age for dating. Be clear that there will be no dating before this age. ..Make it clear that your teen will not date anyone more than two years older or younger than they are. ..Make sure that your teen is not spending a lot of time in unsupervised situations. Sports, tutoring, and even after school jobs are positive ways to ensure that your teen is safe and productive during the after school hours. ..Tell your teen that it is against the rules to entertain a boyfriend or girlfriend in personal spaces like bedrooms. ..Set clear guidelines for your teen’s outings: Where will you be? What will you be doing? Who will you be with? When will you be home? How can I reach you? ..No alcohol. No drugs. No tobacco. Period. ..Be available to pick up your teen if he or she calls in an uncomfortable or threatening environment or situation. ..Set rules for what your teen son or daughter can listen to, read, and watch. Consider keeping the TV and computer in a public area of the home so you will know what your teen is watching. ..Be available to talk with your teen daily. Good communication supports good decisions. Start Talking Early Some parents put off discussing sex, values and expectations until their child becomes a teenager. By that time, it can be too late. In 2005, one out of three teens in grade 9 reported that they had had sex at least once. In the same study, that number jumps to almost two out of three teens in grade 12.17 So talk early and often. Conversations about love, relationships, and sex could begin as early as six and should continue through the teenage years. If your child is old enough to ask questions, he or she is old enough to receive simple, but correct, answers. By the time your child is in middle school, you need to be straightforward. You can talk about the health benefits of making good decisions and setting goals for the future. Talk about waiting to have sex and why it is a healthy choice. And you can talk about emotions and relationships. When your teen enters high school, continue to reinforce what you have already talked about ( dating relationships, values, self discipline, and the consequences of early sex. So always leave the door open. Start talking early so that when it is time to talk about tough topics, you and your teen will have built a relationship that allows those conversations to be comfortable, to sink in and to have meaning. What do you tell your teen? ..Be firm in your decision to choose to wait to have sex. ..Choose friends who respect your decisions and share your values. ..Avoid situations where sex can happen. ..Stay away from people who pressure you to have sex. ..Find nonsexual ways to show you care (give a card or a compliment). ..Remember who you are, where you want to go and how you’re going to get there. Good News There is evidence that teens are making healthier choices. Rates of teen pregnancies are decreasing. Many young people are deliberately avoiding early sexual activity. In 1991, 54 percent of all high school students reported they had sex. In 2005, that number dropped to 47 percent.18 Teens are becoming aware of the problems of teen sex and many are making good decisions, like choosing to wait to have sex. You are key to helping your teen decide to wait for sex. Effective parents not only teach and encourage their teens, they also set high expectations for them. And they clearly communicate those expectations. If you let your teen know that you believe in their ability to make healthy choices like waiting to have sex, it will help them to make good decisions. What Do You Talk About? Your teen son or daughter can get the (facts( from lots of places, but they are not always accurate. Make sure your teen has the right information to make healthy choices. Visit www.4parents.gov for more information and talking tips. Talk About Growing Up Body changes during puberty can happen early or late, fast or slow. Teach your child about changes that are or will be happening. Reassure them through those self conscious stages; and talk to your health care provider if you or your teen is worried about something. CONVERSATION STARTER: How much do you think you’ve grown since last year? More changes are going to happen. Do you know what some of those changes are? Some teens become confused when ideas, behaviors, and friendships with males and females change during puberty. Your teen needs to be able to talk to someone who is constant in their life. CONVERSATION STARTER: I haven’t seen Jason around here lately. Sometimes relationships with old friends change during the teen years. How are things going with your friends? Talk About Waiting Your teen son or daughter needs to know why you don’t want them to have sex now. Help them to understand that waiting to have sex is a healthy choice for them. If they wait to have sex, they don’t have to worry about getting pregnant or getting someone pregnant. They don’t have to worry about STDs, including HIV/AIDS. Nor do they have to worry that their boyfriend or girlfriend is only interested in them because of sex. Waiting for sex shows self respect and respect for your partner. Let your teen know that even though they are capable of having sex, having sex will not make them an adult...making good choices will. What do teens think about teen sex? ..More than half of all teens say that teens should not have sex. ..Nearly three out of four teens do not think it would be embarrassing to say they are a virgin. ..Two thirds of teens who have had sex wish they had waited. ..Nine out of 10 teens think it is important for society to send a strong message that teens should not have sex until they are at least out of high school.19 Talk About How Your Teen Might Feel Talk to your teen, early and often, about how they are feeling about relationships and waiting to have sex.  Their emotions are running on overdrive, so don’t be surprised if they have a hard time describing exactly how they feel.  That’s OK, because there’s no need to conduct a formal research study about your teen.  Just encourage your teen to talk about how they are feeling and be there to listen to them. To start the conversation, let them know their feelings about relationships and sex are normal, not embarrassing; and that as a good parent you want to hear how they feel.  Your teen wants to talk to a parent that wants to listen. What’s the simplest way to learn how your teen is feeling about sex?   Ask them!  And then sit back and listen.  Really listen.  Early and often. Be a better listener SAMSHA (the Substance Abuse and Mental Health Services Administration at HHS) suggests ways for a parent to be a better listener: Be interested and attentive. Forget about the telephone, the television, and whatever else you were doing just listen! Don't interrupt. Sometimes, as parents, we want to jump into the conversation with an opinion or a solution before letting our child finish talking. Give your child active feedback while she is speaking nodding, giving verbal responses such as "I see," etc. Name the feeling You can help your child clarify his feelings through your active feedback by restating his thoughts or asking questions. Watch for nonverbal messages. Posture, eye contact, energy level these can all be clues to your child's true feelings. Ask open-ended questions. Avoid asking questions that can be answered with a yes or no. Don't talk down to your child no matter what his age. You probably know more than he does from experience alone, but don't use this knowledge to discount his opinions. Follow-up. Try to remember and ask about issues or events your child talked about a day or two earlier.20 What If Your Teen Has Already Had Sex? If you find out your son or daughter has already had sex, it’s important for you to take them to a health care professional to be screened for pregnancy or STDs. Be sure to let your teen know that you are concerned about their health and happiness. Talk with them about risks and consequences short and long term. Tell them it is not too late to stop having sex --- that it is never too late to make healthy choices. CONVERSATION STARTER: That song has a good beat, but the words make it seem like having sex makes you a man (or woman). Do you think that’s true? Talk About STDs Review with your teen the facts about STDs, and tell them about the dangers of STDs. Remember to say that sexual contact is any close contact with the genital area, including oral, anal, and vaginal sex. Any of these activities can transmit an STD. Teen girls get infected with STDs more easily than adult women. That seems strange since teens are usually in better health than adults. One reason they can be more easily infected is that they are still maturing and the lining in their reproductive tract is less developed. Infections can enter and grow more easily.21 CONVERSATION STARTER: They never talk about STDs on that television show, even though they have lots of stuff about sex. Have you heard about anybody at your school who has gotten an STD? Talk About Condoms Condoms are a type of contraception that some people may use to reduce the chances of getting pregnant or getting an STD. You and your teen need to know that, while condoms are the only type of contraception that can help protect against STDs, they only reduce the risk but do not eliminate it. They are better at protecting against some diseases than others. For example, studies show that when used all the time and used the right way, condoms can reduce the risk of getting HIV infection.22 CONVERSATION STARTER: I was listening to the radio and heard a commercial about condoms. Do you know what a condom is? What can I tell you about them? Condoms only protect against STDs and pregnancy if they are used every time and are used the right way. CONVERSATION STARTER: I overheard a couple of kids from the neighborhood saying that, if you’re dating someone, you have to have sex with them to prove that you’re loyal and you’re not cheating on them. Do you think that’s what loyalty is about? Even when a condom is used, a person can still get an STD. This is true for bacterial and viral infections that live on the skin. For example, herpes and HPV can be spread by infected areas of the skin that are not covered by a condom. This is true even when physical symptoms are not showing.23 Talk About Teen Pregnancy Do you know that almost one in three teen girls in the United States is estimated to get pregnant at least once before age 20?24 While this is better than two decades ago, when the number was four in ten girls, it is still too high. Pregnancy has very important consequences for teen girls and teen boys, and their children. Although teens who have a child tend to be disadvantaged even before they become pregnant, having a baby as a teen makes it much harder for a boy or girl to reach their goals, such as finishing high school, going on to college, getting a good job, or getting married when they grow up, and poses additional challenges to the child as well.25, 26 CONVERSATION STARTER: Ms. Martin told me that there are five girls at your school that are pregnant. What do your friends think about teenagers having a baby? The good news is that over the past 10 years, the rate of teen pregnancy has decreased. More teens are choosing to wait to have sex. Of those teens who are sexually active, more are using birth control.27 Did you know that babies born to teen mothers are more likely to:28 ..Be born too small or die early in life ..Grow up in homes with low emotional support ..Not earn high school diplomas Did you know that teens who become parents29: ..Are more likely to end up poor or on welfare ..Have fewer educational opportunities ..Have reduced job prospects and likely lower wages Talk About Sex, Teens, and the Law You and your teen need to know the basics about sex, teens, and the law. Each state has laws that set the age at which someone can give consent to have sex, marry, or seek medical care as an independent person. These laws are written to protect young teens from older people who force or pressure them to have sex. If the young teen is young enough, the older person can be a teen as well. In many states it is illegal for a young teen to have sex with someone two or more years older, even if the younger teen (consents( to sex. The older person can be charged with statutory rape or other crimes. AGE DIFFERENCES AND DATING Age difference is important. Only 13 percent of young teens have sex if they date someone their same age. But if they date someone who is 2 years older, 26 percent have sex. If their partner is 3 or more years older, 33 percent of them have sex.30 All states have laws to protect young teens from older partners who force or pressure them to have sex. In many states, it is illegal for a teen to have sex with someone two or more years older, even if the teen (consents( to sex. The older person can be charged with (statutory rape( or other crimes. Talk About Money Talk to your teen about the financial responsibilities of being a parent. Young women are not the only ones responsible when a baby is born. Young men need to know that they will be responsible for 18 years of child support for any child they father. Even teen fathers are held responsible for the baby. The same is true even if the teen father doesn’t want to be involved with the baby or the baby’s mother. It also doesn’t matter if they move to another state or if they join the military. A judge can order their child support payments to be taken out of their paychecks. CONVERSATION STARTER: Did you know that a portion of a man’s paychecks can be withheld for the next 18 years if he gets a girl pregnant and doesn’t pay child support? Talk About Healthy Relationships When teenagers worry about sex, they are often really worrying about relationships. When you talk about sex, also talk about relationships. Help your teen build healthy relationships with their friends boys and girls. * Teach your teen that healthy relationships are based on respect, caring, trust, and desire to help each other grow. Explain how early sexual activity can get in the way of their growth as a teen and young man or woman. * Teach them to show affection without having sex. * Encourage your teen to choose friends who have the same values as your family. * Help your teen know that violence is never a part of a healthy relationship. Healthy relationships do not just happen. They require effort. Healthy relationships, whether between friends, romantic partners, or family members, promote positive, healthy behaviors. They are built on trust and are founded on common goals and interests. They encourage and enable both people to grow and progress. Teens also need to know that marriage has health benefits. Men and women in healthy marriages are31: * More likely to be both emotionally and physically healthier * Less likely to abuse drugs/alcohol or to attempt suicide CONVERSATION STARTER: You’ve told me you want to wait to have a family some day. Tell me what you would look for in a wife (or husband). How will you know she (he) can be trusted to share the future with you? Talk About Preparing for the Future There are two questions that every teen asks themselves: Who am I? What do I want to do? As a parent you can help your teen answer these questions. You can help your teen build their own values. Talk about your values and why they are important. You can also help your teen identify their own goals. Do they want to go to college or trade school after high school, or get a job? Is there something they love to do you can help them learn how that could lead to a job in the future. Help your teen understand that the choices they make today can make a difference for their future. For example, getting pregnant or getting a girl pregnant could change their lives. On the other hand, getting good grades today means they will have lots of choices after high school, and that can mean a better job when they grow up. CONVERSATION STARTER: I was at the store yesterday and ran into Richard, Mrs. Jackson’s son. He joined AmeriCorps right after high school. What do you think you want to do when you graduate from high school? Other Issues to Discuss Sex is not the only topic you should talk to your teen about. Risky behaviors often go together. Teens who smoke are more likely to drink alcohol and use drugs. Teens who drink alcohol and use drugs are more likely to be sexually active. Teens who drink are seven times more likely than teens who don’t drink to have had sex. And teens who use drugs are five times more likely to have had sex.32 So when you’re talking about sex, also talk about other health risks like alcohol, tobacco, drugs, and violence. CONVERSATION STARTER: I heard that there was a wild party last weekend after the game. Have your friends been talking about it? Did you know that alcohol and drugs really increase the chances of having sex and getting a disease? 5. Helping Teens to Have a Voice and Say No You can’t go everywhere with your teen. That’s one reason why it’s important for your teen to choose good friends. Get to know their friends. Know what your teen is doing and who your teen is with. Foster healthy peer group friendships by welcoming your teen’s friends into your home when you are there. Keep your teen busy and involved in productive activities with other young people who are making healthy choices. Encourage your teen to participate in activities in your local community with other kids their age. Then support them in their activities. If your teen is playing baseball, be in the bleachers. If that’s not possible, ask about the game afterwards to let your teen know that you’re a proud parent, even if they ride the bench. If your teen is in a play, be in the front row. While you’re there, get to know the parents of the other young people who are participating. Even when your teen’s close friends are making healthy choices and avoiding sex, drugs, and alcohol, sometimes your teen will be in situations that are unexpected. So they need to learn how to say no when the pressure is on. Let your teen know that you know about peer pressure and how strong it can be. Then help them think through and plan what they will do if they find themselves in a tough or uncomfortable situation. Teach your teen the (N.I.C.E.( way to say (no.(33 Teens are sensitive to peer pressure. They do not want their peers to make fun of them or ridicule them. So when your teen is confronted by a situation that makes them uncomfortable or violates their values, or that is potentially dangerous, they should be prepared to say (no( firmly, but graciously, by following these four steps: N ( Say (No.( Not (maybe( or (later.( Teach your teen to set boundaries and be decisive. If your teen decides not to have sex before being confronted by the pressure to have sex, it will be easier to say (no( when the situation arises. I ( Follow with an (I( statement: (I plan to wait several years before I have sex.( Or (I’m not going to have sex until I marry.( Or (Sex isn’t part of my game plan right now. C ( If pressure continues, (Change.( Teach your teen to change the topic: (Did you see the game on TV last night?( Or change who they’re talking to: (Julie is over there; I need to ask her something.( Or change the location: (I’m going back into the kitchen.( E ( If these strategies do not help, your teen needs an (Exit( plan. Teens should leave a bad situation immediately. If your teen does not have a way home, you or some other trusted adult will need to pick him or her up. It’s a good idea for you and your teen to have a prearranged (code phrase( that means (Come and pick me up. And hurry!( NICE Refusal Skills: Saying (No( and being strong ‘N’No ‘I’An (I( statement ‘C’Change things ‘E’Exit Practice these steps with your teen. Review what they’d do in all different kinds of uncomfortable situations. Make sure your teen remembers the steps by asking, (What would you do if...( Then listen to how your teen would handle pressure when faced with risky choices. Finally, help your teen know how to show affection and caring without having sex. Parents, Speak Up! Remember, you are the most important link between your teen, your teen’s health, and a bright future. You are their most valued source of support, information and hope. You can provide the encouragement and direction that can help them avoid the health risks of early sex, pregnancy, and sexually transmitted disease. It is a tough job, but the rewards are remarkable. You are not alone. Schools, religious organizations, communities, and youth leaders also play important roles in helping young people make healthy choices. What Are the Facts About Sexually Transmitted Diseases (STDs)? STDs are much more common than most people realize. Because so many are undiagnosed, experts can only estimate that there are millions of new STD infections among Americans each year in the U.S. STD Data There are at least 25 different STDs. STDs are the most common infectious diseases in the US. 19 million Americans get a new STD infection each year.34 About 9.1 million teens and young adults (aged 15-24) got an STD in 2000.35 Most teens do not think they are at risk of an STD.36 At least 25 diseases are shared through sexual contact, and many of these diseases may begin with mild or no symptoms. The rates of some STDs are highest among teens.37 Unless tested, many people do not know they are infected until the infection may have caused permanent, lifelong damage. They may have also unknowingly given the infection to their sexual partners. STD Facts * You can not look at someone and tell if they are infected. * STDs can be transmitted through oral, anal, or vaginal sex. * Some STDs can be transmitted by skin-to-skin contact (HPV, syphilis, herpes). * Some STDs can be transmitted from a pregnant mother to her baby. * Many STDs do not have any symptoms, but can cause serious, lifelong problems. * Testing is the only sure way to find out if someone is infected. * Viral STDs cannot be cured by medicines. * Bacterial STDs can be cured by antibiotics, but medicine cannot reverse any damage that has already occurred. * Having some STDs makes it easier to get or spread HIV. * Latex condoms used the right way all the time can reduce but not eliminate the risk of getting STDs. * Latex condoms are better at protecting against some STDS than others. * Because some STDs (HPV, syphilis, herpes) can be in areas not covered by the condom, it is still possible to get infected even when using a condom. Chlamydia & Gonorrhea Chlamydia and gonorrhea are two common bacterial STDs. According to the CDC (Centers for Disease Control and Prevention), the highest reported rates of chlamydia and gonorrhea are among 15-19 year old female teens.38 Chlamydia and gonorrhea symptoms can be so mild that they are often unnoticed. But if there are symptoms, they can include abnormal discharge from the vagina or penis and pain or burning sensation when urinating. Females can also have lower abdominal pain. Antibiotics can cure chlamydia and gonorrhea. But if they are not treated soon enough, either one of these infections can cause scarring of some parts of the reproductive tract which can make it difficult or impossible for a woman to get pregnant naturally. Or they can cause an ectopic pregnancy where pregnancy occurs outside the uterus. Ectopic pregnancies can be very dangerous. Chlamydia and gonorrhea can also cause scarring in men’s reproductive tracts and make it impossible for them to get a woman pregnant naturally. It is important that you talk to your teen about these STDs because they can cause long term problems. Encourage your teen to make healthy choices; give them the information they need to guide their choices; and provide them with the support they need to stick to them. Human Papillomavirus (HPV) Infection with human papillomavirus (HPV) is the most common STD in the U.S. Over 50% of people who have sex will get HPV at some point in their lives. Many people get HPV during their teenage years.39 There are many kinds of HPV. Most kinds don’t have any symptoms. Some can cause genital warts. Most HPV infections don’t cause any problems at all and go away in a year or two without any treatment. However, some kinds that don’t go away persistent infections - are the main risk factors for cervical cancer. The genital warts that are caused by the HPV virus can be treated, but there is no medical cure for the virus (HPV) itself. It is unclear how well condoms protect against HPV, but areas of the skin not covered by a condom can be exposed and infected by HPV. Because HPV can lead to cancer of the cervix, regular pap testing and careful medical follow-up and treatment are important to help ensure that abnormal changes in the cervix caused by HPV do not develop into cervical cancer. Therefore, Pap tests are an important part of female reproductive health. There is now a vaccine that prevents certain types of HPV infection. It helps prevent cervical cancer and other diseases in females caused by some types of HPV. The vaccine is for females ages 9 to 26 years. STDs can lead to: ..Pelvic inflammatory disease (an infection of the reproductive organs) ..Scarring of the reproductive track ..Infertility ..Infection in babies ..Lifelong illness or pain ..Chronic abdominal pain ..Cancers .. In some cases death (HIV and hepatitis B) (HIV/AIDS) Human immunodeficiency virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). There are about 1.2 million people living with HIV/AIDS today in the US.40 However, this number could be much larger because about 25% of people infected with HIV do not know they have it.41 When someone first gets infected with HIV, there usually aren’t any symptoms. But if there are symptoms, people usually think they have the flu. With time the HIV virus can destroy the immune system which leads to AIDS. When a person has AIDS, their immune system is not able to fight off infections. Some of these infections can be serious diseases and people can die from them. Today there are many medicines that can help people live longer, but none can cure the HIV infection. Tell your teen that it is easier to get HIV if you already have another STD, like chlamydia, HPV, or herpes. People who have HIV can pass the infection to their sexual partners. Remember, you cannot tell if someone has HIV just by looking at them. Herpes Herpes simplex virus or "herpes" is one of the most common infections in the world. There are two main types: one that usually infects the reproductive tract, and one that usually infects the mouth and lips. When someone first gets infected, he or she can have a fever, aches, pains, and many little painful blisters close to where the virus made contact with the skin. The soft skin or membranes on the penis, scrotum, or female genital area can become very sore. There also can be painful "fever blisters" around the mouth. This first set of symptoms generally lasts one to two weeks. Symptoms often recur throughout life, but recurrences generally are not as severe as the initial outbreak. There is no cure for herpes. There are new medicines that can help control the symptoms if they are sever, but some people do not need medication because their recurrences are mild. An infected person can give the infection to someone else through sex or close contact with the skin, mouth, or reproductive tract. They can infect someone even if they do not have blisters or other symptoms. Mothers can pass herpes to their babies when they are born. Learn More There are other STDs, like hepatitis B infection, syphilis, and trichomoniasis. The chart at the back of this guide has more information about these and other STDs. It is important for you to know about STDs so you can help your teen make healthy choices to ensure a healthy body and future. HIV and most STDs can be diagnosed with special tests. Tell your teen that you can’t just look at someone and tell if they are infected. It is also essential that your teen receives regular medical care. If your teen has had sex or is having sex, it is important they get tested and treated as needed. Talk Early and Often Remember, your teen wants you to talk to them about relationships and waiting to have sex, and if you want your teen to make healthy choices, you need to talk to them. Talk clearly and openly. Talk now and talk often. Talk about choices and why some are better than others. Talk about values and expectations. Stay connected and involved in their lives. What Parents Need to Know about Sexually Transmitted Diseases There are over 25 sexually transmitted diseases (STDs). The most common ones are: Bacterial Sexually Transmitted Diseases Chlamydia * Where is it found? o Vagina, cervix, urethra, throat, discharge from penis, and rectum * How can it be spread? o Oral, anal, and vaginal sex; mother to child * What are the possible symptoms and complications? o May not have early symptoms, burning or pain with urination, discharge from penis and vagina, chronic low abdomen pain, pelvic inflammatory disease (PID) and infertility may result (mostly in females) * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing and treatment * What are the treatments? o Antibiotics (permanent damage may have occurred prior to treatment) Gonorrhea * Where is it found? o Vagina, cervix, uterus, urethra, throat, and rectum * How can it be spread? o Oral, anal, and vaginal sex; mother to child * What are the possible symptoms and complications? o Males: often have no symptoms; may have burning or pain with urination. o Females: often have o symptoms. May have vaginal discharge, may lead to pelvic inflammatory disease (PID) or infertility * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing and treatment * What are the treatments? o Antibiotics (permanent damage may have occurred prior to treatment) Syphilis * Where is it found? o Genital area , mouth, skin, anus, and rectum * How can it be spread? o Oral, anal, and vaginal sex; contact with sores; mother to child * What are the possible symptoms and complications? o Males: often have no symptoms; may have burning or pain with urination. o Females: often have no symptoms. May have vaginal discharge, may lead to pelvic inflammatory disease (PID) or infertility * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing and treatment * What are the treatments? o Antibiotics (permanent damage may have occurred prior to treatment) Trichomoniasis (Parasite) * Where is it found? o Vagina, cervix, and urethra * How can it be spread? o Vaginal sex * What are the possible symptoms and complications? o Vaginal discharge and itching, burning during urination, males may have no noticeable symptoms but can cause temporary irritation in penis, may cause early delivery and low birth weight babies * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing and treatment * What are the treatments? o Antibiotics (permanent damage may have occurred prior to treatment) Viral Sexually Transmitted Diseases Genital Herpes: Herpes Simplex Virus * Where is it found? o Genitals and/or rectum * How can it be spread? o Oral, anal, and vaginal sex; contact with infected skin; rarely mother to child * What are the possible symptoms and complications? o Often no symptoms are present, painful blisters or sores, fever, and swollen glands may occur, symptoms can recur throughout life, rarely serious infection can occur when passed to newborns * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing and treatment * What are the treatments? o Symptom control that can help reduce recurrences, but no cure Human Papillomavirus (HPV) * Where is it found? o Vagina, cervix, penis, vulva, anus, scrotum, and other genital areas * How can it be spread? o Anal and vaginal sex; contact with infected skin; rarely mother to child * What are the possible symptoms and complications? o Most have no symptoms, but some can get genital warts, can cause cancer of the cervix, vulva, vagina, anus and penis * Prevention o HPV vaccine (for some strains of HPV); Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Condoms used correctly and consistently reduce but do not eliminate the risk * What are the treatments? o No cure for infection, but medications can remove visible genital warts. Regular Pap testing and follow-up medical treatment may deter development of cervical cancer. Hepatitis B * Where is it found? o Blood, semen, and vaginal fluid * How can it be spread? o Oral, anal, and vaginal sex; IV drug use; mother to child * What are the possible symptoms and complications? o Often there are no obvious symptoms, jaundice, abdominal pain, loss of appetite, fatigue, joint pain, can lead to liver cancer and liver failure * Prevention o Hepatitis B vaccine; Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Do not share needles; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing * What are the treatments? o Chronic infection can be treated with medication. No cure. HIV/AIDS * Where is it found? o Blood, semen, cervical and vaginal fluid, and breast milk * How can it be spread? o Oral, anal, and vaginal sex; IV drug use; mother to child * What are the possible symptoms and complications? o No early symptoms or some flu-like symptoms that are often not noticed, rash, weakens immune system, multiple severe infections * Prevention o Abstain from sex; Faithful marriage or mutually monogamous relationship with an uninfected partner; Do not share needles; Condoms used correctly and consistently reduce but do not eliminate the risk; Testing * What are the treatments? o Symptom control with medicines (antiretroviral drugs); Lifetime treatment is required; No cure Sources: Baeten, J.M.; Nyange, PM; Richardson, B.A. Hormonal contraception and risk of sexually transmitted acquisition. Results from a prospective study, American Journal of Obstetrics and Gynecology 2001; 185:380-385. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Fact Sheets. Atlanta, GA: US Department of Health and Human Services. Available at http://www.cdc.gov/std/HealthComm/fact_sheets.htm Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2003. Atlanta, GA: US. Department of Health and Human Services, Center for Disease Control and Prevention, September 2004. National Institute of Allergy and Infectious Disease, National Institute of Health, Department of Health and Human Services, Workshop Summary : Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, June 2000 Available at http://www.niaid.nih.gov/dmid/stds/condomreport.pdf Wald, A; Langengerg, A.G. and Link, K. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women, JAMA 2001, 255 3100-3106 1 Fulkerson, J., Story, M., Mellin, A., Leffert, N., Neumar-Sztainer, D., and French, S., Family Dinner Meal Frequency and Adolescent Development: Relationships with Developmental Assets and High Risk Behaviors, Journal of Adolescent Health, 2006, 39(3), 337-345. 2 The National Campaign to Prevent Teen Pregnancy, Washington, DC, Science Says: Parental Influence and Teen Pregnancy, February 2004. 3 The National Campaign to Prevent Teen Pregnancy. Washington, DC, Science Says: The Association between Parent, Family, and Peer Religiosity and Teenagers’ Sexual Experience and Contraceptive Use, November 2005. 4 Centers for Disease Control and Prevention. Tracking the Hidden Epidemics: Trends in STDs in the United States 2000, p. 2. Available at http://www.cdc.gov/nchstp/dstd/ Stats_Trends/Trends2000.pdf 5 Office on Women’s Health, National Women’s Health Information Center, 2005 Daybook: Generations-Women’s Health Across the Lifespan -- Protect Your Reproductive System. Available at: http://www.4woman.gov/pub/daybook.2005/10_ReproductiveHealth.pdf 6 Centers for Disease Control and Prevention. Healthy People 2010: Sexually Transmitted Diseases. Available at http://www.hhs.gov/pharmacy/phpharm/hpstd.html 7 Maynard, R., ed. Kids Having Kids: A Robin Hood Foundation Special Report on the Costs of Adolescent Childbearing. New York: The Robin Hood Foundation, 1996. 8 McElroy, S.W.; Hotz, J.; and Sanders, S.G. (The Impact of Teenage Childbearing on the Mothers and the Consequences of Those Impacts for Government.( In Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy, edited by R. Maynard. Washington, DC: The Urban Institute Press, 1997. 9 Moore, K.A.; Morrison, D.R.; and Greene, A.D. (Effects on Children Born to Adolescent Mothers.( In Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy, edited by R. Maynard. Washington, DC: The Urban Institute Press, 1997. 10 Centers for Disease Control and Prevention. Trends in Reportable Sexually Transmitted Diseases in the United States, 2005. December 2006.. Available at http://www.cdc.gov/std/stats/05pdf/trends-2005.pdf 11 The National Campaign to Prevent Teen Pregnancy, (two works): With One Voice: America’s Adults and Teens Sound Off About Teen Pregnancy: An Annual Survey. December 2004. This is My Reality: The Price of Sex. January 2004. 12 The National Campaign to Prevent Teen Pregnancy, Science Says: American Opinion on Teen Pregnancy and Related Issues 2003, February 2004. 13 ibid 14 Resnick, M.D.; Bearman, R.S.; Blum, R.W.; Bauman, K.E.; Harris, K.M.; Jones, J.; Tabor, J.; Beuhring, T.; Sieving, R.E.; Shew, M.; Ireland, M.; Bearinger, L.H.; and Udry, J.R. (Protecting Adolescents From Harm. Findings From the National Longitudinal Study on Adolescent Health.( Journal of the American Medical Association, 1997, 278:823 832. 15 Ibid 16 The National Campaign to Prevent Teen Pregnancy. With One Voice: America’s Adults and Teens Sound Off About Teen Pregnancy: An Annual Survey. December 2004. 17, Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance: United States, 2005, Surveillance Summaries, MMWR 2006;55(No. SS-5). Available at: http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf 18 Trends in HIV-Related Risk Behaviors Among High School Students --- United States, 1991 2005, MMWR Weekly, August 11, 2006. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5531a4.htm 19 The National Campaign to Prevent Teen Pregnancy. With One Voice: America’s Adults and Teens Sound Off About Teen Pregnancy: An Annual Survey. December 2004. 20 Adapted from: Substance Abuse and Mental Health Services Administration (SAMHSA), A Family Guide To Keeping Youth Mentally Healthy & Drug Free: Talk with Your Child-Be a Better Listener. Available at: http://www.family.samhsa.gov/talk/listener.aspx 21 Centers for Disease Control and Prevention. Healthy People 2010: Sexually Transmitted Diseases. Available at http://www.hhs.gov/pharmacy/phpharm/hpstd.html 22 Centers for Disease Control and Prevention. HIV/AIDS > Questions and Answers: How Effective Are Latex Condoms in Preventing HIV? (website, last reviewed: October 20, 2006). Available at: http://www.cdc.gov/hiv/resources/qa/condom.htm 23 Office on Women’s Health, National Women’s Health Information Center, 2005 Daybook: Generations-Women’s Health Across the Lifespan -- Protect Your Reproductive System. Available at: http://www.4woman.gov/pub/daybook.2005/10_ReproductiveHealth.pdf 24 The National Campaign to Prevent Teen Pregnancy. National Teen Pregnancy and Birth Data: General Facts and Stats -- analysis of Teen Pregnancy Data. (2006). 25 Hotz, V. Joseph, McElroy, S., and S. Sanders. The Impacts of Teenage Childbearing on the Mothers and the Consequences of Those Impacts for Government. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Ed. Rebecca A. Maynard. Washington, DC: The Urban Institute Press, 1997. 55-94. 26 Brien, Michael J., and Robert J. Willis. Costs and Consequences for the Fathers. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Ed. Rebecca A. Maynard. Washington, DC: The Urban Institute Press, 1997. 95-143. 27 National Center for Health Statistics (CDC), Fact Sheet--Teens Delaying Sexual Activity: Using Contraception More Effectively, December 2004. Available at: http://www.cdc.gov/nchs/pressroom/04news/teens.htm 28 Federal Interagency Forum on Child and Family Statistics, America's Children: Key National Indicators of Well-Being 2005, Available at: http://www.childstats.gov/amchildren05/hea9.asp 29 Ibid 30 Albert, Bill, Sarah Brown and Christine M. Flanigan, eds. 14 and Younger: The Sexual Behavior of Young Adolescents. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2003. 31 Administration for Children and Families, The Healthy Marriage Initiative: Benefits of Healthy Marriages. Available at: http://www.acf.hhs.gov/healthymarriage/benefits/index.html 32 The National Center on Substance Abuse and Addiction. Dangerous Liaisons: Substance Abuse and Sex. Columbia University: December 1999. 33 N.I.C.E. is adapted from the (Achieve Success Program( by the group Aim for Success. 34 Centers for Disease Control and Prevention. Tracking the Hidden Epidemics: Trends in STDs in the United States 2000, p. 2. Available at http://www.cdc.gov/nchstp/dstd/ Stats_Trends/Trends2000.pdf 35 Weinstock, H., Berman, S, & Cates, W., Jr. (2004). Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health. New York: 36, (1), 5-6. 36 Office of National AIDS Policy, Youth and HIV/AIDS, 1995. Available at: http://clinton4.nara.gov/ONAP/youth/youth4.html 37 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2006.  MMWR 2006; 55(No. RR-11); 8-9. 38 Trends in HIV-Related Risk Behaviors Among High School Students --- United States, 1991 2005, MMWR Weekly, August 11, 2006, p. 8. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5531a4.htm 39 Koutsky LA. Epidemiology of Genital Human Papillomavirus Infection. Am J Med. 1997: 102 (5A):3-8. 40 CDC, HIV/AIDS Surveillance Report, Vol. 17; 2006. 41 Centers for Disease Control and Prevention, HIV/AIDS: HIV Testing (Online; last checked February 16, 2007). Available at http://www.cdc.gov/hiv/topics/testing/index.htm --------------- ------------------------------------------------------------ --------------- ------------------------------------------------------------ 1