Over the previous 20 years research reveals a wide array of factors that may influence adolescent development. Throughout this time span changes have occurred in the factors that influence adolescent development sexual activity decision making and contraception which might include the following.
One of the initial studies by researchers suggested that biological family peer school and community factors influence adolescent development and the age of initiation of sexual intercourse.
Further research in this area of study purposed that cultural factors sexual desire media biological factors emotional factors social cognitive factors and environmental factors (peers and parents) influence adolescent development sexual well-being and sexual behavior (Commendador 2010 pp. 147-148).
2. In the Western culture there are a variety of health services available for adolescents. What is missing in Western society that would benefit health promotion for adolescents?
Many healthcare providers and family planning clinics do not address adolescent sexuality until the adolescent is old enough to become a patient in these clinics. Perhaps discussion of sexuality and sexual decision making should be incorporated in the education system as well as is part of the pediatric healthcare providers educational practice and pediatric clinics serving older school age children. Discussion between nurse practitioners (NPs) parents sons and daughters could foster interchange around sexuality such as pubertal development changing body decision making as to sexual activity and contraception (Commendador 2010 p. 150).
3. How do the health problems faced by adolescents impact their health and wellness in their lifetimes?
Although the impact of health problems on an adolescent and his or her family varies by diagnosis and severity chronic conditions by definition last longer than three months alter activities of daily living and often require significant medical care (Jacobs & Popick 2012 p. 228). Health problems faced by adolescents may impact their health and wellness in their lifetimes in the following ways.
Adolescents with chronic conditions may experience mental health and behavior problems due to challenges related to peer socialization and body image altered peer/family relationships missed school regression in development pain physical limitations and modified routines.
In the absence of effective coping skills and supportive peer relationships these challenges can lead to participation in risky behaviors including unprotected sex and substance abuse which can have immediate and long-term consequences on an adolescents health. These behaviors may compound the already existing risk of complications from the chronic condition.
The challenges of living with a chronic condition extend beyond the adolescents themselves. Families of adolescents with chronic conditions may struggle to understand and manage the additional stressors of condition management caretaking and modified routine (Jacobs & Popick 2012 p. 228).
Note. One way pediatric providers and NPs can address the needs of the adolescent and family is to recommend reputable online health resources for social support suited to the specific needs of the adolescent and family such as blogs discussion boards and other social networking modalities (Jacobs & Popick 2012 p. 228).
4. Discuss how you would take the sexual history from an adolescent. Which areas would you need to address during your discussion with an adolescent?
Some NPs prefer to see the family and adolescent together first. This technique can produce a great deal of information in the first few minutes regarding medical concerns and family dynamics. Another straightforward technique is to start by interviewing the adolescent alone which is particularly important for older adolescents. At some point the family may be brought into the interview; however the adolescent should be present to hear what is being said (Woods & Neinstein 2009 p. 18).
The sexual history interview should be in private with the adolescent. Adolescents may delay medical care if privacy is not ensured. The format of the visit should be explained. Because of the sensitive nature of information shared by the adolescent during the visit confidentiality should be maintained. Before proceeding inform adolescent patients of what the limits of confidentiality are such as not sharing answers to personal questions unless someone is hurting them or they are hurting themselves (Sizer 2013 p. 51). An assurance of confidentiality is an important aspect of obtaining an accurate sexual history in adolescents (Fortenberry 2014 p. 4).
The sexual history (see Table 1) should be straightforward and nonjudgmental with appropriate counseling regarding risk-taking behaviors as necessary (Fortenberry 2014 p. 4).
The Five Ps
1. Partners
Do you have sex with males females or both?
In the past 2 months how many partners have you had sex with?
In the past 12 months how many partners have you had sex with?
Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?
2. Prevention of Pregnancy
What are you doing to prevent pregnancy?
3. Protection from STDs
What do you do to protect yourself from STDs and HIV?
4. Practices
To understand your risks for STDs I need to understand the kind of sex you have had recently.
Have you had vaginal sex meaning penis-in-vagina sex?
If yes:
Do you use condoms: never sometimes or always?
Have you had anal sex meaning penis-in rectum/anus sex?
Do you use condoms: never sometimes or always?
Have you had oral sex meaning mouth-on-penis/vagina
For condom answers: