By Carolyn Crist

(Reuters Health) – Healthcare providers and parents should begin talking to adolescents in middle school about healthy romantic and sexual relationships and mutual respect for others, a doctors’ group urges.

Obstetrician-gynecologists, in particular, should screen their patients routinely for intimate partner violence and sexual coercion and be prepared to discuss it, the Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists advises.

“Our aim is to give the healthcare provider a guide on how to approach adolescents and educate them on the importance of relationships that promote their overall wellbeing,” said Dr. Oluyemisi Adeyemi-Fowode of Texas Children’s Hospital and Baylor College of Medicine in Houston, Texas, who co-authored the committee’s opinion statement and resource for doctors published in Obstetrics & Gynecology.

“We want to recognize the full spectrum of relationships and that not all adolescents are involved in sexual relationships,” she said in an email. “This acknowledges the sexual and non-sexual aspects of relationships.”

Adeyemi-Fowode and her coauthor Dr. Karen Gerancher of Wake Forest School of Medicine in Winston-Salem, North Carolina, suggest creating a nonjudgmental environment for teens to talk and recommend educating staff about unique concerns that adolescents may have as compared to adult patients. Parents and caregivers should be provided with resources, too, they write.

“As individuals, our days include constant interaction with other people,” Adeyemi-Fowode told Reuters Health. “Learning how to effectively communicate is essential to these exchanges, and it is a skill that we begin to develop very early in life.”

In middle school, when self-discovery develops, parents, mentors and healthcare providers can help adolescents build on these communication skills. As they spend more time on social networking sites and other electronic media, teens could use guidance on how to recognize relationships that positively encourage them and relationships that hurt them emotionally or physically.

Primarily, healthcare providers and parents should discuss key aspects of a healthy relationship, including respect, communication and the value of people’s bodies and personal health. Equality, honesty, physical safety, independence and humor are also good qualities in a positive relationship.

As doctors interact with teens, they should also be aware of how social norms, religion and family influence could play a role in their relationships.

Although the primary focus of counseling should help teens define a healthy relationship, it’s important to discuss unhealthy characteristics, too, the authors write. This includes control, disrespect, intimidation, dishonesty, dependence, hostility and abuse. They cite a 2017 Centers for Disease Control and Prevention study of young women in high school that found about 11 percent had been forced to engage in sexual activities they didn’t want, including kissing, touching and sexual intercourse. About 9 percent said they were physically hurt by someone they were dating.

For obstetrician-gynecologists, the initial reproductive health visit recommended for girls at ages 13-15 could be a good time to begin talking about romantic and sexual health concerns, the authors write. They also offer doctors a list of questions that may be helpful for these conversations, including “How do you feel about relationships in general or about your own sexuality?” and “What qualities are important to someone you would date or go out with?”

Health providers can provide confidentiality for teens but also talk with parents about their kids’ relationships. The committee opinion suggests that doctors encourage parents to model good relationships, discuss sex and sexual risk, and monitor media to reduce exposure to highly sexualized content.

“Without intentionally talking to them about respectful, equitable relationships, we’re leaving them to fend for themselves,” said Dr. Elizabeth Miller, chief of adolescent and young adult medicine at Children’s Hospital of Pittsburgh of UPMC, who wasn’t involved in the opinion statement.

Miller recommends FuturesWithoutViolence.org, a website that offers resources on dating violence, workplace harassment, domestic violence and childhood trauma. She and colleagues distribute the organization’s “Hanging Out or Hooking Up?” safety card (https://bit.ly/2PQfxEM), which offers tips to recognize and address adolescent relationship abuse, to patients and parents, Miller said.

“More than 20 years of research shows the impact of abusive relationships on young people’s health,” Miller said in a phone interview. “Unintended pregnancies, sexually-transmitted infections, HIV, depression, anxiety, suicide, disordered eating and substance abuse can stem from this.”

SOURCE: https://bit.ly/2JNPgBa Obstetrics & Gynecology, online October 24, 2018.