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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Commentary

Fathers’ Engagement in Their Sons’ Sexual and Reproductive Health

Kate Lucey and Craig F. Garfield
Pediatrics January 2019, 143 (1) e20182595; DOI: https://doi.org/10.1542/peds.2018-2595
Kate Lucey
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Craig F. Garfield
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Abbreviation:
    SRH —
    sexual and reproductive health
  • Despite ongoing efforts to promote sexual and reproductive health (SRH), teenagers continue to engage in risky sexual behaviors. Nearly 60% of high school seniors have had sex, yet only 54% of sexually active teenagers report using a condom during their most recent sexual encounter, down from 62% in 2005.1 Concurrently, rates of sexually transmitted diseases are rising dramatically among adolescents and are increasing at a faster rate among boys than girls.2 A recent Centers for Disease Control and Prevention analysis revealed that over the past 4 years, gonorrhea diagnoses have increased by 67% and syphilis diagnoses have increased by 76%. Nearly 2.3 million new cases of Chlamydia, gonorrhea, and syphilis were diagnosed in 2017 alone, breaking the previous record set in 2016.3 Clearly, new approaches are needed to address these trends.

    The landscape of SRH is rapidly evolving; contraception options are changing, and the days of health class and textbooks are going by the wayside4 as teenagers increasingly turn to their cell phones and the Internet for information.5 As the culture of SRH changes, so must our tactics for sexual health education. In this issue of Pediatrics, Guilamo-Ramos et al6 identify a resource for SRH that is not new or edgy; in fact, it is the opposite. It is a simple resource that has always existed: the father. Fathers’ impacts on their children’s overall health and well-being are widely documented,7 yet fathers are often overlooked as contributors to their children’s SRH.8 There are 27 million boys under the age of 18 living with fathers in the United States9; Guilamo-Ramos et al6 take a first step in examining the feasibility and acceptability of engaging fathers and their sons more effectively in SRH.

    In the study, the researchers interviewed 25 father-son pairs living in the Bronx, analyzing their communication around condom use and uncovering common themes surrounding preferences, barriers, and opportunities for condom education between fathers and sons. They report that fathers and sons want to have more discussions about condom use, but fathers feel they need better communication skills and more education to do this effectively. The authors go further to provide a table of programmatic suggestions for father-focused interventions designed to support teenagers.

    The core message of the study (that teenaged boys want to hear from their fathers about condom use) is profound. Fathers intuitively know this is a tough topic to discuss, and despite lacking knowledge at times, they nonetheless possess some innate communication skills that can be supported and reinforced, such as using humor and starting conversations when they will not be interrupted or overheard. Yet several key follow-up questions emerge from this work. What options are available for sons in homes without a cohabiting or involved father? How can we reach fathers to educate and empower them to be effective sexual health educators to their sons? Where can fathers turn for reliable information to impart to their sons?

    Pediatric providers already fit this role. As a trusted community resource often found in school-based clinics and tasked with administering frequent adolescent immunizations, pediatric providers serve as a reliable and accessible resource for fathers. The American Academy of Pediatrics has even recently published updated guidelines regarding SRH education for pediatric providers. This publication offers information and methods that pediatric providers can apply during patient visits and includes resources parents can use to continue the discussion at home.10 Knowing an adolescent and his parents and the dynamic of their relationship gives the pediatrician a unique ability to coach fathers on how to talk to their sons about condom use and other SRH topics.

    At the same time, clinicians may only see teenagers once a year for a well-child check, and according to 1 study, they only spend an average of 36 seconds talking to teenagers about sex at these visits.11 Furthermore, although evidence suggests a substantial number of fathers attend younger children’s visits,12 parents may not always accompany teenagers, so discussing SRH with fathers at these visits may be difficult. Therefore, identifying ways to involve fathers in SRH that extend beyond the traditional doctor-patient interaction is necessary. Public health campaigns could be used to encourage fathers to communicate with their sons about condom use and to point them toward useful educational resources. Partnering with schools, community groups, or adolescent sports teams (venues where teenagers and parents are often already interacting) may be a good place to start. In addition, as the Internet grows as a source for health education, using Web sites, YouTube, or social media to provide trustworthy and appropriate information may be a valuable way to engage with fathers on this topic.

    As SRH evolves, the unique experiences and viewpoints of male adolescents are becoming better recognized and understood. Guilamo-Ramos et al6 take us back to the basics, reminding us that fathers may be an underused resource for teenaged boys learning about condom use and one worthy of support. Empowering fathers to educate their sons not only regarding condom use but also about sexual health and health education more broadly is a key next step for clinicians caring for male adolescents and their families.

    Footnotes

      • Accepted October 22, 2018.
    • Address correspondence to Kate Lucey, MD, MS, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Ave, Box 152, Chicago, IL 60611. E-mail: klucey{at}luriechildrens.org
    • Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.

    • FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

    • FUNDING: No external funding.

    • POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

    • COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2018-1609.

    References

    1. ↵
      1. Kann L,
      2. McManus T,
      3. Harris WA, et al
      . Youth risk behavior surveillance - United States, 2017. MMWR Surveill Summ. 2018;67(8):1–114pmid:29902162
      OpenUrlCrossRefPubMed
    2. ↵
      1. Centers for Disease Control and Prevention
      . 2016 sexually transmitted disease surveillance. Available at: https://www.cdc.gov/std/stats16/default.htm. Accessed July 31, 2018
    3. ↵
      1. Centers for Disease Control and Prevention
      . New CDC analysis shows steep and sustained increases in STDs in recent years [press release]. 2018. Available at: https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html. Accessed September 15, 2018
    4. ↵
      1. Lindberg LD,
      2. Maddow-Zimet I,
      3. Boonstra H
      . Changes in adolescents’ receipt of sex education, 2006-2013. J Adolesc Health. 2016;58(6):621–627pmid:27032487
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      1. Pew Research Center
      . Teens, social media & technology overview 2015. 2015. Available at: www.pewinternet.org/2015/04/09/teens-social-media-technology-2015/. Accessed July 31, 2018
    6. ↵
      1. Guilamo-Ramos V,
      2. Thimm-Kaiser M,
      3. Benzekri A, et al
      . Father-son communication about consistent and correct condom use. Pediatrics. 2019;143(1):e20181609
      OpenUrlAbstract/FREE Full Text
    7. ↵
      1. Yogman M,
      2. Garfield CF; Committee on Psychosocial Aspects of Child and Family Health
      . Fathers’ roles in the care and development of their children: the role of pediatricians. Pediatrics. 2016;138(1):e20161128pmid:27296867
      OpenUrlAbstract/FREE Full Text
    8. ↵
      1. Guilamo-Ramos V,
      2. Bouris A,
      3. Lee J, et al
      . Paternal influences on adolescent sexual risk behaviors: a structured literature review. Pediatrics. 2012;130(5). Available at: www.pediatrics.org/cgi/content/full/130/5/e1313pmid:23071205
      OpenUrlAbstract/FREE Full Text
    9. ↵
      1. US Census Bureau
      . America’s families and living arrangements: 2017. Available at: https://www.census.gov/data/tables/2017/demo/families/cps-2017.html. Accessed August 6, 2018
    10. ↵
      1. Breuner CC,
      2. Mattson G; Committee on Adolescence; Committee on Psychosocial Aspects of Child and Family Health
      . Sexuality education for children and adolescents. Pediatrics. 2016;138(2):e20161348pmid:27432844
      OpenUrlAbstract/FREE Full Text
    11. ↵
      1. Alexander SC,
      2. Fortenberry JD,
      3. Pollak KI, et al
      . Sexuality talk during adolescent health maintenance visits. JAMA Pediatr. 2014;168(2):163–169pmid:24378686
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    12. ↵
      1. Cheng ER,
      2. Downs SM,
      3. Carroll AE
      . Prevalence of depression among fathers at the pediatric well-child care visit. JAMA Pediatr. 2018;172(9):882–883pmid:30039168
      OpenUrlPubMed
    • Copyright © 2019 by the American Academy of Pediatrics
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    Fathers’ Engagement in Their Sons’ Sexual and Reproductive Health
    Kate Lucey, Craig F. Garfield
    Pediatrics Jan 2019, 143 (1) e20182595; DOI: 10.1542/peds.2018-2595

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    Fathers’ Engagement in Their Sons’ Sexual and Reproductive Health
    Kate Lucey, Craig F. Garfield
    Pediatrics Jan 2019, 143 (1) e20182595; DOI: 10.1542/peds.2018-2595
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