• Niasha Fray is a doctoral student at UNC Chapel

Pop-up Reminders as Prevention Sexual Health and Awareness for Young People

I admire my pediatrician because he has to keep up with so many details, not just about my child, but the multitude of children he sees.

Fortunately, my family has a pediatrician that uses an Electronic Health Record system that keeps up with all the evidence based guidelines, recommendations, and developmental markers that are paramount and soon approaching for my little one. Often times the information my child’s pediatrician shares is not just spoken, but also provided in a print out for me to take home and think about or discuss with my husband.

Many times it has given me insight on what and how to properly protect and improve my child’s health and development.

When EHR systems make use of pop up reminders to help providers remember when and to whom to provide specific evidence based healthcare, then patient health outcomes can be improved. This is not just the case for diagnosis and treatment of health conditions, but also preventive medicine.

The Affordable Care Act has provided provisions to both fund and support the use of EHR systems and cover preventive medicine (including child vaccinations/immunizations such as HPV) free of charge. These provisions were put in place to intentionally improve the health of all Americans, especially our most vulnerable, our children.

For example, STIs are known to effect 9.8 million young people (age 15 to 24) annually. Much of this is because children are naïve about their sexuality, reproductive health, and potential health risks they take when initiating sexual acts. Research has shown that 5.6 percent of U.S. children initiate sex before the age of 13.

Unfortunately, the N.C. Department of Education doesn’t provide sexual and reproductive health education until seventh grade. Due to the political nature of public education, certain restrictions can be placed on the information provided to children.

For example, NC HB 596 enacted April 2015 states that “Information conveyed during the instruction shall be objective and based upon scientific research that is peer reviewed and accepted by professionals and credentialed experts,” but removes the language “experts in the field of sexual health education.”

This means that anyone claiming to be an expert in general, but not specifically sexual health education can control or vet the information that your child receives about their health in public schools.

Even under the best circumstances the benefits of public school education is increased when a child has an open honest and factual conversation with their parents about sex and reproduction (“The Talk”). But for many parent’s this conversation is very hard to initiate. When pediatricians are prompted through EHR pop-up reminder to start the conversation with parents before their child is most likely to begin sexual exploration, then parents have an opportunity to get some factual support from a trusted health expert.

A recently published meta-analysis spanned 30 years of research, examining what kinds of decisions adolescents make when their parents have “The Talk” with them. This study found that adolescents who have had “The Talk” with their parents are more likely to make decisions that will keep them safe from STIs and pregnancy when they later decide to engage in sexual behavior. No matter how awkward “The Talk” is for parents to have, getting support from their provider at the right time, can give parents the best tools possible to help their children remain healthy and not make naïve decisions that could have lifelong negative health consequences.

Fortunately, current guidelines by CDC states that healthcare providers should recommend an HPV vaccine to children between the age of 11 and 12 years old in order to protect them from HPV, the most common STI, before they are ever exposed to the virus. EHR systems can remind providers to begin to have the conversation with parents about protecting their child’s future. In this conversation with parents, providers are skilled in offering parents an opportunity to share their worries, concerns, apprehension, as well as developing skills and giving them the tools to have “The Talk” in a healthy manner with their children.

Parents often complain that these conversations are awkward or simply don’t want to admit that one day their child is likely to have a sexual encounter of some sort. Some doctors have said that these pop-up reminders are a nuisance to their workflow. On the other hand I’m sure giving a diagnosis of genital warts to a child is more than a nuisance, but instead a tragedy to both the provider and the parents who simply didn’t know that there child was sexually active until it was too late.

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