IN THIS ISSUE
How many parents have tried to talk to their teenager about sexuality-related issues, only to be met with the kind of look you see on the face of the youngster on our cover? Both parents and their children want to be able to have these talks, but all too often, the comfort level is low, the frustration level is high and nothing is accomplished. Often, too, parents are painfully aware of their inadequacies as sex educators but do not know where to turn for help or lack the time to attend a counseling or educational program. In this issue of Perspectives on Sexual and Reproductive Health (see article), Karen L. Eastman and colleagues examine an "untapped but promising" setting for programs to help parents learn to talk to their teenage children about sex: the worksite.
Worksite-based programs are convenient for participants and have been successful in promoting such behaviors as smoking cessation and work reduction. It is, therefore, probably not surprising that in focus groups with parents and interviews with worksite executives, Eastman's team found substantial support for worksite-based parenting programs aimed at making parents effective sex educators. The discussions also brought to light a number of concerns and preferences that planners should take into account to design the most appealing and effective programs. Furthermore, focus group discussions with teenagers confirmed that young people want to be able to talk to their parents about sex and would like for their parents to be better equipped to have those conversations.
The researchers acknowledge that the feasibility and effectiveness of a worksite-based program cannot be known until one is implemented and evaluated. However, the results of their analyses leave them hopeful that this approach could be a useful way to reach busy parents with much-needed information and guidance.
Also in This Issue
•Convenience may also be key to providing sexually active teenagers with the services they need—such as services related to emergency contraception. Yet, in a nationwide survey of school-based health centers (see article), Susan McCarthy and colleagues find that considerable proportions of these centers do not provide education about the method, referrals for services or prescriptions for the drug. While the majority of health centers recognize the benefits of providing emergency contraception services, substantial minorities cite barriers that belie a misunderstanding of the method; and perceived benefits and barriers are associated with whether the center provides the method. The authors note that "barriers to services must be addressed and overcome to ensure that students are able to learn about contraceptive issues and receive appropriate reproductive health care."
•Undergoing Pap testing is a critical preventive measure, but it is effective only if women understand the test and its results, and if they know what to do in the event of an abnormal result. Carmen Radecki Breitkopf and colleagues studied the understanding of Pap testing among socioeconomically disadvantaged women undergoing screening, and found considerable knowledge deficits (see article). On average, women gave correct answers to fewer than half of the questions the researchers used to assess understanding of the test, and they made clear that they needed information on the purpose of Pap screening, procedures involved and abnormal results. Familiarizing women with the most basic facts about the Pap test, the researchers conclude, is crucial to ensuring that those who obtain abnormal results take appropriate follow-up measures.
•Using well-trained and closely supervised teenagers to provide services to teenage clients at family planning clinics appears to be a promising strategy, according to Claire D. Brindis and her colleagues who evaluated outcomes at five California clinics employing a peer provider model (see article). Outcomes differed for males and females, and for teenagers exposed to various components of the program. Certain high-risk groups of young people seemed to benefit the most from all of the clinic-based and outreach services that the program offered. "Given the substantial numbers of adolescents who remain in need of family planning care," the authors write, "testing new refinements to the delivery of care to better serve different segments of the sexually active adolescent population is imperative." On the basis of the results of this evaluation, further exploration of the peer provider model clearly is warranted.
•The legal right to have an abortion means little to the thousands of American women who lack access to a provider. In places where physicians who perform abortions are scarce, nonphysician clinicians—nurse practitioners, physician assistants and certified nurse-midwives—trained to perform medical abortions could go a long way toward filling the provider gap. Ann C. Hwang and coauthors report (see article) that one-quarter of such practitioners surveyed in California expressed interest in receiving medical abortion training, and the factors they cited as barriers to provision are largely amenable to change. The authors calculate that if all nonphysician clinicians in California who wanted training received it, the number of potential abortion providers could grow by as much as 4,000. They urge the adoption of training programs and policies that will enable "interested, committed clinicians" to overcome barriers to providing