When it comes to talking to their teenagers about sex, health and condoms, mum's the word for most American parents.
"The core of the problem is that it is harder for adults to talk about sex than substance abuse. Parents don't talk about sex with their children," says Diane Morrison, a University of Washington research associate professor of social work who studies public health issues and the consequences of risky behavior. It is especially hard, she notes, for a parent to talk to a child of the opposite sex.
She believes that if Americans want their children to learn safe and positive sexual behavior, parents have to teach these things just as they should tell their children about the harmful effects of drugs and alcohol.
"People's concerns with teenage health issues and sex have become hopelessly jumbled," she says. "We can accept direct messages of no-alcohol and no-drug use. But when it comes to sex we rely on hidden messages. We believe that if we talk about condoms, birth control and safe sex with our children we are giving an inferred message that it is OK to have sex. We can't seem to tell our kids directly, 'I don't want you to have sex yet,' and why."
Teenagers, she says aren't smart about sex and they are confused about expected sexual behavior.
"Our society is saturated with sex, but primarily the negative side of sex. The idea of sex being something you do with someone you care about is not being taught. You would expect parents to talk to their children about the positive side of sex, but they don't.
Instead, children largely see only the seamy side of sex, and see it as something used to sell everything from books and beer to clothes and makeup. It's a good cheap way for advertisers to get an emotional response," says Morrison.
"Our culture expects schools to teach about sex, but different parents have different standards for what their children should or shouldn't know," she says. At the same time parents, by and large, don't talk to their children about sex and condoms because they don't feel comfortable discussing them. "We need to teach parents how to talk to their children about sex. That way children get culturally acceptable values from their parents."
Condoms and AIDS prevention present special problems. Americans can't seem to look at AIDS as a public health issue because it has a sexual component, she believes.
"We should compare AIDS with tuberculosis. People recognize that controlling TB is in everybody's best interest. In the same way, greater use of condoms is in everybody's best interest. It is one way to keep the rate of HIV infection as low as possible," she argues. "The more condoms are used, the better it is for all of us."
Why are condoms so important?
"Because they are the most common method of birth control used by teens," says Morrison, "and virtually the only one they use when they have sex for the first time. Few teenage girls go on birth control pills before having sex for the first time, so if they aren't using condoms, they aren't using any kind of birth control."
Morrison also thinks that condoms should be distributed at little or no cost in schools or restroom vending machines. Many teenagers, she says, don't have a lot of spending money and many are embarrassed because it can be very intimidating for them to buy condoms at the drug store. The cost of condoms, she says, is much less than the cost of a pregnancy and far less than the cost of controlling a sexually-transmitted disease.
"Teenagers need extra help in setting up good health habits," says Morrison. "The single best predictor of using condoms in the future is having used them in the past. We should want our children to learn safe sexual behavior just as we teach them what moderate and responsible drinking is, even before they're old enough to drink. We should also tell them clearly and frankly what our family values about sex are, and explain why we don't want them to have sex too soon. These messages are not contradictory."