Background & Goals
Adolescent sexual and reproductive health (SRH) is a pressing public health and social welfare priority in the United States. Negative SRH outcomes represent a major source of morbidity among adolescents, both historically and presently, and expenditures associated with teen pregnancies, sexually transmitted infections (STIs), and HIV cost U.S. taxpayers billions of dollars annually.
Although significant progress has been made in reducing teen pregnancy rates in the U.S., the rates remain significantly higher than in other developed countries. Annually, there are approximately 160,000 children born to mothers younger than 20 years old. STIs pose another concern, with diagnosis rates repeatedly recording new all-time highs in the past decade. Youth aged 15–24 years are disproportionately impacted by STIs—accounting for nearly half of the more than 26 million annual new cases of STIs, while representing only a quarter of the sexually active population. In addition, youth (13–24) account for approximately 20% of estimated new HIV infections in the U.S.
Health and social welfare costs associated with unplanned teen pregnancies, STIs, and HIV among adolescents represent a sizeable financial burden on U.S. taxpayers. For instance, the annual federal and state cost of teen childbearing in the U.S. has been estimated at $9.4 billion. Furthermore, estimates suggest that lifetime medical costs associated with incident STIs among youth total $4.2 billion. Each new HIV infection alone has been estimated to accumulate more than $400,000 in lifetime medical costs, and approximately 7,000 youth are estimated to be newly infected with HIV each year.
Further, alarming adolescent SRH disparities exist. Data suggests that Latino and Black adolescents have birth rates that nearly double that of the national average. Additionally, Latino and Black adolescents account for approximately half of reported STI cases and 8 in 10 new HIV diagnoses among adolescents under age 20. These figures point to a pressing need for innovative and efficacious models of care to promote SRH among adolescents in historically underserved communities.
Traditionally, interventions designed to improve adolescent SRH outcomes have focused directly on adolescents through school-based curricula, social media campaigns, and community-based programs. Despite evidence supporting the importance of parental influences on adolescent decision-making, interventions that incorporate the family in preventing adolescent risk behavior are scarce. Families Talking Together (FTT) is unique in this regard, as it focuses on parents as the primary influence in prevention of adolescent sexual risk behavior, unplanned pregnancies, and STIs.
The FTT intervention consists of:
- Face-to-face intervention sessions (in-person or remote) between a parent and an interventionist;
- Printed FTT intervention materials for parents;
- Printed materials for parents to share with adolescents; and
- Homework exercises assigned to parents, such as practicing communication about sexual health with their adolescent.
FTT can be delivered to parents individually, in group sessions, and in a range of settings (health clinics, schools, community-based organizations, households, etc.). The FTT Clinic adaptation specifically designed for delivery in adolescent primary care settings formally integrates healthcare providers (HCPs) into the FTT model, thereby adopting a triadic (HCP-parent-adolescent partnership) approach to SRH promotion. FTT was adapted in linguistically (English and Spanish) and culturally tailored versions for implementation with Latino and Black families.
Evidence of Success
FTT is effective in utilizing parental influences for adolescent SRH promotion and has resulted in numerous positive adolescent outcomes that reduce the risk of unplanned teen pregnancy, STIs, and HIV, including:
- Delayed sexual debut;
- Increased adolescent condom use;
- Reduced frequency of sexual activity;
- Increased parent-adolescent communication about sex;
- Improved parental monitoring and supervision; and
- High quality parent-adolescent relationships.
Estimates suggest that publicly funded programs for the prevention of unplanned pregnancies and family planning resulted in $13.6 billion net public-sector savings. These SRH prevention programs were cost effective, as they resulted in $7 savings for each dollar spent on program implementation.
FTT is currently being implemented across the U.S., with a range of organizations from health departments to community-based organizations adopting the program to promote adolescent SRH locally. FTT has also been recognized as an effective program by the U.S. Department of Health and Human Services (HHS) and highlighted in a consensus study report by the National Academies of Sciences, Engineering, and Medicine (NASEM) as well as an evidence review by the U.S. Preventive Services Task Force (USPSTF).
FTT has received coverage in national media outlets, including NPR’s Latino USA.