EXPERT Q&A

Elizabeth Kuzma, clinical associate professor at the University of Michigan School of Nursing, talks to her young patients regularly about reproductive and sexual health in a digital age.

She tailors these conversations so they are age-appropriate, but topics can include pornography, consent, body autonomy and sexting, among others. Since many of her patients’ parents aren’t talking about these things, she has guidelines for parents on how to start, using a sex positivity framework.

Kuzma says it’s not just parents who aren’t broaching these topics. Many health care providers don’t either. She is the first author on a new study that provides doctors and nurses tools to do that.

Most kids returned to school in September. Should parents be extra vigilant, especially for kids jumping from middle to high school?

I think it is important to be extra vigilant at earlier ages than most would think, often beginning in late elementary school through middle school and staying vigilant through high school. Middle school to high school is always a big jump and major range for development and what kids are exposed to and engaging in. Keeping an open relationship with your high school children is important, so they know they can come to you with questions.

On average, kids today are exposed to pornography, likely digital, by age 11. Why aren’t parents talking about these topics?

What I do know is that parents want to help their children, but many don’t know how to have these discussions, don’t feel prepared or don’t feel comfortable doing so. There is also often a misconception that talking about sex and sexuality will encourage their children to engage in sexual behaviors. Yet, the evidence finds that the opposite is true.

Parents are often not as skilled with technology or may not be aware of what young people face or the evidence around youth exposure to sexually explicit content.

When should parents start talking about sexual health with their children?

Parents should consider a lifelong approach to sexual health with their children, rather than a one-time “talk” when they are teens, which is often much too late. This doesn’t mean talking to very young children about what sex is, how it works, etc. It begins in very small but meaningful ways by talking about and reinforcing bodily autonomy and consent. For example, if a child doesn’t want to give someone a hug, they should be allowed to not give someone a hug. Rather, they could be given options, like, “Would you like to give them a high-five, fist bump, elbow bump or nothing?” This teaches them that they can make decisions about what they feel comfortable with and that they have the right to say what they want or don’t want. It teaches them that their voice is important and their boundaries will be respected.

What challenges or threats do kids face today in a digital world?

What is new is the overwhelming availability and ease of access to sexual content beginning at younger ages, and the many devices available to them to access this content. Online, kids can easily stumble into very explicit sexual content at young ages, either through advertisements, click bait, computer algorithms or seemingly benign search results, among others. The pornography industry has grown significantly with much more content available. Also, it’s much easier to take personal sexually explicit images and share them, with no considerations of the consequences.

What should parents know about social media?

Seemingly innocuous media have advertisements for content that is not age appropriate for the end user. Products like SimLife, Roblox, Minecraft, among others, may be designed for young people and be appropriate for that audience, yet ads on those applications may not be. I had a colleague whose 8-year-old child was on a school device during school hours who was able to use SimLife and came across an ad about “hook-ups” and “threesomes.” Young people are curious and have an incredibly efficient tool at their fingertips (e.g., Google) to look up the words they are not familiar with. Then imagine the type of search results an 8-year-old could have come up on their screen.

Should parents delay providing cell phones or allowing social media?

That decision is a personal one. Rather than dictate what is appropriate for another family, I encourage parents to improve their own media literacy, particularly sexual media literacy, so they can talk to their children about these issues. I recommend investigating ways to monitor their child’s phone activities, set restrictions on devices and content, and set limits on screen time, particularly at different times of the day. This takes a deliberate effort to be vigilant and prepared.

There are national campaigns that push delaying the provision of cell phones and social media, including the Wait Until 8th campaign. The organization provides resources and information for why and how to delay youth phone access. I encourage parents to look at these resources to make an informed decision for when and how to provide a cell phone for their child.

What is sex positivity?

Sex positivity is an approach to sexuality founded in the understanding that sex and sexual desires are a natural form of self expression, and that sexual experiences can be healthy and positive. It’s a different viewpoint that looks at sex and sexuality holistically. Sex positivity includes consideration of healthy relationships, agency, consent, safety, personal beliefs and respect for individuals.