Vital Views

Why do parents sometimes struggle with talking to their children about sexual health and gender identities? Dr. Dalmacio Dennis Flores explains ongoing societal and cultural norms that play a part; a nurse's role in these conversations; and how to properly have gender/sexual health discussions at home and in schools.

Creators & Guests

Joseph Gaccione
Host, Writer, Producer
Dalmacio Dennis Flores
Assistant Professor of Nursing, Penn Nursing

What is Vital Views?

Vital Views is a weekly podcast created by UNLV School of Nursing to discuss health care from a Rebel Nursing perspective. We share stories and expert information on both nursing-specific and broader healthcare topics to bring attention to the health trends and issues that affect us. New episodes every Tuesday.

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Joe Gaccione 0:02
This is Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. One form of social justice is through effective and informative interventions regarding sexual health education. Whether it's discussing sexually transmitted diseases or promoting positive mental health on gender and sexual identities, there is plenty of work to be done in our communities, especially among LGBTQ youth. This is a key area for nurses like our special guest today, Dr. Dalmacio Dennis Flores. Dr. Flores is an assistant professor at the University of Pennsylvania School of Nursing, an affiliated faculty at the Gender, Sexuality and Women's Program, and is a visiting professor at the Center for Research on AIDS at Yale University School of Public Health. He's led several studies that investigate the role of parents in the sexual health education of their adolescent sons who identify as LGBTQ. Through interventions around inclusive parent-child sexuality communication, he believes the early provision of sexual health information attuned to the attractions, behavior and identities of LGBTQ adolescents can reduce the formation of risky sexual behavior and risks for HIV and STI infection. Dr. Flores, thanks for coming by.

Dalmacio Dennis Flores 1:14
Thanks for having me.

Joe Gaccione 1:15
So through your research, what are common struggles of parents trying to teach their children about sexual health?

Dalmacio Dennis Flores 1:20
Yeah, I think there's multiple factors at play that inhibit parents from having these conversations. For one, I think as a country, generally, there's not been a robust practice of parents really being mindful about the inclusiveness of their discussions with their children, regardless of how adolescents may identify in terms of sexual orientation or gender identity. Additionally, we don't have a lot of parents who can think about the many ways that they themselves can be providers of health information. We know from studies in the last 40 years, for example, that majority of US adolescents did not hear from their own parents about concerns regarding sexual health. Their silence in households about how these conversations, or about addressing some of these questions that youth have as they emerge and become full-blown adults, really. And so, without that guidance from their own experience, they are hard-pressed in having conversations with their own children. Additionally, we've got some stigma, perhaps, on some topics that are seen as not for polite society. So, that's another thing that keeps people from broaching these highly sensitive and important topics with their young people.

Joe Gaccione 2:34
It feels like we've advanced so far as a society, but yet sexual health, sexual education, it's still so taboo, even just saying the word sex, it feels like, you know, it feels naughty to say. Why do you think, and maybe this is more of a societal question, maybe less nursing related, but why do you think there's still such a stigma around it?

Dalmacio Dennis Flores 2:54
Yeah, I think our culture is very unique in that the beginnings of this country, you know, the puritan examples, sex was never something that, as I said, polite society talks about. And then there are different taboos regarding what young people are allowed to talk about. There's a notion that kids are too young to be exposed to these conversations. So, added together, we've got what I call, and I'm using air quotes here, “hang-ups” that inhibit these free-flowing conversations. So, as you said, it seems like we've got, we've come a long way and yet some of the same barriers are, are present, or they manifest in, in unique forms in these present times.

Joe Gaccione 3:35
How do the barriers change when a child identifies a certain way, they may say that they're gay, they may say that they're transgender, and now we're seeing more of, you know, gender fluid representation?

Dalmacio Dennis Flores 3:48
I think when you add in this, and I'm using air quotes, “complications” into the mix, into the formula, we have parents who identify as cisgender and straight, thinking, “Oh, my gosh, what is this plot twist that suddenly I’ve been dealt with?” because, as we know, majority, as you know, we all rely on our own experiences to try to share with others about how not to, say, commit the same mistakes we did. But in the case of parents with LGBTQ adolescents, for the most part, these kids come from straight parents. And so, the lack of concordance between the sexual orientation of the parent and the sexual orientation or gender identity of the child, it puts parents at a position where they think, “Well, I don't know where they're coming from and I can't speak with any authority about the topics that are germane to them,” and that's very correct, that's very factual, but in so many ways that becomes a, an insurmountable barrier for a lot of parents. And so, what we say in our researches, despite not having this concordance or similarity in one sexual orientation or gender identity with your child, there are many other ways to overcome that. And it's my work, part of my work is trying to figure out ways to help parents not feel so alienated from a topic and recognize the important responsibility that they still hold in helping raise kids who are, with an array of resources at their disposal.

Joe Gaccione 5:16
Now, in your research, do you look at different cultures as well?

Dalmacio Dennis Flores 5:19
I have not yet, but that's something I badly really want to get started. Because even within specific cultures, there will be nuances that need to be explored, right? And we just want to make it across different subgroups, across different ethnicities, races to make it as seamless or less awkward of a process as possible. So, fingers crossed in the next few years, I'll also venture into different other groupings.

Joe Gaccione 5:44
And it's not just the education component that can trip up a child becoming an adolescent, it's also the mental health because they feel like their parents, they can't talk to their parents, their parents don't want to talk to them about it, in some situations, not every situation. And then what does that do as the, as the child matures and those, those feelings get stronger, but now they feel more repressed? Like, almost like not talking about it isn't the same as fixing it?

Dalmacio Dennis Flores 6:11
Yeah, I think you've nailed it in the head, Joe. Because of the initial silence around conversations on, say, sexual orientation, it might be perceived by a young person as not suited for general conversation and it's the silence around that that fuels stigmatization. For the young person who is emerging during adolescence as somebody who might be a sexual or gender diverse individual, this lack of silence, or this lack of explicit acknowledgment that who they are is valid, this then creates or undermines the growing mental health that they have, and I think you've perfectly captured it during that lead-in question, in that there is a lack of visible resources, the fact that they cannot discuss this with the very important people in their lives means that they're having to develop a lot of coping skills, defense mechanisms that while it may help them, you know, survive into the next phase of life, it does not engender trusting, open conversations with important adults in their life.

Joe Gaccione 7:16
Now, for nurses, when they are dealing with a patient who they might feel is inhibited by these, these barriers, they can't express themselves, what is the nurse's role in that situation? Are they allowed to speak up on behalf of the patient?

Dalmacio Dennis Flores 7:31
Yeah. What I always say in my classes or when I'm meeting with other, other nurses is that because we are part of the most trusted profession, we actually occupy a special spot in that we can give or signal permission for parents or for youth to go there and have the conversation and ask about things that otherwise, you know, they feel like they shouldn't go into. So, as a nurse, I feel like if you're coming in, and you know that on your schedule is a young person and her mother, for example, then one of the ways that we can do that is just normalize with the mom when you're checking in, “Oh, you know, your child's now an early teenager. Have you had any conversations about X, Y, and Z?” And I think even if the typical response might be, “Oh, no, she's too young for that,” or “I've not really thought about it,” the fact that we're bringing it up and explaining that, “This is an expectation, I'd like for you to start thinking about them,” should nudge them to actually having these, you know, dialogues at home. Other ways that nurses can be pivotal in normalizing these conversations is having follow-up conversations and saying or asking in front of the child with their parents in the background, “Do you have any questions regarding X, Y, and Z?” And so, hopefully, that should be a nudge for parents as well to figure out that, “Oh, if this nurse is volunteering information, perhaps I should do something similar when we get home,” because a lot of parents, rightfully so, they're cognizant about, you know, all of the different messages out there and the different sources of information. And the beauty of parent-child sex communication is each family can tailor that to include the unique values that they have, the background they come from, and make it more clear for their child that from where we are, these are the important things, and they can then infuse those specific values they want to, they want to have their child be aware of. So, I think nurses opening the gates and giving permission to say that, “Yeah, an 11 year old is old enough, way old enough to hear about these conversations or these topics,” I think that's one of the crucial spots that we occupy.

Joe Gaccione 9:44
We're talking about the conversation at home, traditionally, I see the parents are the ones that initiate that. But it almost feels like nowadays you could have a child bring it up to the parents themselves, like they don't have to be, the parents don't have to be the ones to initiate it. It can be, it can be their, their son, their daughter, but when it comes to that moment, how should they, like how should each group approach it, whoever brings it up, like, are there nuances to how you tailor that conversation?

Dalmacio Dennis Flores 10:10
Yeah, I think, another excellent point, Joe, in that this is a dyadic conversation. And the, the traditional model that we have is that parents are the wise, senior folks bestowing information about, to younger folks who know nothing. But things have changed, and I think a better way to conceptualize of the sex talks or the discussions about the birds and the bees is that it may be a young person approaching a parent and saying, “Hey, I saw this on social media,” or “Oh, I heard this from my classmates, what does it mean?” and for parents to start thinking that they don't need to know everything. In fact, one of the better ways to go about with it is to acknowledge perhaps a deficit on the parents side to say, “You know, I'm not so sure about that, but it's very important for us to be factual, so why don't we team up and look for that information?” And it's at that crucial point that parents can model for their children how to sift through this, you know, array, the myriad sources of information, figure, figure out what is accurate from what's not, and then really assessing for themselves, “What am I going to believe in? What are the criteria for what is an accurate, non-misrepresented information?” So, that right there is a critical skill on being savvy as a consumer of information and it's the parents showing the way to the child on how to do that. And this does not eventually just pertain to sexual health, but on all issues that may come up in life.

Joe Gaccione 11:42
How did your work in nursing take you to this specialty?

Dalmacio Dennis Flores 11:44
As a nurse, I was focused on HIV/AIDS as my main popular, main issue of interest. And so, I went back to nursing school to make sure that, you know, I was going to be an AIDS nurse, I got to take care of these gay men dying of AIDS back in the early 2000s, and it was wonderful for me because I was indeed part of that community, still am, and, however, I've realized that from those early years, I would rather keep individuals healthy, instead of having to take care of them at the bedside. And so, after a few years of doing bedside care, I swung to the public health side, on the prevention side, and that's when I realized, “What are the things missing out there in society right now, where I, as a nurse, can address that gap so that young people who then realize that they have same-sex, attractions, behaviors or identities, they can then get information that keeps them from perhaps engaging in things that some would say risky behavior and at least just start giving them the safety net on how it is to explore themselves in a way that their heterosexual peers are able to do so without, you know, any, anyone batting an eyelash?” For example, I'm thinking like the typical prom in high school. I mean, we think of it as just the prom, but that's like an exercise for for adolescents on how to be adults, on how to manage relationships, on how to secure consent, for example, if there was going to be sex, but up until very recently, we don't have inclusive spaces in high school settings, where same-sex couples can explore the same, I don't know, dating rituals that their straight peers have. And so, my career from bedside nursing has swung into the public health prevention side, and I feel like it has totally informed the current work. It still does, about a decade later, it informs the work that I do.

Joe Gaccione 13:42
Bigger picture though, how do you get national and international policies to kind of adhere to this lifestyle? I mean, not to get political, we know it's an ongoing debate, I think, I mean, on the outside, it looks like there's more LGBTQ support than there ever was, but it still feels like there's a mountain to climb, especially in schools, when things get really touchy on what you can teach, what you can't teach. As a healthcare professional, how do you encourage policy leaders to try and shift their attitudes if they're hesitant?

Dalmacio Dennis Flores 14:14
Yeah, another beautiful question, because everything is politicized. And so, what used to be non-issue such as, I don't know, being able to affirm the fact that a kindergartener or a second grader has two moms and having that conversation in a school setting and say, “Yeah, some, some youth come with a dad and a mom and some have two moms,” but now that's seen as highly controversial for in some places like like Florida. And so, my work is trying to reassure parents or, hopefully, reassure politicians or policy makers that young people are savvy enough to have these conversations. One of the articles that I recently came up with about a month ago really makes that claim because based on data, we have young people saying, “We want to hear these issues at a young age because that's the time when we're curious.” What's the point of waiting until high school when they already know everything there is to know about, for example, sexual orientation? But those questions start popping up at age seven, eight or nine because it's normative. It's part of typical developmental questions that one has. But if we were having to wait way longer, then again, that's the absence, there's a vacuum of information, which is not good. And so, my research is articulating exactly what are the perspectives of young people on their readiness to have these conversations? And again, my data shows that, yeah, no, they're, they're eager to know more, and they can handle what we think are complex ideas. It's not so complex for them. And so, hopefully, more folks would be reading research, listening to this, to this podcast, and realizing that yes, it might have been different for our, for our generation, but these young kids nowadays, they're a lot more savvy, they have the capacity to, to process this information.

Joe Gaccione 16:08
What resources are out there that you recommend for people that may have questions, whether their families or individuals or even adolescents who might be curious, like how do they get the support if they're not finding it at the home?

Dalmacio Dennis Flores 16:20
Yeah. So, there's a lot of nonprofit organizations for individuals, children who might be LGBTQ. It's interesting how they find these resources online, even in the gaming space, and then parents who might have questions on, “How do I broach this topic?” or, “How can I assure my child that I am an accepting one?” We've got nonprofits such as PFLAG, they have chapters all over the country and they provide support for families with LGBTQ adolescents. We also have a lot of clinical-oriented sites for folks who might have questions on, “What's, what's the health status of my child when they grow up being LGBTQ?” so, I'm thinking of the Fenway Institute, that's another good one, a repository of information, and just a whole bunch of other websites that are vetted. So, I would say that, you know, check out your local LGBT center if you're in a major city and if you're not, again, online, there's a lot of really good resources.

Joe Gaccione 17:20
Through the scope of your research, what is the biggest change you would want to see when it comes to sex health education, LGBTQ communities? What's the one thing that if they could just fix it, it might solve most problems?

Dalmacio Dennis Flores 17:34
I think if we have a way in the school system to be across the board inclusive and have woven all of important tenets of inclusivity, from kindergarten all the way to high school, and not ostracize people just because they may have a different sexual orientation or gender identity, the family system won't have to be the one addressing these gaps. So, if this was a Christmas morning and you asked me this question, I would say policies that support comprehensive sexual health education and public school settings.

Joe Gaccione 18:13
Whose responsibility is it when a child is in the classroom and a teacher is teaching them sexual education? Should they hear it from the teacher, should they hear it from the parent? Because it feels like there's a fine line between objectively saying, “These are the different gender identities,” versus a teacher telling a child, “I think you are this gender,” and that's where, you know, that's where things get heated. Where is, where's the line? Is it a thin line?

Dalmacio Dennis Flores 18:38
Yeah, that's actually part of the ongoing conversation we're having in this country because there are folks who firmly believe that this is within the family's realm, scope of responsibility, and I obviously agree with that, but there's also a space for public school education to provide other information not covered at home because not every, as we talked about earlier, not all parents are capable of having these conversations or might even have awareness of where they stand on these issues. And I think ultimately, it's a combination of both. This is like the societal compact that we have, where we work together between the school system and parents to figure out what is in the best interest of the child, how much should we expose them for, for them to eventually make that call themselves? Just to respond to that hypothetical hypothetical scenario that you posted, I don't know of too many educators saying, “I think you're this gender, gender identity or sexual orientation,” but that might be some fears that parents might have in thinking that that's what happens in the school setting. I'd be hard pressed to think of a curriculum where somebody is being labeled as such, right? But certainly there's a lot of ground for parents to decide for themselves, “This is what I want my kids to learn about.” This is your typical, you know, from back in the day, “Will you allow your child to attend the one-day sex ed class?” There's the consent form that is signed, and for all the others whose parents didn't sign it, then they can go to another classroom and, you know, miss out on that one class. So, I think just having a middle ground between the school and the parents, but not eliminating the option, so I think what's happening right now is this outright, across the board elimination of options for teaching age appropriate sexual health, or gender identity and sexual orientation.

Joe Gaccione 20:33
That's all the time we have today. Dr. Flores, thank you very much for coming in.

Dalmacio Dennis Flores 20:37
Thanks again for the invitation. Joe.

Joe Gaccione 20:38
Thank you for listening out there. Hope you have a great day.

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