For many emerging adults, the period between 18 and 25 years of age marks a stage of life to explore what matters to them and assume new legal rights and responsibilities, including their own private health information and medical decision-making. But this transition to independence can create sticky family dynamics, especially when emerging adults remain on their parents' health insurance plans.
A new study from Iowa State University finds open dialogue and reciprocal information sharing between parents and emerging adults reduces barriers for talking about health, which can lead to better overall health outcomes for an emerging adult.
"If you're an emerging adult who's worried about what a parent might think, particularly if it's a health issue that's stigmatized or your choices in handling the health issue do not align with your parent's values, then chances are you're going to avoid seeking treatment or look for an alternative route," said Katherine Rafferty, an associate teaching professor of psychology and communication studies at Iowa State University, and co-author of the new publication published in Western Journal of Communication.
In the U.S., turning 18 means an individual can make medical decisions without parental consent. They also assume legal ownership over their private health information. But with the Affordable Care Act, adult children can stay on their parents' health insurance plans until their 26th birthday. So, while parents are not privy to their adult child's medical records, they still receive bills.
When mom and dad are paying for their adult child's health, any time they go to a doctor or seek medical care, it lends itself to needing to have a conversation."
Katherine Rafferty, associate teaching professor of psychology and communication studies, Iowa State University
To understand how conversations about private health information were unfolding between emerging adults and their parents, Rafferty, along with Associate Professor of English Tina Coffelt and a research team of undergraduate students, surveyed more than 300 college students; the majority were on their parents' health insurance plans and came from a traditional, nuclear family with a mother and father.
The researchers' found three significant factors that affect whether an emerging adult discloses health information to a parent: relational quality, reciprocity, and conformity.
"Basically, how good of a relationship do I have with mom or dad? Did my parents share their own health information or decision-making with me when I was growing up? Did I grow up in a family that talked about health issues? Were my parents open to differences or expected me to conform to family norms?" Rafferty explained.
The researchers found that emerging adults who perceive their parents as being open and respectful are more likely to talk about health issues, but these conversations tend to happen much more frequently with mothers compared to fathers.
"Given gender norms and the way men and women are socialized differently, it kind of makes sense that in a traditional family, there might be this desire or willingness to be open with mom more so than dad," said Rafferty.
Rafferty and the other researchers emphasized that mothers are typically the ones who keep track of doctor's appointments and health information in families. Sharing health information with mom as an emerging adult may simply be a continuation of past behaviors and build on previously shared knowledge about the emerging adult's health history.
The researchers found emerging adults were much more likely to talk to their parents about their health if their parents modeled this behavior early in the relationship. Rafferty said reciprocal information sharing also helps emerging adults better manage their health, whether they're updating their family health history at the doctor's office or seeking additional care.
"We're learning more and more about certain types of cancers and mental health issues that have genetic components. It's so important in those cases, especially for emerging adults, to know what they are predisposed to, that they're not alone, and that they have their parent's support," said Rafferty.
The researchers found stigma around certain health topics (e.g., sexual behaviors) also had a big effect on health disclosures. Emerging adults who worried about feeling ashamed or wanted to protect a relationship with their father were more likely to conceal private health information from them, particularly if they came from families with "high conformity orientations." However, this did not influence talking with a mother about private health issues.
"With a high conformity orientation, there's a lot of pressure to abide by family norms, usually from a father figure in a traditional family," Rafferty explained, giving the example of Jack Byrnes (Robert De Niro's character) from the movie "Meet the Parents." "There's this expectation about what one can and cannot talk about with family members."
Rafferty pointed to the TV show "Modern Family" as an example of low conformity orientation. In this show, family members are accepted and embraced for having different lifestyles.
The new findings highlight how family dynamics factor into whether emerging adults share private health information and involve their parents when making medical decisions. Open and respectful conversations and reciprocal information sharing early on can improve an emerging adult's overall health and reduce family conflict.
Rafferty, whose research area tends to focus on parents with medically complex children, also recommended parents involve their children when managing their health.
"If your child has diabetes, teach them how to administer their insulin or figure out what foods to eat to combat low blood sugar, rather than just waiting for mom or dad to say, 'OK, it's time to take your insulin," she explained.
Rafferty said including children in their own health management and making medical decisions together can make the transition to emerging adulthood a lot smoother. Emerging adults will feel more empowered and know they have support when they're going through a health issue.
"If COVID has taught us anything, it is that health issues will impact all of us at some point," Rafferty said. "We have all had to pause and re-evaluate our physical health and well-being. How parents' model this for their children will influence how they talk about and approach health issues when they become emerging adults."
Rafferty, K.A., et al. (2021) Understanding Criteria that Predict Private Health Information Disclosures between Emerging Adults & Their Parents. Western Journal of Communication. doi.org/10.1080/10570314.2021.1995622.