The moderating influence of mother-adolescent discussion on early and middle African-American adolescent sexual behavior

Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data

ABSTRACT

Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother-daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18-33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.

Protecting young Black female sexuality

In the USA, Black girls and women face significant health disparities and disproportionately experience violence, racism, discrimination, stereotype messaging and elevated STI/HIV rates. Research shows the importance of familial systems and effective communication in decreasing risky behaviours among Black girls. This grounded theory study explored the sociocultural conditions that influence the process of becoming a sexual Black woman. Analytic results of interviews with 20 Black women identified protection as a major category associated with Black female sexual development and related risk behaviour. This paper describes the role of Black women as protectors of young Black female sexuality, the sociocultural protective strategies they used across the life course and the consequences of absent protection. Findings can inform future evidence-based, culturally sensitive interventions to promote the sexual health and development of Black girls and women in the USA.

The Inescapable Effects of Parent Support on Black Males and HIV Testing

Focusing on parental communication is a promising way to extend the reach of HIV-related interventions and prevention programs to underserved adolescents and their families in the US. One highly relevant population in need of services is Black males who constitute more than one-third of all new HIV infection cases in the US. We sought to determine whether the family context (i.e., parent support, parent relationships) impacted HIV testing over time. For this study, we used the first and third waves of the Add Health restricted dataset from the National Longitudinal Study of Adolescent Health of Black males (average age 16.1 years). Descriptive statistics found that over 75% of the sample had never been tested for HIV/AIDS, while only 58% reported using a condom. Bivariate regression analysis followed by multinomial analysis was conducted to identify the factors that were associated with the likelihood of one-time or continued HIV/AIDS testing. Major study findings indicate that Black males, who reported positive parent support and/or had visited the doctor, were more likely to get tested for HIV/AIDS. Males who had parents or peers that possessed negative attitudes about sex were less likely to get tested for HIV. The findings of this study suggest several implications for prevention and intervention aimed at optimal ways to increase HIV testing among Black males warranting further investigation.

Principal Sources of Information African American Fathers Draw Upon to Inform their Sons about Sex and Sexual Health Risks

BACKGROUND

While parent-child communication about sex is associated with safer sexual practices among African American youth, there is a noticeable gap in the representation of fathers' perspectives on talking with their sons about sexual and reproductive health. Moreover, less is known about the sources from which fathers seek information to inform such conversations.

PURPOSE

To explore the sources of information used by African-American fathers that formulate the basis of conversations they have with their sons about sex and sexual health risks.

METHODS

This was a qualitative study of African American fathers (N = 29) who had sons, ages 10-15 years. The fathers participated in one of five focus groups conducted across urban and rural North Carolina communities. Data were collected using a 2-hour, audio-recorded semi-structured interview.

RESULTS

Qualitative content analysis revealed three themes: a) fathers' personal stories and testimonies; b) instructional media preferences; and c) religious teachings and moral examples. The findings indicated that African-American fathers considered father-son sex education an important and critical aspect of their fathering role. Additionally, we found that the content of father-son sexual and reproductive health communication emphasized the importance of sexual risk reduction, open communication, and sharing their values and beliefs regarding initiation of and appropriate context for sex. The findings have implications for social work, nursing, and public health.

"You've Gotta be Careful": Familial Messages Regarding Sexual Behavior and Sexual Relationships among African American Adolescents

BACKGROUND

Research on the sexual behaviors of African American youth has primarily focused on associated risks, with a dearth of studies examining a fuller representation of African American adolescents' sexual lives. This study explored the range of messages African American adolescents receive from family members regarding sexual behavior and sexual relationships.

METHODS

Participants were 52 sexually experienced African American youth (male = 32, female = 20) between the ages of 15 and 17 recruited from community-based organizations in the United States. Youth participated in individual in-depth qualitative interviews, and data were analyzed using a phenomenological framework.

RESULTS

Participants received a variety of messages about sexual behavior and sexual relationships from a range of family members including parents, siblings, grandmothers, aunts/uncles, and cousins. Types of messages clustered into three domains: sexual decision-making, quantity and quality of sexual activity, and sexual health promotion; with themes and sub-themes emerging within each area.

CONCLUSION

Gender differences in the types of messages received are explored, and applications of the findings to the development of family-involved community interventions that promote sexual and reproductive health are discussed.

Sexual risk among African American girls seeking psychiatric care: A social-personal framework

OBJECTIVE

This study examined individual and social factors associated with sexual risk behavior among African American girls seeking outpatient mental health services across 2 years and key developmental transitions.

METHOD

African American females 12-16 years old (M = 14.5; SD = 1.15; n = 266) were recruited from eight outpatient mental health clinics and completed interviewer-administered and computer-assisted measures at baseline, 12, and 24 months. Analyses tested individual attributes (externalizing and internalizing problems) and family context (maternal acceptance-rejection, mother-daughter communication about sex) at baseline, peer influences (peer support of substance use, girlfriend dating behavior) and partner relationship characteristics (rejection sensitivity, partner risk communication frequency and openness) at 12 months, and girls' sexual behavior at 24 months.

RESULTS

At baseline, 32% of girls reported having had vaginal/anal sex compared with 60% at 24 months. Data analyses revealed robust associations between externalizing problems and maternal acceptance-rejection and mother-daughter risk communication during early adolescence, peer support of substance use and girlfriend dating behavior 1 year later, and girls' sexual risk taking 2 years later.

CONCLUSION

Findings support a social-personal framework (SPF) of sexual risk for African American girls seeking mental health care, underscoring the potential benefits of early intervention to reduce externalizing problems while strengthening mother-daughter communication and relationships to prevent subsequent sexual risk and associated negative outcomes. (PsycINFO Database Record

"Strap up:" Sexual socialization and safer sex practices among African American youth in foster care

Adolescent sexual health is often reflected through a problem-oriented lens. This serves to reinforce prevailing sexual scripts and cultural images of disenfranchised youth. Very little is known about the support young people in foster care, particularly youth of color, need to stay sexually healthy and safe. This article presents data on the sources and types of sexual socialization experiences that supported African American transitional age youth in foster care to protect against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Eighteen African American participants (18 to 21-years old) who reported condom use in two quantitative interviews were selected to participate in a qualitative interview. A mapping exercise and thematic analyses were used to identify the participants' sources of support and sexual socialization experiences. The study's findings indicated the youth had a combination of informal and formal sources that conveyed four types of STI/HIV prevention messages: Effective, Affective, Affinity, & Tangible. The majority of the participants (83%) received all four types of STI/HIV prevention messages from adult, partner and/or peer sources. Sources who motivated the participants the most to protect against STIs/HIV had a strong relationship with the youth and communicated openly about safer sex practices. Results of this study provide implications for future research as well as indications for practice that may be incorporated into training for child welfare practitioners, foster parents, kinship caregivers, and others who encounter youth in foster care.

Exploring the Experience of African Immigrant Mothers Providing Reproductive Health Education to Their Daughters Aged 10 to 14 Years

INTRODUCTION

Adolescents have disproportionate rates of unplanned pregnancies and sexually transmitted infections when compared with all other age groups. Mothers are gatekeepers and providers of reproductive health education, which can prevent teen pregnancy and sexually transmitted infections. Reproductive health education provided by African immigrant mothers is influenced by cultural experiences and cultural contexts that are not well understood and have not been studied. This study sought to describe the experience of African mothers living in the United States providing reproductive health education to their daughters aged 10 to 14 years.

METHOD

A qualitative descriptive design was used. Twenty African immigrant mothers were interviewed in a community setting. Qualitative content analysis approach was used for analysis.

RESULTS

Three main themes emerged: (1) mothers' reproductive health education in their country of origin, (2) mothers' reproductive health communication with their daughters, and (3) changes due to the move to the United States.

DISCUSSION

Mothers believed daughters were too young for reproductive health education, leading to conversations with limited content that were frequently triggered by daughters' exposure to reproductive health education outside the home.

IMPLICATIONS

African immigrant mothers may benefit from culturally congruent discussions with health care providers about the reproductive health information they give their daughters.

Attitudes and Beliefs of African Immigrant Mothers Living in the US Towards Providing Comprehensive Sex Education to Daughters Aged 12-17 Years: A Pilot Study

The literature currently contains no comprehensive sex education (CSE) interventions targeting the African immigrant population. African immigrant mothers have been inhibited by several factors from providing their daughters with CSE. The primary aim of this study was to identify attitudes and beliefs of Sub-Saharan immigrant mothers living in the United States towards providing comprehensive sex education to their daughters aged 12-17 years. The study utilized a one-time anonymous nine-question survey. Fifteen women who met the inclusion criteria completed the study survey online or via paper format. African immigrant mothers are willing to allow comprehensive sex to be taught in schools and at home. Accepted education appears to range from religious and moral teaching to some factual information. This research will potentially assist in the designing of more culturally appropriate comprehensive sex education programs for African immigrant mothers and their daughters.

Parent-Youth Communication to Reduce At-Risk Sexual Behavior: A Systematic Literature Review

There are nearly 110 million cases of sexually transmitted infections (STI) in the United States. The Centers for Disease Control and Prevention estimates that annually there are more than 19.7 million new STI cases. Of those, more than half are accounted for by youth aged 15 to 24 years. Although some STIs are not considered to be life threatening, they can lead to severe health problems, risk of HIV infection or infertility if they are not properly treated. Some research has shown that parent-youth communication can reduce youth's at-risk sexual behaviors. The following is a systematic review of the literature on parent-youth sexual communication and family-level interventions designed to reduce risky sexual behavior in youth.

Fertility Awareness Counseling for Adolescent Girls; Guiding Conception: The Right Time, Right Weight, and Right Way

STUDY OBJECTIVE

To provide a detailed summary of fertility awareness counseling pearls for healthy teens and those with fertility-relevant comorbidities, and to assist providers in offering such counseling to adolescents and young adult women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Comprehensive literature review of English-language studies relating to fertility in pediatric and adolescent female patients (ages 13-21 years), and evidence-based dialogue guide.

RESULTS

The literature indicates that although adolescents are interested in discussing sexuality and reproduction, this is commonly overlooked during the standard office medical visit. As a result, adolescents often turn to less reliable sources and hold a variety of reproductive misconceptions and a sense of lack of control over future fertility. We found no studies that examined the routine provision of fertility awareness counseling with healthy adolescents. There are a multitude of specific gynecologic and medical conditions that have ramifications for fertility. We detail these comprehensively, and provide a dialogue guide to assist with fertility awareness counseling for the female adolescent, containing specific information and indications for referral.

CONCLUSION

Providers caring for adolescent girls have the opportunity to enhance fertility awareness as part of a larger reproductive health conversation that adolescents desire, and from which they might benefit. Identifying potential future fertility issues, understanding age-related fertility decline, and aiding in health optimization before future conception might empower the adolescent to make informed reproductive decisions. We provide an algorithm to use with adolescents to discuss the "right time, right weight, right way" to pursue childbearing.

Will it help? Identifying socialization discourses that promote sexual risk and sexual health among African American youth

Because much of the existing research examining sexual communication to African American youth focuses on demographic and parental factors predicting sexual risk behaviors, less is known about factors predicting sexual health, and little is understood about the contributions of peer communications. The current study aimed to expand existing approaches by assessing which socialization discourses communicated by parents and peers contribute to sexual risk and health outcomes (sexual assertiveness, positive sexual affect, and condom self-efficacy). Participants were 631 African American undergraduates (73% female) who indicated the extent to which they had received from their parents and peers each of 28 messages representing four cultural discourses: abstinence, relational sex, sex positive, and gendered sexual roles. As expected, parents were perceived to emphasize relational sex and abstinence messages more than peers, and peers were perceived to communicate sex-positive and gendered sex role messages more than parents. Greater exposure to abstinence messages predicted lower levels of sexual experimentation, whereas exposure to sex-positive messages predicted higher levels. In addition, exposure to relational sex and sex-positive messages predicted higher levels of sexual assertiveness and positive sexual affect. Implications are discussed concerning sexual communications that could help Black youth develop healthy sexual perspectives.

'The family is only one part …': understanding the role of family in young Thai women's sexual decision making

This study aims to understand young Thai women's perspectives about family influences on their sexual decisions with the goal of informing the future development of HIV programmes and interventions for young Thai women in urban areas. Eight focus groups were conducted with 40 young single women aged 18-25 years, recruited through a peer network of key informants from four sites across Bangkok: universities, government offices, slums and garment factories. Predetermined topics relating to family, sexual decisions and HIV were discussed with 4-5 participants in each group. Qualitative thematic and framework-analysis techniques were used to explore participants' narratives. Findings suggest that young Thai women's sexual decisions are complex and take place under a wide range of personal, familial and social influences. Parents were perceived as a barrier to parent-child communication about sex and HIV. Young women regarded mothers as more supportive and receptive than fathers when discussing sensitive topics. Young Thai women described a tension between having a strong sense of self and modern sexual norms versus traditionally conservative relational orientations. Future HIV interventions could benefit by developing strategies to consider barriers to parent-child communication, strengthening family relationships and addressing the coexistence of conflicting sexual norms in the Thai context.

Sexual communication between early adolescents and their dating partners, parents, and best friends

This study assessed early adolescents' sexual communication with dating partners, parents, and best friends about six sexual health topics: condoms, birth control, sexually transmitted diseases (STDs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pregnancy, and abstinence/waiting. Using a school-based sample of 603 youth (ages 12 to 15; 57% female; 46% Caucasian), we examined communication differences across demographic and developmental factors, tested whether communication with parents and best friends was associated with greater communication with partners, and examined associations between communication and condom use. More than half of participants had not discussed any sexual topics with their dating partners (54%), and many had not communicated with parents (29%) or best friends (25%). On average, communication was more frequent among adolescents who were female, African American, older, and sexually active, despite some variation in subgroups across partner, parent, and friend communication. Importantly, communication with parents and friends--and the interaction between parent and friend communication--was associated with increased communication with dating partners. Further, among sexually active youth, increased sexual communication with partners was associated with more frequent condom use. Results highlight the importance of understanding the broader family and peer context surrounding adolescent sexual decision making and suggest a possible need to tailor sexual communication interventions.

"I got caught up in the game": generational influences on contraceptive decision making in African-American women

PURPOSE

Reproductive health disparities are a significant issue for African-American adolescents. This study was designed to explore the cross-generational influences on adolescent sexuality in a cohort of daughters/granddaughters of U.S. born African-American women.

DATA SOURCES

Data were generated through interviews with triads of African-American women: grandmothers, and their daughters and granddaughters, to gain insight into the phenomena of early sexual debut, high rates of unintended pregnancies, HIV/AIDS, and other sexually transmitted infections from a cross-generational perspective.

CONCLUSIONS

Six themes emerged from the data: southern influences; a worldview of relationships; communication-key to preparedness; seeking information from mom; "I got caught up in the game"; and contraceptive use and beliefs. In this sample, mothers' and grandmothers' culture, values, and beliefs significantly influenced the adolescents' sexual and reproductive decision making.

IMPLICATIONS FOR PRACTICE

Clinicians' knowledge of African-American culture, beliefs, and family values is key when providing guidance about contraception to these young women.

Jamaican mothers' influences of adolescent girls' sexual beliefs and behaviors

PURPOSE

The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters' sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program.

DESIGN

Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis.

FINDINGS

Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers' and daughters' reports were consistent; both groups identified positive and negative influences within each category.

CONCLUSIONS

Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers.

CLINICAL RELEVANCE

In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.

"It Takes a Village:" Familial Messages Regarding Dating Among African American Adolescents

There is a dearth of research regarding the influence of family members on adolescent dating. This study explored messages that African American adolescents received from family members regarding dating attitudes, norms and behaviors. Qualitative interviews were conducted with sexually experienced urban African American heterosexual adolescents (N = 51) between the ages of 15-17. Analyses revealed that participants received a diversity of messages from a range of both nuclear and extended family members, and that these messages were organized around three temporal phases of dating: initiation, maintenance, and termination. Types and sources of messages are discussed, as well as implications for intervention development.

Interventions to improve parental communication about sex: a systematic review

CONTEXT

The relative effectiveness of interventions to improve parental communication with adolescents about sex is not known.

OBJECTIVE

To compare the effectiveness and methodologic quality of interventions for improving parental communication with adolescents about sex.

METHODS

We searched 6 databases: OVID/Medline, PsychInfo, ERIC, Cochrane Review, Communication and Mass Media, and the Cumulative Index to Nursing and Allied Health Literature. We included studies published between 1980 and July 2010 in peer-reviewed English-language journals that targeted US parents of adolescents aged 11 to 18 years, used an experimental or quasi-experimental design, included a control group, and had a pretest/posttest design. We abstracted data on multiple communication outcomes defined by the integrative conceptual model (communication frequency, content, skills, intentions, self-efficacy, perceived environmental barriers/facilitators, perceived social norms, attitudes, outcome expectations, knowledge, and beliefs). Methodologic quality was assessed using the 11-item methodologic quality score.

RESULTS

Twelve studies met inclusion criteria. Compared with controls, parents who participated in these interventions experienced improvements in multiple communication domains including the frequency, quality, intentions, comfort, and self-efficacy for communicating. We noted no effects on parental attitudes toward communicating or the outcomes they expected to occur as a result of communicating. Four studies were of high quality, 7 were of medium quality, and 1 was of lower quality.

CONCLUSIONS

Our review was limited by the lack of standardized measures for assessing parental communication. Still, interventions for improving parent-adolescent sex communication are well designed and have some targeted effects. Wider dissemination could augment efforts by schools, clinicians, and health educators.

Do parents and peers matter? A prospective socio-ecological examination of substance use and sexual risk among African American youth

We examined the direct contribution of parent and peer risk and promotive factors on youth condom use trajectories, in addition to the indirect influence of these factors via youth's substance use over four years in a sample of urban, African American youth (N=679; 51% female; M=14.86 years; SD=0.65). Growth curve modeling was used to estimate changes in substance use and sexual risk across adolescence and test their association with parent and peer factors. Parent and peer risk factors were strongly associated with increasing substance use as youth aged. Substance use and condom use were interrelated. Parent and peer risk factors were indirectly associated with youth condom use; parent and peer promotive factors were directly associated with condom use, after accounting for substance use. Findings suggest the value of considering multiple influences on youth risk behavior.

A mentoring program for the promotion of sexual health among Korean adolescents

The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test-post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.

Gender, sex, and HIV: how well are we addressing the imbalance?

PURPOSE OF REVIEW

Heightened interest in sex and gender differences in HIV warrant a review of the status of current understanding of their determinants and progress in addressing them.

RECENT FINDINGS

The proportion of women among people living with HIV continues to increase in most countries; however, women are proportionately more likely to be on antiretroviral treatment than are men. Inadequate representation of women in clinical trials is compounding the dearth of information on sex-based differences in response to life prolonging antiretroviral medication. Progress in addressing gender inequalities and inequities, though incremental, is too slow to reach Millennium Development Goal 6 of halting and reversing the HIV epidemic by 2015. Structural determinants, such as food insufficiency, poverty, decreased access to credit, and inequitable inheritance practices, continue to act with social gender norms to shape the increased risk of exposure to HIV that women and adolescent girls face in many settings.

SUMMARY

Special measures should be taken to overcome barriers and facilitate enrolment and retention of women in biomedical HIV prevention and treatment trials. Law reform, economic empowerment, gender transformative work, and political mobilization are needed if women and men are to share the power, influence, rights, responsibilities, and opportunities that can create resilience to HIV.

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: pilot study findings

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality-sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent's sexual health.

MINIMIZING THE RISK OF PREGNANCY, SEXUALLY TRANSMITTED DISEASES, AND HIV AMONG INCARCERATED ADOLESCENT GIRLS: Identifying Potential Points of Intervention

Delinquent girls are at elevated risk for unplanned pregnancy and sexually transmitted diseases when compared with non-delinquent peers. Participants-234 incarcerated female juveniles-completed demographic, individual, partner, peer, and family measures and were tested for sexually transmitted diseases. Disease rates were as follows: chlamydia (20%), gonorrhea (4%), and syphilis (1%). Stepwise multiple linear regression analysis assessed the relationship of the predictor variable sets with sexual risk. Demographic and individual variables had the strongest associations with risk. Peer, partner, or family variables did not account for significant additional variance. The results suggest that an intervention could be delivered during the window of opportunity during the girls' incarceration, changing their knowledge, attitudes, and skills that are implicated in risky sexual behavior before they are released back into the community.