African-American Fathers' Perspectives on Facilitators and Barriers to Father-Son Sexual Health Communication

"Speak from a place of love": The family dynamics surrounding Black father-daughter sexual health communication

INTRODUCTION

Parent-child sexual health communication reduces sexual risk behaviors among youth, which in turn lowers the transmission rate of HIV and sexually transmitted infections. Despite being a known protective factor, gender differences persist with mothers being more likely to discuss sexual health with their children than fathers. Although individual characteristics, interpersonal familial factors and societal norms (e.g., communication self-efficacy, parent-child closeness, and cultural and gender norms) are associated with Black parents' likelihood to communicate about sex with their children, the current study seeks to explore which of these factors found among Black mother-child or father-son dyads extend to Black father-daughter dyads and how this phenomenon (i.e., Black father-daughter sexual health communication) relates to family structure.

METHODS

Seven father-daughter dyads (N = 7) and an additional five daughters (n = 5) in the United States completed individual in-depth semi-structured interviews. Daughters (Mage = 20.3) and fathers (Mage = 56.7) were biologically related, majority heterosexual, close, and lived together. Data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Analysis revealed three themes centering around the role of authoritative parenting, the tactics and skills facilitating sexual health communication, and family structure.

CONCLUSIONS

Black father-daughter sexual health communication is facilitated by close father-daughter relationships, non-authoritative parenting styles, and open, supportive, and non-judgmental communication. Fathers can be better supported in knowing how and when best to communicate sexual health messages, and to mitigate the possibly negative impacts on communication of divorce or having multiple children.

Correlates of Sexual Behavior Across Fatherhood Status: Finding From the National Longitudinal Study of Adolescent to Adult Health (Add Health), 2016-2018

Amid national trends in postponed parenthood and more diverse family structures, the fatherhood identity may be important to men's sexual behaviors. This study examined factors associated with reports of consistent contraceptive use and multiple sexual partners across fatherhood status. Using public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Wave V (2016-2018), two sexual behaviors were examined among 1,163 men aged 32 to 42 years. Outcomes were two binary indicators: consistent contraceptive use with partner and having multiple (≥2) sexual partners in the past year. Fatherhood status was categorized as nonfather, resident father, and nonresident father. Demographic (e.g., race/ethnicity, education, income, and relationship type) and health-related (e.g., drinking, perceived stress, depressive symptoms, and insurance status) factors were considered. Logistic regression analysis produced odds ratios and 95% confidence intervals and were stratified by fatherhood categories. In the sample, 72% of men were resident fathers, 10% were nonresident fathers, and 18% were nonfathers; 28% reported consistent contraceptive use and 16% reported multiple sexual partners. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. Key findings suggest that relationship type, income, and education are crucial factors to men's sexual behavior. Heterogeneous effects were observed across fatherhood status. This study adds to limited research on fatherhood and sexual behavior among men transitioning from young adulthood to middle age.

Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls

BACKGROUND

Black girls are disproportionately impacted by HIV and sexually transmitted infections (STIs), underscoring the urgent need for innovative strategies to enhance the adoption and maintenance of HIV/STI prevention efforts. Historically, Black male caregivers have been left out of girls' programming, and little guidance exists to inform intervention development for Black girls and their male caregivers. Engaging Black male caregivers in Black girls' sexual and reproductive health may reduce sexual risk-taking and improve the sustainability of preventative behaviors.

OBJECTIVE

This paper describes the formative phases, processes, and methods used to adapt an evidence-based mother-daughter sexual and reproductive health intervention for Black girls 9-18 years old and their male caregivers.

METHODS

We used the ADAPT-ITT model to tailor IMARA for Black girls and their male caregivers. Diverse qualitative methods (interviews, focus groups, and theater testing) were used throughout the adaption process.

RESULTS

Findings support using the ADAPT-ITT model to tailor an evidence-based HIV/STI intervention for Black girls and their Black male caregivers. Findings highlight the importance of community engagement and the use of qualitative methods to demonstrate the acceptability and feasibility of the adapted intervention. Key lessons learned are reviewed.

CONCLUSIONS

Adapting evidence-based interventions to incorporate Black girls and their Black male caregivers should be driven by a relevant theoretical framework that aligns with the target population(s). Adapting the intervention in partnership with the community has been shown to improve acceptability and feasibility as it is responsive to community needs. Using a systematic process like the ADAPT-ITT model will ensure that the new program is ready for efficacy trials.

Attitudes of parents in the role of a father in Turkey toward child sex education and their sexual communication with their children

BACKGROUND AND PURPOSE

The study aimed to evaluate the attitudes of parents in the role of a father in Turkey toward child sex education and their sexual communication with their children.

METHODS

This descriptive and cross-sectional study was conducted with the fathers of children in the pediatric outpatient clinic at a state hospital between December 30, 2021, and April 15, 2022. The study was reported based on STROBE. The data were collected from 297 fathers using the Descriptive Information Form, the Attitudes Scale Toward Sex education (ASTSE), and the Sexual Communication Scale for Parents(SCSP).

RESULTS

Sample statistics demonstrate that 67.7% of the participants did not receive sex education in their childhood, and 57.4% stated that their children received sex education only from their mothers. Higher attitudes toward sexual education were found in the fathers with a university or higher education degree (χ² = 15.396; p < 0.01), and those giving sex education to their children (χ² = 18.388;p < 0.001). Higher total scores were obtained on the sexual communication scale by fathers with university and higher education degrees (χ² = 12.898;p < 0.01) and those who received sex education in their childhood (t = 2.330;p = 0.021). There is a highly significant positive correlation between the mean scores of the role of a parent subscale of the ASTSE and the mean total score of the SCSP (r = 0.81;p < 0.001).

CONCLUSIONS

There is a positive correlation between fathers' parental role attitudes toward sex education and their sexual communication with their children.

PRACTICE IMPLICATIONS

Supporting fathers' sexual communication with their children can positively affect fathers' attitudes and communication toward sex education.

A systematic review of the evidence on the effect of parental communication about health and health behaviours on children's health and wellbeing

Parents report feeling unsure how best to talk with their children about sensitive health topics and may avoid such conversations; yet if children have questions or concerns about their health, talking to a parent could enhance their health and wellbeing. We investigated the effects of parental communications about health and health behaviours on children's health and wellbeing, and explored what strategies can encourage parents to communicate about health. We conducted a systematic review and narrative synthesis of research published between January 2008 and April 2020 from five databases. Of 14,007 articles identified, 16 met inclusion criteria focusing on five topics: diet and weight (n = 5), body image (n = 2), sexual health (n = 7), physical activity (n = 1) and bullying (n = 1). Positive child outcomes were associated with positive general parent-child communication characterised by warmth, openness and allowing children choice. Conversely, hostility, negative and inconsistent messaging were associated with poorer outcomes. Interventions to increase parent-child communication could be classified as providing single directive messages, media campaigns or intensive support. Single messages increased communication frequency; media campaigns and intensive interventions showed mixed outcomes. No differences in outcomes were found according to child's gender or socio-economic status. Generally, parents were less confident in initiating, rather than continuing, conversations and were more likely to initiate conversations when they felt they had good topic knowledge. While the relatively small, diverse sample limits the strength of these findings, this review provides provisional support for approaches to promote positive parent-child communication about health that are associated with better child health and wellbeing.

Moving from Needs Assessment to Intervention: Fathers' Perspectives on Their Needs and Support for Talk with Teens about Sex

Talk with fathers about sex and relationships can support teens' health, but its impact is limited as few fathers talk with their teens about sexual issues. Needs assessment and fathers' input on intervention content and structure can guide the development of programs that support fathers' health-promoting talk with their teen children about sex and relationships. In the present study, we explored fathers' goals in their talk with teens about sex and relationships and barriers they perceive to these conversations, as well as what they would look for in an intervention program. Content analysis was conducted using interviews in the U.S. with 43 fathers of high school-aged teens (age 14-18). Themes explored fathers' roles in talk with teens, key messages to teens, and approaches and barriers to conversations, in addition to attitudes toward an intervention, and feedback on intervention structure, content, and process. The findings suggest that fathers see talk with teens about sex as part of their roles, but face challenges in accomplishing this goal. Fathers' feedback highlights their openness to an intervention and can guide the development of a peer-based and interactive program that addresses how to talk with teens about sex in addition to the content of these conversations.

Father-Teen Talks about Sex and Teens' Sexual Health: The Role of Direct and Indirect Communication

Family talks about sex can protect against teens' risky sexual behavior, but most research has focused on the role of mothers. The current study included cross-sectional survey data from 728 adolescents in the 11th and 12th grades (Mage = 17.00, SD = 0.90) in the United States. Structural equation modeling (SEM) was used to assess associations between teens' direct and indirect talk, defined as less straightforward ways to communicate one's sexual values, with fathers about sex, and teens' sexual behaviors. There were no significant direct associations between father-teen talk about sex and teens' sexual behavior. However, teen gender moderated associations between indirect father-teen communication and teens' sexual behavior. The results suggest the need to assess indirect talk about sex in studies of family sexuality communication and to further investigate the role of teens' identities in determining the influence of father-teen talk about sex on teens' sexual behavior.

Family Matters: The Support of Parents to Change Black Male's Attitudes Towards HIV

This study explored the associations between family (mother and father support), peers, and individual factors (self-efficacy) and how these relationships influence HIV attitudes among African American males 12 to 19 years of age, with an average age of 16 years. For this study, we used restricted data obtained from Wave I of the National Longitudinal Study of Adolescent to Adult Health (ADD Health). Descriptive statistics suggest that most of the sample had negative attitudes towards HIV. Bivariate regression analysis followed by a linear regression analysis was conducted to identify the factors that were associated with HIV attitudes. Major findings from regression analysis indicate that mother support, father support, self-efficacy, and age, predicted HIV attitudes. Mother support positively predicted positive HIV attitudes and surprisingly, father support negatively predicted HIV attitudes. Our findings can be used to better inform HIV prevention and intervention programs to help Black males stay healthy.

Associations between Parent-Child Communication on Sexual Health and Drug Use and Use of Drugs during Sex among Urban Black Youth

Black youth and their families living in urban settings may experience unique stressors that contribute to underlying issues due to the environmental context. Such factors may exacerbate and promote drug use and engagement in risky sexual behaviors, unknowingly. Little is known about how family factors, peer pressure, condom use, and other related factors are associated with substance use and engaging in sexual behaviors while on drugs among urban African American youth aged 12-22 (N = 638). We used regression models to examine associations between parental bonding, parent-adolescent sexual health communication, condom use, peer pressure on substance use, and having sex while on drugs. Multivariate results indicated that parental bonding was statistically significant and associated with drug use (OR: 1.36, 95%CI: 1.36). Our study highlights that parental bonding plays a critical role in youth using drugs while living in urban environments.

The Association Between African American Father-Child Relationships and HIV Testing

The existing literature identifies parent communication as a protective mechanism in the reduction of sexual risk behaviors among youth; however, not much is known about father-child communication and bonding and its association with HIV testing. Therefore, this study examines the link between the relationship, bonding, and communication shared by African American (AA) fathers and their children and HIV testing over time. This secondary data analysis included data from Waves 1 and 3 of the National Longitudinal Study of Adolescent to Adult Health on the health of adolescents to adults in a sample of AA males and females (N = 509), with a mean age of 16 years. The independent variables included fathers' communication, bonding, and relationships, and the dependent variables included HIV testing. A multinomial analysis assessed the factors that contributed to or prevented HIV testing. It was found that the overall model was statistically significant; F(24, 55) = 8.95; p < .001. The results suggest that father-adolescent communication was statistically significant and positively associated with HIV testing (B = 23.88; p < .05). AA adolescents who reported going to the doctor or making a nursing visit were more likely to get tested multiple times (B = 13.91; p < .001). Our findings indicate that father-child relationships are essential to adolescent sexual development and serve as a protective factor against threats to sexual health. Future studies should be designed to investigate the cognitive mechanisms through which the father-child bonding and communication may impact HIV testing.

"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.

Father 2 Son: The Impact of African American Father-Son Sexual Communication on African American Adolescent Sons' Sexual Behaviors

Parent-child sexual communication has been associated with reducing adolescent sexual risk behaviors. Limited research on parent-child sexual communication has been conducted on African American (AA) adolescent males who are at increased risk of sexually transmitted infections (STIs) including HIV/AIDS. The purpose of this research was to examine AA father-son sexual communication and the effect of contextual factors on the sexual risk behaviors. The final sample consisted of 96 AA adolescent males, ages 16-21 years. Structural equation modeling was used to examine the variables of interest (neighborhood characteristics, father-son closeness and connectedness, father-son communication, sexual permissiveness, condom attitudes, sexual risk behaviors). A path model was developed and tested. Results demonstrated that AA father-son closeness and connectedness were related to father-son communication. AA father-son communication was negatively related to sons' permissiveness and positively related to condom attitudes. Sons' permissiveness positively predicted their sexual risk behaviors. AA sons' condom attitudes did not negatively or positively predict their sexual risk behaviors. The findings from this study demonstrate that AA father-son communication is an important factor in decreasing AA adolescent males' sexual risk behaviors and HIV risk.

Recruiting and engaging African-American men in health research

BACKGROUND

Improving the health of black and minority ethnic (BME) men in the US continues to be a public health priority. Compared with men of other races and ethnicities, African-American men have higher rates of mortality and morbidity from chronic illness and diseases including cancer, heart disease, prostate cancer, diabetes and HIV/AIDS. One way to address these disparities is to include African-American men in health research, to elicit their perspectives on health risks and protective factors. These can then inform interventions aimed at reducing health disparities. However, challenges remain in recruiting and engaging African-American men in health research.

AIM

To provide strategies for recruiting African-American men in health research, using as an exemplar a qualitative study of fathers' perspectives of sexual health promotion with young African-American males.

DISCUSSION

Efforts are needed to increase the representation of African-American men in health research. Ensuring that researchers are aware of the cultural, social and environmental factors related to decisions to participate in research can lead to effective methods to recruit and engage them.

CONCLUSION

There are several essential strategies for increasing African-American men's participation in health research: ensuring the research team is culturally and gender-sensitive; recruiting in trusted environments; using respected gatekeepers; developing trust with participants; and being transparent.

IMPLICATIONS FOR PRACTICE

Implementing strategies to include African-American men in health research has the potential to improve health disparities in the US.

Barber-led sexual health education intervention for Black male adolescents and their fathers

OBJECTIVE

To explore barbers' attitudes and beliefs regarding the feasibility and acceptability of a barber- led STI/HIV risk reduction intervention for fathers and their preadolescent and adolescent sons.

DESIGN AND SAMPLE

A qualitative descriptive design was used. Twenty-two barbers were recruited from barbershops and a barber school in central North Carolina.

MEASURES

A combination of five focus groups and two key informant interviews were conducted.

RESULTS

The following themes were generated: (1) The barbershop was embraced as a venue for an adolescent sexual health father-son intervention, (2) Barbers desired more information about STIs and HIV among Black male youth, (3) The use of incentives to engage barbers and fathers was important, and (4) Time commitment of barbers for a barber-led intervention varied.

CONCLUSION

The trust established between barbers and the Black community presents an opportunity for pre-adolescent and adolescent STI/HIV risk reduction programs that include the role of fathers. Intervention programs can be tailored to address this important intervention opportunity.

Values that Fathers Communicate to Sons about Sex, Sexuality, Relationships, and Marriage

African American males between ages 13 and 24 are disproportionately affected by unintended pregnancy and sexually transmitted infections (STIs) such as chlamydia, gonorrhea, syphilis, and HIV/AIDS; indeed, they account for 50% of HIV infections among all youth. Clear communication between parents and their youth about sex is associated with higher rates of sexual abstinence, condom use, and intent to delay initiation of sexual intercourse, which can prevent STIs and unintended pregnancy. However, barriers exist for parents to educate their youth about sexual health. The purpose of this article is to explore the values fathers communicate to their sons to prevent their risky sexual behaviors that lead to STIs, HIV, and adolescent parenthood. This was a qualitative study conducted from May and June 2015. African American fathers (N = 29) who had sons, ages 10 to 15 years, participated in five focus groups across metropolitan and rural North Carolina communities in barbershops. A qualitative content analysis revealed four themes regarding areas that fathers imparted their values onto their sons to protect them from sexual health risks: (a) sex, (b) sexuality, (c) relationships, and (d) marriage. The findings have implications for social work and public health practice.