A systematic review of parent and family-based intervention effectiveness on sexual outcomes in young people

Regional and Country Prevalence Estimates of Unsafe Sex Among Adolescents in 68 Low-Income and Middle-Income Countries

Prioritizing adolescent health is a public health priority to achieve the sustainable development goals, including reducing the risk of unsafe sex. Data on unsafe sex have remained scarce among adolescents in low-and middle-income countries (LMICs). To estimate the prevalence of unsafe sex in LMICs, we conducted secondary data analysis on the Global School-based Student Health Surveys among 244,863 students aged 13-17 years from 68 countries across five World Health Organization regions. The overall prevalence of ever had sex was 16.2%. The highest to lowest regional prevalence estimation of ever had sex was 30.5% (28.9-32.1) in the Americas, 28.6% (26.8-30.4) in Africa, 10.9% (9.2-12.6) in the Eastern Mediterranean, 9.6% (8.8-10.5) in South-East Asia, and 8.0% (6.8-9.1) in the Western Pacific. The highest prevalence of sexual intercourse before age 14 and practicing sexual intercourse without condom use were 36.5% (34.5-38.5) and 32.2% (30.1-34.3) in Africa, respectively. Findings suggest that current interventions are inadequate in promoting the uptake of safe sexual behaviors and an urgent intervention is needed.

Development and implementation of a worksite-based intervention to improve mothers' knowledge, attitudes, and skills in sharing information with their adolescent daughters on preventing sexual violence: lessons learned in a developing setting, Sri Lanka

BACKGROUND

Sexual violence among adolescents has become a major public health concern in Sri Lanka. Lack of sexual awareness is a major reason for adverse sexual health outcomes among adolescents in Sri Lanka. This study was intended to explore the effectiveness of a worksite-based parent-targeted intervention to improve mothers' knowledge, and attitudes on preventing sexual violence among their adolescent female offspring and to improve mother-daughter communication of sexual violence prevention with the family.

METHODS

"My mother is my best friend" is an intervention designed based on previous research and behavioral theories, to help parents to improve their sexual communication skills with their adolescent daughters. A quasi-experimental study was conducted from August 2020 to March 2023 in randomly selected two Medical Officer of Health (MOH)areas in Kalutara district, Sri Lanka. Pre and post-assessments were conducted among a sample of 135 mothers of adolescent girls aged 14-19 years in both intervention and control areas.

RESULTS

Out of the 135 mothers who participated in the baseline survey, 127 mothers (94.1%) from the intervention area (IA) physically participated in at least one session of the intervention. The worksite-based intervention was effective in improving mothers' knowledge about adolescent sexual abuse prevention (Difference in percentage difference of pre and post intervention scores in IA and CA = 4.3%, p = 0.004), mother's attitudes in communicating sexual abuse prevention with adolescent girls (Difference in percentage difference of pre and post intervention scores in IA and CA = 5.9%, p = 0.005), and the content of mother-daughter sexual communication (Difference in percentage difference of pre and post intervention scores in IA and CA = 27.1%, p < 0.001).

CONCLUSIONS AND RECOMMENDATIONS

Worksite-based parenting program was effective in improving mothers' knowledge about sexual abuse prevention among adolescent daughters and in improving the content of mother-daughter communication about sexual abuse prevention. Developing appropriate sexual health programs for mothers of different ethnicities, and cultures using different settings is important. Conduction of need assessment programs to identify the different needs of mothers is recommended.

"If your mother does not teach you, the world will…": a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda

BACKGROUND

Adolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health.

METHODS

We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software.

RESULTS

Participants acknowledged the key role parents play in communicating SRH matters; however, only a few parents engage in such discussions. Facilitators of parent-adolescent communication were: having a good parent-child relationship which makes parents approachable and motivates children to discuss issues openly, a closer bond between mothers and children which is partly attributed to gender roles and expectations eases communication, and having parents with high education making them more knowledgeable and confident when discussing SRH issues with children. However, the discussions are limited by cultural norms that treat parent-child conversations on SRH as a taboo, parents' lack of knowledge, and parents busy work schedules made them unavailable to address pertinent SRH issues.

CONCLUSION

Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.

Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger

Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents' lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15-24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults' communication skills, and changing the "script" to a more life-affirming view of SRH.

Statutory Rape: Case Characteristics When Offenders are Younger Than 21 Years of Age Versus Older

Statutory rape laws are intended to protect adolescents from harm as a result of sexual activity with older individuals. In this pursuit, many, but far from all, states' statutory rape laws differentiate younger and older offenders. In effect, many of these states differentiate offenders who are 21 and older from those who are under 21. It is unknown, however, whether and how the dynamics of statutory rape vary depending on the age of the offender. To explore the contribution of offender age to the dynamics of statutory rape, data were collected from the records of 105 statutory rape cases referred to a child abuse assessment center over a 63-month period. Records included detailed reports on case history and victims' family history, mental health and health-risking behaviors, medical examination results, and forensic interview summaries. Cases of offenders¹1.Because these cases are under investigation, "offenders" here refers to "suspects." For ease of reading, we use "offenders" to be consistent with prior research terminology. under 21 were compared to the cases of offenders 21 years and older. Compared to cases of younger offenders, cases of offenders 21 years and older more often involved slightly older adolescent victims. Independent of age, victims with offenders 21 and over compared with offenders under 21 were over six times as likely to have a prior history of a high, versus low, number of psychosocial problems and were seven times more likely to experience multiple forms of coercion versus no coercion by the offender. Findings suggest that statutory rape prevention, policy and response strategies should consider the critical ways that case characteristics and victims differ according to this key offender attribute.

Youth Internet Safety Education: Aligning Programs With the Evidence Base

BACKGROUND

This review critically examines the messages of youth internet safety education programs in the light of research about both the dynamics of internet dangers and the efficacy of youth prevention education.

METHODS

Using terms "internet safety education" and "digital citizenship," a Google search identified 12 multi-topic safety programs. Review articles were identified via Google Scholar for six forms of online harm to youth that have been targeted by many of these programs: cyberbullying (19 articles); online sexual exploitation (23 articles); sexting (19 articles); online fraud, hacking, and identity theft (6 articles); online suicide and self-harm promotion (18 articles); and internet overuse or addiction (15 articles).

FINDINGS

There appear to be mismatches between dynamics revealed in the research about internet harms and the messages emphasized in educational programs, particularly on the issues of sexual exploitation and sexting. Overall, the review literature also suggests major advantages to integrating internet safety into already well-established and evidence-based programs currently addressing related off-line harms, for example, programs focusing on general bullying, dating abuse, or sexual abuse prevention. The advantages stem from four factors: (1) the considerable overlap between online harms and similar off-line harms, (2) the apparent greater prevalence of off-line harms, (3) the evidence that the same risk factors lie behind both online and off-line harms, and most importantly, (4) the substantially superior evidence base for the longer standing programs developed originally around the off-line harms.

Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial

BACKGROUND

There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation.

OBJECTIVE

This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time.

METHODS

A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents.

RESULTS

Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations.

CONCLUSIONS

Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115.

'Being a good girl': mother-daughter sexual communication in contemporary Vietnam

This paper examines the ways in which certain fractions of urban educated women residing in Hanoi, Vietnam communicate with their daughters about sex and pleasure, and the various meanings attributed to these verbal interchanges. Drawing on a limited number of qualitative in-depth interviews, the findings suggests that these intimate conversations were framed by discourses concerning the purity of 'modern' women. A distinct lack of sexual knowledge and experience, along with a more generalised shyness in communicating about sexual matters, continue to be highly indicative of those deemed to be 'women of purity', especially before marriage. Such beliefs and allied practices were adhered to not only by mothers, but also by women themselves, exerting significant influence on the determination and expression of sexual perceptions and behaviours.

Parenting Practices and Emerging Adult Sexual Health: The Role of Residential Fathers

Emerging adulthood is a developmental period with high rates of sexual risk behavior. Effective parenting practices can reduce the likelihood of this behavior, but most research on the protective effects of parenting focuses on mothers. Research is needed to assess the role of paternal parenting in regards to their children's sexual risk behavior, particularly for children of teen mothers, who show a greater likelihood of risky sexual behaviors than those with older mothers. We investigated associations between residential fathers' parenting processes-communication, disapproval of teen sexual behavior, parental presence, and closeness-during adolescence and sexual risk behaviors reported by their children in emerging adulthood. Using multiple group structural equation modeling with data from 7399 participants at Wave I and Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined whether and how residential fathers' parenting relates to their children's sexual risk behavior independent of mothers' parenting processes, and whether these associations differ across children's sex and for children of teen and older mothers. We found that adolescents' perceptions of higher father disapproval of teen sexual behavior predicted lower levels of sexual risk behavior during emerging adulthood with no significant differences across emerging adults' sex or for children of teen relative to older mothers. Our findings suggest that teens' relationships with their fathers during adolescence are important for their future sexual health, despite a general understanding of emerging adulthood as a period characterized by independence and separation from parents. Additionally, our results suggest that even though children of teen mothers show greater likelihood of risky sexual behaviors than those of older parents, the processes through which fathers can support teens' sexual health may be similar.

Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya

Background

Parents are an important source of sexual and reproductive health (SRH) information for very young adolescents and are likely to have a significant influence on adolescents’ sexual attitudes, values, and risk-related beliefs. This study explored the nature and content of parent-child communication about SRH issues.

Methods

Thirty-two parents and 30 adolescent boys and girls aged between 11 and 13 years participated in narrative interviews in a resource-poor urban setting in Nairobi, Kenya. Interviews were audio-recorded, transcribed, translated into English, and uploaded on Atlas.ti software for coding and analysis.

Results

Findings from the study show gender differences in parent-child communication. More girls than boys reported that they had talked with their parents about romantic relationships. Four approaches—no communication, fear-based communication, supportive communication, and involving an external person were used by parents in SRH communication. Parents hostile attitudes towards romantic relationships during adolescence discouraged adolescents from disclosing their relationship status. While communication did occur, it was mainly reactive, one-sided, and authoritarian, often initiated by parents.

Conclusions

Parents need to be empowered with adequate and factual SRH information and effective communication strategies to enhance communication with very young adolescents. There is a need for further research to identify the most effective parent-child communication approaches to improve SRH outcomes among adolescents.

Effects of a parenting sexual education program for immigrant parents: A cluster randomized trial

OBJECTIVES

The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents.

METHODS

A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention.

RESULTS

After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively.

CONCLUSIONS

An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents.

PRACTICE IMPLICATIONS

In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis

IMPORTANCE

Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized.

OBJECTIVE

To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness.

DATA SOURCES

A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles.

STUDY SELECTION

Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English.

DATA EXTRACTION AND SYNTHESIS

Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables.

MAIN OUTCOMES AND MEASURES

The primary outcomes were delayed sexual activity, condom use, and sexual communication.

RESULTS

Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = -0.06; 95% CI, -0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose.

CONCLUSIONS AND RELEVANCE

Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.

Effectiveness of the Dual Approach Program to promote sexual abstinence in Thai early female adolescents and improve parent-daughter sexual communication

Purpose

The purpose of this paper is to examine the effectiveness of abstinence-based sexual education programs delivered in parallel to Thai parents and their early adolescent daughters to promote sexual abstinence and improve communication regarding sexual topics between them and their parents.

Design/methodology/approach

A quasi-experimental design included groups of parent/daughter dyads; Group 1 (controls) (n=40), Group 2 Adolescent Program (n=40) and Group 3 Adolescent Parent Program (APP) (n=42). Outcome measures included parent–adolescent communications and adolescents’ sexual abstinence cognitions and intent to abstain from sexual behaviors, measured at five and nine weeks post-programs.

Findings

Generalized estimating equation analyses indicated that the dual program (APP) was more effective in increasing parental communication with their daughters compared with Group 1 (p-value<0.05) and only the daughters in the APP program reported more positive subjective norms, sense of perceived behavioral control and intent to abstain than did Group 1 (p-value<0.05).

Originality/value

The overarching goal of supporting the development of family environments where female adolescents are able to talk about sexuality is essential for adolescent sexual health promotion. The data provide further evidence that a dual program with simultaneous parent and female adolescent interactive activities over three sessions is superior compared with programs that target either the parents or the adolescents only. Hence, further replication with more parent–daughter dyads and then within more diverse cultures and populations is warranted. Developing and testing a similarly structured program for parents and sons is also required.

Evaluating the Role of Family Context Within a Randomized Adolescent HIV-Risk Prevention Trial

Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.

Vocational school students' self-evaluations of a sexual health promotion intervention

Sexually transmitted infections (STIs) continue to pose a health risk among adolescents. School is therefore a logical place for promoting sexual health through interventions, but previous research has not examined student's self-evaluations of these interventions. The purpose of this study was to examine students' self-evaluations of a sexual health promotion intervention carried out in four randomly selected vocational schools in Finland in the year 2011. The participants (n = 168) were first-year students aged 15-19 years. The intervention (11 weeks) consisted of three components: (i) a teacher-delivered classroom lesson about sexual health, (ii) information materials about sexual health and (iii) free condom distribution in the school corridors. An electronic questionnaire was developed and administered to the students after the intervention. The participants' evaluations of the intervention were fairly positive. Almost all of the participants were at least partly satisfied with the classroom lesson. They mostly reported learning new information about STIs and sexuality. Information material was also read and participants self-evaluated themselves as having learned from the materials. Free condoms were obtained and the students felt that the condom distribution was useful. Sexual health promotion interventions might in the future include the classroom lesson, information material and free condom distribution components used in this study.

Sexuality as taboo: using interpretative phenomenological analysis and a Foucauldian lens to explore fathers' practices in talking to their children about puberty, relationships and reproduction

Background

Fathers can play an important role in their children's learning about relationships and sexuality but we know very little about the father's lived experience in this regard.

Aim

To explore eight fathers' perceptions and experiences of discussing puberty, relationships and reproduction with their 10-year-old children.

Methods

The paper commences with a genealogical analysis of the history of sex education in England from the Public Health Act of 1848 to the present day. Interpretative phenomenological analysis (IPA) was used as both a methodology and a method. Face-to-face interviews were conducted with each father and results were analysed ideographically, followed by analysis across the group. Interpretations were developed using a Foucauldian lens of governmentality and biopower.

Findings

The paper explores how synthesis of IPA with a Foucauldian lens revealed significant tensions between the fathers' cognitions, accounts and behaviours, which were underpinned by an enduring perception of sexuality as taboo.

Conclusion

By providing a contextualised understanding of the fathers' practices, this study demonstrates that a more informed approach to health promotion strategy can be achieved and the implications for nursing are explored.

The longitudinal impact of a family-based communication intervention on observational and self-reports of sexual communication

Parents can play a vital role in shaping teenagers' sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.

Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews

ISSUE ADDRESSED

Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people.

METHODS

We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews.

RESULTS

We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.

Effects of Parental Monitoring and Knowledge on Substance Use and HIV Risk Behaviors Among Young Men Who have Sex with Men: Results from Three Studies

Young men who have sex with men (YMSM) are disproportionately impacted by HIV/AIDS and have elevated rates of substance use. Parenting practices, such as knowledge of child whereabouts and monitoring of behavioral rules, protect against these outcomes among heterosexual youth. This article examined the relationship between these parenting practices and substance use and HIV risk behaviors among YMSM. Data are reported from three similar studies of YMSM: ChiGuys (ages 14-18), Crew 450 (ages 16-22), and RADAR (ages 16-29). The ChiGuys and RADAR studies report cross-sectional analyses, whereas Crew 450 reports latent growth curve analyses. In ChiGuys and Crew 450, participants reported significantly higher scores for parental knowledge of general activities than parental knowledge of gay-specific activities. Parental knowledge of general activities was significantly associated with less binge drinking in both samples and with condomless sex in the ChiGuys sample. Parental monitoring was significantly associated with less marijuana use and condomless sex in younger RADAR participants (16-18 years) and with less drug use in older participants (>18 years). Findings support the need for further research on the influences of parents on YMSM health risk behaviors and the value of exploring family- and parent-interventions to address YMSM health.

Promoting Parent-Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives

OBJECTIVES

Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by youth. Intergenerational games may support parent-youth sexual health communication. The purpose of this study was to explore parent and youth perspectives on a proposed intergenerational game designed to increase effective parent-youth sexual health communication and skills training.

MATERIALS AND METHODS

Eight focus groups were conducted: four with parents (n=20) and four with their 11-14-year-old youth (n=19), to identify similarities and differences in perspectives on gaming context, delivery channel, content, and design (components, features, and function) that might facilitate dyadic sexual health communication.

RESULTS

Participants concurred that a sex education game could improve communication while being responsive to family time constraints. They affirmed the demand for an immersive story-based educational adventure game using mobile platforms and flexible communication modalities. Emergent themes informed the development of a features inventory (including educational and gaming strategies, communication components, channel, and setting) and upper-level program flow to guide future game development.

CONCLUSIONS

This study supports the potential of a game to be a viable medium to bring a shared dyadic sexual health educational experience to parents and youth that could engage them in a motivationally appealing way to meaningfully impact their sexual health communication and youth sexual risk behaviors.

A Review of HIV Prevention Studies that Use Social Networking Sites: Implications for Recruitment, Health Promotion Campaigns, and Efficacy Trials

This review describes the use of social networking sites (SNS) in the context of primary prevention of HIV. A review was conducted to assess the published literature for HIV interventions using SNS. Sixteen articles describing twelve interventions were included. SNS were instrumental in recruiting hard-to-reach populations within a short amount of time; were able to reach wide audiences beyond the targeted population for HIV prevention campaigns; and helped to significantly reduce sexual risk behaviors and increase HIV testing. SNS are a viable option to recruit hidden populations, engage the target audience, and disseminate HIV prevention messages. Researchers should use SNS to generate sampling frames that can be used to select participants. Practitioners should use SNS to post images of preventive behavior within health promotion campaigns. Researchers should use multiple SNS platforms to engage participants. As more studies are published using SNS for HIV prevention, meta-analyses will be needed.

Adolescents' Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania

Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study.

'Mum never loved me.' How structural factors influence adolescent sexual and reproductive health through parent-child connectedness: a qualitative study in rural Tanzania

Research in high income countries shows parent–child connectedness to be protective against undesirable sexual and reproductive health (SRH) outcomes among young people. Little has been done to understand the nature of parent–child connectedness, the structural factors that impact on connectedness and parents’ understanding of how connectedness affects their children's sexual behaviour in sub-Saharan Africa and Tanzania in particular. Ethnographic research involved 30 days of observation in 10 households, 9 focus group discussions and 60 in-depth interviews. Thematic analysis was conducted using NVIVO qualitative data analysis software.

The structural factors with greatest influence on connectedness were economic circumstances, gender, social status, state education, and globalisation. Economic circumstances impacted on parent–child connectedness through parents’ ability to provide for their children's material needs, and the time their occupation allowed for them to spend with their children and monitor their activities. Appropriate parent–child interactions were shaped by gender norms and by social status in the form of respectability, adolescents’ adherence to norms of respect/ obedience shaping their parents’ affection. State education affected parents’ preferences between children but also undermined parental authority, as did broader globalisation. Connectedness was related to SRH in a bi-directional way: lack of connectedness was linked to young people's low self-esteem and risky sexual behaviour while unplanned pregnancies seriously undermined young women's connectedness with their parents. Since material provision was perceived to be a central element of parent–child connectedness, structural factors limiting provision made transactional sex more likely both through direct material pathways and emotional ones. Motives for transactional sex were said to be material needs and to feel loved and cared for.

An important pathway by which structural factors shape adolescent SRH outcomes is through parent–child connectedness, especially parents’ ability to spend time with their children and provide for their economic needs. Modifying these structural factors should facilitate parent–child connectedness, which may help delay early sexual intercourse, protect young people against unplanned pregnancy through encouraging communication on contraception use and, overall, promote healthy adolescent development.

Parent-based adolescent sexual health interventions and effect on communication outcomes: a systematic review and meta-analyses

CONTEXT

Parent-based adolescent sexual health interventions aim to reduce sexual risk behaviors by bolstering parental protective behaviors. Few studies of theory use, methods, applications, delivery and outcomes of parent-based interventions have been conducted.

METHODS

A systematic search of databases for the period 1998-2013 identified 28 published trials of U.S. parent-based interventions to examine theory use, setting, reach, delivery mode, dose and effects on parent-child communication. Established coding schemes were used to assess use of theory and describe methods employed to achieve behavioral change; intervention effects were explored in meta-analyses.

RESULTS

Most interventions were conducted with minority parents in group sessions or via self-paced activities; interventions averaged seven hours, and most used theory extensively. Meta-analyses found improvements in sexual health communication: Analysis of 11 controlled trials indicated a medium effect on increasing communication (Cohen's d, 0.5), and analysis of nine trials found a large effect on increasing parental comfort with communication (0.7); effects were positive regardless of delivery mode or intervention dose. Intervention participants were 68% more likely than controls to report increased communication and 75% more likely to report increased comfort.

CONCLUSIONS

These findings point to gaps in the range of programs examined in published trials-for example, interventions for parents of sexual minority youth, programs for custodial grandparents and faith-based services. Yet they provide support for the effectiveness of parent-based interventions in improving communication. Innovative delivery approaches could extend programs' reach, and further research on sexual health outcomes would facilitate the meta-analysis of intervention effectiveness in improving adolescent sexual health behaviors.

Adolescent experiences of HIV and sexual health communication with parents and caregivers in Soweto, South Africa

Communication about sexual health between parents and adolescents has been shown to have a protective influence on behaviours that reduce the risk of HIV transmission. This study explored experiences of HIV and sexual health (HSH) communication between parents and/or caregivers and adolescents in an urban HIV-endemic community in Southern Africa. Adolescents (aged 14-19 years) were recruited from the Kganya Motsha Adolescent Centre and the Kliptown community between June and August 2009. Qualitative data were collected through focus group discussions (n=10 adolescents) and semi-structured interviews (n=31 adolescents). In total, 41 adolescents (56% female, 44% male, mean age=17.2) participated in the study. Adolescent participants identified emotional, physical and sociocultural barriers to initiating HSH communication with parents and caregivers including fear of verbal warnings, threats and physical assault. Adolescents also expressed a desire for mentorship around HSH communication beyond abstinence and peer-based information. Public health interventions need to support adolescents' access to bi-directional HSH information from adult mentors that address the lived realities of adolescents beyond expectations of abstinence.

Parents' perceptions of timing of initiation of sexuality discussion with adolescents in Anambra State, South Eastern Nigeria

STUDY OBJECTIVE

This study was aimed at determining the perception of the timing and practice of sexuality discussion among parents in South Eastern Nigeria.

DESIGN

A cross-sectional, descriptive, community-based study.

SETTING

The study was carried out in 3 randomly selected Local Government Areas in Anambra State, South Eastern Nigeria.

PARTICIPANTS

The study participants were parents with adolescent children resident in the study areas for at least 2 years.

RESULTS

Most parents opined that sexuality discussion should be initiated after puberty. Only 20% of them discussed reproductive health issues often with their adolescents, while another 20% never discussed such issues with their adolescent children. Topics most commonly discussed bordered on the adverse consequences of sex rather than measures for preventing them. About half of parents were willing to discuss contraception with their adolescent child. Predictors of parent-child communication were age, gender, and educational status.

CONCLUSION

Common reasons for low parental involvement in sexuality discussions were due to their lack of capacity and the perception that discussing such issues before puberty is ill timed. Therefore, measures should be taken to improve the capacity of parents to engage in such conversations to provide sexuality information to their teens.

"These issues aren't talked about at home": a qualitative study of the sexual and reproductive health information preferences of adolescents in Vanuatu

BACKGROUND

Onset of sexual activity during adolescence is common in Vanuatu, however access to comprehensive sexual and reproductive health (SRH) information is limited. Improving adolescents' knowledge about SRH is necessary to improve health outcomes, however little is known about the information needs and preferences of adolescents in the Pacific to inform policy and programs in this region.

METHODS

Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years from rural and urban communities on two islands of Vanuatu. Twelve key-informant interviews were also conducted with policymakers and health service providers. Data were analysed thematically using an inductive approach.

RESULTS

Much of the SRH information targeting adolescents focused on sexually transmitted infections and HIV. While this information was valued, important gaps were identified including prevention of pregnancy, condom use, puberty, sexuality and relationships. Peer educators and health workers were adolescents' preferred sources of information because they were considered knowledgeable and trustworthy. Parents were not a common source but were preferred, particularly by girls, despite considerable socio-cultural barriers. Schools were an important but underutilised source of information, as were a range of media sources.

CONCLUSIONS

Providing adolescents with comprehensive SRH information can have life-long protective benefits, however there are important content gaps in information currently provided in Vanuatu. The broad range of sources preferred by adolescents highlights the need to strengthen information provision through multiple channels to reach in and out-of-school youth and respond to individual needs and contexts.

The Emotional Experiences of Early First Intercourse

The experience of the first intercourse at an early age is a well-established sexual risk behavior as it is related to adverse physical and mental health outcomes. However, the diversity within the group of early starters as well as the actual processes that make early first-time intercourse (potentially) more harmful remain understudied. The goal of this research is to understand the mechanisms that make an early experience of the first intercourse either more or less emotionally harmful. Therefore, a combination of quantitative and qualitative data are used. The quantitative data stem from a population survey (ages 14-35 years; N = 705); the qualitative data were gathered by in-depth interviews among 24 young people (ages 16-18 years) with an early first-time intercourse (at age 14 years or younger). Quantitative analyses show that the age at first-time intercourse is positively related to the feeling of readiness. For the male respondents only, it is also positively related to the general experience of the first intercourse. For female respondents, the age at the first intercourse is only related to the general experience of it in interaction with the age difference with the first partner. Qualitative analyses show that much variation goes behind these statistical regularities. Successful early starters can be differentiated from problematic early starters based on relationship characteristics, the preceding sexual trajectory, and the preceding sexual decision making. Practical implications are described, and recommendations for further research are made.

Finnish parental involvement ethos, health support, health education knowledge and participation: results from a 2-year school health intervention

A 2-year, participatory action research school health study focused on developing components for home-school partnerships to support children's health learning process. Two intervention schools implemented strengthened health and collaboration-orientated activities; two control schools followed the national core curriculum without extracurricular activities. The parents of fourth-grade pupils (10-11 years at baseline) completed questionnaires before intervention in spring 2008 (N = 348) and after intervention in spring 2010 (N = 358). A two-way analysis of variance was conducted to determine whether time (2008/2010) and group (intervention/control) influenced parents' perceptions and experiences of parental involvement, health education and health support received from the school. Compared with controls, the intervention schools' parents experienced greater involvement ethos (Cohen's d = 0.57, P < 0.001), increased knowledge of health education (Cohen's d = 0.60, P = 0.02) and health support (Cohen's d = 0.35, P = 0.02). Health education participation among parents increased only partially during the intervention (Cohen's d = -0.12, P = 0.193). School health interventions based on schools' needs may have the potential to influence positively the relationship between home and school and increase the visibility of health education. The study was undertaken within the Schools for Health in Europe program.

Qualitative inquiry into premarital sexual behaviours and contraceptive use among multiethnic young women: implications for education and future research

Background

This study was a qualitative investigation into sexual attitudes and behaviours, and contraceptive use among Malaysian youth, based on constructs from the health belief model, theory of reasoned action, and problem behaviour theory.

Methods

A total of 34 focus group discussions with 185 participants were conducted among the Malay (35%), Chinese (34%), and Indian (31%) young females between November, 2010 and April, 2011. The participants were secondary school students and university undergraduates from Selangor and the Federal Territory of Kuala Lumpur.

Results

The study found a lack of knowledge about sexual issues and contraception among the participants. Many engaged in unprotected sexual intercourse and relied on periodic abstinence, natural methods, and traditional folk pregnancy preventive practices. The findings also revealed numerous categories of factors influencing sexual attitudes and behaviours: ethnic group and religion, level of religiosity, peer pressure and norms, and parental monitoring. With regard to condom use, factors such as embarrassment about condom acquisition, low perceived susceptibility to sexually transmitted infections (STIs), and perceived efficacy of traditional and folk methods of contraception, were uncovered from the discussions.

Conclusion

This study underscores the importance of development of culturally specific interventions that address the identified promoting factors of premarital sex. Behavioral interventions to promote condom use should increase awareness about condom effectiveness against not only unwanted pregnancies but also STIs.

Parenting practices and adolescent risk behavior: rules on smoking and drinking also predict cannabis use and early sexual debut

Previous research has provided considerable support for idea that increased parental support and control are strong determinants of lower prevalence levels of adolescent risk behavior. Much less is known on the association between specific parenting practices, such as concrete rules with respect to smoking and drinking and adolescent risk behavior. The present paper examined whether such concrete parental rules (1) have an effect on the targeted behaviors and (2) predict other, frequently co-occurring, risk behaviors (i.e., cannabis use and early sexual intercourse). These hypotheses were tested in a nationally representative sample of 12- to 16-year-old adolescents in the Netherlands. We found that both types of rules were associated with a lower prevalence of the targeted behaviors (i.e., smoking and drinking). In addition, independent of adolescent smoking and drinking behaviors, parental rules on smoking predicted a lower prevalence of cannabis use and early sexual intercourse, and parental rules on alcohol use also predicted a lower prevalence of early sexual intercourse. This study showed that concrete parental rule setting is more strongly related to lower levels of risk behaviors in adolescents compared to the more general parenting practices (i.e., support and control). Additionally, the effects of such rules do not only apply to the targeted behavior but extend to related behaviors as well. These findings are relevant to the public health domain and suggest that a single intervention program that addresses a limited number of concrete parenting practices, in combination with traditional support and control practices, may be effective in reducing risk behaviors in adolescence.

Paternal influences on adolescent sexual risk behaviors: a structured literature review

BACKGROUND AND OBJECTIVE

To date, most parent-based research has neglected the role of fathers in shaping adolescent sexual behavior and has focused on mothers. The objective of this study was to conduct a structured review to assess the role of paternal influence on adolescent sexual behavior and to assess the methodological quality of the paternal influence literature related to adolescent sexual behavior.

METHODS

We searched electronic databases: PubMed, PsychINFO, Social Services Abstracts, Family Studies Abstracts, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature. Studies published between 1980 and 2011 that targeted adolescents 11 to 18 years and focused on paternal parenting processes were included. Methodological quality was assessed by using an 11-item scoring system.

RESULTS

Thirteen articles were identified and reviewed. Findings suggest paternal factors are independently associated with adolescent sexual behavior relative to maternal factors. The most commonly studied paternal influence was emotional qualities of the father-adolescent relationship. Paternal communication about sex was most consistently associated with adolescent sexual behavior, whereas paternal attitudes about sex was least associated. Methodological limitations include a tendency to rely on cross-sectional design, nonprobability sampling methods, and focus on sexual debut versus broader sexual behavior.

CONCLUSIONS

Existing research preliminarily suggests fathers influence the sexual behavior of their adolescent children; however, more rigorous research examining diverse facets of paternal influence on adolescent sexual behavior is needed. We provide recommendations for primary care providers and public health practitioners to better incorporate fathers into interventions designed to reduce adolescent sexual risk behavior.

A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa

Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of peer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies investigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers to sexuality communication are reviewed. In addition, studies which examine behavioral associations with parent-child sexuality communication, and intervention studies to improve parent-child sexuality communication are examined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a range of socio-demographic and other factors associated with sexuality communication. Overall, findings demonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather than direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue, including lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes to associations between parental communication and adolescent sexual activity and contraception use. However, nascent indications from intervention research suggest positive findings with increases in frequency and comfort of discussions, among other outcomes. Gaps in the research are identified and discussed with implications for future studies.