Family discussions about contraception and family planning: a qualitative exploration of black parent and adolescent perspectives

Building Blocks of Parent-Child Sex Communication: Body Talk During Infancy and Early Childhood

The current study investigated how foundational conversations about the body and sexuality begin, how they develop longitudinally, and whether parental body talk varies as a function of characteristics of both the parent and child. Participants included 442 mothers (M age = 32.50, SD = 5.61, 93% heterosexual, 85% White) and 337 available father-figures (M age = 33.99, SD = 5.68, 98% heterosexual, 80% White), who were the parents of infants (age at Time 1 = 28.13 months, SD = 6.85, 52% male). Factor analyses suggested that parents engaged in positive, avoidant, and scolding body talk with their young children, and growth curve analyses suggested that frequency of positive body talk increased from when the child was age two to when they were age four for both mother- and father-figures. Results also suggested that the most consistent predictors of body talk included parents' perceptions of whether their child was too young to discuss sexuality, and the child's own questions and behaviors about their bodies and sexuality. The discussion focuses on the frequency of parental body talk and the active role of the child in the early socialization of healthy sexuality.

Preferences, educational messaging, and demand creation channels for multipurpose-prevention technologies (MPTs) among women in South Africa

BACKGROUND

South African women, including female sex workers (FSWs), are disproportionately affected by HIV, experience a high unmet need for contraception and high rates of sexually transmitted infections (STIs). Products that address the interlinked risk between HIV, unplanned pregnancy, and other STIs are needed. There are several multipurpose-prevention technologies (MPTs) in development, aimed at preventing both HIV and pregnancy. This study aimed to explore educational messaging and demand creation channels to improve the potential uptake of a hypothetical MPT implant, using participatory action research. It also aimed to look at product and service provision attributes preferred by potential end users.

METHODS

Between July and August 2022, 303 PrEP-eligible adolescent girls and young women (AGYW) (18-24 years), women > 24 years, and FSW's (≥ 18 years) participated in 4-hour workshops, where they were asked about their ideal messaging and demand creation channels and their preferences for different attributes of an MPT implant. Quantitative descriptive analysis was conducted to determine the frequency and ranking for each demand creation message, channel, and each product and service provision attribute, by population group. A chi-square test was used to assess MPT implant characteristics associated with age. Qualitative data were analysed using deductive and thematic analysis.

RESULTS

A total of 104 AGYW, 157 women > 24 years, and 42 FSWs participated in the PAR workshops. Participants preferred demand creation messages that were empowering, motivational and encouraged body autonomy. The use of slang was popular. Community radio stations and newspapers, social media, and information at hospitals and clinics were participants' preferred MPT demand creation channels because they were easily accessible. Providing long-term and dual HIV and pregnancy protection, receiving implant services at the local clinic, manageable side effects, discreet and private implant, and numbing the area before insertion and removal, were the most preferred product and service provision attributes.

CONCLUSION

Early considerations for women's product preferences are key to product development. Educational messaging around the MPT implant should be empowering and in local languages, this may motivate women to learn more about it and use it. Multiple demand creation channels should be used to engage both young and older populations, which may ensure better reach.

Intersections between culture, contraception, knowledge and the body in the USA

Women's contraceptive use is a central feature of US culture around reproduction as evinced by high usage rates and nationwide public health efforts to further increase its use. Paradoxically, women know little about contraception within its biomedical framing, and successive public health-related educational campaigns have produced only moderate knowledge gains. Drawing on 86 in-depth interviews with a diverse sample of reproductive-age women, we set out to understand this persistent learning lag. In doing so, we found that women's limited contraceptive knowledge extended beyond simply being uneducated about various methods. Rather, these learning lags can be attributed to many women's lack of knowledge or misunderstandings about their anatomical bodies and reproductive processes. Employing feminist perspectives, we argue that these misunderstandings derive from factors beyond individual women's control. Indeed, they are rooted in cultural norms that stifle and stigmatise women's reproductive learning. Traditional public health efforts may inevitably fail to overcome these cultural barriers, perpetuating women's gaps in knowledge. Recognising the cultural dimensions of contraceptive knowledge and education reveals how critical action is needed around sexuality education in the USA as well as the limitations of on-going educational efforts.

Adolescent Awareness of the Changing Legal Landscape of Abortion in the United States and Its Implications

PURPOSE

Restrictions on abortion in the United States will have disproportionate and negative impacts on adolescents. Prior to the Supreme Court ruling to overturn federal protection of abortion, we sought to examine adolescents' awareness and knowledge about the legal landscape of abortion and how changes might affect them.

METHODS

We fielded a 5-question open-ended survey via text message to a nationwide sample of adolescents aged 14-24 years on May 20, 2022. We coded the responses using inductive consensus coding. Summary statistics were calculated for code frequencies and demographic data, and analyzed qualitatively using visual inspection of results overall and by subgroups (e.g., age, race and ethnicity, gender, and restrictiveness of state of residence).

RESULTS

A total of 654 responded (79% response rate), of which 11% were under 18 years. Most adolescents were aware of potential changes to abortion access. Most adolescents reported using the internet and social media for information about abortions. Overall, negative emotions about the changing legal landscape predominated, including anger, fear, and sadness. When considering factors for abortion decisions, adolescents most often discussed finances and life circumstances including their future, age, education, maturity, and emotional stability. Themes were relatively, uniformly distributed across subgroups.

DISCUSSION

Our study suggests that many adolescents are aware of and concerned about potential impacts of abortion restrictions, across a diversity of ages, gender, racial/ethnic, and geographic perspectives. Understanding and amplifying the voices of adolescents during this critical time is necessary to inform novel access solutions and policy initiatives that center the needs of youth.

Black Women's Sexual Communication: Retrospective Accounts of Messages from Male and Female Family Members

The study used Black feminist theory and methods to examine messages about the composition of, and potential differences in the sexual health that Black women received from male and female loved ones. Black feminist theory grounded the study by ensuring Black women were involved in research team composition, design, recruitment, and data analysis. Our inductive thematic analysis of focus group data from 24 Black women revealed seven themes: Indirect Communication, Absence of Communication, Messages to Shield, and Prepare from male figures. The themes from female figures included: Absence of Communication, Open Communication, and Empowerment, Pleasure, and Judgment-Free Communication. A seventh theme that connected across gender focused on Objectification and Gender Stereotypes. Findings of the study suggest that there is a need for greater focus on improving family communication about sex for Black women and the need to center communication that empowers Black women to engage in healthy sexual practices.

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study

BACKGROUND

Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions.

METHODS

A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted.

RESULTS

Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice.

CONCLUSIONS

FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Parent Perspectives about Initiating Contraception Conversations with Adolescent Daughters

OBJECTIVES

Parent-youth Sexual and Reproductive Health (SRH) conversations are critical to reducing adolescent pregnancy, yet many parents do not discuss contraception before youth become sexually active. We aim to describe parental perspectives about when and how to initiate contraception discussions, characterize motivators to discuss contraception, and explore the role of healthcare providers in supporting contraception communication with youth.

METHODS

We conducted semi-structured interviews with 20 parents of female youth ages 9-20 recruited from areas of Dallas, TX, with high rates of racial and ethnic disparities in adolescent pregnancy. We analyzed interview transcripts with a combined deductive and inductive approach, with discrepancies resolved by consensus.

RESULTS

Parents were 60% Hispanic, 40% non-Hispanic Black, and 45% were interviewed in Spanish. Most identified as female (90%). Many initiated contraception discussions based on age, physical development, emotional maturity, or perceived likelihood of sexual activity. Some expected daughters to initiate SRH discussions. Cultural avoidance of SRH discussion often motivates parents to improve communication. Other motivators included reducing pregnancy risk and managing anticipated youth sexual autonomy. Some feared that discussing contraception could encourage sex. Parents trusted and wanted pediatricians to serve as a bridge to discuss contraception with youth before sexual debut through confidential, comfortable communication.

CONCLUSIONS

Tension between the desire to prevent adolescent pregnancy, cultural avoidance, and fear of encouraging sexual behaviors causes many parents to delay contraception discussions prior to sexual debut. Healthcare providers can serve as a bridge between sexually naïve adolescents and parents by proactively discussing contraception using confidential and individually-tailored communication.

Navigating family planning access during Covid-19: A qualitative study of young women's access to information, support and health services in peri-urban Nairobi

The COVID-19 response has profoundly affected women's access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women's FP choices. In this qualitative study, we interviewed 16 women (aged 18-25 years), 10 men in partnerships with women, and 14 people in women's social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.

The Continuum of Sexual and Reproductive Health Talk Types Daughters have with Mothers and Siblings

INTRODUCTION

Although sexual and reproductive health (SRH) is considered an important discussion topic for parents and their children, there is great variance in communication style and contradictory results on the effects of these contrasting styles. Research has explored SRH topics, yet still needs to investigate the types of parent-child SRH conversations to investigate how content gets relayed, and their effects, particularly among college-aged children.

METHODS

Data come from qualitative interviews in 2013 with 20 undergraduate Latina students about SRH conversations they had with their mothers and siblings.

RESULTS

Analysis revealed that mother-daughter SRH conversation types fell along a four-category continuum, irrespective of daughters' sexual practices, with open (n = 4) and no talk (n = 3) at the poles. The two middle categories, be careful (n = 6) and responsible sex (n = 7), were limited conversations that provided little guidance and tended to use risk language. Daughters in the no talk and be careful conversation categories tended to be more religious and have higher rates of sexual activity. Daughters' conversations with their siblings, particularly sisters, directly reflected the conversation types that they reported having with their moms.

CONCLUSIONS

Most daughters made assumptions about their mothers' statements and views due to the lack of straightforward communication and reported that most mothers did not alter their conversation styles to match their daughters' specific sexual histories. Moreover, these conversation styles could potentially affect the whole household due to siblings being other sources of sexual socialization and having talk types that reflected parental talk types, irrespective of siblings' sexual activity.

POLICY IMPLICATIONS

We recommend more attention and funding for SRH education programs that include extended family, especially siblings, given their importance in sexual socialization, and include college-aged children who still desire, and need, SRH information. Programs should equip parents and children with the tools to navigate multiple SRH conversations that evolve with and are sensitive to children's specific behaviors and circumstances.

Local realities or international imposition? Intersecting sexuality education needs of Ghanaian adolescents with international norms

The content of comprehensive sexuality education (CSE) programmes is contested in many parts of the world, yet we know less about what primary beneficiaries (learners) consider as (in) appropriate school curriculum. I examined this phenomenon in Ghana. Data generated from focus group discussions suggests that, overall, participants used positive phrases to describe the need for sexuality education. The prevalent and recurrent needs of adolescents centred around personal reproductive health hygiene, pregnancy prevention, healthy relationships, reproductive infections and control, reproductive physiology and maturation, gender differences and sexual orientations, and sexual pleasure and pain. However, these needs varied in some ways between males and females and between early adolescents and older adolescents. The study shows that what adolescents seek to learn fall within international norms/standards on CSE. However, some of these concepts were not covered in the guidelines proposed for Ghana. The prevalent view among many opponents that CSE is not driven by local need may not be consistent with adolescents' own aspirations and realities. The voices of children and adolescents should constitute part of the discussions on the form and content of sexuality education.

"Those are things for married people" exploring parents'/adults' and adolescents' perspectives on contraceptives in Narok and Homa Bay Counties, Kenya

Background

Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults’/parents’ and adolescent girls’ narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya.

Methods

Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15–19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents.

Results

Findings highlighted adults’ perceptions on adolescents’ sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents’ sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion.

Conclusions

Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.

Exploring contraception myths and misconceptions among young men and women in Kwale County, Kenya

Background

Myths and misconceptions around modern contraceptives have been associated with low contraceptive uptake in sub-Saharan Africa and Kenya in particular. Addressing persistent contraceptive knowledge gaps can make a significant contribution towards improved contraceptive uptake among young women. This qualitative study therefore sought to explore and understand young people’s knowledge of modern contraception and to identify their key concerns regarding these methods.

Methods

We used focus group discussions (FGD) with vignette and writing activities to explore key myths and misconceptions around the use of contraceptives. Six FGDs (three for young men and three for young women) were conducted with a total of 28 young women and 30 young men from Kwale County, Kenya. We included 10 discussants aged 18–24 per FGD, one FGD had 8 participants. Predefined codes reflecting the discussion guides and emerging issues in the FGDs were used to develop the thematic coding framework. Our analysis followed a pattern of association on the key preset themes focusing on myths and misconceptions around contraceptive use.

Results

Results are presented under four key themes: awareness of contraception, myths and misconceptions around contraception, males’ contraceptive narratives and young people’s preferred sources of contraceptives. Both men and women participants reported basic awareness of contraceptives. A mixture of biological and social misconceptions were discussed and included perceptions that modern contraception: jeopardized future fertility, could result in problems conceiving or birth defects, made women promiscuous, was ‘un-African’, and would deny couples their sexual freedom. Compared to female respondents in the study, young men appeared to be strong believers of the perceived socio-cultural effects of contraceptives. On preferred sources of contraceptives, respondents reported on two main sources, pharmacies and public hospitals, however, they could not agree on which one was suitable for them.

Conclusions

This study revealed the presence of a mixture of biological and social myths and misconceptions around contraception, with young men also strongly adhering to these misconceptions. The low level of contraceptive knowledge, particularly on contraceptive fears as revealed by the study demonstrate critical gaps in sexual and reproductive health (SRH) knowledge among young people. Improved SRH literacy to address contraceptives’ fears through appropriate and gender specific interventions to reach out to young men and women with factual SRH information may therefore contribute to increased uptake of SRH services including modern contraceptive methods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09849-1.

What If My Dad Finds Out!?: Assessing Adolescent Men Who Have Sex with Men's Perceptions About Parents as Barriers to PrEP Uptake

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for high-risk adults and recently was given US FDA approval for use among adolescents. Yet, the barriers to medication uptake for this population are unique when compared to adult populations, as parents may be just as likely as prescribers to be gatekeepers to access. To better understand the role of parents in adolescents' attitudes towards PrEP, we surveyed 491 adolescent men who have sex with men (AMSM) ages 13-18, using forced choice and open-ended response questions. We measured perceived parent-PrEP supportiveness, hypothetical parent reactions to a request to initiate PrEP, and perceived positive and negative aspects of taking PrEP without parents knowing. A mixed-methods approach was employed. Results indicated a majority of AMSM had heard of PrEP and most reported their parents would be unsupportive of their taking PrEP. Teens perceived their parents would likely be angry, accusatory, and punitive if PrEP use was discovered, and that accessing PrEP independent of parents might increase their health autonomy, agency, and prevent awkward conversations about sex. Furthermore, a path model revealed that fears of parental reaction and poor self-efficacy to communicate with parents about PrEP significantly contributed to participants feeling PrEP was not "right" for them, and as a corollary, less interest in starting PrEP. The study suggests that improving parental knowledge of PrEP and encouraging parents to begin the conversation about PrEP could help increase uptake in AMSM.

Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives

BACKGROUND

Although community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention.

METHODS

This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach.

RESULTS

Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C. programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs.

CONCLUSIONS

Understanding and considering community members' and healthcare providers' views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.

Iranian mothers' needs for reproductive health education of their adolescent daughters: a qualitative study

INTRODUCTION

In order to be effective in discussing high-risk sexual behaviors with adolescents, mothers need to be educated about their adolescent daughters' sexual issues. As no detailed and exact knowledge on mothers' educational needs concerning adolescent girls' reproductive health is available, the current study was intended to investigate mothers' educational needs concerning their adolescent daughters' reproductive health.

MATERIALS AND METHODS

This research was a qualitative content analysis. Purposive sampling was performed to the saturation point. The samples included 26 mothers and 14 key informants. Semi-structured interviews were used for data collection. Data authenticity was verified based on Lincoln and Guba's criteria and data analysis was conducted using conventional content analysis with MAXQDA10 software.

FINDINGS

In this study, three themes and 13 main categories, each with a number of subcategories were extracted. The themes and main categories included: "appropriate educational content (reproductive health, sexual health, general health, psychological health, family health, social health and spiritual health)", "characteristics of the educator (communicative skill, cognitive skill and moral competence)", and "effective factors in learning (teaching method, learning conditions and environment, and the learner's readiness)".

CONCLUSIONS

The results demonstrated that mothers need to be informed about sexual, reproductive, general, psychological, family, social and spiritual health in adolescent girls. Consequently, the results can help the healthcare authorities to implement need-based programs and boost the effectiveness of education about adolescent girls' reproductive health for mothers.

"Sex Is a sin": Afro-Caribbean Parent and Teen Perspectives on Sex Conversations

This study characterized (a) mothers' childhood and teenage experiences with sex conversations and (b) families' perceptions of current parent-child sex conversations within two underserved Afro-Caribbean communities in the U.S. Fourteen dyads comprised of Haitian and Jamaican mothers and teens (aged 14-18) living in Miami, Florida, completed semi-structured interviews sharing their experiences with sex conversations. Researchers analyzed data using thematic content analysis. Mothers' mean age was 41.85 years, (SD = 5.50) and teens' mean age was 16.35 years, (SD = 1.31). Most mothers reported forbidden or little childhood experiences with parent-child sex conversations. They affected their sexual attitudes, behaviors, and ability to discuss sex with their children. Although some mothers benefited from educational and skill development others shared fear-based messages with their children that some teens believed adversely affected the mother-child relationship quality. Culturally appropriate, skill-based approaches are necessary to improve families' communication self-efficacy for healthy sex conversations to occur in Afro-Caribbean families.

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.

Applying Self-Determination Theory to Adolescent Sexual-Risk Behavior and Knowledge: A Structural Equation Model [Formula: see text]

BACKGROUND

National health priorities identify adolescent sexual-risk behavior outcomes as research and intervention targets for mental health.

OBJECTIVE

Reduce sexual-risk behavioral outcomes by applying self-determination theory to focus on decision-making autonomy. This study examined late adolescents' recollections of parental autonomy support/sexual-risk communication experiences and autonomy motivation as predictors of sexual-risk behaviors/knowledge.

METHOD

A convenience sample ( N = 249) of 19- and 20-year-old university students completed self-report questionnaires. Structural equation modeling with latent variables examined direct/indirect effects in the hypothesized model.

RESULTS

Parents contributed uniquely through sexual-risk communication and/or autonomy support to late adolescents' autonomous motivation. The final model evidenced acceptable fit and explained 12% of the variation in adolescent sexual-risk behavior, 7% in adolescent autonomous motivation, and 2% in adolescent sexual-risk knowledge.

CONCLUSIONS

Psychiatric mental health nurses should conduct further research and design interventions promoting parent autonomy support and adolescent autonomous motivation to reduce sexual risk-behavior and increase sexual-risk knowledge.

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.

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

African-American males ages 13 through 24 are disproportionately affected by sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), accounting for over half of all HIV infections in this age group in the United States. Clear communication between African-American parents and their youth about sexual health is associated with higher rates of sexual abstinence, condom use, and intent to delay initiation of sexual intercourse. However, little is known about African-American fathers' perceptions of what facilitates and inhibits sexual health communication with their preadolescent and adolescent sons. We conducted focus groups with 29 African-American fathers of sons ages 10-15 to explore perceived facilitators and barriers for father-son communication about sexual health. Participants were recruited from barbershops in metropolitan and rural North Carolina communities highly affected by STIs and HIV, and data were analyzed using content analysis. Three factors facilitated father-son communication: (a) fathers' acceptance of their roles and responsibilities; (b) a positive father-son relationship; and (c) fathers' ability to speak directly to their sons about sex. We also identified three barriers: (a) fathers' difficulty in initiating sexual health discussions with their sons; (b) sons' developmental readiness for sexual health information; and (c) fathers' lack of experience in talking with their own fathers about sex. These findings have implications for father-focused prevention interventions aimed at reducing risky sexual behaviors in adolescent African-American males. © 2017 Wiley Periodicals, Inc.

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.

21st Century Parent-Child Sex Communication in the United States: A Process Review

Parent-child sex communication results in the transmission of family expectations, societal values, and role modeling of sexual health risk-reduction strategies. Parent-child sex communication's potential to curb negative sexual health outcomes has sustained a multidisciplinary effort to better understand the process and its impact on the development of healthy sexual attitudes and behaviors among adolescents. This review advances what is known about the process of sex communication in the United States by reviewing studies published from 2003 to 2015. We used the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SocINDEX, and PubMed, and the key terms "parent child" AND "sex education" for the initial query; we included 116 original articles for analysis. Our review underscores long-established factors that prevent parents from effectively broaching and sustaining talks about sex with their children and has also identified emerging concerns unique to today's parenting landscape. Parental factors salient to sex communication are established long before individuals become parents and are acted upon by influences beyond the home. Child-focused communication factors likewise describe a maturing audience that is far from captive. The identification of both enduring and emerging factors that affect how sex communication occurs will inform subsequent work that will result in more positive sexual health outcomes for adolescents.

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.

Consequence-based communication about adolescent romantic experience between parents and adolescents: A qualitative study underpinned by social constructionism

Chinese adolescents are increasingly engaging in romantic experiences and high-risk sexual behaviors within a rapidly-changing cultural and socio-economic context. Parental communication about sexuality has been recognized as protective for adolescents to make informed decisions about sexual practice. In this study, we explored what was discussed about adolescent romantic experience between parents and adolescents in China. Twenty-seven parents and 38 adolescents from a northern-eastern city of China were interviewed. Interviews were transcribed verbatim and thematically analyzed using a social constructionism framework. Four themes were identified: (i) detriments of romantic experience to education and future prospect; (ii) health and sociocultural risks of romantic and sexual engagement; (iii) ways of handling romantic experience; and (iv) marriage and family building. The messages were mainly prohibitive and consequence oriented in nature, and lacked specific romantic and sexual information. These messages reflected sociocultural beliefs in education, sexuality, marriage, and family in China, but did not meet the needs of current adolescents. External support from health professionals, such as nurses, is important for parents and adolescents to improve their sexual knowledge and communication skills.

Racial and/or Ethnic Differences in Formal Sex Education and Sex Education by Parents among Young Women in the United States

STUDY OBJECTIVE

We sought to investigate the associations between race and/or ethnicity and young women's formal sex education and sex education by parents.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional analysis of a nationally representative sample of 1768 women aged 15-24 years who participated in the 2011-2013 National Survey of Family Growth.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We assessed 6 main outcomes: participants' report of: (1) any formal sex education; (2) formal contraceptive education; (3) formal sexually transmitted infection (STI) education; (4) any sex education by parents; (5) contraceptive education by parents; and (6) STI education by parents. The primary independent variable was self-reported race and/or ethnicity.

RESULTS

Nearly all of participants (95%) reported any formal sex education, 68% reported formal contraceptive education, and 92% reported formal STI education. Seventy-five percent of participants reported not having any sex education by parents and only 61% and 56% reported contraceptive and STI education by parents, respectively. US-born Hispanic women were more likely than white women to report STI education by parents (adjusted odds ratio = 1.87; 95% confidence interval, 1.17-2.99). No other significant racial and/or ethnic differences in sex education were found.

CONCLUSION

There are few racial and/or ethnic differences in formal sex education and sex education by parents among young women.

Generational differences in the sexual communication process of African American grandparent and parent caregivers of adolescents

PURPOSE

This study assessed generational differences in the sexual communication process between 40 African American parent and 40 grandparent caregivers of adolescent children.

DESIGN AND METHODS

The study reports findings from a secondary analysis of data from two databases. The HIV Risk Reduction Survey was used to examine the sexual communication process.

RESULTS

Grandparents wanted to talk about sex and had open sexual communications, while parents valued sexual abstinence and had limited communications.

PRACTICE IMPLICATIONS

Based on the findings, healthcare providers and programs need to recognize that differences do exist between parents and grandparents with sexual communications.

Racial and ethnic differences in young men's sex and contraceptive education

PURPOSE

Racial/ethnic disparities exist in young men's contraceptive knowledge. This study examines whether the likelihood of receiving sexual health education varies by race/ethnicity.

METHODS

We examined racial/ethnic differences in sex and contraceptive education both in school and from parents with multivariable logistic regression models among 4,104 men aged 15-24 years using data from the 2006-2010 National Survey of Family Growth.

RESULTS

Nearly all respondents (96.6%) reported formal sex education. Fewer reported formal birth control education (66.6%), parental sex discussions (66.8%), and parental discussions specifically about birth control (49.2%). In multivariable analysis, black men were less likely than white men to report receiving formal contraceptive education (adjusted odds ratio [aOR], .70; 95% CI, .51-.96). Both black and U.S.-born Hispanic men reported more parental sex discussions than white men (aOR, 1.44; 95% CI, 1.07-1.94, aOR, 1.47; 95% CI, 1.09-1.99, respectively).

CONCLUSIONS

Nearly all respondents reported having received formal sexual health education. Fewer reported receiving education about birth control either at school or at home. Black men were less likely to report receiving formal contraceptive education.

Parent-daughter communication about abortion among nonpregnant African-American adolescent females

PURPOSE

To identify correlates of parent-daughter communication about abortion among nonpregnant adolescents.

METHODS

Nonpregnant African-American females aged 14-17 years attending one of three charter schools on Chicago's South Side were recruited and surveyed regarding parental relationship quality, attitudes toward sexual health, and communication about sexual health. We calculated odds ratios (ORs) for ever discussing abortion using multivariable logistic regression.

RESULTS

Of the 265 adolescents, 43.0% had ever discussed abortion with a parent. While 72.3% would voluntarily tell a parent about an abortion plan, 19.2% feared a parent would physically hurt her, punish her, or evict her. Ever communicating about abortion was significantly associated with having a mother who had a teen pregnancy (OR, 1.99; 95% confidence interval [CI], 1.05-3.78); having a prochoice abortion attitude (OR, 3.27; 95% CI, 1.29-8.25); having discussed sexually transmitted infections (OR, 2.97; 95% CI, 1.13-7.77) or birth control (OR, 2.96; 95% CI, 1.35-6.47) with a parent; and perceived parental approval of adolescent sexual activity (OR, 3.07; 95% CI, 1.20-7.88). Ever communicating about abortion was inversely related to being sexually experienced (OR, .48; 95% CI, .23-.99) or anticipating supportive parental reactions to an abortion decision (OR, .31; 95% CI, .13-.75).

CONCLUSIONS

Although almost half of our sample was sexually active, the majority had never talked to their parents about abortion. Some reported fears of harm should the situation arise. Public policy should focus on promoting parent-daughter communication before an unwanted pregnancy rather than forcing communication after it occurs.

The role of parents and partners in minors' decisions to have an abortion and anticipated coping after abortion

PURPOSE

Despite the prevalence of laws requiring parental involvement in minors' abortion, little is known about the effect of parental involvement on minors' abortion decision making and anticipated coping after abortion.

METHODS

We analyzed data from medical charts and counseling needs assessment forms for 5,109 women accessing abortion services at a clinic in 2008, 9% (n = 476) of whom were minors aged 17 years and under. We examined differences in abortion characteristics, including parental and partner involvement, between minors and adults, and used multivariate logistic regression models to examine predictors of parental involvement and support, confidence in the decision, and anticipated poor coping among minors.

RESULTS

Most minors reported that their mothers (64%) and partners (83%) were aware of their abortion. Younger age was associated with increased odds of maternal awareness and reduced odds of partner awareness. Compared with adults, minors were more likely to report external pressure to seek abortion (10% vs. 3%), and mothers were the most common source of pressure. Minors overall had high confidence in their decision and anticipated feeling a range of emotions post-abortion; minors who felt pressure to seek abortion were less likely to report having confidence in their decision (odds ratio = .1) and more likely to report anticipating poor coping (odds ratio = 5.6).

CONCLUSIONS

Most minors involve parents and partners in their decision making regarding abortion, and find support from these individuals. For a minority, experiencing pressure or lack of support reduces confidence in their decision and increases their likelihood of anticipating poor coping after an abortion.

Expectations and self-efficacy of African American parents who discuss sexuality with their adolescent sons: an intervention study

OBJECTIVE

Despite research that suggests parental communication may help deter high-risk sexual behavior among adolescents, parents report a lack of confidence in their ability to answer sexually related questions. The purpose of this study was to test the effect of a multimedia intervention on outcome expectations and perceived self-efficacy for the sex educator role for parents of African American adolescent males.

DESIGN AND SAMPLE

A pilot study using mixed methods was conducted. A nonprobability sample (N = 61) was obtained from a large urban community using a combination of convenience and snowball recruitment methods.

MEASURES

Self-efficacy and outcome expectations were measured using self-reported questionnaires.

INTERVENTION

A multimedia intervention for use at home and incorporating an audio CD and associated activities was implemented over a 3-week time period.

RESULTS

Outcome expectations and self-efficacy both significantly improved after the intervention (p < .001).

CONCLUSIONS

Findings indicate that using a multimedia approach may be effective in improving parents' outcome expectancy and self-efficacy for talking about sex with adolescent sons.

Why fathers are too important to ignore: communication about sexuality between fathers and daughters

This cross-sectional study examined perceptions of sexual communication between 38 dyads of fathers and daughters. Results indicate agreement about the 3 topics most and least frequently discussed but significant differences in perceived extent of sexual communication. These differences indicate that interventions may be needed to increase fathers' comfort with sexual communication.

Family planning and contraceptive decision-making by economically disadvantaged, African-American women

BACKGROUND

Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning.

STUDY DESIGN

Structured focus groups were held with adult, low-income, nonpregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, audio-taped and transcribed. Four independent researchers coded the transcripts using the constant comparative method. Codes were organized into overarching themes.

RESULTS

Contraceptive knowledge was limited, with formal contraceptive education often occurring after sexual debut. Attitudes about contraception were overtly negative, with method effectiveness being judged by the presence of side effects. Family and friends strongly influence contraceptive decisions, while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible, although compliance is considered a barrier.

CONCLUSIONS

Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals.

Sexual Health Information Networks: What are Urban African American Youth Learning?

This qualitative study examined sexual health information networks among urban African American youth living in low-income communities. The authors identified sources, message content, and utility of messages about sex and sexual health in a sample of 15-17-year olds (N = 81). Youth received sexual health information from a variety of sources. Messages from parents and sex education had high utility, whereas messages from the Internet and religion had low utility. Four information network patterns were identified, suggesting considerable variation in how youth are socialized regarding sex. Findings suggest that sexual information networks have the potential to affect sexual health and 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.